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Commentaries on Virginia Tech and Mental Health
Four perspectives on the tragedy
and mental health
Helping Troubled Students
Suggested mental health policy
for colleges
by Elia Powers
One of the major questions
to emerge from the Virginia Tech shootings is whether colleges are
prepared to handle a situation in which a student with mental illness
is identified as posing a potential threat to campus.
An advocacy group
for people with mental disabilities says there is no consensus
among college leaders on how to respond. Many campuses have free
counseling services, but when a student’s
behavior raises red flags, colleges often worry about legal liability,
lack a comprehensive plan or having a plan that is overly punitive,
according to officials at the Bazelon Center for Mental Health Law.
In a new report, “Supporting Students: A Model Policy for Colleges
and Universities,” the center outlines what it describes as
best practices for colleges when dealing with the above scenario
and others. The policy, which Bazelon officials hope colleges use
as a model, calls on institutions to stay away from rigid rules that
could discourage students from seeking treatment but that still allow
campus officials to intervene when necessary.
“One of our goals here is to send a clear message to students
that they can seek help early on and not be penalized,” said
Robert Bernstein, the center’s executive director.
Late last month,
center officials said they were troubled by the response to Virginia
Tech, which Bernstein called a “hunger for quick
fixes and quick legislation” instead of a closer look at what
could have been done to treat the gunman long before he attacked. (The
center began work on its policy before the Virginia Tech tragedy, although
Bernstein said that event makes the recommendations “timely.”)
In dealing with
cases of troubled students, the report says that colleges should
make clear all counseling options and allow them to voluntarily
decide whether to seek help. Colleges should suggest that students
visit a counseling center when it learns that the student shows
academic or behavioral difficulties that “appear to be due to depression
or another mental health condition,” or when the student has
been known to have contemplated suicide.
If a referred student
doesn’t proactively seek the help, the
center officials should then reach out. As state law permits, colleges
may seek involuntary treatment of the student in “exceptional
circumstances,” which the report doesn’t define, in order
to “encompass a range of behaviors,” said Karen Bower,
senior staff attorney at Bazelon. As a last resort, a college can
consider using an outside crisis outreach team to contact the student.
Bower said the policy addresses the two areas that are often the stickiest
for colleges: confidentiality and student leaves of absence. The report
says that in almost all cases, the counseling center should not share
information about a student with faculty, staff, administrators or
others unless the student consents. When appropriate, the counseling
center can encourage the student to consent to sharing the information.
Depending on state
law, a center should only disclose information about a student “to
the extent needed to protect the student or others from a serious
and imminent threat to safety,” the
report says, adding that “disclosures are permitted only if
the student will not consent to interventions that will ameliorate
the risk.” Colleges should “reasonably” accommodate
students who are mentally ill by allowing them to remain enrolled,
or make concessions such as allowing them to take a reduced course
load and work from home, according to the report. Bower said it’s
also important that colleges don’t take
disciplinary action against students who choose to take time off
or who display “self-injurious” behavior. A counselor’s
role is to help the student decide whether to take a leave, and in
some cases to help the student secure time off. The report says the
student should be able to attend campus events while on leave, unless
there are documented safety concerns.
Only in “uncommon circumstances,” in
which students cannot remain safely on campus or meet academic standards,
should a college require a student to take a leave — and the
decision should be made by a committee that includes the counseling
center director, the report says. (It adds that the committee can
look into the student’s
mental condition and seek records, but the search should be limited
to essential documents and not rely on access to all confidential
records.)
Robb Jones, senior
vice president and general counsel for claims management and risk
research at United Educators, an insurance company for colleges,
said that while he supports the idea of a policy that promotes
the individual rights of students with mental illness, colleges
should go beyond Bazelon’s guidelines by considering
the rights of all students and faculty members, and by including
safeguards for counselors who find it necessary to share student
records.
It would be easier to agree
with the report if its rules applied only to cases of depression,
Jones said. “But since
colleges are often dealing with more serious forms of mental health
problems, and determining a student’s prognosis can be difficult,
there’s a problem
with coming up with guidelines that will apply to virtually all cases,” he
added.
Jones said a complete
report would go further by noting that in some cases, students
are better off seeking treatment away from campus, and that the
campus would be better off without the student’s
presence. The company agrees with Bazelon that the best practice
is to begin with a voluntary leave policy, and that involuntary removal
should be the last resort.
Bernstein said the center is working on another guide that covers
what students should know about their rights in mental health cases. ![]()
Reprinted with permission from Inside Higher Ed., Editor Doug Lederman.
http://insidehighered.com
Forced
Treatment has Undesired
Side Effects
by Ron Ungar
Many people imagine
that a mental health treatment system that relies on force will
be more effective, for example, at keeping people from hurting
themselves or others. Typically, people
think of a situation where someone refuses treatment, but then is a danger to
themselves or others: they imagine it going much better if the system is
allowed to force treatment on the person. But from a “whole systems” viewpoint,
we have to look at all the consequences of forced treatment, and then wonder
if we are really creating more safety in the overall picture.
Forced treatment has many undesired “side” effects, such as:
• Many
people are traumatized by coercive treatment. This trauma contributes
to future mental health problems which in turn contribute to future suicidality. The
system doesn’t keep people forever, so they just commit suicide sometime
after being released. (Like my partner’s flute teacher, who was not
only coercively treated but also with unnecessary rudeness, and then killed
himself shortly after he got out.)
• Clients who have been coercively treated in the past, or those who are
aware of the system’s capacity for coercion, are likely to avoid the mental
health system. They won’t reach out for voluntary treatment because they
know they could lose control of what treatment they get. Lack of treatment
can then lead to suicide (as with my brother, who avoided the system after seeing
what it did to his older brother).
• When treatment is forced, people often end up on medications they don’t
really want. So when they get out, they quit the medications suddenly. This
causes withdrawal reactions that can lead to more instability than was ever present
to begin with. (Also, of course, people often end up on medications that
increase suicidality, though this seldom gets noticed; it is just attributed
to their “mental illness.”)
With all these negative effects related to the use of force, the overall suicide
(and other complication) rate may be going up due to the use of force, rather
than being reduced. A voluntary system could reach many people who are
frightened by the coercive system, and it would ultimately discharge people who
are less traumatized and more emotionally healed.
A system allowed to use force may easily learn to rely on it instead of going
to more effort to “sell” its services to clients, so that much
of the force used may be unnecessary in that respect. This is especially
true for a system that doesn’t have to even count how often it uses force,
a system that doesn’t have any pressure on it to minimize the use of
force. We’d
at least like to see a goal of minimizing force, along with some accounting
of how much force is used, so progress can be tracked. ![]()
Ron Unger is a mental health counselor in Eugene, Oregon, specializing
in recovery-focused psychosocial methods, and is also a county coordinator
for MindFreedom, advocating for change in the mental health system.
The VA Tech Tragedy
Distinguishing mental illness from violence
statement of Ken Duckworth, NAMI Medical Director
The National Alliance on Mental
Illness (NAMI) extends its sympathy to all the families who have
lost loved ones in the terrible tragedy at the Virginia Polytechnic
Institute. We are an organization of individuals and families whose
lives have been affected by serious mental illnesses.
Despite media reports,
Cho Seung Hui, the shooter in the tragedy, may not actually have
had a serious mental illness relative to other diagnoses. But the
possibility opens the door for reflection on the nature of mental
illnesses—what they are and what they are not— with
regard to symptoms, treatment and risks of violence.
The U.S. Surgeon General has reported that the likelihood of violence
by people with mental illness is low. In fact, “the overall contribution
of mental disorders to the total level of violence in society is exceptionally
small.” More often, people living with mental illness are the
victims of violence.
Severe mental illnesses are medical illnesses. They are different
from episodic conditions. They are different from sociopathic disorders.
Acts of violence are exceptional.
Treatment works, but only if a person gets it.
Questions must be answered about whether the mental health care system
responded appropriately in this case. We know that Cho Seung Hui was
referred to a mental health facility for assessment. Did he receive
the right treatment and follow-up? If not, why not? ![]()
[April 18, 2007]
Mental Health Services and
the
VA Tech Massacre
by Nathaniel S. Lehrman
More mental health services,
and even involuntary mental health screenings, have been proposed
to prevent repetition of the Virginia Tech massacre. But mass murderer
Cho Seung Hui did get mental health care in a hospital. He
then rejected further treatment. The drug-only treatment he got may well have
aggravated his disturbance.
Good mental health care
is based on continuing, caring human contact: knowledgeable people
helping troubled people with problems, while strengthening and
reassuring them. Medication, often with little or no meaningful
human contact, has now almost entirely replaced that older care
pattern. And that’s what Cho got.
And anti-depressant drugs, like those he was given, can themselves
intensify suicidal and homicidal thoughts and behavior.
When considering the
effectiveness of mental health services, we should recognize that
in the fifty years since drugs began to be psychiatry’s
main treatment modality, there has been a five-fold increase in the
fraction of mentally disabled in the population. Before hurrying
to expand mental health services, we should examine more critically
the results of current treatment methods. ![]()
Nathaniel S. Lehrman, Roslyn NY, is former Clinical Director, Kingsboro
Psychiatric Center, Brooklyn NY; former Assistant Clinical Professor
of Psychiatry, Albert Einstein and SUNY Downstate Colleges of Medicine
This letter was first published in Newsday.
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