Crisis on campus
Freshman year was turning out much differently than Christine, 18 at the time, had anticipated.
Away from her family and overwhelmed by courses that were far harder than she’d expected, the University of California student had begun sleeping in, missing classes and skipping meals. Then she received news from home: Her parents’ business had gone bankrupt.
She told no one of the sadness engulfing her. But soon her dorm roommate noticed bloody cuts on Christine’s arms. The two young women weren’t particularly close, and the roommate said nothing to Christine. But she alerted their resident advisor, who confronted Christine about the cuts and her depression. In keeping with federal privacy laws -- and Christine’s wishes -- her family was never notified.
“My resident advisor said I had to get help. I said OK, but I didn’t want anyone in my family to find out,” says Christine. “If I had ever thought my parents would know, I’m positive I wouldn’t have gone to counseling.”
Now, with the overall number of mentally ill college students rising, college administrators, mental-health professionals and students across the country are weighing that right to privacy against the need to assist those students who are deeply distressed or mentally ill.
Several recent high-profile cases have pitted parents against colleges that refused to divulge details of students’ mental-health status. A federal lawmaker has introduced legislation that could pave the way for colleges and universities to more easily share information with family members. And the April 16 massacre at Virginia Tech has provided a real-life worst-case scenario for what can happen when students don’t get appropriate help and information is not shared among college officials and the student’s family.
In the months since student Seung-hui Cho killed 32 students and faculty and injured 17 others before fatally shooting himself, investigators have turned up many disturbing facts about the case -- facts that some mental-health experts, lawmakers and college administrators say warrant an urgent review of how mentally ill students are handled on college campuses.
Mental-health organizations and college administrators are now reviewing an investigative report ordered by the state of Virginia and released by the governor’s office Thursday that describes how Cho -- who had been the subject of numerous complaints from students and faculty for his disturbing behavior -- failed to receive mental-health services that might have thwarted his rampage.
“Mental health has been ignored for so long in the educational system,” says Frank Smith, assistant director of the Mental Health Assn. in California. “As tragic as it was, Virginia Tech opened the door for us to look at the system and see where change is needed.”
One student’s decision
Leaves were beginning to turn golden and a few pumpkins livened the dormitories when Christine’s roommate walked her across campus to the mental-health counseling center. It was the afternoon of Halloween, three days after she learned of the bankruptcy. She didn’t want to go but feared she would be kicked out of the dorm if she didn’t submit to counseling.
During several therapy sessions that followed that fall, a school psychologist tried to persuade Christine to tell her family she was being treated for serious depression. She refused. Now 24 and a grad student, she asked not to be identified by her full name because her family still doesn’t know about her mental-health disorder.
“Counseling was never talked about in my family,” she says. “They came from a background where you solve things within your family. My family also had very high expectations about my grades. I had this fear that I would never be their perfect daughter.”
Over winter break, at home with a family that was reeling from financial problems, Christine’s mood disorder worsened. Her first-quarter grades arrived. She’d failed a course.
“I came back from winter break a whole lot more depressed than when I left,” she says.
A few weeks into the term, she began thinking about killing herself. She began stockpiling pills -- over-the-counter sleep aids, Advil, some Vicodin left over from when she had her wisdom teeth removed. Her roommate spotted the pills and alerted the resident advisor near midnight one evening in January. The pair sat up with Christine all night and escorted her to the counseling center in the morning.
She was referred to a school psychiatrist who agreed not to hospitalize her or call her parents if she would see the doctor twice a week for counseling and submit to close supervision in her dorm.
“I told the psychiatrist that my parents couldn’t find out because I was worried about their health,” she says. Under a federal law called the Family Educational Rights and Privacy Act, college officials must protect a student’s request for privacy and are not compelled to report such things as academic or even health problems.
Christine began taking antidepressants and her outlook improved. Eventually, she exhausted her limited number of free therapy sessions with the college psychiatrist but arranged for off-campus counseling and antidepressant treatment.
Only her roommate, resident advisor, the campus housing administrator and her therapists knew of her ordeal.
“My parents never found out, which I think helped me preserve my relationship with them,” Christine says. “My professors never knew. You really want to limit who knows because once you get through the crisis you want to live a normal life. You want to include all the people you need in your treatment, but you don’t want the whole campus to know.”
A generation in need
But some parents and mental-health advocates contend that an overemphasis on privacy means that college students are not getting the help they need. The charge is of growing significance not just because of the Virginia Tech shootings but because statistics suggest an increasing number of college students are mentally ill.
According to the American College Health Assn., about 15% of college students have been diagnosed with depression. A 2004 survey found that nearly half of college students said they felt so depressed they had difficulty functioning one or more times during the last school year.
The Jed Foundation, an organization that works to prevent college suicides, estimates that 1,100 college students a year take their own lives -- an average of about three a day. Suicidal thinking is common. The American College Health Assn.'s 2005 poll showed that 11% of women and 9% of men in college considered suicide at some point.
Horrific incidents such as Cho’s rampage are rare, but an average of three dozen homicides occur each year on U.S. campuses and scores of rapes, physical assaults and domestic violence incidents are logged -- behavior that may be fueled in part by mental illness or substance abuse.
Colleges today are seeing more students with mental illness for a variety of reasons. For starters, some mentally ill students aren’t diagnosed until then. After all, some illnesses, such as schizophrenia, are most likely to fully emerge in the early adult years. But with a trend toward earlier diagnosis, many mentally ill students receive treatment and depart for college with their family’s blessing and high hopes for success.
“There is a significant increase in the mental-health treatment of adolescents in the last 20 years,” says Daniel Eisenberg, an assistant professor of health management and policy at the University of Michigan who studies student access to mental-health services. “A portion of the population who in the past may not have been able to attend college now can. Their problems may not be completely resolved but they are showing up on campus.”
Will and Micky, a middle-aged couple who live near Boston, were not particularly worried when their 18-year-old daughter left for an Ivy League school about an hour from their home. The girl had received counseling in high school for depression and to deal with “being a girl geek,” says Micky, her mother, but seemed happy during the first few weeks of college.
Then, Micky says, “it was like she fell off the map.” The couple soon learned how closely colleges and universities guard students’ secrets.
Toward the end of October, Will and Micky found they couldn’t reach their daughter.
“We tried to call her room, the dorm master, the campus police. No one could tell us where she was,” says Micky, who asked that she and Will be identified by their first names only to protect their daughter’s privacy. She is now 24. “Finally one of the dorm heads called us and said, ‘We can’t tell you where she is.’ ”
Will and Micky drove to the school and tearfully demanded an explanation.
“The mental-health counselors agreed to meet with us but they refused to divulge any information,” recalls Micky. “We tried to explain about our child. We loved her. She had never been abused. We were just met with stony silence. They told us that she was an adult and she had chosen not to tell us, so they couldn’t tell us. We went home. We felt totally stymied.”
But not all contact was cut off. The following day, the monthly tuition bill appeared in the couple’s mailbox.
Will and Micky hired a private investigator who quickly learned that their daughter had been hospitalized after cutting herself and threatening suicide.
They brought her home in early December and arranged for outpatient psychiatric care. She was diagnosed with bipolar disorder, in which deep depression alternates with periods of restlessness, euphoria and oftentimes reckless behavior.
Will and Micky learned that their daughter had become unstable shortly after starting college and had developed intense anxiety, racing thoughts and paranoia. She told others that her parents didn’t love or support her and that she had no money and needed underwear. Friends sent her packages of underwear.
“The whole thing was absurd,” says Micky. “The college could have called her [hometown] primary doctor or her psychologist. They could have said, ‘Yes, this child is supported by her parents; it’s not a broken home.’ This could have been easily addressed. But they chose to believe we were the enemy and had to be kept away.”
Being shut out from their daughter’s care aggravated her condition, they claim. For example, the doctors at the mental hospital didn’t know that the young woman had a physical health problem that could potentially complicate treatment. And the staff reinforced her paranoid notion that she was alone in the world when visits from her family could have convinced her she was loved and supported, says Micky.
“It was traumatic for our family, but most of all it was traumatic for her,” she says. “She was in the hospital for three weeks with nary a visitor and no information to give to the doctors about her history.
“People just can’t believe colleges can do this.”
But they can. The Family Educational Rights and Privacy Act -- better known simply as FERPA -- was passed in 1974 to strictly limit the disclosure of information from students’ records.
The law is stringent but does permit disclosure to “appropriate parties” in an emergency that involves the health or safety of the student or others. College administrators, however, often hesitate to act on that exception because they fear getting sued for violating FERPA, says Steven J. McDonald, general counsel for the Rhode Island School of Design and an expert on FERPA.
“People are afraid because they don’t know what FERPA says,” he says. “It’s a very complex statute, so they become paralyzed.”
Health professionals are also bound by even more inflexible patient confidentiality rules, such as the Health Insurance Portability and Accountability Act, which took effect in 2003.
Others on campus are not barred by such rules, says Dr. Joanna Locke, program director for the Jed Foundation, a nonprofit group that works to reduce suicide among college students. “Deans and administrators are still able to contact the parents.”
Signs of mental illness in particular constitute an emergency that should warrant parental notification, says Micky.
“I totally support the need to keep sexual issues private,” she says. “If there is a pregnancy or something like that, I appreciate that students don’t want the parents to be called. But when you’re dealing with mental illness, you’re talking about someone who has lost their grasp on reality.”
In recent years, several parents of students who have committed suicide while away at school have sued colleges for not informing them of the child’s deteriorating mental status and failing to provide adequate psychiatric care.
In one well-known case, the parents of Elizabeth Shin sued the Massachusetts Institute of Technology after the depressed 19-year-old set herself on fire in her dorm room in 2000. Shin died of her injuries. The case was settled out of court.
In another closely watched case that went to trial last year, the parents of Charles Mahoney IV sued Allegheny College in Meadville, Pa., after their son hanged himself in his fraternity house in 2002. The depressed young man, age 20, had been receiving counseling at the school’s mental-health center and had insisted his parents not be notified.
Charles and Deborah Mahoney sued the school for not informing them of his serious condition and failing to protect him. Mahoney’s friends testified at the trial that, in the days before his suicide, “we knew something was going to happen” and had alerted campus administrators.
A jury, however, found the school was not liable, saying it had offered Mahoney support and could not have foreseen his suicide.
That case prompted Rep. Tim Murphy (R-Pa.), to begin work on a bill, called the Mental Health Security for America’s Families in Education Act. The legislation would clarify FERPA by stating that if a licensed mental-health professional certifies that a student is a risk to himself or others, the school may inform a parent or guardian.
“Universities are concerned they will get sued if they tell and sued if they don’t tell,” says Murphy, who is a psychologist. “This bill will give schools the authority to make an informed decision about sharing information.”
Murphy believes a clarification of FERPA may help avoid the kind of breakdown in communication that occurred at Virginia Tech.
The report released by the Virginia governor’s office last week recommends revisions to FERPA to make explicit that parents can be notified and information shared among college officials when a student is a danger to himself or others.
Communication problems aren’t limited to Virginia Tech. A report from three Cabinet agencies ordered by the Bush administration after the shootings found that college officials, doctors, therapists and police on campuses throughout the country rarely share information about troubled students with one another -- or parents or guardians -- because they fear violating confidentiality laws.
Moreover, a government-ordered investigation in 2004 found major gaps in college mental-health services, including the lack of round-the-clock crisis management; a shortage of therapists, particularly psychiatrists; failure of campus mental-health staff and student health services staff to communicate or work together; wildly varying interpretations of FERPA; and a dearth of re-integration plans for students who return to college after a hospitalization or crisis.
Privacy or prevention
Many colleges today say they are adding staff and boosting training as a result of the Virginia Tech shooting. Some are trying harder to decrease the stigma surrounding mental illness, assigning counselors to do outreach in the dorms and offering workshops to students on how to deal with stress, problematic relationships and other emotional issues.
Mental-health advocates applaud those improvements but worry that knee-jerk reactions to the tragedy may backfire. Murphy’s proposed law, while well-intentioned, could send students fleeing from the campus counseling center, some say.
“I feel that confidentiality is paramount to being able to receive treatment,” says Smith of the Mental Health Assn. in California. “If there is any notion of the ability to share information, I think colleges will have a large body of people who won’t seek treatment.”
Already, college students -- like much of society -- shun mental-health counseling. A stunning 80% of college students who commit suicide never sought services at their campus mental-health counseling center, according to the Jed Foundation, even though such services are usually free.
A survey conducted by Eisenberg and released in June found that, of 2,785 University of Michigan students, about half of those with significant depression and anxiety do not seek help. Many said they didn’t think they needed help, were skeptical that counseling would make them better, were unaware of services or were concerned about their privacy.
Students may also need reassurance that seeking help now won’t be to their detriment later should school officials find out about their troubles.
In recent years, several students have been kicked out of their colleges after mental-health treatment, including Jordan Nott, who sued George Washington University in 2005 after he was barred from campus for seeking care for depression and suicidal thoughts. The lawsuit was settled out of court for an undisclosed amount.
In March, Virginia became the first state to pass a law prohibiting public colleges and universities from expelling or punishing students for attempting suicide or seeking mental-health treatment.
The final irony for Will and Micky is that after their daughter recovered her health and sought to return to her studies, the college that tried so hard to hide her didn’t want her back.
“She wrote them a letter and asked them how they could discriminate against people with bipolar illness,” says Micky. “They finally let her back in.”
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Help is out there
Students with mental-health problems can turn to a variety of nonprofit organizations for help. Some groups focus on suicide prevention; others work to reduce the stigma of mental illness or help families plan the student’s care while on campus.
* The Bazelon Center for Mental Health Law, based in Washington, D.C., is a national legal-advocacy organization representing people with mental disabilities. In May, the center released a best-practices document for colleges titled “Support Students: A Model Policy for Colleges and Universities.” The document can be found at www.Bazelon.org/pdf/SupportingStudents.pdf. For more information, call (202) 467-5730 or go to www.bazelon.org.
* The American College Health Assn. is a Baltimore-based group that provides publications, reports and statistics on college health issues. For information, call (410) 859-1500 or go to www.acha.org.
* Active Minds is a national organization based in Washington, D.C., that develops and supports student-run mental-health awareness, education and advocacy groups on college campuses. For information, call (202) 719-1177 or go to www.activemindsoncampus.org.
* Families for Depression Awareness is a national, nonprofit group based in Waltham, Mass., that helps families recognize and cope with depression disorders. For more information, call (781) 890-0220 or go to www.familyaware.org.
-- Shari Roan