By Sally Satel
Imagine you are a sophomore in college. The semester has been academically overwhelming, and your girlfriend recently dumped you. One night it reaches crisis level and you go to campus mental health worried you might harm yourself. You volunteer to enter the hospital and are released a few days later feeling more hopeful.
Then your college tells you to leave school. Period. No formal evaluation of your mental health condition. No discussion with you. Just out.
According to a newly released report from the State of New Jersey called College Students in Crisis: Preventing Campus Suicides and Protecting Civil Rights, policies which allow or require removal based solely on the existence of suicidal thoughts or behavior may be increasing. They are premised on the need to remove the student from the stresses of student life and to motivate them to get the care they need.
In the wake of tragedies such as the self-immolation of a sophomore at M.I.T. in 2000 and the shooting spree at Virginia Polytechnic Institute in 2007, concerns among administrators took on urgency. But lawyers argue that such blanket involuntary removal policies infringe upon a student's civil rights.
Within the last few years, several high-profile law suits against George Washington University, Hunter College, and the City University of New York have been waged by students forced into withdrawal. All were found to have violated provisions of the Americans with Disabilities Act, which prohibits discrimination on the basis of mental illness.
As a psychiatrist, not a lawyer, I believe that zero-tolerance policies violate common clinical sense.
But first, let me acknowledge that colleges face real challenges. According to a 2008 American College Health Association Survey which queried over 80,000 students across over 106 schools, forty-three percent of all students said they felt "so depressed it was difficult to function" at least once within the last school year. Nine percent said that they had "seriously considered attempting suicide" within the last year. Should all these students...one in eleven...be asked to leave college?
The fact that mental health problems are increasing on campus is not surprising. For one thing, today's colleges accept students who might not have even applied ten years ago. With psychiatric treatment starting in high school, many students who would not otherwise perform well can attain the grades and confidence to enter college. "Many who wouldn't have gotten to an elite college before are getting here because they were treated when younger," according to Dr. Richard Kadison, director of mental health services at Harvard and author of the 2004 book College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It.
On top of this, the college environment itself, while promising and exciting, is also stressful for both new and established students. Freshmen are separated from family and their network of friends. Grade pressure and the turmoil of personal relationships can afflict any student. Early adulthood, as well, entails the basic maturational - and sometimes disorienting -- task of figuring out who one wants to be. Add to this the problem of campus binge-drinking, and the potential for problems multiplies exponentially.
In response to the troubled state of mental health on the modern campus, schools have adopted two general approaches to students who are suicidal. One of them, boldly illustrated by the blanket removal policy, is largely driven by fear of litigation. As Gary Pavela, Director of the Academic Integrity Office at Syracuse University, told the Chronicle of Higher Education, "The biggest misconception is that we should be looking at student suicide primarily from a risk-management perspective."
The problem is that mandatory no-questions-asked removal policies themselves put students at psychological risk. "They can discourage students from getting the help they need," says David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont who has advised several area colleges. "Removing a student from familiar and supportive surroundings isn't always the best course of action," he explains. "The response should be individualized, based on a careful assessment of the student's clinical needs as well as the realistic safety considerations."
Furthermore, abrupt and mandatory exile from college can easily compound the humiliation a vulnerable student already feels. Removal will disrupt his education (a Catch 22-like situation when anxieties about career and future may be the very reason he feels so distraught in the first place). It will also deprive him of the sense of purpose that comes with being a student.
A healthier approach to suicidal threat is the exact opposite of forced leave: schools should find every way to keep a student enrolled and engaged with the school community while attending to his needs. True, those needs might require time away from school, but that determination should be made after careful assessment of the student's mental health and his acceptance of a clinically appropriate treatment plan.
I am not saying that colleges should never apply pressure - far from it. Given the details of a particular student's situation, a school could require a student to undergo an evaluation with a psychiatrist to determine the extent, if any, of potential danger to self or others. Even ongoing treatment of some sort might be imposed. Nor it is to say that an enforced leave of absence cannot, in some circumstances, be in the student's best interest.
But these should be measures of last resort only. What's more, prospective students should be able to receive, upon request, a description of a school's general policy on responding to mental health emergencies as part of the college application process. Useful information would include a typical sequence of interventions that might be triggered by a serious expression of suicidal intent or an actual attempt. Applicants could also be assured of opportunities to appeal administrative decisions.
The joy, mystery, and, yes, pain of young adulthood is a permanent feature of the college generation. Many schools have already adopted enlightened individualized approaches to helping students whose pain seems too great. It is imperative that more schools do the same.
Sally Satel is a psychiatrist and a resident scholar at the American Enterprise Institute.