Colleges face dilemma deciding fate of mentally ill students

http://www.mysanantonio.com/news/metro/stories/MYSA042007.01A.campus.mental.health.35bbf82.html
http://tinyurl.com/3xtbcl

Campus administrators, health professionals and police, caught between federal privacy and anti-discrimination laws and the need to protect their campuses, face a daunting challenge deciding the fate of mentally ill students.

Before 23-year-old Virginia Tech student Cho Seung-Hui gunned down 32 students and teachers Monday, his violent, lurid work in a creative writing class sparked a string of efforts to get him help.

In 2005, after complaints from two female students that Cho was harassing them and a tip that he might be suicidal, campus police tried to have him involuntarily committed to a mental institution. The evaluating doctor found that Cho was mentally ill, but not an imminent danger. The judge declined to commit him, ordering outpatient treatment instead.

In hindsight, the missed opportunity is haunting. In the moment, campus officials say, deciding if odd behavior adds up to mental illness, or presents a danger of suicide or violence against others, involves a web of factors.

"You have to look at all these angles, your legal obligation, your human obligation, your obligation to the individual and campus community," said Gage Paine, vice president for student affairs at the University of Texas at San Antonio. "The problem in situations like this is that we need to be right 100 percent of the time, but that's not real. All the systems in the world don't always help mentally ill people."

Since 2002, campus officials have been riding a seesaw when it comes to mental health issues.

That year, the parents of Elizabeth Shin, a student at the Massachusetts Institute of Technology, sued the school for $27 million after Shin committed suicide by setting herself on fire in her dorm room. They faulted the university's counseling services for not dealing with her depression adequately. The university settled for an undisclosed sum.

In the wake of that case, universities moved hard in one direction, kicking students they suspected of being unstable off campus, either permanently or temporarily. That move sparked its own backlash.

Last year, George Washington University settled with Jordan Nott, a student who sued the university after he was kicked off campus when he sought treatment for depression. The terms of the settlement are confidential.

Last month, Virginia passed the nation's first law banning public colleges and universities from punishing or kicking out students solely because they tried to commit suicide or seek mental health treatment.

Some campuses, notably the University of Illinois and the University of Washington, require students who talk about suicide to get counseling or take a leave, according to March article on Salon.com about the challenges campus officials face dealing with students they believe are suicidal.

But even if students do get counseling, federal privacy laws bar the counselor from sharing information with other university professionals unless the student makes a specific threat, said Elizabeth Stanczak, director of counseling and health services at UTSA.

And the Americans with Disabilities Act, which protects mentally ill people from discrimination, prevents campus officials from tossing someone out of school simply for being depressed or schizophrenic. If a student is clearly violating the campus' code of conduct, however, suspension is an option, Paine said.

Part of the challenge of identifying and dealing with mental illness has to do with the very nature of campus life. Many universities tolerate a higher level of wacky behavior than other institutions, and being weird, even dreaming up violent scenes for a writing class, doesn't mean a student is going to kill people, Stanczak said.

Paine describes an incident 15 years ago, when she worked at the University of Texas at Austin, that she said demonstrates the tightrope administrators walk.

At that time, a student had a psychotic breakdown in class and took a voluntary mental health leave. He was allowed to come back after doctors prescribed medication. But doctors got the diagnosis wrong, and when the student returned to class, he had a second breakdown. The school tried to suspend the student, but his lawyer warned them that such a move would violate the Americans with Disabilities Act. The university allowed the student to stay, but he was later kicked out after threatening someone with a knife.

"People in that class thought we were wrong to let him back in," Paine said. "There was no good decision in that situation. Should we have violated ADA? No."

Stanczak, who attended a conference in Fort Worth this week of the Texas University and College Counseling Directors Association, said she and her colleagues expect changes as a result of the Virginia Tech killings.

"You will see knee jerk responses on campuses — faculty seeing things in students they didn't pay attention to before," she said. "We are all saying, 'Let's take that one step a little further and be cautious.'"

Psychologist Robert Geffner said paying attention to warning signs and doing something about them is crucial.

"What is clear is the prevention efforts, the follow-through, the ways of identifying people who may be under high stress and may be in trouble are not as good as we would like," he said. "We need to put more effort into these situations, not only at the college level but at all educational levels."

Rethinking how we live together, as a society, is part of the challenge, said Soad Michelsen, a psychiatrist at Southwest Mental Health Center, a pediatric hospital, and president-elect of the Bexar County Psychiatric Society.

American culture values independence and, as a result, people don't always watch out for each other. With Cho's long history of mental instability, there should have been a support system for him and mentors to follow up on his progress, she said.

"When you look at these school shootings, what kind of cultures really have this problem?" Michelsen said. "It only happens in the more independent cultures. Have more empathy toward the person sitting right by you."

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mludwig@express-news.net
Staff Writer Marina Pisano contributed to this report.

There are many organizations across the country and in Texas to turn to for information about mental illness — and help:

• National Alliance on Mental Illness, San Antonio chapter, (210) 734-3349 or visit http://www.nami.org
• National Institute of Mental Health, part of the U.S. Dept. of Health and Human Services, http://www.nimh.nih.gov
• The American Association of Suicidology in Washington, D.C., is dedicated to understanding and preventing suicide. If you need immediate help, call its hotline: (800) 273-8255 or, for more information, see http://www.suicidology.org

The situation is not too different than a threatened victim being told by the police that there is nothing they can do until the threatener actually performs the deed. By that time, of course, the victim is dead.

Yes, I know a mother who went through that with a disgruntled ex who was threatening them. No one would help unless he actually hurt them physically.

I've personally seen and heard patients threastening to kill their children, their parents etc and then MAYBE a Tara Sof is written but more than likely not and they follow through on their threats.

What is a Tara Sof?

Ya have to be very careful about the definition of “menaced.”

Had friend and customer get suspended from a job ‘cause he had some gun magazines in his office and a coworker felt “menaced” or “uncomfortable.”

Shouldn’t expulsion be adequate?

Lawyers are making anything logical, common sense or preventative into "bigotry", "discrimination" or "hatred." It's an enormous cash cow for them.

On the practical level, the psychology of violent mental illness is such that when the person with the damaged ego is rejected, for whatever reason, that is the time they choose to unleash the violent retribution. This is why many women end up staying with batterers, or having to go into shelters if they manage to expel them from the home. Most domestic killings occur just when the woman manages to enforce the separation.

So in the VT case, expelling Cho might have had the same result as what did happen. This boy was now looking at graduation, leaving a familiar environment in which he was at least tolerated, and having to go into a new environment where he would be looked at as weird and rejected again, this time with higher stakes. He had a psychotic break, taking the symbols of his oppression -- well-adjusted kids -- out with him as he committed suicide.

A Tara ZSof is a legal document that is written when a staff member overhears verbal threats or plans as to how the patient is to kill or harm someone.

The staff can issue a Tarasof through the courts and contact the soon to be victim warning them this person is going to be released a such and such a date so please watch your six. Have a nice day!

Today some gal called in to the
TV station and said she was pretty
sure when all the chips are pulled
away on the Cho kid they’ll find
he actually followed the format of
the suicide terrorists: kill as
many Americans as you can with
one fell blow. In light of what
his Grandfather said about the kid,
Time will tell if the gal was right.

Universities are bastions of lieberalism.

Lieberalism is a mental disorder.

Therefore, universities have become a haven for those with mental disorders.

The logical solution is to concentrate it.

Transfer the mose lieberal professors to the most lieberal institutions. Do the same with the students and reorganize them as mental institutions.

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