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June 10, 2007
Commentaries On Virginia Tech & Mental Health Helping Troubled Students Forced Treatment Has Suggested Mental Health Policy for Colleges Undesired Side Effects by Elia Powers
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ne 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.
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.
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.
“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.
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.
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.�)
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 Policy - cont. on p. 13
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
by Ron Ungar who avoided the system after seeing what it did to his older brother).
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any people imag- trauma contributes to future ine that a mental mental health problems which health treatment in turn contribute to future system that relies on force will suicidality. The system be more effective, for example, doesn’t keep people forever, at keeping people from hurt- so they just commit suicide sometime after being reing themselves or others. Typically, people think of a leased. (Like my partner’s situation where someone re- flute teacher, who was not fuses treatment, but then is a only coercively treated danger to themselves or oth- but also with unnecessary ers: they imagine it going rudeness, and then killed himmuch better if the system is self shortly after he got out.) allowed to force treatment on the person. But from a “whole • Clients who have been coersystemsâ€? viewpoint, we have cively treated in the past, or to look at all the consequences those who are aware of the of forced treatment, and then system’s capacity for coerwonder if we are really creat- cion, are likely to avoid the ing more safety in the overall mental health system. They won’t reach out for voluntary picture. treatment because they know Forced treatment has many un- they could lose control of desired “sideâ€? effects, such as: what treatment they get. Lack • Many people are traumatized of treatment can then lead to by coercive treatment. This suicide (as with my 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.â€?) 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, Side Effects - cont. on p. 15
Mental Health Services And The VA Tech Tragedy The VA Tech Massacre Distinguishing Mental Illness from Violence by Nathaniel S. Lehrman
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, Despite media reports, Cho people living with mental illSeung Hui, the shooter in the ness are the victims of viotragedy, may not actually have lence. had a serious mental illness relative to other diagnoses. But Severe mental illnesses are the possibility opens the door medical illnesses. They are for reflection on the nature of different from episodic condi-
tions. 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? â– [April 18, 2007]
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ore 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
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Nathaniel S. Lehrman, Roslyn NY, is former Clinical Director, Kingsboro Psychiatric Center, Brooklyn NY; former Assistant Clinical Professor of When considering the effec- Psychiatry, Albert Einstein tiveness of mental health ser- and SUNY Downstate Colvices, we should recognize that leges of Medicine in the fifty years since drugs began to be psychiatry’s main This letter was first published treatment modality, there has in Newsday. been a five-fold increase in the 5$03 &2168/7,1*
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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. â&#x2013;
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strengthening and reassuring them. Medication, often with little or no meaningful human contact, has now almost entirely replaced that older care pattern. And thatâ&#x20AC;&#x2122;s what Cho got. And anti-depressant drugs, like those he was given, can themselves intensify suicidal and homicidal thoughts and behavior.
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he 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.
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statement of Ken Duckworth, NAMI Medical Director
