With the recent tragedy allegedly perpetrated by suspended college student Jared Loughner in Tuscon, AZ, the role of colleges’ and universities’ student counseling centers has taken center stage. This is a little odd, given that Mr. Loughner attended a community college that lacked a student counseling center. Most community colleges — catering to part-time students who often have families or hold down full-time jobs — don’t seem to have the mental health counseling centers that most traditional universities and colleges have.
Dr. Emily Gibson, a family physician who apparently works with students at a college, recently wrote a blog entry about mental illness in the college student. In this entry, she seems to bemoan the fact that students have come to expect a certain level of psychiatric care and treatment for their mental health concerns — even while at college. Of course, universities have limited resources to offer such care.
Indeed, she asks — but never answers — some compelling questions:
“Didn’t the college understand that removing him from school would make things worse and remove him from daily monitoring of his behavior? Wasn’t there a way to compel him to get psychiatric assessment and treatment?”
The answers to these questions would be interesting and help inform future policy at schools. Let’s tackle the first question…
Universities are traditionally very campus-oriented. What happens on-campus is our problem. What happens off-campus is none of our concern. By having a purposely myopic view of the world, most universities and colleges can pretend that they’re not a part of a community — they are the community.
This benefits most colleges because then they don’t have to deal with larger community issues (such as growth within the town, economic development, care of others within the community, etc.). Sure, they pay lip service to being a part of a community, but having grown up in a college town, it seems that many colleges have a shallow appreciation for the symbiotic nature between college and town.
So when it comes to their students, universities are pretty straightforward — you’re our problem when you’re paying tuition. The minute you stop paying tuition, you’re no longer our problem.
Although it may seem a little heartless, we have to keep in mind that even non-profit colleges and universities are big businesses. They may not make a “profit,” but they are still run like any corporation that takes in hundreds of millions (or even billions) of dollars. A business must be run efficiently, and so anything that doesn’t directly have to do with educating others is an expense. Keeping expenses down is the goal of any business.
Now, of course, the therapists and psychiatrists who work at student counseling centers don’t care about any of this. They will help a student as much as they can, even going above and beyond whatever traditional resources they may have available. But there’s one thing they can’t do — continue to treat or counsel a person who’s no longer a student (e.g., a customer of the university’s services).
The apparent problem with Jared Loughner was that he was primarily categorized as a criminal problem, not a mental health concern. Despite his odd outbursts and nonsensical questions, nobody at the school seemed to think this was a mental health issue. Instead, the police were called. Again and again.
Nobody apparently thought to order a psychiatric evaluation, which the police can do very easily in most states.
So the answer to the second question is that any mental health professional or police officer can compel a psychiatric evaluation if they have reason to suspect the person may be a potential harm to themselves or others. And in this case, from all the media reports, it appears there were professors at the school who felt threatened (and in harm’s way) of Loughner.
Why the police didn’t take these threats seriously remains a big question mark. (Perhaps because they were campus policy? They weren’t properly trained in assessing risk? We don’t know.) Had the police ordered a psychiatric evaluation for Loughner, he may have caught the attention of mental health professionals who could have recognized the danger. Or perhaps not — a psychiatric evaluation may just as easily resulted in little change in Loughner’s plans or behaviors. It didn’t much help in Seung-Hui Cho’s case, the Virginia Tech shooter who killed 32 people.
What’s a University to Do?
I guess that’s one of the key take-aways of this — and any — tragedy. Even had everything been in place and firing on all cylinders, the systems may still not have caught Loughner’s intentions. And all of this is somewhat a moot point in Jared Loughner’s case, however, since the community college he attended didn’t even have a student counseling service.
Last, we have to remember that violence is random and rarely follows any sort of coherent pattern (except around criminal and drug activity). Most criminals don’t have a mental illness and mental illness alone is not a significant predictor of increased violence, so let’s not stereotype those most in need.
Instead, let’s work to increase the resources available to students — especially since we already have access to them on campus. Most colleges and universities already provide student counseling services. Since college tuition has already been on the increase, what’s a few more dollars per student in increased student fees to ensure we offer students the best care possible during this important, transitional time in their lives?
The fact that some university counseling professionals seem to complain about the increasingly complex psychiatric needs of students attending their school seems to me to be pointing a finger of blame at the wrong side. Why wouldn’t students expect a certain level of mental health care while at school? They certainly expect a certain level of security and health care — why should mental health care be any different? And if mental health care needs are increasing, why wouldn’t a school properly plan for these increases and cater to the needs of their students?
After all, a school is there to provide education services to students. Isn’t learning about yourself and developing a coherent and stable personality a part of the learning process of life?
Rather than offer increased mental health services, I suspect some colleges and universities will go in the other direction — increased screening for mental health concerns prior to admissions. Any red flags on such screenings will be used (at least informally) to deny admission to the student, reducing the college’s liability in the future. Because that path is far easier and less expensive than catering to the complex mental health needs of your students.
Read the blog entry by Dr. Emily Gibson: Mental illness in the college student
12 comments
Dr. Grohol,
Thank you making this thought provoking post. I think that it is important to mention that it is difficult to help people who don’t want or think they need help and that the quality of mental health care at Universities may have nothing to do with the tragedy in Arizona. I attend the University of Texas at Austin, where we have had our fair share of tragedies. Maybe I am biased, but I feel that the mental health care offered at UT is superb. Hotlines, therapists, psychiatrists, free classes, and paid classes are all available to students that need it, from the day they pay their tuition through at least one semester after they leave. Last semester, a UT student brought a gun to school and shot randomly into the air and after a police chase and school-wide panic, the shooter killed himself. While the shooter was the only person injured or killed, the experience did foster discussion about the mental health care offered at UT. Naturally, many of my classmates came to the conclusion that what UT offered was not enough. But soon many realized that it was not an issue of the services but the awareness surrounding them.
At a school with 50,000 students, you can’t reach every one. It can’t be the responsibility of the University to monitor every student for signs of mental illness. It has to be the people close to the individual that helps that person with their mental illness. Who was closest to Jared? His parents? Did he have any friends? Maybe he was closest to his teachers. In that case, UT has an anonymous hotline called the “Behavioral Concern Awareness Line” or BCAL line, that anyone can call to share their concerns with a professional. Does Tuscon have anything like that? My point is that Universities can not be held responsible for tragedies; only individuals can prevent events like this. And even at a school , where (my opinion) the mental health care is excellent, tragedies may still occur.
you make some excellent points.
What is so baffling about Loughner is that he expressed overt suicidality on Myspace in mid-September, there for all the world to see. The school situation finally blew up in late September. They already knew he was doing weird things online based on the youtube video that prompted his suspension at the end of that month. And no one apparently thought to look him up online. The writings don’t appear to have been discovered until Jan 8. If I were a teacher, afraid to turn my back in class for fear a student might have a gun, second thing I’d be doing would be looking the guy up online.
I doubt the question was ever asked before he was suspended, “do you feel like harming yourself?” If he was telling it to the world on Myspace, there’s at least a possibility he would have told it to someone who asked him. The suicidality escalated to multiple non-specific threats of killing cops in Dec. (after he bought the gun). “I’m glad I didn’t kill myself…see you on national TV!” and “you’re going to regret not talking to me” (repeated 6 times).
It was all spelled out in his LUCID online postings, yet everyone’s focused on the delusional rants. The story is in what he said when he wasn’t delusional. Going back to last spring, it’s a very clear progression of a desperate , isolated individual, trying to fit into the world (65+ job applications, although they may have contained gibberish), and either not understanding that he is ill or refusing to accept it. Meanwhile understanding that his criminal record had a consequence “2 misdemeanors hurt…don’t do graffiti.” He listed his options as suicide, prison, and career/job. But he couldn’t get a job.
The school’s lawyer now says there was nothing they could do, because he was not a danger to himself or others. How do they know he wasn’t a danger to himself, did they ask him? You don’t have to be a mental health professional to ask that question, you don’t need to have counseling resources to ask that question. At 18, I asked it of my college roommate, who was sleeping all morning and otherwise appeared out of it and sad. When someone is that far out of touch with reality, it should be common sense to ask that question. They claim he was no danger to self, yet they sent him a letter saying he needed documentation from a mental health professional that he was NOT a danger to himself or others, in order to return. Can’t have it both ways. I know they’re in CYA mode, and it’s not “their fault.” It’s at the same time nobody’s fault and everybody’s fault.
The other elephant in the room is WHY is there so much mental illness? WHY are so many college freshmen arriving on campus with serious mental disorders? WHY are so many people depressed (no, it’s not just the economy)? We have a culture that seems to be breeding mental illness, especially amongst children/adolescents. It will only get worse with more and more technology in place of human interactions. Something’s seriously wrong, and not just with the mental health care system.
I checked the PCC site shortly after the killings. According to the page linked below, student counseling services at PCC offers counseling for personal difficulties.
http://www.pima.edu/advising/counselingservices.shtml
No information regarding time-limits, availability of services to part-time students or anything about staff qualifications is provided.
I worked at a large state student counseling center staffed by clinical and counseling psychologists. Had someone like Mr. Loughner showed up as an intake, I have little doubt that he would have caused considerable alarm given what we’ve seen of his presentation.
Yup. In addition to admissions denial, if a serious problem comes up while they are on campus. say a psychotic episode or a suicide attempt, they will kick the student out and make it impossible for them to get back in. Colleges are doing it all the time now. If it’s private then it’s perfectly within their rights. The colleges don’t care if the depressed student will get worse if they are at home, where they may have no access to mental health care, they just don’t want the student to be on campus and thus their problem.
Living near Tucson, I’ve had an opportunity to work with 175 school district pre-teen students in that community. The goal was to use “primary prevention education” to help kids learn about healthy, brain-based coping skills. We focused on simple processes that reduce emotional distress arising from everyday “emotional wounding experiences.” Despite offering these programs free to schools, we don’t start early enough to introduce “emotional health education”. The entire topic of coping skills remains unaddressed in ALL U.S. state education standards! We don’t realize that many students simply lack basic self-regulating ability that can be learned in a few hours of classroom time starting with kids as young as 9-yrs. old. We’ve proven the benefits from learning about “brain functions” involved in regulating instinctive brain impulses that may build up and result in harmful behavior toward self and others. Yes, community and other colleges have a role to play, but the primary prevention has to start as early as elementary school. To help schools and parents with free resources on brain-based coping skills we’ve developed an Internet “virtual classroom” that is being used by 90,000 kids starting in 4th grade. Coping skills for kids can be a major influence in helping youth deal with the turbulent transition into adolescence and even the normal stress of college years.
This sad case will bring out a lot of feelings. Sadness, fear, anger, grief. It is interesting and perhaps a sign of the times that the focus and assumptions of blame immediately moved to PCC and colleges/universities mental health policy, assuming that it failed and ex-student. Honestly, there seems to be a lot of information and other points of view missing from the posts/article above. In addition to Dr. Grohol’s article, it might be helpful for some other perspectives/facts to be included in any discussion.
Here is another viewpoint from NaBITA which I think should be read.
http://www.prnewswire.com/news-releases/nabita-position-statement-on-pima-community-college-jared-loughner-and-the-arizona-shootings-114268404.html
and here is the other side of the issue: forcing treatment through hospitalization on an unwilling/involuntary student.
http://www.nytimes.com/2011/01/14/nyregion/14camera.html?_r=1&scp=1&sq=brooklyn%20college%20lawsuit%20&st=cse
As a professional who has worked professor, psychologist and administrator in a university counseling center for 20 plus years, balancing scope of service and continuity of care are both very difficult. First, psychological and psychiatric services are very expensive to provide. Counseling Centers do not have inpatient services. Psychiatrist are in short supply and frankly may not work for the paltry salaries most Colleges/Universities can offer. Many college counseling centers could double or triple the amount of psychiatric (and psychological) care available and still need more. On my campus, our services must be voluntary with the exception of a mandated assessment to determine risk/immenent danger. I know of no center that has a specifically trained forensic psychologist or psyciatrist on staff. Centers across the country have traditionally been seriously underfunded, understaffed, and facing waiting lists of students who want and need the “short-term” therapy/counseling services that they can provide. Thinking that these centers can or should provide full and unending services to all current and past students is currently illogical and impractical on many levels.
I believe if you look at government cuts you can see the community, state and national priorities about mental health. We need to view the problems that spawned this tragedy from a much higher vantage point and appreciate the complexity of it.
Another view: As an ex-professor, I didn’t have the skills to monitor or intervene with a mentally ill student. At most, a professor sees students four hours a week and they should be teaching, not asking if anyone is suicidal or a danger to others. Yes, the student made some strange statements which made others uncomfortable, but it doesn’t sound like he verbally threatened anyone. The truth is that people with mental illness are more likely to be victimized by other people than victimizing others.
Also, why is a college responsible for a student’s mental health care? If you work at a bakery, is the owner responsible to get you mental health care or are they likely to let you go because of your behavior? They, and colleges, are not responsible to restrict student behavior or get them care. It is great that colleges have counseling services available, but you can’t counsel people who don’t come for services.
To Carole’s question about why a university or college is different than an employer…
The primary difference is that people who go to college are people who are still in the formative stages of their personality development. Psychologists agree that a lot of important personality development and social learning is going on while at college. It’s not just a business of education — it’s a place where a large community of similar-aged individuals are all discovering who they are.
And that large community of students exists not in a vacuum — but in a larger community of individuals who are mature, hard-working ordinary adults and families who’ve already gone through that process.
So I look at it as being very different and the university’s responsibility — since they’ve already taken it on by offering student health and mental health services to begin with (well, at least at most colleges and universities). You can’t go halfway with these kinds of things… “Oh, we offer help and treatment only if you’ve got this condition, but not these 10 other ones.”
Well, you can of course, but then we shouldn’t be surprised when we learn that service is all fragmented and nobody knows what’s going on with any particular individual.
Actually, every college/university counseling center, even thoughs integrated into “health centers” have some pretty clear scope of care: limits as to who and what they can treat within their expertise, available resources, etc. We can only treat a person with an eating disorder if Out-patient weekly appointments is sufficient for their care- if they need more, they must be referred to those services. When a bipolar individual becomes fully manic, they usually have to be referred for hospitalization and stabilization and again, if they require services outside the role and scope of care the center can provide, they must be referred.
Even k-12 schools do not provide “comprehensive services” to their students. I think the thrust upon colleges to assume a “Loco Parentis” role puts a heavy burden on schools that actually have the opposite pressures put upon them (Treat every young adult as an adult). In our society, this balance has moved back and forth, but has moved strongly toward loco parentis, though the schoold have not asked for this. And most students reject it. It does appear that with this generation, adolescence has been extended into the 20’s for many. Our government and community mental health center seem not to even be able to provide the kind and extent of services that are suggested by some colleges provide. Colleges cannot be the mental health hospitals for all. This is the wrong direction, in my humble opinion, or else it will cause education costs to escalate dramatically.
I just want to say that the college I attended previously KICKED ME OUT because of my MENTAL HEALTH CONCERNS. Despite being half way finished a program they had no problem letting me go and never let me return – not only that, all of my professors were aware and treated me terribly as a result.
I decided to give up on returning to college and transferred to a university where no body knew me. I am now thriving at this school. My professors treat me with respect, I see a school counsellor regularly that I can talk to and if needed, I have access to a psychiatrist at the university.
I’m furious with this other college for making my life even harder and more stressful than it had be. However, if it weren’t for such a terrible college, I’d never be doing as well as I am today.
I respect the comments that have been posted here, and the position that post secondary insitutions have responsibility in mental health care.
It’s easy to look for the faults of the college, security, community in this or any case where the end result of bizarre behavior is violence. Hindsight is 20/20! There is no way to predict violent behavior, just risk factors.
I won’t be so naive to think that all institutions are pure and have the students interests at heart, as yes they are a business; but instead of pointing the finger only to colleges and universities how about we look at government funding for mental health care, and government funding for education (whether primary or beyond). Perhaps if institutions had more financial resources there would be less cutbacks in resources such as counselling or psychiatric services.
We need to also applaud the post-secondary counsellors and institutions who do intervene with risk assessments, psychiatric evaluations, police involvement and avert possible tragedies. We do not know how many incidents are prevented, because only the ones that aren’t are in the media.
Let’s find a balance here!
While this is a very extreme case of a mental illness going unnoticed on a college campus, I do believe the article addresses many issues. Mainly, the perspective of the university in such an instance. Many schools do provide mental help services on campus as they are a part of the fees that each student pays in tuition, the only issue is that what happens off campus is not a concern. Although most psychiatric services have normal business hours, there is still someone on staff that can de-escalate an issue over the phone or provide a sponsor to talk to after hours. This is important to have, problems do not have banker hours and the people having them shouldn’t have to wait until the next business day to get them fixed.
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