Mental Health

Mental Health Kathryn Johnson University of Southern California EDHP 569

Mental Health On April 16, 2007 Seung Hui Cho a student at Virginia Tech University shot and killed thirty-two of his classmates and faculty before killing himself (Davoren, 2008, pg. 429). The mental illness of college students around the country has increased by 15% in the last five years, however, 80% of those students have never sought or received any medical attention for their condition (Davoren, 2008, pg. 455). The Family Education Right and Privacy Act (FERPA) was put in place to protect a students academic

freedoms, however, cases such as Virginia Tech have shown that nondisclosure validates the institutions right to not report behavioral misconduct due to a mental disability. Failing to disclose information and report vital information to the proper channels perpetuates students with mental health not receiving the medical attention they need and deserve. College Students with a Mental Health Disability The growing epidemic of mental health issues in the United States demonstrates a higher need for early detection and reporting for proper treatment. According to the National Alliance on Mental Illness, one in four adults in the United States have experienced a mental health disorder in a given year (2006). An epidemiological study indicated that 39% of cases that met the criteria for a psychiatric diagnosis is at the highest for youth in the age category of 15-21, thus many young adults will experience their first psychiatric episode during college (Collins et al, 2006, pg. 227). MIT, Harvard, and several other universities conducted a study discovering that 12% - 18% of students on a college campus have a serious mental illness (Collins et al, 2006, pg. 227). A serious mental illnesss is based on having a diagnosable psychiatric disorder according to the American Psychiatric Association (Collins et al, 2006, pg. 227). These

Mental Health disorders last at least a year and produce an impairment significant enough to be considered disabling such as major depression, bipolar disorder, schizophrenia, severe anxiety, and eating disorders among other mental disorders (Collins et al, 2006, pg. 227). Each of these mental illnesses can create a learning barrier for students to be academically successful. For many students their mental illness will never hinder their performance in college, however, for students that do not proactively seek help they can face detrimental consequences such as suicide or even a Virginia Tech incident. Students Self Identifying Students with mental health issues who self identify are protected under the Americans Disability Act to ensure reasonable accommodations in their educational programs. However, the university is only required to accommodate for disabilities they are aware of and are therefore free from scrutiny if the student does not disclose their mental illness (Collins et al, 2006, pg. 227). Students with a mental illness are often reluctant to disclose their disability or seek services due to fear of stigma, inequitable treatment, ore embarrassment (Collins et al, 2006, pg. 227). In the 80% of the cases where a student commits suicide the mental health office or counseling center has no

record of the student ever seeking services (Davoren, 2008, pg. 455). With mental health cases on the rise it is more important then ever to establish a clear path for students to not only identify themselves, but also for those observing these behavioral issues to have a clear communication path to report without the fear of violating FERPA (Davoren, 2008, pg.426).

Mental Health FERPA FERPA was established in 1974 to protect the privacy of college students (Davoren, 2008, pg. 427). The purpose of FERPA is to protect (parents and students) rights to privacy by limiting transferability of their records without their consent (Davoren, 2008, pg. 427). FERPA provides 18-year-old students the privacy to their educational records, which include their files, documents and other material from the institution. Educational records can only be released if there is legitimate educational

interest in order for administrators or professors to do their job (Davoren, 2008, pg.429). Unfortunately it is not evident what specifically includes legitimate educational interest therefore institutions would rather act on the side of caution and not disclose information in fear of loosing federal funding (Davoren, 2008, pg. 429). Institutions could loose funding if the government discovers that disclosure of students academic information was distributed without just cause (Davoren, 2008, pg. 429). Especially in the current economic hardship universities are acting on the side of caution since a clear definition of disclosure is not made evident in FERPA (Davoren, 2008, pg. 429). Non-disclosure was one of the direct causalities of the Virginia Tech incident. The Virginia Tech Shooting Seung Hui Cho had been diagnosed with having selective mutism and major depression: single episode during his adolescence (Davoren, 2008, pg. 430). In high school he received good grades and was accepted to Virginia Tech University (Davoren, 2008, pg. 431). Chos mental condition was not disclosed to the university under ADAs preadmission inquiry, which prevents institutions from making admission decisions based

Mental Health upon a persons disability, which would create a disadvantage for disabled students (Davoren, 2008, pg. 431). The university could request the information if it was for legitimate educational interest however, what defines legitimate interest is still debated and scrutinized (Davoren, 2008, pg. 430). Furthermore, the Health Insurance Portability and Accountability Act could have prevented the university from accessing Chos prior medical history (2004). After Cho became a student he was very successful in his first year with his academics and seemed to be adjusting well to the college environment (Davoren, 2008,

pg. 432). However, like a majority of college students, he began to struggle in his classes in his second year, and eventually switched majors (Davoren, 2008, pg. 433). The stress and anxiety from college courses are one of the main reasons for mental anxiety or developing depression for students (Collins et al, 2006, pg. 227). Chos behavior became very erratic including stabbing the carpet at a party, writing heavy metal lyrics on his dorm wall, stalking and threatening behavior with female students, and a text message to his suite mate saying he might as well kill himself (Davoren, 2008, pg. 433). Throughout this time frame the universities officials met during a Care Team meeting to discuss Chos behavior (Davoren, 2008, pg.434). The administration did not report this erratic behavior to Chos parents because they believed such communications was prohibited by FERPA (Davoren, 2008, pg. 455). However, under FERPA regulations crimes of violence including destruction, damage, or vandalism of property would not be protected by FERPA therefore enabling the administration to contact Chos parents (Davoren, 2008, pg. 433). FERPAs intentions are to focus on a students educational records and leaves communication of personal observations and conversations with a

Mental Health high-risk student unrestricted (Davoren, 2008, pg. 446). The administration in this

situation were unaware of their ability to report and therefore felt that they were unable to intervene in fear of loosing federal funding for violating FERPA (Davoren, 2008, pg. 433). Cho was eventually involuntarily hospitalized for his threat to kill himself, and was determined to be a threat to himself and others but was released and granted outpatient treatment (Davoren, 2008, pg. 448). Cho attended his first appointment with the counseling center on his campus, but because he was a voluntary patient it was up to his discretion to create a follow up appointment (Davoren, 2008, pg. 448). He never attended counseling again, and in the Spring of 2007 he started buying guns and ammunition, and on April 16, 2007 he shot and killed thirty-two Virginia Tech faculty and students, injured twenty-four, and then killed himself (Davoren, 2008, pg. 448). During this time the universities Care Team believed that he was successfully recovering and had no knowledge of his police record or hospitalization (Davoren, 2008, pg. 449). Virginia Tech is one example of how universities lack of communication, follow through, and reporting vital information to the proper channels enabled Cho to proceed with his plans without intervention. University Jurisdiction The lack of legal understanding for administration to administer proper response and assistance for students with a mental health disability has been firmly rooted in previous court cases that have had inconsistent ruling on university due diligence. In the case of Jain v.State (2000), the plaintiff sued the state university after his son had committed suicide (Davoren, 2008, pg. 444). Jain claimed that the university acted with negligence when they did not notify the parents with their sons first suicide attempt

Mental Health (Davoren, 2008, pg. 444). FERPA was the main reason why it was not disclosed to the parents, however, Jain argued that considering it was an emergency situation after the first suicide attempt he should have been notified in accordance with FERPA (Davoren, 2008, pg. 455). The court ruled against the father since the emergency exception is a discretionary part of FERPA and the school was not required to disclose the suicide attempt to the parents (Davoren, 2008, pg. 455). The vagueness of the discretionary

exemption further perpetuates I dissonance in best practices for university administration. In a similar case of Shin v. Massachusetts Institute of Technology (2000), Elizabeth Shin went to the schools health center before setting herself on fire (Davoren, 2008, pg. 455) and the Massachusetts Supreme Court did not appose Shins parents from suing the administration for not notifying them of Shins condition. These inconsistent rulings generate apprehension from the university to perform best practices in order to provide the proper help and counsel for their students. Whether or not informing the parents would prevent a suicide or a mental breakdown is inconclusive, however, FERPAs ambiguity on the matter leaves universities exposed to lawsuits since a precedent has not been firmly defined. Campus Conduct Furthermore maintaining consistency in disciplinary proceedings becomes a challenge when students violate the code of conduct in the classroom but identify with a mental illness. In Rosenthal v. Webster University (2000) a student was suspended for carrying a gun to school and threatening to use it. The student sued under the universities violation of ADA and the Rehabilitation Act since he had been diagnosed with bipolar disorder (Rosenthal v. Webster University, 2000). The federal appellate court rejected the

Mental Health claim since the university had no prior knowledge of the students mental illness. However, it leads to the question of what would have happened if the university took action and knew about the disorder? What reasonable accommodations could be created for a student that brings a gun to school? Under FERPA this could be seen as an exception due to its emergency nature, however, an imminent emergency is not thoroughly defined in FERPA and is still subject to the scrutiny of the courts (Davoren, 2008, pg. 433). Future Best Practices In the Virginia Tech incident as well as the comments from mental health professionals all discern that there is confusion about the communication that is allowed under FERPA. FERPA should establish an amendment to require disclosure in certain

situations so that administrators will no longer have the option of hiding behind the shield of non-disclosure (Davoren, 2008, pg. 427). The FERPA amendment should mirror the Mandated Reporter policy, which requires any individuals that work directly with students to report child abuse to the authorities (2011). Assessing and disclosing vital information regarding severe mental illness within the student population will help the university accommodate both incoming students and current students. Incoming Students with Mental Illness The ADA has strict regulations to prevent universities from seeking educational records, including disciplinary records, prior to the students admission to a university (Davoren, 2008, pg. 428). This establishes an equitable application process that does not deter a university from selecting a student with a disability. However, the university

Mental Health

should have a right to the educational record once the student is admitted to the university since it validates FERPAs legitimate educational interests (Davoren, 2008, 428). By knowing the incoming student populations needs, the university can more appropriately assess its services to accommodate its student population. Continuing Students Although disclosing incoming students mental illnesses would help assess one portion of the student population, there are still continuing students who may develop a mental illness during their college years. This generates a challenge for academic professionals to identify, address, and take the appropriate action in a timely and efficient manner, without infringing on a students privacy rights. In a study conducted by Penn state in 2009, 25% of the students considered suicide, 19% had experienced a counseling session, however according to Davoren (2008) 80% of students who commit suicide each year are not known by the campus counseling center. For many years administrators, hall advisors, and professors would simply make mental notes of mental health tendencies in students and try to keep an eye on the student (Davoren, 2008, pg.426). By establishing a more proactive approach regarding the awareness of specific symptoms to report will help create an awareness to be on the look out for. At Northern Illinois University Steven Kazmierczak was pursuing a masters degree in social work and was notorious as personable, easy to talk to, and excellent student(Davoren, 2008, pg. 441). On February 14, 2008, Kazmierczak opened fire in a lecture killing five people, wounding sixteen others, and then took his own life (Davoren, 2008, pg. 442). Two weeks before the shooting those interacting with Kazmierczak noticed he was acting erratic after he had stopped taking his medication (Davoren, 2008, pg. 442). If

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students and university professionals were more aware of the severe repercussions mental health patients faced when they went off of their medication these situations could be prevented. Mandated Reporter Similar to the Mandated Reporter policy, institutions should establish workshops and sessions to promote mental health awareness (2011). By knowing what to look for such as severe weight loss, erratic behavior from one week to the next, or other behaviors that are to be considered high risk factors, would help the college population stay alert and aware of any student that may be in crisis. Identifying students who make threatening comments such as Cho did when he text his suitemate that he wanted to kill himself, or overhearing a student say that he went off of his medication, should all be mandated reports to the proper authorities to prevent a reprehensible incident and ultimately help a student in need. Best Practices A student who does identify with any of these traits should automatically be considered an emergency situation and should have the parents notified. The university must create a best practices for students with severe mental illness by having a routine intervention and follow up with high risk students so situations like Cho, where he simply refused to go to counseling, is not an option. In partnering with the ADA, the routine meetings with administrators and medical specialists should be considered a form of reasonable accommodation to help the student successfully integrate back into the classroom. When students meet with a counselor their medical records then become

Mental Health sealed by HIPAA, however, by meeting with an administrator who is trained on both mental illness and FERPA the university can properly asses a students risk factor to the school without violating their personal medical records. Conclusion Students with mental health issues are on the rise in the United States and universities must make it a best practice to keep the campus community safe. Although there is much ambiguity with FERPA a clear precedent should be established across all universities in regards to notifying the parents or not. By creating a proactive and generating more awareness of student mental health issues, the campus population can create accessible accommodations for all of its students to be successful in and outside

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the classroom. Communication, awareness, and follow through are key factors in helping students with mental illness keep the campus environment safe and accessible.

Mental Health References Child Abuse Mandated Reporter Training. (2011) California Department of Social Services. Retrieved from: http://mandatedreporterca.com/ Collins, K. Curlin, C. Kopels, S. Lett, R. Mandiberg, J. Megivern, D. Strauss, S. (2006). Campus Mental Health Services: Recommendations for Change. American Journal of Orthopsychiatry. Vol. 76, No. 2 Davoren, M. (2008). Communication as Prevention to Tragedy: FERPA in a Society of School Violence. St. Lous Health. Vol. 425 Health Insurance Portability and Accountability Act. (2004). United States Department of Labor. Retrieved from: http://www.dol.gov/ebsa/newsroom/fshipaa.html Jain v. State, 617 N.W.2d 293 (2000) Mental Illness Facts. (2006). National Alliance on Mental Illness. Retrieved from: www.nami.org Rosenthal v. Webster University, 230 U.S. App. LEXIS 23733, (8th Cir. 2000).

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