Moreover, it is important to recognize that after the Virginia Tech tragedy, some school administrators understandably became much more skittish about having students with suicidal ideation on campus. One can also find this heightened reactivity and push to remove potentially suicidal students when there has been a recent suicide or suicide cluster on a campus or prominently covered in the news.
There are also situations in which an individual administrator at a college has a particularly hard-nosed or anxious attitude about the risk of having a suicidal or potentially suicidal student on campus. But, all of these problems are quite rare. Most often a student who needs time away from school (and ideally his or her family) is cooperative with university clinicians and administrators, and a reasonable plan can be agreed on—if a leave occurs, it is fully voluntary.
Some schools have made the leave process more cumbersome or unwieldy by establishing policies that make students uneasy or hesitant to take a needed leave. For example, some schools require students who take a medical or mental health leave to stay out of school for a full year. Some schools do this because they don’t want students to take a leave to get out of bad academic performance. Other schools have rigid academic structures that make it difficult for a student to return the subsequent semester.
Others, such as Yale, require students who take a leave of absence to reapply to the college. While students are typically readmitted after they have received the necessary treatment and stabilized, this policy has led students to feel as if the school can arbitrarily choose to readmit them or not—in many cases increasing students’ hesitation to take needed leaves of absence.
What is the truth about involuntary leave?
While there are a few situations or policies that may lead to involuntary leave, there are large numbers of students with significant pathology and many with suicidal ideation and past or recent attempts who are being treated and kept in school. In fact, college clinicians and administrators (and campus at-risk teams) are managing many actively suicidal students.
While I am quoted in the Today report as suggesting that colleges are concerned about their reputations and PR, this was only the beginning of my comment. The truth is that campus counselors and administrators primarily care about their students’ welfare and safety (this was the completion of the quote not included in the story) and they recognize that on balance, if a student can be kept in school, it is better for the student (and the system) to remain enrolled. College attendance may actually protect against suicide—the rate of suicide among college attendees is half that of young adults who do not attend college.7
Furthermore, removing every student with suicidal ideation or a suicide attempt would remove many students who might be better off remaining in school.7 And consider that if a student is depressed but functioning, he or she will be more occupied, potentially better socially connected, and probably more hopeful by remaining in school.
Another incentive for colleges to work with students and their families in a cooperative way and arrive at mutually acceptable plans is highlighted in the Farrow report. In the past 20 years, colleges have made substantial strides in increasing student comfort with help-seeking. The number of students who receive treatment at college counseling centers and support through other campus offices (eg, residence life, disabilities) has grown steadily. This in some part accounts for the lower rates of suicide among college students.
When unbalanced reports such as the Today story or the sporadic reports in campus newspapers about forced leaves of absence appear, these may very well have a negative impact on student help-seeking and ironically (and tragically) make students less safe.
Farrow and the complaining students are correct that colleges need to be sensitive and sensible in managing suicidal students. They have, however, created a misimpression of a much larger problem than actually exists. They have also failed to explain how complicated many of these situations are. Students and families are sometimes not fully able to acknowledge the extent of pathology or risk, and college clinicians and administrators sometimes make mistaken or less than ideal decisions. More often than not, the student, family, clinicians, and administrators can mostly agree about the situation and an acceptable plan emerges. In the rare situation in which the student and the campus professionals cannot reach an agreement, it is best to treat these situations as a clinical impasse and work to understand the motivations and conflicts from a dynamic and therapeutic perspective. If an agreement cannot be reached, a mandated leave is possible and may be the leverage needed to get a student to seek needed treatment.
Dr. Schwartz is Clinical Associate Professor of Psychiatry, NYU School of Medicine; and Medical Director, JED Foundation, New York, NY. He reports no conflicts concerning the subject matter of this article.
1. Mental health policies at universities draw increasing concern. Today. June 2016. http://www.today.com/news/mental-health-policies-universities-draw-increasing-concern-t99441. Accessed July 11, 2016.
2. National Center for Education Statistics. Fast Facts. http://nces.ed.gov/fastfacts/display.asp?id=372. Accessed July 11, 2016.
3. American College Health Association. National College Health Assessment. http://www.acha-ncha.org/pubs_rpts.html. Accessed July 11, 2016.
4. Association for University and College Counseling Center Directors. Director Surveys. http://www.aucccd.org/director-surveys-public. Accessed July 11, 2016.
5. Center for Collegiate Mental Health. 2015 Annual Report. http://sites.psu.edu/ccmh/wp-content/uploads/sites/3058/2016/01/2015_CCMH_Report_1-18-2015.pdf. Accessed July 11, 2016.
6. Lannon OG Jr. Direct threat and caring for students at risk for self-harm: where we stand now. National Association of College and University Attorneys. http://www.higheredcompliance.org/resources/SelfHarm.pdf. Accessed July 11, 2016.
7. Apppelbaum PS. “Depressed? Get out!”: dealing with suicidal students on college campuses. Law & Psychiatry. July 2006. http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2006.57.7.914. Accessed July 12, 2016.