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Do you have a plan to harm yourself or anyone else?
July 5, 2014 7:00 AM   Subscribe

If I were going to pull a Virginia Tech or a Columbine,” he said, “I wouldn’t tell you about it, would I?
posted by and they trembled before her fury (50 comments total) 30 users marked this as a favorite

 
".... Still, I sat outside her classroom, reading, waiting, because it seemed there was nothing else to do."

Therein lies at least part the problem. The underfunding of easily accessible mental health services, coupled with inadequate training of those who, on a regular basis, come into contact with individuals who are in need of those services, allows these crises to escalate.
posted by HuronBob at 7:13 AM on July 5 [2 favorites]


I can't speak to the college level, but I can say that at the high school level, students in crisis are being addressed and are getting help.

I work at a high school for students with behavioral and emotional difficulties. These are kids who usually were in public schools and they became unable to cope with their lives. Some of them began self-harm; all of them needed a higher level of support than their schools could provide. Our students usually require a high level of exposure therapy just to physically get them walking inside our school. It can take months for one of our students to be able to leave their bedroom and go to one class daily. But we celebrate that success.

Our students have core academic classes. They have therapy daily. They have group therapy twice weekly. We have more clinicians on staff than teachers.

Every day, the entire staff meet to discuss how the kids did and what we've noticed. And from daily classroom observations to standing in the hallways and chatting with the kids, very little escapes our attention. We notice when kids are wearing the same clothes twice in a row, we notice when kids move their seats away from certain peers.

Ten years ago, my type of therapeutic high school didn't exist.

What we need is public and parental education. Parents don't know we exist. Parents don't know there are options for kids. We're a well-kept secret in the public school world.

I don't know how we can get out the word that for kids in high school, there are choices. They don't have to suffer through disturbance and mental illness. There are therapeutic schools for them.

And maybe they go to college, they know how to deal with issues, and they don't become dangers to themselves or to others.

Because no, college professors are not equipped to deal with this. But at the high school level, many of us work very hard to help these kids.
posted by kinetic at 7:32 AM on July 5 [26 favorites]


It seems bizarre that the teacher was left to deal with this on their own.
posted by Brandon Blatcher at 7:36 AM on July 5 [3 favorites]


Kinetic... sounds like a great facility.... there are way too few schools/programs like yours! What is your student/teacher ratio in the classroom?
posted by HuronBob at 7:53 AM on July 5 [1 favorite]


I'm a graduate student instructor, so I teach my own independent course for one of the intro courses in my department. I had a student I was very concerned about - one who told me coming to class was too much effort and he couldn't leave his room, who (between the few times I had seen him) had a precipitous decline in hygiene, who made comments about hating himself (over e-mail), who basically checked off all the boxes on the "preventing suicide" online training we had to take to start teaching, etc.

So I spoke to my course coordinator, who told me he didn't know what to do, so call student health services. So I called SHS, who told me they didn't deal with mental health issues but referred me to the student counseling center. So I called the student counseling center, who told me they couldn't do anything unless he came to them specifically. What I could do is call the police and tell them I thought the student was in immediate danger of harming himself and they'd involuntarily commit him in a mental facility! And I was just like ... there is nothing we can do between throwing our hands up in the air and involuntarily committing this kid? Apparently not at our Big10 university where student success comes first.

So yeah, I've got no clue.
posted by ChuraChura at 8:09 AM on July 5 [50 favorites]


What you do is tell the student, "I don't know if I should call the police." I've seen it work wonders.
posted by michaelh at 8:12 AM on July 5 [3 favorites]


We have no more than 8 students per teacher but with our kids sometimes needing hospitalization, rehab and day treatment, it usually works out to 1 teacher per 4-6 students daily.
posted by kinetic at 8:12 AM on July 5 [1 favorite]


From my vantage point, Schumacher’s student—simply because of the way he made his instructors and classmates feel—should have been one of these cases. And perhaps it should be standard practice that any student who, as Whyte’s office puts it, communicates “distress through writing,” be barred from returning to class until that distress is addressed—by someone actually qualified to do so.

Holy. Fucking. Shit.

No. No no no no no no no no no motherfucking NO. That is NOT the way you want to handle that. That's the way you'll push someone over the edge and into becoming a shooter.
posted by Talez at 8:23 AM on July 5 [13 favorites]


> I don't know how we can get out the word that for kids in high school, there are choices. They don't have to suffer through disturbance and mental illness

Just so people know: this is true all the way down through preschool, in the US. Your district's services may vary but in theory therapeutic classrooms are available for all kids, as part of special ed.
posted by The corpse in the library at 8:30 AM on July 5


See, this doesn't sound like help.

What you hear is "prevent another shooting," you hear "cops," you hear "makes other students uncomfortable." All of these helpful responses appear to be associated with helping everyone but the person in question.

No wonder this "help" is not sought.

Have we really descended to such a point such that, just as Human Resources is there to help the company instead of you, we see the same collusion between the administration and the caregiver?
posted by adipocere at 8:41 AM on July 5 [23 favorites]


“We’re concerned about what you’ve been writing. Some of your classmates are frightened. They want to drop the course.”

So if a Stephen King or an H. P. Lovecraft tried to work on his chops today in undergraduate it wouldn't fly, would it?
posted by bukvich at 8:46 AM on July 5 [3 favorites]


Except the "person in question" was refusing to see a counselor. If a student is refusing help, then the only available option is to protect the other students and employees from them. If a student was actively involved with getting mental help, I suspect everyone would have felt a great deal less afraid.
posted by tavella at 8:47 AM on July 5 [1 favorite]


....but in theory....

The operative phrase in that sentence....

In the state in which I live, services are quickly dwindling as the state defunds public education in favor of profit seeking charter schools which do a pretty good job of discouraging any students with special needs from enrolling....

And, from a special education perspective, again I'm speaking from my experience in my own state..... mental health diagnosis are not necessarily going to result in services.....
posted by HuronBob at 9:05 AM on July 5 [8 favorites]


Yeah, I worry that my local city that can't even afford school nurses can really handle major health problems of any kind.
posted by Drinky Die at 9:16 AM on July 5 [1 favorite]


And, from a special education perspective, again I'm speaking from my experience in my own state..... mental health diagnosis are not necessarily going to result in services.....

This is true.

What works is a diagnosis AND a kid who refuses to go to school.

The most efficient way for a kid to be referred to a high-level, intensive school is for them to refuse to go to public school for at least 15 consecutive days.

It's ridiculous and unfair and terrible, but when parents can make a case that their child can not attend their local school, school districts move very quickly to place students elsewhere.

Off the top of my head, at least 80% of the kids at my high school have been referred after refusing their home school.
posted by kinetic at 9:21 AM on July 5 [4 favorites]


In medicine, screening for depression has only been shown to be helpful, if you have services and treatment to offer those who screen positive. Screening for depression has been explicitly shown to be harmful if there is no treatment to offer.

I don't know what we we are to expect of professors and teachers who discover an emotionally troubled student but a disturbing conversation with no action plan is problematic. "Ok, so you are basically all the things I was worried about, um carry on then. I'll see you in class. I've got my eye on you, weirdo."
posted by Slarty Bartfast at 9:32 AM on July 5 [12 favorites]


Thing is, it's just so easy to lie, even to fully trained mental health professionals. A couple months ago I OD'd (on purpose). Ended up in the hospital. They asked me specifically before agreeing to release me if I had any plans to harm myself.

I said no. I did have plans. Never went through with them, but still..
posted by feckless fecal fear mongering at 9:38 AM on July 5 [4 favorites]


What works is a diagnosis AND a kid who refuses to go to school.

The most efficient way for a kid to be referred to a high-level, intensive school is for them to refuse to go to public school for at least 15 consecutive days.


Is this state specific? Because unfortunately that was not the case for this young man. He was away from school from nearly three months out of fear, and was denied a safety transfer because it was near the end of the school year.

While this case did not end nearly as badly, another young boy was bullied and tormented for months before he was even offered a transfer to another school.
posted by lovelygirl at 9:45 AM on July 5 [2 favorites]


Have we really descended to such a point such that, just as Human Resources is there to help the company instead of you, we see the same collusion between the administration and the caregiver?

I think we've been at that point, honestly. It's not a new thing.

You can force someone to "seek care" or "get help." But you can't force someone to actually be cared for or be helped. If there's coercion involved, then there is no way to guarantee that you are providing real help and not just "help" in scare quotes.

Going back decades, getting sent to a school counselor's office has been understood as a de facto form of punishment. It's what happens to you when you're caught breaking the rules or fucking up. It might put you in contact with someone who helps you get your shit back together. But that's never been a sure thing, and I don't see any way of making it a sure thing.

Which sucks, because counseling really is a necessary service. And some people really do need to be shoved in the direction of that service, or at least told "It's up to you, but we're not going to let you register next semester if you don't see a counselor." But as soon as you start telling people that, the counseling office starts filling two roles: they're helpers and disciplinarians. And there's necessarily going to be some conflict between those roles.
posted by nebulawindphone at 9:46 AM on July 5 [6 favorites]


Part of the problem is that the counselling environment is too formal. But you can't really treat someone without informed consent. So what can you do? Have them sign a waiver at the beginning of the term allowing mental health professionals to hang out in classes with TAs? Approach people who are at risk and just talk to them at first?
posted by Talez at 10:03 AM on July 5


lovelygirl, that's a heart-breaking case.

I can't speak to that situation but I can say that kids who get referred to therapeutic high schools are kids who, like I mentioned, have both diagnoses of emotional disabilities and a history of school refusal.

We don't get referrals for kids who are being bullied. Those situations are mediated at the school level. Or not mediated, as your case demonstrates.
posted by kinetic at 10:06 AM on July 5


I also wonder whether it might be worth putting in "amenesty until the first shot" for situations like this? Even if the shooter is on campus with a weapon and threatening people the authority in charge at the time can basically say, "we know you're troubled, we know you need help. If you put down your arms and surrender we won't charge you and we'll get you the help you need in the community".
posted by Talez at 10:07 AM on July 5 [4 favorites]


So let's take a bunch of young, emotional people, convince them that their future ABSOLUTELY DEPENDS on successfully getting through college and/or graduate school, and make them borrow huge amounts of money to attend.

Meanwhile, universities are incentivized to allow as few students as possible to succeed. Courses at large public universities are literally designed to fail large numbers of students so they'll quit and ease the overcrowding. They don't want students to become educated, they want students to GET OUT either by graduating or just quitting. New policies keep getting enacted to push that goal, making it ever harder to be a student with average, or less than average, skills.

It's not clear to me that we should be shocked when students have stress-related mental problems under these conditions. And yet the language we use assigns blame to the student. "The student should get counseling." "The student should be removed from the classroom." But this like saying "This kid is being abused, we should get him some counseling to help him cope with it" instead of helping the kid, or student in this case, by fixing the environment.

I've talked a number of people out of applying to my school because I don't think anybody should go into an environment that encourages student suicides by putting student success at odds with university success.
posted by LastOfHisKind at 10:10 AM on July 5 [10 favorites]


Courses at large public universities are literally designed to fail large numbers of students so they'll quit and ease the overcrowding.

What? Universities get to pick how many people they admit, so there's no unintentional overcrowding. Even here in Texas where the legislature dictates (to some extent) who must be accepted into a university, the universities can still control their population numbers. And when a university is being judged by its metrics, I'm sure "drop out rate" is not one that they are proud of. It would seem that a university would instead have every incentive to graduate as many students as possible. If anything, I'm surprised there's not more skewing to make things EASIER for students.

I'd be willing to bet that the stresses that lead to suicide for college students are rarely academic. These students are navigating their way as independent adults for the first time in their lives, sometimes paying for their own bills for the first time in their lives, having to learn to make friends with other adults, dealing with enormous pressure to lead certain kinds of romantic lives, dealing with body issues, discovering what their own personalities look like outside of the shadow of their parents, making decisions that they are told will determine their entire rest of their lives etc. etc. etc. Coursework is just one little straw in this gigantic pile of hay on the camel's back.
posted by tofu_crouton at 10:27 AM on July 5 [13 favorites]


bukvich: "So if a Stephen King or an H. P. Lovecraft tried to work on his chops today in undergraduate it wouldn't fly, would it?"

Having worked with a lot of college student writers in various capacities, it's not really the Stephen Kings of the class who give off the vibe. I've tried like six times to capture this in my comment but it's hard; it's a holistic thing having to do with the student's demeanor, participation in class, ability to follow assignments, etc. If you've got a student who lends people pens, smiles when you joke around with him, has text messages to answer during the break, and turns in a really disturbing short story, he's probably just exploring those issues in a safe way through fiction and is just interested in horror/dystopias/true crime/whatever.

The kids who raise red flags are often very disconnected -- they don't socialize with other students at all; other students are reluctant to interact with them and become more reluctant over time; they don't come to office hours; they have difficulty being on topic in the classroom (not just sometimes, but all the time), in weird ways; they have difficulty responding to assignments and just write what they're interested in regardless of the topic; they often interrupt class; they're often late or leave early; they're unaware or unconcerned with of the transgressive nature of what they're doing, even after it's pointed out to them. (A lot of students will ASK in advance -- "Hey, I thought of a really creepy horror story way to do this assignment, is that okay or is that too weird?" -- because they know that horror/true crime/whatever might be boundary-crossing. Or they'll leave you a note at the top of the paper like, "This is just a story, I'm not actually thinking of killing anyone.") They're not quite operating in the same reality with the same rules as the rest of us. Sometimes this is because they are extremely stoned. But sometimes it's because they are very, very troubled.

You don't read a Stephen King novel and thing "WOW THIS GUY HAS ISSUES." You think, "Wow, this guy really likes to write creepy stories." You read a Unabomber manifesto and think, "Wow, this guy has issues."

Not that there is a clear bright line, but you get a sense of the totality of the student and whether this is just a kid really fascinated by true crime, or whether this is a kid who's actively planning his true crime. It's not so much that they're "dark" -- plenty of college students are dark -- but that they're off-kilter.
posted by Eyebrows McGee at 10:34 AM on July 5 [44 favorites]


kinetic’s right in as much that models for how to proactively address youth crisis exist but we, as a society, do not have the will to fund these things full scale. It’s going to vary from state to state or even school to school.

I worked at a non-profit that would assign a paid, professional, full-time mentor with the most at-risk youth in a kindergarten class until they graduated from high school. That works. I saw it with my own eyes. Moreover, the evidence proves it. It’s expensive. The evidence also proves that it’s cheaper than the alternatives, such as incarceration or early, unplanned pregnancy.

I had a therapist for depression in college, but only because I sought it out after a friend back home expressed their concerns.

I was alone all the time. I never went to office hours. I was never engaged by an RA. For all intents and purposes, I was a walking social security number. The default counselors for admissions and scheduling were utterly inept, unable to answer any question that I hadn’t already answered for myself by consulting written materials.

Nowadays when people get nostalgic about their college experiences or rave about their college teams, I just feel numb that my university didn’t give a shit about me so why should I return the favor?

I’ve been on the other side, too. One summer under the recovery act, I was a jobs counselor for youth. I have some super great (!) stories about the ones that I helped. But a few youth stand out in memory as slipping through the cracks… when someone’s depressed or in trouble, they can get very good at hiding it.

The reason that we hide mental illness is because of the stigma. And that could be fixed in an institution that’s proactive about its culture.
posted by Skwirl at 11:02 AM on July 5 [7 favorites]


> Just so people know: this is true all the way down through preschool, in the US. Your district's services may vary but in theory therapeutic classrooms are available for all kids, as part of special ed.

I hope this has been a positive change in the past couple of decades. This statement just brought back a flood of memories that I haven't acknowledged in many many years.

So the way this worked out in practice when I was in the public education system was that you were taken off whatever track of education you were presently in, and you were "othered" and lumped into a group of kids with disorders of all types and severity, and were basically babysat all day. Didn't matter what your needs were, you were all lumped in together. You would have maybe an hour or two a week to talk to a counselor, but otherwise, you were just stuck in there. You dropped all of your academic opportunities as you were no longer in any sort of actual class, just "special education." You additionally became an untouchable in the social castes of the school, as you were now labeled as being "different."

These same classrooms were also "detention overflow" if that tells you anything about the quality of care and attention and structure that the students had there.

I was one of those kids who had thoughts of committing violent acts - A social outcast, nowhere to turn, burning with rage, with access to all sorts of explosives and blades, (but thankfully no guns, who knows how this would have gone otherwise.) I had spent more than a little bit of time plotting how and where to place shaped charges and an improvised "napalm" bombs. I had devised clever ways to time delay all of these with what I could find, and I had tested these in some of the clear fields near some of the housing developments under construction nearby, repeatedly. I never told anyone about this at the time, and I came back burned badly more than once, and always had a good cover for it, and learned how to tend to my wounds so I wouldn't have to involve anyone else.

I did have to talk to school counselors more than a few times, as it was clear that there was something going on with me to them. However, the few times I tried to actually reach out and talk honestly to anyone within the school system about my anger at the world around me, it was suggested that I just "get it under control," or I would end up on that special education track. It was used as a threat, and it was an effective one in that it prevented me from talking to anyone else there about it, but not from having those thoughts, or needing to reach out. It did not stop my plotting. I did start to try to talk about it with a couple of counselors and the like a couple of times, but they would ask if I really believed this, with the implication that my life would become so unbelievably different if I did. So of course I said I didn't.

There were two things that helped - One was finding music. I'm not sure entirely how it happened, but I found myself heavily involved in the orchestra, and discovered innate talents I never knew I had and a new form of expression, as well as confidence and some acceptance. It was the first thing I actually felt like I was good at.

The second was having an participating in the variety of "online communities" around me in the form of local BBSes at the time. More people heard my voice and listened there, and thankfully many were willing to engage me in conversations that didn't have any threat of "othering" me.

I think these pushed me away from the edge enough to where I wasn't going to lash out at the world, but I was still troubled for years, and it took adult counseling as well as a couple of wonderful people in my life to really make progress here. I had a deep seated distrust of talking to any counselor/therapist for years, and I think this sort of thing was at the root of that. I often wonder what my life would have looked like if I could have had some more positive counseling and therapy in my younger years. Thankfully, I feel really great and relatively normal and well-adjusted these days. It took a lot of work to get there, and it's by no means over.

So while this sort of therapeutic classroom is great in theory, it only works within the constraints of special education offerings - which could vary greatly across districts. In my case, those therapeutic classrooms were basically daytime "containment" facilities. That would have likely put me over the edge. This was over 20 years ago, and pre-columbine. I truly hope that we have found better ways of doing things since then.
posted by MysticMCJ at 11:03 AM on July 5 [30 favorites]


The issue isn't as much the lack of systems, though that is certainly a problem, but that academics are somewhat isolated in their work environment. They meet with students and each other 1-on-1 so there is no backup or witnesses when things go awry (I've met my wife at work early so that I could strategically interrupt a meeting with a student that she knew would be a problem.). Also the free agent nature of academic employment often means that instructors don't even fully know the system they are working in.

There are also some pretty serious legal constraints in what academics are divulge about students to others.
posted by srboisvert at 11:09 AM on July 5 [1 favorite]


Thanks for the honest and extensive comment, MysticMCJ. I find the remark about finding music of particular interest: I have seen in my own life and in other's that artistic creation has a powerful effect on anger.
posted by not_that_epiphanius at 11:16 AM on July 5


Not that there is a clear bright line, but you get a sense of the totality of the student and whether this is just a kid really fascinated by true crime, or whether this is a kid who's actively planning his true crime. It's not so much that they're "dark" -- plenty of college students are dark -- but that they're off-kilter.

This reminds me a bit of the socially awkward vs creep discussions. You cannot make a list of things that prove a person is on one side or the other, but most people can sense the difference, even if they cannot pinpoint which specific things strike them as off.
posted by jeather at 11:27 AM on July 5 [2 favorites]


Your district's services may vary but in theory therapeutic classrooms are available for all kids, as part of special ed.

This really does vary a lot. kinetic, your school sounds wonderful, but there are a lot of places out there that call themselves "therapeutic" that are really just kid jails. When my kid made some pretty scary statements, our school's response was to call the cops, who said that either we take the kid to the emergency room for mental treatment or they'd involuntarily commit him for 72 hours. I've lived in both affluent and underserved school districts, and none of them have had good therapeutic resources for challenging kids. Our experience has been much more like MysticMCJ's.
posted by Daily Alice at 11:29 AM on July 5 [7 favorites]


feckless fecal fear mongering’s comment made me think of the times that I’ve helped a friend by helping them create a safety plan. How to do that is explained here:

http://www.suicidepreventionlifeline.org/learn/safety.aspx

A safety plan is a written plan of resources (activities, people, emergency numbers) that you can fall back on when having a mental health crisis. It doesn't take very long to make one and any doctor or teacher could also help with creating this document. It's not often that there's an actual deliverable for helping someone with a mental health crisis, which is one reason why it's a helpful thing to do.

fffm — I hope you’re doing well now. I hope we all remember that the MeFi community is one of many resources for the bad times. (http://mefiwiki.com/wiki/ThereIsHelp)
posted by Skwirl at 11:40 AM on July 5 [3 favorites]


This is the same thing it always is: conflating mental illness with violence. They're not the same at all - in fact, people with mental illness are more likely to be victims of violence than perpetrators. A lot of the authors showed a weird, callous lack of sympathy for these students. (How awful it must be for the Slate writer to "endure a hug" by someone whose life she arguably saved. Almost as awful as being suicidal.)

That's the theory. The practice is lumping suicidal students in with potential shooters, which results in depressed or suicidal students either being expelled because they say they're depressed or suicidal, or not seeking treatment because they don't want to get expelled. They go through the same channels and are treated the same way. Here's a good article. It mentions that "placed on leave may not be in the best interests of depressed students, who may thereby be separated from their social network and lose the self-esteem that comes from success in academic and extracurricular activities" -- but I'd go even further, and suggest that the problem isn't self-esteem and social networks, but the fact that being expelled can literally ruin one's future if a student is hoping to get into certain career fields. (One student cited in the journal was kicked out of college in DC. Imagine if he ever wanted to go into politics.) The only rational thing to do is lie.
posted by dekathelon at 11:50 AM on July 5 [8 favorites]


Skwirl, thanks. I'm in a much better place mentally/emotionally than I was four months ago. I actually do have a safety plan, I just ignored it in extremis. A very useful resource to post, so thank you for posting it.
posted by feckless fecal fear mongering at 1:05 PM on July 5 [5 favorites]


I recollect a study, which for the life of me I can no longer find, on socialization in kids. Children fell into three groups: the highly favored, popular kids; the second tier kids; and the bottom of the barrel kids. Their outcomes diverged. See, nobody spent any care or attention on the bottom feeders so they of course became worse off. The second tier kids did not thrive but slowly sank. Ah, but for the favored kids, everything was aces.

After Columbine, the immediate suggestion was that we start identifying and tracking these dangerous kids. The Trenchcoat Mafia. Because that what they need, to be marked off for special surveillance and to be isolated, to be singled out. Nothing says "join the rest of us" like being treated differently. Just imagine having some authority figure pull you in so they can go through this ritual of asking The Question, treating you like you're a time bomb. Yes, that will certainly help bring kids back into the fold.

The human need to be fearful of those who are different, then make a big production out of that fear, is a self-fulfilling prophecy which surprisingly doesn't end in mayhem as much as I would expect.
posted by adipocere at 1:16 PM on July 5 [4 favorites]


"And when a university is being judged by its metrics, I'm sure "drop out rate" is not one that they are proud of. It would seem that a university would instead have every incentive to graduate as many students as possible. If anything, I'm surprised there's not more skewing to make things EASIER for students."

Seconded. They get crap for having so many students that can't graduate before they've been in school for 6 years. They want them out as alumni, not dropouts.

However, due to budget cuts, I'm sure therapy and intervention and counseling aren't as available for every distressed student, of which there are many. Assuming the kids even want to reach out for help in the first place.
posted by jenfullmoon at 1:58 PM on July 5


What happens when you pre-emptively force someone into mental-health treatment against their will? What, realistically, do you think counseling will do for an unwilling client? What, legally, do you want to authorize in terms of forced medications or treatments (ECT, incarceration, etc.) for people who have not committed crimes? (Those are all editorial "you"s.)

There's a sense that I get in the wider societal debate about these issues that (a) mental-health professionals have some sort of magic wand that will fix mental illness quickly and securely, and (b) it's ok to lock up someone who has not committed a crime but is mentally ill, or, even worse, that it's ok to lock up someone who has not committed a crime, who has not even been diagnosed with mental illness, but who might meet the criteria.

Counseling/therapy works in large part, especially with teenagers and younger adults, because it creates a positive, healthy relationship and gives the client a stable, caring connection with another human being. Therapists have extra training in how to help create those relationships with clients with major obstacles to such relationships, but the building of those relationships takes a great deal of time. It is therefore not unreasonable to have a protocol as described in the Slate write-up:
Whyte told me in an email that “student mental health is a top priority” at the university, and the chief duty of the Behavioral Consultation Team he supervises is to work with “students who demonstrate mental health challenges.” Part of that work, he explains, is in fact engaging faculty to interact with “students of concern.” This, he says, is because according to research, these students are “more likely to open up to someone they already know at the University, so often the best approach is to help a faculty or staff member engage with the student.” Thus it’s likely that in suggesting—not, Whyte emphasizes, forcing—Schumacher to reach out to this student, the university was following protocol.
I occasionally work with clients who have mental-health diagnoses and have been previously arrested for violence; I sometimes meet with them when they are not on their medications. I follow more or less the same protocol described by Schumacher -- leave the door open, make sure the client cannot easily block my exit, have other people nearby who know what's happening, have a phone at hand in case I need to call 911. If I have to go to someone's home who might be violent, I try to have the police accompany me if I can do so without freaking the client out. As I said, it's not like I have a magic wand that makes it safe for me to speak to someone who's potentially violent, and maybe I'm reading defensively but Schumacher seems to think that all the risks she was taking somehow disappear in a therapist's office. They don't. (I suppose you could say that I've signed on to take those risks, but Schumacher certainly could have declined to meet with the student at all and she mentions in one of the interviews that she never felt in immediate danger during the meeting.)

As for forced medical treatment or procedures, what makes sense? Most states seem to agree that unless you are in immediate danger of killing yourself, mentally ill and making specific threats of serious violence against an identifiable person or people, or are so mentally ill that you cannot provide for basic needs like food, shelter, and safety, then we cannot imprison you against your will; even in those cases, a separate hearing is usually required to medicate you against your will, and that only lasts while you're in the hospital. Involuntary hospitalizations usually last only 72 hours, though hospitals can petition the courts to extend them to two weeks. Around here, you need to be involuntarily psychiatrically hospitalized at least two or three times in a single year before anyone can begin the process of putting you on a conservatorship, which would mean that you could be medicated or institutionalized against your will; every year, you would have a hearing to determine if you should stay on conservatorship.

Again, that's the standard if you have been diagnosed with a mental-health disorder and have made a threat of serious violence against yourself or an identifiable person. Should it be less if neither of those conditions are met?

One thing I have been thinking about, though, is whether there should be some sort of Transitional Age Youth category for mental-health laws. A lot of disorders don't pop up until the early 20s, and brains don't really fully develop until about 25. I wonder about the feasibility of creating more forced-treatment options (that is, less legal protection) for people aged 18 to 25. I cannot figure out how to do that without creating a world of problems in terms of setting a legal precedent that you're not really fully in charge of your faculties until you're 25, however.
posted by jaguar at 2:34 PM on July 5 [1 favorite]


I occasionally work with clients who have mental-health diagnoses and have been previously arrested for violence; I sometimes meet with them when they are not on their medications. I follow more or less the same protocol described by Schumacher -- leave the door open, make sure the client cannot easily block my exit, have other people nearby who know what's happening, have a phone at hand in case I need to call 911. If I have to go to someone's home who might be violent, I try to have the police accompany me if I can do so without freaking the client out. As I said, it's not like I have a magic wand that makes it safe for me to speak to someone who's potentially violent, and maybe I'm reading defensively but Schumacher seems to think that all the risks she was taking somehow disappear in a therapist's office. They don't.

I can't speak for Schumacher, of course, but as a faculty member, these sorts of situations stress me out because although I want my students who have mental health issues to get help, I am not trained in any way to provide it. I don't feel confident doing anything more than referring people to counselling or other services they might need. Even if I'm not actively scared of the student (and sometimes I am), I'm worried about saying the wrong thing and making the situation worse.

(I suppose you could say that I've signed on to take those risks, but Schumacher certainly could have declined to meet with the student at all and she mentions in one of the interviews that she never felt in immediate danger during the meeting.)

I can sympathize with her--often requests from above are phrased as "suggestions," but there is a lot of external and internal pressure to comply. Sometimes I feel comfortable talking to the student and seeing if they'd like a referral to counselling services. Sometimes they self-disclose and ask me for help. I don't want to fail a student in need, but it's easy to feel very quickly that I'm out of my depth. I am an instructor, I'm good at my job, I'm empathetic and I care about my students, but at the end of the day I need to be able to refer students to someone who is actually trained to help students with their mental health--like a counsellor.

But in the last 5 years my college has lost 60% of its counselling professionals--they've retired or left to work elsewhere--and they have not been replaced. The few counsellors who are left are completely overwhelmed and only have the capacity to deal with a small number of cases, so naturally we are asked to refer only the students who are in the most dire need. What are we supposed to do to help the rest of them? And what constitutes dire need? I'm not trained to assess that! To me, so many of them seem to be in that category. I see more and more students every semester who disclose they're having problems, not fewer. What do I do?
posted by hurdy gurdy girl at 4:43 PM on July 5 [3 favorites]


I don't feel confident doing anything more than referring people to counselling or other services they might need..... And what constitutes dire need? I'm not trained to assess that! To me, so many of them seem to be in that category. I see more and more students every semester who disclose they're having problems, not fewer. What do I do?

Ah, got it. Referring people to counseling or other services is all you should be doing -- "I see that you're having problems, and I care enough to help you get to the resources that could help" should absolutely be the goal/message for those sorts of interactions.

I don't know how much you can push back if the college is trying to make faculty do mental-health triage beyond "Hey, do you need info on getting in touch with counseling services?", but I would absolutely push back on that. Not your job, not your training, not your role. That's totally inappropriate.

Could the counseling office come up with a list of other referrals, hotlines, resources, etc?

(As for saying the wrong thing, it's really really really unlikely that you're going to cause someone to kill or hurt themselves or someone else in one conversation. Even if they do go do those things after talking to you, that doesn't mean you said something to cause it. It's a weird metaphor, but I think it's similar to how I was only able to get comfortable using computers once I learned that it was actually fairly hard to erase all the data or irreversibly destroy all the files. Showing genuine compassion can help get someone back on track, but verbal clumsiness coming from someone who is genuinely trying to help is very unlikely to be some sort of deciding factor for violence. Ongoing abuse or (more damagingly) emotional neglect tend to be the issue. All that said, again, faculty should not be responsible for triage.)

It seems, really, that there are two different issues getting conflated -- lack of mental-health resources for people who want them, and what to do with students (or other legal adults) who might need help but are refusing it.
posted by jaguar at 5:13 PM on July 5


(As for saying the wrong thing, it's really really really unlikely that you're going to cause someone to kill or hurt themselves or someone else in one conversation. Even if they do go do those things after talking to you, that doesn't mean you said something to cause it. It's a weird metaphor, but I think it's similar to how I was only able to get comfortable using computers once I learned that it was actually fairly hard to erase all the data or irreversibly destroy all the files. Showing genuine compassion can help get someone back on track, but verbal clumsiness coming from someone who is genuinely trying to help is very unlikely to be some sort of deciding factor for violence. Ongoing abuse or (more damagingly) emotional neglect tend to be the issue. All that said, again, faculty should not be responsible for triage.)

That's actually very reassuring--thank you. I think it's probably my lack of confidence and comfort that makes me jump to the conclusion I might say the wrong thing and set someone off. Sounds like it is less likely than I thought.

And yes...it's true we should not be doing triage. I think partly we are going to have to just refer everyone and let the counsellors sort them all out. Sigh. I feel for them too, because they feel terrible at not being able to help everyone who needs it but they are, after all, only human, and stretched far too thin.
posted by hurdy gurdy girl at 5:41 PM on July 5 [3 favorites]


> I've lived in both affluent and underserved school districts, and none of them have had good therapeutic resources for challenging kids

Yeah, l should have stressed the "in theory." It hasn't been all tickety-poo here, either.
posted by The corpse in the library at 5:58 PM on July 5


Oh, yeah, and the last district we were in, their solution to school refusal/elopement? Out of school suspension. Oh, thanks, that's helpful.
posted by Daily Alice at 6:13 PM on July 5 [3 favorites]


My beef is that if an institution is taking tens of thousands of dollars per student under the pretense of teaching/guiding/mentoring that student to adult success, then it's not too much to ask for that institution to have real, trained, dedicated counselors that are individually assigned to every student according to fit and who act as a coach for the students who are above water and as a counselor for the ones who are below it. One hour, twice a month and mandatory. No more stigma about going to the counselor and, holy crap, watch the graduation ratio soar.

I interviewed for a job at a call center that provided coaching services mostly for distance learning universities. Great idea if they didn't take the McMentoring approach.

They've probably switched to Skype by now, which still isn't as good as face-to-face but an improvement. I would have taken the job if the caseload was lighter and they had more vacation than 1 week per year.
posted by Skwirl at 6:51 PM on July 5 [3 favorites]


I think it's probably my lack of confidence and comfort that makes me jump to the conclusion I might say the wrong thing and set someone off. Sounds like it is less likely than I thought.

I think it's like parenting, where the people who worry they're going to be bad parents are the ones who are thoughtful enough to be good parents. It's really common for people to think that if they say the wrong thing, they'll cause more problems; if you're compassionate enough to worry about that, you're likely going to be helpful (or, at the very worst, neutral) in talking to people in crisis. There's less research about people contemplating violence, but people who are suicidal are very often relieved that someone's willing to talk to them about it, and most of the time they'll feel better admitting that they're feeling that way. Asking if someone is suicidal will pretty much never suddenly put the thought in their head if it wasn't there already, and I really can't imagine it would be any different for violence against others.
posted by jaguar at 7:03 PM on July 5 [1 favorite]


So if a Stephen King or an H. P. Lovecraft tried to work on his chops today in undergraduate it wouldn't fly, would it?

The problem doesn't seem to be that he was writing disturbing/scary things, but the context in which that was happening. From the NYT op-ed: "despite clear and repeated instructions, the undergrad was writing things that had nothing to do with class assignments — things that made the other students afraid."

> Just so people know: this is true all the way down through preschool, in the US. Your district's services may vary but in theory therapeutic classrooms are available for all kids, as part of special ed.

I hope this has been a positive change in the past couple of decades. .... So the way this worked out in practice when I was in the public education system was that you were taken off whatever track of education you were presently in, and you were "othered" and lumped into a group of kids with disorders of all types and severity, and were basically babysat all day.


As others have mentioned, things vary a lot on the ground, but the law has improved significantly on this over the last 25 years or so. In particular, the Individuals with Disabilities Education Act gives kids with disabilities the right to a free appropriate public education in the "least restrictive environment" - so wholesale separation and isolation of students with disabilities shouldn't happen anymore (emphasis on shouldn't, as opposed to doesn't).
posted by heisenberg at 7:20 PM on July 5 [2 favorites]


The kids who raise red flags are often very disconnected -- they don't socialize with other students at all; other students are reluctant to interact with them and become more reluctant over time; they don't come to office hours; they have difficulty being on topic in the classroom (not just sometimes, but all the time), in weird ways; they have difficulty responding to assignments and just write what they're interested in regardless of the topic; they often interrupt class; they're often late or leave early; they're unaware or unconcerned with of the transgressive nature of what they're doing, even after it's pointed out to them.

I agree, and think this is very well-put -- except that that kind of disconnection isn't necessarily a sign of either violence or even mental illness. That same pattern comes up with a lot of learning disabilities and other processing issues, too.

And that kind of behavior or pattern is actually extremely unlikely, at least in my experience, to actually result in the student getting help, *unless* that student becomes obviously violent or starts breaking the law (for example, through truancy, if they're underage). Unless the student is somehow a liability to the school system or the teachers/students of her school (and maybe not even then) probably she's just going to be left alone and eventually cast out altogether.

I also say "her" on purpose, because in my experience, girls are also less likely to receive help because they're less likely to be perceived as threatening.

The Schumacher article was frankly shocking to me in terms of how little she focused on the student obviously being in trouble versus her fear of him becoming violent. I understand why she was afraid, but her response seemed unempathetic in the extreme, to me.

There's a sense that I get in the wider societal debate about these issues that (a) mental-health professionals have some sort of magic wand that will fix mental illness quickly and securely, and (b) it's ok to lock up someone who has not committed a crime but is mentally ill, or, even worse, that it's ok to lock up someone who has not committed a crime, who has not even been diagnosed with mental illness, but who might meet the criteria.

Yes, thank you. At least in my experience, diagnoses are tossed around with abandon. Which ones a practitioner decides to leap on is based on how common and how easy to medicate that diagnosis is, more than any kind of careful study on their part of whether you fit the criteria well or not. Personally, I've had a therapist "diagnose" me with something even though I told him I didn't think it fit, and *before* he gave me the screening test (and the results of the screening test subsequently didn't support his diagnosis). From the patient's perspective, the most frustrating part is that once a diagnosis is in the practitioner's mind, he is likely to try to force everything you're telling him to fit that diagnosis until you somehow prove that you don't have it. Of course, it's very hard to prove a negative, so you can guess how that's likely to turn out.

And once you have a diagnosis, which might have been pasted onto you within minutes of you entering the office -- and then the symptoms you describe are retrofitted to that diagnosis rather than the other way around -- everything you say is likely to be seen as suspect. This is where the fear of being imprisoned comes in. Of course I would *never* say that I plan to harm myself or anyone else, because being imprisoned against your will and regardless of not having committed any crime is INCREDIBLY SCARY and I doubt anyone *at all* capable of avoiding that wouldn't try and avoid it. If avoiding it means saying you're not going to hurt yourself or anyone else, of course that's what you'll say. And making being imprisoned for not "thinking right" or not saying the right things would only serve to make it even more frightening and thus something that people would go even farther to avoid. So while on the one hand I'm very sympathetic to people wanting to lock away others they think are dangerous, on the other hand, I'm too empathetic to those experiencing the fear and harm that being imprisoned for not saying the right thing or for admitting to needing help to *ever* support making imprisonment easier.

And the worst part, in my opinion, is that "help" isn't necessarily very helpful. This is all based on my experience, and obviously it's not going to be the same for everybody, but what I've come to believe is that "help" for psychological or cognitive obstacles is basically just a euphemism for stigmatization (as MysticMCJ talked about). If you want to try a prescription, you can probably try one or several. That might help on a basic level, though of course for the problems Eyebrows McGee listed (in the quote above), it's likely to be of fairly limited value. If you need any other kind of help, though, and you're not a minor who falls into a very well-defined and common category (and likely even if then), you're probably shit out of luck. Access to any substantial help aside from prescriptions is a *huge* issue. Even getting any kind of real screening or diagnostic testing is *incredibly* difficult, so any help you receive is probably not going to be all that targeted toward your specific problems even in the best of times. You may have a limited number of therapy visits covered in your insurance plan, but good luck shopping around for a therapist who takes that insurance and getting a working relationship with that person before therapy becomes a major financial burden. And good luck even finding a therapist who is equipped to do more than let you vent.

Frankly, Schumacher's article frustrated and angered me, because she came off as so utterly naive, and so utterly lacking in an empathetic impulse that she didn't even seem to *want* to learn more. I felt like the entire article was about making her student seem as threatening as possible, without any self reflection on her part -- as though we were supposed to feel like she'd had a CLOSE SHAVE!!1! and just breath a sigh of relief that this WEIRD STUDENT didn't just bust out an AK on her. When, at least from what I can tell, really what happened is that she watched someone fall through the cracks and was too cowardly and self-centered to reach a hand out to him or even to learn about what to do or if there *even is a safety net* next time she spots someone who's close to the edge of falling through the cracks, too.

In particular, the Individuals with Disabilities Education Act gives kids with disabilities the right to a free appropriate public education in the "least restrictive environment" - so wholesale separation and isolation of students with disabilities shouldn't happen anymore (emphasis on shouldn't, as opposed to doesn't).

Not even to debate on educational models for mainstreaming (or not), people age out of the education system relatively early in their lives (usually sometime between 18 and 23, depending), and then there isn't really a safety net for them. That's a major reason why you see such high rates of disability diagnosis for people living in poverty or people in prison.

Many psychological problems don't even start presenting until early adulthood anyway, and many cognitive or psychological problems are either dealt with as disciplinary issues (that's also a racial and gendered phenomenon) or glossed over if *at all* possible while a child is young enough to be relatively controllable and able to skate by in terms of keeping up with her peers (which is often easier for a child than for an adult, because the academic/social/financial/etc demands on a child are generally fewer and more basic than the demands on an adult). All people with disabilities aren't necessarily educated under the special needs umbrella, because their disabilities don't appear until later in life, or because their behavior is misread, or because their disabilities are invisible, or because their disabilities were glossed over and they were pressured to *not* get labeled as disabled, or for some other reason or for all those reasons.

So while it's incredibly important that children with disabilities are taught instead of warehoused and are incorporated into society as much as possible and in as healthy a way as possible, the improvement of special needs education for children (and I agree that it *has* improved) is very very very far from a solution in terms of providing necessary support for adults with psychological or other disabilities or who are in crisis. When you're talking about legal adults and especially when you're talking about people who have been functional enough during their early lives to go to college, you're talking about a population that has either aged out of special education already or who maybe were never even determined to fall under the special education umbrella to begin with. At least from what I know and what I've seen, if you're talking about adults in crisis specifically, you're basically looking at imprisoning them somehow or just crossing your fingers that they figure it out themselves. It makes me incredibly angry that that's the case, and I've tried hard to hold onto hope that it's not, but that's the conclusion that all the evidence I've seen (and that's quite a lot, though of course not exhaustive) leads me to believe. Unempathetic, incurious, fear-mongering articles like Schumacher's frankly fit with that theory pretty well, too.
posted by rue72 at 7:50 PM on July 5 [8 favorites]


Courses at large public universities are literally designed to fail large numbers of students so they'll quit and ease the overcrowding.

I must disagree. I work an a .edu, and the sole biggest damn number that the leadership talk about is Student Retention -- in other words, what percentage of applicants that we admit make it to collecting a diploma. Raising that number of full point year-over-year is cause for campus-wide jubilation.
posted by wenestvedt at 7:55 PM on July 5 [7 favorites]


On the one hand:
So let's take a bunch of young, emotional people, convince them that their future ABSOLUTELY DEPENDS on successfully getting through college and/or graduate school, and make them borrow huge amounts of money to attend.

Yet
when a university is being judged by its metrics, I'm sure "drop out rate" is not one that they are proud of.
and
the stresses that lead to suicide for college students are rarely academic.

The contradictions here are only on the surface. Our (capitalistic) society is all about separating the winners from the losers. Competition is social as well as (or even more than) academic. Anxiety and dissatisfaction are important motivations in keeping things going. We even have industries whose goal is to increase that dissatisfaction and to promise that product X will turn things around for you. Even after we have all received our certificates of participation, we know who the winners and the losers are. The metaphor of mental illness is an attempt to remove the blame from the victim--a disease is not something one is at fault for contracting--but the kids going to that special school on the short bus all know that the stigma remains. Even getting into the special schools is a contest of a sort. It requires a parent who knows how the system works and is willing to do what is necessary. (In other words, probably not a resident of the projects.)

As kinetic points out, refusing to attend school will help your case, but, at least where I live, the initial response of the system is to threaten both child and parents. ACS comes to visit. The parents who wants to get their child into such a school have a many month ordeal ahead of them and are advised to hire lawyers who specialize in this.

At least one such school, well aware of the stigma of attending it, actually made a deal with a local "regular" high school to allow that school's name to be used on their diplomas so that a graduating student can prove they attended a school for normal people. A dilemma facing parents when their child applies for college is whether to "declare." This is the euphemism that is used when trying to determine if admitting the problem exists will help or hinder their child's acceptance by the college of their choice. It is a bit fashionable these days to be "on the spectrum" so, yes, it can help.

Therapy at these schools can be hit or miss. The less angry and the ones who have better impulse control tend to be the winners here. There are attempts to lessen the heavy competition of the "real world" but the social competition of the society at large can't be totally avoided.
posted by Obscure Reference at 6:57 AM on July 6


When I attended therapy sessions in college, it felt more like probation than anything. "Do you have a therapist? If you're not seeing one by our next session, we're going to expel you." At the actual therapy sessions I was very strongly encouraged to sign over my HIPAA rights and give the college access to my medical records. Because if I didn't they could expel me. I knew enough about people actually getting expelled - see the link above - to know it wasn't just an empty threat. A friend of a friend - the quiet, very smart, driven type, not remotely violent - just disappeared one day, one year away from graduating. Someone told me she was diagnosed with schizophrenia.

You end up feeling like you live in a fucking panopticon, because you do. If you're seen crying anywhere on campus, it will get back to the authorities, and you'll probably be punished for it. You are watched at every moment of your life. (Make your own speculations as to what As soon as I could, I moved off campus so eviction wasn't a possibility (which it is; many court cases about this kind of thing involved the Fair Housing Act, among other things.) I spent as much of my time as possible off campus because it was just safer there. I lied my fucking face off at each therapy session, stalled, made small talk, showed up late, said absolutely nothing incriminating, and basically did everything I could to reduce the chances of getting expelled. The system actively discourages you from getting help because getting help can lead to punishment. (The thing that struck me most about the Nott case is that he voluntarily checked himself into the hospital, which is more proactive about one's mental health than a lot of adults are. And that prompted the college to kick him out.)

But goddamnit, I got out of there and I got a degree. Because the truth no one wants to admit is that the single greatest help a student can receive is successfully getting a college degree, a normal-looking degree that resume screeners can skim over and nod. Even in this economy, where a college degree isn't the boon it once was, if you've already committed tens of thousands of dollars and/or taken out that much in student loans, then it is the best thing you can do to have a good shot at a successful life. Your future might not ABSOLUTELY DEPEND on having a degree, but your immediate future could well absolutely depend on finishing. Colleges realize this, and they're perfectly willing to pull strings to let students graduate - if they see those students as having value. Look at how they bend over backwards to give athletes near-effortless degrees. (I actually have problems with this on another level - namely, seeing athletes as commodities to produce profit for the university rather than people who need education and health insurance and the grounding to succeed should they not want to do sports anymore - but that's another thread.)

Conversely, students experiencing mental difficulties are seen by universities as having no value at all, or even negative value. This is usually justified by some bullshit "they could be violent!" rhetoric which gets debunked every time a nationwide scandal occurs, without anyone listening. Look at some of the warning signs given: students who "don't socialize with other students" and whom other students don't talk to, students who don't go to office hours, students who show up late or leave early. My first guess wouldn't be "they're going to shoot everyone," my first guess would be "they're being bullied," or possibly "they're introverts." People who have difficulty remaining on topic might have ADHD or other learning disabilities, diagnosed or not. The actual red flags tend to be glaring -- histories of violence, misogyny, things like that. But they aren't the ones generally checked for. (If one wants to be cynical, you could speculate that this is because violence and misogyny are basically condoned by society, while being "other" is not.) As it stands, the biggest student-violence-related scandal at my school when I was there was when one student got a gun and committed suicide by cop. He was president of one of the "good" fraternities.

The "making students afraid" bit is also subjective. It's been used to justify not punishing rapists on campus, for instance -- "it makes other students uncomfortable when those damn women talk so damn much about their rape, and inflicts emotional harm on the rapist," for instance. Needless to say, it is a sign that the system is fucked up when it is easier to get expelled for being suicidal than for raping somebody.
posted by dekathelon at 9:23 AM on July 6 [5 favorites]


(The parenthetical bit should say "Make your own speculations as to what such conditions do for one's mental health.")
posted by dekathelon at 9:31 AM on July 6


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