But isn’t warning a student how dangerous getting help can be—how everyone will ‘find out’ keep students from seeking the help that’s available? Making mental illness a *more* secretive disease is not the answer. I have had many students who take medications, seek counseling, and deal with all manner of personal issues. Finding out the others are also dealing with these same things helps them understand that they are not isolated and that their struggles are similar to many of their friends. False generalizations about what others may be experiencing often heighten’s students’ sense of isolation and “negative” difference. I agree that university communities need to offer more services for students but putting mental illness in the closet is unfair to all students, faculty, and staff who cope with mental illness in their own lives and the lives of their families.

Amy Wink, Austin Community College, at 8:25 am EDT on April 20, 2007

Well said, indeed, and the commentator Amy, although well-intentioned, needs to gain a lesson in reality. There ARE real risks involved in seeking help, and while no one wants students to have to put their emotional problems in a closet, it’s immoral to send them off for help that can make problems worse, not better. I speak as someone who was troubled in my senior year of college, 35 years ago, and the effects of forced bad treatment remain. My college handled the situation with concern, but the “therapists” I was required to see hurt me. It is a terrible situation for our students to be in, but we fail them if we sugar coat the facts. One thing I believe college therapists need to do is involve the student’s family in the discussion, not treat the student as if he/she had no family ties, but they are required to get the student’s permission to do that.

M.N., at 11:16 am EDT on April 20, 2007

Good essay

Very thoughtful essay. For my essay on the practical problems of predicting which troubled students present a foreseeable risk to the public, see: http://shurl.org/prediction.

Karen Franklin, Ph.D., Forensic Psychologist, at 3:50 pm EDT on April 20, 2007

Amen

Here at UIUC I dread getting contraceptives or even treatment for things like minor (but embarrassing) infections because the place that hands them out is staffed by students. I know colleges have obligations to the Federal Work Study program, but they need to find other types of make-work that doesn’t make other students miserable.

While the counseling center doesn’t have that problem, it has a major issues with appointments. You have to get up at around 7 AM to get an initial appointment. How many depressed people like to wake up that early?

Kate, University of Illinois at Urbana-Champaign, at 4:05 pm EDT on April 21, 2007

EAPs

My company’s Employee Assistance Program (EAP) is outsourced. There is no direct link between the company and the EAP. There are no direct conflicts of interest.

If college counseling centers are to be fully independent, they have to organizationally separated. That includes no “affiliate” status. Period.

Buzzy, at 5:10 pm EDT on April 22, 2007

Wrong Reactions

Commentary about ways to “figure out” who might lose control misses the point entirely. If being mentally ill did not carry such an awful stigma, 33 people would not have died at Virginia Tech last week. Without the stigma, Mr. Cho might have been successfully treated. Without the stigma, people like Mr. Cho could get relief from their anguish as routinely as one with a physical condition.

Some of the comments were from people who were freaked out that a student worker might “find out” they have a mental illness. That’s the stigma at work.

Just a few short years ago, diseases like diabetes and epilepsy—and HIV/AIDS—also carried a stigma. Lifestyle choices like single parenthood, homosexuality, and wearing body art were also stigmatized. However, these are largely acceptable now. It’s OK to be a homosexual diabetic epileptic HIV positive single parent with cover-to-cover tattoos—but not to have a mental illness.

It’s not the “who did” or “who didn’t” that caused this tragedy. It was the stigma. If we face the stigma and work to overcome it, then perhaps we won’t see more tragedies like Va. Tech, Columbine....

KathyS, Instructor, at 9:30 pm EDT on April 23, 2007

Having each worked in college student mental health for well over 25 years, we strongly agree with Mr. Socol regarding the importance of counseling services being confidential, but strongly disagree with his contention that students can’t depend on confidentiality when using on-campus mental health counseling services.

The importance of confidentiality is undeniable. If students fear that their confidences may be violated, they will rightly avoid opening up and getting the help they may need. Confidentiality is one of the most important professional ethical standards. Moreover, counseling centers are bound by the very same medical confidentiality laws as are off-campus mental health facilities and private practitioners. Preserving confidentiality is important to the professionals who work in university counseling centers across the nation. We take confidentiality very seriously and regularly discuss this and other ethical issues at our professional meetings.

There are only a few extraordinary situations in which confidentiality must be abridged without permission of the client. Limited releases of confidential information may be required to protect people from imminent physical harm to self or others, for example. And the limits to confidentiality are carefully described in the informed consent statements that every student receives before the first counseling session. We take pains to be clear and respectful of what is in the interest of our clients and to protect their rights.

We have serious concerns about Mr. Socol’s contention that students cannot count on receiving confidential services from a university counseling center. His advice to incoming students to be wary of getting services there is harmful in that it will likely discourage students who need care from getting it. Does he have any evidence to support this position? We do not know of a single counseling center whose policy regarding confidentiality would allow clinical information, absent the characteristics that would legally require disclosure, be “repeated to the offices of the Dean of Students” without the student’s explicit and voluntary permission.

Greg R & Jim S, at 3:40 pm EDT on April 24, 2007

ONE LAST REPLY FROM US

Ira,

I guess we have different experiences. However, we stand by what we have said in our previous reply. At our institution and at the institutions of all of our professional contacts (there are many), students and their confidential information are treated with respect and care. Sure, it would be better if counseling centers did not need to employ students, but at our centers and others there are strict guidelines as to what students may and may not, can and cannot access — students do not deal with confidential information, and are well trained as to the responsibilities of confidentiality. Moreover, student workers are important to the many jobs that are non-confidential in nature that originate from counseling centers, e.g., putting together outreach materials for psychoeducational programs on campus. Over the years great and greater emphasis has been placed on having adequate safeguards and procedures to prevent access by those who are not authorized.

Regarding your statement “1 in 10″ students having suicidal ideation, you seem to imply that in 10% of cases counseling centers would allow confidentiality breaches. Not so. It is a mistake to equate suicidal thoughts with permission to break confidentiality. Suicidal thoughts are common enough and a vastly different situation than imminent danger. On occasion we do take action when multiple indicators point to imminent danger. Taking such action does save lives, which is a high priority for us, needless to say. And then we work extra hard in each case to assist the student toward resolution of the danger and to make a quick and safe re-entry into life at the university.

Our concern remains that you seem to be painting with a rather broad brush based on some bad individual experiences. There is a danger over-generalizing, and therefore being in the position of advising students NOT to get the free, accessible, confidential, professional help that earnest campus-based clinicians want to give, and sending them instead off campus to pay for the same kind of help. Or maybe to get help of lesser quality because of the lack of connection with the college experience that counseling center clinicians have.

So, while we do not wish to argue further with your experiences – it does sound like you have had some disappointing ones, we do want to urge you not to draw rash conclusions about counseling centers in general. And we want to encourage people who are in a position to refer those vulnerable students to the many high quality counseling centers that are out there, confident that they are conscientiously doing their best to make a positive difference for students in times of difficulty.

Greg R & Jim S, at 2:50 pm EDT on April 25, 2007