Thread: Purgatory: Mentally ill students at universities Board: Limbo / Ship of Fools.


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Posted by Moo (# 107) on :
 
I have been thinking and reading a great deal about the shootings at Virginia Tech. They happened less than a mile from my house.

I came across a very interesting statement in a Roanoke Times article yesterday. The part I'm interested in is several paragraphs into the article and begins with the words 'Gerald Amada'

He says that VT made the mistake of
quote:
... letting Cho's escalating antisocial behavior be treated as a mental health issue.

Mental health is not an area that most universities are equipped to handle, Amada said. Like Tech's, many university health centers won't take court referrals because these usually are cases where treatment may need to be compelled, something a school is not set up to do.

But universities do have plenty of power to expel students who do not meet codes of conduct, Amada said.
This goes against many people's idea of compassion. However, if Cho had been expelled, he would probably be alive, and his victims certainly would be.

What do you all think about this?

Moo

[ 15. June 2016, 18:40: Message edited by: Belisarius ]
 
Posted by seasick (# 48) on :
 
quote:
Mental health is not an area that most universities are equipped to handle.
Seems to be the critical bit to me. Expulsion sounds harsh, but I think there comes a point when the University has to be able to say that they cannot deal with the student's condition, and that in the interests of the student's safety and that of other students and staff they should no longer be an active student of the University. Ideally this should be in combination with arrangements for the student concerned to receive appropriate treatment somewhere that can handle it. It could be made possible for the student to return to the University and pick up where they left off, if and when they were recovered.

[ 17. June 2007, 19:10: Message edited by: seasick ]
 
Posted by Jengie Jon (# 273) on :
 
From my observations, as a member of university staff, is that university is one of the better places to be mentally ill.

  1. They have counselling services and disability support departments, both open for students to use
  2. There is a student welfare office, who like to keep track of students in difficulties
  3. Academic Staff are specifically given some pastoral responsibility. Normally very light touch but it is there.
  4. Someone will start a chase to contact you if you persistently miss lectures.
  5. Although not stated some students are given space in Halls of Residence precisely because there are worries over their mental health and it allows a closer watch to be kept.
  6. They have access to the student health services who will not just know about the same level as any GP but also are integrated into the University support system and capable of referring that way.
  7. Some university even have a student-student mentoring systems, with older students mentoring younger ones. As far as I am aware, not common but at least two places in the UK have one.

No, I am not saying that Universities are great, in my opinion the whole of society is ill prepared to support/cope with the severely mentally ill. However being mentally ill while at University is probably better than being mentally ill outside them. So expelling a student on mental health grounds may actually worsen that students plight.

Jengie
 
Posted by WatersOfBabylon (# 11893) on :
 
I know of a few cases of enforced mandatory counselling at my college. They were told they would be expelled unless they saw the school's recommended psychological professional.

However, my school is a private institution with fewer than a thousand students. There are very few students who live off-campus, and even most of the faculty and staff live on campus. Under these circumstances, it is much easier to keep an eye on the "at-risk" students and also easier to enforce mental health policies.
 
Posted by Jenn R (# 5239) on :
 
I withdrew from university voluntarily when I became very depressed and felt that continuing to push myself through the exams would have been detrimental to my health. I tried to explain this to my tutor who said "what is depression?" and "so why do you need to leave?". I did leave, but encountered problems when I tried to return, as I didn't have the right paperwork (they wanted proof that I was better - like what, blood tests or something?!). It took a lot of pushing to get them to readmit me, about 2 days before the admissions deadline fell.

That was with a relatively minor mental health issue, and the uni could not deal with it appropriately. Their counsellors were rubbish, and what I actually needed was time and space to get my head around some things, not to continue to push myself through difficult exams when I was depressed.

People at universities are young and put under a lot of pressure. Those whose mental health is fragile can suffer. Universities need to recognise where their limits are and make it easier for people to withdraw for a year or two if necessary. Those who don't or won't may need to be told to withdraw. Such withdrawals need not be permanent, but should be more common.

[cross posted with Jengie - my experiences are clearly different, things are not the same at all unis. Perhaps people shouldn't be put under so much pressure to attend their teachers/parents favoured unis in place of those who actually give more support to their students. I so wish there didn't seem to be that distinction, but it does seem to be there]

[ 17. June 2007, 19:38: Message edited by: Jenn R ]
 
Posted by Hazey*Jane (# 8754) on :
 
Slight tangent, but the quote in the OP made me reflect on how 'mental health problems' is a pretty useless term really, if you're trying to formulate any kind of moral/policy type response to something. If one talked about 'physical health problems' that covers everything from a cold to a neurodegenerative condition. I'm not being trying to get all PC about this - I just think that universities etc aren't going to get far working out how to deal with students with 'mental health issues' if they're all lumped in together.

As for my own experiences, I was referred to the university counselling service after presenting at the uni GPs with mild depression. It was fairly helpful but somewhat brief. University counselling services in the UK are generally very oversubscribed (I was 'lucky' that I'd 'timed' my collapse when things were a bit quieter at the service). So it's an area that universities are probably going to have to consider putting more resources into. But there is going to need to be a range of approaches to respond to the range of conditions.
 
Posted by Jengie Jon (# 273) on :
 
I think there is a mistake being made. The fact is students have access to all the external services for mental health as well as the University's counselling services etc. For instance if the Student Health Service Doctor decides a student needs referral to a psychiatrist, he can make that referral, or to a community mental-health team he can do that. If a student wants to pay for counselling a student can and go to any of the fee taking counsellors there are or even use some of the free services if they can make a case.

In other words the counselling may be poor, limited and all the rest, but it is that on top of what the student could access if they were not a student.

Having twice seen a guy go through a major mental health breakdown, once as a student and once not, I can say that it was far easier to access help for him when he was a student.

The other thing is to realise that with the age of legal maturity dropping from 21 to 18 in the UK it changed hugely the way Universities understood their relationship with students. They stopped being loci-parentii for a group of generally mature children, and became a provider of education to young adults many of whom were not used to being adults. The contract changed from being with the parents to being with the student.

Jengie

[ 17. June 2007, 20:28: Message edited by: Jengie Jon ]
 
Posted by Jenn R (# 5239) on :
 
In some ways Jengie I think you are right, there is the ability to access counselling services etc in a very easy way in a uni, whereas there isn't in the outside world. Sometimes though what a student needs most of all is a break from study, and getting that can be very difficult. Also some students aren't willing to access that support. I think Water's comment about compulsory psychiatric help is an important one, although I worry that implementing such a system might lead t people bottling things up even more, thus increasing pressure and risk.
 
Posted by Ethne Alba (# 5804) on :
 
Peeking my head round the corner and fearing it'll be punched....am going for it all the same.

My take on this is that "this is a mental health issue" .. does not result in a one-size-fits-all solution.

Someone who is chronically depressed and utterly unable to cope is, in my eyes, light-years away from someone whose behaviour is repeatedly frightening and menacing to others.

Maybe I don't know what I'm talking about, but in my experience the first is treated with understanding and help.
And the second requires firm guidlines and enforced behavioural boundaries.

If universities are not the place to be able to legally deliver this. Then maybe universities are not the place for the second group of people.

Harsh. But...

[ 17. June 2007, 20:56: Message edited by: Ethne Alba ]
 
Posted by My Duck (# 11924) on :
 
My experience (albeit quite a while ago) is that my university was used to the problem and dealt with it very well indeed.

Leaving home, often for the first time, being faced with the daunting task of working without the close supervision given at school, matching up with parental expectations etc etc. Many of my fellow undergraduates found it all very difficult to cope with.

I recall that most if not all of these 'casualties' were dealt with professionally and sympathetically with the back-up of a world-class medical establishment.

I cannot say what the situation is now - times have changed and I have a horrible suspicion that many students are just left to sink or swim.
 
Posted by Hazey*Jane (# 8754) on :
 
quote:
Originally posted by Jengie Jon:
From my observations, as a member of university staff, is that university is one of the better places to be mentally ill.

  1. There is a student welfare office, who like to keep track of students in difficulties
  2. Academic Staff are specifically given some pastoral responsibility. Normally very light touch but it is there.
  3. Someone will start a chase to contact you if you persistently miss lectures.
  4. They have access to the student health services who will not just know about the same level as any GP but also are integrated into the University support system and capable of referring that way.
Sounds like your employer has a pretty good approach. And I definitely see your point about it being better to be mentally ill at uni than elsewhere, in terms of access to support. I wonder, however, how well this set-up is replicated elsewhere in the UK? In contrast to the points above, my experiences as a student were
In short, there are plenty of places to go if you are looking for help. But if you don't realise you need help, or don't feel capable of seeking it, you could very easily slip through the net.
 
Posted by Amorya (# 2652) on :
 
quote:
Originally posted by Jenn R:
Universities need to recognise where their limits are and make it easier for people to withdraw for a year or two if necessary. Those who don't or won't may need to be told to withdraw. Such withdrawals need not be permanent, but should be more common.
Of course, that's dangerous ground. Telling a student to withdraw can be challenged under the DDA, just like firing someone from a job for mental health reasons. They'd better be damn sure those concerned are actually a threat to others...
 
Posted by daisymay (# 1480) on :
 
In the centre where I used to work (UK), we had students at uni or college referred to us by their academic places (not always having enough counselling time for everyone), and also ones we had worked with before they went off to uni.

Sometimes we needed to write "official" letters to the unis/colleges to allow the students extra time to complete their work, or even to have a year off and get through their problems so that they would then be able to go back to uni and manage to be OK enough to get through their studies.

We also used to refer student to uni counsellors because we knew and the clients knew that they required that support.

Most times it worked pretty well.

We had a few clients with serious mental problems who definitely needed psychiatric medication and also we got letters from their doctors to se that they got the support and checks they needed.

Maybe we were working with mostly young adults who were obviously in need of help and we managed, and they were sensible or worried enough, to get them supported and helped and conformed to reasonable behaviour - which is defintely not what all "mentally normal" students do. [Biased]

But students who are in such an awful state that they act horribly violently to others and/or themselves might not want any "support" from officials... and they might not all be noticeable... [Frown]
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Ethne Alba:
Someone who is chronically depressed and utterly unable to cope is, in my eyes, light-years away from someone whose behaviour is repeatedly frightening and menacing to others.
{snip}
And the second requires firm guidlines and enforced behavioural boundaries.

If universities are not the place to be able to legally deliver this. Then maybe universities are not the place for the second group of people.

Harsh. But...
Cho definitely fell into the second group. He was in a writing class where his work was so disturbing to listen to that other students wanted to drop the class. He sometimes sat in class with a camera in his lap and photographed the legs of women students.

He was committed to a mental hospital overnight because psychologists had determined that he was a danger to himself and others.

When it comes to things like non-suicidal depression, the university mental health services are fine, but anyone who is considered a danger should be required to withdraw.

Moo
 
Posted by Max. (# 5846) on :
 
I've never seen anybody about it but I sometimes find myself in situations where I get depressed - only a couple of months ago I didn't actually leave my room for anything except food, occasional college classes and church services once a week because of depression.

Thankfully I had really good friends who were genuinely worried about me, forced me to get out a bit, stole my alcohol from me and in the end got me to confront my problems! I was acting like a major jerk, I was getting obsessed by really stupid little things in my life which weren't really important yet those little things still make me feel bad about myself and I suppose that I am still only a stones throw away from locking myself in my room once again and not communicating!

My college has no idea about what I went through, I think we have some kind of support unit but I don't know where it is and I doubt that when I was going through it all I would've actually made the effort to go and speak to them, much easier to lay in my bed watching DVDs, listening to Emo Rock and dying my hair strange colours!


Max
 
Posted by Hazey*Jane (# 8754) on :
 
It's hard to say without more details of the case, but based on your summary there, Moo, I'd say that the health service who dealt with him were at least as, if not more than, culpable as the university. But then it's hard to know what communication went on between the two.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Hazey*Jane:
It's hard to say without more details of the case, but based on your summary there, Moo, I'd say that the health service who dealt with him were at least as, if not more than, culpable as the university. But then it's hard to know what communication went on between the two.
It's not certain that he ever went to the health service. He was ordered by the court to undergo psychotherapy, but the university health service does not accept court orders; it has no means of enforcement.*

There was certainly a massive snafu, but I'm particularly interested in the idea that people who might harm themselves or others should not be permitted to stay at the university. If their health improves, of course they should be re-admitted.

*The question of what the judge thought he was doing when he issued that order remains to be answered.

Moo
 
Posted by Doublethink (# 1984) on :
 
Say you check said student out of college, they still don't get treatment, what stops them coming back on campus.

Fact is this guy exhibited behaviour so rare we're unlikely to be able to predict it. Many other people who act like him do not kill large numbers of people.

However, he was clearly disturbed and didn't get the service he needed. But that may be a broader problem with the delivery of services - do you have assertive outreach teams in the US ?

(I am unclear why he wasn't arrested re the videoing women thing.)
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Doublethink:
Say you check said student out of college, they still don't get treatment, what stops them coming back on campus.
He would have had to find a place to live in this area and the money to pay for it. His family lives more than two hundred miles away.

If he had stayed in the area the university could have gotten a court order barring him from campus. If he violated the order he could have been arrested.

There were mental health services available, but he apparently didn't want them. On campus he lived in a suite of rooms with three other students. They shared a living room and bathroom. He usually did not answer his roomates when they said hello. Sometimes he did not speak to any of them for weeks on end. They knew something was seriously wrong with him.

Moo
 
Posted by Beautiful_Dreamer (# 10880) on :
 
When I was in uni I was diagnosed with depression (I now have bipolar). I availed myself of the counseling services on campus, but when it came to anything beyond the initial diagnosis and prescription, I was referred off campus. I guess my uni was more equipped to handle shorter-term cases than mine. I was not a danger to myself or anyone else, but I knew I had a problem a long time before I actually got help. That is something very common I hear among people with mental health problems-they usually have some sense that they have a problem a long time before they discover that there is a name for it and that it can be treated. Sometimes that realization alone is a help.

I too agree that, if a student is a danger or threat to himself or other people, he should be at least put on suspension to work out his problems. The university system might be good, but they usually are not equipped to handle cases like this.

And as for the videotaping ladies without their consent, I wonder why he wasn't arrested.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Moo:
When it comes to things like non-suicidal depression, the university mental health services are fine, but anyone who is considered a danger should be required to withdraw.
True. Which is exactly why most university counseling services explicitly state that they do not provide long-term counseling or care but will happily provide you with a list of references to local psychologists/psychiatrists who are equipped to offer such services. Just as most student health centers only treat certain conditions, and anyone needing more extensive treatment is referred off-campus. And, of course, you have the problem of determining who is considered a danger to themselves or others.

It sounds to me like there was some sort of centralization/coordination problem (of the type that often afflicts large universities) going on here. His room-mates knew something was wrong with him. A couple of professors and his academic dean knew something was wrong with him. Student judicial services may have had a record on him (although if the women he harassed declined to press any charges as long as he stopped contacting them, they may not have had the authority to do anything about his behavior). The counseling center may have known something was wrong with him (I'm not clear on whether or not they were ordered to provide counseling services and therefore would at least have had his name, or if Cho was ordered to seek counseling services and people have assumed that he would have sought them from the counseling center, even though the counseling center is not equipped to deal with that sort of problem). Even if the counseling center had known, they wouldn't have been able to release the information to anyone else without Cho's consent, but if everyone else had been sharing information, they might have been able to find a way to get him into counseling or out of school.

The problem with suspending students or putting them on an involuntary leave of absence is that they have to have done something wrong for it to be justified. If their grades get low enough, or they consistently break residence hall rules, etc., they can be ordered into counseling or off campus. But it sounds like Cho's behavior, while creepy, didn't cross the line that would have allowed administrative action.

quote:
Originally posted by Doublethink:
Say you check said student out of college, they still don't get treatment, what stops them coming back on campus.
There's generally a clause in the suspension notice that the student is not permitted on campus during the period of their suspension. Actually enforcing it involves someone knowing that the student isn't supposed to be on campus, seeing them on campus, and calling the campus police (which doesn't generally happen unless the suspension is a consequence of stalking or somesuch and the person tries to contact their victim). They can usually then be arrested for trespassing, as well as for violating any other restraining orders that have been put in place. Generally, for students who hope to be readmitted/ allowed to return, the knowledge that if they get caught on campus, they will probably not be allowed to return is enough to keep them off campus. Had Cho been suspended, he might have snapped and gone on his rampage before the university kicked him out of housing, or after he found a place nearby to stay. Or his parents might have been alerted to his mental health problems and sought help for him. Or any number of different scenarios might have played out.

Or, like the GW student suspended for being a danger to himself after voluntarily committing himself to the hospital, he could have sued the school and settled out of court.

quote:
(I am unclear why he wasn't arrested re the videoing women thing.)
When did it become a crime to photograph people without their consent?
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by saysay:
(I'm not clear on whether or not they were ordered to provide counseling services and therefore would at least have had his name, or if Cho was ordered to seek counseling services and people have assumed that he would have sought them from the counseling center, even though the counseling center is not equipped to deal with that sort of problem).
Obviously, if I hadn't done a million other things between skimming the article and composing my response, I might have been a little more clear on that. But since I work in higher ed and have a lot of dealings with the counseling center, I find it a bit surprising that anyone - much less someone in a position to issue a court order - doesn't know that university counseling services usually don't/can't handle serious, long-term care, as that's been explicitly stated at every university I've attended/ worked. Maybe VA Tech does need to make that more clear (or maybe people need to pay a bit more attention to what they have said).
 
Posted by Pastorgirl (# 12294) on :
 
The assumption behind the OP seems to be that if the university hadn't been in place to provide some counseling services, Cho would have been forced outside of that sheltered community where he would have received more adequate services. That's the erroneous part of the equation.

The root issue that the VA Tech tragedy reveals is not the inadequacy of university counseling services, which, while not intended to deal with issues of this severity, as others have noted are better than what is generally available. The root issue is the lack of any sort of adequate mental health system period.

In terms of compulsory mental health care, which is what would be required here since Cho refused treatment, it simply doesn't exist. To get an involuntary placement in a mental health facility one must be an immediate threat to self or others. The way this works out in real life is such that it really isn't going to happen until after the tragedy has occurred. Anything less than a gunshot wound is not usually considered an "immediate" threat. When I was working in the mental health field we cynically referred to this policy as "show me the blood".

This is why we have so many homeless mentally ill. Many would be capable of caring for themselves, self supporting even, if they lived in some sort of halfway house with oversight to insure they stay on their drugs. But because there is no such system, and in fact the system hinders such oversight, literally thousands of patients are on the streets here in L.A. alone.

Other countries it seems to me do a better job of balancing the patient's need for autonomy with the need to protect and care for people suffering from mental illness. We can and should do better.
 
Posted by churchgeek (# 5557) on :
 
quote:
Originally posted by Amorya:
quote:
Originally posted by Jenn R:
Universities need to recognise where their limits are and make it easier for people to withdraw for a year or two if necessary. Those who don't or won't may need to be told to withdraw. Such withdrawals need not be permanent, but should be more common.
Of course, that's dangerous ground. Telling a student to withdraw can be challenged under the DDA, just like firing someone from a job for mental health reasons. They'd better be damn sure those concerned are actually a threat to others...
Excellent point. I assume the DDA is similar to the ADA (Americans with Disabilities Act) in the US.

As someone who's mentally ill myself (bipolar), I get nervous whenever I hear "the mentally ill" painted with one brush.

I was disturbed when I heard right after the V. Tech incident that people were proposing to not allow "the mentally ill" to buy guns. My dad (who isn't mentally ill) owns guns and enjoys target shooting at ranges. I went with him once, and found I enjoyed it too, although certainly not enough to invest money in purchasing a gun. (I shot a couple bulls-eyes!) Under that hypothetical ban on mentally ill people owning guns, I wouldn't be able to anyway. Which would be no problem, really - small price to pay if it could really help. But as we know, guns are obtained illegally all the time. Now I'm the only person in my family who's actually been diagnosed with a mental illness. I'm not the only person in my family who has one, by any stretch. What if I had already enjoyed target shooting before I had a diagnosis, and took it up as a hobby? If I knew I couldn't own a gun if I had a diagnosis, that might be enough to prevent me getting help I need - because being officially labeled "mentally ill" would get in the way of pursuing my hobby. Stuff like that already happens - e.g., when people who need treatment avoid/delay getting a diagnosis which will label them with a "pre-existing condition" which will prevent them buying their own health insurance policies.

What I'm getting at, rather circuitously, is that on top of the potential to infringe on people's rights (per DDA / ADA type laws), there is also the potential of putting something in place that might keep a person with an undiagnosed problem from seeking help. So the proposal people are making to force certain mentally ill students to take time off would have to be very, very carefully done. Students who are goal-driven and under pressure in competitive fields would be especially tempted to ignore their own mental health issues if it would interfere with their academic goals - and I'm living proof that a student can get through 4 years of university (in my case, University of Michigan) without her mental illness detected by anyone in a position to offer any help. And I lived in university housing!

Although ADA- / DDA- compliance shouldn't be an insurmountable challenge. For example, even under ADA & similar laws, a blind person (or even a person with poor eyesight) can't get a job flying airplanes... There must be an analogous way to deal with people with mental illnesses.

[eta: bravo, Pastorgirl!]

[ 18. June 2007, 04:51: Message edited by: churchgeek ]
 
Posted by infinite_monkey (# 11333) on :
 
quote:
Originally posted by saysay:
When did it become a crime to photograph people without their consent?
Behold.

I think most laws are clear about the difference between idle tourist snapshotting, and what was going on here, which would probably also fall under some kind of sexual harassment thing.

But as this thread demonstrates, there's a wide gap between what's "on the books" and what happens "on the ground".
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by infinite_monkey:
Behold.

The site you linked to says that the following states (including Virginia) have laws forbidding
quote:
...recording of persons in a state of undress or nudity...
The women whose legs he photographed were presumably wearing shorts or short skirts. They were not 'in a state of undress'.

Moo
 
Posted by Esmeralda (# 582) on :
 
ISTM that no one is stating the obvious - that as much as they are caused by lack of adequate, proactive mental health services, these student/school shooting tragedies are caused by the ease of obtaining a gun in the USA. Britain also has an inadequate mental health system, but shootings are much rarer here because it's much harder to get a gun.

True, guns seem to be fairly freely available in certain South London pubs, but you have to be in the right circles and a loner like Cho would be very unlikely to get one. Surely a huge contributory factor to such incidents in the US is that the US has a culture where having firearms is considered a human right?
 
Posted by Pastorgirl (# 12294) on :
 
Bingo.

It is the correlation of two insane public policies-- inadequate mental health services and a gun lobby run wild-- that have led to these tragedies.
 
Posted by Moo (# 107) on :
 
I started this thread because I wanted to discuss how universities handle their students with dangerous mental illnesses. As far as I know, this has never been discussed on the ship.

Gun control, however, has been discussed at great length.

Moo
 
Posted by Zwingli (# 4438) on :
 
First, thanks to Pastorgirl, saysay and Churchgeek for the insights.

I have some first hand experience of this. I've suffered from depression most of my life, and I suffered a mental breakdown during honours year of Uni. I managed to get through mid year exams, but then about half way through second semester I dropped out entirely, and ended up long term unemployed. The breakdown wasn't caused by prior depression - there were some other specific problems that precipitated it - but it did exacerbate it.

In hindsight the university didn't handle things at all well, though at the time I thought that was fairly much par for the course. The worst part was that, after I didn't respond to an email, they unenrolled me, with no prior warning and without telling me afterwards, only for me to find out almost by chance and re-enroll, just to then stop showing up a month later. I don't know how I looked to the lecturers and professors, but it must have been clear something was wrong, as I couldn't concentrate on anything for more than a few minutes at a time, and my friends and church were all acutely aware something was wrong.

Anyway, the point is I doubt that University staff are really competent to even identify, much less deal with, mental health issues among students. They had, for example, far less of an idea what I did outside hours and who I lived with than my supervisors at work do. I still only had about 12 contact hours a week. If I missed them, the may or may not have been consequences, depending on what I missed and how often, but it really can't be compared to work where someone notices if I show up 15 minutes late or if I happen to look too down one day. Also, I can't see how they can raise these issues without it seeming like a case of singling out the oddballs and social misfits. A few of them might be in genuine need of psychiatric care, but most are just people who are a bit different or are struggling and who really don't need any stigma or negative academic consequences attached to them. At work, to an extent, managers can force some sort of socially normal behaviour on people during office hours, but I don't think it is the role of a Uni to try to do the same with students.

*Crosspost. Wasn't complimenting Pastorgirl for her views on gun control, but for her earlier posts.*

[ 18. June 2007, 13:40: Message edited by: Zwingli ]
 
Posted by sabine (# 3861) on :
 
quote:
Originally posted by Jengie Jon:
From my observations, as a member of university staff, is that university is one of the better places to be mentally ill.

  1. They have counselling services and disability support departments, both open for students to use
  2. There is a student welfare office, who like to keep track of students in difficulties
  3. Academic Staff are specifically given some pastoral responsibility. Normally very light touch but it is there.
  4. Someone will start a chase to contact you if you persistently miss lectures.
  5. Although not stated some students are given space in Halls of Residence precisely because there are worries over their mental health and it allows a closer watch to be kept.
  6. They have access to the student health services who will not just know about the same level as any GP but also are integrated into the University support system and capable of referring that way.
  7. Some university even have a student-student mentoring systems, with older students mentoring younger ones. As far as I am aware, not common but at least two places in the UK have one.

No, I am not saying that Universities are great, in my opinion the whole of society is ill prepared to support/cope with the severely mentally ill. However being mentally ill while at University is probably better than being mentally ill outside them. So expelling a student on mental health grounds may actually worsen that students plight.
I'm not sure that being in a university is always a better place--at least not at state schools in the US. For example, I attended graduate school at a university of 35,000. Yes, there was a student health center, constantly underfunded; no such thing as a student welfare office, but there was a "campus life office" which basically scheduled extra-curricular events; classes (especially for undergraduates) often were large (over 100 students) and most professors wouldn't really know if a student had a problem or not--missing lecures simply meant a failing grade--and under pressure to publish or perish, hardly had time to do the sleuthing required to find out what was going on in students' personal lives.

And the only way in which residence halls came into play was through the existence of what we called the "suicide dorm," a nine-story graduate residence where people periodically plunged to their deaths when life became too much.

Now, I'm making it seem as though I went to grad school in hell--it was a good place and offered a great education. It's a fairly typical Big-10 university.

And it's just too large to keep tabs on its students in a personal way.

Add this to the fact that the university is situated in a very small town, and you don't have much in the way of resources for dealing with the kind of deeply troubling events as unfolded at Virgina Tech.

sabine

[ 18. June 2007, 17:17: Message edited by: sabine ]
 
Posted by OliviaG (# 9881) on :
 
Just out of curiosity, Moo, why do you wish to focus our discussion on universities (or higher education in general)? From what I have read, Mr. Cho showed clear signs of mental illness long before he attended university. Before he became an adult, his parents and public school authorities had many more options for helping him (or controlling him, if necessary) than any university has over its adult students. OliviaG
 
Posted by Beautiful_Dreamer (# 10880) on :
 
I too am wondering why something wasn't done to help him earlier. Surely he showed signs of a problem long before university. I know I did. And I was never dangerous to myself or anyone else. My sister, who is also bipolar, showed signs of breakdown much earlier than I did. Was he ever diagnosed with any specific illness? Because there are some that have adult onset (i.e. schizophrenia in some cases), but there is usually a sign of a problem long before the illness is full-blown. But then, I am not a doctor, just a person with an illness herself who comes from a long line of illness.
 
Posted by Choirboy (# 9659) on :
 
I lean towards saying that universities are better places than the general public square for getting someone in to treatment. They may or may not be the best place for someone who is in treatment as there can be a lot of stresses not present elsewhere.

But I'd be horrified at any suggestion that those with mental illness should be prohibited from attending university.

The problem in the case of severe mental illness is dealing with someone who is a danger to himself or others. That's very hard in this country - you pretty much have involuntary committal as your only path; the legal barrier is high for good reason; the resulting hospital stay is not always long enough to get someone stabilized on meds before being released, etc.

But I'm not sure this is any worse of a problem at a University than say, at the post office.
 
Posted by Moo (# 107) on :
 
I agree he showed clear signs of having problems long before he came to Tech.

I think his early life was unusually stressful. AIUI he came to America with his family when he was eight years old.

People who remember him as a child in Korea say that he had a speech defect. People who knew him at Tech say he had a weird voice. Apparently he was teased unmercifully in middle school. Once in a class a teacher insisted that he speak although he was extremely reluctant to do so. He began talking in this weird voice and the other kids started laughing at him. Then one of them said, "Go back to China where you belong." This was in the days before schools started to crack down on bullying; apparently the teacher did nothing to defend him.

I'm convinced he had a predisposition toward mental illness, but experiences like this greatly aggravated matters.

quote:
Originally posted by Olivia G
Just out of curiosity, Moo, why do you wish to focus our discussion on universities (or higher education in general)? From what I have read, Mr. Cho showed clear signs of mental illness long before he attended university.
The problem as I see it is that university students have much more freedom than younger students. This makes it more difficult to establsh the fact that a student is dangerous and the community must be protected.

In this case it was partly a procedural problem. The judge ordered therapy at the Tech health center, although the health center does not accept court-ordered referrals.

ETA: I have heard that the Korean community does not think of mental illness the way we do. If someone behaves badly because of mental illness, the focus is on the bad behavior. Mental illness is no excuse. This attitude may have prevented his parents from seeking help for him.

Moo

[ 18. June 2007, 19:12: Message edited by: Moo ]
 
Posted by Moth (# 2589) on :
 
I am a lecturer in a university in the UK. I agree with what Jengie Jon says, but I do think it is easy to fall through the gaps at uni if you have no wish to tell anyone about your problems. Frankly, we have very little time to chase up students, so a student who wants to sit in their room and cry is likely to do it for some time before we really take action, especially if they ignore e-mails and letters.

Years ago, and at a different university, I did teach a very disturbed young man. I was sufficiently concerned by his behaviour to report him, and he was sent for evaluation by a psychiatrist. He was declared fit to continue his course, and two weeks later stabbed a fellow student. I wasn't much impressed by the professional advice we'd been given!

I do think there are problems in identifying the dangerous from the odd. Lots of young people sit in their rooms listening to miserable songs and writing depressing drivel. Some really are depressed, while others are just acting up! They all dress oddly, and many of them behave oddly too, at least to my middle-aged eyes. I'm not sure I, or even an expert, can always tell the difference.

[ 18. June 2007, 19:26: Message edited by: Moth ]
 
Posted by OliviaG (# 9881) on :
 
quote:
Originally posted by Moo:
The problem as I see it is that university students have much more freedom than younger students. This makes it more difficult to establsh the fact that a student is dangerous and the community must be protected.
How is a university different from any other workplace, or a church, or any other community group or institution? A mentally ill student attending a university is also a mentally ill citizen of the country and a mentally ill resident in the larger community. If s/he is employed, that makes the student a mentally ill employee. If s/he goes to church, that student is a mentally ill Christian. Maybe instead of asking what all these communities can do about mental illness, we should be seriously examining what the health system isn't doing.

And again, if we were talking about a physical illness - and let's make it a contagious one, so there's a public health element - would we be having a debate on how universities - and only universities - should deal with students with TB? Isn't that why we have public health departments? OliviaG
 
Posted by deano (# 12063) on :
 
I don't like this "mental illness" blanket term. What would the state of medicine be if we only had the phrase "physical illness" to describe everything from a cold to cancer, from haemeroids to heart disease?

There are many different types of "mental illness" and I think it's high time that we started teaching people a little more about it, starting in schools. There are kids books about broken bones. Why not have them on depression as well. I'm sure many of them have parents with it.

If the students at Virginia Tech knew more about "mental illnesses" themselves then maybe they would have intervened earlier rather than leaving it to staff and policies. After all they interacted with the guy far more than any lecturers. If a fellow-student came into class with a mole on the face that was growing by the day, itching and bleeding, don't you think they would have driven them to the nearest hospital for skin-cancer tests?
 
Posted by Doublethink (# 1984) on :
 
I agree with you very strongly about making a distinction about severity and character of different mental health problems.
 
Posted by Pastorgirl (# 12294) on :
 
deano writes:

quote:
If the students at Virginia Tech knew more about "mental illnesses" themselves then maybe they would have intervened earlier rather than leaving it to staff and policies.
And what exactly would they have done, other than be alarmed?

As has already been noted, Cho was identified-- several times-- as someone with severe psychological problems. Resources were made available to him, but he refused treatment. The problem was not one of identification, it was with the US mental health system that has no process for involuntary admittance of high-risk individuals w/o a pre-existing tragedy.

I would, of course, agree that more education about mental health issues is important and needed. However, it doesn't do all that much godd without a broader reform that provides access to mental health care. To use your analogy, how much good does it do to be able to identify a mole as pre-cancerous if there is no medical care available to your friend?
 
Posted by ken (# 2460) on :
 
quote:
Originally posted by Moo:
When it comes to things like non-suicidal depression, the university mental health services are fine, but anyone who is considered a danger should be required to withdraw.
Why stop at students?

So should someone "considered a danger" but who has not actually hurt anyone automatically lose their job in order to protect others?

Should they be required to leave their home in order not to be a danger to other residents?
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by OliviaG
How is a university different from any other workplace, or a church, or any other community group or institution? A mentally ill student attending a university is also a mentally ill citizen of the country and a mentally ill resident in the larger community.
People spend about forty hours a week at their workplaces. People spend less than two hours a week a church services, although they may also spend time at church for other purposes.

Most students who take classes and live on campus probably spend more than a hundred and fifty hours a week on campus. There is much more time for a disturbing person to disturb people.

Moo
 
Posted by cattyish (# 7829) on :
 
Ken, it's not to infringe on someone's rights that I have recommended their detention under mental health laws but to protect the person who is ill or to protect other people. As soon as the reason for detention ceases (cessation of danger or cessation of illness) the detention should be lifted. It's always a difficult decision to act against a person's expressd wish. I don't know anyone who takes it lightly.
 
Posted by Pastorgirl (# 12294) on :
 
cattyfish--

Again, there seems to be a cross-pond difference that's at play here. In the US it's simply not legal to detain someone involuntarily in that way. A major problem, that leads to all sorts of tragic results.
 
Posted by MouseThief (# 953) on :
 
quote:
Originally posted by Pastorgirl:
Again, there seems to be a cross-pond difference that's at play here. In the US it's simply not legal to detain someone involuntarily in that way. A major problem, that leads to all sorts of tragic results.
And prevents relatives from locking up family members for ill gain. It is possible to detain involuntarily, there are just checks and balances to the process to avoid abuse.
 
Posted by Amazing Grace (# 95) on :
 
Yes, the standards for an involuntary 72-hour hold are very, very high. I imagine even more so for determining whether the hold continues beyond 72 hours.

I imagine that states will be looking at their criteria.

Charlotte
 
Posted by Squirrel (# 3040) on :
 
As somebody who has worked in the field of mental health, I find it sad that people think sociopaths like this guy should be required to undergo counseling. Not only is coerced counseling about as meaningful as mandatory prayer, but even Freud himself would not be able to "cure" somebody with such deep-seated personality problems. Nor do I think that a little Prozac or some other drug would work.

What to do about sociopaths? Well, making it tougher to get guns would surely help. And screw "civil liberties." The really bad ones need to be locked up.
 
Posted by ken (# 2460) on :
 
quote:
Originally posted by Pastorgirl:
In the US it's simply not legal to detain someone involuntarily in that way.
Yes it is. In some states its easier to do than in England (where we call it being "sectioned" for obscure historical reasons). This website claims to be a summary of the laws in different US states.

What seems to be being suggested above is some intermediate stage between being diagnosed as mentally ill in some way, and being subject to a legally enforceable involuntary detention (who are by definition our of your hands). So the student is excluded from the university and told to seek medical treatment and not some back until they have.

Of course a university, like any workplace, has the right (maybe the duty) to keep out someone who is actually causing danger to others. But we weren't, I think, talking abut that. We were talking about someon who is thought to be a possible danger but hasn't actually done anything bad yet.

This intermediate state seems really dodgy to me. Who diagnoses the problem? Who decides when it has gone away? Who ensures that the excluded student really is seeking treatment and not sitting alone in their room getting more and more desperate?

Also it blur the boundaries between counselling and student services on the one hand, and disciplinary controls on the other. And it might tend to make the mentally disturbed student even less likely to let anyone know about their illness.
 
Posted by ken (# 2460) on :
 
Sorry, I was being unclear there. The website I linked to:
quote:
Originally posted by ken:
This website claims to be a summary of the laws in different US states..
is a summary of involuntary outpatient commitment laws, in other words compulsory treatment of patients "living in the community" (bureacrat speech for "neither in hospital nor locked up")
 
Posted by Pastorgirl (# 12294) on :
 
quote:
And prevents relatives from locking up family members for ill gain. It is possible to detain involuntarily, there are just checks and balances to the process to avoid abuse.
Yes, technically it is possible, but it goes far beyond checks and balances... those of us who work in the field have found it to be virtually impossible until after a tragedy has occurred (e.g. after a failed suicide attempt or homocidal act). Involuntary admits are otherwise pretty much impossible to secure. I know, I've tried-- many times. And apparently, so had many others who had been alerted to the problem re: Cho. But it just isn't possible to do an involuntary admit w/o an "immediate" threat-- which means a gunshot wound. Again, this is why we have so many homeless mentally ill, many of whom only need oversight/meds to be fully functioning.

It is true that the reason behind the more restrictive legislation (which came about in the 70s) was the abuse of the system to put away inconvenient relatives, rebellious teens, etc. As I said, balance is needed. The problem is, there is no such balance in the US.

When a Canadian relative became incapacitated due to Alzheimer's I was amazed at the difference in the two systems. From my limited exposure to their system, it seemed much better equipped to acheive the balance you are suggesting-- the rights and autonomy of the patient vs. interceding for their own wellbeing.
 
Posted by Pastorgirl (# 12294) on :
 
One thing Ken's link demonstrates is that even compulsory outpatient care comes about only as the result of a very long, lengthy, and time-consuming legal process. It requires some very dedicated individuals, generally close relatives. I've known a few people who have navigated that process and it took years, and thousands of dollars. More disinterested third parties are not as likely to take on such a feat.

In Cho's case, though, I suspect that anything less than inpatient care would have been inadequate. Most of the states listed the familiar " immediate threat to self or others" as the only criteria. Now it may be that some states interpret that more generously than here in Calif., but from the people I've talked with, so far I've not encountered any states where this is the case.
 
Posted by Pegasus (# 1966) on :
 
quote:
Originally posted by Amazing Grace:
Yes, the standards for an involuntary 72-hour hold are very, very high. I imagine even more so for determining whether the hold continues beyond 72 hours
72 hours? Blimey, here in the UK an initial detention for assessment (called a S2) is for 28 days. At the end of this period, or if you are known sufficiently well by the authorities that assessment isn't thought necessary, than you can be detained under an S3 which lasts for 6 months.

[ETA] An S3 can be extended, first for 6 months, and then in 12 month increments.

[ 19. June 2007, 16:00: Message edited by: Pegasus ]
 
Posted by Josephine (# 3899) on :
 
In this country, it can be exceedingly difficult to get inpatient psychiatric care even if it's voluntary.

I know one mom whose child is frankly psychotic. He's failed most of the traditional antipsychotic medications, and was hospitalized for 10 days so they could take him off his current meds and start him on a last-ditch drug. At the end of the ten days, he was still not at a therapeutic dose of the new drug, but he was sent home anyway, in spite of the fact that he was suffering auditory hallucinations and paranoid delusions.

His mom has been desperately trying to get help for him, but her insurance won't pay for more than 10 days inpatient care, and she doesn't have the money to pay for it herself. The only way she can get him the care he needs is to give up custody to the state, and hope that he will be able to get the care he needs through the foster-care system.

An adult who needs inpatient care doesn't even have the foster-care option, of course, as bad as that option is.

A few states are beginning to require what is called "mental health parity" -- mental illness has to be covered to the same extent as any other illness. But in general, in this country, psychiatric hospitalization of more than a few day's duration is simply not available, even on a voluntary basis, and even if you have insurance, unless you are an immediate danger to yourself and others.

It's a terrible system. But since that's the system we have, I honestly don't know what Cho's family, friends, or teachers could have done for him. It would be illegal to remove him simply because he was mentally ill. But because his behavior disturbed other people, it's possible that he could have been removed from the school through disciplinary channels.

I do wonder, though, about the schools he attended in elementary school and high school. Under IDEA (the Individuals with Disabilities in Education Act), schools have an obligation to identify students with disabilities (including mental illness), to determine whether the disability is interfering with the child's ability to acquire a free and appropriate public education, and to provide specially designed instruction, related services, and supports so that the child can receive such an education.

Did the schools Cho attended ever fulfill their obligations? I'd put money on their not having done so.
 
Posted by ken (# 2460) on :
 
quote:
Originally posted by Pegasus:
An S3 can be extended, first for 6 months, and then in 12 month increments.
Similar-but-different rules in most US states. I just looked up some figures for California. Apparently in 2000 there were about 80,000 72-hour detentions, about 6,000 14-day renewals, almost as many longer renewals, and 200-odd people detained indefinitely.

I'm not sure if the same person committed twice counts as one or two. Two I guess.

Anyone know the numbers for the UK?
 
Posted by Pastorgirl (# 12294) on :
 
Josephine, that has been my experience here in the States as well. It is heart-breaking. We can do better.
 
Posted by Pegasus (# 1966) on :
 
I've done a bit of googling and found some figures here for numbers Sectioned under the Mental Health Act in England.

In essence, for the financial year 1999-2000 26,700 were admitted under Section, and another 20,800 were Sectioned after being admitted informally.

What the figures don't show is the number of people detained under Sections 4, 135 and 136 which last 72 hours and are used in an emergency.

[ 19. June 2007, 20:28: Message edited by: Pegasus ]
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Josephine:
It's a terrible system. But since that's the system we have, I honestly don't know what Cho's family, friends, or teachers could have done for him. It would be illegal to remove him simply because he was mentally ill. But because his behavior disturbed other people, it's possible that he could have been removed from the school through disciplinary channels.
University officials can require students to seek mental health treatment and/or be removed from the university, but they can only do this if it has become obvious that their mental health problem is affecting their ability to participate in the community. Students who seek a late or retroactive withdrawal for mental health problems are almost always required to document that they are actively trying to manage their disease; some of these students probably wouldn't have sought therapy if it weren't required, but they're not usually hostile to it. Students who are, say, required to take an anger management course after destroying dorm property are often less enthusiastic, but don't actively resist.

The problematic cases are those in which the student hasn't broken any written rule, but whose behavior breaks basic unwritten rules. There isn't actually a rule against interrupting your professor every two minutes, talking over all your classmates in discussion, or periodically standing up and jumping off your desk because the assumption is that if you've gotten to college, you already know these things (although you might be able to find some vague, highly interpretable language about maintaining an appropriate learning environment somewhere). Similarly, there isn't a rule against taking pictures of your classmates even if they've asked you not to - it's just not something people do, unless you are a tabloid photographer and I am a celebrity. Some of Cho's classmates found his behavior so disturbing that one of his professors had him meet privately instead of in class; I would have thought that somewhere in all that, there might have been some technicality to hang him on. Except I've seen other cases where students basically couldn't be in a classroom for the sake of the rest of the class, but hadn't really broken any rule, since there isn't a rule against disturbing or annoying others. The scary part is that when they do break a rule, it's often "don't hurt or attempt to kill other people."
 
Posted by Campbellite (# 1202) on :
 
quote:
Originally posted by Squirrel:
And screw "civil liberties." The really bad ones need to be locked up.
The mantra of the current White House, no?
 
Posted by RuthW (# 13) on :
 
quote:
Originally posted by Moo:
quote:
Originally posted by OliviaG
How is a university different from any other workplace, or a church, or any other community group or institution? A mentally ill student attending a university is also a mentally ill citizen of the country and a mentally ill resident in the larger community.
People spend about forty hours a week at their workplaces. People spend less than two hours a week a church services, although they may also spend time at church for other purposes.

Most students who take classes and live on campus probably spend more than a hundred and fifty hours a week on campus. There is much more time for a disturbing person to disturb people.
No, the disturbing person has the same number of hours in a day as everyone else. All you're really proposing is that a disturbed student be shifted off-campus so he/she can disturb different people.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by RuthW
No, the disturbing person has the same number of hours in a day as everyone else. All you're really proposing is that a disturbed student be shifted off-campus so he/she can disturb different people.
That is part of it, but not all of it. I see nothing wrong with spreading the stress around, rather than piling it all on one group.

More importantly, a university is not well-equipped to deal with someone with a dangerous mental illness. Students enjoy a great deal of independence. If a mentally ill student does not want therapy, the only thing the university can do is suspend him. Up until now very few universities had a policy of suspending the dangerous mentally ill. That policy is going to change in Virginia, and probably in other states.

Moo
 
Posted by Pastorgirl (# 12294) on :
 
Ruth is right, all that does is move the problem off campus. The real problem is the lack of mental health services, the inability to get real help for someone before it has reached the level of suicide/homicidal actions.
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by Moo:
If a mentally ill student does not want therapy, the only thing the university can do is suspend him.

I don't think a university can legally suspend a student because the student is mentally ill, or even because the student is mentally ill and refusing treatment. Nor should they be able to. Most mental illness is not a problem to anyone other than the person who is ill.

quote:
Up until now very few universities had a policy of suspending the dangerous mentally ill. That policy is going to change in Virginia, and probably in other states.
How will that work? Who will decide that a student is dangerously mentally ill? On what basis? I don't think universities are qualified to make that determination.
 
Posted by Sir Pellinore (ret'd) (# 12163) on :
 
quote:
Originally posted by saysay:
...University officials can require students to seek mental health treatment and/or be removed from the university, but they can only do this if it has become obvious that their mental health problem is affecting their ability to participate in the community. Students who seek a late or retroactive withdrawal for mental health problems are almost always required to document that they are actively trying to manage their disease; some of these students probably wouldn't have sought therapy if it weren't required, but they're not usually hostile to it. Students who are, say, required to take an anger management course after destroying dorm property are often less enthusiastic, but don't actively resist.

The problematic cases are those in which the student hasn't broken any written rule, but whose behavior breaks basic unwritten rules...
Well said, Saysay! [Overused]

Mental illness - besides being widespread, as it includes anxiety & depression - was also, until fairly recently, the equivalent of leprosy in the Middle Ages in our society.

Fortunately, attitudes seem to be changing. [Yipee]

Universities - Australian & British are better known to me than ones in the USA - have been described as "neurotic subcultures" (the words of a friend who worked in the Student Counsellor's Office at Monash University, Melbourne, in the 1970s).

So many of our professors and lecturers in the Faculty of Arts at the University of Melbourne in the late 1960s-early 70s were extremely eccentric/bordering on the verge of nuttiness/seriously needing help.

Vincent Buckley - a famous Australian poet with a Personal Chair in English - was a chronic alcoholic as was the Sub-Dean of the Arts Faculty - a lovely, lovely guy & well known literary critic both in print & on the ABC: Dinny O'Hearn.

Both are dead now. Both had had traumatic times -Vince was in the RAAF in WWII (extremely hazardous with the constant danger of death) & Dinny had had a bugger of a life, including passing through the hands of the Christian Brothers. Need I say more? Both needed help. Would they have sought it? Well, as Australian males, heirs to the Anzacs, we didn't.

Both were Catholic & we had two Jesuit priests on the English Department. Peter Steele was a man who seemed totally up in the air & spoke a sort of "literaturecritiquese" which was incomprehensible. Tim Kelly - later laicised, thank God! - was a tall, gaunt Irish-Australian who looked like an undertaker and had the sensitivity & interpersonal skills of a charging rhino. I once sought his hearing on a minor administrative matter. Why? I wonder.

Could they have helped anyone? Only if they were writing something on Thomas Aquinas' influence on William Shakespeare, or such...

The late Professor Sam Goldberg, like so many academics at Melbourne then, seemed to be intent on two things: screwing his female students & purging the Department of anyone who disagreed with the long dead school of F R Leavis.

Professors Macartney & Maxwell were a couple of senile old failed actors relentlessly hamming their way through irrelevant recitations of forgotten or irrelevant verse.

Ian Maxwell, complete with clan tie, declaiming Scottish Border ballads was a sight out of a lunatic asylum. He once distributed tissues prior to one of these performances, thinking we would all weep. My eyes were dry. He was a pathetic sight.

Would these nutters have been able to assist ANY fellow staff or students needing help with mental problems? No!

Andrew Deacon, a very bright & highly troubled young lecturer in the Department committed suicide. Their fault? I wouldn't directly blame them, but the "tone" they set, as my old GPS Headmaster, the late Sir Brian Hone, used to say, was atrocious.

Some: Hume Dow, Jock & Maggie Tomlinson & others were pretty normal, but, unfortunately, they had little influence.

Even then, Student Services were underbudgetted & overstressed. Dennis Kelynack, the Student Counsellor & his staff were superb but there was only so much they could do.

I myself had a mild anxiety problem which could've easily been dealt with by meditation & talk therapy. Unfortunately, I got referred to a psychiatrist whose forte was group therapy. It was terrible! One of the girls in the group ended up getting electro-convulsive shock therapy at Royal Park Psychiatric Hospital.

Universities these days are still stressed as far as Student Services go, but their is much more awareness of mental health problems at the university & in the community; vastly more sympathy & psychiatric & psychological help available. The Australian Medibank system is very good in reimbursing costs.

Long may this continue! [Yipee]

Sorry about the long personal anecdotes, but it was necessary to set the scene. [Smile]

[ 21. June 2007, 08:59: Message edited by: Sir Pellinore (ret'd) ]
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Josephine:
I don't think a university can legally suspend a student because the student is mentally ill, or even because the student is mentally ill and refusing treatment. Nor should they be able to. Most mental illness is not a problem to anyone other than the person who is ill.
I should have made it clear that I was talking about mentally ill students who are disruptive or dangerous. The university has a right to insist that other students be allowed to pursue their education in safety and without interference.

quote:
How will that work? Who will decide that a student is dangerously mentally ill? On what basis? I don't think universities are qualified to make that determination.
I agree that universities are not qualified to make that determination. The university has the same right as any private citizen to report that someone appears to be a danger. The mental health authorities have the responsibility of dealing with the situation.

In Cho's case the mental health authorities ruled that he was a danger. Then they released him with a court order to undergo outpatient psychotherapy at the university health service, which had a policy of not accepting court orders because they could not enforce them. [Frown]

Moo

[ 21. June 2007, 12:41: Message edited by: Moo ]
 
Posted by Pastorgirl (# 12294) on :
 
This is the catch-22 that virtually every human services organization-- chuches, homeless shelters, free clinics, and, yes, universities-- faces. You can declare someone dangerous and "at risk" all you like, you can order treatment, but w/o the legal ability to compel treatment, it's all hot air.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Pastorgirl:
You can declare someone dangerous and "at risk" all you like, you can order treatment, but w/o the legal ability to compel treatment, it's all hot air.
The judge had the ability to order Cho to be treated by a facility which did have the legal ability to compel treatment. There are some in the area. However the Tech student health service is not such a facility.

I assume that when the commission investigating this matter submit their report, it will contain the judge's explanation of why he ruled as he did. I look forward to reading it.

Moo
 
Posted by Doc Tor (# 9748) on :
 
I remember two students during my undergraduate time who were increasingly severely mentally ill.

The burden of caring for them fell on us, the students. No one else seemed particularly bothered. I would hazard a guess that this has not changed in the intervening twenty years.
 
Posted by Duck (# 10181) on :
 
Why should being a danger to *oneself* be grounds for suspension / expulsion?
Many students with physical difficulties successfully manage university, and may or may not need accommodations on the way (special arrangements for exams, etc). So do many students with mental health problems, which may include self-harm or suicidal tendencies. Given most people wouldn't suggest expelling a student who needed to use a wheelchair, why would a student who sometimes became suicidal be expelled, so long as they were able to cope academically? Any decision beyond the narrowly academic about whether it is in the interests of the student to complete the course of study should surely be left to the student themselves, with input from health professionals and those directly supporting the student, not university administration.

IME university isn't a great place for people with long-term complex mental health problems (UK experience). My course last term averaged 2 hours contact time per week in a class size of ~50, with no register taken of attendance (that's final-year - previous years ~140 students per class). Believe me, no-one does anything if you turn up to class late, in the clothes you've slept in for 3 days, or not at all. The university counselling service and student health centre are geared up to deal well with problems which typically affect a population previously selected to be mostly young, healthy, & high-functioning. They are good at dealing with exam stress, mild cases of 'the blues', homesickness, that sort of thing - not long-term illness.

Non-university health services IME have problems dealing with students. I have seen someone sent away from a psychiatric ward after housemates called an ambulance at 3am because 'she wouldn't fit in' 'would have nothing in common with the other patients' who were from a working-class area - not because she didn't need treatment, just that the service decided it couldn't be provided because she was a student. Being articulate, well-informed about your illness, and studying at degree level, seems to convince health professional that you can't be properly ill, even if you are functioning significantly below pre-morbid levels. If you are studying a related degree subject it's even worse - IME most health professionals don't appreciate patients who have done more recent study in more depth into their illness than the health professional, and fluctuate between patronising, ignoring, and if you are really unlucky assessments for Munchhausen's. You may be treated by people who are / will be involved in your academic and career progression. If you've studied the standard diagnostic interviews for your illness then it's hard to give 'natural' answers, and many standard screening tools simply aren't normed to deal with a population who have been pre-selected for excellent functioning.
Practically it's difficult to get care if you live in one place in term-time and another in the holidays - Uni facilities shut down, and usually you can't be referred for a month or three months to services near parents and then return straightaway to services in the university area - if you try you may get knocked back and forth from the bottom of one waiting list to another, as if the lack of stability from spending half the year in one place & half another wasn't detrimental enough. Unstable postal addresses make accessing health services still more difficult. Universities also run on the basis that students will get support from family during holidays. Not everyone does.

University is a demanding place to be, and to succeed you need to be not just functional but working to capacity. Living with a fluctuating long-term mental illness makes that really rather difficult, but with appropriate support & flexibility from the university then it's possible, and universities _could_ be a positive & enabling environment. Unfortunately they aren't always.

I'd echo those posters who have suggested that 'mental health' is much to broad a term to be talking about here. Killing strangers is much more likely to be related to drug and alcohol use by young men, than people with mental health problems.
 
Posted by welsh dragon (# 3249) on :
 
I don't know whether me chipping in is really going to effect much change in the course of this discusion but here goes.

1. most people with a mental illness are not a danger to themselves or anyone else

2. 1 in 4 people develop a mental illness in their life time. Up to 20% adolescents have been shown in studies to have a mental health diagnosis. How many people could you tolerate excluding and where do you draw the line?

3.prediction of behaviour is very difficult in mental health. This is because "harm" acts are rare. For example, in a particular case, we can look up the the factors in the research literature that suggest someone might kill themselves. We can add them up - and our calculations might indicate relatively high risk. But these factors are fairly common (amongst others, recent discharge from hospital, drug/alcohol abuse, history of suicide in the family) and completed suicide is relatively uncommon. So there is a lot of false "noise". You might have 100 "high risk" patients but only 1 is going to carry through.

4.With homicide, the completed act is much rarer. So we are talking 1 in 10,000* perhaps. So, 10,000 individuals might be at relatively high risk of carrying through such an act, judging from their mental history and behaviour but only 1 will actually do it.

So do you lock up the 10,000?

5. Personality disorder (PD). Very common as a percentage of the population. In so far as this is described in the illness books, this is technically an illness. But it effectively isn't amenable to medical treatment in the way other mental illnesses are (though there are options).

The UK government wants us (psychiatrists) to be able to lock up PD patients. We don't want that. I think innocent till proven guilty is a good way to go.

Many people who commit a violent crime might have a troubled past - maybe they were hit by their father or bullied at school or used drugs as a teenager. You might see these as "psychological problems" - maybe we all have some sort of psychological problem. Not the same as mental illness though.

For the most part, I think that there are good reasons why psychiatrists are really lousy at predicting risk. No we don't have crystal balls. And we can't read minds. People are responsible (for the most part) for their own actions. Just because someone commits a heinous act does not mean they automatically have a mental health diagnosis. And just because they have a mental illness doesn't mean they should be discriminated against or denied opportunities.

(I think that's enough for now).
*as I recall, I'm afraid rather vaguely, from an academic meeting about 10 years ago

[ 23. June 2007, 21:15: Message edited by: welsh dragon ]
 
Posted by Pastorgirl (# 12294) on :
 
good points.
 
Posted by Pegasus (# 1966) on :
 
Further to what Welsh Dragon has said, it's a mistake to assume that a psychiatric ward is automatically the bast place for someone who is suffering mental health problems. Over-worked nurses, over occupancy on beds, lack of privacy and autonomy, being in the constant company of seriously disturbed individuals... none of it makes for a therapeutic environment.

Associating exclusively with psychiatric patients also gives one a very distorted idea of what is "normal": self harm, poor (or non-existent) personal hygiene, refusal to eat etc all become par for the course.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Duck:
Why should being a danger to *oneself* be grounds for suspension / expulsion?
In the US, the legal obligation of universities to act in loco parentis is a bit murky. Parents have successfully sued a university because their child killed themselves while at school. I think most people would prefer it if universities didn't have that legal liability, but right now they do. Also, the suicide of a student on campus tends to affect the rest of the community a lot more than the suicide of former student; the former is much more likely to trigger other suicide attempts than the latter.

I don't think students should be suspended for thinking or voicing suicidal thoughts. But universities do have an interest in the matter, and it's a very tricky area.
 
Posted by pimple (# 10635) on :
 
Is suicide illegal in all, or most, US states? I know that it is common for mental patients to sign a contract which binds them to taking medication, or even hospita;izing themselves, if they feel suicidal. This somehow sounds more like the caring community watching its (financial?) back than anything else. Am I stereotyping, though?
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by pimple:
Is suicide illegal in all, or most, US states?


No. According to The Straight Dope, attempted suicide was illegal in only six states in 1963. I didn't see anything more recent with a quick Google, but I'm sure you could get current info if you wanted to take the time to find it.

quote:
I know that it is common for mental patients to sign a contract which binds them to taking medication, or even hospita;izing themselves, if they feel suicidal. This somehow sounds more like the caring community watching its (financial?) back than anything else.
I don't understand what you're saying. The reason for getting the contract from someone with suicidal ideation is that it makes the person far less likely to actually commit suicide. It's an effective prevention strategy.
 
Posted by pimple (# 10635) on :
 
Sorry, Josephine, I didn't make myself clear. The impression I've had from time to time is that carers in the states are quicker to "take over" what some might regard as the rights of mental patients - for their own good, of course.
Patients may then sometimes regard themselves as prisoners, who may be punished for not acceding to the regime prescribed for them. It's a tricky business for everyone, I think. Carers who err on the side of overprotection can be understood.
But from the perspective of those contemplating suicide, it can sometimes feel that even thinking about it is regarded as criminal - in effect if not in law.

There may also be a feeling on the carer's side that not to take custodial action or demand "safe" sedation would be tantamount to negligence at best or make them morally or legally culpable if the patient did kill him'herself.

[ 24. June 2007, 21:46: Message edited by: pimple ]
 
Posted by pimple (# 10635) on :
 
I hope this is not too tangential. But getting back to the university situation, a student would obviously benefit from talking to a counsellor if they felt depressed. But they might be discouraged from being completely open if the default remedy for suicidal ideation was heavy sedation or hospitalization - both of which would seriously interrupt their studies.
(I'm not saying that woldn't in some cases be necessary. The son of a friend had to take a whole year off. He still managed a "first" when he got back. But the year off was advised, not demanded. It was he himself who decided that was what had to happen.)

[ 24. June 2007, 21:56: Message edited by: pimple ]
 
Posted by ken (# 2460) on :
 
quote:
Originally posted by welsh dragon:

4.With homicide, the completed act is much rarer. So we are talking 1 in 10,000* perhaps.

[...]

*as I recall, I'm afraid rather vaguely, from an academic meeting about 10 years ago
If there are, say, 500 murders a year in Britain out of 50 million that's 50 in 5 million, 10 in a million, 1 in 100,000... so 1 in ten thousand sounds an order of magnitude too high for the annual chance of killing someone , an order of magnitude too low for the chance you might kill someone in your lifetime.

Whoops, maybe I was misreading your post. Do you mean 1 in 10,000 of the general population or of those showing risk factors for violent crime? If the latter it would, presumably, be in the right ball-park.
 
Posted by mountainsnowtiger (# 11152) on :
 
quote:
Originally posted by pimple:
I hope this is not too tangential. But getting back to the university situation, a student would obviously benefit from talking to a counsellor if they felt depressed. But they might be discouraged from being completely open if the default remedy for suicidal ideation was heavy sedation or hospitalization - both of which would seriously interrupt their studies.
I've never heard of sedation being a treatment for suicidal ideation.

Suicidal ideation varies enormously in degree and type. Many people experiencing suicidal ideation may only be at low to moderate risk of actually making a suicide attempt. In the UK, hospitalisation would usually only be suggested if it was felt (by mental health professionals) that there was a very high risk of the individual making a serious suicide attempt in the immediate future. If that were the case, then the individual's academic studies would almost certainly already be being seriously interupted by their mental state.
 
Posted by Pastorgirl (# 12294) on :
 
quote:
The impression I've had from time to time is that carers in the states are quicker to "take over" what some might regard as the rights of mental patients - for their own good, of course.
I believe it is actually quite the reverse. As was detailed in earlier posts, such a "take over", whether benign or malignant (and there are both of course) is much harder to achieve in the US. When an elderly Canadian relative became incompacitated I was absolutely flabbergasted when the provincial authorities stepped in and mandated an involuntary admit. This simply would not happen in the US, which is why we have so many homeless mentally ill.

Prior to deinstitutionalization in the 70s, however, what you described was very much the case.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by pimple:
I hope this is not too tangential. But getting back to the university situation, a student would obviously benefit from talking to a counsellor if they felt depressed. But they might be discouraged from being completely open if the default remedy for suicidal ideation was heavy sedation or hospitalization - both of which would seriously interrupt their studies.
(I'm not saying that woldn't in some cases be necessary. The son of a friend had to take a whole year off. He still managed a "first" when he got back. But the year off was advised, not demanded. It was he himself who decided that was what had to happen.)
Well, yes, ideally students would recognize the need to talk to a counselor or take time off (can't say that I've ever heard of heavy sedation or hospitalization for suicidal ideation; AFAIK most people don't get those for suicide attempts). But the 18-22 set sometimes overestimate their ability to "just get over it."

For example, I had a student A. A's room-mate killed himself in their dorm room; A. found the body. A was understandably traumatized, but decided to continue with the semester, although he did change dorm rooms. I believe he struggled with depression before the incident, but he became severely depressed and started failing his classes. At his request, the counseling center recommended that he be allowed to withdraw from the classes he was failing (so that those failing grades wouldn't bring down his GPA, since his failure was probably due to unforseeable circumstances not within his control), and required him to continue to get counseling. We talked about whether or not he wanted to go on a leave of absence for the next semester; he didn't think it was necessary (he had the summer in between semesters to recover).

But when he returned he was depressed and, I believe, suicidal. He again failed his classes. If he hadn't been granted a medical withdrawal the previous semester, he would have been eligible for academic suspension. Since he had been, he wasn't. The counseling center recommended another medical withdrawal, but only if A. agreed to go on a leave of absence. There's a small chance that he would have come back spring semester and done well. The alternative would have been to either allow him to flunk out, or to allow him to continue paying the university upwards of $35, 000 a year to make no progress towards his degree. I know it sound horrid to talk of suspending students/ forcing them to go on a leave of absence for mental health issues. But we're not talking about suspending everyone who mentions to a counselor that they've thought about suicide.
 
Posted by Professor Kirke (# 9037) on :
 
Many people are talking about how obvious it was that Cho was disturbed. Does anyone have any of the references for why we think this?
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Professor Kirke:
Many people are talking about how obvious it was that Cho was disturbed. Does anyone have any of the references for why we think this?
I've got tons of them. The Roanoke Times published an enormous number of stories after the shootings, including interviews with people who knew Cho. Here is the text of an interview with someone who lived with him.

He was in a writing class where the students' writings were read aloud. Cho's writings were so disturbing that some of the other students left the room. Finally the professor told the university that if they didn't get Cho out of her class, she would resign. The head of the English department volunteered to tutor him privately. He spoke very little during the tutoring session and never looked at her.

Somewhere on the internet there is a story he wrote. The URL was on the newspaper website along with a warning that this was extremely disturbing. Sensitive people were advised not to read it, so I stayed away.

Moo
 
Posted by Moo (# 107) on :
 
There is one aspect of the situation that just occurred to me.

No single individual at Tech knew everything that Cho was doing. When the professor threatened to resign if Cho were not removed from her class, the head of the English department dealt with the situation. I don't know whether the dean was notified.

If someone had known how he was behaving in class and that he was stalking some women students, action would probably have been taken.

I think that in general the university should not ask students about the behavior of their roommates. However, in cases like this, they should.

Moo
 
Posted by welsh dragon (# 3249) on :
 
But the problem is that there are loads of students out there behaving oddly, at times very oddly. That is what student life is like. You would have to nobble thousands of students to pick up one Cho, and even then you might miss him.

Oh hindsight is a very wonderful thing but none of Cho's room-mates and none of the girls he is said to have stalked took it further and went to the police or the college authorities did they? So what he was doing wasn't so out of context or unusual. Male students who are decidedly solitary or completely inept with girls were certainly thick on the ground at the universities I attended.

As for producing literature that is "disturbing" or violent, well after the fact , yes you can read something into it. But people like Stephen King or Quentin Tarantino, no doubt both eccentric in their own way, do not have "I am a future mass murderer" inscribed on their foreheads. (If they did do something violent I guess people would say "ooh you could see that in their work" but that's the way round it goes"). Even the most concerned professor could not have predicted the actual outcome at Virginia Tech.

Human nature seems to have a dark side that comes out sometimes - you just can't predict with accuracy who will turn around and do something like this out of many thousand "weird" students. And there would be a huge cost to clamping down on the eccentrics and the misfits - I don't mean financial but in terms of freedoms - which our societies can't afford to pay and which would outweigh any speculative benefit.

So I think on the one hand, breezily sending people away from college would be daft and cause more problems than it solves. 'Course putting in more mental health resources for students is likely to be a good thing...

[ 28. June 2007, 05:36: Message edited by: welsh dragon ]
 
Posted by Ethne Alba (# 5804) on :
 
When many students and lecturers go to hierarchy of a Uni and say :
Something's wrong here, I am uncomfortable, this feels dangerous, I am unhappy, I am scared, I am desperately concerned, I am so worried that I would like to drop the course...
.......and nothing is done.

Then the university has problems with its management.
 
Posted by MerlintheMad (# 12279) on :
 
quote:
Jengie Jon: ...in my opinion the whole of society is ill prepared to support/cope with the severely mentally ill....
That line sort of leaped out at me.

Imho, people who go to universities in the first place are a bit whacked. But it isn't our fault; society makes us go, more or less forces us to. It's all about competition. The pressure is incredible, and starts for most kids before they are even half way through grade school, sometimes even in preschool (and not "fergwadsakes", but quite the opposite). That so few wig out as badly as Cho did, is, quite frankly, a surprise to me.
 
Posted by Jengie Jon (# 273) on :
 
quote:
Originally posted by Moo:
There is one aspect of the situation that just occurred to me.

No single individual at Tech knew everything that Cho was doing. When the professor threatened to resign if Cho were not removed from her class, the head of the English department dealt with the situation. I don't know whether the dean was notified.

If someone had known how he was behaving in class and that he was stalking some women students, action would probably have been taken.

I think that in general the university should not ask students about the behavior of their roommates. However, in cases like this, they should.

Moo
Moo you do realise what this requires don't you?

It requires a real and deep change in society where it is held as normal and healthy to hold oneself accountable to someone else or a surveillance effort like in East Germany during the cold war.

Why so? Because for there to be full information on Cho there has to be full information on every other student. The only way to get that is either to have half the populace spying on the other half, or for it to be felt normal for a person to have a mentor who they share everything with.

In other words you have to strip everyone of their individualism and privacy to some extent.

Privacy is not today guarded by secrecy it is guarded by the fact that the information gathering groups are fractured and do not hold a cohesive knowledge of anyone. They interpret data on a need to know basis. As long as facts remained separate there was nothing to set the process of building a picture going.

No University today is going to organise itself along those lines, just because of the cost implications.

Jengie
 
Posted by Moo (# 107) on :
 
I have not suggested surveillance on anyone.

I have suggested that when a student's behavior is extreme enough that a faculty member threatens to resign, the other people this student is in contact with should be asked whether his behavior is disturbing when he is with them.

I agree that privacy is very important, but when one danger sign is noticed, it is appropriate to see if there are other danger signs.

Moo
 
Posted by Jengie Jon (# 273) on :
 
Believe it or not Moo the only way of knowing who to ask whether his behaviour is bizarre is surveillance or him telling who he has had fixations on.

I have on occasion had to put this data together after serious complaints, worse than those of intimidating a member of the University Staff. It has been very difficult and I have had to use all my social networking skills to do it.

My experience is the sharing that needs to happen between health professionals, social services, law enforcement agencies and the lay people involved in a case does not happen.

I broke silence as an observer on one case, simply because I needed information about the case to help one of the victims. That resulted in the foster parents of a child realising that one of his grandfathers was alive and relatively sane. Still because others have not met me, we have not moved further in finding out what involvement this grandparent would like if any. The child is around fifteen.

Jengie
 
Posted by Pastorgirl (# 12294) on :
 
quote:
When many students and lecturers go to hierarchy of a Uni and say :
Something's wrong here, I am uncomfortable, this feels dangerous, I am unhappy, I am scared, I am desperately concerned, I am so worried that I would like to drop the course...
.......and nothing is done.

Then the university has problems with its management.
Again, given the legal constraints in the US, I don't know of anything they could have done that wasn't done.
 
Posted by Ethne Alba (# 5804) on :
 
That being the case, my kids won't be going to uni in the states!
 
Posted by Josephine (# 3899) on :
 
Why is that? Killings at schools (from elementary through university) get an enormous amount of publicity because they are exceedingly rare. In reality, a university campus is one of the safest places you can be.

The fact is, the risk of injury and death from almost anything else you'd let your kids do is greater than their risk of being injured or killed by a mentally ill student at an American university. Do you let them drive, or ride in, a car? Would you let them swim in the ocean, scuba dive, surf? What about rock climbing or hang gliding or horseback riding? Would you let them play sports?

If you'd let them do those things, why not let them attend an American university? Seriously -- why not?
 
Posted by Ethne Alba (# 5804) on :
 
Because.......huge sigh here, don't want to upset the states friends.....over in the UK I think that something could have been done and that young man would have been stopped.

But I am Quite Possibly wrong.
Big Time.
Others with more knowledge than me will no doubt come along soon.

Pastorgirls response shocked me.

It seems so unfair
and
mostly because the system seems to have failed the young man in question Most of all.

Of course I am dreadfully upset for the families of the people he killed. Of course.
But
For me
The question is about Cho.
He was left, no one interveined, no one was able to help him and actually
I think that's appalling.

So that would be the reason.

He could have been anyones son.
And his victims could be anyones children.
Legal systems have to protect all.

Sorry. That was a rant..
 
Posted by Pastorgirl (# 12294) on :
 
quote:
Because.......huge sigh here, don't want to upset the states friends.....over in the UK I think that something could have been done and that young man would have been stopped...

It seems so unfair and mostly because the system seems to have failed the young man in question Most of all.
Yes, I agree with you here. Yes, the system DID let Cho and his family down-- as it has let down so many of our homeless mentally ill. As it let down Andrea Yates. And, as I said before, I do think other countries do a much better job of balancing the right to autonomy with the need to intervene to protect people even from themselves.

That being said, Josephine is correct-- statisticly, the odds of your child getting harmed by a mentally ill student at an American university are exponentially minute compared to the odds of him/her dying in a car crash during the drive to the airport.
 
Posted by OliviaG (# 9881) on :
 
quote:
Originally posted by Ethne Alba:
Because.......huge sigh here, don't want to upset the states friends.....over in the UK I think that something could have been done and that young man would have been stopped.

But I am Quite Possibly wrong.
Big Time.
Others with more knowledge than me will no doubt come along soon.
Hopefully not. I don't feel the need to be reminded of other school shootings in other countries, including the UK. It's enough to know they happen. [Frown]

On a slightly different angle, we know that Cho was bullied in middle and high school (and bullying has been an element in many other tragedies of this sort). Why are those bullies and those schools off the hook? They may have exacerbated his condition and made it harder for him to ask for help, and, as I've mentioned before, there were many more options available to his family and his community when he was a minor. There are probably more bullies in any educational institution (and not just among the student body) than there are mentally ill students. OliviaG
 
Posted by Chorister (# 473) on :
 
I read this sad story today which made me think about the role of parents in situations of risk. The student is treated as an adult which is good and proper (she was 22, not 18 years and 1 day which might have been more of a grey area) and she did express a wish that they should not be contacted.
 
Posted by Amorya (# 2652) on :
 
quote:
Originally posted by Ethne Alba:
Because.......huge sigh here, don't want to upset the states friends.....over in the UK I think that something could have been done and that young man would have been stopped.
No, nothing would have been done in a UK university.

The States actually have universities with more power in such situations I believe, due to lawsuits forcing them to act in loco parentis. In the UK, students are adults, so the parents can't be informed about behaviour without the student's permission. A university can't force someone to have mental health treatment, and they can't throw someone out for mental health issues due to discrimination risks. Not to mention the difficulty in spotting such things - most students aren't known by name by any of the staff except possibly their personal tutor.

The university isn't supposed to look after its students in that way. Students are adults -- the university doesn't have to do any more pastoral care than an employer would.

Amorya
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by OliviaG:
On a slightly different angle, we know that Cho was bullied in middle and high school (and bullying has been an element in many other tragedies of this sort). Why are those bullies and those schools off the hook?


I think it would be next to impossible to establish a causal relationship between their action or inaction and what Cho did. The fact is that many thousands of kids get bullied when they're in school. Lots of people on the Ship readily admit to having been bullied as kids. But most of them do NOT go on to commit violent crimes.

quote:
as I've mentioned before, there were many more options available to his family and his community when he was a minor.


In theory, yes. In reality, probably not. The schools are responsible for identifying and providing services for children with disabilities (including mental illness) only if the disability prevents the child from receiving a free and appropriate public education. And even then, if the necessary services are complex, expensive, involve the family, or affect the child's education indirectly, the school is likely to do nothing.

So that leaves it to the family. Who may not have had insurance. And if they had insurance, the insurance may not have covered mental illness. And if it did cover mental health, it may not have provided enough coverage to be meaningful.

And that's if the family was willing to acknowledge that their child was mentally ill. Because of the stigma attached to mental illness, they may have been in absolute denial (and have been facilitated in that denial by the schools, who wouldn't have wanted to provide the services he needed).

I know families who are desperately trying to get care for seriously mentally ill children. Often the only choice is giving up custody of the child to the state, allowing the child to be put in foster care, and hoping that the foster family and the state will provide the necessary care. That's not an option all families are willing to accept. And if they're thinking about it, they may end up reading something like this (worksafe, but not for the faint of heart), and change their mind.

The fact is, mental health care in this country is simply not available to most people, and the more serious the mental illness, the less likely it is that the person will be able to access care. Our system for providing mental health care is broken beyond repair. And sadly, I don't think we're going to get a new system any time soon.
 
Posted by Pastorgirl (# 12294) on :
 
Well said, Josephine. That is exactly the dilemma in this country.
 
Posted by Pastorgirl (# 12294) on :
 
quote:
In the UK, students are adults, so the parents can't be informed about behaviour without the student's permission. A university can't force someone to have mental health treatment, and they can't throw someone out for mental health issues due to discrimination risks.
All of this is true in the US as well.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Pastorgirl:
quote:
In the UK, students are adults, so the parents can't be informed about behaviour without the student's permission. A university can't force someone to have mental health treatment, and they can't throw someone out for mental health issues due to discrimination risks.
All of this is true in the US as well.
Actually, it's a bit murkier than that. FERPA prevents university officials from releasing anything but directory information to anyone. However, if the parent can demonstrate that they are financially supporting the student (basically, that the student still qualifies as a dependent for tax purposes), then the university can release information about grades, behavior, etc. to the parent. Staff can also share confidential information about the student with other staff members, as long as it's considered somehow necessary to the student's education, which leaves a certain amount of wiggle room. However, campus health and counseling services are not only bound by FERPA, but also by the standard doctor-patient privilege.

Which basically means that most parents can be informed of most everything that happens on campus (since most students are financial dependents) as long as it doesn't happen in the counseling center or student health center, and even then I think there may be exceptions. Practically speaking, since universities tend to encourage students to act as adults, they don't divulge information unless the parent asks (notable exception: automatic parental notification for certain alcohol violations).
 
Posted by Emma. (# 3571) on :
 
That is **quite** different from here then I think. Partly as the age you can buy alcohol is 18, so you are already considered an adult at 18 in all practical senses here. (why is it 21 over there? Is the USA age of adulthood 21 rather than 18 or just in the area of alcohol? Does that mean you can get married, vote, have several kids etc but not drink?). Grades wouldnt be released to parents at all. It really is just between student and uni. Under 18 though and its a different matter, with 16-18 being a blurred line.
 
Posted by Doublethink (# 1984) on :
 
quote:
Originally posted by Pastorgirl:
[qb] In the UK, students are adults, so the parents can't be informed about behaviour without the student's permission. A university can't force someone to have mental health treatment, and they can't throw someone out for mental health issues due to discrimination risks.[/b]
But they could

a) call a GP and ask for a mental health act assessment if they were really concerned (and the police can pick someone up for the same purpose and take them to a place of safety for assessment)

b) chuck the student for academic failure if they weren't meeting the demands of the course.

c) call the police if the student's behaviour was illegal - and in the UK that would include stalking, verbal aggression if it was intimidaitng enough, harrassment of other students, filming people without their permission would be borderline and of course if they thought he was carrying any kind of weapon. (Weapon being defined as anything you carry with that intent, and operationally defined as knife with blade over three inches, batons brass knucles or whatever.)

[ 28. June 2007, 22:26: Message edited by: Doublethink ]
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Jengie Jon
Believe it or not Moo the only way of knowing who to ask whether his behaviour is bizarre is surveillance or him telling who he has had fixations on.
No, they could have asked his roommates. This interview (which I linked to earlier) makes it clear how much his roommates knew about Cho's behavior. That's how I learned about the stalking.

If a student's behavior raises red flags, it is appropriate to interview the people he lives with, the people he takes classes with, the people he works with. I repeat, this should be done only if some aspect of the student's behavior indicates he could be a danger to himself or others.


Moo
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Emma.:
That is **quite** different from here then I think. Partly as the age you can buy alcohol is 18, so you are already considered an adult at 18 in all practical senses here. (why is it 21 over there? Is the USA age of adulthood 21 rather than 18 or just in the area of alcohol? Does that mean you can get married, vote, have several kids etc but not drink?). Grades wouldnt be released to parents at all. It really is just between student and uni. Under 18 though and its a different matter, with 16-18 being a blurred line.
Why is the drinking age 21? IIRC because Mothers Against Drunk Driving convinced the federal government that there would be fewer drunk driving fatalities if the drinking age were raised from 18 to 21, and the federal government pressured the states to raise the age to 21 by threatening to withhold highway funds. Yes, that does mean that you can do all sorts of things like vote and join the military but not purchase alcohol, as you're considered a legal adult at 18 for most purposes.

Not all universities have automatic parental notification for alcohol violations (and even if they do, it's often for only for certain alcohol violations, such as your third violation, or if you have to seek medical treatment for alcohol poisoning). It's not about the fact that underage drinking is illegal, it's about the fact that every year some student gets drunk and falls off a balcony or jumps out of a window and dies. If the parents of such a student could demonstrate that the university knew that a student had a problem with alcohol (they'd been cited for several alcohol violations) and had done nothing to address it, they could sue.

It's all about the lawsuits. (Oh, and the grades: 'Merican parents will not pay $25-50,000 per year for their kid to go to school and be told that they aren't allowed access to their kid's grades. They get annoyed enough when you tell them they have to sign something before you can talk about their kid's grades with them.)
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon

As for producing literature that is "disturbing" or violent, well after the fact , yes you can read something into it. But people like Stephen King or Quentin Tarantino, no doubt both eccentric in their own way, do not have "I am a future mass murderer" inscribed on their foreheads.
Cho's writings bore no resemblance to those of Stephen King. This website has the text of one of Cho's plays. His poems were equally disturbing.

Moo
 
Posted by Janine (# 3337) on :
 
quote:
Originally posted by Max.:
I've never seen anybody about it but I sometimes find myself in situations where I get depressed - only a couple of months ago I didn't actually leave my room for anything except food, occasional college classes and church services once a week because of depression.

Thankfully I had really good friends who were genuinely worried about me, forced me to get out a bit, stole my alcohol from me and in the end got me to confront my problems! I was acting like a major jerk, I was getting obsessed by really stupid little things in my life which weren't really important yet those little things still make me feel bad about myself and I suppose that I am still only a stones throw away from locking myself in my room once again and not communicating!

My college has no idea about what I went through, I think we have some kind of support unit but I don't know where it is and I doubt that when I was going through it all I would've actually made the effort to go and speak to them, much easier to lay in my bed watching DVDs, listening to Emo Rock and dying my hair strange colours!
Max., have you looked up places to get help during your better times, so you can be prepared if the bad times hit again?
 
Posted by welsh dragon (# 3249) on :
 
Well, Moo, the point I was making is that just because someone writes about disturbing subject matter it doesn't automatically mean they are a) mentally ill or b) dangerous to themselves or others. The point stands.
 
Posted by Amorya (# 2652) on :
 
quote:
Originally posted by saysay:
If the parents of such a student could demonstrate that the university knew that a student had a problem with alcohol (they'd been cited for several alcohol violations) and had done nothing to address it, they could sue.

It's all about the lawsuits. (Oh, and the grades: 'Merican parents will not pay $25-50,000 per year for their kid to go to school and be told that they aren't allowed access to their kid's grades. They get annoyed enough when you tell them they have to sign something before you can talk about their kid's grades with them.)
None of that would happen in England. Partly a different culture (parents here seldom contact the university about anything, in my experience, especially to talk about the kid's grades), and partly some very strict confidentiality rules.

BTW, I recall a case that was in the news recently, where the parents of a student who committed suicide sued their (American) university for not letting them know about the student's mental health problems. That's the sort of thing I'm talking about.

Amorya
 
Posted by Emma. (# 3571) on :
 
I wonder if that will change over here in the uk with higher fees and (some) parents paying towards them? It used to be that you could be independent at 18 with a govt grant....
 
Posted by Jengie Jon (# 273) on :
 
quote:
Originally posted by Moo:
quote:
Originally posted by Jengie Jon
Believe it or not Moo the only way of knowing who to ask whether his behaviour is bizarre is surveillance or him telling who he has had fixations on.
No, they could have asked his roommates. This interview (which I linked to earlier) makes it clear how much his roommates knew about Cho's behavior. That's how I learned about the stalking.

If a student's behavior raises red flags, it is appropriate to interview the people he lives with, the people he takes classes with, the people he works with. I repeat, this should be done only if some aspect of the student's behavior indicates he could be a danger to himself or others.


Moo
Yeh and if students are anything like the lot over here there is a good chance such a student will change "room" pretty frequently as situation breakdown and the finding of "room" mates will only be as good as University record, which was probably updated the last time he had to contact student services which could be as much as nine months ago.

When someone is notorious it is easy to find room mates, former room mates. When they are just an ordinary student the information is just as good as the people providing it, i.e. the students themselves. If they move and don't tell student services, how are student services expected to know?

Jengie
 
Posted by Duck (# 10181) on :
 
quote:
Originally posted by Ethne Alba:
Because.......huge sigh here, don't want to upset the states friends.....over in the UK I think that something could have been done and that young man would have been stopped.
I really doubt anything would have been picked up in the UK.
UK students are legally adults, we don't usually have room-mates, many students live off campus for part or all of their degree... I don't think there's much in the UK apart from gun control which would stop this happening here.

My younger brother has a diagnosis of Asperger's syndrome. He spends a lot of time alone in his room playing violent computer games, can dress & act in ways that can go from the merely unconventional to the worrying-to-strangers, doesn't socialise much with housemates or anyone else, and can come over as argumentative, combative, and confused. He spent his first year not turning up to any lectures or contact time at all. The university finally noticed when he was thrown out at the end of the year for not sitting any exams at all, but before that then none of this was picked up on. That's at an academically well-ranked UK university.
His current uni has been informed of his diagnosis (made since he left the last one), and being within the formal support system he's getting a bit more help. But if someone doesn't want to be picked up - or even doesn't go & camp outside the relevant office waving the right bits of paper & fill in the correct forms in quadruplicate - then no-one will notice & no-one will help.

I read the story Chorister linked to with interest. I think it misses an important point - that if the parents were to have been informed, the student may not have sought any help in the first place. It's already very difficult for students with mental health problems to seek appropriate help because of fears that this will impact on their family, course, or future prospects. Keeing things confidential may well save lives by allowing people to seek help at an earlier stage in in a less formal way.

quote:
Originally posted by Doublethink:
quote:
Originally posted by Pastorgirl:
In the UK, students are adults, so the parents can't be informed about behaviour without the student's permission. A university can't force someone to have mental health treatment, and they can't throw someone out for mental health issues due to discrimination risks.
But they could

a) call a GP and ask for a mental health act assessment if they were really concerned (and the police can pick someone up for the same purpose and take them to a place of safety for assessment)

Unlikely. Even if anyone in your department knows about & decides to make that call - and an academic supervisor won't have had any training in how to deal with this - you aren't likely to get a formal mental health act assessment just for the asking. Beisdes which, at some point 'confidentiality issues' will almost certainly be brought up. Unlikely to happen unless someone's actually waving a knife at the lecture theatre, IMO.

b) chuck the student for academic failure if they weren't meeting the demands of the course.

Doesn't help the student, & they don't have to tell anyone why things went so wrong

c) call the police if the student's behaviour was illegal - and in the UK that would include stalking, verbal aggression if it was intimidaitng enough, harrassment of other students, filming people without their permission would be borderline and of course if they thought he was carrying any kind of weapon. (Weapon being defined as anything you carry with that intent, and operationally defined as knife with blade over three inches, batons brass knucles or whatever.)

This is criminal law, not treatment, and surely by this time it's already gone too far. Departments are going to be reluctant to do this without an immediate threat, particularly in fields where a criminal record will effectively destroy future employment prospects (against a background of the increasing prevalence of CRB checks)

quote:
Originally posted by Moo:
If a student's behavior raises red flags, it is appropriate to interview the people he lives with, the people he takes classes with, the people he works with. I repeat, this should be done only if some aspect of the student's behavior indicates he could be a danger to himself or others.
Nice idea, but what 'red flags' in particular? Welsh Dragon explained earlier why harm is so difficult to predict - and would you really want to disclose details of a student's difficulties to their housemates, who they may not have chosen to live with, may not get on with, and are probably 18-21ish? I don't think this would encourage appropriate help-seeking.


I find this thread title rather threatening. 'Mentally ill students at universities' does not [just] refer to one person, who may or may not have had a diagnosable mental health problem, which may or may not have been the cause of his shooting a lot of people. Students with mental health problems mostly just want to get on with their degrees, the usual student activities, & the rest of life, & might need a bit more support to do that - same as Deaf or wheelchair-using students. If this thread was 'Asian students at universites' with an OP & much discussion about Cho, it would be similarly misleading (I'd guess at my uni there are more students with mental health problems than Asian students, so it would actually be more accurate here).

[code]

[ 29. June 2007, 18:39: Message edited by: Duck ]
 
Posted by OliviaG (# 9881) on :
 
quote:
Originally posted by Duck:
I read the story Chorister linked to with interest. I think it misses an important point - that if the parents were to have been informed, the student may not have sought any help in the first place. It's already very difficult for students with mental health problems to seek appropriate help because of fears that this will impact on their family, course, or future prospects. Keeing things confidential may well save lives by allowing people to seek help at an earlier stage in in a less formal way.
Having seen this situation from a number of angles, the student often has a very good reason for not wanting to contact the parents. To put it bluntly, sometimes the parents are part of the problem and the student may not have confidence they are ready to be part of the solution. [Frown] OliviaG
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Jengie Jon:
Yeh and if students are anything like the lot over here there is a good chance such a student will change "room" pretty frequently as situation breakdown and the finding of "room" mates will only be as good as University record, which was probably updated the last time he had to contact student services which could be as much as nine months ago.
{snip}
When they are just an ordinary student the information is just as good as the people providing it, i.e. the students themselves. If they move and don't tell student services, how are student services expected to know?
AFAIK, students are required to keep the university informed of their current local addresses. In any case, Cho was living in Tech dormitories at least from fall, 2005 until he did the shooting. The university knew where he lived and who his roomates were.

quote:
Originally posted by Duck
Nice idea, but what 'red flags' in particular? Welsh Dragon explained earlier why harm is so difficult to predict - and would you really want to disclose details of a student's difficulties to their housemates, who they may not have chosen to live with, may not get on with, and are probably 18-21ish? I don't think this would encourage appropriate help-seeking.
It is a fact that a distinguished faculty member threatened to resign unless he was removed from her class. It is also a fact that many women students said they refused to be in a classroom with him any more. I consider these to be red flags. (If you don't consider them to be red flags, do you think the university should allow one student to disrupt the education of quite a few others? I think it would have been appropriate to throw Cho out for interfering with the education of others.)

I did not suggest that the university disclose anything to Cho's roommates. I suggested that they be asked if any behavior of his disturbed or concerned them.

Moo
 
Posted by Pastorgirl (# 12294) on :
 
again, so they could do what? Their legal options were severely limited.
 
Posted by flickeringflame (# 12703) on :
 
This is the core problem in UK also. Mentally ill people seem to need to commit a criminal act before the wheels start rolling. Behaviour of an apparently mentally disturbed individual can "disturb" you - at that point it is of no real concern to the authorities.
 
Posted by welsh dragon (# 3249) on :
 
quote:
Originally posted by flickeringflame:
This is the core problem in UK also. Mentally ill people seem to need to commit a criminal act before the wheels start rolling. Behaviour of an apparently mentally disturbed individual can "disturb" you - at that point it is of no real concern to the authorities.
In fact, most of my patients have not committed a criminal act prior to being seen. Usually, they go and see their GP who makes a referral.
It is quite a straightforward process.

If someone really doesn't want to be seen, they may get as far as having an assessment for commital under the Mental Health Act before they see a mental health professional. This is because people have civil rights, and the threshold for forcing someone to be assessed or receive treatment is, appropriately, very high (just think about this one).

All sorts of people can act in a way that "disturbs" you. That particular criterion is a bit subjective, isn't it?

Neither does one have to have a mental illness to have a problem getting on with one's professor, and so on. We cannot be sure that, if Cho had had a mental health assassment, he would have received a diagnosis of a treatable mental illness. It is all conjecture and after the fact assumption.

Of course, what happened in Virginia was awful. But I see no reason for automatically assuming that it should have been prevented by either the University or local Mental Health authorities.
 
Posted by Arabella Purity Winterbottom (# 3434) on :
 
quote:
Originally posted by Josephine:
I do wonder, though, about the schools he attended in elementary school and high school. Under IDEA (the Individuals with Disabilities in Education Act), schools have an obligation to identify students with disabilities (including mental illness), to determine whether the disability is interfering with the child's ability to acquire a free and appropriate public education, and to provide specially designed instruction, related services, and supports so that the child can receive such an education.
This is the subject of my dissertation, specifically looking at high school students. In NZ, no funding is provided to support students who develop mental illesses. If you have a lifelong disability or an allergy to peanuts, you can get funding and staff get training. Develop a mental illness and the student (and the school) is left hanging in the air. This doesn't gel with the curriculum statements at all, guaranteeing equitable access to education. A student with a lifelong disability will probably have learned coping strategies by the time they start high school - they'll know the drill as far as looking after themselves. The onset of a serious mental illness in adolescence disrupts the student's life far more, and certainly leaves the school searching for options.

It is my observation that it is often down to individual members of staff, who usually don't have training in dealing with mental illness of any kind, to care for these students. They do it out of the goodness of their own hearts, but the outcomes are not always ideal, as it can involve considerable boundary crossing and dual relationships. I'm not talking about sexual boundary crossing or relationships, but the damage it can do to the teacher-student relationship - the reason the student is at school in the first place.

Sectioning refers to the use of section 11 of the Mental Health Act 1985 (in NZ, anyway) to involuntarily commit someone to psychiatric treatment. In NZ this can either be for residential treatment, or more likely these days, for community treatment. It involves rather a lot of paperwork and has to be reviewed regularly - depending on the nature of the sectioning, between fortnightly and monthly.
 
Posted by Ethne Alba (# 5804) on :
 
just so I get this one right.......
So lots of students go to The Authorities at a uni ( in whatever country) and say
We're worried,
We're disturbed by this fellow student,
This other student frightens us,
then
Nothing is done?
And that's OK?
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon
Neither does one have to have a mental illness to have a problem getting on with one's professor, and so on. We cannot be sure that, if Cho had had a mental health assassment, he would have received a diagnosis of a treatable mental illness. It is all conjecture and after the fact assumption.
He did have a mental health assessment in December, 2005. He was adjudged to be a danger to himself, and the court ordered outpatient psychotherapy. He was referred to the Virginia Tech mental health service, which does not accept court referrals because they have no means of enforcing them.

The English department head, who knew of Cho's disruptive behavior in class, almost certainly had no way of knowing this.

One thing I wanted to discuss when I started this thread was that different people at the university had different bits of information. It was neve put together. If it had been, thirty-three people, including Cho, would probably be alive.

Moo

[ 30. June 2007, 10:59: Message edited by: Moo ]
 
Posted by Chorister (# 473) on :
 
I read that as 'having a problem getting off with one's professor'. Need to get my eyes tested.

I see a link here between joined up thinking in the case of severe mental illness and joined up thinking in the case of muslim extremists possibly operating on campus (big news recently in the UK when lecturers were asked to inform on them). How far does one extend the right to adults (for that is what they are) being given due entitlement to their civil liberties and not being reported to a central establishment for official action, and the civil liberties of all those other adults also studying there whose health, welfare and sometimes lives are put at risk by respecting the freedom of an individual causing concern.
 
Posted by Pastorgirl (# 12294) on :
 
quote:
He was referred to the Virginia Tech mental health service, which does not accept court referrals because they have no means of enforcing them.
Again-- that's the key point. They had no legal way to compel treatment, no matter how many people were concerned.


quote:
The English department head, who knew of Cho's disruptive behavior in class, almost certainly had no way of knowing this.

One thing I wanted to discuss when I started this thread was that different people at the university had different bits of information. It was neve put together. If it had been, thirty-three people, including Cho, would probably be alive.
This is a good point, and certainly one of the lessons we learned (or whould have learned) from 9/11. But I'm not sure it would have made a difference in this particular case w/o some sort of legal means to compel treatment.
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by Moo:
He did have a mental health assessment in December, 2005. He was adjudged to be a danger to himself, and the court ordered outpatient psychotherapy. He was referred to the Virginia Tech mental health service, which does not accept court referrals because they have no means of enforcing them.
The problem is not anything to do with the university, then, but with the lack of any coherent system of mental health care in this country. The judge ordered something that did not exist, based (presumably) on the recommendation from the mental health professionals that evaluated Cho. Either their recommendation was faulty, or the judge misunderstood it or disregarded it.

Again, the problem wasn't the university. It was that Cho did not get the treatment he needed. If he was so ill that it was judged he wasn't competent to decide whether or not he needed treatment -- if he was found incompetent to make his own medical decisions -- then it's hard to imagine that he was competent to manage his own outpatient therapy. He should not have been ordered into outpatient therapy, but inpatient.

But inpatient care is expensive, and often there are simply not beds available. Maybe there was simply no facility that could provide inpatient care, so the outpatient was ordered as a stopgap? The problem with that, of course, is that no one can enforce outpatient care. But the judge could have appointed a guardian for healthcare for Cho, and made the guardian responsible for making the appointments and seeing to it that Cho went, and reporting to the judge if he didn't. The guardian couldn't enforce the order, but he could let the judge know if the order were being violated.

Instead of talking about how universities could better supervise their adult students, if we want to keep this sort of thing from happening in the future, we need to be talking about how mental health care is provided in this country, or rather about why it's not being provided to those who need it, and how that can be changed.

Having university staff ask students about the behavior of their roommate is not going to fix the problem. The university system isn't what's broken. Asking your state legislators to make mental health care a priority in the state budget, to provide adequate funding for a range of care, and to provide supervision and support to those who need it -- that would address the real problem.
 
Posted by Jengie Jon (# 273) on :
 
[Overused] Josephine

Jengie
 
Posted by Pastorgirl (# 12294) on :
 
quote:
Instead of talking about how universities could better supervise their adult students, if we want to keep this sort of thing from happening in the future, we need to be talking about how mental health care is provided in this country, or rather about why it's not being provided to those who need it, and how that can be changed.
Bingo.
 
Posted by AverageGuyOnTheStreet (# 12501) on :
 
I've never been a risk to anyone other than myself so my experience is probably not relevant to this topic but I have some experience with mental health services at uni (I was diagnosed with depression just before I dropped out).

The biggest issue I had with the counselling services was that I went onto the waiting list in early March and was on for many weeks longer than I was told I would get an appointment by. I had to get bumped up the list because I had got so bad whilst I was waiting. Then the senior tutor at my uni found out that I was feeling suicidal so I was sent home (I don't have a great relationship with my parents so I was living with friends, who happened to be students). I understand his decision but I had just started being able to get help when I was completely uprooted and also my only source of support was my closest friends.

This situation is around in the community too, so it is not a problem I have with university mental health services as such but mental health services in general. I'm back on waiting lists.

What really annoys me though is none of this (though I do feel a little ignored, despite my history), but the way that the media has a tendency to blow things out of all proportion. I feel that the message they are trying to get across is that all mentally ill people are psychotic mass murderers. That is not true, far more are either only a risk to themselves or not a risk to anyone. I agree that some people are a risk to others but it is the exception rather than the norm.
 
Posted by welsh dragon (# 3249) on :
 
I am puzzled by the involvement of the judge. Had Cho been convicted of a crime then? I don't understand...it sounds completely different from anything I've seen in the UK. I've seen people sectioned to hospital, but the only circumstances I've heard of where someone is compelled to undergo therapy is when a crime has already been committed.

As far as the inadequacies of mental health or indeed other health services are concerned, there is a major funding issue. If people wanted to pay more taxes to fund health services, it would be possible to have increased availability of counseling, therapy and so on. There has been an increase in funding for health services generally in the UK, but proportionately less has gone to mental health than other healthcare specialities.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Ethne Alba:
just so I get this one right.......
So lots of students go to The Authorities at a uni ( in whatever country) and say
We're worried,
We're disturbed by this fellow student,
This other student frightens us,
then
Nothing is done?
And that's OK?
Not quite. Part of the problem that (I think) Moo is getting at is that universities don't have a clearly defined "The Authorities." So Cho's roommates, professors, and the campus police may all have independently received complaints about his behavior, but there wasn't anyone who could put them together and actually do something about Cho's behavior. Although Josephine is also right in that the lack of mental health care in this country may very well have prevented anyone from doing anything particularly useful at all.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon:
I am puzzled by the involvement of the judge. Had Cho been convicted of a crime then? I don't understand...it sounds completely different from anything I've seen in the UK. I've seen people sectioned to hospital, but the only circumstances I've heard of where someone is compelled to undergo therapy is when a crime has already been committed.
In Virginia an involuntary commitment to a mental facility can be made only by a judge. I have the impression that the process you call "sectioning" achieves the same result.

Moo
 
Posted by Doublethink (# 1984) on :
 
True, but it is done by two doctors and a social worker. The social worker being seen as independent of the medical professionals. Individuals who have been sectioned have the right of appeal, and can employ legal counsel to do so.

If I have it right, the police can pick up someone who is behaving in such a way they appear unsafe - e.g. walking naked down the street and apparently responding to voices noone else can hear - but they then have to arrange an immediate medical evaluation.

People who have been voluntrialy admitted can be detain on a nurses holding power for 5 hours or a doctors holding power for a day - to arrange a section assessment basically - if they pose a threat to themselves or others.

Then there are 72 hour, 28 days and upto six month dententions under the mental health act.

There are also forensic sections but those are different - person would have committed a criminal act, and might well involve a court order. (So if Cho had survived in the UK he might then have been sectioned into a secure hospital like Broadmoor, though there would have been a massive argument about capacity and intent at trial.)
 
Posted by welsh dragon (# 3249) on :
 
So he'd had a mental health assessment, and actually been "sectioned". (Presumably it wasn't the judge doing the assessment then).

So did he have a diagnosis? In the UK, someone being sectioned for treatment would usually go to hospital first off for a full assessment - on the 28 day order. They might be given treatment over this time, probably medication predominantly at first. If they were thought to need further treatment then the 6 month order might be put in place. Psychological input usually follows after (partly because it is more effective when the person has stabilised a bit, partly because of waiting list times), although there is often some degree of psychological input on acute wards.

The major problem doesn't now seem to be that the mental health services and legal system were unaware of a possible problem with Cho. The problem might be instead that having identified the problem, there was not sufficient resource to assess and treat (this is conjectural obviously cos I don't know the details of the case).

I still don't think it would be practical to put troubled university students under the surveillance of their peers. But it might be that your healthcare system needs to be empowered to take better care of people with mental illnesses. (I'd say the same about ours as well, mind). I don't have great in-depth knowledge of the US healthcare sytem, but I do remember that when the Clintons wanted to institute healthcare reforms they met a very high level of opposition. People didn't want their money (and taxes) organised in that way. Neither do people want tougher gun laws - and I have a vague memory of the current President making just this point very early on in the press exposure of the Cho case.

Well, you pays your money and you takes your choice, IMO.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon
I still don't think it would be practical to put troubled university students under the surveillance of their peers.
As I have already said twice, I don't either. One of Cho's roommates reported him to someone when he said he might as well kill himself. This is why he was referred to the mental health system in the first place. I am sure that roommate did the right thing, and I presume you agree.

It's as if a student found one of his roommates unconscious for no apparent reason. It would be negligence not to get help for him.

Moo
 
Posted by Pastorgirl (# 12294) on :
 
quote:
But it might be that your healthcare system needs to be empowered to take better care of people with mental illnesses.
Bingo-- as we've been saying all along.
 
Posted by Fauja (# 2054) on :
 
quote:
Originally posted by Pastorgirl:
quote:
But it might be that your healthcare system needs to be empowered to take better care of people with mental illnesses.
Bingo-- as we've been saying all along.
Better still if everyone was more aware of mental illnesses, stopped stigmatising people who suffer from them, and actually cared about them instead of judging them and keeping them at arms length. A very large proportion of students suffer from some forms of mental illnesses either temporarily or long-term and these problems can be aggravated by loneliness and the stress that comes with feeling pressured to perform well.
 
Posted by AverageGuyOnTheStreet (# 12501) on :
 
quote:
Originally posted by Fauja:
quote:
Originally posted by Pastorgirl:
quote:
But it might be that your healthcare system needs to be empowered to take better care of people with mental illnesses.
Bingo-- as we've been saying all along.
Better still if everyone was more aware of mental illnesses, stopped stigmatising people who suffer from them, and actually cared about them instead of judging them and keeping them at arms length. A very large proportion of students suffer from some forms of mental illnesses either temporarily or long-term and these problems can be aggravated by loneliness and the stress that comes with feeling pressured to perform well.
I agree completely. [Overused]
 
Posted by Pastorgirl (# 12294) on :
 
As do I, although I'm not sure I'd say "better still." Even when people are very aware of mental illness, compassionate and well-meaning and don't hold people at a distance, it doesn't help all that much if there is no health care available to them. In this case, quite a few people seemed to be quite concerned about Cho, but lacked the legal or other ability to do anything substantive to help him.

In reality, it shouldn't be an either/or proposition. We should indeed be better educated, not isolate or stigmatize mental illness. And we should have adequate funding for mental health care. And we should have legal systems that balance better the need for autonomy and the need to protect the most vulnerable among us, sometimes even from themselves.
 
Posted by Fauja (# 2054) on :
 
quote:
Originally posted by Pastorgirl:
As do I, although I'm not sure I'd say "better still."
Yes, sorry, I meant as well as not instead.

quote:
We should indeed be better educated, not isolate or stigmatize mental illness.
I don't claim to be an expert on mental illness and I don't feel particularly obliged to learn a great deal more either, although I would hope I would be willing to listen and learn from someone talking about their own experiences of suffering from mental illness. One thing I do know is that there are many different types of mental illness and plenty of sufferers are good citizens who are no more likely to harm someone than anyone else.

Unfortunately, there are Cho's in this world who don't take personal responsibilty for their own actions and are quite likely to do whatever they do irrespective of whether or not they are allowed to continue their studies. What would have stopped Cho from committing mass genocide in a busy shopping centre? Better gun controls? I'm not sure, but I am convinced that prevention is better than cure; better to get to the root of the problem that prompts the urge to kill other people than to simply remove the means by which people can be killed.
 
Posted by Pastorgirl (# 12294) on :
 
quote:
Unfortunately, there are Cho's in this world who don't take personal responsibilty for their own actions and are quite likely to do whatever they do irrespective of whether or not they are allowed to continue their studies.
I suspect (although no way to know for sure after the fact) that Cho was incapable of taking personal responsibility for his actions, making it all the more tragic that the system let him down.
 
Posted by Duck (# 10181) on :
 
quote:
Originally posted by Chorister:
I read that as 'having a problem getting off with one's professor'. Need to get my eyes tested.

I see a link here between joined up thinking in the case of severe mental illness and joined up thinking in the case of muslim extremists possibly operating on campus (big news recently in the UK when lecturers were asked to inform on them). How far does one extend the right to adults (for that is what they are) being given due entitlement to their civil liberties and not being reported to a central establishment for official action, and the civil liberties of all those other adults also studying there whose health, welfare and sometimes lives are put at risk by respecting the freedom of an individual causing concern.
Good comparison. I see using compulsion for anyone not already covered by the Mental Health Act (or local equivalent) as analogous to demanding that every single student declaring any faith affiliation be ordered to be report to a police station weekly for interrogation. It would be about as therapeutic to the students, about as helpful in establishing the sort of trust which makes reporting real problems possible, and the 'number needed to treat' ratio would probably be comparable.
My right to not be caught in drunken fights is counterbalanced by the right of my fellow students to drink alcohol. My right to ride my bike on campus has to be balanced with the right of other sudents not to be squashed. It's the sort of calculation people make all the time. Sometimes the odds get reconsidered, as with the new English smoking ban [Smile] but I think any attempt at surveillance comprehensive enough to pick up the next 'Cho' would be completely unbalanced in view of the risks involved.

quote:
Originally posted by AverageGuyOnTheStreet:
I've never been a risk to anyone other than myself so my experience is probably not relevant to this topic [...]
No, it's much more relevant to a thread called 'Mentally Ill Students at Universities' than discussion of Cho.
I've never been a danger to other people either.

It is actually very difficult for concerned friends to get help for someone who is mentally ill to the point that they are a serious suicide risk or not able to minimally look after themselves. It's difficult to get inpatient treatment until someone's actually made a suicide attempt (and often not even then). If you aren't a 'next of kin' you can't ask or be told much, even if you are the primary carer and next of kin are far away knowing nothing (not uncommon for students). It's frightening sometimes to have a friend you know is dangerously ill & needs help & there just isn't anything there even when you do ask for it and they'd accept it. I haven't tried to seek help for someone who was a risk to others - don't know if it would be any better then. But before getting anywhere near compulsion, we need decent voluntary mental health services.
 
Posted by Duck (# 10181) on :
 
quote:
Originally posted by Moo:
He did have a mental health assessment in December, 2005. He was adjudged to be a danger to himself, and the court ordered outpatient psychotherapy. [...]

One thing I wanted to discuss when I started this thread was that different people at the university had different bits of information. It was neve put together. If it had been, thirty-three people, including Cho, would probably be alive.

Moo
As Welsh Dragon explained, predicting a rare event isn't really possible. Putting together some danger to self + antisocial behaviour could probably describe a lot of people. It would be A Good Thing if they could be offered help, but to go any further you would have to impose coercive 'treatment', surveillance, imprisonment...? on very many people who haven't done more than low-level antisocial behaviour. Even if this was feasible, I don't think it would be desirable.
 
Posted by Duck (# 10181) on :
 
quote:
Originally posted by Moo:
quote:
Originally posted by Jengie Jon:
Yeh and if students are anything like the lot over here there is a good chance such a student will change "room" pretty frequently as situation breakdown and the finding of "room" mates will only be as good as University record, which was probably updated the last time he had to contact student services which could be as much as nine months ago.
{snip}
When they are just an ordinary student the information is just as good as the people providing it, i.e. the students themselves. If they move and don't tell student services, how are student services expected to know?
AFAIK, students are required to keep the university informed of their current local addresses. In any case, Cho was living in Tech dormitories at least from fall, 2005 until he did the shooting. The university knew where he lived and who his roomates were.

quote:
Originally posted by Duck
Nice idea, but what 'red flags' in particular? Welsh Dragon explained earlier why harm is so difficult to predict - and would you really want to disclose details of a student's difficulties to their housemates, who they may not have chosen to live with, may not get on with, and are probably 18-21ish? I don't think this would encourage appropriate help-seeking.
It is a fact that a distinguished faculty member threatened to resign unless he was removed from her class. It is also a fact that many women students said they refused to be in a classroom with him any more. I consider these to be red flags. (If you don't consider them to be red flags, do you think the university should allow one student to disrupt the education of quite a few others? I think it would have been appropriate to throw Cho out for interfering with the education of others.)

I did not suggest that the university disclose anything to Cho's roommates. I suggested that they be asked if any behavior of his disturbed or concerned them.

Moo

 
Posted by Duck (# 10181) on :
 
[Sorry - didn't mean to post in bits! How did it do that?]
 
Posted by Jengie Jon (# 273) on :
 
Moo

"Required" and "Does" are two different verbs. Yes students are "required" which actually means every time they contact student services their address is checked.

"Does" is another matter and that only happens if a student is willing to inform. A student who moves many times between contacting student service is unlikely to have an up to date address on the register.

Universities have no enforcement power on this one for a student who might not wish student services to know where they are. Sorry to disillusion you.

Jengie
 
Posted by welsh dragon (# 3249) on :
 
1.
quote:
Originally posted by Pastorgirl:
I suspect (although no way to know for sure after the fact) that Cho was incapable of taking personal responsibility for his actions, making it all the more tragic that the system let him down.
It depends what you mean by "incapable of taking responsibility". In the UK, the criteria are pretty stringent. That is, if you think that you are surrounded by aliens (because you are a deluded schizophrenic) and you then shoot people, thinking they are aliens, you would be seen as not responsible. Was Cho psychotic? In my limited knowledge of this case, no evidence has been presented to suggest that.

If you are severely learning disabled say, and hurt someone, you might be seen as not capable of understanding what you are doing. But Cho wasn't.

Also, if one had a disease of a physical nature, such as diabetes with a very high blood sugar level, so the balance of one's mind was impaired, one might not be culpable under the law if one's actions were deranged because of a physical illness. But there's no suggestion Cho was physically ill.

Even if someone has an illness like schizophrenia, it would be very unusual if in report writing they would be deemed as not responsible for violent acts, unless they are deluded to the extent described above.

Why specifically do you suppose Cho was not responsible?


quote:
Originally posted by me:
But it might be that your healthcare system needs to be empowered to take better care of people with mental illnesses
quote:
Originally posted by Pastorgirl:
Bingo-- as we've been saying all along.
I don't remember anyone else on this thread discussing the tax-to-financing of mental health care, and I can't find it on looking, but I'm glad you share my socialist approach!
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Jengie Jon:
Required" and "Does" are two different verbs. Yes students are "required" which actually means every time they contact student services their address is checked.

"Does" is another matter and that only happens if a student is willing to inform. A student who moves many times between contacting student service is unlikely to have an up to date address on the register.

Universities have no enforcement power on this one for a student who might not wish student services to know where they are. Sorry to disillusion you.
I live in the town where Virginia Tech is located, and I know for a fact that most students live in the same place for at least an entire semester.

ETA: I gather things are different in Britain.

Moo

[ 03. July 2007, 22:44: Message edited by: Moo ]
 
Posted by OliviaG (# 9881) on :
 
quote:
Originally posted by Moo:
I live in the town where Virginia Tech is located, and I know for a fact that most students live in the same place for at least an entire semester.
IME, most students move several times during the course of their studies, sometimes as many as 2-3 times in a calendar year. More and more services - yes, including teaching and advising - are provided via e-mail and web applications. Snail mail - i.e. a home address - is pretty much obsolete at many institutions. OliviaG
 
Posted by Moo (# 107) on :
 
In Blacksburg, the students who live in univeristy dorms sign a housing contract for the semester.

Almost all landlords for rental housing in the town require a lease which runs the length of the semester.

Under the circumstances, anyone who moves will incur a lot of extra expense.

Bear in mind that there are more than twice as many students in this town as there are year-round residents. This may make for an unusual housing situation.

Moo

Moo
 
Posted by flickeringflame (# 12703) on :
 
In fact, most of my patients have not committed a criminal act prior to being seen. Usually, they go and see their GP who makes a referral.
It is quite a straightforward process.

If someone really doesn't want to be seen, they may get as far as having an assessment for commital under the Mental Health Act before they see a mental health professional. This is because people have civil rights, and the threshold for forcing someone to be assessed or receive treatment is, appropriately, very high (just think about this one).

[ 04. July 2007, 00:09: Message edited by: flickeringflame ]
 
Posted by flickeringflame (# 12703) on :
 
quote:
Originally posted by flickeringflame:
In fact, most of my patients have not committed a criminal act prior to being seen. Usually, they go and see their GP who makes a referral.
It is quite a straightforward process.

If someone really doesn't want to be seen, they may get as far as having an assessment for commital under the Mental Health Act before they see a mental health professional. This is because people have civil rights, and the threshold for forcing someone to be assessed or receive treatment is, appropriately, very high (just think about this one).
I don't have to "just think about this one". I know. And it ISN'T a straightforward process in the UK. If you say that, I think you don't have much experience of what it is actually like to deal with a mentally deranged person.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Jengie Jon:
Universities have no enforcement power on this one for a student who might not wish student services to know where they are. Sorry to disillusion you.
This isn't true in the US. Cho lived on campus, in campus housing, which means that not only did the university know where he lived (they assigned him the space), but also that he couldn't have moved rooms without the university knowing/ approving of the move.

Students who live off-campus are required to supply the university with a valid address. "Address holds" (restrictions on a student's account which prevent them from doing certain things until they confirm/provide a valid address) are fairly common at some universities. Could a student who was planning something devious provide the university with something that seemed like a valid address, and would it take the university a while to realize this? Yes. But it's not the normal state of things.

I've never contacted room-mates to check on a particular student's behavior, but I have chased down students (sometimes students in a different school/college at the same university) because their room-mates were concerned about them.
 
Posted by welsh dragon (# 3249) on :
 
quote:
Originally posted by flickeringflame:
quote:
Originally posted by flickeringflame:
In fact, most of my patients have not committed a criminal act prior to being seen. Usually, they go and see their GP who makes a referral.
It is quite a straightforward process.

If someone really doesn't want to be seen, they may get as far as having an assessment for commital under the Mental Health Act before they see a mental health professional. This is because people have civil rights, and the threshold for forcing someone to be assessed or receive treatment is, appropriately, very high (just think about this one).
I don't have to "just think about this one". I know. And it ISN'T a straightforward process in the UK.
The point I was making is that there is a big difference whether the ill person themself wants to get help, or whether they don't want that help.

If someone sees their GP asking for help, and their GP thinks they are ill, a doctor-to-doctor referral will get them an appointment within 8 weeks and possibly much sooner. From where I'm sitting, that looks quite straightforward.

Now, if someone doesn't want help, or if the real problem is that they are taking lots of booze or drugs, or if they don't actually have a treatable mental illness, or if they have some variant on a personality disorder or a major attitude problem then, yes, it would get more complicated than that. But someone with schizophrenia or severe depression who needs assessment and drug treatment can get help very quickly, if they need it quickly, by going to their GP, at least in the areas where I've worked.
 
Posted by Newman's Own (# 420) on :
 
I've found this to be quite an interesting thread - as one example, I found the contribution by welsh dragon quite thought provoking.

"Mental illness" is a very wide term, most certainly. I can recall Ship mates, of university age (among others), referring to periods of severe depression and the like - but this hardly makes them dangerous. Most schizophrenics are not dangerous, to take an extreme case, though how they would fare in a university environment I cannot know.

I can see potential for innocent people (known to have any sort of mental illness) being misjudged and possibly detained and so forth - not because they have been dangerous, but because of others' fears. (Sad to say, I've known clergy who won't have anything to do with even those who have had depression, because they so fear that the person will commit suicide, develop an undue attachment to them, or otherwise 'interfere with their treatment.' Balderdash, most of the time! It's a fear of mental illness, full stop.)

There certainly are people with mental problems (I am remembering a few kids I taught) who are no danger to others, but who might have panic attacks, outbursts, times of coming out with a stream of foul language, or otherwise broadly anti social actions. Often, it is provoked by panic and fear, not a desire to be violent. Yet, judging from what I've seen in some online articles, they can be classed as 'violent' for shouting during an attack of anxiety and therefore being guilty of 'verbal assault.' It only takes fear on the part of others - everyone wanting to shout for the police or ambulance.

Someone I know works in an outpatient mental health facility. Those who are in psychotherapy there often do not have the (previously helpful) opportunity to shout and express pain - security guards are running to the office the minute anyone raises his voice.

In my (limited and regrettable) experience of having some dealings with violent criminals, I could not help but notice that the genuine sociopaths often appear to be engaging, charming people. One can know them casually for months or years and may have no suspicion of their very dark side (until they talk of some of the things they have done, without batting an eye.) I could see a genuine sociopath going totally undetected, and some unfortunate student who has an outburst from depression or anxiety being considered 'dangerous.'
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by OliviaG:
IME, most students move several times during the course of their studies, sometimes as many as 2-3 times in a calendar year. More and more services - yes, including teaching and advising - are provided via e-mail and web applications. Snail mail - i.e. a home address - is pretty much obsolete at many institutions. OliviaG
I suspect that you are describing students at universities in large cities. In Blacksburg the apartment buildings are occupied almost entirely by students. They are usually full. It is rare for students to move during a semester; for one thing it's not that easy to find a satisfactory place to live when everyone else is settled in.

quote:
Originally posted by saysay
This isn't true in the US. Cho lived on campus, in campus housing, which means that not only did the university know where he lived (they assigned him the space), but also that he couldn't have moved rooms without the university knowing/ approving of the move.
Not only did the university know where Cho lived, they also knew who his roommates were. It was one of his roommates who reported that Cho was suicidal.

I know this contravenes Cho's privacy rights, butI think that if those roommates had been questioned, Cho would have been committed. Cho said he might as well kill himself after one of his roommates had told him he had to stop stalking a woman who lived down the hall. The woman was frightened and told the roommate.

The psychologist who evaluated Cho did not know that he had stalked a woman, that he surreptitiously photographed women's legs, and that some women refused to be in the classroom with him. I think if he had known these things he would not have decided that outpatient treatment was best. Several people on this thread have assumed that Cho was not committed because there was no space for him. This may be true, but there is no evidence for it. The psychologist may somply have thought that the university was a better environment for Cho than a mental hospital. When the governor's commission makes its report we will have the answer to this and many other questions.

I realize that what I have said suggests that Cho's right to privacy should have been put aside. I think that his right to life should have had higher priority. I fully understand the implications of what I am saying.

Moo

[ 04. July 2007, 13:13: Message edited by: Moo ]
 
Posted by Josephine (# 3899) on :
 
For those interested, this page provides a summary of the laws regarding involuntary outpatient commitment of most of the 50 states. (I didn't know that involuntary outpatient commitment was even a possibility!)

In Virginia, it appears that, when Cho did not comply with the outpatient commitment, there should have been another hearing, and he should have been transferred to an inpatient commitment. However, unlike some other states, the Virginia law apparently doesn't specify who has to notify the court of the noncompliance. That's a legal loophole that ought to be closed, I would think.
 
Posted by Duck (# 10181) on :
 
quote:
[...]
I realize that what I have said suggests that Cho's right to privacy should have been put aside. I think that his right to life should have had higher priority. I fully understand the implications of what I am saying.

Moo [/QB]
It's not just 'Cho's' right to privacy. It's the hundreds of thousands of other students who would be caught up (see Welsh Dragon's earlier post about the difficulty of accurate prediction).
If it's routine for every student who admits to mental health problems to be cross-checked with academic departments, people they live with, etc etc, then people who need help won't come forward for treatment, & the costs & risks of mental ill-health will be greater.

Incidentally, even if I tell my uni what my new address is every year, they still aren't very good at keeping track of it - never mind trying to 'hide', administrative inefficiency means it's unlikely that a fully accurate record could be maintained for students who aren't actually living in university-owned accomodation.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Duck:
]It's not just 'Cho's' right to privacy. It's the hundreds of thousands of other students who would be caught up (see Welsh Dragon's earlier post about the difficulty of accurate prediction).
If it's routine for every student who admits to mental health problems to be cross-checked with academic departments, people they live with, etc etc, then people who need help won't come forward for treatment, & the costs & risks of mental ill-health will be greater.
Cho did not admit to mental health problems. He was reported by someone else to be suicidal. Since he did not admit to mental health problems, I cannot see why those who do admit to having problems should be deterred from seeking help.

quote:
Incidentally, even if I tell my uni what my new address is every year, they still aren't very good at keeping track of it - never mind trying to 'hide', administrative inefficiency means it's unlikely that a fully accurate record could be maintained for students who aren't actually living in university-owned accomodation.
I note that you are in Britain. In the US universities do not find it so difficult to keep track of where their students live. This post of saysay's confirms my statement.

Moo
 
Posted by Duck (# 10181) on :
 
quote:
Originally posted by Moo:
quote:
Originally posted by Duck:
]It's not just 'Cho's' right to privacy. It's the hundreds of thousands of other students who would be caught up (see Welsh Dragon's earlier post about the difficulty of accurate prediction).
If it's routine for every student who admits to mental health problems to be cross-checked with academic departments, people they live with, etc etc, then people who need help won't come forward for treatment, & the costs & risks of mental ill-health will be greater.
Cho did not admit to mental health problems. He was reported by someone else to be suicidal. Since he did not admit to mental health problems, I cannot see why those who do admit to having problems should be deterred from seeking help.

[...]

Moo
So he did admit to mental health problems, but to another student, rather than a health worker or university staff. IME most students will turn initially to friends, rather than health services, & might need encouragment to use formal sevices.
If fellow-students know that there will be adverse consequences from contacting health professionals or the university (contact with department, questioning other students, etc) that will make them less likely to encourage people who need it to seek help. I'd think twice about pushing a friend to see their GP if I knew that this would lead to questions being asked at their academic department.

I don't know how US systems work, but in the UK then health care on campus is provided by the NHS. Though we've a doctor's surgery in the university grounds, no-one there is employed by the university - they just rent the premises. Student's NHS health records are kept separately from their university files. I can sign a release allowing my GP to give information to the university (for example where health affects an exam performance) but that involves the GP physically posting a bit of paper to whatever academic I give the name of, same as any employer. Sharing information would mean joining the University's files to those of the whole NHS, which would be technically & legally very difficult if not impossible. I can't really see how it would work in practice over here - don't know enough about the US to say.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Duck:
So he did admit to mental health problems, but to another student, rather than a health worker or university staff. IME most students will turn initially to friends, rather than health services, & might need encouragment to use formal sevices.
I'm not sure what you mean when you say he admitted to mental health problems to another student.

If you are thinking of his statement, "I might as well kill myself.", I don't see that as an awareness of mental health problems. He didn't think that he had problems. He thought that the problem lay outside himself.

Earlier on this thread I asked a question that no one has answered. If a roommate finds a student unconscious for no apparent reason, he will quite properly get help for that student. Is it wrong for the doctors to question the roommate about what the student had been doing lately? The doctor wants the information to help him make a diagnosis. I believe that when someone's behavior results in involuntary commitment, the doctors should get all the information they can.

quote:
I don't know how US systems work, but in the UK then health care on campus is provided by the NHS. Though we've a doctor's surgery in the university grounds, no-one there is employed by the university - they just rent the premises. Student's NHS health records are kept separately from their university files.
Cho's mental assessment was not done by the university health service. It was done by the state department of mental services to determine whether Cho was dangerous. The information that he had been stalking a young woman would have been highly relevant to this assessment.

Moo
 
Posted by ken (# 2460) on :
 
quote:
Originally posted by Moo:
If you are thinking of his statement, "I might as well kill myself.", I don't see that as an awareness of mental health problems. He didn't think that he had problems.
If you locked people up for saying thigns like that that then ten percent of the studednts in London would be in the looney-bin.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by ken:
quote:
Originally posted by Moo:
If you are thinking of his statement, "I might as well kill myself.", I don't see that as an awareness of mental health problems. He didn't think that he had problems.
If you locked people up for saying thigns like that that then ten percent of the studednts in London would be in the looney-bin.
It's not appropriate to lock them up, but it's a good idea to have them evaluated, especially if they say they might as well kill themselves if they're not free to stalk.

Moo
 
Posted by welsh dragon (# 3249) on :
 
quote:
Originally posted by Moo:

Earlier on this thread I asked a question that no one has answered. If a roommate finds a student unconscious for no apparent reason, he will quite properly get help for that student. Is it wrong for the doctors to question the roommate about what the student had been doing lately? The doctor wants the information to help him make a diagnosis. I believe that when someone's behavior results in involuntary commitment, the doctors should get all the information they can.
Well, many, many students have suicidal thoughts during their studies; some talk to their friends about it, quite a few even take overdoses.

One issue here is medical confidentiality, and we could discuss this at more length later if you like.

Another is that loads of people take overdoses. Even more think fleetingly of trying to kill themselves. Saying "I might as well kill myself" does not sound like a clear statement of suicidal intent to me, one would have to know the context.

So, the above statement is not like someone finding a fellow student unconscious. It is more like the fellow student having an unusual slight rash on their genitals perhaps. Now, the rash might be serious; it might be syphilis; if it were syphilis, it might be fatal and there might be public health consequences I suppose. But it is much much more likely just to be spots or something less serious, or just a rash, I suppose.

The student didn't do any harm by reporting what was said & might have done some good. Certainly a medical review was a sensible idea. But rushing round asking all the other students about someone else's intimate problem would embarrass that student; it would breach medical confidentiality and it would almost certainly give rise to very little benefit. Because so many people would have evinced a similar problem, staff would be spending all their time trying to ask prying and inappropriate questions and wouldn't have any time to teach.

By the way, just because someone is sectioned/committed, it doesn't completely remove all their rights for confidentiality, at least in the UK, unless there is a very good reason clearly apparent. Which there probably wasn't in this case.

ETA cross posted with Ken, evidently making same sort of point

[ 04. July 2007, 17:48: Message edited by: welsh dragon ]
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon
But rushing round asking all the other students about someone else's intimate problem would embarrass that student;
I did not suggest asking all or, for that matter, any other students. I suggested asking the student who reported the suicidal statement to give information about the context.

I do not see how this could be considered a breach of confidentiality.

Moo

[ 04. July 2007, 17:58: Message edited by: Moo ]
 
Posted by Jengie Jon (# 273) on :
 
Right lets do some maths.

Student population in London 378000 from Wikipedia . So as all figures are historic, student numbers are growing and it makes it easier to do the maths, lets say 400,000. First lets divide by 4, as it is a quick way to work out how many per year. So that is 100,000. Right Ken's figure of 10% of students (which is probably low) that is 10,000 students. Lets say it takes 5 hours to do an assessment, two hours with the student and three hours doing other stuff including writing a report.

That gives us 50,000 hours of psychiatrist time. At 40 hours a week 50 weeks a year that means that a psychiatrist will work around 2000 hours a year. So you are asking Universities in London or the Health service to employ 25 psychiatrist in London alone.

Lets say there are 10,000 psychiatrists in United Kingdom (an over estimate because it is based on the Royal College of Psychiatrist membership level and that will include some overseas, some not in or seeking employment and possibly retired as well). Lets say 10% are in London. Then you are asking that 2.5% of the capitals total supply of psychiatrist be taken up with assessing these students, not with treating them, just assessing them.

Jengie
 
Posted by Moo (# 107) on :
 
Bear in mind that on that occasion two psychologists agreed that Cho was a danger to himself and others. This means that the referral was completely justified.

The point on which they disagreed was whether Cho should receive inpatient or outpatient treatment.

Moo
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by Moo:
I did not suggest asking all or, for that matter, any other students. I suggested asking the student who reported the suicidal statement to give information about the context.
I could be stupid, but I can't see how they could have got so far as doing an assessment without asking the student who reported the information about the context.

Certainly, one can say, "I might as well just kill myself" without having any real suicidal intent, just as you can say, "I want to kill my boss" without having any homicidal intent. Given how limited psychiatric resources are, and given that even to do an evaluation for an involuntary commitment has implications regarding the subject's autonomy and liberty, I can't imagine that the person reporting the comment would not be asked to provide all the information they had before the decision was made to evaluate.
 
Posted by Moo (# 107) on :
 
I gather that Cho's demeanor and behavior made the authorities think that an evaluation was in order.

Moo
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon
So, the above statement is not like someone finding a fellow student unconscious. It is more like the fellow student having an unusual slight rash on their genitals perhaps. Now, the rash might be serious; it might be syphilis; if it were syphilis, it might be fatal and there might be public health consequences I suppose. But it is much much more likely just to be spots or something less serious, or just a rash, I suppose.
A genital rash is no one's damn business except the person who has it and his/her sex partners.

Our society generally holds that people should be prevented from committing suicide. I know not everyone agrees with this, but I believe it's the norm.

Therefore, if your roommate has a genital rash, look the other way. If he's talking about suicide and has always appeared to be very unhappy, call for help.

Moo
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by Moo:
Not only did the university know where Cho lived, they also knew who his roommates were. It was one of his roommates who reported that Cho was suicidal.

I know this contravenes Cho's privacy rights, butI think that if those roommates had been questioned, Cho would have been committed. Cho said he might as well kill himself after one of his roommates had told him he had to stop stalking a woman who lived down the hall. The woman was frightened and told the roommate.
I don't want to speculate too much, since I have limited knowledge of Virginia Tech, hindsight is 20/20, etc. But existing rules allow staff members to share otherwise confidential information about students if doing so is thought to be necessary.

In most places, if a student living in a dormitory were ordered to undergo a mental health assessment, the resident assistant or hall director would know about it. They would also usually know if a student had been told to stop harassing another student (particularly if that other student was also a resident). It's possible that Cho's roommates tried to deal with these problems by themselves and their R.A. didn't know about them.; it's also possible that the R.A. didn't have a general sense of Cho's behavior and how his roommates regarded him. But, IME, that's fairly rare.

Given that Cho's odd behavior was interfering with his education, I think that staff members would have been justified if they had decided that sharing otherwise confidential information was necessary. However, I'd guess that the professor who was troubled by Cho's behavior would not have known this, would not have known how to find out who a student's R.A. or hall director is, and would not have been able to do anything with the information anyway (so Cho acts oddly at home, too? I'm so surprised).

I also don't know what kind of computer system VA Tech uses, or how much flexibility it has in terms of recording non-standard things about students. At most schools, different aspects of a student's life (academic, housing, judicial) are handled by separate people and are kept completely separate. This is as it should be, since for most students, whether or not they've moved rooms several times is unrelated to whether or not they've had an alcohol citation which is unrelated to whether or not they can do the academic work. The problem is that for a small number of students, they are very much related, and people who have the security clearance to access one part of a student's record don't always have the clearance to access another part. And if VA Tech uses any of the popular educational database programs, there probably isn't any way for a staff member to record really odd information, such as the information about Cho's classroom behavior.

Which is one reason some universities (or schools or colleges within those universities) employ advisors whose job is largely to keep an eye on the whole student; they can keep a record of information and behavior that's been flagged by professors, other student support services, etc. And they can generally release that information to the counseling center without confidentiality/privacy concerns. That's expensive, though.
 
Posted by Josephine (# 3899) on :
 
A court deemed, on the basis of an appropriate professional evaluation, that Cho was a danger to himself and others. The court ordered mandatory outpatient care for Cho.

Until this point, the system worked exactly the way it's supposed to. I don't know who did what to get Cho the evaluation, but whoever and whatever it was, it looks like the right things happened.

But the court sent Cho to a university facility that would not or could not provide the care that was ordered. Did the university counseling center let the court know, "We can't do that?" If not, then I would say that there are things that need to be changed at the university. I don't see that it's necessary to add staff to keep an eye on students, or make computer systems talk to each other, or have faculty members record personal impressions of their students along with the grades. All that needs to change is that the university counseling center needs either to comply with the court order, or to let the court know immediately that it can't or won't comply.

If the university counseling center did that, then the fault lies with the judge, who ordered something that wasn't available, then didn't change his order when he found out it wasn't available, and didn't make anyone responsible for following up to make sure Cho got the care that was ordered.
 
Posted by saysay (# 6645) on :
 
I agree, but there are two systems in play in this scenario - the mental health care system (and the process for involuntary commitment), and the university system.

I hope that the governor's commission finds that there are holes in the mental health care system which need to be closed, and that the problems within VA Tech's system wouldn't have happened if the mental health system had been working properly. In other words, if Cho had received appropriate mental health care on an outpatient basis, or been ordered into inpatient care when he failed to comply with the order for outpatient care, then the problems he caused attending class wouldn't have happened, and therefore the fundamental problems that need to be addressed are within the mental health care system.

Given that a university's legal obligation to act in loco parentis is up in the air, and that the courts sometimes rule that educational institutions can be held responsible for the final results of certain policies but can't design policies to address those problems, I'm not sure that's what the governor's commission will find. But I may be having a particularly cynical week.
 
Posted by AverageGuyOnTheStreet (# 12501) on :
 
A couple of points I would like to reply to:

Firstly, finding someone unconscious in their room. That happened to me once. I had been ill for a couple of days with something related to my chronic illness (which I chose not to tell my flatmates about). Nobody knew why I was ill. Eventually, I passed out in my room and one of my flatmates found me and thought I had meningitis. I went insane at her once I had the energy to do so but I know that she did the right thing given the information she had. I always think it is best to assume that the person wants to live.

Secondly, is stating to a friend that you might as well kill yourself an indication of suicidal intent. I think it depends on the situation. People exaggerate all the time. But if the person is known to suffer from depression, then they need help. I know that I am far more likely to confide in my friends when I want to discuss problems than anyone else. I've never been honest about my feelings apart from to one person. I couldn't even be totally honest in my recent psychiatric assessment. But I know that the time I attempted suicide a few months ago, nobody knew anything until some time later.
 
Posted by welsh dragon (# 3249) on :
 
quote:
Originally posted by Moo:
I realize that what I have said suggests that Cho's right to privacy should have been put aside. I think that his right to life should have had higher priority. I fully understand the implications of what I am saying.

Moo
Moo,
1. just because someone says “I might as well kill myself”, it does not mean he is actively suicidal.

2. suicidal thoughts are really common. Really, really common. For example, see this letter.

21% of junior doctors in the UK agreed or strongly agreed with the statement "I have been having more suicidal thoughts than usual". So at least 21% of junior doctors would admit to having suicidal thoughts! By Moo's standards that would give us at least 6,300 people to assess - and that's just the doctors!

Of course, if someone admits to feeling suicidal, it is sensible to listen and it may be helpful to tell services. We call this suicidal ideation . Often, it can be fleeting.

Suicidal intent is a bit different, at least in our usage. It tends to involve a plan. Someone with serious suicidal intent might think of hanging themselves or using a car exhaust.

People who have serious suicidal intent may have performed final acts . That is, they may have made a will or left a note or said goodbye to family.

Often, people being assessed by mental health services will actually have made a suicide attempt . Even if someone has gone so far as to make a suicide attempt, they most often would not be admitted to hospital. This is because many people have fleeting thoughts about suicide and even might take an overdose (the commonest form of suicide attempt) but usually they quickly regret their action.

Assessment of suicide risk is obviously not infallible; these are just some of the factors used but it gives you something of an idea.

So in the context of assessing behaviour and risk, Cho's comment in itself would not carry huge weight. In terms of risk, it was low grade. His assessors were not overlooking his "right to life" . From the information we have, no one could clearly predict either that he would go on to turn a gun onto other people or that he would soon lose his own life.
 
Posted by Pastorgirl (# 12294) on :
 
All of which, and our attempt to "find an answer" point to the tendency we have when a tragedy happens to think "we could have stopped this if we had just done..." In a way, this is a form of denial, it's our "lizard brains" refusing to process this huge affront to reality. So we keep searching for explanations, thinking that'll lead us to some sort of magic bullet that will ensure this never, ever happens again. It's a natural, human tendency and one that does push us toward some positive, helpful transformations. But at some point we have to accept that this is a broken world and bad s**t is always going to be a part of that.
 
Posted by Moo (# 107) on :
 
welsh dragon, I used to answer the phones for the Samaritans; I also used to give talks in schools about suicide-prevention. I know how to assess suicide risk.

It is a fact that a psychologist declared Cho a danger to himself a few hours after he said he might as well kill himself. This means that the roommates concern was fully justified.

Moo
 
Posted by welsh dragon (# 3249) on :
 
Moo, the room mate's action was not altogether unreasonable. But that isn't at issue.

The point I was trying to make was that Cho's ultimate actions could not be clearly predicted from the limited information available. - in particular the rather vague comment about ending his life. So , at least from the information you have given, it isn't clear to me that there is any glaring omission, anything obvious that the University or mental health services ought to have done otherwise (especially not cross examining a student or other students for third party information. I rather give up on whatever scheme for this you were or were not suggesting). Though as we've said, it would be great if the mentally ill got a better deal and better financed services in both our countries.

What happened was very unusual and sad, wasn't it? But that, it would seem is life.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon:
The point I was trying to make was that Cho's ultimate actions could not be clearly predicted from the limited information available. -
I don't think anyone ever suggested that his ultimate actions could be predicted at the time he was assessed. It's obviously impossible to predict anyone's ultimate actions, no matter how much information is available.

Moo
 
Posted by welsh dragon (# 3249) on :
 
Ok, so Cho wasn't showing suicidal intent, you aren't suggesting that there would have been any point using other students to put him under surveillance and his bizarre behaviour couldn't have been predicted.

We agree [Smile] !
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon:
Ok, so Cho wasn't showing suicidal intent, you aren't suggesting that there would have been any point using other students to put him under surveillance and his bizarre behaviour couldn't have been predicted.

We agree [Smile] !
You make several points here;

1) Cho was not suicidal.

The evaluating psychologist said he was a danger to himself. I assume the psychologist was competent.

2) There was no point in using other students to put him under surveillance.

You are the only person posting on this thread who has mentioned surveillance. I suggested it was worthwhile asking Cho's roommates about HIS PAST ACTIONS. There was no suggestion that they should watch him in future.

3) His bizarre behavior couldn't have been predicted.

His specific behavior could not have been predicted. The fact remains that he had been declared a danger to himself and others. In this post saysay makes some very constructive observations.

quote:
n most places, if a student living in a dormitory were ordered to undergo a mental health assessment, the resident assistant or hall director would know about it. They would also usually know if a student had been told to stop harassing another student (particularly if that other student was also a resident). It's possible that Cho's roommates tried to deal with these problems by themselves and their R.A. didn't know about them.; it's also possible that the R.A. didn't have a general sense of Cho's behavior and how his roommates regarded him. But, IME, that's fairly rare.

Given that Cho's odd behavior was interfering with his education, I think that staff members would have been justified if they had decided that sharing otherwise confidential information was necessary. However, I'd guess that the professor who was troubled by Cho's behavior would not have known this, would not have known how to find out who a student's R.A. or hall director is, and would not have been able to do anything with the information anyway (so Cho acts oddly at home, too? I'm so surprised).
Moo
 
Posted by Sir Pellinore (ret'd) (# 12163) on :
 
It is always easy to be wise after the event.

Dealing with a complex real time situation is more difficult.

To a non-American the ease of access to weapons would be a worry. Particularly to a mentally ill person who might use it for suicide/murder.

This is not the first incident of this sort to happen at a US university.

Discipline/supervision at a US university dormitory seems to be a little different to residential colleges in Australia.

Americans also seem to have different attitudes to civil liberties to Brits or Commonwealth citizens.

Gun control could be a good way to start.
 
Posted by welsh dragon (# 3249) on :
 
In response to Moo
I do agree pretty much with everything Sir Pellinore put.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon
my point was really that the "might kill myself" was not the absolute proof of suicidal intent that it could on face value seem to be.
I never said it was. I said it indicated that an evaluation was in order.

Moo
 
Posted by welsh dragon (# 3249) on :
 
More specifically, you equated that rather vague comment to being found unconscious.

In terms of medical triage, the unconscious patient coming into A and E would be a very high priority for immediate attention and care, until the problem were diagnosed and treatment put in place.

In terms of assessing suicidal risk, a one-off comment "might as well kill myself" would not cause that level of concern most of the time (It might if the person were standing on top of a high building I suppose).
 
Posted by Newman's Own (# 420) on :
 
Question: Even if someone were suicidal (and comments one could make do not seem to make that a certainty), wouldn't he be most likely to be a danger to himself? Would wanting to harm others be a part of this?

As well, wouldn't there be more behind Cho's actions than suicidal tendencies or mental illness? Most people who are mentally ill, even severely so, are not about to slaughter people around them.

(I will save my comments about the importance of gun control for another thread.)
 
Posted by 3M Matt (# 1675) on :
 
Skimmed over this thread very briefly, Welsh Dragon's comments strike me as very sensible.

The sad fact is that mental health is all about risk management. There is always some risk, and, when carrying out a mental health assessment, you have to use experience, guidelines, and, to some extent, gut-feeling to decide what is appropriate input for a particular patient.

If I admitted to inpatient care every patient I saw in outpatient clincs with suicidal ideation I'd need a half hourly bus service between the outpatient clinic and the inpatient hospital!

The key is picking up those who are close to a crisis point.
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by welsh dragon:
In terms of assessing suicidal risk, a one-off comment "might as well kill myself" would not cause that level of concern most of the time (It might if the person were standing on top of a high building I suppose).
And you're talking about a hypothetical, while Moo and I are talking about an actual case in which a person made the statement and - because of his other disturbing behavior - was thought to be serious enough to warrant a mental health assessment, which found that he really was a danger to himself and others. Enough of a danger that it was initially recommended that he undergo involuntary inpatient care, which was modified to involuntary outpatient care.

I think what gets to a lot of people about this case (at least it's what gets to me) is the "so close" factor. Cho's behavior in the classroom and dorms was close to what it would have taken to have him suspended/ placed on involuntary leave from VA Tech (and there is some indication in what was released of his manifesto that he was targeting VA Tech students, so it's not necessarily true that if he had been removed from campus he would have simply gunned down people at a department store instead). He was close to being involuntarily committed for inpatient care. He was close to being prevented from purchasing guns. If he had been just a bit closer on any of those fronts, this tragedy might not have happened. Which is why some of us are interested in talking about whether or not the line distinguishing between "close" and "there" needs to be shifted.
 
Posted by OliviaG (# 9881) on :
 
quote:
Originally posted by saysay:
I think what gets to a lot of people about this case (at least it's what gets to me) is the "so close" factor. ... He was close to being involuntarily committed for inpatient care. He was close to being prevented from purchasing guns. If he had been just a bit closer on any of those fronts, this tragedy might not have happened. Which is why some of us are interested in talking about whether or not the line distinguishing between "close" and "there" needs to be shifted.
If Cho had been in danger of flunking math, it would be the school's responsibility to help him. However, since his problems were health problems, not academic problems, I still feel that the responsibility for helping him belonged to the public health and legal authorities. And to me it looks like they dropped the ball when they ordered him to get care that wasn't actually available and then failed to follow up. [Frown] OliviaG
 
Posted by saysay (# 6645) on :
 
I think I agree that the primary responsibility for helping him/ failing to help him belongs to the public health system (or lack thereof).

However, I've read/heard enough about how much his behavior disrupted other students' educations (although I grant that some of it might not be accurate) that I'm not sure it's fair to equate VA Tech's responsibility to the responsibility they'd have if he were flunking math (which wouldn't affect anyone but him).
 
Posted by saysay (# 6645) on :
 
[too late to edit]

Which is also to say that I'm sympathetic to people who think that painting with too broad a brush ("mentally ill students at universities") is dangerous. But I also think that Moo's core topic (which is more along the lines of "students who have been judged to be a danger to themselves or others at universities") is worth discussing. Particularly since the reality is that universities have been sued for failing to prevent a student from committing suicide and for suspending a suicidal student.
 
Posted by welsh dragon (# 3249) on :
 
What you are talking about is a case in retrospect and after a very unusual event.

What I am trying to do is explain the principles of risk assessment and some of the issues around risk. I suppose that is on one level theoretical but on another level it is based on solid knowledge.

We have various snippets about Cho's management on this thread:-

saysay:
quote:
it was initially recommended that he undergo involuntary inpatient care, which was modified to involuntary outpatient care
Josephine:
quote:
The court ordered mandatory outpatient care for Cho
Moo
quote:
He was committed to a mental hospital overnight because psychologists had determined that he was a danger to himself and others.
and
quote:
It's not certain that he ever went to the health service. He was ordered by the court to undergo psychotherapy,
and
quote:
It is a fact that a psychologist declared Cho a danger to himself a few hours after he said he might as well kill himself.
pastorgirl
quote:
In terms of compulsory mental health care, which is what would be required here since Cho refused treatment, it simply doesn't exist.
I couldn't stand up in court that I swear I know what was going on with Cho's mental state and treatment because I don't (but then I don't think anyone else on this thread can give a professional-level opinion on that either). We have bits and pieces of information culled from articles here and there that might or might not be correct.

It might be more appropriate to discuss what actually was happening with Cho when the official report comes out. A psych assessment takes hours and a forensic report will have a dozen (or dozens) of pages of detail. That would be a more informed way to do this - if informed is what you want.

What does attract me to this thread is the discussion on risk. I do know a lot about assessing risky behaviour, because it is what I do for a living. And I am fascinated by how people understand risk and how to explain risk to people.

And we just don't have enough facts on Cho to discuss his diagnosis and management properly, but we can have a rattling good discussion on risk...

ETA - we could make that "risks among University students" if you like - which might actually deal with the proposed OP title...

[ 06. July 2007, 18:27: Message edited by: welsh dragon ]
 
Posted by saysay (# 6645) on :
 
quote:
Originally posted by welsh dragon:
What does attract me to this thread is the discussion on risk. I do know a lot about assessing risky behaviour, because it is what I do for a living. And I am fascinated by how people understand risk and how to explain risk to people.

And we just don't have enough facts on Cho to discuss his diagnosis and management properly, but we can have a rattling good discussion on risk...
Except that I will be the first to admit that I am not qualified to discuss risk or how to assess risky behavior. I assume that those doing the assessment are generally competent.

I understand that not everyone who says "I might as well kill myself" is a danger to themselves (otherwise I, and several other people I know, would spend a lot of time having our mental health assessed, since 'or I could shoot myself' is a common phrase). I also understand that not everyone who stalks a girl is dangerous, and that not everyone who writes violent poems/play/fiction is dangerous. Post-Columbine, there was a lot of paranoia about kids who exhibited certain kinds of behavior, and I don't want to encourage that same paranoia on the university level.

And you're right, we don't know all the facts in this case (and privacy laws may keep us from ever knowing all the facts). AFAIK, Cho never received a diagnosis, because he never received psychiatric care beyond the initial assessment which determined that he was in need of care and was incapable or unwilling to volunteer for care.

So this:
quote:
So , at least from the information you have given, it isn't clear to me that there is any glaring omission, anything obvious that the University or mental health services ought to have done otherwise
is inaccurate. Documents that have already been made public have made it clear that he was ordered into psychiatric care which he didn't receive. This points to a flaw in the system somewhere.
 
Posted by welsh dragon (# 3249) on :
 
Except that you make the diagnosis first - or a provisional diagnosis if you're not sure - and then you give the treatment.

And none of the symptoms described so far make one think "well he was obviously schizophrenic" or "gosh, they missed that manic episode".

So, no glaring omission there. That is what I meant.

As far as the committal goes, as I have also said, the process in the US is very different to that in the UK.

It isn't clear whether they will end up with a mental health diagnosis at all (despite the involuntary commital arrangements) but if they do, then "personality disorder" would be one possibility.

Personality disorder (PD) is often treated out of hospital and psychotherapy would be one sort of therapeutic possibility. So discharging someone from hospital and advising them to get therapy would be a reasonable plan in that circumstance. In fact, other things being equal, inpatient units in the UK would be keen to discharge PD patients from hospital as they don't tend to benefit much from sitting on your average acute ward.

On the other hand, psychotherapy set up as a mandatory activity is an unusual idea, as patient motivation and commitment is such an important part of the process. So it wouldn't be surprising if someone told to go to therapy in the community didn't attend. The main place I have heard of "enforced" psychotherapy was an open prison where prisoners had to attend groups (or go to a much more unpleasant set up). They really didn't have any choice!

I should say, also, that therapy is a fairly long term business. Someone's risk of harm to self or others might be reduced by it, but in the medium to long term, not overnight. So suggesting to someone that they take up therapy in the community would be the sort of option you choose if the risks are relatively low. Inpatient admission is what you would stick with if the risks are high.

So it really isn't obvious to me that mental health services missed something big. Nor does it seem particularly remarkable that the University had difficulty enforcing the therapy order (at least with the knowledge I have). I meant what I said.

I do wonder
a) why the order was being made by a judge (as I said before)
b) whether the therapy idea was the judge's own idea or
c) how much advice as to risk and to disposal he had from the medics/psychologists
d) whether this part of the decision-making could have been improved (the bit with the judge ordering therapy)

Also, in the UK, assessments and sectioning of the acutely mentally ill are carried out by psychiatrists not psychologists (who give therapy but do not prescribe), so I find that part a bit puzzling also.

But like I also said, this is just with the fragments of possibly incorrect information that I have.

[ 06. July 2007, 20:37: Message edited by: welsh dragon ]
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon:
More specifically, you equated that rather vague comment to being found unconscious.

In terms of assessing suicidal risk, a one-off comment "might as well kill myself" would not cause that level of concern most of the time (It might if the person were standing on top of a high building I suppose).
No.

You gave me the impression that you thought a student was never justified in notifying the health service that another student had problems. I gave the example of someone being found unconscious for no apparent reason. I said that under certain circumstances it is appropriate for a student's roommate to contact the health service on his behalf.

Most one-off suicidal comments mean nothing. Cho had always appeared to be very unhappy, and he was extremely agitated and despairing when he was told he would have to stop stalking. His roommates' reporting him to the health service was proven justified by the results of his assessment.

Moo
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by welsh dragon:
I do wonder
a) why the order was being made by a judge (as I said before)


Who else could give such an order?

On this side of the pond, the way it works (in broad general terms, with some variation amongst the states) is that someone goes to the court and presents some sort of evidence that the person may be a danger to himself or others -- usually a statement by someone with first-hand knowledge of the person or situation is enough at this point.

The court issues a warrant requiring the person to report to, or be taken to, a facility where a psychiatrist can do an emergency evaluation and report back to the court (usually within 24 hours).

Based on the report from evaluation, the judge can order that the person be held longer for additional evaluation or treatment. Usually, they can be held another 2 or 3 days for more evaluations. If they're to be held longer, another hearing will be scheduled within 7 days, or 10 days, or something of the sort.

All of this is intended to prevent abuse of the system, and to protect your right to liberty, even if you're weird, eccentric, or unpleasant.

quote:
b) whether the therapy idea was the judge's own idea or
Possible, but unlikely.

quote:
c) how much advice as to risk and to disposal he had from the medics/psychologists
Ordinarily, the order would be based entirely on the report from the mental health care professionals, unless someone was contesting the report.

quote:
d) whether this part of the decision-making could have been improved (the bit with the judge ordering therapy)
It's pretty clear that someone screwed up in this case -- whether it was the judge or the psychologist/psychiatrist making the recommendation, I have no idea.
 
Posted by welsh dragon (# 3249) on :
 
Re Moo's comment, not sure where you got your "impression" from, glad you agree with me re one-off suicidal comments, good.

quote:
Originally posted by Josephine:
quote:
Originally posted by welsh dragon:
I do wonder
a) why the order was being made by a judge (as I said before)


Who else could give such an order?

[snip]

All of this is intended to prevent abuse of the system, and to protect your right to liberty, even if you're weird, eccentric, or unpleasant.

[snip]

It's pretty clear that someone screwed up in this case -- whether it was the judge or the psychologist/psychiatrist making the recommendation, I have no idea.
In the Uk, the person would be sectioned to hospital (as an inpatient). The initial assessment would be 28 days, though it can be much less. Because people can be sectioned for assessment, it may be that after the assessment they are found not in fact to be mentally ill (at one training day on UK mental health law, we were told the story of the chap who was picked up exclaiming apparent gibberish...he was eventually found to have been an intoxicated Welsh man...taken off section next day when they worked it out)

In the UK, the people ordering treatment are medically qualified doctors, who have a training in law (under Section 12 of the Mental Health Act) and are working at consultant level, or their deputies. There is an assumption we are acting in the best interest of the patient, backed up by a complex appeal and review process, which does involve the legal profession and often second opinions from other doctors of equivalent seniority.

It seems decidedly unclear from the information we have whether Cho was treatably mentally ill (with schizophrenia or a mood disorder), personality disordered or to borrow your phrase "weird, eccentric or unpleasant".

This appears interesting, re our discussion here. According to that article, Cho was evaluated by a community services board worker and an independent doctor - who differed on whether he was a danger to himself or others, and on whether he required hospitalization. That's interesting to me because in UK law you need the agreement of 2 doctors and a social worker to detain someone for a 28 day assessment, for example.

I also note that the article goes on to state usually a judge would send someone to an inpatient unit. Usually, a treatment plan is relatively low key is that way because the risks are not thought to be very high. The disagreement among professionals may also have played a part in this.

This article, from TIME, suggests that an assessing doctor found that Cho was "mentally ill but not an imminent threat to himself or others". The TIME article says that, according to the polce, Cho technically went to hospital voluntarily.

So these give a picture with less associated risk, overall, than some of the other accounts on this thread. It is suggested in one article here that the diagnosis made was depression, although that does beg a number of questions. Another diagnosis mooted, searching the web, is autism; another that is discussed is a psychotic illness (there is some mention of possibly paranoid feelings towards rich students, which I hadn't seen before). These leave even more questions unanswered.

It certainly seems possible, even likely, that Cho was not committed to hospital at the time of assessment in December 2005 because the evidence did not suggest that he was very high risk. Evidence of risk of harm to self was minimal - he seems to have no history of overdoses or other self harm. Biological symptoms of depression -for example, weight loss - haven't been clearly described in the accounts I've seen. There don't seem to be plans to self harm. The other students haven't described heavy drug or alcohol use.

He does not seem to have used a weapon, or indeed physical violence of any sort, prior to the shootings. It appears that he had not directly threatened others (which is why he wasn't prosecuted for his contretemps with other students apparently). There is no forensic history (which is why he could purchase guns). There is no history of the specific psychotic phenomena that might be associated with increased risk of violence. These would all be important indices in gauging risk to others.

So a lot of the most important warning signs just aren't there. If that was why a low key approach was taken, well, that doesn't seem so very unreasonable. So it doesn't seem so obvious that "someone screwed up" - at least regarding TIME's account of the assessing doctor not finding a risk of imminent danger. And, mind you, this was about a year before the shooting, wasn't it, so a lot could have happened in that time.

[ 07. July 2007, 12:18: Message edited by: welsh dragon ]
 
Posted by ken (# 2460) on :
 
quote:
Originally posted by welsh dragon:
In fact, other things being equal, inpatient units in the UK would be keen to discharge PD patients from hospital as they don't tend to benefit much from sitting on your average acute ward..
Well yes. Taking someone who is excessively angry, aggressive, hyperactive and bored. but also intelligent and thinking clearly, and then locking them in a building full of vulnerable, depressed, confused people, doesn't seem like a good plan for anyone.

[ 07. July 2007, 13:21: Message edited by: ken ]
 
Posted by Josephine (# 3899) on :
 
quote:
Originally posted by welsh dragon:
So a lot of the most important warning signs just aren't there. If that was why a low key approach was taken, well, that doesn't seem so very unreasonable. So it doesn't seem so obvious that "someone screwed up" - at least regarding TIME's account of the assessing doctor not finding a risk of imminent danger.
That wasn't the screw-up I was thinking of. What I had in mind was the court ordering mandatory outpatient care at a facility that refused to provide that care. Either the judge screwed up by ordering treatment at that facility, or the facility screwed up by not notifying the judge that they wouldn't provide the care, or the facility did notify the judge and he didn't amend his order to send Cho somewhere else.

I also think that either the court was amiss in not assigning a guardian ad litem (or equivalent) to ensure that Cho complied with the order, or the guardian ad litem screwed up in not bringing Cho's noncompliance back to the attention of the court. The judge can't personally monitor and follow up on all his orders. That responsibility has to be assigned somewhere. Either that didn't happen, or the person to whom it was assigned didn't follow through.

So I'll stand by my assertion that someone screwed up. Not in the psychiatric assessment -- that may have been as good as was possible at the time and under the circumstances. But appropriate followup was lacking.
 
Posted by welsh dragon (# 3249) on :
 
Well, fair enough, there doesn't seem to have been follow up.

I would be reluctant, though, to blame the subsequent tragedy just on that. That is, maybe you personally wouldn't, but I guess it is somehow comforting for people (especially politicians) to fix on this sort of detail and use it as the entire excuse or explanation for a ghastly outcome, when - even if it is a significant part of the story- the truth is a whole lot more complicated.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by welsh dragon:
...I guess it is somehow comforting for people (especially politicians) to fix on this sort of detail and use it as the entire excuse or explanation for a ghastly outcome, when - even if it is a significant part of the story- the truth is a whole lot more complicated.
It's not a matter of blame. It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.

Moo
 
Posted by Pastorgirl (# 12294) on :
 
quote:
It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.
I doubt if that's a realistic goal-- or at least, not w/o such an infringement of personal freedoms that it would be unacceptable.

We certainly should look at the causes with an eye toward reducing risk. As indicated by my posts, I do think we can do much, much more-- particularly in increasing access to mental health care in the US, funding for mental health care, and in correcting the skew in the balance between autonomy and acting in the best intrests of those who can't care for themselves. But to suggest that we could ever say with any kind of certainty that this could "absolutely never happen again" is unrealistic and doomed to failure. And it's the kind of thinking that led to the Patriot Act and other excessive measures.
 
Posted by Pastorgirl (# 12294) on :
 
quote:
It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.
I doubt if that's a realistic goal-- or at least, not w/o such an infringement of personal freedoms that it would be unacceptable.

We certainly should look at the causes with an eye toward reducing risk. As indicated by my posts, I do think we can do much, much more-- particularly in increasing access to mental health care in the US, funding for mental health care, and in correcting the skew in the balance between autonomy and acting in the best intrests of those who can't care for themselves. But to suggest that we could ever say with any kind of certainty that this could "absolutely never happen again" is unrealistic and doomed to failure. And it's the kind of thinking that led to the Patriot Act and other excessive measures.
 
Posted by Doublethink (# 1984) on :
 
Of course, even with more restrictive laws, these things still happen - the Dunblane Massacre happened at a time when our gun laws were more restrictive than the USA and when exactly the same mental health act was in place.

In the end our government responded by tightening the gun laws. I don't think it has ever been possible to establish whether Hamilton could be considered to have a mental health problem. He certainly wasn't behaving "normally".
 
Posted by Doublethink (# 1984) on :
 
Doubleposting, to add:

Prior to Dunblane, probably the most well known recent massacre was in Hungerford, basically Michael Ryan went round the local area shooting. And I guess this was what I was thinking of earlier when I asked what difference it would have made to get Cho off campus. Would he simply have killed a different group of people ?

In this instance, which was earlier than Dunblane, the government also responded with restrictions on gun ownership. Again it is unclear what Michael Ryan's mental health status was.
 
Posted by Doublethink (# 1984) on :
 
And tripleposting to add:

For the what it is worth, the gun control response seems like a good idea to me and this is why. You still have a disturbed individual trying to kill people with a lethal weapon - but far fewer people die.

The assailant in this case definitely did have recognisable mental illness. But that doesn't seem to be the norm for the perpetrators of these kind of acts.
 
Posted by Moo (# 107) on :
 
quote:
Originally posted by Doublethink

For the what it is worth, the gun control response seems like a good idea to me and this is why. You still have a disturbed individual trying to kill people with a lethal weapon - but far fewer people die.
On the other hand, if Timothy McVeigh had been using a gun, he would have killed fewer people.

Moo
 
Posted by Twilight (# 2832) on :
 
Yes and if the U. S. Airmen had dropped homemade bombs over Hiroshima more of those people would have survivied.
On the other hand, Tim McVeigh wasn't mentally ill and would be quite welcome in your university.
 
Posted by Duck (# 10181) on :
 
Reading between the lines - was 'Cho' actually legally committed to outpatient treatment, or was it quasi-voluntary - in a 'I agreee to consent to this so I won't be treated as an inpatient without my consent' sense? ISTM that the lack of follow-up, inappropriate referral, etc would make more sense if Cho had consented under pressure rather than actually been formally sectioned / equivalent.
IME it's quite common for this sort of quasi-compulsory treatment without legal section to take place - more so than formal sectioning. Would explain a lot, & posibly why the university didn't do more in the way of follow-up too, if Cho was [involuntarily / pretending] co-operation with psych treatment.

quote:
Originally posted by Josephine:
quote:
Originally posted by welsh dragon:
I do wonder
a) why the order was being made by a judge (as I said before)


Who else could give such an order?
[...]
In the UK, psychiatrists, although nurses and other professionals can give very short sections (basically long enough for a psychiatrist to turn up). Sometimes two are needed, and for long-term treatment there may well be formal legal involvement, social workers, and other professionals, but it's dealt with mostly as a health rather than a legal matter.

quote:
Originally posted by saysay:

Which is also to say that I'm sympathetic to people who think that painting with too broad a brush ("mentally ill students at universities") is dangerous. But I also think that Moo's core topic (which is more along the lines of "students who have been judged to be a danger to themselves or others at universities") is worth discussing. Particularly since the reality is that universities have been sued for failing to prevent a student from committing suicide and for suspending a suicidal student.
'Students who are a danger to themselves' on some level is a huge topic, possibly even deserving of a Heaven thread to detail all the creative and entertaining ways my fellow-students create truly innovative new levels of risk where none previously existed. Fellow-students have been a danger to themselves through enthusiastic but woefully ignorant attempts to cook a meal for the first time, scurvy on account of refusing fruit and vegetables, smoking, hobbies involving fiddling about with electricity, risking deadly diseases by swimming in a polluted lake, and others to numerous to mention, all whilst having nothing a psychiatrist could diagnose.
'Students with mental health problems' is another topic that's worth discussing, but not dominated by one unrepresentative individual who may or may not have had a diagnosable mental health problem - it's exactly analogous to discussing 'Asian students' and then devoting most of the thread to Cho, and about as nasty.

quote:
Originally posted by Newman's Own:
Question: Even if someone were suicidal (and comments one could make do not seem to make that a certainty), wouldn't he be most likely to be a danger to himself? Would wanting to harm others be a part of this?

As well, wouldn't there be more behind Cho's actions than suicidal tendencies or mental illness? Most people who are mentally ill, even severely so, are not about to slaughter people around them.
Thank you. The overwhelming majority of suicidal people do not want to hurt others. Of the minority who do, it's usually people close to them in an 'extended suicide', for example a depressed mother who kills her child along with herself to 'save' it from the world she can't live with. A tiny minority of a tiny minority might be a danger to strangers. Mentally ill people are more likely to be the victims of murder than the perpetrator.

I share a student house with at least one Shipmate - I'm quite sure I've not shown any signs of wanting to kill them, though judging by some of the things said on this thread maybe they'd better keep being conscientious about the washing-up [Smile]
 
Posted by Sir Pellinore (ret'd) (# 12163) on :
 
quote:
Originally posted by Moo:
...It's not a matter of blame. It's a determination that this absolutely must never happen again. In order to prevent that, you need to figure out how it happened this time.
Moo
With the best will in the world, Moo, I think we can't be certain that it will never ever happen again. Like the First World War: "The War to End Wars".

There are always, as Welsh Dragon and others pointed out, so many variables.

Whether a mentally ill person suicides, kills others with a readily available weapon (Good Ole USA gun laws!) or combines both, they're all tragedies.

Unless you have:
(1) 100% surveillance of anyone remotely dangerous (to themselves or others).
(2) The ability to lock such people away in a safe padded cell with nothing dangerous in it and 24/7 surveillance.
(3) Vastly improved medical facilities for the mentally ill.
(4) A sensitive, aware university administration with the facilities, time and interest to care for all troubled students
it will keep happening.
 
Posted by Twilight (# 2832) on :
 
Even with all Sir P's excellent points we wouldn't be able to predict who belongs to the "danger" group.

Two students were randomly shot and killed at Ohio University by a fellow student who happened to be out in the woods with his gun. He had no mental illness, just very poor impulse control.

I'm sure after McVeigh bombed the Murrah building, there were victims and family members who wanted to outlaw militia groups, like the one he and Terry Nichols belonged to. They probably said, "so this will never happen again."

If we make new laws and restrictions on the rest of the population, based on isolated incidents then haven't we allowed the perpetrators to do even more damage?
 
Posted by Sir Pellinore (ret'd) (# 12163) on :
 
You're quite correct, Twilight.

We live in a society where there is a great deal of emphasis on isolated incidences of violence like the Cho one.

We have enough problems with the, quite justified, fear of Islamicist terrorists striking anywhere, anytime.

If Cho had not killed others would he have caused such a ruckus? I doubt it.

What the Cho incident does is to point out gross failures in our systems of university student care, appropriate mental health provision for all who need it and extremely lax US gun laws.

My post was partly ironic because I think the only "ultimate" solution to this happening is a total 100% surveillance state ruled by impossibly wise "guardians". A totalitarian one with which I don't agree.

Ultimately, as so many wise posters, like Max, said, is that it's other students caring for students experiencing depression or other mental problems that works. Of course, we do need much better appropriate mental health facilities. But it's people, compassion, community that matter as well. Foreign students, or students from nonmainstream backgrounds, who are adrift and alienated are often the ones who most need appropriate help. And universities are big businesses, making big bucks from overseas students in this country for one. Do they care properly for them? It's a mixture. Usually it's the overseas student groups that provide support. Cho was, I believe, a very betwixt and between person, somewhat isolated from his own Korean background but not fully integrated into American society. Add mental illness, let him slip through the treatment gap, provide gun...
 


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