By Charles Anderson
May 20, 2015
Eight years ago, with the tragedy at Virginia Tech, the nation had an opportunity to turn its full attention to the issue of college mental health in America. In a sense, this issue has also been alive more broadly across the nation as we seek to come to a comprehensive plan that would give all Americans access to quality health care, including mental health. Some of the questions are the same: How do we serve our clients/patients with integrity? How do we back up our values with the resources to accomplish these goals?
If this article were about funding, you would be forgiven for using it as a soporific at bedtime, or folding it into origami, and I’d probably be falling asleep trying to write it.
What snaps me out of it is the eighth suicide in four years (and fourth in the past eight months) at the College of William and Mary, followed shortly by the eighth anniversary of the shooting at Virginia Tech that took the lives of 32 students and faculty.
This discussion is about money only insofar as any mismatch between stated values and evidence of commitment should be getting our attention if our ‘something-is-out-of-whack’ detector is working properly. No, these issues are only secondarily about money, and any discussion that begins with resources misses a chain of influence that is actually both more disturbing and more amenable to change.
Had the mass shooting of April 16, 2007, begun a national debate on what mental health care might properly look like on a university campus, we might have established a healthy model for the nation by now.
Instead of that discussion, we had quite a different outcome as other voices weighed in with legal and administrative questions.
These voices did not ask how we could do the work of mental health care better.
They asked instead how we might better avoid liability.
The question was transformed into, “Should we as a university be involved in mental health care at all?”
With the discussion reframed as an existential one for the counseling center, any questions about quality of care, resources, and mission became moot. In the end, the counseling center was happy to be alive, and all too eager to accept the breadcrumbs offered by administration thenceforth.
The cost of this strategy, though, continues to be paid across the country as counseling centers nationwide receive loud and clear the existential message of Virginia Tech: Be happy that you are still here. Be grateful for anything you may receive in terms of resources. Keep your mouth shut.
The shift toward liability-focus has played out in an ascendancy of the legal voice in the work of health care in general, and mental health in particular. Please don’t misunderstand me — I have great respect for lawyers and the law, and the perspective they bring to any discussion. I may be needing one soon myself if this article gets published. But it’s important to remember that the legal perspective is only one point of view.
As I reflect on discussions that I have been involved in about students of concern, I recall the legal voice being quite consistent in coming from a perspective of fear.
This voice consistently urged us toward strong interventionist responses that clearly minimized risk — risk of liability.
The fear of liability can be contagious.
It is a persuasive voice and has a way of instilling fear in all who hear it. It is a voice that argues its case as if it were the only way of seeing the world.
When we allow the legal voice into ascendency, we may win at safety and liability, but we lose at compassion and humanity.
Students start to become objectified in an actuarial way, and it starts to become about the numbers. As the gravity of the legal voice becomes more influential, we begin to enact the very problems we are trying to avoid.
In a sense, while the legacy of Virginia Tech has had a direct influence on colleges and universities nationwide, it is still left to individual schools to interpret and actualize that influence.
As I joined the staff of William and Mary as associate and clinical director, I expected to see a lot of familiar things that would speak to Virginia Tech’s influence. Indeed, there is a CARE Team designed to respond to emergent issues among the students, and a TAT (Threat Assessment Team) to respond to more severe emerging concerns among students and staff which is a helpful aspect of Virginia Tech’s legacy.
What I wasn’t prepared for, though, was the strong administrative response to students who were deemed at substantial risk of harm to self or others.
As noted by Cassie Smith-Christmas in her recent, very moving article about her brother’s suicide while a student at William and Mary, it is indeed the case that these students tend to be responded to in a way that seems best explained by the influence of the legal voice.
Such students tend to be maneuvered in the direction of their parents or toward the temporary safety of a hospital environment. When this happens students are, in fact, administratively disenrolled and their ID cards deactivated. They do not have the option of returning to their dorms if they are living on campus.
This liability-driven intervention creates exactly the kind of risk that the healthy aspect of the Virginia Tech legacy has sought to minimize: that of the most at-risk students falling through the cracks with no plan for follow-up care.
There is no therapeutic basis for such a policy.
It is the antithesis of treatment planning and continuity of care.
As Smith-Christmas points out, it is a strategy that treats students as a problem to get rid of rather than a person who is suffering and in need of care.
Ironically, I have seen William and Mary’s “wellness agreement” (that students must agree to in order to be readmitted) become its own oppressive force as students return to a course load that includes this semester’s classes, last semester’s ‘incomplete’s, and a tangle of bureaucracy that has little to do with responsible transition and continuity of care.
Recent articles in the W&M school paper, the Flat Hat, point to even more specific concerns in the counseling center. Along with Dr. Smith-Christmas I, too, am curious about what has changed in the last four years at the College of William and Mary.
We might rightly wonder how such a thing could come to pass. But it all seems to fall into place when we remember that the controlling value system is not therapeutic, it is legalistic.
Not only is this true in principle, but it is literally, physically true as we note key administrative positions occupied not by those skilled in wellness approaches to treatment, but by attorneys—from the college president, to the dean of students, and culminating in those who answer the after hours on-call phone for the counseling center: the William and Mary Police Department.
When students get the idea that they are going to be mishandled by administration for reporting suicidality, it’s pretty clear that the next step will be to under-report symptoms or avoid the school’s mental health resources altogether. As recent articles in the Flat Hat have noted, the predominant fear students have in coming to the counseling center is of being kicked out of school.
When students change their healthy behavior to avoid administrative consequences, the increased risk of harm falls to the failed administrative policies and those who implement them.
After Paul Soutter’s suicide, I listened to these administrative voices from the audience of the mental health forum convened by W&M administration.
The students held the floor, speaking with passion and conviction, even throwing the staff photographer out of the room as they intuited administration’s motive to create a slick PR moment.
When administration finally spoke, it was not with a voice of compassion and understanding, but of defensiveness and self-interest. The putative goal was to hear the concerns of the students, but in the end it was clear no actual listening had taken place. We heard, instead, predominantly legal voices stating in effect “this is why we have to.”
From my perspective, “this is why we have to” have the long-postponed discussion about college mental health. The culture of fear articulated by the dominant voice of the era after the Virginia Tech tragedy has resulted in a legalistic, liability-focused approach to students in distress that is not only unworkable, it is costing lives.
Like Smith-Christmas, my point is not to cast blame on Virginia Tech or William and Mary, but to try to point to structural dynamics that maintain an approach to mental health treatment that has taken a surprising, unexpected, and costly turn.
The discussion we needed to have about how to meet the actual mental health needs of students in a university environment was sidetracked eight years ago and has never returned.
Like a skinny kid trying to deal with bullies, universities ever since have gone the way of bulking up, overcompensating for their perceived vulnerability, and resources have poured into the musculature of law enforcement, policy, regulation, and the legal department.
Instead of teaching relational skills and building confidence, we have a beefed-up division of student affairs drawing salaries equivalent to a partner in a law firm, and writing labyrinthine policies that leave students burdened, poorly treated, and at even greater risk.
It is this aspect of the legacy of Virginia Tech that is unhealthy, and has sent universities and student affairs divisions nationwide down a road of defensive build-up that, as we might have predicted, is costing rather than saving lives.
Perhaps the most tragic irony in all this is that I do not know of any university that has ever been sued out of existence.
One might think from the level of fear that exists around lawsuits that universities and colleges were being existentially threatened all the time. Instead, it appears that fear itself is the most salient force driving the behavior of college administration.
Dare we call it an irrational fear? As a clinician I see this kind of thing all the time. Usually if someone has a strong fear that is causing problems I will ask for evidence in support of the feared circumstance. Ninety percent of the time there is no evidence, and without that evidence we can begin to question together a belief that seems to have no basis in reality and yet acts as if it did, and begin to nurture a healthy curiosity about this strange circumstance.
Is it possible that a shift like this could occur in college mental health?
If I didn’t believe it possible, I wouldn’t be writing this article.
Maybe I shouldn’t be. A number of trusted friends (some of them lawyers) have given me many reasons to fear that my perspective may not only be unwelcome, it may be received in a hostile manner. I hear in these warnings their love and care of me, and I also hear the fear that says “don’t rock the boat,” “how will this help you,” “you can’t change the system,” “keep a low profile,” “keep your mouth shut.”
I can’t be a therapist and be persuaded by these warnings. Therapy is a challenging place. Boats get rocked all the time if your therapist is any good. Systems get changed by helping one small part of the system change first. It is about heart, and hope, and a different kind of risk-taking altogether. The moment I lose hope is the moment I lose whatever power I may have to encourage the conditions of change as a therapist. If that time ever comes, I’ll know I’m ready for retirement.
In the meantime, the stakes are too high to let this dynamic go without comment. The stakes are the lives of our children, the health of our college communities, and our ability to imagine our way forward toward quality care for all people.
As it stands, students are getting a firsthand look at how corporations handle vulnerability, compassion and loss (not very well), and I’m getting a firsthand look at how students can have a traumatic response to the e-mails the administration sends out after a suicide. Even one more such email is too many.