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College Officials Re-evaluate Handling of Troubled Students

April 18, 2007 at 12:00 AM EDT
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RAY SUAREZ: Can anyone know when a troubled student might become violent? If so, what should be done? And who decides?

For those questions and more, we turn to three people who deal closely with these issues. Bob Portnoy is director of counseling and psychological services at the University of Nebraska in Lincoln. Dr. Paramjit Joshi is chief of psychiatry at Children’s National Medical Center in Washington. And Adam Garcia is chief of police for the University of Nevada at Reno and joins us from there.

Bob Portnoy, the picture that’s filling in after the fact is one of a very troubled man at Virginia Tech. How does someone come to your attention in the first place? What are the normal circumstances?

BOB PORTNOY, University of Nebraska, Lincoln: Well, typically, an individual will come voluntarily. They are aware of our services. They may be troubled and will contact us by telephone or walk in, and we’ll be able to see them immediately, if it’s an emergency, or alternatively we’re able to set up a time within the next day or two where they can be seen for an initial evaluation.

There are a lot of other avenues, though, for gaining access to services. And what’s particularly relevant here in our discussion is that there are a number of students who come to the attention of faculty or staff across campus, may present some concerning behavior, and, as a consequence, we’ll get a phone call from one of those faculty or staff members asking us to help them to evaluate the situation and whether some intervention might be in order.

RAY SUAREZ: Do you encourage those kinds of phone calls? Or do you worry that people might be getting turned in for being different?

BOB PORTNOY: No, we don’t discourage that in any way. In fact, we very actively encourage that. A number of years ago, we developed a brochure called “Recognizing and Assisting the Troubled Student,” specifically for purposes of talking with our faculty and staff about how to recognize when things are of concern.

And we encourage our faculty and staff not to rely upon their own expertise, which may not be in the mental health realm. And, therefore, we very strongly encourage them to give us a call. We’ll talk them through that.

We may encourage them to meet with the student to discuss this further. If they’re not feeling safe to do that, certainly we can involve our campus police, possibly even in undercover.

But we provide lots of support to our faculty and staff through counseling and psychological services, the program that I direct, and we find that faculty are really appreciative, as are staff, of that sort of backup. It’s really been critical for them to feel safe and feel that they can provide a safe environment for the rest of our students.

Crossing the criminality threshold

Chief Adam Garcia
University of Nevada, Reno
[O]nce a crime is committed, we can take the appropriate action. Or if there's some form of a threat that takes place, they're a threat to themselves or to others, we can involuntarily take them to a mental health counseling center.

RAY SUAREZ: Chief Garcia, how do you most often become involved, when there are students who are out of the ordinary in their behavior and their effect on other students?

CHIEF ADAM GARCIA, University of Nevada, Reno, Police: Well, it's a delicate balance. What we do is typically refer them to counseling at the university campus. Obviously, being different or strange is not illegal, so in order for them, for police action to take place, there has to be a crossing of the threshold in the criminality. Otherwise, it's an administrative issue, and it's then referred to the administration or counseling for further action.

RAY SUAREZ: So it's not until they demonstrate that they have the potential for doing something wrong that you know that they're able to do something wrong and they come into your purview?

ADAM GARCIA: That's correct. And, once again, once a crime is committed, we can take the appropriate action. Or if there's some form of a threat that takes place, they're a threat to themselves or to others, we can involuntarily take them to a mental health counseling center. Otherwise, it is an administrative issue.

RAY SUAREZ: Dr. Joshi, someone like Chief Garcia is, in effect, the police chief of a small city, but it's a city that's highly selected in its population. Aren't young adults and older teenagers in the years when they're most likely to first exhibit mental problems?

DR. PARAMJIT JOSHI, Children's National Medical Center: Certain disorders are much more prevalent in the older teenagers and young adults. And usually the disorders are major depression, schizophrenia, bipolar disorder. They tend to occur more frequently in this age group. So, yes, you're right that this is a population where there's the highest incidence of these disorders perhaps first appearing.

RAY SUAREZ: But something's different about having to watch this condition in a college from, let's say, a high school, isn't there?

PARAMJIT JOSHI: Well, that is true, because when you're a minor, you have lots of other eyes and you can take some actions. Even if the young person really doesn't want help or doesn't think anything is wrong, you can still get resources for the young person. But for an adult, you're crossing that threshold, because then you're always worrying about violating their personal rights.

A fine balancing act

Paramjit Joshi
Children's National Medical Center
Either they actually really appreciate someone watching out for them, or they can really get very angry and feel even more stigmatized. The third one is that they quietly, on their own, try and get some help for themselves.

RAY SUAREZ: And what are those rights, in legal terms, Mr. Portnoy? Does someone who suffers from a mental illness have certain expectations of privacy rights that they can use to keep the school off their back, in effect?

BOB PORTNOY: Well, absolutely, and it's always a fine balancing act between the civil rights of the individual and the safety of the community. Generally speaking, we tend to err on the side of conservatism, which means that if there is concern, we would like at least to talk with the individual.

Certainly, you know, as was mentioned previously, there are a number of mechanisms for sitting down and discussing these situations. Oftentimes, some of the concerning communications are, in fact, just the product of overactive imaginations, and certainly we don't want to stifle creativity, and we don't want to label people as ill if, in fact, they're functioning quite well in the community.

But we do have a very strong need to protect the university community. And so we do have, in addition to what Chief Garcia mentioned, in terms of emergency protective custody, we also have a student code of conduct on campus that is handled through our student judicial affairs office. And in that way, we're really able to do some informal investigation that allows us to determine whether counseling might be helpful.

RAY SUAREZ:  Is there a risk, Doctor, if Bob Portnoy and their staff are trying to make an intervention, of alienating a young person even further?

PARAMJIT JOSHI: That's always possible, and then there's the whole issue of stigma, especially when it comes to mental health, and that's very prevalent. And so, even though the young person may know that he or she may benefit from mental health services, is reluctant to ask for that help, and if someone actually suggests that to them, one of three things can happen. Either they actually really appreciate someone watching out for them, or they can really get very angry and feel even more stigmatized. The third one is that they quietly, on their own, try and get some help for themselves.

RAY SUAREZ: But the state in this case can't compel them to remain in treatment, can it?

PARAMJIT JOSHI: No, unless the person is a danger to themselves, an imminent danger to themselves or to others, you really can't. You cannot involuntarily force them to get treatment.

RAY SUAREZ: And, Chief Garcia, you know, it's one thing to close down a kegger or make sure the curfew is being observed, but do officers get trained in judging whether someone is in imminent danger to themselves and to others?

ADAM GARCIA: Certainly there's a protocol in place that we look at to determine whether they are a danger to themselves or to other people and in what instances they would be taken into custody, either for arrest or for further mental health treatment.

Improving the communication network

Bob Portnoy
University of Nebraska, Lincoln
But, beyond that, we really rely upon our ability to convey to the individual student why it's in his or her interest to continue in treatment, but there is no way in which we can compel that.

RAY SUAREZ: And, Mr. Portnoy, are there barriers between arms of the university administration? If something bubbles up through the health system, so it comes to Dr. Joshi's attention, or something bubbles up through the law enforcement system, and it comes to Chief Garcia's attention, is there a way that these different parts of the university can talk to each other without compromising the privacy of an individual student?

BOB PORTNOY: Well, we've, in fact, worked very hard at improving that network of communication. And we do try and be extremely sensitive to the privacy issues that you've mentioned.

But we did have an incident here on campus a number of years ago that could very easily have played out very similarly to what happened at Virginia Tech. Fortunately, the individual in that case had his semiautomatic weapon jam, and everyone was able to escape from a classroom without any bullets being fired.

But we had a lot of emotional fallout from that, in the days, weeks, months, and even a good year after that, where we were working with people who had been extremely traumatized. So I'm horrified to think about what the folks at Virginia Tech must be going through.

RAY SUAREZ: Earlier, you heard the doctor mention how difficult it is to compel somebody to remain in treatment. Can you make it a condition of their further study at an institution -- yours is a public institution...

BOB PORTNOY: We are public.

RAY SUAREZ: -- can you say, "Look, you have to continue to go to the doctor or else you can't be a student here anymore"?

BOB PORTNOY: No, we've not been legally able or nor has it been desirous to pursue that particular tact. We do have an option where judicial affairs can require an individual to go through an initial evaluation over in counseling and psychological services at our health center. But, beyond that, we really rely upon our ability to convey to the individual student why it's in his or her interest to continue in treatment, but there is no way in which we can compel that.

Following up on troubled students

Paramjit Joshi
Children's National Medical City
[T]here's such a dearth of mental health services on many college campuses. And so I think it's really going to be important that, while you provide and have access to acute care, the follow-up is really absolutely critical.

RAY SUAREZ: Chief Garcia, if a student has threatened another or threatened themselves, are they on a kind of watch list? Do you keep a different kind of eye on them than you would on another student who hasn't come to the administration's attention in this way?

ADAM GARCIA: Well, not necessarily. The University of Nevada-Reno has approximately 20,000 students, faculty, and staff, and you can imagine the job of keeping these people on a particular watch list.

Obviously, there are people that we're familiar with, who we've had contact with, who have been referred to either administrative services or counseling, judicial affairs, but to keep a full-time eye, so to speak, on these individuals would be extremely difficult on the local law enforcement.

RAY SUAREZ: And, quickly, Bob Portnoy, is there follow-up, if someone has been getting treatment for being a danger to themselves or to others?

BOB PORTNOY: Well, certainly, if they've been hospitalized, we've worked out a very close working relationship with the local hospitals and the crisis center so that we can develop a very strong discharge plan. And that almost always includes a direct referral to be seen by one of our psychologists in counseling and psychological services, as well as we have substantial psychiatric backup within our agency.

RAY SUAREZ: And, Dr. Joshi, is follow-up a weakness here when we're talking about college campuses?

PARAMJIT JOSHI: It certainly is, because there's such a dearth of mental health services on many college campuses. And so I think it's really going to be important that, while you provide and have access to acute care, the follow-up is really absolutely critical.

RAY SUAREZ: Thank you, guests, all. Good to talk to you.

PARAMJIT JOSHI: My pleasure. Thank you.

BOB PORTNOY: Thank you.