The Delicate Balance of Security versus The Provision of Help to Troubled Students

As promised, the following is the presentation I made at the CAUBO Workshop: Emergency Preparedness of Canadian Campuses: an executive perspective; March 27 and 28, 2008; Toronto, ONHere is the link to the actual Powerpoint presentation:

“Student Counselling to Recognize “at risk” Individuals and how to Intervene before Violence Occurs”

Below is the text of my presentation.

I have brought you here under false pretenses! The title of my presentation: “Student Counselling to Recognize “at risk” Individuals and how to Intervene before Violence Occurs” is only half correct (the first half because the second part hints that we can somehow anticipate violence). Nonetheless I was told that the conference was already a “sellout” so I didn’t change it. Instead I got permission from Russ Federman (Director of Counselling at the U of Arkansas) to use the title of his talk: “University Student Mental Health and its Relationship to Campus Safety” because it more closely mirrors what I will be talking about.

I also have a confession to make, unlike the previous speaker I am not a psychologist, not even a counselor. What I am is an administrator (the Dean of Students). I have been a professor for 30 years though and have learned a lot about students. I am also responsible for essentially all of the student services at McMaster University though (including counseling and judicial affairs) and through my involvement in the Ontario Committee on Student Affairs I know pretty much what goes on at most universities in the province as it relates to student behavior and I’ll brag about what some of my colleagues are doing here. A commercial - you should engage the professionals working in SA on your campuses as you deal with these issues.

Initially I wasn’t even going to attend this workshop because I didn’t think the topics applied to me. But I was asked to give a Student Affairs perspective and I’m very pleased to do that and especially to follow Dr. Klassen who actually is an expert in mental health. Dr. Klassen has given us many suggestions for implementing programs at our universities. What you will hear is that at McMaster and several other universities programmes are already in place for identifying students at risk.

Since the title is a little misleading, I’ve decided to give my presentation a sub-title borrowed from Dr. Federman’s presentation : “The Delicate Balance of Security vs. The Provision of Help to Troubled Students”.

The abstract of my presentation will serve as an outline.

In this presentation Dr. Wood will review the current landscape of mental health issues and counseling centre usage in Canada and the U.S. Rampage shootings are almost always suicides, hence suicide prevention is violence prevention. Current suicide awareness programs in use in Canada (QPR and Mental Health First Aid) will be introduced. Profiling is not the answer since according to a 2003 U.S. NRC report: “There is no accurate or useful profile of the school shooter”. A better approach is Threat Assessment which will be discussed. Many universities also have committees to support students in difficulty or committees of concern to identify students in need of support. McMaster and other universities have also created “Assessment of Behavioural Risk Teams”. The folder- “Connections: Identifying and Referring a Student in Difficulty” will be distributed . This folder and a memo are used at McMaster to communicate with faculty members to engage them in identifying students who are exhibiting mental health issues. Finally, changes to the Student Code of Conduct that allow for “voluntary withdrawal” will be discussed. I also showed the picture from this article as an outline.

What are our expectations of safety on our campuses? As employees, we expect that our campuses are safe places to work. When students are surveyed (as they are presently are) by the Globe and Mail and asked about safety they usually respond with an A. However we have seen examples of violence on our campuses in both Canada and the U.S. Parents are much more involved in the education of their children and they have taken a much greater interest in their safety and security as well. The reality is that our campuses are open and easily accessible and given that are vulnerable to violence. Most schools do their best to convey a feeling of safety. Senior administrators make themselves available to students to help make them feel included on campus.

Their can be no question though that a campus is a microcosm of the greater society (albeit generally safer!). We have all of the things that one sees in a city - violent acts including physical assault, sexual assault, stalking and, unfortunately, murder. Although campuses are usually safe and tranquil havens - violence shatters this fantasy. Because the two shooters at Virginia Tech and NIU were suffering from mental illness at the time of their murders, mental health services are under increasing pressure to identify and treat potentially violent students. The reality however is that the mentally ill are much more often the victims of violence than the perpetrators.

International students are particularly vulnerable. Language issues and social customs often prevent an international student from seeking help. Although most universities have offices to support international students, it is frequently difficult to get the students the help that they need.

There is no question that counseling centres on university campuses are under siege. An article “The Mental Health Squeeze” appeared as recently as March 18^th!

In a very heartfelt essay, Dr. Jonathan Perry, Director of Counseling and Psychological Services at the University of Arkansas wrote: “I will not be at all surprised if, somehow or other, it emerges that Kazmierczak had been diagnosed with a psychiatric condition while at NIU and prescribed medication for it. I will not be surprised if he was treated at either the counseling center or the health center (or both) there. I will not be surprised if it turns out that he was being treated, or had been, by the counseling center and/or the health center at UIUC. (Let me state that I DO NOT have any insider information. I know nothing that hasn’t come straight from the media, nor do I expect to. So please do not take what I have just written as “the truth”.) In other words, I will not be surprised to learn that he was one of THEM–people with mental disorders. Except “them” is us. NUTS-R-US. Twenty-five percent of Americans suffer from at least one episode of a mental disorder every year. TWENTY-FIVE PERCENT. We believe that this number applies to college students as well, and it may be even higher.”

“There is emerging a tremendous pressure for campuses to do something about “them”. Many actions are admirable: the founding of student peer support groups such as Active Minds, the pumping of additional resources into student mental health services, the tremendous support offered students with psychiatric disabilities. But there is also a growing number of potentially dangerous and poorly conceived efforts to find out who “they” are: requirements that incoming students disclose their mental health treatment history (see ASU), weakening of rules concerning the confidentiality of contacts with counseling centers and health centers, the ejection from campus of “them” if they get into any trouble at all or if their suffering and symptoms are too evident. I said after Virginia Tech that one result of that tragedy would be the targeting for suspicion of all of the creepy, quirky, weird, or unpleasant students, and I was right. It has happened, it IS happening, and now it is just going to get worse, because “we” are scared of “them”.

Some data:

“research indicates an increase in the severity and acuity of presenting issues among students presenting to college counseling centres. For example, during a 13 year period of study [1989-2001] at a large Midwestern university counseling centre, rates of depression doubled and suicidal ideation tripled.

There are a number of clinical issues presenting on campuses including depression, eating disorders, anxiety disorders, personality disorders and self-harm.

From the 2006 survey of the American College Health Association (ACHA):

• Young adults (ages 18-24) have the highest prevalence of diagnosable forms of mental illness in the whole population at 27%
• Suicide is the 2^nd leading cause of death for college students. However, college may be seen as a protective factor since the rate of completed suicides is 7.5 per 100,000 students compared to 15 per 100,000 for the general population.
• 95% of college students who commit suicide suffer from mental illness, usually depression; and if depressed, substance abuse, anxiety, impulsivity, rage, hopelessness and desperation incrase the risk
• 9% of students report suicidal ideation. 1 out of every 12 students has made a suicidal plan.
• 17% of college students practice self-injurious behavior (eg. “cutting” - this is a much more prevalent problem than shootings obviously and one that our Security has had to deal with)
• 75% of people with schizophrenia develop the disease between the ages of 15 and 25
• More than 40% of U.S. students become so depressed during their college years that they have trouble functioning. 16% suffer from clinical depression - up from 10% in 2000.

From the 2006 National Survey of Counseling Center Directors (367 campuses reporting)

• 9% of enrolled students seen
• 16.4% re referred for psychiatric evaluation
• 25% are on psychiatric medications (17% in 2000; 9% in 1994)
• 91.8% believe that the number of students with severe psychological problems has increased in recent years
• 40.1% of clients had severe psychological problems, 8.3% so severe they can’t remain in school without extensive psychological help
• 30.5% believe that violent incidents against students have increased over the past 5 years
• 466 cases of obsessive pursuit with 129 students being injured and 10 being killed by their pursuer
• 142 suicides - only 10% current/former clients

Similar data also exist from the 2007 Survey.

From the February 15, 2008 issue of “The Pavela Report” : Rampage shootings are almost always suicides - “Suicide Prevention is Violence Prevention“. As noted by Richard Filion in today’s first presentation - the shooting at Dawson College was also a suicide.Suicides have a wide and lasting impact on campuses. In the U.S. suicide is the second leading cause of death among college students and the third leading cause of death among all youth 15-24 years old. In the United States, only accidents and homicides claim more lives of young people. In the U.S. it is estimated that there are approximately 640 suicide attempts every day. I expect that the situation is similar in Canada and would suggest that there would on average be 50 to 60 attempts per day.

As a result universities are investing in suicide awareness training for their staff and students. At McMaster for example we are heavily invested in the QPR (Question, Persuade, Refer) programme as described in a Daily News article. The University of Waterloo is also training its staff in QPR. At Queen’s University Residence Life Staff receives training in Mental Health First Aid a commercial venture aimed at providing training for teachers and staff the work with students of all ages.

When her older brother took his own life in 2000, Alison Malmon, then a freshman at the University of Pennsylvania, wanted to reach out to other students who suffered in silence like Brian. Her answer was the creation of Active Minds, a not-for-profit organization that uses the student voice to raise awareness about mental health on college campuses and provide access to information and resources.

Since the founding of Active Minds, Inc. in 2003, student-run chapters of the organization have been created on more than 100 college and university campuses in the U.S. and Canada, according to Malmon. She anticipates the growth to continue, reaching more than 300 campuses in the next three years.

One of the issues that we face in Student Affairs is that mental illness can become a disability. Under Human Rights Law “disability” includes both past disabilities and perceived disabilities in addition to current ones. A university has a duty to accommodate under the Human Rights Code. I’m sure that this will be addressed in Dan Michaluk’s presentation tomorrow. University’s are also bound by FIPPA and PHIPA legislation that limits the information it collects on students from being shared. Similar legislation in the U.S. (called FERPA) is presently under review with a view to clarifying when information can be released and perhaps making it easier.

From “The collection use and disclosure of personal information and the risk of catastrophic on-campus violence” Hicks Morely opinion to COU: “creators of the Human Rights Code…did intend that universities and other institutions manage security risks without reliance on discriminatory stereotypes and without reckless disregard to the privacy of individuals.”

Nonetheless this is exactly what is being proposed at some U.S. universities like Arizona State.

To me, this is a very dangerous precedent. If counseling centres are required to report on students with mental illnesses it is likely that they will simply not attend the centres. Already we know that only 20% of the students at college that commit suicide have actually attended a counseling centre. An article in the March 25^th Globe and Mail is very much to the point. Titled: “A disorder in disguise: Poor grades, irritability, suspicion. What distinguishes the beginnings of schizophrenia from normal adolescent turmoil? New research identifies key warning signs.” Quoting directly from the article: “And in retrospect, Ridwan Tahseen’s decision to answer the school counsellor truthfully was nothing less than life-changing. Otherwise, he may have been on a fast track to schizophrenia. Mr. Tahseen’s university grades had plummeted so far that the 20-year-old was talking to his counsellor about being suspended. Feeling he had nothing to lose, he blurted out a string of disturbing revelations: He was devastated by a breakup. He had been cutting himself. In crowds, he thought people were staring at him and about to harm him.” I wonder if the student would have even presented at the Centre if he knew that the details of his illness would be shared with police or his parents.

According to Gary Pavela: “Threat assessment by a trained professional” is a better approach.

At McMaster we have three teams that deal with various kinds of threats. We have a “Threat Assessment Team”. It is called the “Crisis Management Group”. Its membership is: Vice-President (Administration) who Chairs the Committee; Associate Vice President (Student Affairs) and Associate Vice President (Academic) whoa alternate as co-Chairs; the Director of Security; Director of Physical Plant; the Director of Public and Government Relations; the Assistant Vice President (Human Resources) and the manager of Environmental and Occupational Health Support Services. We recently added a person from the faculty of Health Sciences to address their specific needs.

This committee meets frequently. We met last Thursday for example to prepare for a demonstration and then today for a de-brief. This team would meet for almost any threat - particularly if a shooter was involved.

Within Student Affairs we have a “Committee to Support Students in Difficulty (CSSD)”. The committee is comprised of representatives from key services within and outside of Student Affairs. These are The Centre For Student Development (counselling, disability services, and mental health), Campus Health (including mental health), Chaplaincy, The Office of the Ombudsperson, Campus Security, Office of International Students Advisor, Residence Life, Judicial Affairs, Associate Dean Academic, the AVP Student Affairs and Dean Of Students as well as Human Rights and Equity Services. In addition the committee has a linkage with Human Resources for advice and consultation, where appropriate. It was created to attempt to identify students who were presenting at different offices with the idea that together we could assist the students better.

Once a student is identified as being in this or a similar category, the Dean of Students, the committee chair, or a committee member can immediately convene an examination and consultative process with the committee’s core membership, (The Assesment of Behahavioural Risk Sub team (ie. Marion’s ABR team) , and bring other appropriate parties to the table as required. In most situations it will be the Dean of Students who will convene such an examination. The Core members are responsible for acute response, namely the Dean of Students, CSD, Campus Health, and Security. Once this group, or the appropriate members from this group examines the presenting information, with any further fact finding, as warranted by the situation, a course of action would be immediately recommended, or taken. This team has met twice so far. Its focus is on mental health related cases where a student is likely to harm her/himself or cause harm.

One of the major efforts at McMaster has been to get all members of the community involved in identifying students at risk and getting them help. A bright orange file folder (called “Connections”)has been circulated to all faculty, staff and TAs. It is also available on the web and contains topics like: Identifying and Referring Students in Difficulty; Who is a Student in Difficulty?; TEN STEPS TO MAKING AN APPROPRIATE REFERRAL; and, Resources Available. This folder has been emulated at other universities and indeed the concept has been borrowed for other important activities at McMaster - like the Workwell Audit.

Student Code of Conduct Changes

Brock University has a well developed section of their Student Code of Conduct dealing with “Students at Risk” beginning at Section 26.

McMaster University recently modified its Student Code of Conduct to allow for the possibility of “Voluntary Withdrawal”. These changes take effect on May 1, 2008.

University of Western Ontario is pursuing a “Safe Campus Communities” approach.