To the Editor:
The recent article by Brian Van Brunt claiming that universities "brush off" emotionally troubled and psychologically disturbed students highlighted a common misconception about mental-health services on campus, with the net effect magnified further when the individual arguing the case is a mental-health professional ("Giving Troubled Students the Brushoff," February 21). Mr. Van Brunt's claim that "we can't pick and choose the mental illnesses that we treat in our centers" is absurd. The expectation generated from his article reveals a surprisingly poor understanding of severe and chronic mental illness, particularly the treatment of such disorders. As a psychologist specializing in the treatment of suicidal behavior and a college dean, I've seen the problem from multiple perspectives, including from the lens of a clinician providing care, an expert doing research and providing testimony in legal cases, and as an administrator managing the education, safety, and welfare of thousands of students.
University health centers offer a very limited scope of medical care to students. Never would a student or parents expect a health center to offer surgical procedures, kidney dialysis, cancer treatment, Lasik vision correction, or advanced diagnostic procedures. Student-health centers offer a remarkably limited range of medical care to students. To confirm the difference in expectations between student-health and counseling centers, I completed a research project reviewing the mission statements of each for over 400 major universities around the country. There was no surprise in the finding that every single student-health center provided a clear and precise medical mission statement along the following lines, "We diagnose and treat common illnesses and minor injuries." That's every single one. Not one single student-health center failed to provide a clear and precise statement of medical services provided.
In sharp contrast, less than 5 percent of counseling centers provided comparable information on limitations in therapy services. Now that counseling centers have recognized the irresponsibility (and legal risk) of propagating the myth that they can provide whatever is needed to all students, professionals step forward to provide pushback, claiming that it's actually possible and the ethical thing to do. What a disappointment.
In order to meet the expectations articulated by Mr. Van Brunt, universities will have to evolve into residential-treatment facilities, grossly expanding staff and resources, and most likely will need to add bed space to effectively respond to crisis and emergent needs for some of the more seriously psychiatrically ill. Doing so will forever change the landscape of higher education. The intensive and enduring care needed by some chronically psychiatrically ill and suicidal students is simply unmanageable on campus. Agreeing to do so in these cases actually heightens the risk that something tragic will happen. Colleges and universities certainly have obligations and responsibilities to students and their parents, but it's not simply to provide everything for everyone. Mr. Van Brunt is arguing for a different kind of health center and, in many respects, a different kind of university. Universities are in the education business, not the health-care business. The evolution of expectations has gotten out of control. Reasonable boundaries are not unethical. As a plaintiff's attorney once said to me, "If you don't do a better job defining your health-care mission, I'll convince them it's to do everything."
Mr. Van Brunt argues that providing comprehensive mental health care is an ethical as well as a legal issue, noting the tragedy of student suicides. Having served as an expert in dozens of cases involving student suicide, I can claim without hesitation that the risk involved in trying to do everything and making irresponsible promises to students and their parents only fuels the risk in many cases. There are some psychiatrically ill students, though the overall numbers are limited, who simply cannot function in a university context, with some simply unable to function in an independent, autonomous, and high-stress environment. I can cite example after example of universities that attempted to help students and their parents understand and agree that their son or daughter was not ready or able to be successful in such an environment. It doesn't mean that someday they could not be successful, but that intensive and enduring therapy was needed to establish the necessary skill set for not only survival, but also to help them thrive on campus. I can cite numerous examples of students and parents who willingly and knowingly refused that advice and left their children on campus, only to witness the tragic death of their sons or daughters in the months that followed. In many instances, a failure to be clear about the limitations of a student struggling with psychological symptoms, and the inherent risks of being on campus, is irresponsible for a college or university. Colleges and universities have an obligation to understand and be clear about not only their mission, but also about the services they provide, including health care.
University counseling centers need to clearly articulate their mission and provide responsible and effective care and treatment, and they must simultaneously embrace their limitations. To do any less only elevates the risks for some students and misleads parents when making a decision about what's best for their son or daughter.
M. David Rudd
College of Social and Behavioral Science
University of Utah
Salt Lake City