Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011.
Dr. Dombeck received his Ph.D. in Clinical Psychology in 1995
While returning from lunch today, I heard a story on NPR concerning a college student, Jeremy, who was kicked out of college for letting his college know that he was experiencing suicidal ideation. It’s early still and the complete story is not yet posted on the NPR website, but I believe it will appear here, as titled, “Some Students Fear Openness On Mental Health“, airing December 2nd, 2008 on “All Things Considered”.
As I recall, Jeremy’s story was that, while a student at an Ohio college not long ago, he was in a fist fight with a fellow student and sustained some sort of head injury, a concussion of some sort, which made it difficult for him to complete his studies, and which also appears to have altered his mood, so as to contribute to a depression. In the midst of recovery from the head injury, and in the middle of this mood difficulty, Jeremy expressed significant frustration with his situation, and told someone that he was thinking of killing himself. This disclosure precipitated a trip to a psychiatric hospital by way of the student mental health center. Before he could return to school, he received a letter from the college informing him that he had been expelled from school because of his suicidality, and that he was not welcome to return, even for a temporary visit. I may possibly have recalled some of the key details of this story incorrectly. Please forgive me if this turns out to be the case, as I’m working off my memory alone.
I was kinda horrified upon hearing this story, and I expect many people will have similar feelings.
What these college administrators were likely trying to do was to play it safe and limit the potential liability that a suicidal (and possibly homicidal, who knows really) student might pose to their larger student body. It is arguably a college’s right to bar a student from attending classes who is likely to become disruptive or a threat. A college does have a balancing act to perform, weighing the needs of each individual student against the needs of the collective student body. In the wake of mass shootings such as have recently occurred on college campuses like Virginia Tech , it is easy to see why administrators will want to err on the side of caution and remove students known to be making threats of lethal harm (if only against themselves) from their midst. “if Seung-Hui Cho had been removed from the Virginia Tech campus”, they might have been thinking, “the shootings that occurred later might have been avoided”. “Maybe Jeremy isn’t Cho, but who can afford to take the risk?”.
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Though I can understand the extreme desire for caution that must have been present, and the need to act quickly that must have been so urgently felt at the level of administration so as to keep the student body safe, the decision to expel a student for admitting he was in need of help is nevertheless a wrong decision, and for a simple reason. When you offer rather extreme negative consequences for seeking mental health help (such as getting kicked out of school), you discourage students from seeking help, and thereby cause them to be likely to not get help. If students who need help can’t get the help they need for fear of punishment, the ultimate chances that they will decompensate later on and become acutely dangerous to themselves or to others increase rather dramatically, is my guess. If I’m right, that makes these administrators’ decision to expel Jeremy quite short sighted; “penny wise, and pound foolish” as the saying goes. They have maybe dodged an immediate possibility of liability, but only at the expense of creating the potential for a much more widespread liability, and the serious possibility of contributing to an increased number of otherwise possibly preventable suicides or homicides.
When you’ve worked in the mental health field for a while, you learn that suicide is a very difficult act to predict, even in cases when people tell you directly that they are suicidal. On any given sizable college campus, there are likely to be numerous people who experience suicidal ideation , either in a fleeting form or on a more constant basis. Only a fraction of these people will ever actually attempt suicide. Suicidal ideation is indeed a serious warning sign of suicidality, but it is not highly predictive in of itself that a suicidal act will definitively take place. This is why people who have been hospitalized for suicidal talk are routinely kicked out of the hospital well before they actually feel all that much better and often when they are still actively experiencing low level suicidal ideation. So long as the suicidal threat is not “acute”, in the hospital’s judgment, it is generally considered most likely safe to send ’em home.
Jeremy, stating point blank that he is a threat to himself, is in actuality quite likely not a serious threat to himself. His suicidal statement does absolutely need to be taken seriously, and immediately and exhaustively evaluated. It is absurd, however, that he should be judged and punished so harshly on the appearance of his momentary intent when the actuality of his longer term intent is so likely non-threatening. The decision to expel permanently appears to have been made in an emotional, hysterical and reactive manner, and not in relationship to the ultimate facts of the case. According to the radio story, Jeremy does not continue to feel suicidal, and has actually enrolled in a new college. The better way to have made the decision would have been to make a decision to suspend enrollment on a temporary basis pending the opportunity to evaluate the facts of the case as they emerged from the hospital stay and subsequent counseling sessions, the content of which, under the circumstances, the college arguably had reasonable need to be granted access to.
I’m fortunately not blessed with the responsibilities and pressures of being a college administrator needing to make a judgment call like the one made in Jeremy’s case. I’d like to say that I’d make a different call if I were called upon to make such a decision, but in fairness to these anonymous men or women, I don’t know the full range of pressures they were operating under. I’d like to think, however, that a middle ground could have been found which might have better preserved the balance of rights and needs for both Jeremy and the student body. The act of expulsion trampled Jeremy’s reasonable expectation of being able to attend school. It sent a frightening message to anyone else attending that college (and by extension to all college students) thinking about seeking mental health care that care seeking will not be tolerated, which in my opinion, will have served only to heighten the overall risk for future mental health crises within these communities. Finally, the decision ignored the likely reality that more than a few other suicidal kids at Jeremy’s college might have also been feeling suicidal for one reason or another, but just not talking about it out loud. In a less fearful world, Jeremy’s crisis could have become an opportunity to encourage those other hurting students to come forward and get help they could benefit from, secure in the knowledge that they would not be punished for expressing an “intolerable weakness”. Instead, I fear, everybody in that college community, and certainly those who need help most of all, have lost out.
Edit: the audio is now up on the NPR site and I’ve been able to fill in some details I missed. The college in question is the College of Mount St. Joseph, located near Cincinnati, Ohio. Jeremy was not expelled, but rather “placed on involuntary leave until January 2009 at the earliest”.
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