Since 1971, when the legal voting age became 18, students theoretically have had control over all aspects of their lives. Universities no longer imposed curfews or dress codes, and co-ed dorms became the norm. Parental influence became less and less of a factor as bills and reports were sent directly to the student.
Although the student is considered an adult, who is responsible for the student’s mental health? When away at college, does the responsibility for student’s mental well-being shift from the parent to the University?
Suicide is the second leading cause of death among college students, and depression is a growing issue. In recent years, the in loco parentis debate surrounding universities has been reopened as to whether the school should act in place of the parent when a student’s health is at issue.
A recent example occurred at the Massachusetts Institute of Technology in 2000 when student Elizabeth Shin burned herself to death due to her severe depression and stress.
Her parents were never informed that the school psychiatrist had considered hospitalizing their daughter due to her serious and dangerous mental state.
Two years after the incident, Shin’s parents filed a $27 million wrongful death suit again M.I.T. They claimed that M.I.T had been overly concerned with protecting Elizabeth’s confidentiality. By failing to inform them about their daughter’s state, the Shins lost the chance to save her life. To make the matter more complicated, the Shins claimed that M.I.T. failed to act in their place – “in loco parentis to the deceased.”
Dr. Robert Winfield, University Health Service director, commented on the difficult balance between protecting a student’s personal safety and protecting a student’s personal privacy.
“At University Health Services, we act as health care providers and teachers for learning how to cope, recognize care and help individuals who are experiencing depression. At times when deemed appropriate, we act in advisory ways, like a parent would, but we do not take the place of parents,” he said.
“Generally, we treat students as adults who are needing support and care. At the University, we are not guided by the legal in loco parentis, but rather guided by good judgment for the students’ well-being,” Winfield added.
Not only have universities treated students as adults but students have also gained legal rights to privacy. Two decades ago, universities saw their roles as parental. Today, the level of privacy control has increased through such measures as the Health Insurance Portability and Accountability Act of 1996, which created higher national standards for health care records and data.
“HIPAA created a higher level of privacy control and reinforced the importance of confidentiality. In general, the University protects the privacy of the student unless there is a profound risk to the safety of the student or to other students,” Winfield said.
Under the Family Educational Rights and Privacy Act of 1974, there is legal protection of a student’s educational records. FERPA and HIPAA are important legal means for guaranteed protection to which all universities must adhere.
Todd Sevig, director of University Counseling and Psychological Services, said CAPS is primarily governed by the Michigan Mental Health Code as opposed to specific University policies.
“The mental health profession is based on privileged communication in a confidential manner. Confidentiality is the hallmark of our profession and it is not taken lightly,” Sevig said.
“In accordance with the Michigan Mental Health Code, the University’s responsibility for mental illness is to provide adequate resources, education and quality services along with working with the community to increase awareness,” Sevig added.
In the M.I.T. case, Shin’s parents argued that confidentiality should have been breached. It is a very unclear and gray area as to when a university should break confidentiality with a patient to inform outside sources such as family members. The decision is often between violating the rule of privacy to possibly save a person or protecting the rule of privacy to preserve the patient-doctor relationship.
“It is a difficult judgment call, because violating privacy damages the established relationships. It is also hard to know if the student is in real danger or just experiencing pain,” Winfield said.
Although the University provides services such as CAPS and UHS, there are many reasons why students suffering from mental illnesses like depression may not seek the help they desperately need.
“There are also some societal fears because in some cultures, mental illnesses are more unacceptable than in others. Thus, students are more reticent to seek help,” Winfield added.
Other students in need of treatment believe they cannot afford treatment. Yet, the University provides alternatives and makes the important resources available to all students.
Community awareness is essential to reduce the negative stigma associated with illnesses. When the community gets involved in helping students, whether it is faculty, advisors or the media, problems may be treated before they become too advanced.
“Within the past five years, there has been a fairly significant increase on campus in the number of people concerned about mental health. The University has been continually trying to advance knowledge and coordination which is wonderful,” Sevig said.
“With University responsibility, it is important to know it is not a clear yes or no answer. Rather, it is a multidimensional effort, collaborating education, resources and community to help any student who needs assistance,” Sevig added.