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WORKING WITH MENTAL HEALTH

STUDENTS FACING MEDICAL LEAVE


Jennifer Currie, Jennifer Mole, Elizett Pires

Proposed Project

What: Three-Hour Training


Who: Academic Advisors, Residence
Directors & Hearing Officers
When: Summer Departmental
Development Sessions

Mental Health facing the population

Anxiety 46.2%;

Depression 39.3%

Define; prevalence

Bipolar disorder 0.6%

Define; prevalence

Suicide thoughts/behaviors 17.9%

presence of sad, empty or irritable mood, accompanied by somatic and cognitive


changes that significantly affect the individuals capacity to function

Relationship problems 35.8%

Panic Disorder (11.2%) , Social Phobias


fear and anxiety and related behavioral disturbances [and specifically fixate on]
anticipation of future threat

Manic, hypomanic: abnormally persistent elevated moods. Depressive: at least 2


week period of loss of interest and pleasure.

Eating disorder 1.5% (Bulimia), 0.4% (Anorexia)

An illness that causes serious disturbances in your everyday diet.


Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 2013

Mental Health facing college students

Anxiety 46.2%

Depression 39.3%

Define; prevalence

Eating disorder 7.38%

Define; prevalence

Psychotropic medication 25%

Define; prevalence

Suicide thoughts/behaviors 17.9%

GAD, OCD, Panic Disorder, PTSD, Social Phobias

An illness that causes serious disturbances in your everyday diet.

Relationship problems 35.8%

Define; prevalence
AUCCCD Annual Survey 2011-2012 school year. Mean of Colleges 10 15,000 students.

Identifying Signs of Distress


Changes in sleep and eating patterns
Loss of interest in activities they used to
enjoy
Changes in mood and energy
Engagement in unhealthy and risky
behaviors
Physiological symptoms

How to address students showing signs:

Establish rapport

Show empathy

Open Ended Questions

Use silence

Ask direct questions if concerned about


harm to self

Interventions/Assessments

Student of concern protocols

Judicial meetings/hearings

Psychological Assessments

Alcohol & Drugs Assessments

Identifying campus resources

Academic Services &


Advising
Health & Wellness
support
Counseling Services
Campus Police
Community Standards
Campus Ministry
Off Campus Providers

Federal Disability Law

Department of Justice delegated to the Office of


Civil Rights in the Department of Education authority
to enforce Section 504 of the Rehabilitation Act of
1973 and Title II of the Americans with Disabilities
Act.
OCR to hold private college and universities to the
same standard as public institutions.
Federal law prohibits discrimination on the basis of
disability, including mental illness.

Direct Threat

March, 2011 Revised Title II Regulation regarding


direct threat. Removed threat to the student.
Direct threat means a significant risk to the health or
safety of others that cannot be eliminated by a
modification of policies, practices, or procedures, or by
the provision of auxiliary aids or services as provided
in 35.139
Threat to self not specifically addressed and not
directly protected under law.

Violation of student code of conduct?

http://www.ada.gov/regs2010/titleII_2010titleII_2010_withbold.htm

Case Law

Spring Arbor University 2010

First case after new Title II Regulations


Depression/Bi-polar
No written policies in place
University found in violation

Purchase College of the State University of New


York (SUNY) 2011

Hospitalization for overdose


3 written policies in place
University not in violation

Case Law

Quinnipiac University 2011


Student visits counseling center 1 time
Depression
Transport to hospital and released
Placed on mandatory leave instantly
Not allowed back on campus
University did not consider alternate accommodations
Settlement:

$17,000 compensation
Reimburse $15,126 student loans
Develop nondiscrimination policy and provide training

Civil Rights v Colleges

Balance between addressing the OCR


interpretation of law and doing what is in the best
interest of the students, community, and institution
New regulation is less clear and leaves little
guidance.
Colleges are using OCR decision letters resulting
from investigations to clarify reactive approach
(Grasgreen, A., 2014)

Concerns

Students might choose not to seek counseling out of


fear that the institution could force them off campus.
Possibility that students will fare worse if sent home
- no support system.
Not all students have access to or can afford proper
medical care off campus.
Financial strain no tuition reimbursement.
Return from leave is challenging.

Involuntary Leave of Absence

Brown University

When student exhibits behavior resulting from a


psychological, psychiatric, or other medical condition
that:
Harms

or threatens to harm the health or safety of the


student;
Harms or threatens to harm the health or safety of others; or
Significantly disrupts the educational and other activities of
the University community.

Re-admittance

Brown University
Leave

lasts two semesters


Must apply for readmission
Therapists letter containing DSM diagnosis
Current mental state
Medications
Follow-up plans
Interview Counseling and Psychological Services staff
Not guaranteed to be allowed back

Recommendations

Educate students, parents, faculty, and staff about what


resources are available on campus.
Policies should focus on conduct, not disability, which applies to
all students. Therefore, a student cannot be penalized because
of disability.
Avoid direct threat to self language as the sole basis for
adverse action.
Policies must ensure individualized assessment is made. Do not
base decisions on stereotypes or fears of mental health issues.
Base decisions on observed or recorded behavior.
Policies must ensure consideration of reasonable
accommodations.

Recommendations Cont.

Policies must ensure due process.


Consider voluntary leave first and seek agreement of
students and families for at risk students.
Consider behavioral contracts, designed to reduce or
manage the conduct at issue. The conditions should be
protective, not punitive in nature, and address behavior.
Research case studies for education, clarification, and
precedents.
Know the law and seek legal counsel and/or contact the
OCR or DOJ for clarification.

Supporting students

Things to be mindful of:


Amount of time student demands of campus resources
Impact the student of concern has on other students
Symptoms and signs frequency

Things to do:
Implement protocols
Refer to appropriate on campus and off campus
resources

Supporting students

What are BSUs policies around


Drug violations
Alcohol violations
Disruptive behavior
Other mental health issues
What resources do we have to support

Health

services
Counseling services
Student conduct

BSU alcohol policy

Bridgewater State University prohibits the


possession, consumption, storage or service of
alcohol by students except at the Great Hill Student
Apartments by apartment residents and their guests
who are 21 years of age or older, or at approved
or licensed locations.
Public intoxication is prohibited
Limits apply to full, partially full or empty alcoholic
beverage container
http://handbook.bridgew.edu/PoliciesProcedures/AlcoholPolicy.cfm

BSU alcohol policy violations


Offense
1st being in the presence
or possession of EMPTY
containers

Residents

Commuters

Disciplinary warning

Disciplinary warning

1st

Disciplinary probation,
Educational assignment

Disciplinary probation,
educational assignment,
temporary suspension from
residence halls

2nd

Temporary suspension from


residence halls

Permanent suspension from


residence halls

3rd

University suspension

University suspension

http://handbook.bridgew.edu/PoliciesProcedures/AlcoholPolicy.cfm.

BSU Drug policy

The unlawful possession, use or distribution of illicit


drugs and alcohol by students and employees on
university property or as a part of any university
activities is strictly prohibited.
BSU has a no-tolerance drug policy for all students,
employees and staff

http://handbook.bridgew.edu/PoliciesProcedures/Alcohola
ndDrugFreeCampusStatement.cfm

BSU Drug policy violations


Subject to disciplinary action

Unit employees: disciplinary action in accordance with


collective bargaining agreement
Possible suspension, mandatory participation in alcohol/drug
program. Possible termination of employment
Reporting of criminal law to appropriate law enforcement
agency for prosecution
http://handbook.bridgew.edu/PoliciesProcedures/DrugFreePolicy.cfm

BSU Medical, Psychiatric & Eating


Disorders Policy

BSU requires students with severe medical and mental health


problems to seek help.
A student may be required to seek professional help if
physical or psychological health problems place that
student's life, or anothers life, in potential danger; impairs
her/ his ability to maintain an academic program; or when
her/his behavior is a serious disruption to others. Examples
of such serious mental health problems include, but are not
limited to; symptoms of serious mood disorders; suicidal
behavior/ideation; threats to others; homicidal ideation,
hallucinations/delusions; serious eating disorders and
serious psychoactive substance use disorders
http://handbook.bridgew.edu/PoliciesProcedures/MedicalPsychiatricandEatingDisordersPolicy.cfm

Forced Medical Leave

Often referred to as involuntary medical leaves


Looks at risk and management harm to selves and
to others
Disruptive behavior / violation of student code of
conduct
Many institutions are now revisiting these policies in
light of ADA / Title II issues
Anti-discriminatory practices
Assessment and evaluation of each students case

Forced Medical Leave examples

Brown University

Expected to last two semesters, letter from therapists,


reinstatement

Bridgewater

Required to seek help if there is a threat to self and


others, disruptive behavior, reinstatement process

Reinstatement at BSU

Undergraduate students who have not registered for courses for one or
more semesters, or who have been academically separated from
the university and who wish to re-enroll must file an application for
reinstatement/readmission with the Office of Admission. An official
transcript from all colleges attended (if any) since last enrolling at BSU as
well as a personal statement explaining the circumstances of
separation/non-enrollment must be submitted with the application while
meeting the above published priority deadlines for transfer students. Oncampus housing is not offered to reinstated or readmitted students. Students
seeking on-campus housing may add their name to the residence hall
waiting list but will only be considered if space becomes available.
Upon readmission/reinstatement, transfer credit, if applicable, will be
awarded according to established policies. The grade point average
achieved at BSU upon separation will be resumed as grades achieved at
other institutions are not included when calculating a students BSU grade
point average.
Students who have been academically separated from the university must
meet the requirements of separation outlined by their appropriate dean
before being considered for readmission.

Reinstatement after a forced medical


leave

Supporting students
Individual assessment and support recommendations
Encourage voluntary medical leave, empower the
students
Connect to on-campus resources first
Encourage them to understand medical insurance
coverage for off-campus support if needed
Explain reinstatement process and a return plan

Limitations of Training
Summer = vacation time = potential
for limited staff availability
Three-hour training can be too long
loss of focus + information over
load
Limited to knowledge of current
employees only

Strengths of Training
Staff gain better understanding of
policies
Staff on same page and understand each
persons role
Challenge professionals to be more
proactive
No to low cost program in house
trainers

References
Barr, V., Krylowics, B., Mistler, B., & Reetz, D. (2012). 2012
AUCCCD Survey | Reporting period: 9/1/12-8/31/13. Data file
retrieved from
http://files.cmcglobal.com/AUCCCD_Monograph_Public_2013.pd
f.
BSU student code of conduct:
http://handbook.bridgew.edu/docs/BSU_StudentCodeofConduct
032015.pdf
BSU Alcohol Policy:
http://handbook.bridgew.edu/PoliciesProcedures/AlcoholPolicy.cf
m
BSU Drug Policy:
http://handbook.bridgew.edu/PoliciesProcedures/DrugFreePolicy.
cfm.

Image References
Student Health Center:
http://www.nmsuvirtualtour.org/buildings/student_suppor
t_services_and_resources/campus_health_center/
BSU Police cars:
http://rccblog.com/2010/11/17/collegesafety/
Student Counseling: http://ucc.nd.edu/counselingservices/individual-counseling/