Leadership Exchange

The 2006 National College Health Assessment found that 44 percent of students reported that they were “so depressed it was difficult to function” in the past year, 9 percent had seriously contemplated suicide, and 1.3 percent had actually attempted suicide. At the very least, these results highlight the reality that colleges and universities must have effective strategies in place for responding to these complex concerns. College counseling center clinicians and other student affairs staff across the country routinely must decide how to manage students who may be disturbed, suicidal, or threatening to others.

Needless to say, these decisions are extremely difficult on many different levels since the rights and interests of individual students must constantly be balanced with those of the larger community. Counseling service clinicians and other student affairs professionals frequently feel overwhelmed. This article briefly explores guiding principles for campus policies and reviews common considerations for formulating responses to troubling student behaviors, including eating disorders, alcohol and other drug issues, self-injury, suicidal threats or gestures, and odd or aberrant behavior, which can range from Asperger’s spectrum disorders to potentially violent psychoses.

Strong collaboration among various systems within and outside the institution is key to responding to all of these concerns, including the development of clear distinctions in student behaviors related to conduct and mental health issues and a keen understanding of applicable laws and ethics codes. A guiding principle for any policy must also include some level of flexibility that allows determinations of mental health needs to be made on a case-by-case basis. Any policy that requires an automatic dismissal or withdrawal will always be legally and ethically vulnerable to challenge. The primary obstacle to applying these principles involves accurately determining the level of risk involved (see related article, p. 26).

Once the level of risk has been determined, institutions
should review the range of possible responses related to the
relative risk and determine the most appropriate response for
the situation. Specifically, counseling center staff who are
concerned about a student in treatment can do any or all of
the following: review on-call and emergency procedures,
refer for a psychiatric consult, establish a verbal and written
safety plan, increase the frequency of sessions, and schedule
between-session phone contacts. If the student needs more
intensive treatment, a voluntary or involuntary hospitalization
may be required. When a hospitalization occurs, it is essential
that counseling and student affairs staff
collaborate with the hospital discharge

team to ensure a therapeutic and safe return to campus for both the student and the campus community.

In instances in which a more chronic pattern of concerning behavior exists, the most effective counseling intervention may require an administrative response. In particular, many colleges and universities enlist the assistance of a student-of-concern team or alert team. Such teams typically include key student affairs officers, such as directors of residential life, health services, student judicial services, public safety, and counseling services. The team can be an invaluable resource when assessing and responding to student and campus safety concerns. If deemed appropriate by the team, a decision may be made to conduct a more formal threat or risk assessment that would include legal counsel.

Another potential administrative course of action involves notifying parents or significant others. Involvement of family or significant others should be discussed on a voluntary basis, but if the student is unwilling to