The Role of Higher Ed in Providing Mental Health Services

This podcast will help you answer, “What should my institution’s role be in providing mental health services to our students? Are we providing enough resources? When should I tell parents about suicidal ideation?” We’ve asked three experts to the table to help you think about the appropriate parameters around scope of service, as well as legal considerations.

Kelly-Wesener-Micheal, Ed.D.
Chief Student Affairs Officer, Dean of Students
Northern Illinois University

Bonnie Gorman, Ph.D.
Assoc. VP for Student Affairs, Dean of Students
Michigan Technological University

Carolyn Reinach Wolf, Esq.
Director, Mental Health Law Practice
New York
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Table of Contents:

• What should the role of the university be in providing mental health services?
• What are the potential legal implications if a university doesn’t clarify their scope?
• How has your institution clarified scope of service?
• At what point does the institution have a liability to act/notify parents about suicidal ideation?
• How do I best meet the increasing demand for student mental health services?
• Advice to get started

 

AI: Nowadays, college campuses are like mini-cities. It’s expected to provide an array of services and supports for students, including mental health services. But how can your institution be sure you’re setting the appropriate parameters around your scope of service? It’s a topic that has many differing opinions in higher education.

In this podcast, you’ll hear from three experts with different backgrounds and opinions:

• • • • Kelly Wesener-Michael is the Chief Student Affairs Officer and the Dean of Students at Northern Illinois University. Kelly and her team already defined their scope and have been refining it over the years.
      • Bonnie Gorman is the Associate Vice President for Student Affairs and the Dean of Students at Michigan Tech. Bonnie and her team are currently in the middle of defining their scope.
      • Carolyn Reinach Wolf is an attorney and the director of the Mental Health Law Practice in New York.

Thank you all for sharing your expertise with us.

We’ll begin with this question: What should the role of the university be in providing mental health services? Kelly, can you kick us off?

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): Yes, absolutely. I think minimally, the institution is responsible for being able to do an initial assessment of the student need and a responsible treatment plan beyond that and a treatment plan will depend on again your resources and referral and all of that.

For me at the core of it, is that an institution needs to have the staff to be able to do that ethically, reasonably, to do an intake, assess and then get the student to the best level of care and that for me is the primary piece any institution needs to do.  The offshoot of that is obviously behavioral intervention teams and all those other things, but for the core for mental health it’s that initial assessment and a responsible treatment plan.

AI: Bonnie, same question. What should the role of the university be in providing mental health services?

Bonnie Gorman, PhD. (Michigan Technological University): I think about mental health services in the same context as I  do in terms of the role of the college campus providing developing for the whole student. So, we provide resource and programming to foster development in lots of different areas.  We do a prevention program around drugs and alcohol, sex, financial issues and I think we should be providing resources for students so they can stay mentally and physically healthy ultimately so they can succeed academically.

Good service and support to students improves retention which obviously keeps them here which has a financial impact, but ultimately leads to their graduation and graduation rates are a national metric for institutional success, so that piece comes in too.

AI: Carolyn, from a law perspective, what should the role of the university be in providing mental health services?

Carolyn Reinach Wolf, Esq. (Dir., Mental Health Law Practice): Given the increase in the number of students who are coming to campus, with serious mental health problems, more than ever before. Students tend to be more open about talking about their mental health issues. The substance abuse problem that certainly is not a winning combination with psychiatric issues and all of the stress students are under these days. I think that the university should make it a priority to provide mental health services.

I think there needs to be an increase in funding for these services, so they can increase their staff, their hours, their expertise they can offer, the level of credentialing, but again, it needs to be a priority. It’s very important for them to practice within the scope of their expertise, so what they’re licensed and experienced to do they should only provide those services within that framework. You increase liability when you practice outside the scope of your expertise or your credentials and it also goes to the issue of managing expectations of the students, the families, the staff. You can’t hold yourself out to do more than again you’re licensed or credentialed to do.

AI: Have you seen institutions go beyond their scope before? 

Carolyn Reinach Wolf, Esq. (Dir., Mental Health Law Practice): The answer is yes I do see it and I often see it on more rural campuses because and I’ve gotten feedback from college counselors who say, ‘We think we can do a better job than the outpatient center down the street that only has a psychiatrist who comes in once a month or doesn’t have the same level of expertise or credentialed counselors that we do, so we think it would be safer for students to stay on campus and use our services than being referred out to outpatient centers or private practitioners.’ Often that’s true, but again that’s the balance between practicing within the scope of your credentialing and expertise versus saying it’s beyond what I can provide and I really do need to make an outside referral.

AI: What are the potential legal implications if a university doesn’t clarify their scope?

Carolyn Reinach Wolf, Esq. (Dir., Mental Health Law Practice): If there’s a bad outcome or you’re holding yourself out to have expertise beyond the scope of your training or experience, there’s liability for negligence, for wrongful death, can sometimes be even breach of contract. If a student is going to a counseling center and they say we only have social workers, but they’re providing therapy beyond what a social worker would provide there’s either an implied or written contract for those services, so there is liability from a variety of different clauses of action in the legal world.

We’re seeing a lot of student suicides on campus, so if you have a student who’s come to the counseling center, talks about suicidal ideation, depending on the extent of the evaluation that’s done, based on again what the counselor’s level of experience and expertise may be, if they don’t properly follow up on that kind of presentation and something bad happens, they’re at risk not only for lawsuits, but their own licensure because they’re governed by state licensure, and so the licensing board can come after them as much as a lawsuit could.

There have been a variety of cases around the country where the plaintiffs that allege you knew or should’ve known of their child’s mental health issues, suicidal ideation, psychiatric instability, and you didn’t go far enough or you didn’t refer early enough or you didn’t care for them in the proper way. Right now the cases kind of go back and forth across the country. There are some courts that hold the university liable saying the student is on your campus. They live there. That’s where they spend most of their time. There is an established what’s called a special relationship, so you the university are responsible for acting in the best interest of the student and taking care of them. Then some courts have said well, ‘You’re on loan to the school. The student lives at home, is supported by the family. You’re only there for the months of the semester…’ and so that it doesn’t establish what’s called again, a special relationship and there is no liability.

AI: Carolyn, how can institutions make sure they’re protecting themselves?

First, there should be a good, solid credentialing system in place. There should be notice and addressing expectations. Notice to students and families as to what the level of services a counseling center is able to provide. For example, we have a psychiatrist on staff and he or she comes in once a week or we don’t have a psychiatrist we only have a psychologist or we only have counselors. Again, whatever your staffing is should be made known and the counseling center if they can provide certain services should establish a referral network so that when a student comes and it is beyond the scope of what they can provide, they have access to outpatient programs, mental health professionals in the community and so on.

Counselors also should have a relationship with their local hospitals. Know who is in charge of the emergency room. Know if there’s a psychiatric emergency room or unit hospital in the area and who t hose contact people are.

They should be establishing policies and procedures for how to deal with students who have mental health issues. They need to establish an on-call process. You can’t say, ‘Well, we close at 5 o’clock, so if you’re feeling suicidal you’ll have to wait until we open again at 9 am.’ That’s not going to fly. Maybe you do close at 5 o’clock, but then there needs to be an on-call system where somebody is available to either call 911 or campus security or whatever the policy is with regards to off hours.

Then, if you establish policies and procedures you better make sure everybody knows what they are and is trying to follow them because there’s nothing worse than violating your own policies and procedures.

Then lastly, as a former hospital risk manager, I am very big on the issue of documentation. Universities should be training their staff on proper medical record documentation.

In a lawsuit or any sort of legal challenge, you don’t want to get into a situation where it’s your word against mine because the adage in the community (is) if it’s not written, it didn’t happen. So, you don’t want staff to be in a position of saying, ‘Yes, I saw him. He didn’t seem upset when I saw him.’ And then, he goes back to the dorm and something bad happens. You want to document: I saw the student, had a discussion with him, explored this or that, and made a referral, or told him to come back tomorrow, or sent staff to check on him, or spoke to the RA and asked them to look in on him this evening, whatever the follow up is.

AI: Thanks, Carolyn. Kelly same question as before…What legal implications were you most aware of while defining scope?

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): The thing we try and keep in the forefront of our mind that any type of situation you always run the risk of setting the precedent of creating a special relationship, because that’s a precedent you’re setting moving forward. If that community advisor is having that student come in and is spending a lot of time with them working with an eating disorder, that’s well beyond their scope. Institutionally, you’ve set a precedent that that’s what your staff might be doing, and so to be really considerate about defining scope and educating supervisors about how to best manage that and hold people accountable so you’re not running into this well-intentioned piece.

For us, we’re always talking about what’s the precedent that’s been set? What is the due diligence in this situation? What is the most responsible way to handle this individual situation and again that large umbrella needs to be under what does this individual need, so that we can individualize the care, but do that within a consistent way and that’s challenging because individual situation is nuisance as we all know.

AI: And Bonnie, your answer about potential legal implications.

Bonnie Gorman, PhD. (Michigan Technological University): From a legal standpoint, there’s privacy issues. There’s accommodation issues. There’s parental notification issues, that sort of ties to privacy. There’s,

I’ll say, scope in the context of what we can require for an individualized assessment. So, there’s those pieces again working directly with the student.

In terms of worrying, maybe not from a legal perspective so much, but I just worry about students who aren’t seeking service, who need it.

I guess another piece of that too is our volume, in terms of what we’re able to provide and I think more centers our defining scope because we’re realizing that we cannot be all things to our students. So, for example, lots of centers are defining scope in the context of brief kind of support. So, if a student is coming to campus on medication for bipolar and has been seeing a mental health provider whether that’s a psychologist or psychiatrist on a weekly basis, we cannot sustain that kind of support through our center on campus and I think a lot of centers are feeling that and that’s in part because of the volume, right?

If we don’t define our scope clearly enough, there can be an expectation that we are able to do more than we’re able to do. If you think about it from a parent’s standpoint, they’re sending their son or daughter to school and they’re thinking, ‘Oh well, they’re going to do x.’ And we don’t do x and then the parents come back and say, ‘But, you said you were going to do x,’ right? So, I think from a legal standpoint there’s a piece there.

AI: Kelly, What are the ways NIU has clarified scope of service?

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): I think that when it comes to defining scope of services is really to understand your institution, what you are able to do and it’s not only your institution, it’s the context of the surrounding area, region and services available. So, whatever you do you need to do it with the due diligence and the responsibility of understanding the parameters and your resources, so you can do those responsibly.

So, if you are a large institution that has the resources to provide drug and alcohol counselors for those who might be struggling with addictions, that is fantastic and what a great service to your students. However, if you have a counseling center group that is able to provide not necessarily those specialty pieces, then responsibly you need to figure out what other resources outside of the institution where you can make responsible referrals. So, to understand the expertise and the credentials of your particular staff and resources on campus and operating within that. Knowing what is out of bounds and what are the referral on-campus or off that’s available to you so that you can not only maximize resources, but you can be responsible about meeting the needs of students.

For example on our campus, we have some training labs so-to-speak for students who are learning to be counselors in those educational programs, so when we have students who might want some time to work through a situation, but has no level of crisis, doesn’t necessarily need ongoing counseling, this is a great opportunity to refer them to a lab. If there’s something beyond the bounds of what our counselors are, so for example if we don’t have that drug and alcohol specialist to do a referral out in the community and then some of that middle ground, that ongoing counseling, is able to be provided on campus, but every institution has different levels of expertise and resources and to understand that and be responsible to it.

The other piece is understanding your surrounding communities. So, you might be in a community that has lots of resources with psychiatry support and mental health support but if those resources are maxed out by the community and there’s not the capacity in beyond the institution to also be mindful of that in terms of referral because it’d be great to say, ‘Hey, here are some outside resources.’ But, if you know they aren’t going to be able to access those for an extended period of time, that also needs to be taken into consideration as many communities are struggling with having the capacity to manage the demand and then put on top of that a rural institution who has less of that access and all of those pieces need to be put together to be able to clear about what you can and can’t do so you can provide that explanation to your campus community. You can educate your students and you can educate your faculty and staff about how this works on your campus and the way that you work with the community or not based on the resources they have.

We have a pretty diverse student population. There are agencies in our community that maybe don’t have the cultural competency within their staff to be able to give optimal care to some of our students because as college campuses become more diverse, that doesn’t mean always the surrounding communities and services within those communities have a cultural competency to be able to maybe maximize a service in ways that we would hope for and how do you do this all responsibly, right?

We have to be creative with the resources that we have. We all know that dwindling resources in higher ed. So, are there ways that not only that you could be able to make sure that you are having the cultural competencies within your own staff, not only the counseling center staff, but then it comes up to the division of student affairs or academic affairs, depending on where this all sits in your university structure. It comes back to the institution to be able to ensure cultural competency across all the faculty and staff so that we can have a supportive environment so that if a student is struggling and you are working with a student and you have cultural competency you can help support that student in a different way that might stop a situation from escalating. So, part of it is an institutional responsibility but also then being creative. Institutions have that town-gown relationship, so can you do an institute on cultural competency where the counseling center could host that and you bring in surrounding agencies. They have to do continuing education for certification. There’s no reason your counseling center can’t do some of that education piece, open it up to the greater community so you’re helping educate that larger group. It’s win-win. It’s continuing education. It’s building relationships and so there’s I think some ways that strategically you can bring your interdependency along in positive ways with the intellectual capital of the institution, for the good of all.

Also, there is this intersection between mental health and disability accommodations that I think institutions have to be mindful of as more students come to our institutions with accommodations, many of them tied to mental health in that invisible disabilities so-to-speak. How can counseling and your disability resources services team together to educate the campus community about what that is and also helping your staff be clear on how do we manage this from an accommodations perspective, a support perceptive, how does that all work together? How do we work as a team to support these students because there’s a different role that the disability resource center plays from counseling, but they do need to work together and I think that those relationships, making sure that we all understand how that works together on our campus is going to be of increasing importance.

AI: Kelly, can you talk about how you explain the different layers of service to students?   

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): So, on our campus, I talked about how we have these different layers where if you’re coming in because you had a breakup with your significant other and you’re sad and you’re just going to need some support for a few sessions, we will refer those students to one of our counseling centers on campus that’s really working with graduate students.

Sometimes student perceive that as having lesser care and sometimes they get frustrated if we have to refer. Like if you have some extreme level of schizophrenia let’s say or some significant diagnosis, we do refer those out because we can’t support those on an on-going fashion over the course of their academic career and we want to be responsible and make sure that they’re in a referral agency that can support that through their time here at college. Students don’t always understand that and get frustrated.

So, I think the lens for me the lens to look at this is an educational opportunity because really our healthcare system and our mental health systems in our society at large, are really designed at this point to handle the level of urgency in a different way. So, in your medical model let’s say you fell down. You twisted your ankle. You’re not sure. It’s swollen. It hurts. You’re going to go to an urgent care. You’re probably not going to get into your primary care doctor for weeks, so we have a medical system that’s designed for short term immediate care, not significant issues. That’s the medical healthcare model in the states right now and really this is the way that we’re handling mental health nationally as well as on college campuses and so, to help students understand that if they have a mental health or medical need, we want to be able to best address this in the most responsible way possible but this looks like what you will have to navigate beyond college.

AI: Bonnie, what has Michigan Tech done so far to clarify scope of service?

Bonnie Gorman, PhD. (Michigan Technological University): We are in the middle of this right now. We have not done it here. So, I can tell you kind of what things we have taken into consideration and kind of what we’re looking at. Certainly, there’s some standards out there, right? So, professional associations: NASPA (National Assocation of Student Personnel Administrators), the International Association of Counseling Services, which is an accrediting body for counseling centers. For us, we’re not in a position to go toward accreditation, but those standards… we take some of the things that are in their standards into consideration as we’re working on this I think.

We start talking about it and then we say, ‘Well, what do other people do?’ and so we start looking. We did start with the International Association of Counseling Services document. We did look at that as kind of an initial, out of the gate place to look. We are a JED campus, so those are the two probably where we started.

JED is a non-profit organization that supports campuses to help us develop a strategic approach to mental health, drug and alcohol education and suicide prevention. There’s an assessment piece, so they assess your students up-front. They do a campus assessment and then they come to campus and kind of give you the results of all of that information and then help you to map out a strategy for how to build your program in a more comprehensive way. It’s really awesome and we’re so fortunate. Blue Cross Blue Shield of Michigan actually is funding us to be able to do this, which is really cool.

JED has a lot available to particularly in terms of helping students identify what they need to do before they come to college, so the kinds of questions they should be asking campus before they get here. Again, just reflection piece in terms of, if that’s what they’re doing how do we communicate with understanding that those are the things that they’re looking for and then other models. There are some really good models out there already. University of Illinois at Chicago is one. If you look at a couple of different models you’ll see there is some standardization, or patterns I guess is a better way to say it, across some of the websites that have scope posted on their websites

And then, we have been talking with our counselors in terms of what services we provide and trying to identify what we need to refer out to other providers. One of the challenges for us in particular in this process is that we’re a very rural location and we do not have a lot of services in our community. When you say you’re going to refer them out that sometimes means a couple of hours away and that can be challenging, so that’s part of our conversation.

Who we service: enrolled students. Guest students is a question for us right now. There’s a visa classification and they can be guest on our campus as a colleague for a faculty member. They could be a graduate student but not enrolled in our campus but doing research with someone else. So, do we provide resources for those students? Those are things that we’re trying to sort out.

What do we do in crisis situations? I think that we all feel we will respond in a crisis to get the situation stable, but then we need to make a referral. So, those are the kinds of things we’re looking at. Once we get it established, once we get all of this written down, how are we going to communicate it to students, parents and faculty and staff and then how are we going to determine whether or not we’re being reasonable? Sort of an assessment piece if you will.

AI: Thanks Bonnie. Carolyn, can you tell us how you’ve seen other institutions clarify their scopes of service?

Carolyn Reinach Wolf, Esq. (Dir., Mental Health Law Practice): Publication, it’s called. Meaning, you let the campus know what your scope of services are. There’s a counseling center, here are our hours. This is what you do off hours. This is what we provide and so on. So, you give notice to the campus of what your services are and again, you establish policies and protocols that people are knowledgeable about following them.

And then, it’s really important to do education and training as to what are the legal guidelines and what are the laws that pertain to this area. The mental hygiene laws, confidentiality laws, hospital commitment laws. Some states have mental health laws and I am very big when I speak at saying it’s important to know the law, but it’s important to know the exceptions to these laws. Every one of these laws have exceptions and often it’s the exceptions that you may need to utilize in a crisis and every law has what’s called a health and safety exception, so if somebody’s a danger to themselves or others all bets are off in terms of confidentiality or who you can speak to or who you can notify. You always want to err on the side of saving a life.

AI: Bonnie, at what point does the institution have a liability to act/notify parents about suicidal ideation?

Bonnie Gorman, PhD. (Michigan Technological University): We have said that we will notify family/emergency contact if we believe that a student will in the near future cause harm to themselves or cause harm to others and we have laid out what that looks like. So, suicidal ideation, attempt physical assault with or without weapons, specific oral or written threats, major mental health concern like paranoia or even a severe eating disorder and typically the way that that works is that those are the cases where a student would end up being hospitalized and our goal is always first when that happens, is to have the student contact their family. Sometimes students are not willing to do that then they are told that the Dean of Student’s Office will make contact and from a legal standpoint we fall back on FERPA, which is the Family Education Rights and Privacy Act, which has a emergency health and safety clause in it to say that we can contact if we believe there’s a health and safety emergency.

AI: Kelly, same question.

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): Some of the federal laws define that. FERPA in terms of when there’s a threat to self or others and that question of threat to self and reaching out continues in the courts to be a question of what does that look like? It’s really the intersection of many things. So, if you have a student who has a disability and there’s accommodations that go with that, what are those laws dictating in terms of being able to have that discussion or not. You have the HIPPA, if it’s a health issue. You have obviously, FERPA and at the end of the day to some degree it’s how well do you sleep at night as an administrator who has to make those calls? I have a great relationship with our legal folks, so we in the middle of the night if we need to talk through that, because I don’t always want to look to the laws what we can’t and can’t do, are there things you can finesse in the middle?

For me, the really key piece in this is talking early and often to students and parents about waivers and their importance and if you institutionally have the opportunity to offer students to up front be able to sign something that gives the administration the ability to speak to parents, to understand those things, and to really work with parents early on to talk about what this is and the constraints. So, in our orientation I talk to parents about they may call us and they’re concerned and I can’t talk to you about your son or daughter situation. However, I tell them, ‘I’m going to talk to you a little bit about what we typically do in situations such as this,’ and so what we’re telling you is that this is the procedure that we’re probably using or something close to it and it will inform you in ways we can about what we’re doing and we encourage them to talk to their son or daughter about if they get in trouble or they’re concerned, the institution will ask about waiver and having that conversation at home before they get to college about if you’re ever offered this, as your parent as your person who loves you, we want to be able to support you, so please don’t ever be afraid to sign that because we’re in this together and obviously group dynamics and family dynamics. So, I think you have to work on the frontend with students and parents to set up success on the backend.

At the end of the day, I need to sleep well because I made the best decision in that moment in terms of who to shar information with or not and sometimes that’s a conversation with the lawyers to make sure that we’re all comfortable with here that is.

AI: How do I best meet the increasing demand for student mental health services?

Bonnie Gorman, PhD. (Michigan Technological University): So, we have done several things with regard to meeting demand, kind of even outside the scope piece. We have introduced a step-care model for our students. So, that means when they come into counseling services they are assessed and then determined whether or not they should be meeting with an individual for counseling or whether they should go into a group because there’s a lot of power in students understanding that they’re not alone. So, we have really built our group services significantly in the last year and a half in an effort to service more students so that’s been one way I think we’ve been trying to meet demand.

AI: Kelly, same question.

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): This is an ongoing conversation among the counseling center directors in higher ed right now and they’re looking at different ways to do this creatively. So, lots of times when most counseling centers have some type of wait list for students who aren’t in crisis, many of them have developed different group therapies that can be ongoing. So, for example students might have x amount of sessions that the university counseling center is able to provide. Group sessions not only allow students to be able to work through issues, make connections with other people who might be struggling with the same thing, but those lots of time are you can go be in that group therapy for as long as you would like, so it helps alleviate some of the pressure and lots of times they do that short term until they can get them in for some appointment. So, certainly they’re using that. 

There’s opportunities to use technology in different ways. Again, it’s a tricky how do you do that in a way that makes sense, but this particular group of college students are pretty comfortable texting or doing chat bot or whatever with a counselor or therapist and again, that’s not necessarily long-term, large-scale therapy, but it is ways that you can connect with students, get a sense of their level of crisis, be able to engage with them, check in with them.

We have a shortage of psychiatry nationwide and so there’s also tele-psychiatry, looking at things like that. Also, and more so for private institutions, what’s the role of ministerial support for students and how do you start to think about that more broadly for some students who value spirituality or have religious tradition. Are there ways you can partner with your ministerial resources on campus or we have a consortium for all of the religious leaders that have campus roots or campus student groups, we have that in our community so are there ways to partner with them that you might be able to support students differently?

What is the use of a memorandum of understand with different agencies in the area for referrals so you have some base line and some expectations around that. So, you have to think broadly about what are ways we can support students.

AI: If you were to give advice to another institution around clarifying scope of services for mental health, what would it be? Kelly we’ll start with you…

Kelly Wesener-Michael, Ed.D. (Northern Illinois University): I think that’s an educational opportunity and if we see it from that lens as administrators and we can help educate around that in a way that we would educate about any other issues. And that educate and kind of getting to the advice piece, the education piece has to be across the institution. The last thing you want to do is talk to the dean of the college when there is a student in his or her office, wanting to attempt suicide in that moment or something’s happened in the academic building and they’re having to respond. That’s not the time to educate them, ‘Well in this situation…’ 

First of all, it starts with helping your institutional leadership understand the model you’re working with and how this works on the campus and how this is a responsible way to manage the needs of our students. It’s also an opportunity with institutional leadership to talk about resources because the model you work from lots of times is from the resources you have and if the institutional leadership thinks that needs to be different, then that’s a different conversation. So, that education piece at the highest level and so your president and your senior leadership understand how you provide services, the rationale behind it and most importantly to be able to demonstrate to them the level of care responsibility and ethics that go into those choices and what’s important in that education too is they can champion to the campus community that our counseling center, they’re responsible for assessment and then getting students to the care that is most appropriate and really helping the campus community trust the counseling center staff to make that first assessment and get them to where they need to be, so that it’s not the, ’Well the counseling center just referred them because they don’t want to deal with that’ or whatever that narrative might be, you can get ahead of it with some institutional leadership support.

And then, all the layers, right? You need to have your academic leadership, your college deans understand what you do, how you do it and what it means to be in an emergency situation and how you’re going to respond and also how you identify students in distressed or struggling to make sure they know the resources and then that goes down to the heads of program. You have to have a pretty methodical way that you’re working your way through the institution to make sure you’re educating not only what you do, what they can expect, but what they’re responsibility is in supporting students who might be in distress or might just need generally to get to the counseling center and so, in that moment people have a sense of it and we can walk through it in a very different than if that’s being introduced in that moment to them.

Some years we have some emergency guides that have gone out that talk about students in distress and what to do. We now have lots of web resources as we’ve moved way from paper. Faculty and staff can get to a website and be able to assess that. We have a ways to go with the website. That’s the next three months is working on that but really you have to have a web presence where people in that moment can click and go, ‘Okay, student in distress. Let me click here and it’s going to help walk through that situation.’ So, you have to have those resources so students, faculty and staff can see what’s available to them to support.

We had our counseling center, the executive director come in and talk to our council’s deans, all of our deans and lead academic staff to help them understand. The counseling center staff go out regularly and try and work with different academic programs and educate them. That’s an ongoing education piece. We’re fortunate in our student association is really invested in mental health concerns, so they’ve partnered with us to do lots of ongoing education for the campus community, for students, to keep it at the heart of the conversation so we’re lucky that way but whatever works on your campus you’re going to have to figure out a layered plan to make so you’re making sure to do due diligence across all these audiences.

The responsibility of the institution is to clearly define their scope: what they can do, what they can’t do and then they have to do due diligence to that and then they have to do due diligence to that and there’s another training piece that I think goes with this as well, because that scope goes beyond just the counseling center. It goes to all of your other areas and departments, so the scope of a faculty member is not necessarily to do ongoing, heavy duty, kind of empathetic conversations, unless they’re equipped to do that, which most faculty aren’t. Their scope of service so-to-speak would be to identify students in distress and get them to the resources they need. To have faculty or a community advisor move beyond that to promise confidentiality, then that’s when the institution’s taking on more legal risk and so it’s not only having them understand the scope institutionally, but also each individual who touches students, can you promise confidentiality? Should you ask for that student to come back to talk about this topic? Is that within your scope of responsibility because that’s really where you start getting on shaky ground is that somebody takes on more responsibility than they reasonably should and we aren’t getting the students to the resources that are most appropriate under that situation and to be mindful of that. So, you have to work with your community advisors to make sure they understand they can’t promise confidentiality. They have to pass information along and when you’re working with student staff who are outward facing and more of us are working with student staff and graduate staff as resources dwindle. That particular group, there’s a lot more vulnerability because they don’t always grasp those lines as well as others and to really spend time because the last thing you want is to do harm to a student because you have a staff member who is diligent and well-intentioned but really stepped beyond what is their scope of services that they’re responsible to provide.

AI: Bonnie, what’s your advice?

Bonnie Gorman, PhD. (Michigan Technological University): Because of my scope, so I have in addition, housing and residence life and I have a Student Success Center, wellness is in my scope, student activities, center for diversity and inclusion. We work really collaboratively so we also have put together some workshops and seminar series kind of across the whole unit, plugging in counseling with wellness with the residence halls to provide as I said workshops and seminars for students on topics that maybe they would go talk to a counselor about but they could get enough information from some of these that they can try a few things before they need counseling, so it’s a quasi-preventative I guess in some ways.

For some students they’re still reluctant to go to a counselor like, ‘Eh, I don’t really want to do that.’ This is much less…they just want to do some exploring, right?

AI: And Carolyn, can you take us home with your last pieces of advice?

Carolyn Reinach Wolf, Esq. (Dir., Mental Health Law Practice): Establishing policies and procedures. Education and training. You also want to have a chain of command that people are familiar with. So, you don’t want the counselor to have to make a decision alone if they need to call 911 or violate confidentiality or notify parents. You want to have some sort of procedure where maybe they have to notify a supervisor and the supervisor may have to notify the dean. Again, whatever the campus policy is and it’s up to them to establish that policy. There needs to be a procedure that people are trained on in calm times. The worst thing that could happen is you’re in the middle of a crisis and you’re starting to pull out the policies and procedures, trying to figure out what to do.

A credentialing system, know what credentials you are… a counseling center has the funding for or what the plan is for them in terms of staffing, making sure people are properly credentialed and then re-credentialed let’s say every year. Once you’ve established that, then you also need to establish these policies and procedures for who’s going to do what and when and how students can access these services, both regular hours and off hours and then once you’ve established the policies and procedures, then you want to do education and training.

People often look to lawyers for the ‘legal answer’ and I really encourage people to think about the common-sense answer and often it comes down to what I call playing pick your liability. So, sometimes it won’t be here’s the right or the wrong answer, it’s picking between two choices. For example, we have very strict confidentiality laws under federal law and state law and you’re in a situation where a student’s having a crisis or having some sort of issues and the question is, ‘Should we call parents?’ and the student is saying, ‘I don’t want you to call my parents.’ And so, often you have to make the choice of violating the student’s confidentiality in light of a possible life and death situation. So, you could get sued for violating confidentiality or wrongful death and it’s as I say it’s sort of pick your liability. I’d rather defend a campus for violating student confidentiality than wrongful death.

But realistically, is any court going to hold a campus accountable for violating a student confidentiality when a student is saying, ‘I’m going to hurt myself’ or ‘I’m going to hurt someone else.’ So, that’s certainly more defensible than you knew or should’ve known, which is the tort standard, the negligence standard, you knew or should’ve known this student was going to hurt themselves or hurt someone else and you didn’t take any responsible action to try and stop that.

From a law perspective, it’s a form of risk management. It’s a form of liability protection, so the reality is we have students coming to campus with serious mental health issues and if we’re going to keep them on campus, because our goal is for students to succeed, we want to make sure we give them the tools and the support that will help them succeed. So, it’s not just succeed in their classes, but it’s  succeed from an emotional standpoint.