The apparent suicide of first-year Carleton University student Nadia Kajouji highlights one of the major challenges universities face when it comes to helping mentally ill students. The parents of 18-year-old Ms. Kajouji are blaming the school for failing to contact them about her treatment for depression, but because she was over 16, Carleton was subject to privacy laws that forbade it.
It’s a legal and health care conundrum, says Michael Bay, a mental health law expert and associate professor in the department of psychiatry and behavioural neurosciences at Hamilton’s McMaster University. Many mental illnesses, such as depression and schizophrenia, arrive in the late teens. And heading to university can be a generally stressful time.
So every university in the world faces the problem of major mental illness presenting itself in first- and second-year students, he says.
About one-third of Canadian undergraduates reported symptoms of elevated distress during a 2004 survey of campuses by the Centre for Addiction and Mental Health. Women were more likely to report distress in general, and 36 per cent said feeling depressed was the cause.
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But by law, health information can only be shared when it is necessary to prevent serious bodily harm to the patient or others. Even a potential or reported case of cutting oneself or talking about suicide may not be severe enough, Mr. Bay says.
It’s a pretty high standard, he says, adding that he wouldn’t want to see the standard lowered - especially with mental health.
Mental health information is the most sensitive of information because of the stigma of mental health in society, Mr. Bay said.
As a father of two, he says he feels for Ms. Kajouji’s parents, but says, there is no way on God’s green Earth that you can provide a crystal ball to the mental health services at the university so that they can somehow identify somebody at risk. And you’re not going to then take every student who shows signs of depression at university and start running to their parents or identifying them as high risk.
Still, every time a case like this happens, university officials grapple with their own procedures, says Jane Everett, dean of students at Montreal’s McGill University. As in Ontario, Quebec privacy laws stipulate that McGill may in some cases release medical information to prevent acts of violence.
You can’t take that as blanket authorization, except in very rare cases, she says.
When first-year students and their parents arrive on campus, officials make the privacy issue clear, she says. It can be quite frustrating, I imagine, for parents.
At the same time, universities such as McGill continue to refine their protocols about how a student in distress might make their way through the system. Front-line workers are trained to accompany very distressed students to the appropriate care provider instead of merely supplying a phone number, for instance.
To supplement their medical and administrative services, most universities educate student leaders such as residence dons to be alert to the signs of mental distress. Mr. Bay says one of his daughters underwent this kind of training in 2002 at Carleton. They’re very serious in their training and in the backup they give them. They take it enormously seriously, he says.
But it would be a mistake to see dons or other student representatives as outside the law.
If they are tapped into the mental health network, they too would be bound by privacy laws if they learned of a student’s illness from that network, Mr. Bay says. If, instead, they are the first to encounter a student’s problems, their job would be to help the student access mental health care, not call parents.
They’re there to help students get treatment, not blow the whistle on them.
Beyond the legality of any action, any move to share information without a student’s consent could do more harm than good both for the individual and for students in general.
Word is going to go around the university that if you go see the mental health professional, the next thing you know is mommy and daddy are on your doorstep.
Health officials and social workers could ask students who approach them if they’d like to involve their parents as a matter of course, Mr. Bay says.
Even then, terrible consequences can still happen. Mr. Bay has testified in a number of inquiries in which, he says, he has to look distraught parents in the eye and tell them, Sometimes systems work well and people die. Some young people are going to succeed at killing themselves.
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