HealthNovember 10, 2015

Virginia Tech shooting has lessons for strengthening college mental health services

As the nation reels from another mass shooting on a college campus, analysis of the 2007 attack at Virginia Tech University highlights the need for "comprehensive and coordinated mental health services on college campuses, according to a paper in the November/December issue of Harvard Review of Psychiatry. The journal is published by Wolters Kluwer.

The Virginia Tech shooting can be viewed as a "sentinel event," highlighting the need to improve college mental health services—including an increased role of psychiatrists in assessing and managing students with severe mental illness, according to a perspectives article by Dr. Marisa A. Giggie of University of Alabama School of Medicine, Tuscaloosa. She writes, "Effective communication and the coordination of intervention opportunities among campus mental health and administrative resources are paramount for preventing future tragedies."

Preventing the unpredictable—what can college mental health services do?

Dr. Giggie reviews the history of missed opportunities to identify the attacker's deteriorating mental health. A series of disturbing acts and statements, including a suicide threat, led to repeated evaluations by mental health professionals.

Dr. Giggie discusses missed warning signs in light of the challenges of identifying and responding to mental health concerns. There were missed opportunities for the counseling center, campus police, and administrators to share information on the student's history of mental illness, which might have identified him as a high-risk individual in need of treatment.

A key contributor was confusion and "overly narrow interpretations" of federal laws protecting the confidentiality of patients' and students' information—particularly the duty to warn or protect potential victims of violence. "Balancing a student’s right to privacy against a university’s need to ensure public safety is the primary mental health–related legal issue" in the Virginia Tech incident, Dr. Giggie writes.

Since the Virginia Tech shooting, most colleges have acknowledged the need to improve communication among mental health providers and administrators and to provide threat assessments for students of concern. But while student access to psychiatric care has increased over the years, the demand for mental health services at most colleges far exceeds the supply.

"Comprehensive mental health prevention and treatment services on college campuses, with ready access to psychiatric services, are key components for addressing the growing mental health needs on campus," Dr. Giggie writes. She discusses the threat-assessment team approach, in which teams of trained professionals "judge risks, provide guidance on privacy laws, and make firm recommendations that balance the health and safety of the individual against the larger college population."

While violent events on college campuses garner the most public attention, they remain rare events in the context of the larger mental health needs of college students. Dr. Giggie reviews the statistics on common mental disorders in the college student population and argues for an increase in mental health resources for college students.

Dr. Giggie also believes that psychiatrists should play an expanded role in college mental health services, including assessing students who may pose a threat. She concludes, "Psychiatrists, because of their training and duties as both clinicians and consultants, should serve as leaders in providing psychiatric services for college students, assessing risk in high-risk emotionally troubled students, and advising others on best ways to manage complex situations involving emotionally disturbed students."

Click here to read "Virginia Tech as a Sentinel Event: The Role of Psychiatry in Managing Emotionally Troubled Students on College and University Campuses."

Article: "Virginia Tech as a Sentinel Event: The Role of Psychiatry in Managing Emotionally Troubled Students on College and University Campuses" (doi: 10.1097/HRP.0000000000000088)

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