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David Baxter PhD

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Colleges take hard line on psychological problems
By Bonnie Miller Rubin and Megan Twohey, Chicago Tribune
December 27, 2007

Critics see harm; officials cite court rulings, Virginia Tech

Jill Manges was in her French history class at Eastern Illinois University, when she felt the symptoms -- the waves of nausea, the tightness in the throat -- that signaled an impending flashback.

Threading her way through the row of desks that September afternoon, Manges -- who suffers from post-traumatic stress disorder -- willed herself to the door, blacking out just outside her classroom.

Twelve days later, the school gave her two options: Take a medical leave or we'll kick you out.

That same month, Michelle Pomerleau, a student at St. Norbert College in Wisconsin, faced a similar fate when she overdosed on prescription drugs.

"I am concerned for your well-being, Michelle, but your behavior is impacting other students in a negative manner," wrote a school vice president in a letter delivered while the Lake Zurich native was still in the hospital.

From large public institutions to small, private colleges, a growing number of schools are taking punitive action against students who display mental illness, ranging from bipolar disorder to eating disorders, experts say.

With better mental health services in younger grades, more youth with mental illness are arriving on college campuses than ever before. At the same time, courts have indicated that schools can be held legally responsible if students harm themselves or others.

Administrators, mindful of the safety of the larger community, say they need to be proactive.

But critics call it overreactive. They say schools are discriminating against those who have a medical condition, deterring students from seeking help and driving dangerous behavior underground.

"The message is that we only want people here who don't have physical or mental impairments," said Karen Bower, an attorney with the Bazelon Center for Mental Health Law. "And if you have one, you'd better have it under control at all times."

The Washington-based organization represents students who were removed from campus. Bower used to get one call a month; now, she says, she's getting one a week.

A turning point was 2002, when a state court held that officials at the Massachusetts Institute of Technology could be sued for failing to prevent the suicide of a student. Then came the Virginia Tech shootings last April, a wake-up call that today's counseling centers are dealing with much more than angst over failing grades or bad break-ups. Administrators say it doesn't take a violent episode to disrupt a campus.

St. Norbert would not take action against students who quietly battle their own demons, said Jay Fostner, a vice president at the school. But it would move against students who repeatedly pull classmates or faculty into their suffering.

"It is not about suicide attempts or mental health issues," said Fostner, who, like all administrators in this story, cited privacy laws in declining to comment on specific cases such as Pomerleau's. "It's about behavior."

Pomerleau said she displayed a suicidal gesture last year -- taking nearly 20 painkillers, anti-anxiety pills and muscle relaxers one night in an attempt to self-medicate manic symptoms -- before she was diagnosed with bipolar disorder and placed on medication. Months later, she took a medical leave when her best friend committed suicide.

There were times, she acknowledges, when she was crying loudly in her room and leaning on classmates for support. After swallowing dozens of pills in September, she called a friend and paramedics had to carry her out of the dorm on a stretcher.

But Pomerleau said her grades were good and she had been commended by the college for performing community service. Her suicide attempt in September followed a change in medication, which, according to her doctor, has since been corrected.

"It felt like they were dismissing me strictly for my mental health," said Pomerleau, who opted for a medical leave because it allowed her to get a tuition refund.

Manges of Grayslake believes she was on EIU's radar -- even though her behavior was not life-threatening.

After her episode, which, according to the university, included screams and "sobbing uncontrollably," two classes were canceled and one was moved. She said she was told the behavior was "traumatic" to others who witnessed it. She had not kept her disorder a secret. On her residence hall application, for example, she wrote: "Diagnosed with severe PTSD and would strongly prefer a suite rather than a communal bathroom."

"It doesn't happen that often," she said of the flashbacks, "but when they do come, I just deal with it. ... It's just part of me," she explained in a restaurant on Charleston's main drag, because she is prohibited from being on campus.

In fighting the eviction, Manges didn't lack for allies -- including the professor of the French history class she was in at the time. Her Buffalo Grove-based therapist also lobbied on her behalf, citing her "solid set of coping strategies."

But it was not enough to change the verdict of the judicial board. Sandra Cox, head of EIU's counseling center, emphasized there's much more to the story.

"There has to be significant concern for someone to reach out to judicial affairs," she said.

In letters from school officials both Manges and Pomerleau were told they could come back to campus in 2008, but only if they signed a contract. They also would have to produce proof that they could keep their illness under control.

Instead, both young women have opted to go elsewhere -- Manges is relocating to Boston. Pomerleau, back at home, has been taking classes at a community college while applying to four-year schools in the area.

Dan Nadler, an EIU vice president for student affairs, said such contracts are used in a variety of situations -- from aggressive students with a penchant for punching walls to those prone to binge drinking -- and should not be viewed as punitive. The pacts, he said, are a way to keep students on campus, not oust them.

"If that was our philosophy, we wouldn't bother," Nadler said. "Our first goal is to ask: How can a student stay in the environment? How do we help them be successful academically and personally?"

The colleges, though, are walking a fine line.

Federal law permits a school to remove a mentally ill student for disruptive behavior, but only if the institution would act against other students for similar conduct, according to the Office of Civil Rights at the U.S. Department of Education.

Colleges can also move against those who pose a "direct threat" to themselves or others. But in order to do that, they must first perform a comprehensive assessment, consider making accommodations and finally, give students an opportunity to defend themselves and appeal any decision.The civil rights office has ruled against schools that have not followed these procedures.

EIU and St. Norbert said they follow federal law when removing students from campus. Manges and Pomerleau say they felt like they were not given a real voice in the process.

Legal issues aside, suspending students for mental illness is poor policy, said Keith Anderson, a psychologist chairman of an American College Health Association mental health task force. Not only does school provide structure, routine and friendship -- all part of the healing process -- but sending them packing, he says, unleashes a whole new set of problems, such as: What am I going to do? Where am I going to live?

Some students who remain on campus, such as Nichole D'Antonio, have become afraid to seek treatment. When D'Antonio sought help at the EIU's counseling center for bulimia in 2004, she ended up on medical leave instead.

"I was told that I was too much of a liability," she explained. She returned to Charleston the next semester, after participating in an eating disorders program. But when she relapsed a month later and confided in a counselor, she was asked to leave campus again, she said.

"They said that I should have come back 100 percent better," explained D'Antonio, who graduated this month. Only because a professor intervened was she able to stay in school, providing she signed a behavior contract, she said.

Alexian had taught her that it was essential to be honest about her self-harming behaviors and to reach out for help; Eastern sent a different message, she said.

"That's what makes me so mad," D'Antonio said. "I was doing the right thing, and I was punished for it."
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