Campus Mental Health: Know Your Rights!

A guide for students who want to seek help for mental illness or emotional distress

Produced by the Leadership21 Committee of the Bazelon Center, this guide will also be produced in print form (availability to be announced on this page).

• Introduction
• Seeking help
• Parents and privacy
• Academic accommodations
• Discipline
• Involuntary leave of absence
• Going to a psychiatric hospital
• Forced medication
• Resources
• Conclusion and Notes

Development and dissemination of the guide is supported by the Morton K. and Jane Blaustein Foundation, with additional support through funding for the UPENN Collaborative on Community Integration from the National Institute on Disability and Rehabilitation Research.

Introduction

Though we don’t know you, and we may never meet you, Campus Mental Health: Know Your Rights! was created with you in mind. As a committee of mental health advocates, we worked together to provide information to assist you in finding help and protecting your legal rights.

If you or someone you love has a mental illness or is experiencing extreme emotional distress, we know that what you’re going through right now may be extraordinarily challenging. We hope the information in this guide will enable you to find and use mental health resources on your campus and to safeguard your rights.

Seeking Help

What can I do? Where do I go? On campus or off?

You should know that, as a college student, it’s easier to get professional help now than it may be after you leave school. This doesn’t mean you won’t run into any problems, but now is the time to get help. You’ll find confidential on-campus resources at your school’s counseling center, health center and places like a Women’s Center, if one exists on your campus.

Often, the best place to start is your school’s counseling center. Visit its website or call its main number to find out what they can offer you. Most on-campus centers provide two to eight free visits, so you can use their confidential services free of charge.

Students sometimes feel embarrassed or scared to seek help, but talking about your problems actually takes an immense amount of strength, and it’s important to move past the stigma surrounding mental health issues to get the help you need. Counseling centers can offer a range of services, from individual sessions with psychologists or social workers, to group sessions for people who share a common issue (such as body-image issues, grief and loss, or academic anxiety), to sessions with psychiatrists. . . . . Since services vary campus to campus, your best bet is to see exactly what your school offers.

If your school doesn’t have a counseling center, check with the school’s health center; psychologists and psychiatrists may be able to see you there.

You should be aware of some risks in visiting the campus counseling center. Some counseling centers may disclose information to the school administration if a student is suicidal or has thoughts of hurting him- or herself. Some schools have policies that require students who disclose self-injurious thoughts or acts to take an involuntary leave of absence; they may require students who have been hospitalized to be cleared by the counseling center before they can return to classes or live on campus. You should check your school’s leave policies, code of conduct and residence hall contracts, or ask the counseling center or dean of students about the school’s policies and practices. See pages 8 and 13 for more information.

You also want to look into what health insurance you have (if you have it) and what it covers. If you don’t want to see a clinician on campus, or if the number of visits your counseling center will allow you isn’t enough, your insurance policy may dictate what outside options are available for you.

The counseling center can give you referrals to people off campus. You may end up seeing a psychologist, psychiatrist or social worker in a private practice near your campus or in your hometown. You can go to a family doctor to discuss your symptoms, though it is recommended that you follow-up with a psychologist since a general practitioner is not the most knowledgeable about mental health issues.

If your school participates in ULifeline, an online resource that details mental health issues and professional resources on and around your campus, you can get additional information at http://www.ulifeline.org. Your school may have other online services; be sure to check the school’s website.

What will happen when I call to make an appointment?

When you call to make an appointment at the counseling center, the receptionist will likely take your name, address, student information (class year) and ask what is wrong. You may not be asked directly, but if you are experiencing an emergency, you should say so immediately so you get in to see a clinician as soon as possible.

If you are calling an off-campus resource, spend a few minutes talking with the clinician on the phone, ask about his or her philosophy and approach to working with patients, and whether or not he/she has a specialty or concentration. If you feel comfortable talking further to the counselor or doctor, then make an appointment. Please know that if you call a professional off campus you may not get a return call right away, as you are a new patient.

Especially if using an off-campus or independent therapist, use this checklist as a guide to set your goals for a first conversation. Many of these questions will probably be covered without your asking, but if not, don’t be afraid to ask.

• What academic qualifications and training have prepared you to practice as a therapist?
• What specialized training and/or experience have you had in working with the issue I am dealing with?
• What professional associations do you belong to?
• What are your fees?
• How will my insurance claim be handled?
• What type of therapy do you do (e.g., mostly talking, role-playing, visualizing, hypnosis, artwork, “body-work”)?
• What are your office protocols (booking appointments, payment for missed appointments, emergencies, etc.)?
• Can you give me a brief explanation as to what I can expect to happen in my first session?

What are the steps for choosing a therapist?

If you are using on-campus resources, you may be assigned to a specific clinician based on your intake and the strengths of your counseling center. You can be comfortable knowing that most people at the counseling center have experience and genuine interest in working with college students, and that they regularly work with students who are dealing with similar issues. If a specific characteristic in a therapist is important to you, such as gender, ethnicity or age, let the counseling center know and they will most likely do whatever they can to accommodate your requests.

If you are not using on-campus resources, the following steps from an article by the Substance Abuse and Mental Health Services Administration entitled “Choosing the Right Mental Health Therapist” may be helpful:

1. You may want to see your primary care physician to rule out a medical cause of your problems. If your thyroid is “sluggish,” for example, symptoms—such as loss of appetite and fatigue—could be mistaken for depression.

2. Once you know your problems are not the result of a medical condition, you should find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare.

3. If possible, it may be helpful to get a couple of referrals (from your counseling center, friends, online) prior to making an appointment. If a particular characteristic, such as age, sex, race or religion, is important to you, you may want to mention that when asking for referrals.

4. Call to find out about appointment availability, fees and location based on what your insurance covers or if they have accommodations if you don’t have insurance.

5. Find out if the therapist has experience helping individuals with problems similar to yours. You may want to ask the receptionist about the therapist’s expertise, education and experience.

6. If these answers are satisfactory, make an appointment.

7. Be sure the psychotherapist takes a unique approach to your treatment and does not believe that what works for one individual will necessarily work for another.

8. An important element of successful therapy is rapport. After your first visit, reflect on how you feel about your therapist.

If you felt comfortable with the therapist, schedule another appointment. If for any reason the match does not feel right, call another mental health professional from your referral list and schedule another appointment.1

What happens if I call, and they can’t see me for two, three or four weeks?

If it’s an emergency, you should tell the receptionist right away—just as you would when making a doctor’s appointment for a physical health problem. If you say that it is an emergency, they can try to fit you in right away.

If it is not an emergency but you still don’t feel comfortable waiting multiple weeks until your first appointment, ask the person at the counseling center if there are any other resources for you in the meantime—for example, a Women’s Center, someone at the health center or a peer group. Otherwise, you may want to seek off-campus treatment through a clinic or a therapist in private practice that would likely be able to see you earlier.

While it may be frustrating to have to wait, the counseling center wants to give you the best service possible and won’t be able to give you the time you need until they have an opening, which could be weeks away.

If you are in crisis and need immediate help:

If you are contemplating hurting yourself or attempting suicide, tell someone who can help immediately:

• Call your doctor’s office.
• Call 911.
• Go to the nearest hospital emergency room.
• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or Hopeline at 1-800-442-HOPE (1-800-442-4673) to be connected to a trained counselor at a suicide crisis center, or visit http://suicidehotlines.com/national.html. The toll-free numbers are available 24 hours a day. (Note that the goal of these hotlines is to keep callers safe. If hotline staff believe the caller is actively suicidal, the police may be alerted.)2

What will happen when I get there? What should I expect at my first visit? What’s the first session like?

If you have never been in therapy before, then it is natural to feel a little nervous about what will happen. The first session can be pretty intense. However, it is a good opportunity for you to see whether you feel comfortable talking with a counselor and think you might benefit from further sessions on a regular basis.

If you are using on-campus services:

When you get into the counseling center they will have you check in for your appointment just like at the doctor’s office. They may have you fill out some information about family history, insurance and why you are there, or they may just wait until you are seen by someone. The waiting room is pretty much just like every other doctor’s office.

If you are using off-campus services::

The only other thing you may run into if utilizing off-campus services is financing the visit. You will likely be informed about financial arrangements when you make the appointment. When you arrive, you will be asked for financial documentation, such as insurance cards, who is responsible for payments, etc.

Your first session will be a time for the therapist to get to know you and your needs and begin to develop a plan to proceed. It can be a little more basic than later visits, which should be more therapeutic, though it can also feel very intense if it’s the first time you are talking about disturbing issues.

Therapy is a long-term process, so don’t expect an instant solution on the first day. The goal is to help you develop ways to deal with issues over the long term.

The first visit will cover what is wrong, any changes/symptoms in your life, history of these problems in you and your family, if you are using drugs or alcohol, or are smoking. The therapist may have time to ask about your childhood, education, relationships, current living situation and ability to function in school. The questions may seem invasive and uncomfortable, but remember this is your therapist’s chance to learn as much about you as possible to devise the absolute best treatment plan for you. If you feel uncomfortable answering a question honestly, let the therapist know; don’t make up an answer—you will only be hurting yourself and your chances of dealing with the disorder or problem if you’re not honest.

You may discuss also length of treatment, methods the therapist will use and patient confidentiality. At the end, the therapist may ask if you have any questions.

If the therapist feels you are experiencing the onset of a mental disorder then he or she may ask you to complete a one to one-and-a-half hour questionnaire to determine what disorder you are experiencing. This is normal, and mental health professionals use these questionnaires routinely. After the questionnaire, the therapist may give you a tentative diagnosis. If so, the therapist may recommend medication or may ask you to speak with a psychiatrist, who may recommend medication. (Only psychiatrists and other medical doctors can prescribe medication.)

Below is a checklist of questions you will want answered during the first session. Many of these will probably be covered without your asking, but if not, don’t be afraid to ask.

• Can you give me a brief explanation as to what I can expect to happen in subsequent sessions?
• How long will each session last?
• How many sessions is it likely to take to resolve my issue?
• How will my confidentiality be assured? If seeing someone on campus, you may want to ask specifically about whether and under what circumstances information will be shared with your parentss or the administration.

  Who is licensed to provide therapy?

Many types of mental health professionals are licensed to provide therapy. Finding the right one for you may require some research. The most common mental health professionals are psychiatrists, psychologists, clinical social workers, licensed professional counselors, mental health counselors, certified alcohol and drug abuse counselors, nurse psychotherapists, marital and family therapists and pastoral counselors.

What are the different types of therapy?

Common types of therapy are psychotherapy, cognitive behavioral therapy, family therapy, group therapy, psychoanalysis and drug therapy. You should speak with your mental health professional to learn what may work best for you. There is no one way for everyone to deal with mental health issues.3

Depending on the size of your school, your campus counseling or health center likely provides brief individual, group and couples psychotherapy as well as referrals for students. Long-term, open-ended psychotherapy and after-hours emergency services may or may not be available through the school. School counselors are likely available for consultation to both parents and students, either by phone or by appointment. Parents may want to be involved if they have any questions about services offered, about how to assist their child for whom they have some concerns, or about how to obtain specific services on campus or in the community.

What happens if I don’t like my therapist?

You should feel comfortable with and respected by your therapist. If your first choice in a therapist isn’t working out, you have the right to choose another one with whom you have better rapport. Remember, the therapist works for you. If you feel the therapist is not listening to your concerns or providing enough feedback, let him or her know. If it still isn’t working for you, don’t be afraid to change. Although it’s not easy to end any relationship, it helps to remember that the therapist is a professional.

The best way to find a good therapist is by word of mouth. Satisfied customers say a lot about the kind of therapy you will receive. Although you might feel embarrassed to ask friends or family for a referral, you should consider doing it anyway. It increases the odds that you may find a therapist who will really help you.

Can a therapist share what I have said during therapy?

You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential. However, therapists also are bound to report information that leads them to believe you are likely to be a threat to yourself or others. They may report threats to blow up a building, to harm another person, or to engage in other life-threatening acts. If you are seeing a therapist on campus, you will want to find out about your particular school’s policy. Some campus counselors also report threats of self-injury or hospitalization to administration officials.4

Parents and Privacy

What are my rights to privacy? Will my parents find out if I seek treatment?

Mental health treatment providers are ethically and legally obligated to protect your privacy from third parties, including your parents. Therefore, school counseling centers and outside providers generally will not release your medical information—including to family, parents/legal guardians or faculty—without your written authorization. However, there are practical issues. If your parents get insurance statements or bills related to your care, they will know you are seeing a therapist.

Nonetheless, as noted above, disclosure without consent is permitted to protect the safety of the patient and others. But whether someone is dangerous often comes down to a judgment call, and most therapists are hesitant to make such judgments.

If mental health information is reported to your school, the school may be able to share that information with individuals who have a “legitimate educational interest” in the information, as defined by law.5

The law in this area is complex. The federal Health Insurance Portability and Accountability Act (“HIPAA”), Family Education Rights and Privacy Act (“FERPA”), Public Health Service Act and state laws may apply to your situation. These laws may allow disclosure of information without your consent to other treatment providers, payers of health care, other sources of financial assistance, public agencies that oversee treatment providers and others. These laws may also allow disclosure when you are considered incapacitated.

Given this complexity, you should discuss confidentiality with your treatment provider to understand if, under what circumstances and with whom your information will be shared.

Academic Accommodations

What accommodations can I get from the school? How and whom do I ask for accommodations?

Federal law provides that individuals with disabilities— in general, those with physical or mental impairments substantially limiting one or more major life activities—are entitled to academic accommodations and reasonable modifications in school policies.

In general, if your mental health disorder or difficulty substantially limits you in one or more major life activities (sleeping, working, learning, speaking, caring for yourself, etc.) even after you have taken medication, you may be a person protected by the Americans with Disabilities Act (ADA). To comply with the ADA, schools must provide academic accommodations and make “reasonable modifications” to policies and rules when necessary to accommodate the needs of students with disabilities. However, schools need not modify their policies—bend their rules—if doing so would “fundamentally alter” the way they do business or cause them undue financial burden.6

Depending on your need, the first place you should start asking for accommodations is your disability services center on campus. They will be able to help you with housing, academics and other accommodations you may need. If your campus doesn’t have a disability services center, then you should check with your resident advisor, academic advisor, counseling center, health center, Dean of Students office or housing services for what types of accommodations are available. You may be asked to provide a medical professional’s statement about your disability before receiving accommodations or modifications.

If you have trouble after contacting the appropriate people on campus, contact the local or state mental health department or a local chapter of the National Alliance on Mental Illness, Mental Health America or, if your campus has a chapter, Active Minds. Local Protection and Advocacy organizations (find yours at http://www.ndrn.org) may provide legal advice about whether you are protected by the ADA or similar state laws and what accommodations or modifications would be considered reasonable.

Academic accommodations:

Academic accommodations for people with disabilities include:

• Allowing additional time to complete exams.
• Providing a private environment or alternate location in which to take exams.
• Permitting students to use equipment to take exams (e.g., a word processor or a machine that enlarges print).
• Allowing students to audio record lectures.
• Providing modified deadlines for assignments.
• Reducing course load or alternate work assignments.
• Providing preferential classroom seating.
• Providing early availability of syllabus and textbooks.
• Providing transportation services.
• Providing access to extracurricular programs.
• Providing orientation to campus facilities.
• Allowing excused absences.
• Allowing the student to postpone assignments and exams.
• Allowing the student to work from home.
• Allowing the student to drop courses.
• Allowing the student to change roommates or rooms.
• Allowing an aide or helper to stay in the student’s room.
• Providing retroactive withdrawals from courses if academic difficulties were due to depression or another mental health condition.
• Providing a leave of absence.

Please check with your school to see if these accommodations are available. At most schools these services are standard and you shouldn’t be afraid to ask for them. You may be asked to provide a doctor’s note about receipt of medical services for your impairment.

What resources should the school offer?

Universities and colleges should offer the following:

• equal access to a civil, productive, non-discriminatory learning and working environment; and
• equal access to all university-sponsored programs, activities and benefits in the most integrated setting.

If you are a qualified student with a documented disability—whether undergraduate or graduate, in a degree or non-degree program, enrolled in credit or noncredit courses—you are eligible for services through school's office of disability services or its equivalent.

Your school officials should be working to provide optimal mental health care for you. This includes working to reduce stigma and discrimination; training staff to assist students with mental illnesses and to better recognize warning signs; reducing barriers to mental health services; adequately staffing the mental health or counseling center; and maintaining active relationships with providers in the community who offer care to students. The school should appoint an individual and implement a coordinating group with the responsibility and authority to work toward these goals.

As a concerned college student, you should ask these questions of your university or college administration:

• Have staff and faculty received adequate training to identify and provide support for students who have mental illnesses or are experiencing extreme emotional distress?
• Are mental health services adequately available on your campus?
• Are support services available to families of students who are receiving mental health services?
• Have students received training and information about how to recognize warning signs in themselves or others?
• Does your university maintain relationships with available mental health providers in the community?
• Is there an adequate crisis management plan in place for students and staff to deal with a suicide or traumatic event?
• What are the university’s policies regarding leaves of absence, involuntary leaves of absence and confidentiality?

  How do I generate awareness?

You may want to help generate awareness around these issues on your campus. One way is to engage your student peers to team up with the school’s campus counseling services, office of disability services, office of student affairs or office of diversity to raise awareness of mental health problems and the importance of good mental health—especially during orientation, May (Mental Health Month), and the first week in October (Mental Illness Awareness Week). Some ideas for generating awareness may include:

• hanging signs about mental health problems and support services;
• presenting about these issues to classes or groups;
• organizing mental health information for student orientation sessions;
• using the media (internet, newsletters, etc) to get the word out;
• organizing training opportunities for staff and students;
• showing relevant movies;
• offering free mental health screening;
• organizing an event such as a walk or benefit concert supporting this topic; or
• establishing a formal mental health-related student group/club.

Discipline

What should I do if my school wants to discipline me for something I think happened because of my illness?

Ideally, you should not be disciplined for seeking help or because of behavior that is due to your illness. However, we do want to mention that in recent years some schools have responded to students who have threatened to hurt themselves or who have had mental health crises by charging them with disciplinary action for violation of codes of conduct. Without knowing what school you attend, we cannot assure you that you will not be disciplined for any behavior brought on by a mental health crisis, but we can say it isn’t the policy at most schools. However, you may want to ask school administrators about your school’s policies.

If university personnel seek to discipline you for something you think was caused by your illness, they will probably provide some type of hearing and/or appeal process. It may make sense at that point to disclose your illness, if you have not done so already. Obviously, this is a very difficult and deeply personal decision. It also has legal implications, and you may want to seek legal counsel. However, offering information about your illness might help the school better understand the behavior they seek to discipline. As a reasonable accommodation, you can request that disciplinary action not be imposed or a disciplinary sentence be mitigated when the offense was the product of a mental health condition.

It may be helpful to show that, with specific supports and services, you are likely to comply with university rules and/or the code of conduct in the future. Also, if a university has a policy that charges students with violation of university rules or housing contract for engaging in behavior that poses a risk to life—the student’s own or others’—a student with a mental illness can argue that conduct such as a suicide attempt should not subject him or her to the policy. The policy would be discriminatory when implemented against a student in need of mental health services whose behavior was a result of mental illness.

If a student is disciplined for violation of a rule that prohibits disrupting a class, the student would need to disclose his or her disability and demonstrate how the disruption was caused by the disability and how it would not recur with accommodation in the form of appropriate supports and services.

In general, the more a student can support a claim that his or her disability contributed to the action, and the more detailed the plan for addressing the behavior, the more likely it is that disciplinary action for disability-related behavior will be waived.

Once I’m in trouble, must I tell them everything?

While disclosure and sharing information with university staff may be one way to help them understand your situation and make them less likely to discipline you, you are not required to provide a blanket release of all mental health information, nor should you do so. A blanket release could lead to a search through old records for evidence of past malfeasance and risk to self. Some students reasonably fear sharing information that might touch on past sexual abuse or information that is otherwise private. You should release information carefully after assessing what is needed to demonstrate the existence of your disability and the likelihood of your future success and safety on campus.

To minimize the risk of disclosing something harmful, embarrassing or hurtful, it may make sense to write a letter disclosing the disability and to compile a subset of records (such as a doctor’s letter summarizing the link between the illness and the conduct in question) instead of signing a blanket or full release. Additional requests for information from the administration could be addressed through carefully written releases permitting the university to converse with a specific provider or providers. Again, how you should proceed will depend on the situation. Finding a lawyer may be helpful to you in navigating these issues.7

Involuntary Leave of Absence

Can my school require me to take leave?

We also want to mention that in recent years some schools have responded to students who have threatened to hurt themselves, have been hospitalized or who have had mental health crises by placing them on involuntary leave or by evicting them from their dormitories. These practices have been legally challenged. As a result, some legal standards have been developed.

The decision to impose a leave of absence should only be made in the uncommon circumstance that a student cannot safely remain at a university or meet academic standards even with accommodations and other supports. The same applies to exclusion from university housing, which should be imposed only if a student cannot safely remain in university housing, even with accommodations.

A school should only impose a leave of absence or require a student to live off campus after having an expert conduct an individualized assessment. The expert should evaluate whether there is a significant risk that the student will harm him/herself or another and whether the risk cannot be eliminated or reduced to an acceptable level through accommodations. If the school then does decide to act, the student is entitled to due process protections. These include notice to the student of the action the school is considering and an explanation of why the school believes that such an action is necessary. The student and his or her representative should have an opportunity to respond and provide relevant information.

The school may inquire into a student’s current condition, including requesting recent mental health information and records. But it can only request information and records that are necessary to make a determination if the student is a threat. The school may not insist on unlimited access to confidential information or records.

At the very least, the school should provide the same arrangements for withdrawal from classes, incompletes and refunds of tuition or other costs as for a student who takes a leave of absence or leaves university housing for physical health reasons.

If the school is considering action against you, you can take several steps that may turn things around. First, you could obtain an evaluation by a psychiatrist or other mental health professional. You could suggest that you be permitted to take classes but not reside on campus as a way of addressing the administration’s safety concern. You should proceed with an honest and earnest tone and manner. However, when Your efforts to communicate with the administration are wholly disregarded and bring about no dialogue, it is probably time to obtain competent legal advice and/or file a complaint with the Department of Education, Office of Civil Rights.

Can a school put restrictions on my returning from leave?

Students on leave, whether voluntary or involuntary, may request to return to the school. Similarly, students excluded from housing may request to return to university housing. A university cannot require that your mental illness be “cured” before you return.

If you were on leave because of a direct threat to the safety of others or yourself, the school may ask you to agree to receive treatment, including prescribed medication, before returning. Otherwise, the school may not require you to continue treatment. In either case, the decision about whether you need to continue treatment should be made by a mental health professional, not the school administration.

Schools may also ask you to agree that you will leave if there is another incident of self-injury. Rather than agreeing that the school can make you leave if you try to hurt yourself, agree to seek help if you feel like hurting yourself. These types of contracts will give you more flexibility if the future does not go as well as you had hoped.

A student who wants to return to school after taking a leave of absence for mental health reasons should not be subjected to more rigorous standards or procedures than a student who wants to return after taking a leave for physical reasons. An opinion from the student’s treating mental health professional that the student is fit to return should, in most cases, be sufficient. In exceptional cases, a school may seek a second opinion.8

Going to a Psychiatric Hospital

What’s it like? What can I expect?

For many people going to a hospital for psychological issues can seem scary and difficult. In our society there are negative images of psychiatric wards; many are false stereotypes. For some people a hospital is the first place they meet other people who are experiencing severe emotional distress, drug addiction or other difficult experiences. For some it may be a place of recovery and comfort, much as hospital stays are when someone has a physical problem.

When you arrive at the hospital a mental health professional will talk to you to determine whether or not you should be admitted. If you have previous arrangements with your psychiatrist or doctor, the person admitting you will explain why you are there and what you hope to gain. Some people will be admitted for observation to better understand a mental disorder or as they go through a change with their medication or treatment. Others may be admitted to begin treatment and find something that will work best for them.

A psychiatric ward is very similar to any other hospital ward, although psychiatric wards are typically locked. Most psychiatric wards have been developed to help stabilize you. There are generally nursing staff, auxiliary nurses, social workers and administrative staff on the ward at all times. You will most likely be supervised by staff at all times.

If you are hospitalized because you attempted to take your own life or have suicidal thoughts, a staff person may be with you at all times of the day. You will not have access to anything with which you can hurt yourself. As your suicidal thoughts subside you will require less one-on-one monitoring.

Most hospitals have systems to encourage people to cooperate with their treatment plans. There is usually a set time for everyone to wake up, programs to participate in, times to eat meals, times when you may go outside and when to go to bed. The hospital may determine when and which visitors can see you. A nurse or social worker will work with you daily and take notes on your behavior in your medical chart. A psychiatrist will check in on you as well.

You will have basic privileges, which may increase the longer you are there and as you abide by the rules. These privileges may include phone use, watching TV, using the computer, smoking, possible hospital leaves, eating certain foods and times when you can be out of your room. Some of these privileges will be affected by your situation. For example, if you are hospitalized and in an abusive relationship, the abuser may not be allowed to visit. You will also participate in group activities such as painting, drawing, therapy or other things.

In some hospitals, if you don’t participate in the system they have established, privileges may be revoked. Sometimes the severity of disorders greatly affects a person’s ability to function and the hospital tries to be accommodating.

While in most circumstances, forced medication is not allowed and informed consent is required, you may not be released from the hospital unless you comply with a course of psychiatric treatment, i.e., taking medications, etc. You may have blood samples taken to monitor the levels of medication in your blood, so that your psychiatrist can know what level is most effective and be certain the medications aren’t affecting you negatively.

Again, a stay in a psychiatric hospital can be a time of working hard to stabilize your disorder or problem, so that you can better function outside of the hospital. You may want to get a recommendation or talk to your mental health professional about the best hospitals available in your area.

What happens and what are my rights after I leave a hospital?

After release from the hospital, you will likely be referred for treatment on an outpatient basis. You may be prescribed medications and asked to get your prescriptions filled and to stay on the dosage that worked for you in the hospital. In general, your rights after discharge are the same as they were before you were hospitalized.

What services should be available in the community after I am discharged from the hospital?

After you leave a hospital, there should be appropriate services and supports in the community to help you recover your independence and pursue your life goals. If you wish, you should have access to appropriate psychological and psychiatric care. You should receive information about and have access to alternative treatments and therapies. You should also have access to emotional supports (see the section below on resources). You may have access to financial supports, such as Supplemental Security Income (SSI), if your disability is severe.

You may want to establish a psychiatric advance directive (PAD). An advance directive is a legal document spelling out the health care you do or do not wish to receive “if an illness renders you unable to make decisions about your care.”9 In such a document, you can designate someone to make decisions for you in such circumstances. An advance directive, whether for health care or psychiatric services, should also specify the conditions under which it can be implemented.

You should provide copies to trusted individuals and health professionals whom you want to know about the PAD. Laws about advance directives vary from state to state. You can work with a lawyer, paralegal or advocate to write a PAD or go to the National Resource Center on Psychiatric Advance Directives. The site has web videos and easy-to-use information to get you started. Detailed information on advance directives is also available at the National Empowerment Center.

You should provide copies of both types of advance directives—for health care and for mental health treatment—to trusted individuals and to the health and mental health professionals who are most closely involved with your care.

What if I have difficulties after leaving the hospital?

You should seek support, whether through local peer organizations, trusted mental health professionals, family, friends or other supportive individuals as soon as you detect that you are having difficulties. Return trips to psychiatric hospitals may be necessary as you continue to find what treatment works best for you. If you feel that you need the support of round-the-clock care, you should discuss this possibility with people you trust to determine whether this is the best option for you, and whether you can receive the support you need in a community setting.

Forced Medication

Can I be forced to take medication?

In almost all cases, the answer to this is no. No one can force you to take medication when you go in for treatment unless you are found to be, or are on the verge of becoming, dangerous to yourself or others.

In general, states give the power to medicate without consent only to hospital staff and they must have either 1) a court order permitting it or 2) documentation meeting strict criteria based on safety concerns.10

Most states have involuntary outpatient commitment (IOC) laws under which, in certain circumstances, a person can be required to take medication as a condition of living in the community. The Bazelon Center website has a summary of state statutes regarding IOC as of 2004.

What is informed consent? What are my rights to informed consent?

Informed consent is consent obtained freely, without threats or improper inducements, after appropriate disclosure to the patient of adequate and understandable information in a form and language understood by the patient:

(a) the diagnostic assessment;
(b) the purpose, method, likely duration and expected benefit of the proposed treatment;
(c) alternative modes of treatment, including those that are less intrusive;
(d) possible pain or discomfort, risks and side-effects of the proposed treatment.11

As a patient, you have a right to an explanation of every procedure or treatment that a doctor or healthcare professional prescribes. Legally, a doctor or healthcare profession is responsible for:

1. Disclosing and explaining to the patient, in language which the patient can understand, the nature of a proposed procedure or treatment, its potential risks and benefits, and reasonable alternatives, if any exist.
2. Ensuring that the patient understands what has been explained.
3. Determining whether the patient accepts any risks and consents to proceed.12

Resources

What types of assistance and supports are available?

Every state has a Protection and Advocacy (P&A) program that safeguards the rights of people with mental disabilities. When problems arise, the P&A can pursue legal, administrative and other remedies to ensure protection of your rights. You can find contact information for the P&A in your state at www.ndrn.org.

The National Empowerment Center, “carry[ing] a message of recovery, empowerment, hope and healing to people who have been labeled with mental illness,” has a toll-free information and referral line and may be able to provide information about support groups in your area: 1-800-769-3728.

On many campuses there are student-run support groups. Active Minds, “a peer-to-peer organization dedicated to the mental health of college students,” is one, with chapters on more than 100 college campuses. You can also contact local chapters of Mental Health America, Mind Freedom International, the National Alliance on Mental Illness, the Depression and Bipolar Support Alliance, the Suicide Prevention Action Network or the Suicide Awareness Voice of Education.

Where else can I go for help?

If you don’t want to go to one of the types of mental health professionals described above, there are many other people you can talk to or places you can go. Your campus may have some of the following resources: support groups, a resident advisor or resident director, coach, faculty member or advisor, health center, women’s center, LGBT center, spiritual center or Active Minds chapter.

You can also access local mental health organizations such as those listed under supports above, many of which have state or community-based chapters and offer local resources. Some on-line resources include the Jed Foundation, www.ulifeline.org, www.halfofus.com, and the National Institute of Mental Health, all of which offer information that you may find helpful.

What are alternative approaches to mental health care?

It is crucial to consult with your physical and mental health care providers about the approaches you are using to achieve mental wellness. Different treatments work for different people, and communicating with health care providers about what does and doesn’t work for you is vital.

There are many alternative approaches about which you can educate yourself in order to find something that works for you. A short list of approaches you can learn more about includes: self-help groups, diet and nutrition groups, pastoral counseling, animal-assistance therapy, art therapy, dance/movement therapy, music/sound therapy, acupuncture, ayurveda, yoga/meditation, cuentos, biofeedback, guided imagery or visualization, massage therapy, telemedicine, telephone counseling, electronic communications and radio psychiatry. A range of other alternative approaches—psychodrama, hypnotherapy, recreational and Outward Bound-type nature programs—offer opportunities to explore mental wellness.

Before beginning any therapy regimen, learn as much as you can about it. In addition to talking with your health care practitioner, you may want to go online, to a bookstore, health food store or holistic health care clinic for more information. Also, before receiving services, check to be sure the provider is properly certified by an appropriate accrediting agency.

Conclusion

We hope this guide answered most of your questions and we wish you the best as you continue to learn more about yourself and take care of your mental health!

Notes

1 “Choosing the Right Mental Health Therapist,” The Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, http://mentalhealth.samhsa.gov/publications/allpubs/KEN98-0046/default.asp, visited Dec. 7, 2006.
2 “If You Are in Crisis and Need Immediate Help,” National Institute of Mental Health, National Institutes of Health (April 9, 2004), http://www.nimh.nih.gov/suicideprevention/sui911.cfm, visited Dec. 6, 2006.
3 “Choosing the Right Mental Health Therapist,” Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, http://mentalhealth.samhsa.gov/publications/allpubs/KEN98-0046/default.asp, visited Dec. 7, 2006.
4 Bazelon Center for Mental Health Law’s Model Student Policy http://www.bazelon.org/pdf/SupportingStudents.pdf
5 Family Education Rights and Privacy Act (FERPA), 20 U.S.C.§§ 1232g (a) (1), (b) and (d).
6 Reasonable accommodations are modifications to rules, policies or practices that will enable a student with a disability to meet academic and technical standards. A school is not required to fundamentally alter the essential nature of its programs or its core degree requirements. A modification is unreasonable or a fundamental alteration if it compromises essential academic and technical requirements or places an undue burden on the school, such as a significant difficulty or expense.
7 Bazelon Center for Mental Health Law’s Model Student Policy http://www.bazelon.org/pdf/SupportingStudents.pdf
8 Ibid.
9 www.samhsa.gov
10 http://www.bazelon.org/issues/restraintandseclusion/moreresources/randshandout.html
11 United Nations principles for the treatment of persons with mental illness and the improvement of mental health care, available at http://www.unhchr.ch/html/menu3/b/68.htm
12 http://info.med.yale.edu/caim/risk/patient_rights/patient_rights_2.html