Supporting College students with mental health conditions: the false roadblock of confidentiality

College professors have told me stories of student behavior in and out of the classroom that was bizarre, scary, inconsistent, emotional, or otherwise interfering with the student's success or even interfering with instruction.  In another post, I'll give some basics on how to recognize and manage conditions such as ADHD, depression, substance abuse, PTSD, schizophrenia, bipolar disorder, anxiety, narcolepsy, and Asperger's/autism spectrum disorder.
    But it isn't tbe the job of a professor to diagnose and treat mental and emotional conditions.  Instead, it would simply be nice to know what to make of it if a student's attendance is irregular, the student is nodding off in the middle of a conversation, or saying something bizarre and off topic, or is seemingly unresponsive with a glazed stare, or suddenly crying.  It would be nice to know if someone is helping this student.  It would be nice to know what the professor is supposed to do when unusual behavior happens, especially during class or in the office or with alarming words in an email.
    What can get in the way of helping the professor help the student:  Confidentiality/privacy rules.  You're not supposed to know, on most campuses, anything about the student besides perhaps their picture.  You may not even be allowed to be told why a student gets to take tests under different conditions than the rest of the class.  To give you this information might bias you and is an unnecessary intrusion into the student's private life.
    This confidentiality barrier is unfortunate, and doesn't necessarily make sense, even ethically.

Is it a private matter?
    It not just the private life when a student is starting fixedly at a point in space and mumbling, or saying disruptively bizarre comments in class, or crying and running out of the room.  Even if it is a symptom or behavior that other students don't notice, is it just a private matter if it affects success in the course?  That's perhaps up to the professor to let students fail or try to orchestrate an assessment or intervention.

Sharing:  Crisis vs. conditions
    Students often choose to share private information with a professor.  But instead of doing so in a calm informative manner early in the semester, the information comes out in crisis, with tears or anger, sobbing in the office or sending paragraphs of sad stories by email.  This information often comes out at a time of academic pressure, which makes it hard to tell whether the emotional crisis is in part a function of that stress or is even exaggerated to support a request for extensions and other relief of academic stress. All the while, the person hearing this information doesn't know whether there is an ongoing challenge in the student's home environment or mental health that may need to be addressed in order for the student to be successful.
    Professors get to hear a lot about boyfriends and trauma and roommates and nights without sleep, but in all of this emotional content they are not likely to hear about the ongoing conditions such as depression, bipolar, or anxiety. The instructor can recommend using counseling/psychotherapy resources at the college or elsewhere, but it would have been nice to assure ongoing treatment and support of any pre-existing mental health issues before they contributed to an emotional and academic crisis.

The high school confidentiality cliff
    In education from day care and preschool through high school, it is often assumed that teachers are informed about issues and conditions affecting a child's behavior and learning.  In fact, the teacher is expected to be an active participant in the assessment of the child and in the coordination of plans and interventions to address the child's developmental needs.  Some teachers choose not to look in a student's records unless (or even if) they are required to do so becuase there is an education plan based on the child's conditions, but for the most part parents, and teachers act as a team sharing information to work together for the child's benefit.  Students are eventually aware of this collaboration and sharing of information, and often gradually become part of the team, joining parent-teacher conferences and even IEP reviews and other intervention planning meetings.
    But then upon graduation from high school, the child is suddenly legally an adult, entitled to privacy, and apparently entitled to a breakdown of the structured parent-instructor-child-administrative team.  This is an understandable practice based on legal age and the child's path to independence from the parents.  But it would be nice if there were some transitional phase, just as there is a time with a learner's permit when the student is doing the driving but a parent or instructor is in the car.  504 plans sometimes follow students to college, but the professor/instructor is now in the dark and can no longer help with ongoing assessment or intervention other than to give alternative testing arrangements when required. Some students might make more continued progress in managing learning or attention issues if the professor could help them gradually wean off of some supports (as mentioned in a separate essay on accommodation vs. challenge); instead, it is usually all or nothing, a cliff or a plateau.
    This is a bad time in the child's development for either a cliff or a plateau: College age is right when some conditions improve as the frontal lobes finish connecting to the rest of the brain, while some conditions such as bipolar disorder and schizophrenia, which may every hundredth student you see, emerge for the first time. Educational and mental health records can't tell you about a condition that is just now developing; ongoing assessment is crucial to prevent crises.  This assessment, even if it's just informally pooling information and deciding about referring to formal mental health or learning assessment, should have input from the people who see a lot of signs of a student's mental functioning:  the people leading the student in the classroom and reviewing the student's work outside the classroom.  This proactive, pre-crisis pooling of information should not end when college begins, but because of privacy rules and related practices, it does.

Education vs. confidentiality 
Colleges have student support mechanisms, but these often don't kick in until the student is already failing classes; because it is not proactive, the student may be having moderate problems in three different classes but none of these are reaching the threshold of calling in the student support team.  Instead, student struggle and failure often becomes an issue of discipline of behavior, academic probation, or the student simply dropping out. Academic deans are often in the position of enforcing standards for academic performance and campus behavior.  It is hard for administrators to  focus on supporting student success when problems have become too severe (persistent rule-violating behavior, or failing many courses).  Even if deans wanted to intervene earlier, they do not find out about issues early enough or when they do, they feel limited in what they can bring up with students and parents because they feel they are overstepping bound of expertise and overstepping limits of privacy.
    The result of this system is that a student's confidentiality rights are protected, but not their rights to an appropriate education, which are guaranteed by law only up until the high school cliff.  This is not an issue of anyone not caring about the student.  Many instructors and administrators might be happy to spend efforts in prevention of problems rather than documenting and implementing the consequences of academic failure.
    This is a difficult challenge, which includes to understand and manage the range of problems that can come up (how exactly might Asperger's affect success on a college campus? this type of issue will be addressed in a separate essay).  The challenge, ending too often in frustration and failure, is also about barriers, raised under the principle of privacy, to collaboration at early stages of assessing or managing a problem, leading to crises which end (or interrupt) the student's career rather than supporting it.
    The challenge of creating least-intrusive supports continues into college, and the solution is not necessarily to helicopter over student's lives, but to remove these barriers to collaboration in addressing conditions affecting learning and performance.

Solution:  Until we can change the rules and their implementation/interpretation at the federal, state, and campus level, there is another option for removing the privacy barrier:

Ask.

Asking the class: you can state up front to the whole class that you'd like to know about any conditions that may affect their performance not only on tests and assignments but in the classroom.  Students may assume, not knowing about the high school cliff, that you already know about their backgrounds and conditions. You need to make it clear that such conditions are not necessarily going to result in accommodations (see my post on accommodation vs challenge), and that you're not going to necessarily work directly on dealing with those conditions, but that you want to understand issues when they arise and make sure the conditions are managed well so the student can succeed.

Asking individuals: When a student has a behavior or symptom that repeatedly interferes with learning, you can let it go, you can ask the student's adviser or other student support system, or you can ask the student about it. your are not violating confidentiality if the student responds to your question and chooses to volunteer information.  You may be intruding on privacy by asking the question, but if you're asking for an explanation for a behavior, your question has a legitimate educational purpose; most professors don't have a desire to probe into student's personal lives just based on voyeuristic curiosity.

Instructor's life beyond secrecy:
Before you are overwhelmed with a crying sobbing student, it would be nice to know in advance of family issues or depressive tendencies. Before a student has a panic attack while doing a presentation, it would be nice to know in advance of social anxiety to make it part of the assignment to get the appropriate supports in place to make it possible for the student to successfully present information to the whole class.  When a student has separate testing due to ADHD, it would nice for the student and professor to be free to make their own arrangements in a nearby classroom rather than making arrangements in the learning center.  When a student says something bizarre, it would be nice to know if the student likes to be goofy, needs a nudge of social awareness, or needs a nudge about worsening thought disorder needing treatment.

Administrative life beyond secrecy: 
A student who is legally an adult may protect information but also may consent to release it.  It is in the student's interests for instructors and administrators to pool information not only about when the student has a grade below C, but also when the student has inconsistent attendance, incoherent moments, or disruptive agitation.  Overloaded professors and administrators may choose not to mentally file this information unless they see more signs of a crisis, but being proactive may potentially reduce some of the crisis overload.  How do we know whether the student wants professors to share information about the student's difficulties before they become crises?  Ask.  Students too may prefer to be proactive and have a support system in place before they are facing a discipline or academic hearing.  If they say no, then we have respected their privacy and their adult right to choose.  But at least we have not kept a support system fractured by barriers of discomfort about mental health and about privacy, barriers of which the student, especially a student fresh out of high school, may not be aware.

Origins of the knowledge posted here

Me and my first child, now in college

Besides having gone through various stages of development and various systems of education myself, and raising my kids through them all, I've been involved in the other side of those various systems:
-- On the board of directors of a combined preschool and day care (coming up with the slogan "your child's first school and second home") in Wooster OH).
-- As a special education teacher and dropout prevention coordinator in public high schools in Boston.
-- As a middle school intervention specialist doing school and home based counseling for at-risk youth in Syracuse NY.
-- As an elementary school (K-6) counselor in Wooster OH.
-- As the creator of an program of student-led courses, and the creator of a student-run counseling and referral service, at Williams College in Massachusetts.
-- Teaching Psychology courses and professional education programs at various colleges and universities in Ohio and Massachusetts.
-- editing and writing material for introductory, developmental, and abnormal psychology for MacMillan Publishing.
-- as a psychotherapist working with clients involved in day care, preschool, elementary, middle, and high schools, and college and universities, interfacing with professionals in those systems as part of my work.

    Along the way, I've developed some observations about what works at those various levels of education.  This blog will focus on:
1)  ideas (insights, strategies, research, concepts) which relate most directly to the way our minds and identities develop, and
2) ideas that have been useful to my clients and teachers, professors, and other professionals.

Please comment and ask questions!