My Journey into Collegiate Mental Health Advocacy by Yulia Mikhailova

I was brought to mental health advocacy by a life-shattering experience when my daughter, a sophomore at the University of Michigan, had a mental health crisis on campus. The “life-shattering” part was not the crisis itself – I have never been scared by manifestations of what is conventionally called “mental illness,” such as somebody having visions, hearing voices, or otherwise displaying an altered state of mind not induced by chemicals.  In our culture, if somebody under the influence talks incoherently or moves erratically, but does not wield a weapon or assault anyone, most people are not greatly alarmed and simply give this person a chance to sleep it off. However, the same behavior without drugs or alcohol is called “psychotic” and perceived as terribly dangerous.  I have never shared this popular prejudice. I knew that psychotic symptoms, if not combined with substance abuse, do not make one dangerous  and, if addressed promptly and compassionately, often go away with no lasting damage . What I did not know was that, in the modern “ all-administrative university ,” compassionate help is not an option. A student in crisis is not a suffering human who needs help, but a liability that needs to be removed.   I am a Russian immigrant in my late fifties. I stood on the barricades facing tanks during the attempted coup that sought to overthrow Yeltsin’s government and to restore the Soviet Union . I then lived through an economic collapse that surpassed the Great Depression . And still, the greatest shock of my life has been the way the university responded to my daughter’s crisis. Between facing tanks and seeing my child caught in the bureaucratic psychiatric machine, I will choose tanks any time.  Approximately 100,000 young  Americans a year experience what is conventionally called a first-episode psychosis. College is often an emotional roller-coaster. Many students struggle with the challenges of balancing work, study, and social life, often leading to sleep deprivation. The latter was a major factor in my daughter’s breakdown. Before her crisis, she repeatedly sought help from university counselors – in vain.  When they dismissed her problems as “not serious,” this gave us, her parents, a false sense of security. When I was in grad school in the late 1990s, my experience with American college counseling was highly positive. One of my friends was saved from despair and suicidality by a campus therapist. I still trusted the system when my daughter went to college in 2018. If therapists employed by a top American school told her she had no serious problems, put her on a waiting list, and never called back, this meant she was fine, right?  Little did I know about the transformation of college counseling in the aftermath of the Virginia Tech shooting and ill-conceived “suicide prevention” programs. Of course, there are still good therapists there, making great efforts to help students, but they work against the system. Counselors are now part of the web of surveillance identifying “ students of concern ,” that is, predicting future acts of violence or suicide. Given the regrettable lack of crystal balls, this fortune-telling is done using “risk assessment”: going through scripted questions and checking the student’s reaction against a list of scripted answers.  If deemed “not at risk,” the student is dismissed, as was my daughter. Not suicidal? Check. Not homicidal? Check. Good buy. Who cares about any emotional problems she may be experiencing as long as she is not an immediate liability to the school image?  In case of doubt, the student is harassed with intrusive check-ins, leading to fear and isolation . If deemed “at risk,” the student is forced either to take a leave   of   absence or be hospitalized. Never mind that study after study   show s  that “risk assessment” procedures have   no predictive value  and that psychiatric hospitalization increases   the risk of suicide . There is no data on how it affects violence against others – which is very rare among people with psychiatric diagnoses anyway  –  but anecdotal evidence indicates that hospitalization does not prevent, and probably increases, it. Examples include the man who pushed Kendra  under the train within days after being out of the hospital ; the pilot who intentionally flew the plane into the French Alps after he was discharged as “fully recovered” and was taking all his medications as prescribed ; and the Virginia Tech shooter Seung-Hui Cho. There is no evidence that Cho had been homicidal before he was caught in the college web of surveillance. “His roommate became concerned” when Cho talked about being suicidal  and did what students are advised to do – reported Cho, who was then hospitalized overnight. Patients hospitalized for suicidality often have traumatic experiences  ranging from strip   search  to being repeatedly woken up at night  to outright sexual and physical   abuse .  We don’t know what Cho experienced in the hospital. What we do know is that on the next day, he underwent a “risk assessment” – his third one – and “denied any suicidal or homicidal ideation.”  Of course, at this point, he must have realized that admitting such ideation would get him hospitalized again. He became one of the many people who lie to therapists and conceal their thoughts  because they are “worried about being carted off to the hospital.”   Four months later, he killed 32 people and then himself. Would this have happened if Cho’s roommate had offered sympathy and comfort instead of sending Cho to the hospital? What if Cho could safely talk about his self-destructive impulses with a professional and receive therapeutic help instead of useless assessments? We will never know. What is clear is that neither “risk assessment,” nor hospitalization prevented the tragedy.  Contrary to all logic, colleges have since doubled down on the policies that failed Virginia Tech. Students and faculty are bombarded by messages about reporting anyone they feel concerned about. In addition to counselors, “risk assessment” is done by “ Behavioral   Intervention ” or “ Threat Assessment ” teams. They identify “ possible perpetrators ,” using a  “methodology” described at a webinar for college administrators: “If something feels wrong, it probably is … trust your gut” (PaperClips Communications webinar, 12/8, 2022). A mental health condition automatically makes a person “high-risk,”  according to the materials recommended at the webinar. My daughter became a victim of these discriminatory policies. After U-M counselors determined that she had no problems meriting their attention, she went through a sleepless period and developed mild psychotic symptoms, which can happen after just one sleepless night . She was not violent or aggressive at all. After somebody called for a wellbeing check purely out of concern for her, police entered her room, when she was finally catching up on much-needed sleep, dragged her out of bed and took her to the ER, where she displayed “pressured speech” and “emotional lability,” but nothing worse. Like other colleges, U-M keeps its mental health policies secret, but from what I could gather,  students are not admitted to their university hospital, because the goal is to ship them off campus. My daughter was sent to a rural for-profit hospital. What followed, was a nightmare. For 72 hours, she was awake almost continuously. In medical experiments, “the clinical picture” presented by healthy subjects after 72 sleepless hours “resembled that of acute psychosis or toxic delirium.”  This was exactly what happened to my daughter in the course of her “treatment.” The longer the duration of psychosis, the worse the outcome , and she was approaching the point of no return. This was of no apparent concern to the doctor, who threatened to retaliate if I complained, sought a second medical opinion, or attempted to get her transferred to another hospital. His motifs appeared profit-driven: he gleefully told me that if her symptoms continued, this would mean schizophrenia and require a very long hospitalization. He bragged of his complete legal power over patients, since the local court always granted petitions for involuntary hospitalization. Without committing any crime, my daughter became a prisoner. In vain did I call university offices charged with students’ wellbeing, begging their employees to provide legal assistance, to attend the court hearing, or at least to call the hospital to show that they cared. I said I feared to lose my child. They responded with cold language about “no liability” for what happened to their student in the place where they had sent her. Eventually, I lied to the hospital staff that the Dean of Students was concerned about my daughter and would send somebody to the hearing. The hearing was canceled, but she improved immediately and was soon released – apparently, the university could  influence the hospital profiting off its students.  I have since met many students similarly victimized by their colleges. Some of them suffered long-term harm to their physical and mental health, which my daughter, thankfully, escaped: she recovered completely under the care of an Open Dialogue  provider and is now healthy and thriving. I am grateful for this opportunity to offer my thoughts on policies targeting vulnerable students. An efficient solution would be for the university to cover medical bills generated by its employees’ actions: the ER, the ambulance ride to a distant hospital, and hospitalization itself. This would create an incentive to invest in crisis prevention, such as quality therapy , instead of the “risk assessment” sham. In the current climate, however, this would be hard to implement.  It should be possible, though, to seek transparency. The Department of Education can require reports of the number of students forcibly removed from campus; the reasons for and the manner of the removals; and other related data. These numbers must be publicly available, along with the information about the policies concerning students in crisis. Another reasonable requirement would be that university employees check on the student during and after the hospitalization initiated by the university, maintain contact with the family, transport the student back to campus, and arrange academic accommodations.  My daughter, wearing nothing but pajamas, was discharged the day before the finals started. What would she do if I were not there to buy her clothes and shoes, to take her back to campus, and to explain how to request an exam extension? The professed concern for the student’s well-being ends the moment the student is sent away. What if people implementing these policies know that they can’t simply forget the object of their “concern” as soon as the police car leaves the campus? At the root of the problem is the prevalence of sanism  and ableism  on campus. Many sincere supporters of the DEI values , who would never pronounce somebody “dangerous” based on race, religion, or sexual orientation, express blatant prejudice against individuals with mental health struggles, going on about “violence caused by mental illness.” They never cite any evidence, because such evidence does not exist : people with psychiatric diagnoses , who do not abuse substances , are no more violent than   other people in their demographic cohort living in similar circumstances . A psychiatric diagnosis is less statistically associated with violence than being a male is .  Mental health “risk assessment” is a modern iteration of eugenics which “proved” that someone had a “criminal personality”  by measuring their skull and earlobes .  In my experience, however, no amount of rational argument can convince people with sanist prejudices, even when they are intelligent and progressive otherwise. The appeal of the dream about ensuring campus safety by removing “possible” perpetrators is too strong, and if innocent students are harmed in the process, this is considered acceptable collateral damage. This attitude should be censured in the same way as racism, misogyny, and other forms of bigotry. Regrettably, they still exist, but nowadays it is unthinkable to openly proclaim policies based on the purported “dangerousness” posed by someone’s race or gender. A growing   student   movement  against discrimination based on mental condition gives me hope that one day these policies will go the way of racial and gender segregation, and students in psychological crisis will be met not with fear and rejection, but with help and support.