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Jillian Twomey hadn't heard about the rash of suicides at New York University, where five students jumped to their deaths between September and June. But over the summer, as she prepared for her first year at NYU, Twomey received the school's newly revamped request for a medical historya questionnaire that, with its probing inquiries, shows how hard it has become for universities to balance legal liability, individual privacy, and appropriate care.
"There were some things on the form that I didn't think related to my health at school," says Twomey, an 18-year-old freshman from Plymouth, Massachusetts, who dutifully filled out the form. "But it's my first year in college and I wasn't really sure what I was supposed to let them know."
Sandwiched among standard yes-no questions about allergies and immunizations was a handful of inquiries into students' psychiatric records. Have you ever had back pain? Chicken pox? Psychosis/schizophrenia? Are you taking medicine for acne? For headaches? How about for anxiety or depression? Made any suicide attempts?
The psychiatric questions, never before posed to NYU students, were part of an extensive mental health and wellness program debuting at the private school this year. Officials say the idea is to try to better understand the needs of their community and to make sure those needs get met.
"The university was pleased with the responses in terms of both quantity and honesty," says spokesperson Josh Taylor.
A letter accompanying the formwhich was sent to 5,650 new studentsexplained that only the information about immunization was mandatory, yet the first sentence on the form read, "All NYU students are required to complete this health history." The mental health questions came on page two, under the heading "All Students Must Complete Questionnaire."
Twomey says she thinks NYU is correct in seeking the information and in acting on it. "I do think they have the right to ask so they can keep track of people who have those types of problems," she says.
While Twomey and others may not have minded the intrusion, and NYU may have been well-intentioned, the questionnaire appears to some to have run afoul of federal laws about individual privacy and fair treatment for people with handicaps.
Jennifer Mathis, senior staff attorney at the Bazelon Center for Mental Health Law, cites potential violations of the Americans With Disabilities Act. "Even the general principle is problematic," Mathis says. "As a civil rights matter it's troubling and appears to violate the ADA."
Courts have found that questions about mental health may violate the law if they lead to discrimination. Particularly problematic for Mathis is that university officials plan to use students' answers to identify those in need of mental health services. That in itself could amount to discrimination. "Nothing is set in stone when it comes to civil rights law," Mathis says. "But I think many situations could arise where a court would find these questions to violate the ADA."
NYU could also face another kind of legal issuethe threat of legal action from grieving parents. The family of Elizabeth Shin, a Massachusetts Institute of Technology student who committed suicide in 2000, is suing the school in state court, claiming that M.I.T. did not provide adequate care. The suit also alleges that M.I.T. was so concerned with Elizabeth's privacy that it wrongly failed to alert the Shins when school counselors learned she was suicidal. The Shin case follows one in which Ferrum College, in Virginia, paid an undisclosed financial settlement last year to the family of Michael Frentzel, a freshman who hanged himself in 2000.
So far, NYU hasn't faced a similar suit. But even as the university has been trying to balance its need to care for students with federal mandates about those students' rights, the list of suicides has grown. On September 9, the day before classes began, Joanne Leavy, 24, a graduate student in the film department, jumped to her death from the roof of the 12-story Tisch Building.
Sophomore Jimmy Lynch's roommate was the second student to jump from the upper reaches of NYU's Bobst Library last year. Stephen Bohler's death was later ruled an accident after it was discovered that he, a member of the diving team, was under the influence of marijuana and hallucinogenic mushrooms when he leaped from the 10th floor into the atrium.
Lynch has mixed feelings about the medical questionnaire. "I doubt that the people who committed suicide would've declared themselves in need of help," he says. "At least the university is doing something."
Mental health programs, complete with assessments and follow-up counseling, are becoming more common at American universities. The legal points may be tricky, but from a treatment perspective, if you ask students questions, you have a responsibility to use what you learn. Professor Ralph Rickgarn, a suicidologist at Normandale Community College in Minnesota, believes assessment is a step in the right direction. "But now the university is obligated to follow up," he says.
Rickgarn, like many other suicide and mental health experts, praised NYU's wellness program, but warned of a slippery slope. "You can't take general information and then mandate treatment," he says. In research for his book, Perspectives on College Student Suicide, he encountered students who were penalized after sharing intimate mental health issues.