Opinion: A Critical Balancing Act

Adam C. Powell, Ph.D. / October 15, 2018

What the recent MIT ruling tells us about protecting the mental health of students

In 2009, a doctoral student at the MIT Sloan School of Management died by suicide shortly after his doctoral program director confronted him about an email that he had sent which was considered offensive. During the confrontation, the professor offered to assist him in crafting future emails and suggested that he consider a career outside of academia. Immediately afterwards, the student leaped from a building.

Although the professor was aware of the student’s pre-existing mental health issues to the extent that they related to exam anxiety – and had even provided him with an extended period of time to take his exams – he felt it was necessary to address the offensive email, which had been sent to a colleague.

Having earned a doctorate and worked as a university lecturer, I have come to appreciate the moral tension that all universities today face, not to mention the angst that this doctoral program director no doubt experienced. Having had instances of cheating in my courses, I have had to balance the university’s need to uphold academic integrity with the potential impact that such actions may have on the mental health of students.

I likewise recall my time as a doctoral student, during which I witnessed a number of my colleagues get dismissed from their programs due to inadequate academic performance. While the department sought to uphold a set of standards, its efforts to do so placed profound stress on a number of people – in some cases, forcing them to pursue entirely different careers.

These situations have caused me to contemplate the extent to which universities must protect the mental health of their students, when fulfilling the academic mission of the university is sometimes at odds with doing so.

In 2018, the Massachusetts Supreme Judicial Court was asked to ponder the duties of the university in protecting students from suicide, in the context of the 2009 incident at MIT.

The judge presiding over the case arrived at a multifaceted conclusion, and ultimately found the university and professors to be innocent. He started by defining the university-student relationship:

“We conclude that a university has a special relationship with a student and a corresponding duty to take reasonable measures to prevent his or her suicide in the following circumstances.

Where a university has actual knowledge of a student’s suicide attempt that occurred while enrolled at the university or recently before matriculation, or of a student’s stated plans or intentions to commit suicide, the university has a duty to take reasonable measures under the circumstances to protect the student from self-harm.”

(Note: This case was made more complex by the doctoral student’s status as both a student and an employee. The doctoral advisor plays a mentor/employer role, and the doctoral student in part learns through working. When a doctoral student behaves offensively, it can be simultaneously student misconduct and employee misconduct.

The doctoral advisor is in a challenging situation, as discipline is sometimes necessary to maintain a proper workplace environment, while the academic community has a charge to enhance the lives of students.)

The judge tempered his remarks by clarifying the limitations of a university’s duties to prevent suicide:

“It is definitely not a generalized duty to prevent suicide. Non-clinicians are also not expected to discern suicidal tendencies where the student has not stated his or her plans or intentions to commit suicide.

Even a student’s generalized statements about suicidal thoughts or ideation are not enough, given their prevalence in the university community. The duty is not triggered merely by a university’s knowledge of a student’s suicidal ideation without any stated plans or intentions to act on such thoughts.”

The judge concluded by specifying what he believed to be the responsibilities of the university, and how he believed that they needed to be executed:

“Reasonable measures by the university to satisfy a triggered duty will include initiating its suicide prevention protocol if the university has developed such a protocol. In the absence of such a protocol, reasonable measures will require the university employee who learns of the student’s suicide attempt or stated plans or intentions to commit suicide to contact the appropriate officials at the university empowered to assist the student in obtaining clinical care from medical professionals or, if the student refuses such care, to notify the student’s emergency contact.

In emergency situations, reasonable measures obviously would include contacting police, fire, or emergency medical personnel. By taking the reasonable measures under the circumstances presented, a university satisfies its duty.”

The professors involved in the case were cleared because they were unaware of the doctoral student’s intention to commit suicide, as well as of his prior suicide attempts. While MIT and the professors were found to have behaved appropriately in accordance with their duties, in order to provide guidance to resolve future situations, the judge provided clarity around the duties of universities.

Nonetheless, one lawyer has pointed out that there are still areas of ambiguity in the standard to which universities will be held. While additional duties are triggered to protect students with suicide attempts “recently before matriculation,” the word “recently” was not defined.

The student in the MIT case made a suicide attempt about a year and a half before enrolling at MIT; it is unclear whether this was deemed recent by the case, as it was not the deciding factor. Furthermore, the ruling did not provide clarity around the timeline for when a university has fully fulfilled its duties to take reasonable measures to prevent suicide.

As a result of the case, it is now clear that Massachusetts universities and their personnel have an obligation to initiate suicide prevention protocols in the event that it is learned that a student intends or is planning to commit suicide.

While non-clinicians within the university are not expected to be able to discern unarticulated suicidal intentions, they are expected to act as the university’s eyes and ears, and to ensure that the appropriate protocol is initiated once they learn that a student is suicidal.

In order to meet this obligation, universities may wish to train their faculty and staff about the protocol that should be followed in the event that they are informed of a student’s suicidal intentions. The spirit of the training could be similar to that used to inform personnel about other emergency situations, such as fires or active shooters.

Some organizations are already following these practices. For instance, one organization operating a call center unrelated to mental health has a protocol in place for addressing incidents in which callers discuss suicide. Employees are expected to review the protocol on an annual basis, and are assessed on their comprehension of it.

The tragedy at MIT helped clarify the responsibilities of university personnel in Massachusetts. It is a relief to hear that non-clinicians, like myself, will not be held accountable for assessing whether the students we meet are facing potential mental illness. Likewise, theoretical potential for mental health consequences does not appear to be a barrier to maintaining the decorum of life within the university, be it in a classroom or workplace setting.

Having non-clinician instructors intuit the mental state of students would be an increasingly herculean task, as instruction moves to online platforms where it is less possible to assess the presentation of students. The verdict is empowering to academia, as it provides a definition of what constitutes a reasonable response to being informed by a student of suicidal intentions.

By defining a reasonable response to a suicidal student, the verdict acts as a call to action for universities. The verdict makes it clear that there is an obligation to provide appropriate responses, and that universities should be proactive in ensuring that appropriate responses are delivered. Just as the call center has done, universities may wish to institute training programs to ensure that all personnel are prepared. While many universities have already programs in place to help troubled students, it is important for universities to ensure that everyone affiliated with the university, regardless of role, is familiar with the programs and proactively refers students to them when necessary.

Adam C. Powell, Ph.D., is President of Payer+Provider Syndicate. He is a healthcare economist known for his expertise in healthcare finance, healthcare technology adoption, and operationally-oriented problem solving. Dr. Powell holds a Doctorate and Master’s degree from the Wharton School of the University of Pennsylvania, where he studied Health Care Management and Economics.

Note: Dr. Powell is a healthcare economist, not a lawyer. This article should not be treated as legal or compliance advice.