While working on my bookmarks this AM I glanced at the rightwing American Spectator and could not resist reading an op-ed entitled Thirty-Three Dead: Unintended consequences of the therapeutic culture.
It is written by a Yale Kramer a psychiatrist who seems to know something about screening suspected psychotics. His basic line is that the killings were a result of what he calls "the therapeutic culture" which took root in the 70's when "activist reformers discovered the notion that mentally ill patients were an oppressed people" and "and decided that they must be set free from their sadistic doctors and nurses (deinstitutionalized) in order to become independent (homeless)."
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I posted some a version of this diary on another forum and got this answer from someone who is well informed as to legal issues. It seems that there is an issue here that might need some attention, though exactly how to deal with it is not clear. Perhaps a federal law which changed the standard of proof that schools had to meet when defending such cases.
Kramer is referring to section 504 of the Rehabilitation Act of 1973, a statute that forbids recipients of federal $$ from discriminating on the basis of disability. Unlike Title Three of the ADA (applicable to private colleges and universities) under which only injunctive relief is available, section 504 permits private suits for damages; unlike Title Two of the ADA (applicable to public universities), section 504 conditions acceptance of federal $$ on a waiver of immunity from suit and therefore presents no eleventh amendment issues.
Both section 504 and the ADA forbid discrimination on the basis of disability, subject to an exception when an individual can be shown to be a direct threat to the health or safety of himself or others because of his disability. Schools get into trouble when they make ad hoc decisions about students with symptoms of or a history of psychiatric impairments on the basis of stereotyped assumptions rather than legitimate medical judgments. Because the direct threat defense hinges on consensus public health understandings rather than good faith medical judgments, it is more difficult to prove that a student with a psychiatric impairment is a direct threat to others than that a student with fulminant TB is a direct threat to others; the reality is that we don't know very much about mental illness, and much of what we think we know often turns out to be wrong.
A second statute that comes into play is HIPPA; many schools have campus health centers to which students can go for anything from a broken arm to a psychiatric problem. Just as would be the case if the treating physician or psychologist were in private practice off campus, the health care professionals who treat students in campus health centers are bound to respect the confidentiality of student medical records, and therefore cannot inform campus administrators that a particular student is significantly impaired save for narrow exceptions in some states that arise when the patient discloses a threat to harm a specific individual.
Everybody has a pet theory about what happened at VPI; people who don't like antidiscrimination laws will blame them.
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While I don't buy his short version of the deinstitutionalization of the mentally ill, I think he does make some good points about how ideas that may work well in the context of treatment can easily be misapplied to other institutions in a way that simply encourages "toleration" of behavior that is clearly aberrant the may well indicate a serious progressive illness.
The attitudes and techniques of the therapeutic culture -- non-judgmental toward behavior (moral neutrality), empathic, understanding -- have only one useful and proper place -- a treatment venue: a consulting room or hospital. There is no place for these in schools or in any other life situations. Their use outside of clinical situations can only result in a perversion of normal guidelines for social behavior, confusion for teachers and students, and ultimately resentment and mischief.
But that aside, Mr. Kramer says that this idea has not only influenced for the worse the way institutions act toward the mentally ill but -- at least in the case of educational institutions -- have been written into our legal system. He claims that
Unfortunately, the laws enacted since the seventies protect this state of things. A school may not suspend or expel a student with mental illness who is or becomes psychotic -- more absence of common sense. And further, the school may not share any information about the student and his aberrant behavior with anyone, even if such information might be helpful in the patient's treatment.
Is this a reference to the Americans with Disabilities Act? And are there really school records protections that would prevent an educational institution from sharing information if requested during a court-ordered mental evaluation? Or is this guy just quoting from the right wing press without any real support?
In the discussions around all of this issue I have seen the closest thing I heard along these lines was a mention that there is at least one case where a college had to pay a big settlement for the improper way it handled the expulsion of a mentally ill student. But that seemed to have depended upon the details of the case and was not based on some national law the somehow gives tenure at institutions of higher learning to a mental ill person once they reach the point of psychoses.
Does anyone have any idea what these laws "enacted since the seventies" dealing with this might really be if they exist at all?