Mental Health Response Criticized
EDITOR IN CHIEF
Two people hospitalized by MIT as undergraduates have said they felt the decision was either unfounded or inappropriate, and in both cases that MIT did not act quickly to resolve the situation and remove them from what they described as a traumatizing experience.
The two, a man and a woman, requested their names remain anonymous for privacy reasons, but for convenience will be referred to by the pseudonyms “Alex” and “Shirley.” Alex was committed in 1998, Shirley in 2003.
Both stayed a total of 12 days at McLean Hospital, a large psychiatric facility of Harvard Medical School, and both sought to leave substantially earlier while relying on visiting friends for clothing, personal items or academic work.
Neither said that in retrospect being hospitalized was necessary or particularly helpful in fixing the situations that initially led to them being committed to McLean.
Due to anonymity, MIT administrators were not able to comment on the specific cases, but Robert M. Randolph, senior associate dean for students, said that the length of the two’s hospitalizations are “so unusual these days because of managed care that there must have been something serious going on.”
Director of Mental Health Alan E. Siegel said that “it’s a difficult thing to be in the hospital,” and “that’s why we only hospitalize students when there’s the greatest urgency.”
A spokesperson for McLean Hospital declined to comment.
Nationwide, demand for mental health services has been rising on college campuses. The number of hospitalizations at MIT rose from 16 in 1995 to 27 in 2000, according to MIT’s Mental Health Task Force report in 2000, although Siegel said that the number has decreased since then.
The report, instigated following the suicide of Elizabeth H. Shin ’02, found that “MIT currently sees 12% of its student body annually as compared to 14-16% of the student body annually in comparable schools.”
Establishing risk of serious harm
For doctors to commit a person to a mental hospital against his or her will, they must demonstrate “that the failure to hospitalize would create a likelihood of serious harm by reason of mental illness,” according to Massachusetts general law.
Both Alex and Shirley, however, signed a paper agreeing to voluntarily commit themselves; the consequences for refusing can be serious.
Given that in both cases, MIT administrators or doctors had documented evidence of a risk of serious harm, they or the doctors at McLean could have pursued an involuntary commitment, which would be valid for a total of six months the first time and could also come with “Roger’s Orders” that give permission for involuntary medication.
The student’s status at MIT is also not guaranteed. MIT Director of Mental Health Alan E. Siegel has said that following a hospitalization, MIT has to “make a decision about whether we believe it’s safe enough for [the student] to come back.” In Shirley’s case, MIT ultimately decided to send her home after her hospitalization and required her to reapply for admission as an undergraduate.
“Massachusetts laws are such that unless there’s a real perceived danger to self or danger to others, you can't hold anybody in the hospital,” Randolph said, so MIT does not make a decision to hospitalize a student lightly.
“It would be embarrassing to send a person to the hospital” only for the hospital to find them healthy and turn them away, he said.
Stressed and suicidal
Shirley went to the doctors at MIT Medical in the late summer of 2003 because she had become extremely unhappy about a disagreement where she might have had to pay several thousand extra dollars for housing both on and off campus or possibly lose her registration as a student.
She said she was “pretty much a non-functional person” and “hysterical” at the time, but that she was looking for a “verbal punching bag,” someone at MIT Medical to help her calm down.
Her current doctor, Kristine A. Girard, to whom Shirley gave permission to speak about her case, said that, according to Shirley’s medical records, “she was indeed talking about a great deal of stress” and “not knowing what to do about it.”
Girard said that Shirley had “talked about wanting to kill herself” to the admitting physician. She had also been hospitalized once before for risk of suicide for a shorter period of only three days.
“I don’t fault them” for committing her, Shirley said, especially given MIT’s possible liability for her actions otherwise. However, she said that it would have been better “if I had just been isolated for a few days... not in a mental hospital.”
“What I found in the hospital, I wouldn’t wish it on anyone else,” she said. “I don’t think anybody should have to go through that, not even for a day”
A ‘threatening,’ misquoted e-mail
MIT, including Randolph, sought to commit Alex because of a perceived risk to his hallmates.
The Department of Mental Health Form 5A that MIT Psychiatrist Lili A. Gottfried filed petitioning to commit Alex to McLean cited as its primary evidence for risk of harm a “tense, angry recent e-mail (attached) threatening ‘to get a rifle’ and shoot all of you.” [Alex said that the copy he received from McLean did not include the attached e-mail, and that he no longer had a copy.]
Alex said that the e-mail was “grossly misquoted and cited out of context.” He said the full sentence was, “If you really think I would get a rifle and go postal, they should send you to the mental hospital.”
The wording of the sentence changed several times according to several of his medical documents Alex obtained.
His Discharge Outright Summary quoted it as, “You know, maybe I will go nuts and get a rifle and just start killing all of you. If you believe that, they should send you to medical for counseling.”
The Forensic Consultation done by Senior Forensic Psychologist Ronald S. Ebert, quoted it only as, “You know, maybe I will go nuts and get a rifle and just start killing all of you.”
The documents cite other evidence for Alex’s hostile behavior, including other angry e-mails, possessing an air rifle, and nailing shut the hall’s kitchen door. Alex said that the gun was owned by someone else on the floor and was turned over to the graduate residence tutor upon request. He also said that he had nailed the door shut to make a point after finding the kitchen in an extremely unpleasant condition, and that the nails were only halfway in and were easily removed.
According to his discharge summary, after sending the e-mail about the rifle, Alex “was urgently requested to report to the dean’s office. He replied via e-mail that although he would be happy to come and speak with the dean, he would be unable to comply with this request until his exam periods were finished [Alex’s hospitalization overlapped with finals week]. At this point the dean and MIT psychiatrist, Dr. Gottfried, decided that the patient should be sent on Section XII to McLean,” referring to Massachusetts general law, chapter 123 on emergency restraint of dangerous persons.
Alex said that he was working on a research project in his lab when he found about MIT’s intention to hospitalize him as hallmates with police scanners “e-mailed me that they were told I was ‘armed and dangerous,’ and my neighbors said Campus Police were waiting on the hall.”
He said that when he returned to his room to get a book around 1 a.m., the police officers there were relaxed in their manner and said “MIT Medical just wants to talk with you.”
When he arrived at MIT Medical, he said that Gottfried told him after a brief physical that he was to be committed to McLean. He said the police then strapped him to a stretcher, citing “standard procedure,” and took him to the hospital.
Contact with MIT limited
Shirley said that when the doctor she had seen decided to have her committed, an emergency medical technician or police officer came to the room and escorted her directly to the ambulance, which took her to the hospital.
She said she had no opportunity to bring any personal belongings or a second set of clothes, and had to wait until some of her friends were able to bring her some during visiting hours.
Alex, whose hospitalization overlapped with finals week, said he was dependent on his friends to bring him his books and homework and to contact his professors about postponing his exams.
Both Shirley and Alex said their contact with administrators or doctors from MIT was very limited.
Alex said that only Randolph visited the hospital regarding Alex’s hospitalization, and then primarily to speak to McLean doctors.
“The thing that angered me most,” Shirley said, “was that I heard from a nurse that [MIT was] going to put me on a medical leave,” rather than hearing it from someone at MIT.
She said she had to wait for about seven days before receiving a visit from anyone from MIT. She said it was Siegel who visited, but after seeing him she then had to wait for him to return from vacation over the weekend to be released.
“I got [to McLean],” she said. “I thought I was going to get out in three days like last time.”
Eventually, though, “I felt like I was never going to get out of there,” she said. “I was so mad I had to wait an extra long time the entire weekend” for Siegel to return.
Siegel said that he would visit the student “at the point that McLean feels that they have enough information” to determine how the student is doing.
He also said that much of the level of outside contact was dependent on the desires of the student. “We let the McLean staff know to ask the student to please contact the housemaster,” he said, but due to medical privacy laws, MIT cannot inform anyone without the student’s consent.
Medical care of mixed value
The workers at McLean “were very accommodating, very quick,” Shirley said. She said they were nicer to her than to some of the other patients because she was from MIT. “They won’t talk to you like a baby like they do for the others,” she said.
She said, though, that she avoided many of the other patients. “I didn’t want to hang out with the other patients because they scared me.”
She described one middle-aged man who “had a thing for girls,” and another woman who went into a angry rage at another female patient, screaming, “Don’t you call me a fucking cunt, you fucking bitch.”
She said there was very little to do in the hospital, which offered basic television, newspapers and board games, but not internet access.
“I did nothing,” she said. “I was so bored. Finally, I don’t know, on Wednesday [six days after being admitted], I tried to make friends with one of the more normal patients.”
“The most difficult part” of being in McLean, Alex said, “is that there are patients in genuine need of help... People had seizures. People were placed in padded cells or restrained for medication. People cried and screamed. Such an environment is stressful. The patients saw right away I was OK.”
He said the length of his stay was due to a consistent conflict with McLean doctors because he maintained that the e-mail was misquoted, and because he had filed a three-day notice for release as permitted by law. The law allows any voluntarily admitted patient to request discharge, subject to a maximum three day delay by the hospital supervisor, but the doctors at McLean saw it as a hostile action on Alex’s part.
The Forensic Consultation done by Ebert said that “he has been seen through this hospitalization to minimize his behaviors, to show poor insight, and to lack understanding of why others might be troubled by his E-mails.”
The accounts of various doctors’ interviews with Alex, however, rely almost entirely on the evidence provided by MIT. “Throughout the process,” Alex said, “I told the psychiatrists that if they wanted a realistic picture of the hall and me, they should talk to people that know me -- my friends. They refused.”
The documents do not give further evidence for Alex’s perceived risk of harm, and generally refer to him as a “guarded” but moderately social and cooperative patient.
A summary of his stay at McLean found that “he submitted a three-day letter requesting discharge... Nevertheless, the patient’s behavior was appropriate. He was not threatening or self-destructive and he was cooperative with the evaluation process.”
Alex, who was a member of ROTC at the time, said that his job after graduation required two further evaluations to clear him for work in the navy because of his hospitalization, and that both examinations quickly found him mentally sound.
Shirley forced to leave MIT
Shirley said she was ultimately diagnosed as “mildly hypothymic” and bipolar, essentially being unable to deal effectively with depressive mood swings. She said that MIT sent her home after her release from McLean and required her to reapply for admission to return.
Upon leaving McLean, she said she took a taxi back to MIT and learned that MIT had bought her a plane ticket back home, “which I figured was the least they could do since they put me through all that shit.”
She also said that Assistant Dean of Counseling Services Kunya S. Desjardins “was adamant about getting me out of there as fast possible,” ideally in one day. Shirley said it was her perception that the urgency was because MIT would be legally liable should she hurt herself while still on campus.
She said she was frustrated with having to leave so quickly. She said she felt like “I would really like to accommodate you,” but “I have to pack... [and] get my friends to store stuff for me” at MIT.
Desjardins “had an undertone that she really wanted me out of there really soon,” Shirley said.
Desjardins said she was unable to comment in detail, but wrote in an e-mail that “there are a lot of complex issues involved in students who are hospitalized and in their taking time off... I think we try to do the best we can to think through what is in the best interest of students.”
Randolph said that the “issue is never liability for MIT.”
Shirley said that after returning home, she began taking antidepressants, and applied for admission in the regular fall early action program, but was rejected.
After that, she said she took the MCATs and volunteered at a local hospital. In general, she said she “just tried to be normal,” but by the summer was “losing all faith” of returning. She said she applied a second time during the spring, and was finally readmitted at the end of July.
Two say little was gained
MIT’s actions were “inappropriate,” Alex said. “They were beneficial only in that I believe people can grow from any experience, no matter how unpleasant or unfair.”
“You can’t ever say what would happen,” Shirley said, but “nobody likes to be seen as some dust to be swept under the rug.”
She said she sees “no reason to keep the students in the hospital in those conditions for that long.”
“When I was on leave I wanted to say something that would change MIT Medical,” she said. They are “doing the best they can, but I think they can do better.”