Editor’s note: This letter from Siegel came in correspondence with the writer who interviewed him. See opposite page for that interview.
It is natural for high school and college students to begin to wonder about their purpose in life, and with that questioning they often consider whether or not they want to go on with life. In the JED Foundation’s Ulifeline website (jedfoundation.org/students), a site especially focused on college student mental health and suicide, there is a poll in which they ask visitors to the website to answer if they have ever thought about killing themselves. When I just checked today’s poll, 83 percent said “Yes,” and 17 percent said “No.” I sent you some college survey data which made it quite clear that many, many people feel horrible at times. If you go to the American College Health Association website (acha-ncha.org), you will see undergraduate surveys that are done each year.
I think the percentage of students who seriously considered suicide is about 14 percent of those polled. However, thinking about suicide, talking about suicide, considering suicide, does not mean that a person is acutely suicidal, at high risk for suicide. It is important to take seriously what people are thinking about and saying, but there are many risk factors, many “protective” factors to be considered. If you go to the American Foundation for Suicide Prevention (afsp.org), they have a section called “About Suicide,” and “Risk Factors” and they provide a pretty comprehensive list of what a clinician considers when one is doing a suicide assessment.
So thinking about suicide is a frequent experience for college age people, including MIT students. Students talk with us at Mental Health and Counseling (MH&C) quite a lot about their thoughts of suicide. But, as is stated in the Risk Factors section, simply having thoughts of suicide is not a reason to hospitalize a person; it is a reason for counseling and support.
About numbers of psychiatric hospitalizations and medical withdrawals for mental health reasons — this is a complicated question. Students enter the psychiatric hospital for a comprehensive assessment for many reasons — being acutely suicidal is only one of them. More often, MIT students enter the hospital because they cannot function, study, or think. Sometimes this is because of a depression, sometimes a psychotic process. Sometimes students are hospitalized because of severe eating problems and the emotional turmoil that goes along with it. Sometimes because they have been emotionally, physically, or sexually abused by people in their lives. There may be other reasons. Some students are psychiatrically hospitalized more than once during an academic year. Some students admit themselves to the hospital, and some are hospitalized when their friends bring them to emergency rooms outside of MIT. I see all students in the hospital, or Simon Lejeune does. When we need assistance, we have an internationally known psychiatrist who is an expert on suicide and psychosis who also sees students in the hospital for consultation.
Last academic year, my data show that 43 students were psychiatrically hospitalized — 11 graduate students, 32 undergraduates. In all, 878 undergraduates were seen at MH&C over the year for mental health counseling of some sort, of which 32 were psychiatrically hospitalized; 1048 graduate students were seen of which 11 were hospitalized.
Of those hospitalized, 9 of the 11 graduate students quickly returned to school after being in the hospital, and 17 of the 32 undergraduate students quickly returned to school after being in the hospital. The other students decided to withdraw or were withdrawn for medical reasons. These numbers of student hospitalized last year were in the high average range for MIT over the years. The Medical Withdrawal Policies are posted on the S3 and ODGE websites and detail the processes for withdrawals since those Deans are responsible to determine when students are to be on medical withdrawal status, and the process by which students return to school.
Anecdotal information from our peer schools indicate that MIT hospitalizes fewer students than others do, but those data are not good enough to be able draw any conclusions from them. But I hope you can see that the idea that students are hospitalized every time they mention suicide, and then are sent away on medical leave, is not accurate. This is a much more complex issue than that. The perception that the staff at MH&C are preoccupied with suicide is not correct. And this idea does not recognize what I think you all are trying to address in this issue of The Tech — to identify what students are up against on a daily basis and trying to make things better. I also know the “myth” exists at other schools, too.
About psychiatric medications, I will try to gather very accurate data for subsequent conversations, but this is the best data I have now. We also see 900 - 1000 faculty, staff, and dependents each year, and our medication data are not divided into categories of patients. Many students are seen in the community by local clinicians who also prescribe psychiatric medications filled in our pharmacy. Or students are in therapy outside of MIT, and their clinicians and the students ask us for medication. I estimate that 30-35 percent of students seen at MH&C are prescribed some psychiatric medication at some time. The estimate includes medications for ADHD, and medications for panic disorders that are taken only as needed for extreme anxiety. We do have a comparatively large number of staff who can prescribe medications. However, they also provide talking therapy, groups, and structured therapies. Whether students elect to take medication routinely or episodically, we do not mandate treatment and so students can decide what sort of treatment will be most useful for them, and we gladly honor those informed decisions.
Thanks, and any thoughts you and the staff might have about these topics will be most welcome.
Alan Siegel is chief of mental health at MIT. He is also an assistant clinical professor of psychology at Harvard Medical School. He can be reached via email at firstname.lastname@example.org.