UNDERSTANDING VIOLENCEWho are the predators we keep hearing about and what do

theyhave in common? Very revealing are the first five

indicatorsidentified by the Safe School Initiative Final Report by the

U.S.Secret Service and U.S. Department of Education:• Incidents of targeted violence at school rarely were

sudden, impulsive acts.• Prior to most incidents, other people knew about the

attacker’s idea and/or plan to attack.• Most attackers did not threaten their targets directly

prior to advancing the attack.• There is no accurate or useful “profile” of students

who engaged in targeted school violence.• Most attackers engaged in some behavior prior to the

incident that caused others concern or indicated a need for help.

What do we know?

• Roughly 80% of school violence perpetrators raised serious concerns about the potential for violence amongst friends, family, peers, or other community members prior to their acts

• Roughly 80% of school shooters shared their plans, or parts of their plans, with others prior to their shootings.

• Trust your instincts! Share what you hear!

Youth Risk Survey 2001 13,600 HS students

• 28.3% sad or hopeless almost every day> 2 wks stopped some activity due to symptoms

• 19 percent of students reported that they seriously considered attempting suicide

• 14.8 percent had made a specific plan to attempt suicide.

• 8.8 percent had attempted suicide in the previous year [Grunbaum et al 2002].

Recent Suicide Data• 1 FTE per 1700 students. Higher ratio

smaller schools• 4 hours psychiatric consultation per

week/ 1000 students, up from 2.1 in 2004

• 25% clients on meds• 366 schools 154 suicides, adjusted

rate is 6.6/100,000• 10% attempters die over 10 years• 45 of 76 suicides occurred during first

week post hospitalization

On the lookout for IcebergsIn 2001, a study by David Lisak, Ph.D., at the

Universityof Massachusetts, Boston revealed:• 120 male students (of a surveyed population

of 1,882) were responsible for 483 total acts of sexual violence (Lisak & Miller, 2002).

• 76 of those 120 men were responsible for 439 of the acts of sexual aggression (6 acts each) (63% multiple perpetrators, 37% one-time perpetrators)

• and 1,045 total acts of physical violence. • 76 men. 1,000+ crimes. 14 acts each. And,

Lisak’s measures used very conservative definitions of crimes.

FULL AND CONTEXTUAL FULL AND CONTEXTUAL COMPLIANCECOMPLIANCE

• HIPAAHIPAA• FERPAFERPA• COUNSELOR PRIVILEGECOUNSELOR PRIVILEGE• CLERY ACT TIMELY WARNINGCLERY ACT TIMELY WARNING• SECTION 504 OF THE SECTION 504 OF THE

REHABILITATION ACTREHABILITATION ACT• LIABILITY IN NEGLIGENCELIABILITY IN NEGLIGENCE

HIPAAHIPAA• HOW DO YOU KNOW IF HIPAA APPLIES HOW DO YOU KNOW IF HIPAA APPLIES

TO YOUR CAMPUS HEALTH OR TO YOUR CAMPUS HEALTH OR COUNSELING SERVICE? COUNSELING SERVICE?

• You may be surprised by the answer…do a You may be surprised by the answer…do a two-level analysis:two-level analysis:– 1) Does your counseling service or health 1) Does your counseling service or health

service transmit electronic data about patients, service transmit electronic data about patients, such as health insurance or billing information? such as health insurance or billing information? If not, HIPAA does not apply. If so, ask… If not, HIPAA does not apply. If so, ask…

– 2) Does your counseling or health service treat 2) Does your counseling or health service treat students only, or other community members as students only, or other community members as well? well?

HIPAAHIPAA

• If you treat only students, HIPAA does If you treat only students, HIPAA does not apply.not apply.

• If you treat other community members, If you treat other community members, HIPAA will apply.HIPAA will apply.

• Here’s why…if you only treat students, Here’s why…if you only treat students, the Department of Education has stated the Department of Education has stated that FERPA is the governing law for that FERPA is the governing law for these records, not HIPAA.these records, not HIPAA.

• So, let’s talk FERPA next…So, let’s talk FERPA next…

FERPAFERPA• If FERPA is the governing law for If FERPA is the governing law for

counseling and/or health service records, counseling and/or health service records, we recognize the FERPA specifically we recognize the FERPA specifically exempts health and counseling records exempts health and counseling records from the definition of educational records from the definition of educational records protected by the Act. protected by the Act.

• Thus, while FERPA is the governing law, it Thus, while FERPA is the governing law, it is inapplicable, and the only law governing is inapplicable, and the only law governing the privacy of these records is the state the privacy of these records is the state statute on privilege of health and mental statute on privilege of health and mental health records, and the professional health records, and the professional ethical requirements imposed by licensure.ethical requirements imposed by licensure.

MORE ON FERPAMORE ON FERPA

• Who’s your dependent?Who’s your dependent?• FPCO relaxed its stance on proof of FPCO relaxed its stance on proof of

dependency, and will allow us to use an dependency, and will allow us to use an opt in/out form at registrationopt in/out form at registration

• For students who indicate they are For students who indicate they are dependents, additional verification via dependents, additional verification via tax returns in unnecessary.tax returns in unnecessary.

• Even if a student does not indicate they Even if a student does not indicate they are a dependent, a parent may still show are a dependent, a parent may still show they are via the tax return method.they are via the tax return method.

MORE ON FERPAMORE ON FERPA

• What is the consequence of dependency?What is the consequence of dependency?• Colleges and universities MAY share Colleges and universities MAY share

ANY information from a student’s ANY information from a student’s educational record with any educational record with any parent/custodian claiming the student as parent/custodian claiming the student as a dependent:a dependent:– Tommy got a D in biologyTommy got a D in biology– Beth is cuttingBeth is cutting– Pak is in fact a College RepublicanPak is in fact a College Republican

MORE ON FERPAMORE ON FERPA

• Congress may liberalize the Congress may liberalize the emergency health and safety emergency health and safety exception to FERPA.exception to FERPA.

• Regardless, FERPA allows us to Regardless, FERPA allows us to share information as necessary in a share information as necessary in a crisis, and that will apply to most crisis, and that will apply to most cases where a student is a potential cases where a student is a potential harm to themselves or others.harm to themselves or others.

MORE ON FERPAMORE ON FERPA

• What college administrators observe What college administrators observe about students (not sourced from about students (not sourced from protected records) is not protected by protected records) is not protected by FERPA. FERPA.

• FERPA covers written records and FERPA covers written records and recorded media. What you see or what recorded media. What you see or what someone says to you is not an someone says to you is not an educational record.educational record.

• Internally, officials can communicate to Internally, officials can communicate to each other when they find there is a each other when they find there is a “legitimate educational need to know.”“legitimate educational need to know.”

PRIVILEGEPRIVILEGE• Can be waived when Tarasoff applies, or Can be waived when Tarasoff applies, or

when a direct threat is posed (in non-when a direct threat is posed (in non-Tarasoff jurisdictions)Tarasoff jurisdictions)

• Can be waived by the clientCan be waived by the client• Confidential information can be shared Confidential information can be shared

between counselors and health providersbetween counselors and health providers• What are the peripheries of the What are the peripheries of the

privilege?privilege?

CLERY ACT TIMELY CLERY ACT TIMELY WARNINGWARNING

• Was the Virginia Tech warning too little, Was the Virginia Tech warning too little, too late?too late?

• What should we do until the Department What should we do until the Department of Education decides?of Education decides?

• Use the standard law enforcement criteria Use the standard law enforcement criteria for warning:for warning:– Can we identify the nature of the threat?Can we identify the nature of the threat?– Can we identify the source of the threat?Can we identify the source of the threat?– Can we give those being warned specific Can we give those being warned specific

information about steps they can take to information about steps they can take to protect themselves from the threat posed?protect themselves from the threat posed?

NEGLIGENCE – DISCUSSION OF DUTY

– Historical “no duty” rule– Present erosion of the no duty rule

• Schieszler v. Ferrum College• Shin v. MIT

– Why Jain v. Iowa may not be the leading case on college liability for student suicide

– What is the Restatement (3rd) of Torts, and why should we care?

FEDERAL DISABILITY LAW: HOW BEST TO ADDRESS SUICIDAL

STUDENTS – A Suicidal Student Has a Disability – Both the ADA and Section 504 Apply

• Section 504 gives recourse to students who are discriminated against on the basis of a recognized disability.

• The Americans with Disabilities Act (ADA) entitles students who are otherwise qualified to participate in the programs and activities of college to reasonable accommodations once they seek qualification with the campus disability services office.

• Neither law requires that a suicidal student march into the disability services office to qualify as disabled.

THE LAW: HOW BEST TO ADDRESS SUICIDAL STUDENTS

• Once suicidality is clear to college officials, our obligations under these laws are in effect. – We should explore whether the

disability can be accommodated, and provide whatever support we can, within reason.

IT IS POSSIBLE, AND SOMETIMES DESIRABLE, TOSEPARATE A STUDENT FROM THE UNIVERSITY

– Direct Threat Test• To rise to the level of a direct threat, there must be a

high probability of substantial harm and not just a slightly increased, speculative, or remote risk;

• In a direct threat situation, a college needs to make an individualized and objective assessment of the student's ability to safely participate in the college's program;

• This assessment must based on a reasonable medical judgment relying on the most current medical knowledge or the best available objective (non-medical) evidence;

• The assessment must determine; the nature, duration, and severity of the risk; the probability that the potentially threatening injury will actually occur; and whether reasonable modifications of policies, practices, or procedures will sufficiently mitigate the risk.

IDEATION, NON-SPECIFIC THREATS, GESTURES

The direct threat test tells us that a student who is ideating, threatening or who is making non-specific gestures without a plan or means to carry though may not represent a high probably of substantial harm.

– When George Washington University recently separated a student who reported suicidal thoughts at a hospital, it clearly overreacted. It did not make a finding that met the four elements of the direct threat test.

– OCR is, by practice, deferential to our determination of direct threat, but they insist that we make one.

The direct threat test requires

an assessment• This is not mandated to be a therapeutic

assessment, but an overall assessment of a student’s ability to function effectively and safely in a campus environment. – A therapist’s conclusion under DSM-IV

diagnostic criteria or other accepted evaluative instruments that a student is likely to be an imminent threat of harm to themselves or others

• We are to use objective evidence, and if possible, the most current medical knowledge available

Mandated Assessment – The Legal Aspects

• If the student will not share medical records from the hospital, and is not cooperative with your efforts to have him or her assessed, the law permits you to require the student to be assessed.

• Who chooses the therapist?• Who pays?• Can we impose the condition that the

student waive confidentiality, permitting you to communicate with the therapist about the student’s welfare?

What happens if the student does not attend required sessions?

• If the student refuses, I recommend that you use your conduct code (or at least the threat of it).

• We should all have and use policies addressing a student’s failure to comply with the directives of a college official.

• If you then sanction, and even separate a student, it will not be on the basis of their disability, but on the basis of their conduct.

• This approach is fraught with potential to push a fragile student over the edge, so I really entreat you to do everything you can first to ensure voluntary cooperation.

DISRUPTION AS PRETEXT

– It can be easier for smaller or less affluent campuses to look to shift the burden elsewhere. They may be more likely to try to separate a suicidal student.

• They often look to use their code of conduct to address behaviors, which has long been considered a best practice. A suicidal student may be disruptive, that is true.

• But, today there are only limited circumstances in which OCR will find that our decision to separate a student for disruptive behavior is not a violation of Section 504.

Disruption as Pretext, con’t

•The only instance I am aware of that might pass muster would be a decision to separate a student for disrupting the academic environment, made in an absence of knowledge that the student was suicidal.

•Any other separation based on a disruption policy--where officials are aware of suicidality or the disruptive behavior occurs not in the classroom but in a residential setting--is highly likely to be seen by OCR as a pretext for discriminating against a student with a disability.

THE CONDUCT CODE APPROACH

– I have similar concerns for using a conduct code provision on “threat of harm to self or others” as the basis for separating a student.

• Certainly, it can be used for an interim suspension, because an interim suspension is not subject to the direct threat test.

– The problem with the “threat of harm to self” policy is that it is not usually backed up by the four elements of a direct threat finding.

• If it were, I think it would satisfy OCR.

THE CONDUCT CODE APPROACH, con’t

– I recommend instead that you develop and utilize a medical withdrawal procedure, with both voluntary and involuntary options.

• I read recently that some commentators fear that involuntary medical withdrawal policies have been abused by some campuses, and so as I recommend this, it is with these assumptions:– that you would have already exhausted

accommodation options, – that you will use the direct threat test as the

standard for your medical withdrawal policy, – that you would have in place a requirement that

you do not separate a student unless you have a plan for where they will go when they are separated, and have made appropriate efforts to see that support mechanisms are in place for that student.

HEIGHTENED DUE PROCESS

– Another reason for preferring a medical withdrawal policy is because disabled students are entitled to heightened due process rights--according to OCR--and we fear that our conduct processes may not meet those requirements.

• For example, OCR states that a student who is being withdrawn for medical reasons is entitled to an appeal. Our conduct procedures may cover that, but may not.

• A student is also entitled to present medical evidence countering the finding of a direct threat. Our conduct procedures may not permit that.

Mandated AssessmentMandated Assessment

• The process of requiring that a student be The process of requiring that a student be evaluated by a mental health evaluated by a mental health professional.professional.

• Often an assessment will be completed Often an assessment will be completed over 2-4 personal counseling sessions.over 2-4 personal counseling sessions.

• Assessment can be provided by an on-Assessment can be provided by an on-campus resource or an off-campus campus resource or an off-campus therapist.therapist.

• Trusting the source of evaluative findings Trusting the source of evaluative findings is important, especially if they indicate a is important, especially if they indicate a student is a direct threat.student is a direct threat.

Mandated AssessmentMandated Assessment

• What is the purpose?What is the purpose?• Objective findings of whether a student Objective findings of whether a student

poses a risk of harm to him/herself or poses a risk of harm to him/herself or othersothers

• To “coerce” a student into a therapeutic To “coerce” a student into a therapeutic relationship in the hope that s/he will feel relationship in the hope that s/he will feel comfortable there with time, and will comfortable there with time, and will maintain a personal counseling maintain a personal counseling relationship voluntarily once the relationship voluntarily once the assessment is completed.assessment is completed.

Mandated AssessmentMandated Assessment• Isn’t mandated assessment just a palatable Isn’t mandated assessment just a palatable

way of selling counselors on mandated way of selling counselors on mandated counseling?counseling?

• Evaluation and assessment are counseling Evaluation and assessment are counseling functions. They are provided to a client in a functions. They are provided to a client in a counseling relationship. counseling relationship.

• Calling it assessment may make it more Calling it assessment may make it more palatable to those who believe that palatable to those who believe that counseling is optimized when it is voluntary. counseling is optimized when it is voluntary.

• But, for determining harm to self/others, But, for determining harm to self/others, administrators need objective evaluative administrators need objective evaluative results. results.

Mandated AssessmentMandated Assessment

• Virginia Tech was the 9/11 for colleges and Virginia Tech was the 9/11 for colleges and universities.universities.

• It gave us wake up call to a previously It gave us wake up call to a previously unanticipated threat.unanticipated threat.

• We have to ask what did we learn from We have to ask what did we learn from tragedy?tragedy?

• What needs to change?What needs to change?• We need to be willing to mandate We need to be willing to mandate

assessment.assessment.• College counseling centers need to provide College counseling centers need to provide

assessments, or we need to find outside assessments, or we need to find outside providers who will.providers who will.

Mandated Assessment Mandated Assessment

• CriticismsCriticisms• Some people believe that a mandated Some people believe that a mandated

assessment-based suicide prevention assessment-based suicide prevention program, such as the UIUC model, may program, such as the UIUC model, may identify students who pose a remote risk of identify students who pose a remote risk of suicide.suicide.

• But, critics suggest such approaches may But, critics suggest such approaches may drive the truly suicidal underground for fear drive the truly suicidal underground for fear they will be caught up in a net if they they will be caught up in a net if they ideate, cut, or otherwise tip administrators ideate, cut, or otherwise tip administrators to their potential suicidality.to their potential suicidality.

Mandated AssessmentMandated Assessment

• We must focus holistically on “red We must focus holistically on “red flag” behavior, not just on indicators flag” behavior, not just on indicators of suicidality. of suicidality.

• The NCHERM CUBIT draws from a The NCHERM CUBIT draws from a greater base of threat indicators, greater base of threat indicators, and may enable intervention through and may enable intervention through mental health screening, enhanced mental health screening, enhanced monitoring of excessive monitoring of excessive absenteeism, and alcohol screening.absenteeism, and alcohol screening.

WHAT IS A RED FLAG?

• Distress-level behavior rarely results in violence

• Disturbed behavior, especially when repeated or rapidly escalating, can be a red flag.

• Dysregulated behavior is a red flag.– A suicidal student may be a homicidal

student– A suicidal student may be willing to risk

other lives to accomplish his or her mission

WHAT IS A RED FLAG?

• Alarming behavior that may show a lack of control by the actor (stereotype)

• More often, flat affect and calm planning are indicative.

• The “thousand-yard stare” shows a level of detachment from self that is concerning

• Suicidal threats or gestures– “I don’t need my hard drive any more”– “No one cares about me”

WHAT IS A RED FLAG?

• In addition to suicidality, there is a correlation between violence and a history of the actor being subject to extreme bullying.

• Look for patterns in writing, class discussion or class interaction.– Themes of revenge– Themes of annihilation– Themes of “outsider” exclusion

REPORTING THESE BEHVIORS

• Faculty have been reluctant to report disruptive activities in the classroom. In Coping With Disruptive College Students (1994), Gerald Amada identified four possible (and typical) reasons:– Faculty hope for a spontaneous resolution– Faculty fear that they will not be supported

by the administration– Faculty fear that reporting will be viewed as a

reflection of inadequacy as an educator– Faculty fear retaliation.

DISRUPTION UNPACKED• Distressed

– Emotionally troubled– Individuals impacted by situational stressors and

traumatic events– Psychiatrically symptomatic

• Disturbed– Behaviorally disruptive, unusual, and/or bizarrely acting– Destructive, apparently harmful to others– Substance abusing

• Dysregulated– Suicidal– Parasuicidal (self-injurious, eating disordered)– Individuals engaging in risk-taking behaviors (e.g.,

substance abusing)– Hostile, aggressive, relationally abusive– Individuals deficient in skills that regulate emotion,

cognition, self, behavior, and relationships

CLASSIFYING THE RISK

• USE THE NCHERM CUBIT MODEL RUBRIC TO CLASSIFY THE RISK OF EACH OF THE FOLLOWING SCENARIOS:– MILD– MODERATE– ELEVATED– SEVERE– EXTREME

SCENARIO #1• June and Ryan dated for several months,

until he broke up with her for being “nuts”• After they broke up, June created a fan

web site “Everybody Loves Ryan” and posted pictures, intimate details of their relationship, and a daily blog in which she chronicle her belief that Ryan represented male perfection personified.

• Several months after, June found out that Ryan had begun dating Ho. She made liberal use of the obvious pun in her blog, e.g. “Ryan is now dating a huge Ho” and seemed to obsess.

SCENARIO #1

• By email, Ryan asked June to stop writing about him.

• In early May, June went to Ryan’s room, armed with a machete. She threatened Ryan and Ho with it, telling them she had a right to write anything she wanted.

• On her way out the door, June buried the blade in Ryan’s door and left it behind.

SCENARIO #2

• Paul is in your Contemporary Authors class. His writing is brilliant, thought-provoking and evinces an authorial style quite reminiscent of Henry James.

• Unfortunately, Paul never writes on the given assignment. His essays are handed in whenever an assignment is due, but tend to be screeds on whatever catches his attention.

SCENARIO # 2

• Recent topics have included the plight of disabled veterans, trace elements of prescription drugs in drinking water, $4.00 gallon gas and the $17 billion in excess profits declared by the oil companies, how wrong Michael Moore was about health insurance, how the frat boys on campus get special treatment, and his theory that the head football coach is “banging the President’s wife.”

SCENARIO # 2a

• What if Paul’s essays covered the following topics, instead:– The poison found in Cheerios– The conspiracy to require Bill Clinton to be

called the First Philanderer– His belief that small microchips detect

whether you are speeding and email the police directly from your car to report you

– His belief that the housekeeper in his residence hall is a slave who is chained in the basement at night

SCENARIO # 3• Student Karol informs you that she is aware

that two of her friends, fellow students Bela and Yuri, hacked into the student information system just for fun, but discovered a page that gave access to anyone’s social security numbers.

• She doesn’t know what, if anything, they may have copied down, but she overheard them talking about it in the cafeteria.

• Simultaneously, the reporting database indicates an increasing trend of students experiencing identity theft, with one reported in September, two in November and four in December.

SCENARIO # 4

– Kevin joins a Facebook group called “Bush Sucks.” In it, he gleefully trumpets each of the President’s misstatements, lies, verbal flubs and pictures depicting blank expressions published by various media outlets.

– He often posts about how much better the world would be without Bush, whom he calls Shrub.

– He fantasizes about what the world would be like without Bush, and starts a contest with his fellow group members “The Top Ten Ways to Trim the Bush” in which they compete for the best ways to kill the President.

SCENARIO # 4

• Some propose arsenic, others hypoatremia, while others suggest allowing him to be “questioned” at Gitmo. Some suggest sending him personally to find Bin Laden.

• Kevin proposes that instead of Mission Accomplished, he will offer the President a Final Solution. A bomb that will blow up the Rose Garden when the President endorses a successor. Two with one blow, Kevin calls it.

SCENARIO # 4

• Simultaneously, one of Kevin’s professors reports to your team that he has a student who has been asking alarming questions about bomb-making in his Chemistry class.

• Another student reports anonymously that he observed a student fitting Kevin’s description downloading “how to make your own bomb” recipes from the Internet on a library study carrel computer.

SCENARIO # 5

• Nadia calls the Dean of Students to report that her boyfriend, Sig, made a casual reference to killing himself last night on MySpace.

• He told her he is bi-polar, and she knows this because she saw Prozac in his medicine cabinet.

• She asked him if he was serious, and he said if he intended to kill himself, she would be the first to know.

SCENARIO # 6• Your health service receives the following

email from a student at a nearby college:– To Whom it May Concern…I met your student

Daniel Kim playing World of Warlocks online. At first, I thought he was just completely absorbed in the game. He seems to play 24/7. But, then his character told my Avatar that he is not going to play anymore because he is going to die soon. He told me that he lives off-campus, in a high-rise apartment, and that there is roof access from the 12th floor. He said that he is going to “Drink Everclear until the world is spinning, blindfold himself and wander around the roof.” He also said he hopes that he “doesn’t land on anyone on the ground and squash them like a bug”

• Signed, Justin Rembicki, Senior at Millsaps College

SCENARIO # 7

• Information comes into your database about Mary as follows:– March 7 – Mary sends an inappropriate

picture to “all recipients” of the campus email system, using a function that she accessed while working as student worker in the student affairs office

– -- April 2 – transferred to the counseling center, Mary posts online anonymous, personal, sensitive information she learned about multiple students while working at the counseling center.

SCENARIO # 7

• April 17 -- A frequent blogger and participant on Facebook, you learn that Mary suddenly erased her website, deleted her blog and removed all her history from Facebook.

• April 18 – Mary’s roommate reports that Mary, a long-time cutter, left blood all over the floor of their room last night

• April 21 – A bloody knife is reported found in the Mary’s hall bath by the RA

SCENARIO # 8• Jeff’s RA reports that Jeff is being

bullied quite harshly on his hall, and is arranging to move him to another hall.

• He is concerned for Jeff because Jeff just joined Mega Iota Pi, a campus fraternity known for its vicious hazing.

• The RA has a friend at MIP who told him they only initiated Jeff for the sport of torturing him. “They love easy targets”, the RA writes in his report.

SCENARIO 8a

• Add the following – – The RA reports Jeff has become increasingly

withdrawn as the semester progresses– He looks sleep-deprived– He insists he is not being hazed when the

RA asks– In the bathroom, he has taken to wearing a

full-length bathrobe, which is odd for him– Jeff’s Mom called the RA wondering why he

son stopped his regular calls two weeks ago

SCENARIO # 9

• Victor, a senior, is one of the brightest students at your university. He is an SGA leader, editor of the newspaper, and a finalist for a Truman Scholarship.

• At the end of April, he suddenly covered himself with an enormous plate of mashed potatoes in the cafeteria and proceeded to lick the food off of himself with his fingers for almost an hour.

SCENARIO # 9

• In early May, Victor was found wandering the campus wrapped in construction paper.

• He told a professor that he “needed to retake the SATs, to make sure he could get into the college of his choice”

• Working closely with his faculty advisor on the Truman application, the professor noticed that several of the essays seemed to be transcriptions of George Carlin stand-up routines.

SCENARIO # 10

• You have been tracking Wei because she tried to kill herself in fall of 2006. She return to school in spring of 2007, and has been meeting regularly with a counselor on campus.

• Starting this semester, the counselor alerted you to her belief that Wei was entering a crisis phase again, with respect to extremes of suicidal ideation.

SCENARIO # 10

• The counselor tells you that Wei has repeatedly fantasized about taking an overdose, and about slitting her wrists.

• One of her friends shares with you anonymously that Wei claimed to have a rope and talked about hanging herself.

• At the same time, you become aware of two incidents in three weeks time in which Wei was transported to the hospital for alcohol overdoses.

SCENARIO # 10

• Checking in with her housemates, one tells you that Wei “is always telling us this is the last week of her life”

• Another housemate tells you that Wei told her she intends to kill herself in Rome this summer when she goes on a university-sponsored cultural tour.

SCENARIO # 10

• Now add the final piece of information that Wei and her lover Babette have just broken up and the counselor reports to you that Wei is distraught.

SCENARIO # 11• John believes he is a transformer. The

Camaro, actually. At some times, he is the hero robot, at other times, he believes he is a yellow car.

• When he transforms, often publicly, he makes a show of human origami and great commotion.

• He beeps his “horn” at people.• You have one report that he “transformed”

himself once in a classroom, resulting in significant disruption that was ignored by the professor.

SCENARIO # 11• John broke into a local convenience store

“to turn on the gas pumps.” The store was closed for the night, but John claimed he would die without refueling.

• Police have referred the matter to the DA.

• In discussions with John’s parents, you learn that he had a normal childhood, never suffered delusions, but was incarcerated in a juvenile home twice when he was 11 and 14, once for acts of vandalism, and once for breaking and entering.

SCENARIO # 12• Lakisha, a junior, came to the attention of your

team.• Staff at the Rec Center noticed that Lakisha was

working out for well over two hours a day, and her pattern of use in the Center appeared to be increasing over time.

• Give her extreme leanness, one of the staff members alerted you to the possibility of exercise bulimia.

• The staff member observed Lakisha in the locker room weighing herself at 105lbs. Lakisha is about 5’11”.

SCENARIO # 13

• Brian is identified in your database as a known alcoholic as the result of repeat alcohol violations in his conduct record.

• Members of his freshman hall have approached their RA with concerns about Brian’s extreme alcohol abuse.

• Brian went missing for two days last week, but showed up on Friday without explanation for his absence.

SCENARIO # 14

• Justus is a former enlisted soldier who returned from two tours in Iraq last year. Upon his return he enrolled in your university as a freshman.

• He has qualified as a person with a disability suffering from PTSD, and he receives a number of needed accommodations.

• Justus has been the subject of several conduct complaints this year, including:

SCENARIO # 14

• Justus suffers from nightmares and wakes up screaming. His hallmates and roommate have complained to the RA and RD in the building about repeated being awakened.

• Justus one evening lost his temper with a bunch of drunk students who were teasing him, and he pinned one against the wall and would have struck him had the others not intervened.

SCENARIO # 14

• His roommate, looking for a way to get Justus out of his room, snooped in his desk and found documents related to Justus’ counseling sessions at the VA Hospital, as well as a diary.

• He brought all of these documents to your team, claiming they prove Justus is unbalanced, erratic, potentially violent and heavily medicated.

• The diary contains fantasies of extreme violence against the “brat kids” who live on Justus’ hall.

SCENARIO # 15• Charlton is the President of the campus

Student Advocating for Concealed Carry (SACC) organization.

• Last week, he organized a protest against the campus weapons ban, in which he orchestrated the wearing of empty holsters by many members of his organization as they went about their campus business.

• It was reported by two students and one faculty member that the holster Charlton was wearing that day was not empty.