University is already supporting mental heatlh

As Chief Medical Officer of Princeton University, I am pleased that Fernando Delgado chose to shed light on a mental health issue that concerns us all deeply here, that of suicidality in the college aged population. I would like to address some of the important issues his editorial raises. Fernando is correct in saying that the University takes mental health very seriously and cites the physical renovations to the Counseling Center on University Health Services third floor as proof of this proposition. I would add that the Priorities Committee's funding of two additional full time Senior Staff Psychologists in the recent past and the University administration's decision to invite me, a Board Certified Psychiatrist, to join Princeton as its Executive Director of University Health Services, are strong statements about how much importance is being placed upon concerns for the mental health of students here.

Perhaps in need of more clarification are Fernando's concerns about University Health Services ability to deal with "unfolding crises." Readers may not be aware of important recent innovations in the model of mental health care that we have implemented at UHS.

For the past year, the Counseling Center has staffed a "Crisis Team" of social workers, psychologists and psychiatrists that can triage and respond to students in crisis, often within minutes of their arrival, Monday through Fridays from 8:45 a.m. until 5 p.m. The Crisis Team provides same day evaluations and can institute a "crisis plan" until the student's need for intensive outpatient care, partial or complete hospitalization can be thoroughly assessed.

After regular hours counselors are on call every evening and weekend and are expected to see any students who feel suicidal in person regardless of the hour. They are also asked to "round on" or see in person all students hospitalized on the inpatient unit at UHS for mental health reasons on both Saturdays and Sundays.

This year we have initiated in-service training sessions, focusing on the management of psychiatric emergencies and the care of students with mental health concerns, for the UHS inpatient nursing staff. To date the sessions, taught by one of the UHS psychiatrists, have covered suicidal assessment, the conduct of mental status exams and the uses of psychotropic medications.

Finally as to the variability of response when "a student expresses signs or states that they might kill themselves," if a student calls UHS after hours and speaks with the nurse-on-call, they will be urged to come in immediately and should they be hesitant to do so, we do ask Proctors to seek the student out and transport them to UHS or the University Medical Center at Princeton. This semester we have already transported half a dozen Princeton students for emergency psychiatric hospitalization safely and successfully.

I applaud Fernando's efforts to ask what are we doing to insure high quality mental health care be available to all undergraduate and graduate students at Princeton. While no system of care is perfect and sometimes students may not receive an ideal response because of the complicated nature of emotional crises, I was concerned to read that Fernando's friend may not have been given strong enough encouragement to speak with a counselor in person. In the particular situation he described, I have learned that the student spoke with a counselor with whom he had interacted in the past and to whom he was well known. Apparently they both agreed that he could safely stay in his room that evening and attend the meeting scheduled with his father, the Dean of his College, a member of the counseling staff and myself scheduled the next day. Nonetheless we take very seriously the enormous stress placed upon roommates and friends asked to support a student in crisis who may be feeling suicidal. We will review our responses in this specific situation and in general as we continue to improve our systems of care.

As to the more specific suggestions of creating another hotline or having a counselor present in the building twenty-four hours a day, UHS welcomes feedback on our efforts to live up to our twenty-four hour a day, seven day a week commitment to compassionate medical and mental health care of the highest quality during the academic year. This very morning at 3:30 a.m., one of our counselors on call met with two students whose roommate was safely transported to the medical center for emergency psychiatric care earlier in the evening. We do want students to know that we are here ready to assist all students who may need our help regardless of the time or circumstances. In particular, we want to urge the friends, roommates or RAs of students in crisis not to hesitate to contact us for help, guidance or perhaps most importantly, to mobilize resources on behalf of the student as soon as is humanly possible.