For many parents, the issue is what their children might call a no-brainer: If their offspring has stalked a peer or stayed in a mental-health clinic or been watched for suicidal inclinations at college, they want to know. Immediately.
Yet parents may be among the last people to be told of any concerns. Because of strict confidentiality laws, such problems cannot be reported to parents – or roommates or others close to a young adult in trouble.
The laws, say counselors and mental-health experts, are there for good reason. Without them, few students would seek help, and a trusting relationship could be impossible.
But such legal constraints – particularly in the wake of the killing of 33 students and staff at Virginia Tech – are deeply distressing to many parents who harbor a sense of love as well as responsibility for children they may see as not yet fully adult. Add to that their role in providing financial support, and parents can find it tough to be barred from learning about a child's mental health – or that of a child's roommate – without the appropriate consent.
"Parents who care about their children want them to become adults with their own rights, but we don't want them to have any more hardships than necessary when stepping out into the world," says Elizabeth Root, a parent with one child at the University of Illinois and another who will head there next year. She recalls an incident last year when her college-age son ended up in the emergency room; she wouldn't have been told had he not called her himself. "We pay for the tuition and the health insurance," she says, "but we can't be informed unless he dies, I guess."
Medical professionals are sympathetic, but say the assurance of confidentiality – except in dire circumstances – allows them to do their job. "The students trust us. They come and tell us things they might not have told anyone ever before," says Maggie Gartner, chief of student counseling at Texas A&M University and president of the Association for University and College Counseling Center Directors.
She explains to every student who comes in what confidentiality means, and when – if the student seems to pose a danger – she might breach it.
That decision to break confidentiality or to commit someone to involuntary care can be one of the toughest a counselor or psychiatrist has to face, says Dr. Gartner, especially since it may mean the loss of any relationship. Still, she's done it several times.
"It's an art and a science," she says, noting that she'll assess how much of a plan students seem to have, whether they can harm themselves or others, and how stable they appear. "We continually seek the place where we can go home at night and go to sleep, she adds."
No assessment is perfect, Gartner notes, and schools – like Virginia Tech – are often blamed if things go awry.
In one highly publicized case, the parents of Elizabeth Shin sued the Massachusetts Institute of Technology after she committed suicide by setting fire to herself in her dorm room in 2000, arguing that the school hadn't done enough to prevent it. The case was eventually settled out of court. In another case, George Washington University, saying that he posed a danger, barred sophomore Jordan Nott from campus after the sophomore checked himself into a mental-health facility with suicidal thoughts. Mr. Nott sued, and the case was settled last year.
Virginia Tech has faced considerable criticism for its lack of early action on the day student Cho Seung-Hui went on his deadly rampage. But some experts say there weren't enough signs to warrant an involuntary commitment or to breach confidentiality. In 1995, many commentators were equally critical of Harvard for its decision to rescind admission to Gina Grant once it came out that the student had bludgeoned her abusive mother to death when she was 14.
For parents, the concerns center less on liability than the welfare of their child. "I understand privacy issues, but 18 years old is way too young to have no parental guidance or awareness or involvement," says one mother, whose daughter experienced serious depression her freshman year. Her other daughter tipped her off, and she instantly went to the school to help. But, she says, it was excruciating to go to the psychiatrist and find she couldn't learn the smallest detail about her daughter's condition. "As a mother, it rips you up inside."
Root, the Illinois parent, says she would want to know if her child's roommate had serious mental-health issues – and says it might be a good safety measure.
But sharing that information with roommates or parents is often not just illegal but counterproductive, say experts. "A counseling center couldn't operate if there wasn't some guarantee that what the student said in that setting was confidential. It's a cornerstone of the whole therapeutic process," says Robert Gallagher, who annually surveys university counseling center directors and ran the University of Pittsburgh's center for 25 years. He says he often asks students' permission to contact family.
In last year's survey, 92 percent of directors said they have seen a growing trend in the number of students attending with severe psychological problems.
It's unlikely privacy laws will change soon, though Dr. Gallagher and others say some clarification of exceptions that give counselors more flexibility might help.
But the Virginia Tech incident has made parents and students more aware of what they don't know. "Colleges should do more to make sure everybody is fit to be around other students," says Ashley Brown, a marketing major at Radford University in Virginia. If they can't inform roommates about medical issues, they could still do more background checks and perhaps determine that some students need solo living situations, she suggests.
"You never had to think about who your roommate was before," Ms. Brown says. "Now you want to know who that person really is."
Patrick Jonsson contributed to this report.