Concerns on Confidentiality Policy Prevent 38.8% of Students from Seeking Medical Aid

Last month’s State of the Academy survey reflected an alarming trend among the student body: a hesitancy to seek help from Graham House for psychological or emotional problems. Approximately 39% of 725 students who responded felt that statements made to Graham House would not remain confidential, while 50.9% said they would not send a friend to Graham House if they thought that he or she was depressed or experiencing some form of psychological or emotional difficulty. According to Director of Psychological Services at Graham House Dr. Max Alivosetti, there is a stigma surrounding Graham House that “if you have a psychological distress and you seek professional help, people tend to view you as weak.” This prevents more students from seeking treatment, along with misconceptions regarding Graham House’s confidentiality policy. Mr. Alovisetti said, “There is a fear that because we are a close-knit community, the word will get out.” However, both Graham House and Isham Health Center are bound to confidentiality by HIPAA, a federal act that mandates patient privacy and protection. Medical Director Dr. Richard Keller claimed that a student coming to Isham would be treated in the same way as he or she would be at his or her own local hospital. According to Dr. Keller, Isham operates under “two tiers of confidentiality.” The only information that the Isham staff is not legally permitted to release to a student’s parents is anything reproductive health-related, such as pregnancy, birth control, and HIV results. Parents can view all other information on their child’s medical record, and Isham will release it on request. The “second tier” of confidentiality is between Isham and the rest of the school; Isham cannot divulge information to other members of the community without the consent of a student and/or his or her parents. The only exception to this protocol is admittance times, which are required for a student to be excused from class. Dr. Keller also said, “I will alert faculty of a student’s severe allergies, or in the case of mono[nucleosis] or a concussion, with the student’s permission. Under law, Isham can talk to members of the training room staff or Graham House about a student’s condition without breaching confidentiality because they are other health care providers.” However, if a student exhibits a potentially life-threatening condition or behavior, Isham must breach the confidentiality policy. Dr. Keller said, “In the case of someone who is borderline, for instance has an eating disorder but hasn’t lost a dangerous amount of weight, we work with the student to get them to tell their parents.” He said, “The faculty and house counselors, as the ‘in loco parentis’ of the students on campus, are in a difficult situation, as they have full responsibility but no legal right to be informed of a student’s medical condition. In the event that it would be helpful or necessary, we try to encourage students and their parents for permission to notify their house counselor.” Graham House follows the same philosophy. However, Dr. Alivosetti also said that “there are limits to absolute confidentiality, and the limits are based on safety. If the psychiatrists determine that a student is a danger, we are legally bound to break up the confidentiality rule in order to ensure the student’s safety and others’.” If a student’s presence on campus becomes a danger to himself or others, the Student Response Team (SRT), comprised of Dr. Keller, Dr. Alivosetti, Dean of Students Marlys Edwards, and Dean of Studies Dr. Margarita Curtis, meets to discuss a leave of absence. Students can also be required to have a professional evaluate them off-campus to ensure their safety. Leaves of absence are automatically required in the case of suicidal behavior, or if the student cannot fulfill the requirements of attending PA and becomes a disruptive member of the community. In some cases the Andover atmosphere is overwhelming, and being at home would provide better treatment. Dr. Keller said, “This place is so demanding in all aspects of life, academic, social, everything, that in some cases a student with a significant medical problem could get better care that he or she needs at home.” Dr. Alivosetti said, “Let’s say that a student swallowed pills in a suicide attempt. Regardless of what he or she says later, that event remains a suicidal attempt. What about a week [later]? What about when the student is overwhelmed? Chances are high that the student is going to make another attempt. But a majority of the students who have gone on leaves for the reasons mentioned, return and do very well.” It is extremely rare for a student to be required to take a leave, and Dr. Keller said, “The vast majority of students, I would say 98%, can be and are successfully treated on campus, without taking a leave.” Dr. Alivosetti said, “It’s important to realize that before the SRT meets regarding any student there has usually been a long history of many adults involved in providing support to that student. In situations such as suicide attempts, the SRT must follow school policy, which mandates a leave for the rest of the school year. This is the policy that is followed in most of our comparable boarding schools.” Dr. Keller said, “The SRT only gets involved if a leave is being considered, and we keep the medical piece [of the conversation] to a bare minimum to protect the student’s privacy.” The goal for healthcare providers on campus has always been and remains the well-being and safety of students. Dr. Keller said, “The last thing I would want would be for someone who needs professional help not to seek it because they are afraid of losing control of the situation. We are here to help students and our foremost and most important aim is to do what’s best for them. As a physician, maintaining students’ health is my objective.