Care and Concern illustration

She laid in her extra-long twin-sized bed on the sixth floor of Millikan Hall thinking about how she didn’t just not want to get out of bed that morning, but didn’t want to wake up at all.

Seemingly on top of the world in her junior year at Northwest with straight A’s, a job as a BRIDGE with residents and coworkers she loved, Pooja Poudyal thought she should feel content and accomplished, but instead found herself sitting in a hospital room signing a Care and Concern Contract.

The Care and Concern Contract is part of the University’s Care and Concern Policy, outlining how the University is to manage concerning student behavior. Concerning behavior, defined by the policy, presents an immediate danger to the life, health, welfare, safety or property of any Northwest community member.

If the University has a credible report of concerning behavior, the Behavioral Intervention Team will step in and determine a response. If warranted, the BIT will recommend the student sign a Care and Concern Contract.

The contract requires students to attend four, one-hour sessions with a licensed mental health professional, which can be a staff member at Wellness Services or a private practitioner. The contract enables the practitioner to give a Risk Assessment Summary to the BIT.

According the Care and Concern Contract, the purpose of the Risk Assessment Summary is not to cure or diagnose underlying conditions, but to evaluate whether the student is able to safely participate in the campus community.

The policy is designed to help students with mental health issues, but some don’t feel like they are getting the help they need.

“At some point, I felt like I was just lost in the rules,” Poudyal said. “I did not feel like I was getting the help that I needed. I was really worried to talk to my counselor about any thought that I had because I knew if I say anything, they’re just going to put me in the hospital. If I’m going to talk to my boss, he’s definitely going to send me to counseling; if I talk to my counselor, they’re definitely going to send me to the hospital.”

Two years and three Care and Concern contracts after Poudyal was first admitted to the hospital in February 2018, she was still struggling with mental health issues and took a semester off school to go home to Nepal.

When Poudyal came back to the University for her final year this fall, she said just felt pushed around by the University.

At the time she signed the first Care and Concern Contract, Poudyal said she felt it was a gesture showing that the University cared about her wellbeing and wanted her to succeed.

She said Assistant Vice President of Student Affairs Kori Hoffmann explained the contract would help the University to work with her to make up missed classes, assignments and tests.

“It felt like a supportive statement in that moment,” Poudyal said. “It felt like it’s something that every student needs when they’re in such similar situations, so I didn’t think much of it at the time.”

Hoffmann said the Care and Concern Policy has been in effect for at least as long as he has been in his role, more than seven years. It was last updated Aug. 5, 2011.

Hoffmann said the goal of the policy and the contract is to support students and keep everyone in the community safe, including any students who enter into a contract.

Hoffmann said around 98% of Care and Concern Contracts are presented to students who have been hospitalized for mental health treatment. He said the contract supports students from an academic front and to direct students to resources.

Beyond the mandatory four evaluations by a mental healthcare professional stipulated in the contract, the Care and Concern Contract also contains contact information for Wellness Services, counseling services through Wellness Services, University Police, Residential Life and Student Affairs.

Senior Starr McClain, who uses they/them pronouns, signed a Care and Concern Contract at the Maryville Mosaic Medical Center April 10, but under different circumstances.

McClain said they have dealt with anxiety and severe depression for as long as they can remember, but said they were not suicidal until after they went out to The Outback the Friday before hospitalization. At the bar, they said someone drugged their drink without their knowledge.

After escalating suicidal thoughts, McClain said they checked into the hospital. McClain said their doctor told them after they signed the Care and Concern Contract that there were benzodiazepines in their system.

Benzodiazepines, according to the Mayo Clinic, slow down the nervous system, and drinking alcohol can exacerbate the depressive effect. A common drug containing benzodiazepines is Xanax, a drug used to treat anxiety.

After sleeping for 15 hours in the hospital, McClain said Steinman came to see them that Monday. McClain and Steinman met one-on-one, and McClain signed the Care and Concern Contract that day.

McClain said the language of the contract began to bother them a few weeks after being released from the hospital. They also did not feel they were in the right state of mind to be signing a contract at the time, since they believed they still had benzodiazepines in their system.

“I had no choice. It was either sign the contract or you can’t come back to school,” McClain said. “He basically said that, and what I heard a lot of, is, ‘You did something that could have potentially disrupted the Northwest environment and caused distress to the rest of the students.’”

McClain said while they were still reeling from the weekend’s events; they didn’t feel cared for; they felt like a burden and a problem to be dealt with.

“I had always had it in my head that they want to kick me out of school for being depressed and being drugged by someone else,” McClain said. “It’s a saddening feeling that someone else’s actions, they will allow it to ruin you, and if anything, they will help it.”

McClain filed police reports with UPD and Maryville Public Safety April 10 after they were released from the hospital for the night they believe they were drugged.

Hoffmann said Northwest is unique in its Care and Concern Policy in that concerning behaviors are not considered conduct violations, and students who attempt to harm themselves or others do not always have to immediately go through a conduct violations process, which he said is typical nationally.

“Something about that doesn’t feel right to me,” Hoffmann said. “Students are already experiencing some mental health concerns — anxiety, depression, stress, whatever it may be — and then you add onto that by saying we’re going to charge you with a conduct violation, and then say here’s the outcomes. That doesn’t feel right to me or our institution.”

According to the contract, the purpose of the policy is not to punish students, but is intended to provide structure for responding to concerning behavior.

However, if a student is presented with a Care and Concern Contract and doesn’t sign it, or if they continually fail to comply with the terms of the contract, Hoffmann said the student would go through the conduct violations process.

One potential sanction is involuntary withdrawal from the University. According to the University’s Involuntary Withdrawal and Readmission Policy, withdrawal does not bar students from attending the University again.

Hoffmann said in his seven years here, a student has never refused to sign a Care and Concern Contract.

When the time came for McClain to verify for their fall classes, they were told there should have been a hold on their account for not fulfilling the mental health evaluation requirements.

While the four mandated evaluation appointments had to be completed by Sept. 20, the contract stipulates the first appointment must be within the first week of signing the contract, which McClain did not do.

McClain said they could not afford private counseling over the summer and Wellness Center counseling was unavailable to them. However, Hoffmann said Wellness Center counseling services are available over the summer to students who are registered for a future term.

McClain said after they had verified for and started classes for the fall semester, Steinman called them and said there should have been a hold on their account because no progress was made on their mandatory evaluation sessions.

Hoffmann said the only reason an academic hold would be placed is because a student is not completing their sessions.

“We’ll send out multiple reminders via email, via text; we’ll make phone calls,” Hoffmann said. “Students are always aware that they are not completing those sessions. I have students sometimes say, ‘Nobody ever told me,’ and I can go into our system and pull up all the different emails we sent them, and it can even show when they opened and read the emails. So it’s not something we do lightly.”

While McClain was still able to verify for classes, a hold was placed on their account preventing them from adding or dropping any other classes. They said the hold was removed from their account by setting up an appointment with counseling in Wellness Services and notifying the BIT of it.

Poudyal said she took no issue with the requirements to see a counselor, since she felt she could be utilizing the resources available to her. However, she said her treatment plan from the hospital was not the right fit.

Poudyal said she was diagnosed with major depressive disorder, panic disorder and anxiety, and she was prescribed two medications, but within a week, she only felt worse. She said she was still disassociating and having panic attacks, but she began to hallucinate, have seizures and pass out multiple times a day.

She said her suicidal thoughts got worse. Poudyal said she called a suicide hotline, and the staff at the hotline contacted UPD. She said UPD took her to the hospital again, but this was when she said she began to lose faith in people who said they would support her.

Although she was not admitted to the hospital that night, she missed one of her mandated appointments. In the process of communicating why she missed the appointment, she said she felt lost in the system.

“People are so concerned about following rules and protocols that they don’t really care about the person being treated, and that’s how I felt like throughout this process,” Poudyal said. “It’s not about what I need; it’s about what they are told to do.”

After talking to her counselor about the missed appointment, Poudyal said her counselor requested she meet her at the hospital, where she said she was admitted by court order. Poudyal said there were no openings for her in Maryville, so she was assigned to a Mosaic facility in St. Joseph, Missouri, where she remained for around 11 days.

In St. Joseph, Poudyal said she received a new diagnosis: bipolar disorder, which the medications she was taking exacerbated. She said Hoffmann came to the hospital, and she signed her second Care and Concern Contract April 18, 2018.

Poudyal received new medication and went home to Nepal for the summer, returning to campus in fall 2018.

That fall, while working as an assistant complex director in South Complex, she said she had a panic attack and collapsed at the front desk. She said she didn’t want her coworkers to call UPD because she didn’t want to go back to the hospital.

Poudyal said she was put on probation for not following protocol and not letting her staff call UPD.

“That was a very, very stupid situation, because I felt like I did what was right for me,” Poudyal said. “It was just weird because I knew I didn’t need UPD coming in asking — I just didn’t feel good about it. My job was the one thing that was keeping me sane, and it was the one thing I was proud of, and I felt like I was doing good in it. I started spiraling, and I felt like I was done with living.”

This time, Poudyal said she tried to kill herself.

Poudyal said she was taken to the Intensive Care Unit and then admitted for mental health treatment. There, she signed her third Care and Concern Contract. After being released, she met with Steinman and he told her they contacted her parents.

According to the Care and Concern Contract, “The BIT, where appropriate, may take steps, including contacting the student’s parents and/or other appropriate parties in connection with an emergency if knowledge of the information is necessary to protect the health or safety of the student or other individuals.”

Hoffmann said while the policy says parents, in practice, the students’ emergency contact is usually the party reached out to, and only after notifying the student about it.

After her third hospitalization, Poudyal said she took the spring semester off to stay home and focus on her mental health.

Poudyal said she felt caught in a repetitive system that wasn’t helping her get better. She said if a student is in the hospital repeatedly, then something is not working and a new approach needs to be tried.

She said she struggled with talking to a counselor because she comes from a culture that doesn’t talk openly about mental health, and she said the University shouldn’t assume students know how to talk to a counselor.

She said as a BRIDGE and later as an ACD, she was trained to direct students to resources. She said she felt she was just being directed around and not receiving help at any of the places she was sent.

“I just felt pushed around,” Poudyal said.

McClain said while the concept of the contract and the Care and Concern Policy is good, in practice, it let them down.

“The thing that really disappoints me, and it turned me away from the Northwest professional community, is that they didn’t acknowledge that I could have died,” McClain said. “They go about it with zero care at all for the person who is going through whatever they’re going through. I was labeled as a disruption, as an inconvenience to be removed. I hated that more than anything. I felt zero support; I felt worse than I did going into the hospital.”

Hoffmann said he has worked with students from other universities who were expelled for attempting or threatening suicide, and he said those students and their parents were grateful to Northwest for its process of handling mental health issues.

“From a privacy perspective, we can’t share the name of every student who has signed a Care and Concern Contract,” Hoffmann said. “By nature, you’re only going to hear from the people who have complaints. You’re not going to hear about the many other cases where students are thankful for that.”

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