This story contains references to students with thoughts of suicide and self-harm that may be troubling to some readers.
This is based on one Stanford student’s account of a hospitalization mandated by California Welfare and Institutions Code Section 5150: a voluntary or involuntary 72-hour psychiatric hold on an individual identified as a threat to themselves or others. The identities of the student and his roommate have been withheld out of respect for the student’s patient privacy.
At 3 a.m. on Thursday, Feb. 1, 2018, a Stanford student closed his laptop in his dorm room on a half-finished philosophy paper.
He scribbled notes like “don’t come in; I don’t want you to see this” in his philosophy notebook and ripped out the pages. Quietly, he opened his door and taped the notes to the outside before locking himself in. His roommate was hanging out with a friend into the early hours of the morning, unlikely to return that evening.
The student sat down in front of his closed laptop and considered opening it again.
But he was tired of trying — not only with the paper, but also with battling depression, hiding his sexuality from his parents and working to pay for school as a first-generation, low-income student.
He pulled out his tool kit and took a deep breath, hoping it would be one of his last.
Suicide is on the rise in America. Almost 45,000 Americans died from suicide in 2016, according to a report from the Centers for Disease Control and Prevention released in July 2018, and suicide among people age 10 and older increased more than 30 percent in half of the U.S. between 1999 and 2016. Suicide is now the second-leading cause of death for 15- to 34-year-olds and is the 10th-leading cause of death in the United States. According to the report, most people who have attempted or died by suicide are never identified as having mental health disorders.
Stanford is not immune to this issue. Two Stanford students died by suicide this winter. Engineering graduate student Ziwen Wang was found dead in the Paul G. Allen building in February. In March, a master’s student, Olympian and three-time world cycling champion, Kelly Catlin, was found dead in her dorm after dying by suicide at age 23. University President Marc Tessier-Lavigne and Provost Persis Drell held a moment of silence at a Town Hall the week she died. The Office of Religious Life is holding a grief memorial in light of these recent losses as well as the tragic loss of undergraduate Mischa Nee ’20 on April 11 in Memorial Church.
Just as Catlin had expressed frustrations with balancing school and life, so did the student in his dorm room at 3 a.m. The student developed a plan, but an hour passed and his plan wasn’t working.
“So by that point it must’ve been 4 or 4:30 a.m. and I was out of options,” he said. “I made another plan. I was just going to go buy a hose and gas myself in the car. But this was of course 4:30 to 5 a.m. Nothing’s open, so I couldn’t go buy a hose. I knew I needed to wait; I didn’t want to wait.”
Asking for help
At 5 a.m., the student called the 24-hour campus hotline through Stanford’s Counseling and Psychological Services (CAPS). The operator asked for his location: She could send Stanford Department of Public Safety (SUDPS) officers but not a counselor; it is not customary to send counselors to dorms in an emergency at this hour of the night. The student did not want to deal with law enforcement and refused to disclose his location. Finally, the operator told him to seek counselor assistance when Vaden Health Center — where CAPS is located — opened.
When he arrived at CAPS at 9:00 a.m., tired from fewer than three hours of sleep, the receptionist told him to sit in the waiting room. He saw the first available counselor. She asked him to describe his thought process and how he was feeling, the student recalled. When he finished recounting the events of the previous night, the counselor smiled and left.
When she returned, she brought two SUDPS officers. “Sorry,” is all the student remembered she said.
The student was taken in under the California Welfare and Institutions Code Section 5150: a voluntary or involuntary 72-hour psychiatric hold placed on an individual who is identified as an imminent threat to themselves or others. He was not informed of this until he was taken to the Inpatient Psychiatric Service ward at Stanford Hospital six hours later, he said.
Section 5150 is part of the Lanterman-Petris-Short Act of California’s Welfare and Institutions Code, which went into full effect on July 1, 1972, according to the California Hospital Association. It was the first bill of its kind for modern mental health institutions in the United States, giving more power to psychiatrists in the decision to commit an individual to a hold.
CAPS, law enforcement and community providers such as Residence Deans (RDs) can recommend students for 5150 evaluations, according to Student Affairs Communications Director Pat Lopes Harris. Evaluations and 72-hour holds are recommended at the hospital by trained psychiatric staff in the emergency department at a designated hospital to decide whether or not the student should be held for the 72-hour 5150 hold. Students can elect to go to the hospital for an evaluation voluntarily, Harris wrote in an email to The Daily.
“CAPS will only write a 5150 when we believe that a student is at acute risk of being a danger to self, danger to others or so gravely disabled that they cannot meet their basic needs outside of a care facility,” Harris wrote, adding that less than 0.2 percent of CAPS visits end in 5150 recommendations.
The University does not keep a running record of the number of students who are transported to a 5150 hold each year, Harris said.
“We feel it is important for students to know that CAPS providers work every day with students who experience thoughts of suicide, self-harm or feelings of anger and aggression,” she wrote. “For the vast majority of these students, treatment plans can be developed that do not require inpatient admission.”
Once an individual is recommended for a psychiatric hold on campus, SUDPS officers transport the individual to a hospital for further evaluation and treatment, according to SUDPS spokesperson Bill Larson.
SUDPS officers undergo “Peace Officer Standards and Training,” a required crisis intervention training that teaches law enforcement how to respond to individuals with mental illness, intellectual disability and substance use disorder, Larson said.
Wrists scraped from last night, the student was handcuffed and put into the back of a police car.
“As a general practice, deputies handcuff individuals for safety — to prevent self harm or harm to others — when transporting a person,” Larson wrote in an email to The Daily, explaining that the transport is not an arrest. “A person who has been placed on a hold and transported by ambulance may be placed in restraints by Emergency Medical Technicians for the same safety reasons.”
The identity of the individual in this article was not disclosed to Larson or Harris.
“The police officers were really nice,” the student said. “[One of them] told me this happens a lot, it’s not like I’m under arrest and I don’t need to fret like that — even though I was in handcuffs in the back of a squad car.”
The hospital
First, the student was admitted to the Stanford Hospital Emergency Room, where he spent five hours sitting in a hospital bed with occasional visits from nurses and doctors. A law enforcement officer removed his handcuffs when they arrived, he recalled.
After SUDPS brings individuals under a Section 5150 to a hospital, supervision is transferred from SUDPS officers to medical professionals on site, Larson said, adding that SUDPS does this at no cost to the individual as opposed to an ambulance transport fee.
Once there, hospital staff allowed the student to text a few of his loved ones — including his roommate, a friend and his then-boyfriend — about his location.
“Please don’t fret, I am doing well,” he wrote. “I was taken to the hospital from CAPS. I don’t know how long I’ll be here, but wanted to let you know.”
At 3 p.m., the student was brought in a wheelchair to the securely-locked psychiatric ward, Unit H2. From there, he was stripped of his shoes, phone and wallet and provided a set of blue-striped pajamas.
“I remember the nurses telling me that they get a lot of Stanford students [in H2] — they were telling me that in a reassuring way,” he said. “That there’s clearly something at Stanford and it’s not me.”
This student’s situation was not unique. According to an estimate by the former director of the ward, Dr. Rona Hu, H2 admits between one and three students every week, meaning at least one out of the 15 beds is constantly in use by a Stanford undergraduate, graduate or postdoctoral student.
“The unlocked unit, G2, has less publicity, but students can also check in there when they are feeling more depressed than suicidal,” Hu said, meaning that the total number of students admitted to Stanford Hospital each week could be higher than the one-to-three estimate. She added that there are four other psychiatric wards in the area that students could go to, meaning that the rough estimate of students admitted to psychiatric wards per week could be higher.
Other beds in H2, like the other psychiatric wards available in the area, are dedicated to patients suffering from various mental illnesses and diseases, ranging from mood disorders to schizophrenia, she added. It is the same ward where one of the nurses was attacked by a patient in March.
The identity of the student in this article was not disclosed to Hu.
When asked about the nature of H2, Stanford Health Care declined to comment, on patient privacy grounds.
While in the ward, the student was allowed to read, engage in group and cognitive therapy, play board games and have visitors. There were two phones in the ward which patients could call friends and family on.
The student recalled a plastic mirror and private bathroom with a padded door in the sleeping room. The room looked like a typical hospital room with a thin curtain separating the student from his hospital roommate.
“It wasn’t a good place, but it wasn’t a bad place either,” the student said. “It’s like purgatory.”
Friends find out
On Feb. 1, the student’s Stanford roommate woke up to the text that he had been hospitalized. The roommate had returned to his room around 7 a.m. when the student was sleeping. The roommate recalled a conversation he had with the student a few weeks prior in which the student mentioned ending his life.
“I told him that if I got the call that he had slit his wrists I would be furious with him,” his roommate said. “I didn’t want him to end up in the hospital because he had attempted to take his own life.”
The roommate didn’t realize that the student had been serious at the time. Now, the roommate found himself rushing to the ward with an extra set of clothes and a book titled “Good Omens.”
When the roommate arrived at the ward, he had to call for a nurse to unlock the outer door to H2 which opens to a small waiting room. After the first door shut, the nurse buzzed in for the second door to open. From there, visitors had to check in at the nurses’ desk and hand in any items that were prohibited by the ward, including sharp objects or objects that could be used for strangulation. Visiting hours are limited to 6:30-8:30 p.m. during the week and 12:30-8:30 p.m. on weekends with minimal exceptions, according to Hu.
RDs and CAPS keep in contact with hospital staff during a student’s stay, according to Harris, and can schedule visits with students. RDs can send emails to teachers and bring allowed items from the student’s dorm room.
The student’s friends, RD and Academic Advising Director (AAD) visited him during his stay. On the first evening, the student asked his roommate to sneak him a wristwatch. The student said it wouldn’t be hard.
Time passed slowly in the ward, the student said. There were two clocks: one behind the nurses desk and one in the entertainment and meeting room, according to the student. Alone in his room, the student had no concept of time apart from when he was called for meals and group therapy sessions.
The next day, the roommate brought the student his watch.
“I think my experience would have been very different if I didn’t have my wristwatch,” he said, adding that not knowing the time would have driven him crazy.
Release and now
The student’s 5150 commitment was extended into a Section 5250 commitment, a psychiatric hold that can last up to 14 days. Many 5150 holds get extended into 5250 holds to offer patients more time to heal, Hu said. The patient has to be cleared by a hearing officer and can leave at any time that the hearing officer proclaims that the patient can leave.
The student stayed in the ward for five days before being released by the hearing officer on Monday.
The student said his hold was extended because he saw three different doctors during his stay — the doctor who gave him his initial check-up, an interim doctor and the doctor who let him go on Monday — making it impossible for them to coordinate for him to leave.
The release process is like a hearing, according to Hu. A doctor unaffiliated with the ward serves as a hearing officer and determines if the patient is healthy enough to leave. The patient is represented by an outside advocate who must present evidence that the hospital is overreacting by extending the hold.
After a student is discharged, CAPS reaches out to students to offer supplementary support, according to Harris. CAPS support includes consultation on care, transitioning back into campus and following a hospital-recommended treatment plan. Depending on the level of need, RDs will work with students for anywhere from a few days to a few quarters on their self-care and schoolwork.
After being released from the hospital, the student said he was required to attend La Selva, a “partial hospitalization” program, which mandated the student attend therapy and group classes for five hours a day, three days a week. The student, already overwhelmed from having missed five days of schoolwork, decided to take a leave of absence for winter and spring quarter.
“If a student chooses to take time away from their studies, an RD will support this decision and can help facilitate logistics for the student such as working with families and/or packing belongings,” Harris wrote.
Last spring, a group of students joined Disability Rights Advocates (DRA) in filing a lawsuit against Stanford, claiming that the University discriminated against students with mental health disabilities by encouraging them to take a leave of absence after being hospitalized for an actual suicide attempt, act of self-harm or vocalization of suicidal ideation. The case seeks modifications to Stanford’s leaves of absence policy. The lawsuit also asserts that Stanford does not consider whether its actions would put the student at an even greater risk.
The University contests these allegations, saying that the University’s leave of absence decisions are made on a case-by-case basis.
The case was started as part of DRA national investigation into the mental health policies of universities and colleges. The first case was targeted at Stanford, as the study found the University’s policies the “most egregious.”
Litigation has since been paused as the DRA continues to work on settlement with Stanford.
The student in this article is not part of the lawsuit.
The student had his hospital fees waived from the 5150 commitment due to his income status, but he recalled that the bill was over $500. He currently pays $125 per week for therapy, which he has attended five days per week, every week since the hospitalization — over a year — amounting to over $6,750 thus far, he said.
Still, he came back to Stanford in the fall with an improved outlook on life — even though he never finished that philosophy paper from the year before.
“That paper almost killed me,” he joked wryly.
The student has since taken another leave of absence, citing the pressures of Stanford for putting him in this position.
Author’s note: If you or someone you know is contemplating self harm or suicide, there are available resources both on and beyond campus that are reachable 24 hours a day, seven days a week:
National Suicide Prevention Hotline: +1 (800) 273-8255
Stanford Counseling and Psychological Services: +1 (650) 723-3785
Stanford Confidential Support Team: +1 (650) 725-9955
This article has been updated to include information about two campus suicides and the assault in H2 as these incidents occurred after the print version of the magazine was designed.
Editor’s note: This article has been further updated to remove a description of self-harm methods utilized by a student referenced in the story.
Contact Gillian Brassil at gbrassil ‘at’ stanford.edu.