tag:theconversation.com,2011:/fr/topics/university-of-michigan-5984/articlesUniversity of Michigan – The Conversation2017-09-26T16:44:15Ztag:theconversation.com,2011:article/839862017-09-26T16:44:15Z2017-09-26T16:44:15ZWhy mediation and arbitration offer a better route to solving medical disputes<figure><img src="https://images.theconversation.com/files/187037/original/file-20170921-8194-1g0yduo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>A medical scandal in South Africa, that resulted in the deaths of 94 patients with mental health disorders after they were moved from the Life Esidimeni Hospital to unlicensed facilities, is taking a new turn. Retired Chief justice Dikgang Moseneke has been appointed to <a href="http://www.news.gauteng.gov.za/content/news/makhura-welcomes-the-announcement-of-the-life-esidimeni-alternative-dispute-resolution-process.html">arbitrate the dispute</a> between the Department of Health and the families of the patients who died. Judge Moseneke will make a binding award of compensation to avoid a costly legal battle. Health and Medicine Editor Candice Bailey spoke to Romany Sutherland about medical mediation.</em></p>
<p><strong>What is medical mediation?</strong> </p>
<p>Mediation is one of a few alternative dispute resolutions tools. The idea behind it is that as soon as a conflict or dispute arises, an independent person gets involved to facilitate conversation between the parties. The process is voluntary, confidential and “without prejudice” so nothing that is said or conceded can be used in court later. It offers a safe space for the parties. With the assistance of a mediator they discuss their concerns and interests.</p>
<p>Before medical mediation was allowed, the only redress in a dispute be it after a breakdown in the patient-doctor relationship, a dispute around accounts or allegations of negligence or misconduct – was via an attorney who would investigate and litigate. </p>
<p>But litigating a medical negligence dispute can take <a href="http://www.med.umich.edu/news/newsroom/Boothman%20et%20al.pdf">seven years</a> or even longer. And very often costs exceed the compensation sought. In addition, parties can be left despondent, emotionally exhausted and sometimes, financially ruined.</p>
<p>In most litigation matters there is also no platform to discuss what actually happened. Most patients pursuing litigation in medical matters need the three A’s: Answers, Accountability and Assurance – an explanation as to why the results were not as intended or predicted and what happens as a result. </p>
<p>The benefit of a medical mediation is that the emotional toll on both parties in the dispute is minimised.</p>
<p><strong>How big is it in South Africa and elsewhere in the world?</strong></p>
<p>Medical mediation is on the rise in South Africa. Roughly a quarter of all the mediators trained and working in the country are <a>medical mediators</a>.</p>
<p>There is a need to channel disputes towards mediators to try and find solutions inexpensively and quickly. This is particularly important because government health departments are in financial distress and are facing a medical malpractice litigation storm. In the country’s wealthiest province Gauteng for example, the department of health has had to pay out over <a href="http://www.news24.com/SouthAfrica/News/more-than-r1bn-paid-in-medical-negligence-payouts-by-gauteng-health-da-20170523">R1 billion</a> (US$75million) in medical negligence claims since January 2015. </p>
<p>Legal claims are so high that obstetricians in the private sector have left the profession because they can’t afford indemnity cover <a href="https://www.medicalbrief.co.za/archives/sas-obs-gynae-crisis-innovative-risk-solutions-needed/">that exceeds</a> R850,000 (USD64,000) per annum.</p>
<p>The South African Constitution gives everyone the right to seek legal remedy for any dispute. But the country is in the process of introducing legislation that, if promulgated, may make medical mediation compulsory before litigation is commenced. </p>
<p>In the rest of the world, medical mediation and alternate dispute resolution are common. </p>
<p>In the US several medical centres have used mediation to divert potential litigation claims. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314770/">University of Michigan</a> adopted mediation procedures in 2002 and included a premediation agreement at its teaching hospital. As a condition of treatment, patients agree to try mediation before pursuing litigation for any potential claim. As a result the university managed to drop claims by 60% and <a href="https://www.google.co.za/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjnl-vHsbjWAhUFPRoKHUJZD5wQFggkMAA&url=https%3A%2F%2Fwww.help.senate.gov%2Fimo%2Fmedia%2Fdoc%2Fboothman.pdf&usg=AFQjCNE2zrMx88h2NnswX0ed9myaBCQ_fQ">reduce claim processing</a> time from 20 months to nine over five years.</p>
<p>Australia, the UK and the US are among the few countries where sanctions are imposed if mediation doesn’t precede litigation. In India, the courts/judges facilitate mediation themselves.</p>
<p><strong>What is the difference between mediation and arbitration?</strong> </p>
<p>During mediation a trained mediator facilitates the conversation. The mediator is an independent third party with no vested interest in the outcome. The mediator doesn’t give advice or make a decisions on how the matter should be settled. The parties themselves make decisions about how the matter is settled. </p>
<p>Also, mediators aren’t allowed to give legal advice.</p>
<p>Arbitration can be used instead of mediation. As with mediation, the arbitrator is independent. But the arbitrator, like a judge, is given powers to make binding awards on the parties. </p>
<p>It’s preferable for all parties to have legal representation in all alternative dispute resolutions. This is important to ensure matters are not under-settled, that patients’ claim period doesn’t lapse and that legal advice is on hand. </p>
<p><strong>What are the dangers of mediation not being handled correctly?</strong></p>
<p>Mediation works well because the process is confidential. Documents, conversations, progress, process and the outcome of a mediation is totally confidential until both parties have agreed to the terms of settlement.</p>
<p>This is important because it means that none of the negotiations, agreements and concessions during the mediation are binding until the matter is finalised, reduced to writing and signed by both parties.</p>
<p>In most mediation agreements the terms will include a further confidentiality clause that covers the settlement terms after agreement has been reached.</p><img src="https://counter.theconversation.com/content/83986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Romany Sutherland owns Romany Sutherland & Associates, Medical Mediation Consultants
She is affiliated with South African Medico-legal Association and well as Mediation in Motion. </span></em></p>Medical mediation has become a buzzword in health departments across the world as an alternative to taking legal action to solve disputes.Romany Sutherland, Part time lecturer in medical mediation, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/589742016-06-01T01:00:33Z2016-06-01T01:00:33ZExplainer: how campus policies limit free speech<figure><img src="https://images.theconversation.com/files/124674/original/image-20160531-2812-ye2osb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Why do campuses have "free speech zones"?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/dcjohn/72584084/in/photolist-7q1HJ-4X9M2M-7D5JfA-HTGBB-9Uc9k-pGpXND-7V7cqt-9Uc9f-75sh3p-78gv5m-78cAQR-nsgQhu-LBZ8L-LBZcQ-7FpLkh-AUh7cY-az8W7f-dAmHum-nsxR52-LC8WD-nb4rSV-f7EzS-nsAtB5-aYLHjV-R9AT-6xe2Xo-nsxSt4-bpqjMG-pd6Wrs-F3arAS-bCkij4-7TgoJP-bCkiVD-dAmHpU-bCkeua-amMQpE-nb4BR5-nb4yXQ-dAgeAT-nb4wec-8xa8SD-dAmGXL-4af4My-bpqk5J-4jGQxN-2oyvb-PN5LS-9qP2QX-7w3pz3-5ggTE2">John</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Colleges and universities are supposed to be places where freedom of expression flourishes. Sadly, that is not the case. At a recent debate on the Yale University campus, 66 percent of the attendees supported a proposition that <a href="http://www.theatlantic.com/politics/archive/2016/03/the-glaring-evidence-that-free-speech-is-threatened-on-campus/471825/">“free speech <em>is</em> threatened.”</a></p>
<p>Places of higher learning seem more interested in “safe spaces” rather than in freedom of expression. <a href="http://www.slate.com/articles/news_and_politics/jurisprudence/2015/11/campus_protests_need_dialogue_not_safe_spaces_and_offense.html">Several incidents</a> across campuses illustrate this. Recently, at Emory, students complained after they found <a href="http://www.nytimes.com/2016/04/02/us/pro-trump-chalk-messages-cause-conflicts-on-college-campuses.html">chalk messages scrawled</a> around campus voicing support for Donald J. Trump. </p>
<p>Last year at the University of Ottawa, a yoga class designed for handicapped people was suspended because the student federation thought it was a form of “cultural appropriation.” And at Smith College a student sit-in blocked media from entering unless reporters agreed to explicitly state support for the movement in their coverage. </p>
<p>Illustrating how contentious the debates have become, two of the most respected American comedians, Chris Rock and Jerry Seinfeld, said that colleges are eager “<a href="http://www.theatlantic.com/magazine/archive/2015/09/thats-not-funny/399335/">not to offend anybody.” </a> Some students at a private Ivy League school even signed a petition to <a href="http://reason.com/blog/2015/12/17/yale-students-eagerly-sign-petition-to-r">repeal the First Amendment.</a> </p>
<p>Ideally, colleges and universities would foster an exchange of competing and controversial ideas. The reality is much different. Some colleges and universities limit discourse by silencing speech that might offend others through so-called speech codes and free speech zones.</p>
<p>In studying free expression issues for more than 20 years, I strongly believe such polices have led to a <a href="https://www.thefire.org/the-chilling-effect-in-action-campus-speech-codes-and-political-disengagement/">chilling effect</a> on speech. They also have led to a mentality where students do not wish or want to face an opposing viewpoint. </p>
<p>So, what are these policies?</p>
<h2>Combating hateful speech</h2>
<p>First, let’s look at speech codes on campuses. A speech code refers to a <a href="http://www.firstamendmentcenter.org/hate-speech-campus-speech-codes">set of provisions or regulations</a> that limit certain types of offensive or harassing speech. </p>
<p>Colleges and universities usually don’t call their regulations speech codes. Instead, they refer to them as <a href="http://www.firstamendmentcenter.org/hate-speech-campus-speech-codes">anti-harassment policies</a>.</p>
<p>It was in the 1980s and 1990s that more than 300 colleges passed these policies to combat hateful speech. <a href="http://www.firstamendmentcenter.org/free-speech-on-public-college-campuses">Schools tried to address</a> harassment of gays and lesbians, women and members of other ethnic groups. The policies were further enforced when white students wore blackface for sorority and fraternity parties. Many schools were trying to <a href="http://www.popecenter.org/commentaries/article.html?id=1774%E2%80%8B">achieve more diversity</a> in their student bodies.</p>
<p>The intent was good. Many of these policies sought to <a href="http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1046&context=journalismdiss">prohibit speech or conduct</a> that created an intimidating or harassing environment on the basis of race, sex, religion, or other criteria.</p>
<p>However, the <a href="http://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=1916&context=law_lawreview">results were not good</a> for the First Amendment and freedom of speech.
Policies at the University of Michigan and the University of Wisconsin were invalidated on First Amendment free speech grounds.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124679/original/image-20160531-1955-1d8aryi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">At the University of Wisconsin, speech codes were adopted following racial incidents.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dharma_for_one/3662595252/in/photolist-6zDKY1-6zzEnV-6zzEAz-6zDLNG-6zzDNV-fCEtm9-nrko9M-dryJ3u-fFaJkV-oRuADe-4JaWZo-6zDLCb-6zzEjX-4JaX5E-6zzBYx-6zzDye-7CUsff-osbc6y-8GUYJ5-7QVJmz-eNfMky-7QZ4J1-eXo4kU-eWhwNN-c3cA6d-7PUUvT-fL6Wwa-oQka9f-dybmjC-4JaY2f-iawq9K-6zDH3A-7PuHr9-7YLrLy-fQE89b-aFdRmp-ehUn7M-6zDKxu-ehUoS8-c3cyr7-7YLoyG-4J6H3t-c4xWQU-4J6GVX-6zDCRN-ge7o9J-7QVGpZ-7PYqbQ-fM8NEE-6zDHnd">JanetandPhil</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>At the University of Wisconsin, for example, university officials adopted the speech code after several racially insensitive displays at fraternities. For example, one fraternity held a “slave auction.” A student newspaper and several others <a href="http://www.firstamendmentcenter.org/hate-speech-campus-speech-codes">challenged the policy</a> on the ground that the policies infringed on academic freedom and stifled some legitimate speech. In UWM Post v. Board of Regents of University of Wisconsin (1991), a federal district court struck down the policy, writing:</p>
<blockquote>
<p>The suppression of speech, even where the speech’s content appears to have little value and great costs, amounts to governmental thought control.</p>
</blockquote>
<p>Similar problems occurred at Michigan, which had its share of disturbing racially charged incidents. At Michigan, a student disc jockey allowed racist jokes to be aired. University officials reacted with a speech code. The problem was that officials applied the policy to chill the speech of students engaged in classroom discussion or academic research. </p>
<p>A federal district court judge <a href="http://www.firstamendmentcenter.org/hate-speech-campus-speech-codes">invalidated</a> the policy in Doe v. University of Michigan (1989), writing:</p>
<blockquote>
<p>While the Court is sympathetic to the University’s obligation to ensure equal educational opportunities for all of its students, such efforts must not be at the expense of free speech. </p>
</blockquote>
<p>The problem was that these codes were not drafted with sufficient precision. Courts ruled that these polices were <a href="http://www.firstamendmentcenter.org/hate-speech-campus-speech-codes">either too broad or too vague</a>. </p>
<h2>Overbreadth and vagueness problems</h2>
<p>A policy is too broad if it prohibits speech that ought to be protected in addition to speech that can be prohibited. In legal terms, <a href="http://www.firstamendmentcenter.org/glossary">this is called “overbreadth”</a>. For example, a policy that prohibits “offensive and annoying” speech sweeps too broadly and prohibits lawful expression. </p>
<p>A policy is <a href="http://www.campusspeech.org/page/cfs/speech-codes#vague">too vague</a> if a person has to guess at its meaning. Vagueness is rooted in the notion that it is fundamentally unfair to punish someone when they did not know that their speech violated the policy. </p>
<p>For example, the University of Michigan had a policy that prohibited “stigmatizing or victimizing” individuals or groups on the basis of race, ethnicity, religion, sex, sexual orientation, creed, national origin, ancestry, age, marital status, handicap or Vietnam-era veteran status.</p>
<p>In Doe v. University of Michigan, a <a href="http://cdn.publicinterestnetwork.org/assets/_CBLOGgQUrqYOGQU2RFpxg/SPEECH-CODES-DOE-V.-U-MICHIGAN.pdf">federal district court judge ruled</a> the policy too vague, writing:</p>
<blockquote>
<p>Students of common understanding were necessarily forced to guess at whether a comment about a controversial issue would later be found to be sanctionable under the Policy.</p>
</blockquote>
<p>Controversies <a href="http://www.uvm.edu/%7Evtconn/?Page=v20/garrett.html">still abound</a> over speech codes at colleges and universities. The <a href="https://www.thefire.org/">Foundation for Individual Rights in Education (FIRE)</a> regularly challenges policies that it believes run afoul of the First Amendment. </p>
<p>In its annual report, <a href="https://www.thefire.org/spotlight/reports/">the group contends</a> that nearly half of the speech codes at 440 colleges infringe on First Amendment free speech rights. FIRE contends in its report that “any speech code in force at a public university is extremely vulnerable to a constitutional challenge.” </p>
<h2>Restricting where students can have free speech</h2>
<p>In addition, many colleges and universities have free speech zones. Under these policies, people can speak at places of higher learning in only certain, specific locations or zones. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124676/original/image-20160531-1925-8c05p8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Free speech zones limit expression to a few places on campus.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/pennstatelive/4947091245/in/photolist-8xa8SD-dAmGXL-7AveRD-8xa8Ya-9biaMe-4af4My-bpqk5J-aD3pQM-4jGQxN-8xda7u-3SirtV-2oyvb-6SHjKF-9hv2K4-9wCcPE-72tP85-7YiKLg-7DQVuv-9qP2QX-aD7cCG-7byzGU-aD3oF2-9wzfw4-7VFNmU-8xda4q-aD3nhe-aD78kU-aD7eP7-aD7dgs-aD7hFW-aD3qbx-aD7g8Q-7ZGe7B-aD3s88-aD3rD8-aD7bRf-aD78Zm-aD7bmo-3WHWP-6qCngA-aD3iQe-3WHL9-7VGVY7-wmJrgm-nb4UdF-nb4BPQ-nb4Bob-nqvsXy-yj5kJr-yiXxhm">Penn State</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>While there are remnants of these policies from the 1960s, <a href="http://www.firstamendmentcenter.org/free-speech-zones">they grew in number</a> in the late 1990s and early 2000s as a way for administrators to deal with controversial expression. </p>
<p>These policies may have a seductive appeal for administrators, as they claim to advance the cause of free speech. But, free speech zones often limit speech by relegating expression to just a few locations. For example, some colleges began by having only <a href="http://www.firstamendmentcenter.org/free-speech-zones">two or three free speech zones </a>on campus.</p>
<p>The idea of <a href="http://www.firstamendmentcenter.org/blog-moot-court-topic-the-zoning-of-speech">zoning speech</a> is not unique to colleges and universities. Government officials have sought to diminish the impact of different types of expression by zoning adult-oriented expression, antiabortion protestors and political demonstrators outside political conventions. </p>
<p>In a <a href="http://www.firstamendmentcenter.org/on-college-campuses-zoning-out-free-speech">particularly egregious example</a>, a student at Modesto Junior College in California named Robert Van Tuinen was prohibited from handing out copies of the United States Constitution on September 17, 2013 – the anniversary of the signing of the Constitution. </p>
<p>Van Tuinen was informed that he could get permission to distribute the Constitution if he preregistered for time in the “free speech zone.” But later,
Van Tuinen was told by an administrator that he would have to wait, possibly until the next month.</p>
<p><a href="http://www.firstamendmentcenter.org/author/charleshaynes">In the words of</a> First Amendment expert Charles Haynes, “the entire campus should be a free speech zone.” In other words, the default position of school administrators should be to allow speech, not limit it.</p>
<p>Zoning speech is troubling, particularly when it reduces the overall amount of speech on campus. And many free speech experts view the idea of a free speech zone as <a href="http://www.firstamendmentcenter.org/free-speech-zones">“moronic and oxymoronic.”</a></p>
<p>College or university campuses should be a place where free speech not only survives but thrives.</p><img src="https://counter.theconversation.com/content/58974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Hudson is affiliated with the Newseum Insitute. He is the Ombudsman for the Newseum Institute's First Amendment Center. </span></em></p>Are speech codes and free-speech zones silencing speech on college and university campuses?David Hudson, Adjunct Professor of Law, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413242015-05-08T09:53:32Z2015-05-08T09:53:32ZDepression common on college campuses; graduate students more at risk<figure><img src="https://images.theconversation.com/files/80736/original/image-20150506-10961-mkprvt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Suicides are the second leading cause of death on college campuses. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=PXYBTGr-noxxRYHvoh47xg&searchterm=depression&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=197995073">Girl Image via www.shutterstock.com</a></span></figcaption></figure><p>Graduate <a href="http://www.ncbi.nlm.nih.gov/pubmed/24711096">students experience significant stress </a> and are more prone to depression and anxiety than other groups of students. They report greater levels of eating disorders, substance abuse and feelings of hopelessness.</p>
<p>A recent report from the University of California, <a href="http://ga.berkeley.edu/wellbeingreport/">found</a> 47% of doctoral students and 37% of master’s degree students, who were surveyed, to be depressed. Furthermore, 64% of graduate students in arts and humanities <a href="http://ga.berkeley.edu/wellbeingreport/">showed higher levels</a> of depression and suicidal thoughts. Based on the university’s <a href="http://grad.berkeley.edu/admissions/rankings-stats/">enrollment data </a> from 2013, we can estimate 2,800 of the 6,000 PhD students to be clinically depressed.</p>
<p>This is a high number and not limited to the Berkeley campus. Other studies, too, have shown high rates of student depression. As a researcher working on suicide prevention programs, I have found this to be true for our own campus.</p>
<h2>Stressed students</h2>
<p>On a single day last fall, we randomly stopped students on our campus and administered a depression questionnaire. Of the approximately 250 students we contacted on this one particular day, no fewer than eight were having active suicidal thoughts. </p>
<p>While the students with suicidal thoughts received emergency counseling, another 12 scheduled appointments voluntarily after seeing their scores. Ten more students presented themselves over the next few days, saying that the questionnaire helped them realize they needed counseling. </p>
<p>This meant that 30 students, or 12% of the students we stopped, were experiencing depression serious enough to need intervention. </p>
<p>Relative to the total campus enrollment, these are small numbers, but in terms of the number of students we contacted, <a href="http://www.sprc.org/collegesanduniversities/scope-problem">they are higher than previously reported percentages</a> and quite probably more in line with reality. </p>
<p>Suicide is the <a href="http://www.suicide.org/college-student-suicide.html">second leading cause of death</a> for college students after <a href="https://www2.nami.org/Content/NavigationMenu/Find_Support/NAMI_on_Campus1/Mental_Illness_Fact_Sheets/Suicide.pdf">traffic accidents</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80737/original/image-20150506-10937-fgpbif.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students have a great deal of anxiety over job prospects after college.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=PXYBTGr-noxxRYHvoh47xg&searchterm=depression&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=94267417">Pencil image via www.shutterstock.com</a></span>
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</figure>
<p>We do not have adequate data that separates the suicide rate of graduate students from that of under-graduates. But studies among graduate students show that a substantial percentage suffer from depression, anxiety and have suicidal thoughts. </p>
<p>According to <a href="http://www.ncbi.nlm.nih.gov/pubmed/24711096">one such study</a> where an email questionnaire was sent out to 301 graduate students nationally, 22% were found to be on medication for depression or anxiety and nearly 19% were in counseling. </p>
<p>At the University of Michigan, researchers <a href="http://psycnet.apa.org/psycinfo/2007-19519-005">found</a> nearly 2% of graduate students were having suicidal thoughts in the four weeks preceding a survey they conducted in 2007. </p>
<p>Other studies, too, have reported that <a href="http://psycnet.apa.org/psycinfo/2009-08599-001">4% of graduate students </a> and <a href="http://annals.org/article.aspx?articleid=742530">11% of medical students</a> having serious suicidal thoughts in the year prior to the studies. </p>
<h2>Anxiety over life after college</h2>
<p>The most common risk factors, as reported by researchers at the University of Michigan, for depression in graduate students include financial concerns, post-graduate job prospects, isolation and lack of social support. </p>
<p>We don’t know what makes the arts and humanities graduate students more vulnerable to depression and suicide. Since there are no other studies that point to these fields of study as having greater risk, it may be that this is simply coincidental or specific to the Berkeley campus, or their fears about post-graduate employment are realistic. </p>
<p>This is not to say that undergraduate students are not at risk. Data from the <a href="http://www.sprc.org/">Suicide Prevention Resource Center</a>, a federally-supported program, shows about 8% of college students (undergraduate and graduate) as <a href="http://www.sprc.org/collegesanduniversities/scope-problem">having</a> suicidal thoughts, about 2% making a suicide plan and about 1% making an attempt. </p>
<p>As not all universities respond to surveys about student suicide and in many cases suicidal thoughts or attempts go unreported, actual numbers are likely to be higher. </p>
<p>A university can be a stressful place. Students might feel <a href="http://www.sprc.org/sites/sprc.org/files/library/SuicideAmongCollegeStudentsInUS.pdf">overwhelmed</a>, hopeless, isolated and not able to cope at college. Under such circumstances, they may perceive suicide to be the only way out.</p>
<h2>Depression on campus</h2>
<p>So, what can colleges and students do?</p>
<p>University administrators and counselors should focus on <a href="http://www.ncbi.nlm.nih.gov/pubmed/24711096">developing mental health and wellness interventions</a>. College students in general and graduate students in particular need to be encouraged to seek help. </p>
<p>Additionally, students need to know there are a number of online resources available. </p>
<p>These resources include the <a href="http://www.sprc.org/">Suicide Prevention Resource Center</a>, the <a href="http://www.jedfoundation.org">Jed Foundation</a>, <a href="http://www.thetrevorproject.org">The Trevor Project</a>, <a href="http://www.nimh.nih.gov/index.shtml">The National Institute of Mental Health</a> and <a href="http://www.samhsa.gov">The Substance Abuse and Mental Health Services Administration</a>. Information can also be found on the <a href="http://www.apa.org">American Psychological Association</a> and the <a href="http://www.psychiatry.org">American Psychiatric Association</a> websites. </p>
<p>It is important to break the silence and to bring to public attention the problem of student depression, anxiety and suicide. The larger issue of lack of resources on some campuses needs to be addressed urgently.</p>
<p>Otherwise, the numbers will continue to rise.</p><img src="https://counter.theconversation.com/content/41324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeannie D DiClementi receives funding from a Garrett Lee Smith suicide prevention grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) that is referenced in the article.</span></em></p>Suicidal thoughts among college students are more common than we think. Graduate students, especially those in the humanities, are at a greater risk.Jeannie D. DiClementi, Associate Professor of Psychology, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/381992015-03-02T18:02:19Z2015-03-02T18:02:19ZIn defense of the great MOOC experiment<figure><img src="https://images.theconversation.com/files/73520/original/image-20150302-15965-13k7c8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Are MOOCs sustainable?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/93112746@N05/11059505474/in/photolist-hRhRES-9Vdrg8-dQkC93-d69m5W-bR3ThV-ggH827-gTdSqd-cJrxNA-dRvhn4-dUTNf5-dDRGpb-h1FxoP-nvZ6HN-ffV2Sy-bVGbrg-ftGwPa-ftGvY6-ftGv6M-ftGuXK-ftWNtw-ftWMJQ-ftGrFn-ftWMcb-ftGqUg-ftWLeC-ftWKWq-ftGpAH-ftGprx-ftWJRS-ftWJGf-ftGosM-ftGoig-ftGofi-ftWHMQ-ftGnZe-ftWHHQ-ftGnT2-ftGnyk-ftGnuT-ftGnbT-ftWGPG-ftGmT6-ftWGjw-ftWFZs-ftGkPe-ftWFp5-ftGjTX-ftWEx9-ftGjiH-ftWDHs">mksmith23/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Let’s face it; we should expect a level of impatience with all things digital. We live in an era where an iPhone release is met with excitement quickly followed by a collective sigh: when is the next release? Shiny things lose their luster quickly in a design-thinking, highly networked world. </p>
<p>A year ago I boarded a plane for the 2014 Coursera Partners’ conference with a Pocket app full of stories declaring massive open online courses (MOOCs) a failed experiment after just two years. As I fly out for this week’s <a href="http://conference.coursera.org/">2015 conference</a> my reading list is flooded again with opinions declaring that this alternate form of offering modularized learning experiences to the masses has failed to measure up. </p>
<p>The only difference in a year is that attention turned from a criticism of course completion rates to the question: are MOOCs sustainable? Seems like a fair question. But is it sufficient? Don’t we want to understand the overall impact of MOOCs? Have we given ourselves enough time to experiment, prototype and scale?</p>
<p>As assistant vice provost for <a href="https://record.umich.edu/articles/digital-education-and-innovation-leaders-address-office-goals">digital education and innovation</a> at the University of Michigan, I have the privilege of partnering with the many faculty who were pioneers in establishing MOOCs, as this university was one of the trailblazing institutions. I also get to encourage and help faculty members that want to advance teaching and learning through the creative use of technology and learning analytics.</p>
<p>Why are we motivated to write the history of MOOCs so soon? This level of impatience seems at odds with the typical longevity of experimentation with teaching and learning. </p>
<h2>Universities are places of discovery and change</h2>
<p>There is a marvelous contradiction in the world of universities. We are, at one and the same time, supremely impatient engines of creativity and powerfully patient conservators of cultural tradition. We are in search of solutions that will enable engaged, personalized and life-long learning.</p>
<p>So, how we can declare MOOCs a failure in year two, and again in year three, while we simultaneously scan the centuries-old “experiment” that is large lecture halls and ask passively for incremental change? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=557&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=557&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73515/original/image-20150302-15956-bvk507.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=557&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">MOOCs will not address all the challenges that universities face.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mathplourde/8448541815/in/photolist-dSyZ94-cv7uVU-cwEbMA-e4vnEA-e4A4GW-desGMt-dQqHN3-ftGudZ-ftWGq1-ftGaGt-ftWSUE-ftWMVf-ftGe8c-hRhRES-9Vdrg8-dQkC93-d69m5W-bR3ThV-e6NW3q-dUTNf5-dDRGpb-gTdSqd-ggH827-cJrxNA-dRvhn4-h1FxoP-nvZ6HN-ffV2Sy-bVGbrg-ftGwPa-ftGvY6-ftGv6M-ftGuXK-ftWNtw-ftWMJQ-ftGrFn-ftWMcb-ftGqUg-ftWLeC-ftWKWq-ftGpAH-ftGprx-ftWJRS-ftWJGf-ftGosM-ftGoig-ftGofi-ftGnZe-ftWHMQ-eQ1Dmw">Mathieu Plourde/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Many of us believe passionately that high quality education can be delivered nimbly, affordably and at scale. We also know we’re not there yet. There are wonderful explorations of learning underway, whether your academic sport is modularity, <a href="http://solaresearch.org">learning analytics</a>, <a href="http://www.gradecraft.com">gameful learning</a>, <a href="http://digitaleducation.umich.edu/about/dig-digital-innovation-greenhouse/">digital badging or personalization</a>. </p>
<p>There is no single solution. Yet, MOOCs have been strangely cast as the heroic Most Valuable Player (MVP) to this sport. They will save the day. Wait, the preliminary reviews are in - guess they won’t. </p>
<p>Without good numbers overnight we conclude they are a failure. Expectations are everything. Problematically, the massive public discussion around the destiny of MOOCs focuses on the wrong kind of “MVP”. MOOCs are not the Most Valuable Player that will independently address all challenges faced by universities, students and others impacted by higher education institutions. MOOCS are another kind of MVP: a Minimal Viable Product. </p>
<p>MOOCs renewed the conversation around teaching and learning. They have given life to educational experiments in <a href="http://solaresearch.org">learning analytics</a>, <a href="https://blended.online.ucf.edu/about/what-is-blended-learning/">blended learning</a>, and <a href="http://www.mblem.umich.edu">alternative credentialing</a>. They have pushed forward important policy conversations around student privacy, academic review, data sharing and cross-institutional collaboration. </p>
<p>But they are, nonetheless, a minimal viable product. This kind of MVP has the core features that allow the offering to be deployed, and no more. Perhaps the greatest outcome for a MOOC is for it to go away and to give life to new long-lasting changes to the way we enable engaged, personalized and lifelong learning.</p>
<p>I’m not suggesting that universities should be uniformly slow and methodical or fast and risk-loving. Both approaches make sense. Some challenges demand near instantaneous dissemination of knowledge while others are dependent upon careful experimental structures and protocols unique to research universities. </p>
<h2>Michigan’s experiment with MOOCs</h2>
<p>At Michigan, there are two fundamental questions that drive <a href="http://digitaleducation.umich.edu/curricular-innovation/moocs/">our experimentation with MOOCs</a>: One, how can experimentation with MOOCs help us redefine public residential education at a 21st century research university and enable engaged, personalized and lifelong learning? And two, what is it that is only possible at a great public residential research university? </p>
<p>As we’ve moved beyond the initial wave of experimentation with MOOCs, our evolution has taken many forms. Let me provide some early examples of how we are thinking about MOOC 2.0 at the University of Michigan:</p>
<p>• Taking a MOOC on <a href="https://record.umich.edu/articles/first-residential-mooc-u-m-students-focuses-health-care-policy">US healthcare policy</a> and adapting it for use on our own campus. </p>
<p>• Remixing and reusing content from a MOOC on <a href="https://www.coursera.org/course/modelthinking">Model Thinking</a> to bring complex systems thinking to a blended nursing course on optimal models and systems for healthcare delivery.</p>
<p>• Leveraging modules and digital assets from a MOOC on the <a href="https://www.coursera.org/course/introfinance">introduction to finance</a> to flip the finance core and create advanced, personalized learning experience for MBA students. </p>
<p>• Utilizing assessments developed for global learners in a MOOC on the <a href="https://www.coursera.org/course/introthermodynamics">introduction to thermodynamics</a> on campus to enrich the residential learning experience.</p>
<p>• Building a repository of expert perspectives through MOOCs like <a href="https://www.coursera.org/course/cataractsurgery">Introduction to Cataract Surgery</a>, <a href="https://www.coursera.org/course/aidsfearandhope">AIDS: Fear & Hope</a> and History of American Roots Music, to enhance residential offerings. </p>
<p>• Developing an open MOOC data initiative to advance scholarship around teaching and learning. </p>
<h2>Are MOOCs sustainable?</h2>
<p>Each of these examples, and many others, is helping us to think differently about the delivery of high quality learning experiences in a digital age. </p>
<p>So should we think about MOOCs as minimal viable products? Should we think about MOOCs as rapid dissemination of knowledge? My answer is, yes, to both, and more. </p>
<p>MOOCs are intended to be iterative. We should expect them to evolve. But are they sustainable? Sustainability is the wrong framing. If we’re focused on a MOOC as an idea that is first delivered through a minimal viable product and evolves in different ways, we may agree on a different set of organizing questions. </p>
<p>When MOOC experimentalists from many of our great institutions meet in southern California this week I hope we’ll learn from each other about the many ways in which we’ve evolved our thinking since the dawn of MOOCs a mere three years ago.</p>
<p>My hope is that our embedded quiz includes more than two drop-down options (sustainable or unsustainable) and focuses instead on the myriad branches of experimentation that have ensued in a remarkably short amount of time. </p>
<p>Higher education leaders refuse the traditional tradeoff argument: it can’t be fast, cheap and good. In communities bound together by a commitment to the discovery of what’s next, these rules are merely cautionary.</p>
<p>We know that to truly transform learning we must think impractically before layering in constraints. Universities can and should live with contradiction as patience and impatience are both positive virtues. We need to embrace a culture of experimentation that encourages us to investigate new things, find pathways to scale and share what we learn. </p>
<p>Let us not constrain our thinking about sustainable innovation to the immediate impact of MOOC 1.0. Like information, the ideas born from MOOCs want to be free. </p>
<p>If we agree that we should not accept a reality where we must choose between fast, good and cheap, shouldn’t we embrace more experimentation and ensure we institutionalize and disseminate the learning that results?</p><img src="https://counter.theconversation.com/content/38199/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James DeVaney does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Is there an impatience to write the history of MOOCs? Have universities even given sufficient time to experiment with MOOCs?James DeVaney, Assistant Vice Provost for Digital Education and Innovation, University of MichiganLicensed as Creative Commons – attribution, no derivatives.