Reason for Policy: To provide students an opportunity to designate a person to whom the University may disclose certain private mental health information if a University-employed physician, clinical psychologist, or qualified examiner determines that the student poses a clear danger to themselves or others. This policy establishes procedures to comply with the Illinois Student Optional Disclosure of Private Mental Health Act while protecting students’ private mental health information. 

Scope: This policy applies to all enrolled students at North Park University. 

Policy Elements: 1) At or near the time an incoming student enrolls, North Park University will provide the student with an opportunity to complete a written authorization to disclose certain private mental health information to a designated person. Students may either authorize or decline authorization. Students may change their designation at any time by completing a new form, which will supersede any previous form. 

2) The university may disclose the student’s private mental health information if a university-employed physician, clinical psychologist, or qualified examiner determines that the student poses a clear danger to themselves or others and the disclosure is necessary to protect the student or another person against a clear, imminent risk of serious physical or mental injury or disease, or death. 

3) As soon as practicable, but no later than 24 hours after making the determination, the physician, clinical psychologist, or qualified examiner will attempt to contact the designated person and notify them that the student has been determined to pose a clear, imminent danger to themselves or others. 

4) This policy is separate from the university’s Emergency Contact and Missing Student Notification Policy.  An emergency contact designation does not constitute a designation under the Illinois Student Optional Disclosure of Private Mental Health Act. Likewise, a designation under this policy does not constitute an emergency contact designation unless the student separately provides that information for that purpose. 

Definitions: 

A designated person means a parent, guardian, or other person over the age of 18 designated by the student to receive disclosure of certain private mental health information.  

A qualified examiner is a physician, clinical psychologist, or qualified examiner who is employed by the institution of higher education. A qualified examiner includes a licensed clinical social worker (LCSW), a registered nurse (RN, MSN), a licensed clinical professional counselor (LCPC), or a licensed marriage and family therapist (LMFT) with education and experience as described in Section 1-122 of the Illinois Mental Health and Developmental Disabilities Code (405 ILCS 5/1-122), as amended. 

Procedures: 

• Opportunity to Complete the Form 
  • At or near the time a student newly enrolls, the university will provide the student with an opportunity to complete the Student Optional Disclosure of Private Mental Health Form. 
  • Admissions will manage this process for all newly enrolled students except Seminary students. 
  • The seminary will manage this process for newly enrolled Seminary students. 

• Changes to Designation 
  • Students may modify or revoke their designation at any time by completing and submitting a new form. The most recently submitted form will supersede any previous form. 

• Storage and Access 
  • Completed forms will be stored in Softdocs-eTrieve, the University’s electronic document repository. Access will be limited to authorized personnel with a legitimate need to access the information. Full-time Counseling Support Services employees will have access to the forms in Softdocs-eTrieve. 

• Notification of Designated Person 
  • When a University-employed physician, clinical psychologist, or qualified examiner determines that a student poses a clear, imminent danger to themselves or others, the qualified examiner, or the qualified examiner’s supervisor as appropriate, will attempt to contact the designated person as soon as practicable and no later than 24 hours after the determination. 

• Documentation 
  • Notifications made under this policy will be documented in the qualified examiner’s records system. 

Student Optional Disclosure of Private Mental Health form