This article originally appeared in The Bar Examiner print edition, Summer 2022 (Vol. 91, No. 2), pp. 8-18.
By Jerome M. Organ, David B. Jaffe, and Katherine M. Bender, PhD1
This article summarizes some specific results from the 2021 Survey of Law Student Well-Being (2021 SLSWB), which the authors administered as an anonymous and voluntary web-based survey at 39 law schools in the United States in spring 2021. It follows up on an article in the December 2015 Bar Examiner outlining the results of the 2014 Survey of Law Student Well-Being (2014 SLSWB).2
In addition to presenting a brief overview of the 2021 SLSWB results compared to those from 2014, and touching on some of the new data in the 2021 SLSWB derived from three new sets of questions described below, this article will focus particularly on the help-seeking data, acknowledging modest progress while calling for more efforts from various stakeholders to better aid students in choosing to get the help they need to be successful students and legal professionals. The second half of the article focuses on interpreting and learning from the help-seeking data and raises three initiatives for boards of law examiners’ consideration to encourage law students to seek help for substance use issues and/or mental health issues.3
The 2021 Survey Expands to Ask Three New Sets of Questions
Like the 2014 SLSWB, the 2021 SLSWB assessed alcohol and drug use among law students, including prescription drug use/misuse, mental health issues, and help-seeking attitudes. The 2021 SLSWB also incorporated three new sets of questions, one on the extent to which respondents had experienced trauma during their lifetime, one on concerns of third-year respondents as they prepare for and take the bar exam, and one with open-text questions asking respondents to identify actions their law schools currently take or could take to support law student wellness.
General Help-Seeking Takeaways from the 2021 Survey Responses
The 2021 SLSWB results suggest that significant percentages of law students are dealing with mental health issues and/or alcohol/drug issues but are often reluctant to seek the help they need to manage their issues in a healthy and responsible manner. Reasons provided for this reluctance included concerns about potential threats to bar admission, potential threats to job or academic status, financial burdens, and/or social stigma. While percentages of those reporting mental health or substance use issues improved modestly in comparison with the 2014 SLSWB, the range of responses across law schools suggests there may be effective interventions that could increase law students’ likeliness to seek help.
Participating Law Schools
The authors initially invited the 15 schools that participated in the 2014 SLSWB and then expanded the invitation to other law schools with faculty or administrators known to be interested in law student well-being.4 Over 40 law schools expressed interest in participating in the 2021 SLSWB, with all their JD students invited to participate. The 39 participating law schools in spring 2021 (3 additional law schools participated in the fall) had a total of more than 24,000 invited participants. With over 5,000 respondents, the response rate was roughly 23%.5
The participating law schools reflected a cross-section of all ABA-accredited law schools based on affiliation (public, private, religiously affiliated), geographic region, size, and ranking. The students at participating law schools closely resembled the population of JD students during the 2020–2021 academic year, although the respondents were disproportionately women and slightly disproportionately White (which was true with the 2014 SLSWB as well). We did not weight the results in any respect to make them more representative.
Results from the 2021 Survey
Substance Use and Mental Health Results
To provide some understanding of the extent to which law students are dealing with alcohol issues, drug issues (whether involving street drugs or prescription drugs), and/or mental health issues, this section briefly summarizes some of the most notable results.
Alcohol consumption among respondents to the 2021 SLSWB declined compared to the respondents to the 2014 SLSWB. The percentage of respondents who drank enough to get drunk in the prior 30 days declined from 53% in 2014 to 43% in 2021. Similarly, those engaged in binge drinking in the prior two weeks declined from 43% to 33% in 2021.6 We are suspicious that these declines may be partly attributable to the social distancing and social isolation associated with the COVID-19 pandemic, which likely meant law students engaged in social drinking with less frequency. The percentage of respondents who affirmatively answered two or more of the four questions that comprise the CAGE assessment, a widely used tool to screen for alcoholism,7 increased slightly from 25% in 2014 to nearly 27% in 2021.
Drugs (Street Drugs and Prescription Drugs)
Use of marijuana increased since the 2014 SLSWB, which is unsurprising given the legalization of marijuana in several states and some participating law schools being located in those states. Marijuana use was reported over the past 12 months and the past 30 days; it increased in both dimensions, going from 25% in 2014 to 38% in 2021 (12 months) and from 14% in 2014 to 25% in 2021 (30 days). Use of other street drugs remained the same or declined between 2014 and 2021.
Regarding prescription drugs, the survey distinguished between use of prescription drugs with a prescription and without. The percentage of respondents using prescription drugs with a prescription increased between 2014 and 2021. Between 9% and 15% of respondents reported in 2014 using one or more of five categories of prescription drugs with a prescription in the prior 12 months (sleeping medication, sedative/anxiety medication, stimulants, pain medication, and antidepressant medication). In 2021, between 7% and 23% reported using one or more of the five categories of prescription drugs with a prescription.
As the next section shows, this increase in use of prescription drugs with a prescription is attributable to a much larger percentage of respondents reporting they have a diagnosis of anxiety and/or depression. Even though more respondents had prescription drugs available to them, the percentage of respondents who shared prescription drugs with others fell from 13% to 5%. Similarly, the percentage of respondents using prescription drugs without a prescription declined from 14% to less than 12%. This latter decline probably is attributable to two things—a larger percentage of respondents have prescriptions and the COVID-19 pandemic probably reduced social interactions that might have resulted in sharing of prescription drugs.
The percentage of respondents who had a diagnosis of depression at any point increased from 18% in 2014 to 33% in 2021. The percentage of respondents who had a diagnosis of anxiety at any point increased from 21% in 2014 to 40% in 2021. Over 80% of those with a diagnosis of depression or anxiety were diagnosed before coming to law school. In total, slightly more than half of those responding to the 2021 SLSWB had some type of mental health diagnosis, roughly doubling from the more than one-quarter of respondents reporting having one or more diagnoses in 2014 (depression, anxiety, eating disorders, psychosis, personality disorder, and/or substance use disorder).
The survey also contained the PHQ-9,8 a nine-question screening tool for assessing depression, and the Kessler-6,9 a six-question screening tool for anxiety/mental distress. On the PHQ-9, 43% screened positive for moderate to severe depression. On the Kessler-6, 54% screened positive for anxiety/mental distress. Thus, the percentage of respondents dealing with depression and/or anxiety may be higher than reflected in the percentage with diagnoses.
Nearly 33% of respondents indicated they had seriously thought about attempting suicide in their lifetime, up from 20% in 2014. The percentage of respondents who indicated they had thought seriously about suicide in the past 12 months was 11%, up from 6% in 2014. Given that isolation and lack of connection increase the risk for suicide, the fact that the survey was conducted during the COVID-19 pandemic might explain some of this increase.
Trauma and Bar Concerns
To provide some understanding of the extent to which law students are dealing with trauma and the nature of the concerns third years have as they approach the bar exam, this section briefly summarizes some of the most notable results.
The 2021 SLSWB added a set of questions to better understand the extent to which law students have experienced trauma in one of 15 categories during their lifetime, including, for example, natural disaster, accident, assault, sexual assault, serious illness or injury, or emotional or physical abuse. Over 80% of respondents reported having experienced trauma in at least one category, with roughly 70% reporting having experienced two or more types of trauma.
Those who reported having experienced at least one trauma category were then asked to complete the PCL-5, a 20-question screening tool for post-traumatic stress disorder (PTSD).10 Scores of 31 to 33 represent the most common scoring range used to identify those who may benefit from a PTSD evaluation. Of those who experienced trauma, 28.6% met the cutoff score of 31; 26.3% met the cutoff score of 33.
Recognizing that these data do not tell us that 26.3% or more of respondents who have experienced trauma are, in fact, suffering from PTSD, these data do suggest that at least 26.3% would benefit from further evaluation from a mental health professional for PTSD. Given that more than 80% of respondents had experienced some trauma, this means roughly 20% or more of all respondents should be evaluated for PTSD.
In the 2021 SLSWB, we asked third-year respondents about the extent to which a variety of factors concerned them as they were preparing to take the bar exam. For those anticipating taking the July 2021 bar exam, the factors of greatest concern, based on the percentage of respondents who were somewhat concerned or very concerned, were the following:
64% Feeling overwhelmed by the amount of material
48% Lack of confidence because of imposter syndrome or sense that I don’t belong
32% Inadequate time management
32% Not having a quiet place to study
Notably, for the top three items, more female respondents than male respondents identified these concerns to a statistically significant degree. Those who screened positive for PTSD had higher percentages on all six concerns, with the difference being statistically significant for all of them. Among those planning on taking the February 2022 bar exam, similar percentages of respondents shared these concerns, except even higher percentages of respondents had concerns about anxiety (59%) and depression (44%).
Help-Seeking Attitude Results
One of the most important aspects of the research conducted in both surveys relates to respondents’ attitudes toward seeking help for substance use or mental health issues. These help-seeking results are detailed in the following paragraphs.
Seeking Help Individually
The surveys initially asked about the extent to which respondents would be likely to seek help from a health professional (physician  or physician or counselor ) or to consult with a state Lawyer Assistance Program (LAP) or a dean of students either for help with a substance use or a mental health problem. Regarding seeking help for a substance use issue, respondents indicated they were much more likely to seek help from a health professional, with 81% indicating that they would be very likely or somewhat likely to seek help in 2014 and 2021. LAPs came in second at 30% in both 2014 and 2021, with deans of students third at 14% in 2014 and 13% in 2021.
Regarding seeking help for mental health concerns, the results relating to health professionals and deans of students were comparable—roughly 80% in 2014 and roughly 15% in 2021. The 2021 SLSWB added three additional options not found in the 2014 SLSWB—seeking help from LAPs, from on-campus counselors, and from online or telehealth providers. Respondents favored online or telehealth providers (59%), followed closely by on-campus counselors (57%), with LAPs lagging (22%).
As for emotional or mental health concerns more generally, over 67% of respondents indicated that in the past year they had thought they needed help for emotional or mental health problems, with more female respondents than male respondents feeling a need for help. Of the respondents who had thought they needed help in the last year, however, only 57% had actually received counseling from a health professional, with female respondents reporting getting help with more frequency than male respondents.
Factors Discouraging Respondents from Seeking Help
The survey then asked respondents about factors that would discourage them from seeing a health professional for substance use issues and, separately, for mental health concerns.
The top six factors that would discourage respondents from seeking help for substance use issues were the following (sorted by descending order in 2014):
|Substance Use Issues — Top Six Factors||2014||2021|
1. potential threat to bar admission
|2. potential threat to job or academic status||62%||59%|
|3. social stigma||43%||39%|
|4. concerns about privacy||43%||41%|
|5. financial reasons||41%||46%|
|6. the belief that they could handle the problem themselves||39%||38%|
Encouragingly, there were modest declines for every factor other than financial reasons. There were statistically significant differences in responses between male and female respondents for four factors in 2021, with more female respondents identifying potential threat to bar admission, potential threat to job or academic status, and financial concerns as factors, whereas male respondents were much more likely than female respondents to believe that they could handle the problem themselves.
The top six factors that would discourage respondents from seeking help for mental health issues were the following (sorted by descending order in 2014):
|Mental Health Issues — Top Six Factors||2014||2021|
|1. potential threat to job or academic status||48%||45%|
|2. social stigma||47%||42%|
|3. financial reasons||47%||54%|
|4. potential threat to bar admission||45%||44%|
|5. the belief that they could handle the problem themselves||36%||47%|
|6. concerns about privacy||30%||34%|
Factors with increases in 2021 compared to 2014 included financial reasons, belief that they could handle the problem themselves, and concerns about privacy; potential threat to job or academic status, social stigma, and potential threat to bar admission all saw modest declines. Once again, to a statistically significant degree, male respondents were much more likely than female respondents to believe that they could handle the problem themselves and also were more concerned about social stigma, whereas female respondents were more likely to identify financial reasons as a factor in not seeking help.
In addition, both surveys asked respondents the extent to which they agreed with the statement that talking with a dean of students or a LAP about either substance use concerns or mental health concerns would delay or prevent admission to the bar. Encouragingly, the percentage who agreed or strongly agreed with the statement declined with respect to both substance use and mental health concerns. With respect to substance use concerns, the numbers declined from 54% in 2014 to 46% in 2021 for a conversation with a dean of students and from 46% in 2014 to 45% in 2021 for a conversation with a LAP. With respect to conversations about mental health concerns, the numbers declined from 42% in 2014 to 36% in 2021 for a conversation with a dean of students and from 39% in 2014 to 32% in 2021 for a conversation with a LAP.
On a less encouraging note, in both surveys respondents were asked the extent to which they agreed with the statements “[i]f I had a drug or alcohol problem, my chances of getting admitted to the bar are better if the problem is hidden,” and the same statement regarding a mental health problem. With respect to substance use concerns, there was no change in the percentage who agreed or strongly agreed with the statement—coming in at 49% in both 2014 and 2021. Regarding mental health concerns there was modest improvement, with the percentage who agreed or strongly agreed with the statement coming in at 43% in 2014 and at 40% in 2021.
Encouraging Others to Seek Help or Informing Appropriate Parties about Concerns about Other Students
Both the 2014 SLSWB and the 2021 SLSWB also asked respondents about the extent to which they would be likely to encourage another student to seek help if the student had an alcohol/drug problem or a mental health problem “that was sufficient to significantly impair his or her ability to fulfill his or her responsibilities as a student.” In both 2014 and in 2021, roughly 80% of respondents indicated they would be somewhat likely or very likely to encourage the student to seek help from a campus counseling center for either an alcohol/drug problem or a mental health problem, while roughly half indicated they would be somewhat likely or very likely to encourage the student to seek help from a LAP, and roughly one-third indicated they would be somewhat likely or very likely to encourage the students to seek help from a dean of students.
Although those numbers were remarkably consistent between 2014 and 2021, the percentage of respondents who said they would be somewhat likely or very likely to do nothing dropped from 33% for alcohol/drugs in 2014 to 23% in 2021 and from 36% for mental health in 2014 to 19% in 2021. This decline is very encouraging.
Notably, in both 2014 and in 2021 female respondents were more likely to encourage the student to seek help from campus counseling, whereas male respondents were more likely than female respondents to do nothing. Perhaps more significantly, however, in both 2014 and in 2021 first-year respondents were more likely than third-year respondents to encourage the student to seek help, while third-year respondents were more likely than first-year respondents to do nothing.
If the student with an alcohol/drug problem that was sufficient to significantly impair their ability to fulfill their responsibilities as a student did not seek help following the respondent’s encouragement to do so, the vast majority of respondents were somewhat likely or very likely to do nothing in both 2014 (63%) and 2021 (67%).
If the student with a mental health problem that was sufficient to significantly impair their ability to fulfill their responsibilities as a student did not seek help following the respondent’s encouragement to do so, the majority of respondents were somewhat likely or very likely to do nothing in both 2014 (55%) and 2021 (51%).
Notably, these indicators went in different directions. Respondents were more likely to do nothing in 2021 than 2014 if a classmate with an alcohol/drug problem that was significantly impairing the classmate’s ability to fulfill responsibilities did not seek help following the respondent’s encouragement to do so, but less likely to do nothing in 2021 than 2014 in a similar situation regarding a classmate with a mental health problem that was significantly impairing the classmate’s ability to fulfill responsibilities.
Again, in both 2014 and in 2021, male respondents were more likely than female respondents to do nothing; third-year respondents were more likely than first-year respondents to do nothing.
Factors Discouraging Respondents from Informing Appropriate Parties about Concerns about Other Students
In both 2014 and 2021, the top three reasons respondents gave for being discouraged from informing a campus counseling center, a dean of students, or a state LAP about concerns about another student who did not seek help following the respondent’s encouragement to do so were potential threat to the student’s job or academic status (up from 60% in 2014 to 71% in 2021 for alcohol/drugs and up from 53% in 2014 to 54% in 2021 for mental health); potential threat to student’s bar admission (up from 57% in 2014 to 64% in 2021 for alcohol/drugs and from 48% to 51% in 2021 for mental health); and social stigma (up from 54% in 2014 to 56% in 2021 for alcohol/drugs, down from 53% in 2014 to 48% in 2021 for mental health).
Perhaps somewhat encouragingly, the percentage of respondents who indicated that they simply did not want to get involved in such situations declined for both alcohol/drugs (53% in 2014 to 37% in 2021) and mental health (54% in 2014 to 32% in 2021).
Interpreting and Learning from the Help-Seeking Data
State disciplinary authorities, boards of law examiners, and law schools all want lawyers and law students to get the help they need for substance use problems or mental health problems and to address and manage these problems so that they can be successful legal professionals and work responsibly on behalf of their clients. Data from a few jurisdictions suggests that a significant percentage of lawyers who face discipline have an underlying addiction or mental health issue that has made it more difficult for them to fulfill their responsibilities to clients and the profession.11 Accordingly, helping law students address substance use problems or mental health problems while in law school would seemingly reduce the number of disciplinary proceedings against lawyers and the number of clients who are ill-served by members of the legal profession.
From the standpoint of the law as a self-regulating profession, these data should be very worrisome. In both 2014 and in 2021 third-year respondents were less likely than first-year respondents to seek help for their own problems or to inform appropriate parties about significant concerns about another student. Although law students should be socialized into their responsibilities to participate in self-regulation as members of the legal profession, their time in law school appears to be socializing them away from taking such responsibility.
Likely Causes for Students’ Reluctance to Seek Help
Several components likely contribute to the challenge faced in getting law students and lawyers to understand that they are better off seeking help as opposed to keeping problems hidden.
First, even before getting to law school, prospective law students may hear from prelaw advisors or from lawyers with whom they consult that they are better off not answering character and fitness inquiries on law school applications affirmatively unless the phrasing of the question absolutely requires them to do so. This is the adversarial mindset many lawyers embrace in the context of discovery disputes in litigation, but applied to the law school application process. It is as if the character and fitness questions on the law school application were interrogatories, with some lawyers advising some applicants that if their situation is not clearly within the scope of the question, they need not answer affirmatively and provide an explanation. There are many anecdotes from law students saying that they failed to disclose something on their law school applications because they were advised by a lawyer not to do so. Although this is almost always bad advice, the point here is that many law students are sensitized, even before getting to law school, to think carefully about disclosing information and to be wary of how disclosure might be perceived by law schools or by state boards of law examiners.
Second, while in law school, students are socialized into a competitive environment in which showing any vulnerability is discouraged. Seeking help is an acknowledgment of vulnerability. The competitive nature of law school reinforces a message that students are better off not seeking help and instead trying to handle problems on their own.12
Third, as students move through law school and begin contemplating the bar admission process, they may see questions on some jurisdictions’ applications that make them think they should not seek help so that they do not have to disclose anything in response to those questions.13
In addition, anecdotal evidence suggests that students still hear rumors about the bar admission process from recent graduates that leave them with the perception that seeking help is likely to delay or prevent their admission to the bar. We appreciate that these are not the messages law schools and boards of law examiners intend to have students receive, and that law schools and boards of law examiners have little control over the people communicating these messages. Nonetheless, these messages remain a concern.
Ongoing Efforts to Encourage Disclosure and Help-Seeking
Students are frequently encouraged during orientation and/or sometime during the first year of law school (and sometimes again during their third year) to update their law school application files if there is anything that they may not have disclosed on their law school application for which disclosure might have been anticipated and is likely to be required on a bar application. This is designed to make students aware that in most cases, it is not the conduct disclosed, but the inconsistency between a law school application and a bar application, that can raise issues about the student’s honesty and trustworthiness. Thus, law schools are trying to send a message emphasizing the importance and wisdom of disclosing information.
In addition, in some jurisdictions representatives from the board of law examiners visit law schools to help students better understand the bar admission process. As part of their presentations, those representatives often also impress upon students the importance of disclosure. They may communicate, for instance, that the board of law examiners is less likely to be concerned if an applicant with an alcohol issue has been sober for a significant amount of time or that an applicant with a mental health issue has been or is being treated and has no current negative conduct associated with their mental health issue.
For example, two of the law schools with the lowest percentage of respondents indicating that their chances of getting admitted to the bar are better if they keep their alcohol or drug problem or mental health problem hidden are in Minnesota, with a third in North Dakota. The Minnesota Board of Law Examiners is very intentional in providing messaging during its presentations to first-year students that it is important for students to get the help they need while in law school because it actually can help them in the bar application character and fitness process.
The North Dakota Board of Law Examiners likewise is very clear when meeting with first-year students about the importance of law students getting the help they need. Although we cannot demonstrate a direct causal relationship, and while these three schools that participated in the 2021 SLSWB have programming in place to reinforce the messaging of their respective boards of law examiners, we find these data encouraging that intentionality in messaging by boards of law examiners appears likely to have favorable results.
Some law schools also have presentations from state LAPs making students aware of the availability of confidential resources to help them with substance use or mental health issues, another example of such intentional messaging.
More Work to Be Done to Counteract Misconceptions about Seeking Help
Despite these efforts at communicating the importance of disclosure and of seeking help, the 2021 SLSWB data suggest that law students at many institutions continue to believe that seeking help for alcohol/drug issues or mental health problems will result in negative consequences for bar admission. This perceived association is such that the students are disinclined to seek help individually and disinclined to inform appropriate parties if they have significant concerns about another student’s inability to fulfill their responsibilities because of an alcohol/drug issue or a mental health problem.
As reported above, 49% of respondents in 2014 felt they had a better chance of getting admitted to the bar if their substance use challenge remained hidden. That figure did not change among respondents in 2021. There was a slight improvement on the mental health side, as 40% of respondents believed they had a better chance of getting admitted if their challenge was hidden in 2021, down from 43% in 2014.
Looking behind the numbers, respondent schools had a fairly significant variance rate, from 28% to 68% for substance use, and from 21% to 55% for mental health. This broad range indicates that messaging is inconsistent across law schools and jurisdictions.
The authors ask boards of law examiners to consider three initiatives to support the effort to encourage law students to seek help for substance use issues and/or mental health issues.
1. Explicit Messaging about the Importance and Benefit of Seeking Help
First, as noted above, three law schools at which respondents felt least inclined to believe they would benefit from hiding their substance use issues or mental health issues have had a member of the board of law examiners from their respective states present at orientation or as part of a professional development course with a very intentional message about the importance of seeking help and about why seeking help actually will aid the applicant in the bar admissions process. We encourage more such collaboration between law schools and boards of law examiners to support clearer messaging around the benefits of seeking help.
2. Greater Transparency about the Number of Cases in which Disclosure of Substance Use and/or Mental Health Issues Has Resulted in Delay or Denial of Admissions
Second, in addition to encouraging help-seeking, boards of law examiners could reshape student perceptions by promoting greater transparency around the number or percentage of cases in which disclosure of substance use or mental health issues has resulted in a delay of admission or denial of admission. In conversations the authors have had with members of boards of law examiners, the board members continually share that very few applicants actually are denied admission because of substance use issues or mental health issues, and that, in fact, few applicants even experience delays in admission when they can demonstrate that they have received treatment for a substance use or mental health issue and that treatment has allowed them to perform successfully in law school. Although this is what the authors have heard, it does not appear to be what law students perceive or believe, partly because many boards of law examiners appear reluctant to be transparent about the percentage of applicants that experience delay in or denial of admission because of substance use or mental health issues.
As noted above, in the absence of meaningful data, law students tend to fill the void with their own worst-case analysis of what might happen. Accordingly, the authors believe that greater transparency about the limited number of applicants who actually experience denial of admission or even delay of admission due to a substance use or mental health issue also can go a long way to overcome the misperception among law students regarding such issues’ effect on admission.
Once again, when members of the Minnesota Board of Law Examiners speak at orientation to the law students at law schools in Minnesota, they have been forthright about indicating that very few applicants are denied admission or even experience delays in admission because of substance use and/or mental health issues. This reinforces the message that the board wants students to seek help for such issues and that seeking help benefits students when they apply for admission to the bar because they will be able to demonstrate that their problem is being well-managed and does not impair their ability to practice law effectively.
3. Revising Questions in the Bar Application
Going back to the mid-1990s, various parties have raised concerns that some character and fitness questions are counterproductive because they may discourage students from seeking help. The responses to the help-seeking questions in the 2021 SLSWB provide some empirical grounding for opinion testimony that has been in reported decisions suggesting that this is the case.14
When the Disability Rights Section of the US Department of Justice challenged Louisiana’s character and fitness questions as violating the Americans with Disabilities Act in 2014,15 the litigation resulted in changes in these questions in Louisiana.16 Prior to the resolution of that case, NCBE made changes to its standard character and fitness application, which is used by many US jurisdictions, by eliminating certain questions relating to mental health. Since then there has been increased attention on the framing of character and fitness questions from multiple stakeholders. In 2017, the National Task Force for Lawyer Well-Being called for changes in bar character and fitness questions.17 In February 2018, the ABA passed a resolution in support of the Task Force recommendations.18 Subsequently, in February of the following year, the Conference of Chief Justices adopted a resolution in support of the goal of ensuring that all the member jurisdictions revise their bar application questions with respect to mental health and substance use issues.19 A number of jurisdictions have taken these cues and amended their questions, although more progress still needs to be made.20
Though having more carefully constructed character and fitness questions will be helpful, simply changing the questions is not likely to result in a change in perception among law students without greater intentionality in messaging, as noted previously. By changing the questions, boards of law examiners eliminate one significant source of discouragement to help-seeking by law students; but this change, while necessary, is not sufficient. Boards of law examiners also need to be much more intentional about communicating messages that help reshape student perceptions and explicitly highlight the importance and benefit of seeking help.
Changing culture is difficult, particularly when the voices that shape the culture are quite diverse and diffuse—from lawyers advising prospective law students; to law professors, law school administrators, law students, and alumni; to boards of law examiners and state LAPs. Getting all to be “on message” regarding the importance of having law students choose to engage in help-seeking behavior will be challenging. Ensuring that those law students most at risk actually learn that help-seeking behavior is preferable to hiding the problem needs to be our collective goal.
Boards of law examiners, state LAPs, and law school representatives need to get together to talk about how we can do better to make sure we are accomplishing the desired outcomes for our students—that they understand the value of seeking help for alcohol/drug or mental health problems, that they get the help they need to be successful as law students and as legal professionals, and that they likewise encourage their colleagues to get the help they need to be successful in these roles.
- The authors are grateful for the cooperation of the 39 participating law schools and the research assistance and statistical assistance of the team at SoundRocket, which helped implement the survey and assist with the compilation and analysis of the data. We are very grateful for the financial assistance from AccessLex Institute, without which the 2021 Survey of Law Student Well-Being would not have been possible. (Go back)
- See Jerome M. Organ, David B. Jaffe, and Katherine M. Bender, PhD, “Helping Law Students Get the Help They Need: An Analysis of Data Regarding Law Students’ Reluctance to Seek Help and Policy Recommendations for a Variety of Stakeholders,” 84(4) The Bar Examiner 8–17 (December 2015). For a more detailed compilation of the results of the 2014 SLSWB, see Jerome M. Organ, David B. Jaffe, and Katherine M. Bender, PhD, “Suffering in Silence: The Survey of Law Student Well-Being and the Reluctance of Law Students to Seek Help for Substance Use and Mental Health Concerns,” 66(1) Journal of Legal Education 116–156 (Autumn 2016). (Go back)
- The data reported here are excerpted from an article published by the Louisville Law Review: David Jaffe, Katherine M. Bender, PhD, and Jerome Organ, “‘It’s Okay Not to Be Okay’: The 2021 Survey of Law Student Well-Being,” 60 Louisville Law Review 441–496 (2022), which describes in much greater detail the results of the 2021 SLSWB. (Go back)
- The authors also posted an invitation on the National Association of Law Student Affairs Professionals (NALSAP) listserv. While working on recruiting law schools the authors worked to finalize the 2021 SLSWB and to obtain Institutional Review Board (IRB) approval. The IRB at the University of St. Thomas (at whose law school this article’s co-author Jerome M. Organ is on the faculty) conducted a full IRB review and granted “master” approval of the survey project as an anonymous, confidential survey. A number of law schools accepted the University of St. Thomas IRB master approval, whereas several other law schools made a determination that the school was “not engaged” in research (given that the school was not actively involved in the process of designing or implementing the survey). See US Department of Education, ED Guidance on “Engagement” of Institutions in Research, https://www2.ed.gov/policy/fund/guid/humansub/guidan1.html. (Go back)
- This response rate declined from the 2014 SLSWB, for which the response rate was just under 30%, but this decline is consistent with that of a similar long-standing study, the Healthy Minds Study, an annual survey-based study launched in 2007 examining mental health and related issues and utilization of services among college students, which has seen response rates drop from roughly 25% to roughly 15% over the last several years. See The Healthy Minds Network, http://healthymindsnetwork.org/. (Go back)
- Binge drinking is defined as five or more drinks in a row for men and four or more drinks in a row for women. This definition of binge drinking is a fairly common metric used in surveys of alcohol use, such as the Harvard College Alcohol Study. See, e.g., Henry Wechsler, PhD, and Toben F. Nelson, ScD, “What We Have Learned from the Harvard School of Public Health College Alcohol Study: Focusing Attention on College Student Alcohol Consumption and the Environmental Conditions That Promote It,” 69(4) Journal of Studies on Alcohol and Drugs 481–490, at 481 (July 2008) (citing use of five drinks for men and four drinks for women as a measure of binge drinking). This measure also has been used in the Healthy Minds Study (see supra note 5); see “The Healthy Minds Study (HMS): Questionnaire Modules,” HMS-Questionnaire-2021-22-clean-1-1.pdf (healthymindsnetwork.org), under “(4) Substance Use” (last visited May 11, 2022). (Go back)
- The CAGE, an acronym of the key words in its four questions, can identify alcohol problems over an individual’s lifetime, with two positive responses out of the four indicating a positive test warranting further assessment. See National Institute on Alcohol Abuse and Alcoholism, http://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htm (last visited June 8, 2022). (Go back)
- The PHQ-9 is used as a screening tool for depression and is proven to have strong reliability and consistency in a variety of settings. See, e.g., Simon Gilbody et al., “Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ): A Diagnostic Meta-Analysis,” 22(11) Journal of General Internal Medicine 1596–1602 (November 2007). Questions on the PHQ-9 ask the respondent to rate on a four-point Likert scale (from zero indicating not at all to three indicating nearly every day) the frequency with which they have experienced symptoms of depression. Symptoms assessed in the PHQ-9 include but are not limited to difficulty with sleep, changes in appetite, and depressed mood. (Go back)
- The Kessler-6 (hereinafter “K6”) is a screening tool commonly used to screen for psychological distress that was embedded in both the 2014 SLSWB and the 2021 SLSWB. See Louise Mewton et al., “The Psychometric Properties of the Kessler Psychological Distress Scale (K6) in a General Population Sample of Adolescents,” 28(10) Psychological Assessment 1232–1242 (October 2016). The K6 is a shorter version of the Kessler-10 (hereinafter “K10”), both of which are reported to have sound psychometric properties. See Bert L.R. Cornelius et al., “The Performance of the K10, K6 and GHQ-12 to Screen for Present State DSM-IV Disorders among Disability Claimants,” 13 BMC Public Health 128 (February 2013), https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/1471-2458-13-128.pdf [https://perma.cc/4FYV-XRDE]; see also Satvinder S. Dhingra et al., “Psychological Distress Severity of Adults Reporting Receipt of Treatment for Mental Health Problems in the BRFSS,” 62(4) Psychiatric Services 396–403 (April 2011) (describing K6 as an effective screening instrument for anxiety). (Go back)
- See F.W. Weathers et al., “The PTSD Checklist for DSM-5 (PCL-5),” US Department of Veterans Affairs (2013), https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp [https://perma.cc/4H4N-7AGE]. The instrument consists of 20 items associated with the diagnostic criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) regarding PTSD. Respondents are asked to rate on a Likert scale of zero to five (zero meaning not at all to five meaning extremely) as to how often they have been bothered by a particular symptom of PTSD. (Go back)
- See Jerome M. Organ, “The Relationship between Attorney Discipline and Attorney Impairment: The Need for Better Information to Protect Clients and to Help Attorneys,” 17(4) University of St. Thomas Law Journal 941–951, at 942–945 (February 2022) (noting that while some claim half or more of discipline cases involve impairment, data from the few states that track such data put the percentages in the 14% to 28% range). (Go back)
- See, e.g., Lawrence S. Krieger, “Institutional Denial About the Dark Side of Law School, and Fresh Empirical Guidance for Constructively Breaking the Silence,” 52(1–2) Journal of Legal Education 112–129, at 117–18 (March/June 2002); Roger C. Cramton, “The Ordinary Religion of the Law School Classroom,” 29(3) Journal of Legal Education 247–263, at 262 (1978). (Go back)
- See Alyssa Dragnich, “‘Have You Ever…?’ How State Bar Association Inquiries into Mental Health Violate the Americans with Disabilities Act,” 80(3) Brooklyn Law Review 677–742, at 683–84 (2015); Jennifer Jolly-Ryan, “The Last Taboo: Breaking Law Students with Mental Illnesses and Disabilities Out of the Stigma Straitjacket,” 79 University of Missouri–Kansas City Law Review 123, at 128–31 (2010–2011). (Go back)
- In re Petition & Questionnaire for Admission to R.I. Bar, 683 A.2d 1333, 1336 (R.I. 1996) (questions regarding mental health may prevent a person in need of treatment from seeking help); Clark v. Va. Bd. of Bar Exam’rs, 880 F. Supp. 430, 445–46 (E.D. Va. 1995) (mental health question may deter applicants from seeking counseling and treatment that would be beneficial); In re Petition of Frickey, 515 N.W.2d 741 (Minn. 1994) (“the prospect of having to answer the mental health questions in order to obtain a license to practice causes many law students not to seek necessary counseling”). (Go back)
- See Letter of Findings from US Department of Justice to Louisiana Supreme Court, available at http://www.ada.gov/enforce_activities.htm#lof (February 15, 2014); see also Dragnich, supra note 13, at 700–702. (Go back)
- See “Settlement Agreement Between the United States of America and the Louisiana Supreme Court Under the Americans with Disabilities Act” (2014), available at http://www.ada.gov/louisiana-supreme-court_sa.htm. (Go back)
- See The Path to Lawyer Well-Being: Practical Recommendations for Positive Change, at 27–28 (2017), https://lawyerwellbeing.net/wp-content/uploads/2017/11/Lawyer-Wellbeing-Report.pdf. (Go back)
- See ABA Commission on Lawyer Assistance Programs, Policy, https://www.americanbar.org/groups/lawyer_assistance/policy/. (Go back)
- See Conference of Chief Justices, Policy Resolutions, Bar Admission, https://ccj.ncsc.org/Policy-Resolutions.aspx. (Go back)
- See David Jaffe and Janet Stearns, “Conduct Yourselves Accordingly: Amending Bar Character and Fitness Questions to Promote Lawyer Well-Being,” 26(2) The Professional Lawyer (January 2020) (noting California, Michigan, New York, and Virginia, among others, as states that have changed their questions), https://www.americanbar.org/groups/professional_responsibility/publications/professional_lawyer/26/2/conduct-yourselves-accordingly-amending-bar-character-and-fitness-questions-promote-lawyer-wellbeing. (Go back)
Jerome M. Organ is the Bakken Professor of Law and Co-Director of the Holloran Center for Ethical Leadership in the Professions at the University of St. Thomas School of Law (Minnesota).
David B. Jaffe is Associate Dean for Student Affairs at the American University Washington College of Law.
Katherine M. Bender, PhD, is Assistant Professor of Counselor Education at Bridgewater State University.
This article is based on the authors’ presentation at the 2022 NCBE Annual Bar Admissions Conference held on April 28–May 1, 2022, in New Orleans, Louisiana.
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