A tragedy showed the risk of underestimating mental-health problems. Now schools are intervening sooner.
He displayed all the signs of a young man headed for trouble. Professors raised alarms over his violent writings. Roommates worried about his isolation and lack of friends. Around campus, his creepy attempts to befriend female classmates led authorities to hospitalize him for a psychiatric evaluation. But despite all the warning signs, administrators at Virginia Tech weren't able to find a way to help—or stop—Seung-Hui Cho before his murderous rampage left 33 dead, including himself.
The Virginia Tech tragedy in April added a violent new data point to an ongoing debate over whether colleges are doing enough to help mentally ill students. By all accounts, schools are dealing with more students with emotional problems than ever. In a 2004 study, 8.3 percent of Penn State undergraduates reported having taken psychiatric medication (including drugs like Ritalin) before they came to college, 22 percent had received counseling and 1.6 percent had been hospitalized over psychiatric issues. National surveys also suggest that college students suffer high rates of depression. According to a 2005 survey by the American College Health Association, four out of 10 college students said that at times they felt "so depressed it's difficult to function." Ten percent said they'd "seriously considered suicide"—which remains the third leading cause of death among college-age Americans (behind car accidents and homicides), according to the American Association of Suicidology.
Health-care professionals cite various causes for the distress. Some observers blame added pressure on today's adolescents—including the anxiety that can accompany college admissions. Others say college students are now less resilient, since today's "helicopter parents" have often been more involved in their teenage lives than was typical a generation ago. But the biggest factor, most experts believe, is that thanks to better diagnosis, treatment and medications, children with mental illnesses are more able to attend college. For parents of children who've already experienced emotional problems—and even for those who haven't—getting a handle on how schools deal with these issues is becoming another part of the college search.
Parents are right to be concerned, since some university mental-health centers are facing strains. In the past decade, many colleges have beefed up their counseling centers, but it can still be hard to keep up with student needs. In 2001, the counseling office at the University of Virginia had 24 one-hour psychiatrist appointments available each week; earlier this year it had 80. Still, like the staffers at most campus counseling offices, those at Virginia must typically limit their therapy to eight or nine sessions. "We focus on brief treatment and stabilization," says psychologist Russ Federman, UVA's head of counseling. "Once a student's initial needs are met, we refer them into private [counseling]."
At the majority of colleges, the most serious cases—particularly those requiring hospitalization—are usually referred off campus. The number of students who require those interventions is growing. Last year, the typical college hospitalized eight students for psychiatric reasons, up from five in 2001, according to an annual mental-health survey conducted by University of Pittsburgh education professor Robert Gallagher. But even when they're treating more students, counselors can have a difficult time actually preventing suicides. Out of 154 suicides reported by the colleges in Gallagher's survey, 82 percent of the victims had no contact with the school's counseling staff beforehand.
That so many troubled students never walk into the clinic is a key reason colleges are spending more time focusing on getting faculty and fellow students to identify disturbed students—and to understand how to work together to get help. Cho's case shows how important this is: while individual Virginia Tech faculty, roommates and administrators recognized aspects of his troubling behavior, no one had enough information to connect the dots and understand the extent of his problems. That's why some mental-health pros say the most important thing colleges can do is improve communication between departments—to create a sort of early-warning system that's actively looking for troubled kids.
MIT has worked hard to develop its system. Between 1990 and 2001, 11 MIT students committed suicide; critics said that number was far higher than at comparable schools, and some blamed the school's counseling operation for not doing more to prevent student deaths. One such death—the 2000 suicide of Elizabeth Shin, who set herself on fire in her dorm room—led to a highly publicized lawsuit in which her family alleged that MIT should have done more. The case was settled, but since then experts both inside and outside MIT say the school has tried to create a community in which everyone is hyper-alert for kids who need help.
It's a system that needed revamping. When MIT's current mental-health chief, Alan Siegel, arrived in 2002, two thirds of counselors' time was spent providing therapy to faculty, staff and dependents, instead of students. His team quickly reversed that ratio. They hired more staff to boost the number of appointments, reduced the wait time to see a counselor and began offering more walk-in hours. Beyond providing more resources, MIT focused on outreach: today the university's Center for Health Promotion and Wellness acts as a sort of recruiting service for the counseling office, sending health educators into dorms. They talk about time management, eating disorders and sleep habits—but they also emphasize that it's perfectly normal to seek counseling when college stress piles up.
The university's job has been made easier, they say, as a generation that's grown up watching Zoloft commercials—and has seen friends, siblings and parents go for counseling or receive psychiatric meds—arrives on campus. "There's been an erosion of the attitude that going to a mental-health counselor is like pulling a fire alarm," says Zan Barry, an MIT health educator. Over time, Barry and her colleagues aim to make students realize that "going in for a well-being check is like going to get your teeth cleaned—we want it to evolve into that type of mentality." Today, roughly one in five MIT undergraduates undergoes counseling at some point.
For troubled students who won't voluntarily come in, the university has systems in place to try to identify them. The health form that's filled out by admitted students contains nine questions about mental health, and those who check "yes" will get periodic e-mails from counselors inviting them to drop by. Like many colleges, MIT puts residence staff and faculty through a standardized suicide-awareness training program called QPR (for "question, persuade, refer"). It also seeks to forge familiar relationships among counselors, dorm supervisors and faculty so professors or housemasters who spot signs of trouble can call someone they know, instead of phoning a random hot line. For example, psychiatrist Kristine Girard is the designated counselor for Random Hall (a big MIT dorm) and the Phi Sigma Kappa fraternity, and when she's not counseling students she attends interdepartmental meetings, where she picks up intelligence on students—including which ones are at risk for failing a class. "When people know each other and trust each other, you're more likely to have [these] conversations," says Siegel.
At MIT and elsewhere, administrators aren't the only ones trying to get students to watch out for each other's mental health. In 2000, Alison Malmon was a student at the University of Pennsylvania when her brother, Brian, a student at Columbia, committed suicide. Looking around her campus, she saw groups aimed at helping students of different ethnicities and sexual orientations—but no groups focused on mental-health issues. So she created one. Today Active Minds has chapters on 69 campuses and more than 1,000 members nationwide, many of them pre-med majors or students planning careers in social work. Malmon serves as executive director. At a typical chapter event, students might watch a movie like "A Beautiful Mind" or "Prozac Nation" and then hold a discussion. Particularly since the Virginia Tech shootings, Malmon has been trying to raise awareness that dealing with students' mental illness is a task that extends beyond the counseling department.
Even as more students use counseling, these offices are not a stop on campus tours. Nor should they be. Families of students who have mental-health issues may want to do some due diligence on the scope of treatment a college offers and make contact with the counseling department before a freshman goes to school. But families of students without a history of emotional problems are often better off looking at the general campus atmosphere to get a sense of how their child might fare emotionally. Instead of finding out the number of counselors on staff, experts suggest examining the student body: Do kids who remind you of your child seem happy there? Does the general vibe suggest that your student will fit in and make friends?
While colleges should be lauded for doing more to improve the mental health of their students, none of their efforts offers any guarantee that another tragedy won't occur. "What happened at Virginia Tech is an incredibly rare, rare event that's the kind of thing that could elude the most comprehensive and collaborative and well-orchestrated set of services," says Ben Locke, cofounder of the Center for the Study of College Student Mental Health at Penn State. For parents and students who already have their fair share of anxieties about the transition to college, tragedies like this one can never be rare enough.