September 13th, 2006 05:22 EST
College, Depression, and Suicide: ARE UNIVERSITIES DOING ENOUGH?
On the typical American college campus, depression and suicide are hardly rare. Consequently, the significance of the mental health issue on campuses nationwide is growing rapidly, and the mental well-being of students is becoming a top priority on many campuses.
Sure, most college students have experienced a moment of depression, when they’ve felt sad, blue, or down-in-the-dumps. But that’s not clinical depression.
As Dr. J. Russell Ramsay, psychologist at the Hospital of the University of Pennsylvania, explained, “depression is a mood disorder that is both biological and behavioral: it is not a personal failure. What is more, it is easily treatable but people must seek and use help.”
The National Institute of Mental Health highlights this ease of treatment, saying clinical depression can be successfully treated by mental health professionals or certain health care providers. With the right treatment, 80 percent of those who seek help get better, and some may even begin to feel better within a few weeks.
According to a study done by the American College Health Association, approximately 10 percent of college students have been diagnosed with clinical depression; and another 15 percent would qualify as clinically depressed if they were evaluated.
Why? Experts like Ramsay believe that the major causes for the increase in depressed students are academic performance, relationship changes, an uncertain job market and high expectations from their parents or themselves. Couple these factors with the traditional hallmarks of college life - lack of sleep and excessive use of alcohol - and it is no wonder that one in four students will experience a depressive episode by the age of 24.
With rates as high as they are, suicide has become an important but feared issue on many campuses. According to ACHA, the Jed Foundation, and National Institute of Mental Health, suicide is the second leading cause of death among college students, claiming approximately 1,100 lives per year. Although most suicides are in fact committed by white males over 85, more young people die from suicide than from all other medical illnesses combined.
In order to combat depression and suicide, counseling centers on the nation’s campuses are striving to help students manage the difficulties of college life.
Certain universities, such as the Massachusetts Institute of Technology, Cornell University, and New York University, have been shocked into making drastic improvements on their mental health services.
For NYU, the 12-story atrium of the infamous Bobst Library, often called “The Atrium of Horror,” has been the site of several student suicides over the past 10 years, according to Hillary Marcovici, a freshman at NYU.
"The 12 floors overlook the atrium which has a marble floor with geometric designs," Marcovici said. "People say that when you look down at it the design is supposed to look like spikes pointing up at you, and I guess it can kind of look like that."
Despite the design of the floor to dissuage potential jumpers, the university has made another attempt more recently by installing extra-high plexi glass, surrounding the banisters on the upper floors, as Marcovici explained.
Victor Wong, a sophomore at Bucknell University who has dealt with suicidal ideation extensively, said “The atrium is clearly an ideal place to jump because it is so tall and has only one horizontal rail separating each floor.” Wong, a longtime sufferer of depression, has battled with suicide for a number of years and knows the terrors and tactics of that world.
After four student suicides in the 2003-2004 school year, NYU has spent the past few years bettering its counseling programs, in addition to educational programs and depression screening, by speaking with national experts and looking critically at its own programs. Most of these improvements have been praised by students; however, some believe that the university is doing more to save face than to save lives.
Although there have been few suicides since that year due to drastic campus improvements, it should not take four student deaths, or even just one, to persuade a university to take a serious look at its mental health programs and make the necessary improvements that can save student lives.
At the University of Delaware, administrators highlight the Center for Counseling and Student Development, and its resources, to prospective and incoming students. They emphasize its accessibility and staff, referring to it as the place to turn for help on campus. But it is emphasized more to parents then to the students themselves.
Dr. Joseph Siebold, director of Student Health Services at University of Delaware, supported this when he said “parents have been especially thankful that their son or daughter has someone on campus to contact for a medical or mental health concern.”
It’s great that parents know about the services that their children can access, but if the students do not know about them, how are they supposed to be expected to use them?
For one thing, most students don’t view the CCSD as accessible. And UD senior English major Angela Evans agrees.
“The university needs to increase its efforts toward advertising counseling services,” Evans said. “In my 4 years here, I’ve heard very little about the counseling center - I don’t even know where it is!”
Knowing about the CCSD and where it is essential for those students suffering from depression and other psychological troubles. As Donna Satow, co-founder of the Jed Foundation, said, students need to know that there is support out there and should not have to continue living without it.
“We must prevent students from suffering silently from these things,” Satow emphasized.
Many students note a lack of advertisement for the CCSD, especially toward the student population. Parents are often much more informed about the services offered than the students.
UD sophomore Kirsten Holst said, “It was actually my academic advisor that recommended I go to CCSD because I was having concerns about my major. I hadn’t heard of it before then.”
The statistics show just how widespread these issues are. According Dr. John Bishop, associate vice president for CCSD at University of Delaware, only 1,865 students, or roughly 12 percent of the student body, used the CCSD last year. This is an increase of approximately 300 students since 1991.
And yet the annual National Survey of Counseling Center Directors survey, which polls 274 college-counseling centers nationwide and CCSD participated in, found 85 percent reported an increase in severe psychological problems and those students seeking counseling.
So why haven’t UD’s numbers shot up too?
Most UD students who have used the services at CCSD are split over the Center’s effectiveness. Because so few students use the Center and many of them failed to find it helpful, other students may feel as if a trip to the CCSD is worthless. For many of those who think otherwise and might want to seek out CCSD’s services, the actual location of the CCSD is unknown. Or they may know that the Center’s strengths are actually in helping students in the early stages of the career decision-making process.
In a CCSD publication Bishop affirmed this:
“The center is strongest with helping in the early stages of career decision-making and is most beneficial to undecided majors,” he said.
A look at programs at other area campuses similar to the University of Delaware, in size, demographics, and academics, show it’s the university's policies, programs and services are dangerously inadequate.
The University of Pennsylvania, Johns Hopkins University, the University of Maryland, the University of Virginia and NYU all have at least four psychiatrists on their counseling staff. The University of Delaware has two, and the second largest student body of these schools.
These schools also all have crisis intervention teams and suicide prevention programs. The only crisis intervention team Delaware has is one belonging to New Castle County and many students, like Evans, have said they had never seen a suicide prevention program on campus.
Specifically, UMD and JHU each have model programs that emphasize mental health. UMD’s is a four credit freshman course that helps them deal with stress, time management, and other similar issues. With students finding the program extremely helpful, approximately 2,000 colleges and universities now offer such courses.
JHU’s program gives extra attention to potentially suicidal students to ensure their safety. A detailed questionnaire designed to identify these students is given to every student who seeks counseling. The counseling staff then adds at-risk students to the center’s “suicide tracking” list. Those students put on the list make up 22 percent of clients, and are carefully monitored by staff, who meet one a week to review the student’s status.
The University of Delaware’s publicly accessible records, including meeting minutes from faculty meetings, shows the university has not openly addressed any of these issues, like suicide prevention, since September 2002.
And yet Bishop said “Our campus has employed a number of strategies which are aimed at suicide prevention.”
One such strategy is a link on the CCSD Web page to ULifeline, a Web site that offers a confidential place for students to learn about mental health, to have access to a free and confidential evaluation of mental health, and to find help. ULifeline was started by the Jed Foundation, a group committed to strengthening the mental health safety net for college students. According to the Jed Foundation Web page is now available to more than 1.5 million students at 90 of the nation's colleges and universities.
Customized for each participating school, UD’s ULifeline is very informative about mental health services on-campus. While the link is on the CCSD's emergency options page, it is difficult to find. In fact, many students say they have never even heard of the website. Bishop said that the link will be made more prominent when the CCSD updates its webpage.
Providing students with access to information is an important step, but the University of Delaware has numerous other inadequacies that it must better in order to rise to such national standards as the ACHA suggests.
As both ACHA and NIMH stress, colleges need more than just services to adequately address suicide and related mental health problems.
Siebold stated in an e-mail message that SHS is open 24 hours a day, seven days a week, when the residence halls are open.
“There are very few universities providing this availability to their students,” Siebold said.
Many universities have such a system in place on campus, such as UPenn, UVA, UMD, JHU, and NYU.
Although the University of Delaware always has both a psychiatrist and a psychologist on-call, Cynthia Cummings, associate vice president for Campus Life, said an imminent suicide attempt would be handled by University police.
“We do not have a crisis management team to respond to calls about imminent suicide attempts,” Cummings said. “If a suicide attempt were imminent, trying to get a team of people together would waste valuable time.”
According to studies by the ACHA and the Jed Foundation, having campus security or administrators handle mental health emergencies is hugely inadequate and dangerous.
Elizabeth McCourt is a representative of Contact Delaware and a member of Delaware’s suicide prevention committee. Contact Delaware is Delaware’s 24-7 Crisis Hotline.
According to the organization’s Web site, “The mission of Contact Delaware is to provide the highest quality telephone counseling, crisis intervention, information and referral, education and prevention services for persons in crisis and for persons in need of listening services.”
Unlike ACHA and the Jed Foundation, McCourt said she did not believe that having campus security handle a mental health emergency was dangerous.
“One key attribute of suicide prevention, no matter what the population, is gate keepers,” McCourt said. “They don’t have to necessarily be medical professionals; rather they are the person that might come in contact with someone who is suicidal. It’s important to be able to get help in your community, from the people you see, or can contact, each and every day - and that certainly would include campus police.
“The key,” she said, “isn’t who is doing the intervention, but that they are educated to recognize the eminent signs of suicidal ideation and then knowing what actions to take.”
The eminent danger created by the University of Delaware’s lack of a crisis team is bad enough for students. But their situation is only made worse because many Public Safety student employees are not trained to handle suicidal situations, according to Chief James Flatley, of the university’s Police Department and Department of Public Safety.
As Flatley explained, “Student Police Aides (or part-time student employees) do not receive such training, mainly because the issue hasn’t been raised. It is something, however, that we may look at for future training programs. Upon receiving a call from a potentially suicidal person, a student would immediately hand it over to a full-time dispatcher, who would be trained to deal with such a situation.”
Flatley even said that a representative from NAMI (the National Association for Mental Illness) would be presenting to all full-time, non-police employees later this year.
Whether in support crisis control teams or just well-trained campus employees, Dr. Kimberly Valentine, one of Delaware’s two psychiatrists, said she believes the campus police have done an exemplary job responding to mental health crises on campus. As a result, there have been no successful on-campus suicides over the past few years, despite at least 5 attempts in 2005 alone, according to university daily crime reports.
The University of Delaware may benefit from incorporating more of the essential services recommended by Jed and ACHA. One such service is to provide an on-campus screening program to identify students at risk for suicide. Examples of such programs are National Depression Screening Day and the College Screening Program, which was developed by the American Foundation for Suicide Prevention.
The Jed Foundation and ACHA say screening programs are essential for addressing suicidal behavior on campus. Although more than 90 percent of suicide victims have serious psychiatric illnesses, many of them go undiagnosed and/or are inadequately treated, which both The Journal of the American College of Cardiology and Dialectologies journal now suggest can lead to diabetes and serious cardiac problems.
Other ACHA recommended programs to address depression and suicide include: targeted educational programs and campus-wide education programs, stress reduction and management programs, non-clinical, student-run support network, and post-vention programs. Instead of some programs running in residence halls that focus on suicide prevention, depression, and ways to handle a stressful college life, UD focuses only on topics like long-distance relationships, getting the most from college life, time management, test taking and how to pick a major.
Satow said that expanding upon this success and investing similar, if not greater, resources into these mental health issues could put the university in the forefront in this important area as well that so desperately needs to be addressed.
Nationally, there is a massive problem surrounding the fear and the mental stigma of depression and suicide. This is even worse on college campuses, where depression is more prevalent, but widely feared.
A freshman music major at Smith College says that negative social stigma hits home. She has dealt with depression everyday for more than three years and knows many students do not want to talk about it, even if they themselves suffer.
“The fact that society doesn’t really accept depression can make it very hard to deal with,” McElwain said. “A lot of people don’t see depression as a medical condition, like a broken leg or allergies; instead, people think of those with depression as being crazy or extremely mentally unstable.”
Satow pointed out that society has only worsened the fear of suicide by tabooing depression too. This makes the implementation and advertisement of prevention and treatment programs much more difficult.
Freshman Katie Makos recognizes this negative social stigma and thus can not see herself seeking help from a program other than individual counseling.
“If I was seeking help, I wouldn't get involved with a program that would advertise the fact that I was depressed,” said Makos. “That’s a very private subject.”
This fear is also a huge problem when it prevents a person from seeking help or treatment, or prevents a friend from seeking help for another, especially because it can increase risk of suicide.
One senior nursing major, knows the pain of suicide all too well. After her brother’s untimely death early in the fall semester, she cannot stress enough the importance of counseling, medication, and help.
“My advice is that if someone tells you something concerning suicide or depression in secrecy or you are really worried about someone, tell somebody else, especially their parents,” she said. “If the parents have even the slightest idea that their son or daughter may commit suicide, it makes all the difference. I know it's hard to do and your friend may be mad at you for a while, but later he/she will realize that you saved his/her life - and the permanent loss of life is much worse than a temporary loss of friendship.”
The Jed Foundation has continued to stress that something must be done to de-stigmatize depression and suicide in society; and it must be done soon. This fear has kept the nation from keeping track of suicide deaths for any demographic other than a state or the nation. Although the state of Delaware does track suicides by county, the complacency on the lack of national records is alarming.
The ACHA pointed out in studies and publications that college-age population, for example, has been seriously neglected by statisticians. Thus there is no accessible record of college student suicides in the nation. Each individual state collects data on it community members, but not on college students in that state. And no university or college in the nation keeps a cumulative record of student suicides either.
This means that person x, a UD student from Minnesota, can commit suicide on-campus and disappear without any lasting record with Minnesota or UD. And, if that same person x commits suicide off-campus, such as in White Clay Creek Park, the university does not put it in the daily crime statistics, because it was off-campus.
Some campuses only record the number of suicides and attempted suicides for the current school year, but that is heavily guarded if the number of successful suicides is anything other than zero.
As Flatley explained, “We track the number of crimes and incidents that occur on our campus by writing reports.”
These reports are annually filed by the department in the Clery Report, Flatley said. The federal government requires colleges and universities to publish this report each year, but it does not require the report to include an annual suicide tally.
With no publicly accessible annual report of suicides on college campuses, it’s almost impossible to collect the information, especially because individual universities keep it heavily guarded. In fact, they keep it so guarded that the Jed Foundation actually had to terminate a project that they began in 2005 to create a National College Suicide Registry.
The Jed Foundation and many national suicide prevention programs all agree that this complacency and lack of information is a problem because it allows universities and colleges to ignore the signs of campus malfunctions.
A National Suicide Registry would help schools compare themselves against other schools of similar size and demographic, which would then allow administrators to assess the success and effectiveness of the school’s prevention and treatment programs. Without it, schools are left only to wait until they get a wake-up call like NYU’s four students’ suicides.
Although the publication of any suicide information is very sensitive information, the Columbia Suicide Research Center, the largest and most federally funded suicide research project in the nation, is investigating suicide in hopes of beginning to lower suicide rates and stopping the suicide fad.
By publishing only essential information - such as age, race, gender, occupation, state/area/college, pre-death diagnoses - families would not be advertising a loved one’s suicide unless they chose to, and essential information could still be collected. Understandably, suicide is hard for families to talk about especially if their religion prohibits it, and often because the law prohibits it.
Despite these difficulties, it is essential for families to think of how their information can help lead to a better understanding of depression and suicide, and possibly, a better way of stopping suicide. For the many depressed patients who chose this path, whether they were treated or untreated, each one is forgotten, as his or her memory fades, with no legacy.
Alternatively, those affected by loved one’s suicide need to band together to prevent others from such pain.
Phil and Donna Satow did just this after their youngest son, Jed, committed suicide in 1998. Instead of suppressing their personal tragedy, they chose to create The Jed Foundation in 2000, which has become a nationwide effort to make mental health a priority on college campuses and prevent suicide from darkening another family or college campus’ life.
As Donna Satow said, “There’s such a negative social stigma with depression and suicide. That’s why we’re speaking out.”
“People have to remember that suicide is preventable. Depression is treatable,” Satow said. “And if you can direct a young person toward getting help and understanding what is affecting them, then you may be able to prevent it.”
Satow said the federal government was finally implementing a National Violent Death Reporting System that will report suicides and possibly attempted suicides.
But even this is only a small step on a long path.
“What we really need to do is change the culture of college campuses,” Satow said. “Counseling Centers need to become more visible on campuses and less embarrassing for students to utilize. Somehow, we need to help students admit if something is bothering them or if something doesn’t feel right.”
“Depression doesn’t mean the end of the world,” she emphasized. “It only means the beginning of a journey, toward recovery.”