Suicide rates at college campuses have been relatively low and constant over the past several years—about 7.5 per 100,000 students compared with about 15 per 100,000 matched young people in the non-college population, according to a 10-year study in Suicide and Life-Threatening Behavior (Vol. 27, No. 3). Nonetheless, counseling centers' perceptions that more highly troubled students are entering their doors are prompting center directors to try fresh suicide-prevention tactics.
For many campuses, that means beefing up counseling services and fostering campus climates that encourage people to seek help. Some centers are seeking extra funds from their institutions, while others are seeking grant money from the Substance Abuse and Mental Health Services Administration (SAMHSA) and other entities (see Congress funds innovative prevention programs). Other institutions are increasing services for more troubled students without extra resources, making it more difficult to adequately address the needs of those with more normative problems, some say.
Some of the new efforts are casting wider nets to reach more people, such as through student-friendly Web sites and public education campaigns. Others are taking creative approaches to counseling, for instance, by making services available to students in places they frequent and de-stigmatizing services by calling them "consulting" services.
"The change is to be a little more 'out there' in terms of developing innovative ways to reach and engage the current generation of students, faculty and staff," says Todd Sevig, PhD, director of counseling and psychological services at the University of Michigan.
Preliminary results—which show that these efforts are reaching a broader range of students and that more students are using mental health services—suggest the changes are worth it, center directors say.
Creating 'campuses of caring'
Cornell University launched a new suicide-prevention program in 2002 following the suicides of three students within a short span of time. While the suicide rate was generally consistent with the national average, campus officials were concerned about the impact on students' mental health, says Gregory Eells, PhD, director of Cornell's Counseling and Psychological Services.
So in 2003, Cornell's Division of Student and Academic Services and the provost provided extra funds to increase the number of positions in the counseling service and to increase health promotion and anti-suicide activities on campus. Campus psychologists were inspired by a comprehensive Air Force suicide-prevention program designed by psychologist Kerry L. Knox, PhD, whose program reduced suicide risk by a third, according to a 2003 study in the British Medical Journal (Vol. 327, No. 7428). The success of her program hinged on two factors: harnessing leaders' support and sending the message that the entire community needed to play a part.
Cornell took a similar tack. The school convened a mental health and welfare council and, to foster a sense of community, created a team of administrators, campus police, residence life staff and counselors, who meet weekly to discuss signs of student distress. The counseling center also trained faculty and staff—from custodians to faculty members to department secretaries—to recognize and report worrisome student behavior.
Statistics suggest Cornell's program is working. In the five years since these initiatives began, Cornell has not had a single suicide on the campus, Eells says.
Like Cornell, the University of Michigan re-invigorated its suicide-prevention efforts in 2006, through catchy marketing and new media approaches. University of Michigan psychologist Christine Asidao, PhD, helped to create the school's public education campaign. Asidao and her colleagues encourage students to intervene if they see others in trouble, by using outreach methods that directly engage them such as talking one-on-one with students during events and handing out T-shirts, baseball hats or flash drives with the campaign slogan, "Do Something."
Michigan also adopted a suicide-prevention package called QPR: Question, Persuade and Refer. In short training sessions, faculty, staff and students learn ways to work with troubled students, by asking them appropriate questions, convincing them to get help, and referring them to mental health professionals. In the two years since Michigan adopted QPR, the center has trained about 1,500 people, says Sevig.
The center has also developed a Web site on mental health issues. MiTalk provides online screening for the most prevalent mental health disorders among college students. It also answers common questions about mental health issues and offers videos on mental health and stress reduction techniques. Early data show that the Web site reaches a wide swath of students, not just those interested in professional counseling, Sevig says.
Similarly, Penn State University is using a Web-based video program to help faculty spot at-risk students. The module includes four professionally acted vignettes of troubled students who professors might see in class, including potentially violent students and those with serious emotional disorders.
"The videos are very catchy for faculty, who will see people like themselves encountering these situations and thinking through and managing them," says Dennis Heitzmann, PhD, Penn State's director of counseling and psychological services.
Making grant money count
Other campuses are using funds from SAMHSA to improve their suicide-prevention outreach. Arizona State University's Tempe campus counseling center received six years of funding through two grants totaling $525,000. In the first round, it conducted training to enhance the mental health competence of resident advisers, campus recreation workers and other staff who work with students.
"The training is designed to help them feel more confident about having conversations with students about difficult mental health topics," says Martha Christiansen, PhD, director of counseling and consultation at the campus. Now, the Tempe center is exporting this training to Arizona State's three other campuses.
Likewise, Pace University received six years of SAMHSA funding, totaling $364,000. It is using the money to enhance the multicultural competence of its counseling center.
"We understand that there are different ways that students demonstrate depression and suicidality," notes Richard Shadick, PhD, director of the counseling center at the university's New York City campus, who is writing a paper on the topic with Christopher Brownson, PhD, of the University of Texas at Austin and colleagues. For example, given their ethnic and cultural differences, students may vary in their emotional presentations, he says.
"The way a young gay Puerto Rican man will tell you he is feeling depressed and suicidal is markedly different from the way an Asian-American student will tell you she is distressed," Shadick says.
To address such diversity, Pace disseminated brochures, public service announcements and training vignettes targeted to students from a variety of groups, including African-Americans, Asian-Americans, Muslims, Latinos, international students, disabled students and those who are lesbian, gay, bisexual or transgender. Center staff members are now developing more comprehensive multicultural competence kits that they hope to disseminate to other campuses as well.
Revamping mental health centers
In addition to campus-wide education campaigns, schools are retooling their clinical services to better meet the needs of students who may need help. Cornell, for instance, is reaching out to more diverse student populations, including international students, through its "Let's Talk" program. The effort lets students visit mental health professionals at various sites that don't have a "mental health" stigma attached to them, for example in academic buildings and student centers.
The strategy is working: About 55 percent to 60 percent of students who use the service are categorized as ethnic minorities, corresponding to the 40 percent of minority students who visit the traditional counseling center, Eells says. About 26 percent of Cornell's students are ethnic minorities and about 15 percent to 20 percent are international students.
At Michigan, the campus mental health center is boosting its accessibility by keeping its doors open four evenings a week. It is also hiring a case manager to work with the most troubled students—a common trend among campus mental health centers, notes Penn State's Heitzmann.
Meanwhile, Sevig and others say, while tragic events have garnered many headlines, it's worth emphasizing that the suicide rate in this group is low. Sevig credits that in part to good prevention efforts.
"We know that if we catch things early, it's the best way to prevent those really tough situations," he says.
Tori DeAngelis is a writer in Syracuse, N.Y.
Flynn, C. & Heitzmann, D. (2008). Tragedy at Virginia Tech: Trauma and its aftermath. Suicide and Life-Threatening Behavior, 36(3), 479–489.
www.samhsa.gov/SAMHSA_News/VolumeXV_6/article3.htm: SAMHSA newsletter highlighting the Campus Suicide Preventions Grants.
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