Worried Colleges Step Up Efforts Over Suicide...

December 3, 2004

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December 3, 2004

Worried Colleges Step Up Efforts Over Suicide

By KAREN W. ARENSON

had been at Columbia University for only a few weeks when

she went out drinking with a group of friends downtown last year and became

separated from them. She had skipped her medication for bipolar disorder.

Now it was 3 a.m. and, crying and in a panic, she called friends; she told

them, she said, that she " just wished the traffic would take me out. "

Although she made it back to campus safely, her friends had already notified

Columbia that they were worried about her. For Columbia officials, it was

the first clue that Ms. faced any kind of mental health problems.

" I wasn't on Columbia's radar at all, " said Ms. , who is back on

campus now after being forced to take a medical leave.

Increasingly, college officials and mental health experts have come to

realize that many of the most vulnerable students - the ones prone to

self-injury and suicide - are like Ms. : they never go near the

counseling centers or reveal anything about their experience before college.

As a result, colleges are stepping up efforts to find them and to get them

into treatment, sometimes forcing them to leave temporarily.

The goal is to help students like Ms. . But colleges have more at

stake. Suicide - the second-biggest cause of death among college students -

can be costly, injuring reputations and prompting litigation. The suicide of

a student at the Massachusetts Institute of Technology, Shin, in

2000, and strings of suicides at New York University, Washington

University and the University of Illinois, have drawn wide attention. There

has also been a rise in lawsuits involving student suicides.

Ann H. e, a vice president of United Educators, a company that insures

1,200 universities, colleges and schools, said suicide prevention had risen

in priority as claims had risen; her company, Ms. e said, now has a

" handful " of claims, up from none six years ago.

" They can be very severe claims financially, " Ms. e said, " not to

mention the emotional and reputational impact they can have on a school. "

In a closely watched case, the family of Shin has sued M.I.T. for

$27 million.

One study of suicides on college campuses, based on a dozen universities in

the 1980's, found a rate of about 7.5 per 100,000 students, which is about

half the rate for young adults not in college and represents about 1,100

suicides a year for the entire college population. Although there have not

been comparable studies since then, most mental health experts say they

believe the rate has remained at about that level.

To address the problem, Emory University and the University of North

Carolina are inviting students to fill out anonymous mental health

questionnaires. Duke University is asking faculty members to be alert to

changes in behavior - noticing, for example, when a student suddenly becomes

sullen or quiet, or stays away from class. Columbia, New York University and

Cornell now place counselors in residence halls. The University of Illinois

and the University of Puget Sound in Tacoma, Wash., are requiring any

student who threatens or attempts suicide to attend counseling sessions.

But the best way to reach these students remains unclear, and students do

not always welcome the intervention. Some experts fear that forcing students

to enter treatment or to take a medical leave can dissuade others from

asking for help and discourage their friends from sounding the alarm, even

though students who take such leaves generally come back and graduate.

The recent forced withdrawal of a freshman at N.Y.U. was front-page news in

the student newspaper, Washington Square News. The student, Sue Schaller,

told the paper that although she had been briefly hospitalized for

depression and suicidal thoughts, she felt much better when she returned to

campus and wanted to stay in school, but that the university would not let

her.

An editorial in the newspaper called for the university to " do everything it

can, including requiring therapy and regular check-ins, to ensure that

troubled students who wish to remain on campus can stay and that they pose

as little risk as possible, " adding, " Pushing those students out of the

university community is not the answer. "

In retrospect, Ms. , the Columbia student, said she had mixed

feelings about how the university treated her. She said she still felt

wounded by the process - she called it a " charade " - that ejected her from

school.

Even with things going smoothly, Ms. , whose dark hair is tinted

purple and who speaks with energy and humor, said her mind sometimes

wandered to what she missed last year, while she was on leave, and to the

possibility of running into new trouble.

" I am so scared about screwing up, " she said, " and of being sent home

again. "

Columbia officials declined to comment on Ms. 's case. They said

that the university did not keep statistics on how many students were forced

to go home, but that there were few of them.

For years, colleges and universities have been grappling with a growing

flood of students with histories of mental illness. Most have expanded the

number of counselors and the hours they are available.

But now they are going further. Some are turning to the Internet as a way to

bring troubled students in for help. The American Foundation for Suicide

Prevention has developed an anonymous online mental health questionnaire and

a program to steer troubled students to counseling, which is being tested at

Emory and the University of North Carolina. Those involved say the initial

results seem promising.

At Emory, which started using the program in 2002, only 8 percent of the

students who received the survey filled it out, but 85 percent of those

students were deemed at moderate or high risk of suicide or other severe

problems based on their responses to the questionnaire. They are encouraged

to speak to a counselor on or off campus, or to consult anonymously with a

counselor online.

" The yield is relatively small, " said Ann Haas, research director for the

suicide-prevention foundation. " However, we are absolutely convinced that

those kids would not have gotten into treatment. We think we are reaching

the right kids. "

Many campuses, including Duke and M.I.T., are asking faculty and staff

members and students to tell a dean or the counseling office if they see

students who show signs of depression or potential suicide.

At Duke, when faculty members or parents relay concerns about students to

Larry Moneta, the vice president for student affairs, he and members of the

residence hall staff check up on the students, sometimes surreptitiously.

" Many times I've called the residence hall staff and asked if they can

dispatch a paraprofessional to inadvertently drop by a student's room as if

it were a casual encounter, " Dr. Moneta said. " I do that all the time. "

After Ms. Shin's suicide, M.I.T. began running training sessions for faculty

members, departmental administrators, athletic coaches, dormitory personnel,

fraternities and sororities to help them spot people showing signs of

problems - one of several steps recommended by a mental health task force

created after the suicide.

Cornell is making a special effort to reach out to Asian and Asian-American

students. Of 16 students there who have committed suicide since 1996, 9 were

of Asian descent. The university created a task force to explore those

students' experience at Cornell and how to help them when they have

problems, since they do not use Cornell's counseling services at the same

rate as their classmates, said H. , the university's vice

president for student and academic services. Often when they do seek help,

" they are in real crisis, " Ms. said.

Colleges are also leaning more heavily on students who show suicidal

tendencies to enter counseling. Several are examining or adopting a program

developed by the University of Illinois at Urbana-Champaign, requiring any

student who threatens or attempts suicide to attend at least four counseling

sessions.

Joffe, the program's director, said the results had been good: all but

one of nearly 2,000 students in the program over 20 years remained at the

university during the counseling sessions, and none committed suicide. And

although the university has had suicides among students not in the program -

including six in the last academic year - it says its suicide rate is about

half of what it was before the program started.

While some college officials question whether students should be forced into

counseling, others favor the heavy-handed approach. The University of Puget

Sound, one of the campuses that recently began using the Illinois approach,

bluntly describes the program as " a public statement that suicide is

unacceptable here. "

" We don't know what it is about that model that is so effective, " said Donn

Marshall, director of counseling, health and wellness services at Puget

Sound. " Is it that somebody stands up and says suicide is unacceptable? Or

is it that somebody says, 'I care'? Or is it something about what happens in

the four sessions with a psychologist? "

When Ms. arrived at Columbia last year from Nashville, she had been

struggling with bipolar disorder and problems with drinking and drugs, and

she had a cabinetful of medications. She had planned to contact the

counseling service to find someone to talk to, but three weeks into the

school year, she had not gotten around to it. She said she had arrived

confident she could succeed.

" There was a big to-do before I went to school to ask my doctors if I was

ready, " she said. " They all said yes. " What most put her off about the way

Columbia handled her case, she said, was the quick interview with a

university psychologist that she thought was intended to figure out what she

needed to do to stay at school, but that she later learned was to decide

whether she should be allowed to remain.

She said she had been totally candid in talking to him, because " I've talked

to a lot of psychologists, and realized that if you tried to butter them up,

you don't get the help you need. "

But she said she did not believe the university had been equally candid. " He

worked for the school, not the patient, " she said. " If they don't tell you

that, you lose trust. The kids they are dealing with are smart enough to

understand the dynamic after the fact. "

Margo D. Amgott, assistant vice president for health services at Columbia,

said the university tried to make sure students understood that the

interview was for the university's evaluation purposes and even required

that they sign a document saying they understood.

Ms. said that while she did indeed signed papers, she had had no

choice, and thought that the decision to stay or leave would still be up to

her and her family. But when she and her father talked about lining up

support for her in New York, they learned that it was not their call, and

she was given four days to move out of her room.

Being sent home to Nashville just three weeks into her freshman year made

her feel worse rather than better, she said, and she ended up in a

psychiatric hospital.

She said that now that she was back at Columbia, she was doing well. She is

majoring in anthropology and has a late-night radio program, " Zombies vs.

Ballerinas, " that features groups like Mogwai.

And while she is in regular touch with a college adviser assigned to her,

she has not sought psychological help, either at Columbia or outside.

" Last year's treatment was so expensive that it has driven my father into

debt, " Ms. said. " It makes me feel guilty. "

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December 3, 2004