Many health professionals on college campuses agree that it’s important to be aware of mental health issues year-round. Some have implemented depression and suicide prevention programs throughout the academic year. Additionally, health professionals have identified a need to educate others on campus about how to identify at-risk students and provide proper resources. To help colleges that don’t already have depression and suicide intervention programs on campus, we sat down with Laurie Davidson, M.A., manager of campus programs at the Suicide Prevention Resource Center (SPRC) at Education Resource Center, Inc., to get the scoop on which students to look out for and how to effectively help them.
Risk factors for depression and suicide include relationship troubles, mood disorders, and barriers to accessing mental health care. For suicide, easy access to lethal means, like poisonous chemicals or firearms, is a risk factor. A lack of social support may also be a risk factor, and students who are somehow “out of sync,” as Dr. Mort Silverman says, with the rest of the campus community, may be at risk. For example Dr. Silverman and colleagues’ Big 10 Suicide study shows that older female students are more at risk for suicide, so transfer students and graduate students may be at higher risk.
In the University of Michigan Healthy Minds study, men and women screened about equally for depression. A very interesting finding from this study is that students with financial difficulties, either growing up or at present, are more likely to screen positive for depression or report suicidal thoughts. These students were also substantially less likely to receive mental health services. This data tells us that we might be able to prevent mental health problems by helping students to work through their financial difficulties.
How do you recommend training staff about identifying, referring, and assisting at-risk students?
There are a lot of training options, including one that’s called Campus Connect, created specifically for colleges and universities by the staff at Syracuse University. It’s important to train people who are on the frontline with students to intervene when they see students exhibiting the warning signs or risk factors for mental health problems or suicide. (For more about warning signs, go to http://www.sprc.org/featured_resources/bpr/PDF/AASWarningSigns_factsheet.pdf.) Most campuses that are conducting these trainings target faculty as a primary audience, along with RAs and student affairs staff. There are a lot of less obvious people who may have even more contact with students than faculty such as teaching assistants, administrative assistants in academic departments, tutors, and financial aid advisors.
Clinicians in the counseling center and health center should receive training in assessing and managing suicide risk, too. And there is a very good collaborative program in identifying and treating depression in primary care that was piloted at NYU in recent years. The results showed lowered symptoms and improved functioning among the participating students.
There are different entry points on campus where a student can get help (health services, counseling services, RA, advisor, coach). What’s the best way for a college to ensure coordinated care?
Many campuses have case management teams or student-at-risk response teams, which are designed to keep students from falling through the cracks. Core people on the team usually include someone from the counseling center, health services, resident life, student affairs, and campus safety, and some include faculty. These teams meet to identify students who may be at risk, and to figure out different ways to assist that student. This type of case management program is a growing trend on college campuses.
How are campuses responding to the increase in reported depression and mental health issues?
There’s some disagreement as to whether there has been an increase in depression or simply an increase in reported cases. What is most important is that there is a serious gap between the number of students who report being depressed and those who are actually receiving treatment. For example, the Healthy Minds study shows only 50% of the students who screened positive for depression reported receiving treatment.
Can you share some examples of successful depression or suicide intervention programs?
There is no one program or intervention that is going to take care of all the complex issues associated with depression and suicide; however, campuses are doing a number of things to identify students who may be at risk and to provide quality services. The most important factor for success is for a school to know its student population and understand the risk factors, and then to develop programs based on that understanding.
Many schools are now using a comprehensive, multilevel approach developed by the Suicide Prevention Resource Center and the Jed Foundation, which recommends seven program strategies:
- Identify students at risk
- Increase help-seeking behavior
- Provide mental health services
- Follow crisis management procedures
- Restrict access to potentially lethal means
- Develop life skills
- Develop social connections
St. Peter’s College in New Jersey, for example, created a customized program based on their predominantly local, Hispanic student population. The college reached out to the families of these college students in order to teach the parents how to reduce parent-child conflicts, which according to data are a factor in suicidal behavior in adolescent Hispanic females.
Another example is Arizona State University. The school developed a comprehensive program including many of the seven areas of strategic intervention, with the aim of creating an overall protective environment and identifying students in distress. ASU has a social marketing campaign to encourage help-seeking behavior; supports a chapter of Active Minds, a national student organization that works to reduce the social stigma of mental health problems; offers an online mental health assessment tool; provides a mental health/life skills group for students called Think Different and Feel Better; and offers stress management training.
What are some solutions to overcome barriers (personal, environmental, or cultural) of an at-risk student seeking depression help?
A couple of different groups, ‘Feel Better Fast’ and ‘Think Different and Feel Better’, are designed with the student in mind, meaning the help-seeking process is modified to provide easier access for the student. Programs like these offer students a chance to recognize if they have a problem that warrants counseling while overcoming any social stigma that may be present.
Other barriers can be caused by assumptions. For instance, many people assume that students don’t seek help due to social stigma, which may be a factor. But further exploration of the reasons may reveal something else – that the counseling center is in a very exposed location, for example, or that the counseling center’s hours are not conducive to a student’s schedule. If campus data show that students who have mental health problems or suicidal ideation are not seeking help, it’s important to go a step further and ask students why they don’t seek help.
Other barriers to help-seeking may be cultural. Most campus mental health services are designed based on a Western psychology that is not shared by many other cultures. Trying to encourage students from some cultures to go to the counseling center may not be a useful approach. Instead, campuses need to think about what those students need and where they would feel comfortable talking about their problems.
What about depression screening programs?
There are several screening program options. For instance, the JED Foundation offers a free program called ULifeline. It’s an online resource where students can use the screening tool and learn ways to help themselves and their friends with emotional issues.
A more involved screening program is offered by the American Foundation for Suicide Prevention called the College and University Screening Project. This is another web-based screening program. It uses a three-tiered assessment method whereby a trained online clinician encourages at-risk students to seek help.
And most people are familiar with National Depression Screening Day, coordinated by Screening for Mental Health, Inc. The company also has a program called College Response, which includes a year-long online screening that can be customized for specific campuses.
Are there any online resources that you would recommend for someone who would like to learn more?