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July 2002

Suicide Prevention On College Campuses
By Molly Wallace

Suicide is the second leading cause of death among college aged students. In his 2001 book Noonday Demon, Andrew Solomon wrote that “Someone in a first depressive episode is particularly likely to attempt suicide.” Many experience their first bout of depression in college. As a result, college counseling services and administrations are crucial to preventing suicide.

“When we’re talking about suicide among college students, generally we’re talking about
mental illnesses,” says Dr. Laura Smith, Director
of Barnard College Counseling Services. Confirming Dr. Smith’s comments are Solomon’s statistics from the National Institute of Mental Health : 90-95 percent of suicides, especially at the college age, are the result of mental illnesses, the most prevalent being depression. Studies cited in Kay Redfield Jamison’s noteworthy book on suicide Night Falls Fast (reviewed in this issue), depressives are at approximately twenty times the suicide risk of the general population. Those who have previously attempted suicide are at thirty-eight times the risk: “Contrary to popular myth, those who talk about suicide are the most likely to kill themselves,” states Solomon’s book. Targeting these populations can cut suicide rates.

Dr. Smith contends that peer support and student groups play an invaluable role in raising awareness, de-stigmatizing the seeking of help and helping others recognize depression in themselves. There is less stigma attached to therapy than there once was, Dr. Smith explains, but still not every one who needs help seeks it. Some want to prove that they can handle the independence that comes with college without help. Others, especially at highly selective institutions, are used to succeeding on their own and looking for help simply does not occur to them. For those adjusting to college, or who are under academic or other forms of stress it can be difficult to draw a line between what is an appropriate response and what constitute symptoms of depression. In these cases student groups can help by having students being open about their experiences with counseling and referring students to the services they need. Jamison writes of a young man who took his own life, “Drew’s family, whose warmth and understanding of him would have been, in a fairer world, more than sufficient to keep him alive, could not compete with a relentless and ruinous disease,” explaining that all the kindness and support shown to a suicidal person is not necessarily enough. As Andrew Solomon points out, “Illness of the mind is real illness…and it requires treatment.”

So what do college counseling services do once a patient is in their hands? Both Dr. Smith and Dr. Paul Buckingham, Director of Counseling Services at Brigham Young University (BYU) Hawaii explain that there is no textbook response to how to handle a severely depressed or suicidal patient. Each case must be evaluated on an individual basis. Doctor/patient relationships remain confidential unless the student’s safety is at risk. Students at both institutions are encouraged to contact family members, if appropriate, and generally they are willing. If it were necessary and appropriate, family members could be contacted without consent of the patient. If the situation calls for it, students can be hospitalized. Dr. Smith observes that generally students who bring themselves in know they are struggling, and in that sense they are better off than those who are brought in by others. The latter tend to require hospitalization more often.

“Colleges are not equipped to be mental health centers,” says Dr. Buckingham justifying the hospitalization of students. At BYU Hawaii suicide is an honor code violation. Consequently, if a student is talking about suicide and refuses treatment he or she can be forced to leave the school in order to get treatment. In such a case acceptance is guaranteed with reapplication provided that the student includes a letter from a mental health professional stating that he or she has been treated successfully. Hospitalization also has the advantage of taking pressure off friends. Dr. Smith emphasizes that although it is important for students to have peer support, friends of depressed patients need to put their own well-being first.

Dr. Smith’s statistics show that around 23% of Barnard students use counseling services (numbers went up after September 11th), and Dr. Buckingham’s numbers show that at BYU Hawaii 8%-12% of students do. Few of these cases are severe enough to require hospitalization. Both Dr. Buckingham and Dr. Smith say that a large number of people who come in complain of depression. The causes range from academic stress to family problems to romantic problems, and at BYU Hawaii where a large part of the student population is international, adjustment difficulties. Both doctors say treatment for less severe cases of depression vary. In some cases medication is suggested. “We would never put a student on medication, without following through with therapy,” says Dr. Smith. In other cases only therapy is used.

The University of Illinois, Urbana–Champaign has a successful suicide prevention program that follows up every suicidal gesture or attempt with an incident report and four weeks of mandatory assessment. Approximately 1,500 students have gone through this program in seventeen years. None have committed suicide. Considering the high risk that these students were at, this is a remarkable feat.

Another program called Columbia Teen Screen, researched at Columbia University under Director Dr. David Shaffer, has been successful in high schools. The program has four steps: obtaining permission, then completing a questionnaire. If the participant scores positively on the first screening, they are more thoroughly assessed by a computerized diagnostic interview called the Voice-DISC (Diagnostic Interview Schedule for Children). The DISC allows for youth to complete the interview independently and eliminates the cost of having trained interviewers. Those who are identified by the Voice-DISC as meeting criteria for a disorder are evaluated by a mental health professional. The clinician may then recommend further evaluation and/or treatment to the child and the child’s parents after discussing the results. The advantage of this program is that it catches young people before they attempt suicide thereby helping to predict or prevent depression later in life. Dr. Ted Greenberg, a coordinator of the program says, “it should be used in colleges”.

Programs like the University of Illinois’ and Columbia Teen Screen’s only exist in a few communities. In 1997 Senate resolution #84 that declared suicide a national problem, passed unanimously. In 1998 a similar resolution (House Resolution #212) passed unanimously in the House of Representatives. The Surgeon General has also made suicide one of his priorities. All these are signs that help is on the way. Part of the senate resolution states, “the Senate acknowledges that no single suicide prevention program or effort will be appropriate for all populations or communities,” pointing out how important it is for every community to take its own initiative. Organizations such as the American Foundation for Suicide Prevention, and the American Association of Suicidology have already been established to provide such initiatives with the necessary resources, and to encourage networking.#

Molly Wallace is a student at Barnard College and an intern at Education Update

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