Brian also harbored a dark side. What friends and family did not know was the depth of troubles he kept to himself, suffering in silence from severe depression and voices only he could hear. On March 24, 2000, Brian ended his pain in an act of suicide. He was 22 years old.
The desperation that Brian Malmon experienced is reflective of a growing trend in higher education today — one that is redefining the landscape of college campuses: mental illness. Affecting multiple areas of an institution — from counseling centers to academia, from finance to retention — the number of college-age men and women afflicted with some form of mental health disorder has reached crisis proportions. In turn, college and university presidents across the country are faced with unprecedented challenges as they make mental health a new institutional priority on their campuses.
Going beyond counseling
While it's true most colleges and universities offer some form of crisis intervention, individual counseling, and/or referrals to outside community resources for students, they do not provide sufficient support and services that address specific anxiety disorders, such as obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, or certain phobias, according to the Anxiety Disorders Association of America’s (ADAA) 2007 audit of mental health care at America’s college and universities (PDF 548KB).
Indeed, the American College Health Association reports that about 44% of college students were so depressed last year that it became difficult for them to function at some point. Similar findings were revealed by college and university counseling center directors who participated in the 2006 National Survey of Counseling Center Directors conducted by the University of Pittsburgh and the American College Counseling Association. An overwhelming majority — 92% — of the directors surveyed said the frequency of college students with severe mental health issues has grown exponentially, with 40% of their own clients experiencing severe psychological problems and 8% with impairments so serious they could no longer remain in school.
Mental health in the news
The subject of young people and mental illness is not without precedent. It was perhaps first thrust into the national spotlight with the Columbine High School massacre. On April 20, 1999, in Littleton, Colorado, Eric Harris and Dylan Klebold armed themselves with semiautomatic pistols and sawed-off shotguns and proceeded to kill 12 classmates and one adult, leaving 24 others wounded. Numerous reports suggested that mental illness was a contributing factor leading to the destruction they imposed.
More recently, there was the Virginia Tech tragedy.
On April 16, 2007, 23-year-old Seung-Hui Cho, a senior at Virginia Polytechnic Institute and State University, went on a shooting rampage that would end as the deadliest school shooting in United States history. A total of 32 people were killed and 25 wounded. Diagnosed and treated in childhood for mental health problems — which included selective mutism, depression, and thoughts of suicide — Cho's psychological issues continued in college. This time, his troubles were marked by violent tendencies: On two separate occasions, Cho was accused of stalking female students.
In the months following Virginia Tech, stories involving students with mental health issues continue to make news. As recently as Oct. 11, 2007, a high school in Cleveland, Ohio, was held hostage by 14-year-old Asa Coon, who walked into the school and systematically began shooting people before killing himself.
Cases like these are the exception. Most mental health experts will agree that the vast majority of people with mental illness rarely are the perpetrators of any kind of violence. Still, the question remains: Why are young people so troubled today?
What the research shows
Dr. Robert Gallagher has studied the issue of mental health and young adults for more than two decades. Gallagher, the editor of the National Survey of Counseling Center Directors survey for the past 25 years and the former vice chancellor for Student Affairs at the University of Pittsburgh, suggests there are myriad reasons behind the increase of students facing mental health challenges today. The breakdown of the traditional family, lack of adequate coping skills, the transition from high school to college, the destigmization of mental illness itself, and the efficacy of new medication all are contributing factors, he says.
"Many students begin taking medication in high school for their mental health problems, which allows them to manage their lives appropriately. When they go off to college, however, and are out on their own for the first time, they may discontinue taking their medication. This is where real problems can start," Gallagher explains.
Chris Burris knows this firsthand. Burris, a 17-year veteran of the mental health profession, served as director of counseling for the North Carolina School of the Arts for six years. Today, he operates a private practice. He contends that not only are more college students seeking counseling and therapy but the problems themselves have become increasingly more complex: Suicide is the second leading cause of death among college students and the third leading cause of death among all youth 15–24 years old. In the United States, only accidents and homicides claim more lives of young people.
"There are a number of different theories behind this phenomenon," Burris says. "There are the arguments citing peer and societal pressures, increased drug and alcohol use. But the bottom line is students are in a crisis today."
Mental health providers on campus
No one knows this better than those on the frontlines of student mental health: the counselors and mental health providers on college campuses. Adding to their struggles to keep up with the rising demand for mental health services are budget constraints, lack of resources, and limited staff.
At least half of higher education institutions operate with "time limited" counseling offerings. This means a student is allowed to see a counselor for a maximum of six to 12 times. For individuals with more serious mental health issues, this is simply not enough, Gallagher says. Left unchecked, life-altering consequences can occur for these students.
Active Minds
When her older brother took his own life in 2000, Alison Malmon, then a freshman at the University of Pennsylvania, wanted to reach out to other students who suffered in silence like Brian. Her answer was the creation of Active Minds, a not-for-profit organization that uses the student voice to raise awareness about mental health on college campuses and provide access to information and resources.
"I knew very little about the landscape of mental health," Alison says. "It was through my own research that I found out that symptoms of so many mental health issues first show up during high school or college. My goal was to raise the dialogue on my campus so that other students [at Penn] would know the signs and symptoms of different disorders, seek help earlier and know they were not alone."
Since the founding of Active Minds, Inc. in 2003, student-run chapters of the organization have been created on more than 100 college and university campuses in the U.S. and Canada, according to Malmon. She anticipates the growth to continue, reaching more than 300 campuses in the next three years.
"In the wake of prominent news stories, student mental health has become more of a priority for campus administrations than it was five or 10 years ago," says Malmon, "as they begin to realize the need to think more creatively and out of the box when it comes to supporting students’ mental health.
"At the same time, more education needs to happen. Many of today’s campus counseling centers are completely overwhelmed with student visits — to the point that we have heard of campuses with over 10,000 students having just one on-campus counselor. More prioritizing and additional resources need to be devoted to on-campus services so that every student has the chance to access the help he or she needs," she adds.
Putting campus mental health on the forefront
In recent years, a tide of change has surfaced regarding student mental health, as more college and university presidents incorporate the issue into their overall strategic plans and goals. Following the Virginia Tech tragedy, student mental health was catapulted even further as a campus priority, with a number of institutions making immediate changes to improve their mental health programs and services. Others invested in additional staff, peer mentoring efforts and campuswide training to help faculty spot students exhibiting signs of mental distress.
For Burris, however, piecemeal solutions are not the complete answer; he proposes a more systemic approach.
"A lot of schools have certainly made changes in the way of their mental health services and programs. And that is good, of course. But, a more total solution needs to take place on campuses," he says. "It is less about resources and more about clear communication and coordination between various parts of an institution — from the counseling department that works with the resident life people, who in turn work with the school staff and parents of students, and so on.
"More ‘talking’ needs to happen," Burris adds. "There is a disconnect today in schools on the issue of mental health. Every area of the institution — from the president down to bus drivers — needs to be working together, so that everyone knows what to watch for in a student, how to make a referral to get someone who needs help to the right place. This is what will prevent a student from slipping through the cracks."
Malmon echoes those sentiments, adding she believes in order to underscore the importance of mental health and provide the necessary support for students, colleges and universities must take mental health out of just the counseling center.
"Students, faculty members, coaches, staff, and RAs all need to be trained in recognizing signs and symptoms of mental health issues and how to get help for someone for whom they're worried," she says. "Wellness activities should be an integral part of daily activities on a campus, and students must be brought into all parts of the conversation so that they are actively engaged in the issues and can make mental health, mental illness, and wellness programming most effective on their campus."
Privacy laws and campus policy
Complicating the mental health issue for colleges and universities is the cumbersome and often complicated nature of federal and state privacy laws, which dictate what school administrators and other officials can and cannot report to families, other institutions, and outside agencies regarding a student who displays signs of trouble.
Burris cites a case at the Massachusetts Institute of Technology in 2000. On April 10, 2000, Elizabeth Shin, a student who had made several suicide attempts at school, set herself on fire in her dormitory room. She died four days later. In 2002, Elizabeth’s parents filed a $27 million wrongful death lawsuit against MIT, alleging the school failed to inform them of their daughter’s mental condition or provide adequate mental care to help her. (In April 2006, the case was settled out of court for an undisclosed sum.)
"MIT was an example of several cases preceding Virginia Tech that clearly demonstrated how imperative it is to have a better understanding of FERPA [Family Educational Rights and Privacy Act] and other privacy laws so that schools and counseling centers are not in conflict with them and there’s no dispute as to what needs to happen," Burris says.
Recommendations from Virginia Tech
Indeed, one of the 70-plus recommendations to evolve from the Virginia Tech Review Panel’s August 2007 report underscored the dire need to make information privacy laws governing mental health, law enforcement, and education records more transparent; the report also cited a widespread lack of understanding on how the laws currently are interpreted today.
Among the FERPA-specific amendments recommended by the Virginia Tech Review Panel:
- Creation of a better balance between an individual’s rights of privacy with the rights and safety of others;
- removal of barriers that impede universities from sharing information on mentally ill students with other departments of an institution, law enforcement, medical providers, parents and others; and
- mandatory disclosure of students' mental health records by high schools once a student has been admitted to the college.
Several of the recommendations found in the Virginia Tech Review Panel’s report reiterate what some colleges and universities have long advocated in terms of mental health polices, programs, and practices.
In 2000, for example, the University of California launched a campuswide collaborative awareness campaign to bring greater focus to the issue of student mental health. As part of the effort, a 12-member Student Mental Health Committee was appointed to examine national and local mental health trends and identify whether the 10 campuses in the University of California system were equipped with the necessary level of support to manage those trends. In September 2006, the Committee released its final report detailing a three-tiered strategy — which included targeted mental health intervention programs and crisis response efforts — to better serve the mental health needs of students at UC’s campuses.
Michael Young, vice chancellor for Student Affairs, UC Santa Barbara, served as co-chair of the Student Mental Health Committee. He says a catalyst for the formation of the Student Mental Health Committee and the subsequent work that followed was the 2004 suicide of 21-year-old Adam Ojakian, a senior at UC Davis. His parents, Victor and Mary Ojakian, also provided information and data to UC’s Student Mental Health Committee as it developed a process to build healthier learning environments for students in trouble.
UCSB already has instituted several of the recommendations stemming from the Student Mental Health Committee's report, according to Young. Among them:
- the addition of new professional medical staff members, including a medical social worker, a disability specialist and a mental health coordinator;
- peer-to-peer support and training programs; and
- a 24-hour mental health hotline for students.
"Colleges and universities need to understand that there has been a 'sea change' in our reality. The rise in young people with mental health issues is no longer a phenomenon. It’s the new normal for higher education," Young says.
"Ten years ago if you asked college and university presidents what kept them up at night, I would guess that the mental health of their students was not one of their responses. Today, you can believe this no longer holds true. It is a top priority now," he says.
Heightened awareness nationwide
The positive news surrounding the topic of mental illness and college students may be the heightened visibility of the subject itself.
Nearly 85% of the directors who responded to the 2006 National Survey of Counseling Center Directors said college presidents and higher education administrators on their campuses not only were more aware of the demand for additional counseling services, but also had a better understanding of the complexity of problems exhibited by students today.
Approximately 40% of the same directors (up from 35% in 2004) reported that the awareness had resulted in additional resources and other improvements at their centers; 20% (up from 15% in 2004) believed that new resources would be coming in the near future.
Perhaps the renewed focus on student mental health — as well as the emphasis on creating systemic campus approaches to address it — are the real lessons to be learned not only from the events that took place at Virginia Tech in April, but also from the many others that preceded and continue to follow. Now, the question becomes one of whether these lessons maintain momentum in the months and years ahead. Will student mental health be viewed as a national priority? Will colleges and universities, government, parents, businesses, and others commit to working together to develop resolutions that enable students who enter the dark abyss of mental illness to find their way back?
UC’s Young is cautiously optimistic:
"Nightmares happen; we know this," he says. "And while there is absolutely no way to guarantee what will or will not happen on any college campus, we can put in place a comprehensive array of support structures, services and programs to help prevent, as well as respond to, students in need. This requires a will on the part of institutions that they recognize the new reality in which we are living today. In doing so — by making the changes that need to be made — we can make a big difference. Kids who otherwise would have died will live because of what we do."