Campus Security Begins With Caring

A comprehensive program can help students who are at risk of doing violence, whether to themselves or others

Following the mass shootings at Virginia Tech and Northern Illinois University, I have repeatedly been asked, as a former director of the Student Counseling and Resource Service at the University of Chicago and clinical associate professor of psychiatry, two questions: “Could this have been prevented?” and “How can we ensure that it doesn’t happen on our campus?”

I have no easy answer to either one, because it is virtually impossible to “violence proof” or “suicide proof” any campus. Beefing up security or increasing counseling-center staffs may be important first steps, but they can go only so far in preventing violence and promoting mental health.

Short of creating a virtual police state, with metal detectors and constantly monitored surveillance cameras in all buildings, how we can guarantee that our campuses will be safe havens? Higher-education institutions are simply microcosms of the world around them — a world that often includes violence. Also, while mental illness usually plays a role in mass killings that end in suicide, most of the emotional disorders that students struggle with do not lead to violence, and students are more likely to die by harming themselves than by violence inflicted by others. The challenge is to preserve an open educational culture for everyone at a time when the focus is on safety, security, and stability.

The facts and figures about mental-health problems on our campuses are sobering. When the American College Health Association’s National College Health Assessment surveyed college students in the fall of 2006, 78 percent reported having felt very sad at least once within the preceding 12 months, 42 percent felt so depressed it was difficult to function, 9.4 percent had seriously considered attempting suicide, and 1.4 percent had attempted suicide. Fourteen percent of women and 10 percent of men reported feeling hopeless nine or more times.

Similarly, respondents to the 2007 National Survey of Counseling Center Directors reported that almost half of their student clients had severe psychological problems, and close to 8 percent had impairments so serious that they could not remain in college, or could do so only with extensive psychological or psychiatric help. On the 272 campuses surveyed, almost 2,000 students were hospitalized for psychological problems in 2007.

Indeed, for people the age of traditional undergraduates, 17 to 22 years old, as well as for those who are the age of typical graduate students, 23 to 30 years old, suicide is the third-leading cause of death, after accidents and homicide. The median age of onset for most major mental illnesses is between the late teens and late 20s.

Yet with earlier diagnosis and better treatments available, more students are now able to complete high school and enter college. Hence student mental-health services are faced with at least three categories of students with major mental disorders: those coming to campuses already diagnosed and actively seeking continuing treatment, those who develop major mental illnesses while enrolled, and those who decide to forgo further treatment once enrolled and subsequently have relapses.

It’s clear that students perceive campus life as stressful, and they often lack the basic coping skills and strategies to perform at their full potential. Moreover, certain groups whose numbers are growing on campuses — among them returning veterans; older, nontraditional students; and international students — experience increasing difficulties. Many students have had traumatic and stressful life experiences that can’t be adequately resolved by brief interventions. Many are still in various stages of recovery, while others lack the resiliency to confront the stresses and strains of campus life. Still others come from cultural backgrounds and belief systems that do not advocate “talk therapy” as a means of coping with the stresses of college life.

As we in higher education think about ways to help such students, we should first distinguish between students whom I would call “distressed and distressing” and those whom I would call “disturbed and disturbing.” Although the underlying makeup and outward behaviors of the two types overlap, they are not one and the same, and accurate differentiation will lead to better outcomes for all of us who study and work on campuses.

The differences relate to the interactive domains of cognition, emotion, and behavior. Students don’t go to college without good cognitive skills — memory, learning, intelligence, speech, language — and they don’t advance as students unless those cognitive skills are further developed over time. Coping skills, among the domains of cognitive functioning, involve different levels of psychological functioning and are often seen as protective factors. Some examples include problem-solving abilities, anger management, and stress management. Coping skills are needed to deal with stress and help navigate among cognitions, emotions, and behaviors. Without adequate and accessible sets of coping skills, we are psychologically vulnerable.

Distressed and distressing students have developed coping skills over time but under certain circumstances are unable to access them. Disturbed and disturbing students, in contrast, may have not developed coping strategies to the degree that they can be used. There are many reasons why, including genetic, structural, and developmental factors.

One tantalizing theory is that the prefrontal cortex of the brain — where, we believe, reasoning, judgment, impulse control, and the capacity for coping skills reside — continues to develop and mature into people’s mid-20s. According to that theory, some students lack the ability to cope with stress because parts of their brain have yet to develop that capacity. Such students are deficient, or “immature,” in some of the key functions that are essential for community living, socialization, and accurate perceptions of socially acceptable behaviors. For those students, the struggle to develop into mature and responsible adults is quite difficult.

Hence the fundamental difference between distressed and distressing, and disturbed and disturbing students is that one group has learned adaptive ways of coping with stress and developed the requisite skill sets to do so, while the other group has not. When under stress, disturbed and disturbing students resort to less adaptive and age-appropriate behaviors than their peers. They lack resiliency. While student-counseling services can help distressed and distressing students regain their coping skills or teach them adaptive ones, counseling centers may not be able to help disturbed and disturbing students. That’s because those students are not easily amenable to the traditional forms of counseling and therapy available on their campuses — nor do they even have the skill sets to ask for help or know when they need it most.

All of us on campuses must be alert to disturbed and disturbing students and communicate better about them with one another. We should also recognize that college is not for everyone, and that campuses are not therapeutic communities. Sometimes the safety, security, and stability of the community trump the needs of individuals. Sometimes students are not ready to benefit from or engage in that which a college environment can offer. Sometimes plans for their own recovery dictate that those students spend some time away. Under certain circumstances, it is in everyone’s best interests for some distressed and disturbed people not to try to function as students, even when it appears that their cognitive skills are in place and they are deemed “capable” of doing the academic work. An absence or deficit in coping strategies can preclude being a responsible member of a community, even when other cognitive functions are intact. Decisions about recurring enrollment should ideally occur case by case, and be based on due process and due diligence.

At the same time, colleges have an obligation to try to help students learn, develop, and succeed. Those of us in higher education should strive for the ideal of maintaining openness and inclusiveness whenever possible. We should demonstrate, encourage, and reward civility, respect, tolerance, social support, and caring in ways that set standards and provide examples for this generation of students. Part of the learning process itself should include how to be responsible for one another and part of a community.

The Jed Foundation and the Suicide Prevention Resource Center, which work to prevent suicide among college students, recommend that colleges take a comprehensive approach to promoting mental health on campuses. Institutions should:

Promote social networks that reinforce a sense of campus community and relationships among students. Colleges should work to reduce student isolation and to encourage feelings of belonging. It is not simply a matter of urging each student to “get involved” but of creating opportunities in an environment of caring and connection. For example, the trend on many campuses to create smaller living-and-learning environments fosters relationships among students and between students and faculty members. Such relationships can be a significant protective factor against depression and suicide.

Help students develop life skills to face challenges. Colleges should encourage and create programs that improve students’ management of the rigors of campus life and equip them with the tools and techniques to manage triggers and stressors. Arizona State University, among other institutions, offers workshops to increase coping skills and help manage stress.

In addition to workshops, we should evaluate how the entire college experience provides opportunities to learn life skills that are appropriate for the developmental stage of traditional college students — not quite adults, no longer just adolescents. Toward that end, Arizona State is also working to include life-skills development in academic and orientation programs such as ASU 101, a course that the university encourages first-year students to take.

Educate students about mental health and wellness, and encourage them to seek appropriate treatment for emotional issues. According to last year’s National Survey of Counseling Center Directors, about 20 percent of student suicides involved former or current clients, suggesting that counseling may be a protective factor against suicide — and that only a fraction of the students who need such help are seeking it. Thus it’s important to stimulate campuswide cultural change that reduces the stigma surrounding mental illness and the barriers that keep students with suicidal thoughts and behaviors from looking for help. For example, Howard University has developed a film aimed at reducing the stigma associated with help-seeking among its among its primarily African-American student population. Colleges should also teach students about the signs and symptoms of mental illness and suicide, and provide online self-assessment tools and information.

Identify students who may be at risk for suicide or violent behaviors, through the use of outreach efforts, screening, and other means. Some examples include asking questions about mental health on students’ medical-history forms, voluntary screening to identify high-risk or potentially high-risk students, and increasing coordination between campus disciplinary processes and mental-health services. Colleges should also consider establishing a case-management committee, made up of people from various disciplines and areas of the institution, to deal with troubled students.

All administrators, faculty members, and students should also learn how o identify and refer a student in distress to the people who can help that student — and then practice those skills. As with CPR, it is one thing to learn how to do it from a manual, but it is another to practice it and receive feedback. Syracuse University, for instance, has developed an experiential training program based on that principle, teaching people on the campus how to recognize and respond appropriately to a student exhibiting the warning signs and risk factors for suicide.

Increase access to effective mental-health services that accurately diagnose and appropriately treat students with emotional problems. Colleges should institute policies and procedures that improve counseling services, work with other organizations in the community that focus on mental-health issues, and train counseling-center staff members and others about confidentiality, parental notification, and other legal issues.

At the same time, it is important to take the broadest possible view of mental-health services and recognize that the help students need may not always be clinical. Simply adding more therapists isn’t always the best way to improve access to high-quality services. Students from cultures that do not understand or acknowledge mental illness, or that discourage revelations of personal problems, are not likely to seek services, so colleges need to develop creative approaches to respond to those students in ways that they will find helpful and nonthreatening.

Many small colleges can’t afford to increase counseling-center staffs, so they require more-creative approaches to meeting the demand. Some colleges are being more innovative in providing access to services that are perceived by students as less stigmatizing. The University of Massachusetts at Amherst and Cornell University, for example, have triage systems, which allow brief, same-day appointments by phone, for quick assessment and determination of the urgency of the student’s need. Northeastern Illinois University, a commuter campus without residence halls, offers a “Feel Better Fast” option of four group sessions for students who may not need more-intensive therapy.

Create policies and procedures that promote the safety of distressed or suicidal students and outline how to respond to crises, including suicidal acts. That includes policies and procedures that respond to suicide attempts and high-risk behaviors, as well as the development of a comprehensive disaster and follow-up plan. The State University of New York at Albany has a protocol in place, Care Net, to identify students who may be suicidal and help them find the crisis treatment, and educational services they can use to cope with their problems and remain productive contributors to the university. Many colleges have also found the Jed Foundation’s “Framework for Developing Institutional Protocols for the Acutely Distressed or Suicidal College Student” to be an excellent blueprint for the development or revision of crisis procedures. Using it as a guide, the Massachusetts Maritime Academy’s counseling center convened the president, the vice president for student services, the commandant of cadets, faculty members, and the academic dean to review and revise existing policies.

Restrict access to potentially lethal sites, weapons, and other agents that may facilitate suicide attempts. Such actions might include limiting access to roofs of buildings, replacing windows or restricting the size of window openings, denying access to chemicals, like cyanide, that are often found in laboratories, prohibiting guns on the campus, and controlling the use of alcohol and other drugs. A working group at Oregon State University is examining the availability of lethal means on its campuses, reviewing institutional and national data about the most common forms of dangerous behavior, and studying other colleges’ firearms policies. The group also plans to inventory toxic chemicals and review policies for their storage, and to survey buildings to identify where students have access to high places.

Developing a comprehensive institutional plan that incorporates such strategies requires campuswide collaboration among many people, who are as diverse as bus drivers, coaches, campus ministers, dining-service personnel, facilities managers, and faculty members. We can avoid mass killings on our campuses similar to those at Virginia Tech and Northern Illinois, but only through cooperative and coordinated efforts that maintain vigilance and continuity over time. And although we can’t ever “fix” the problem of suicide or stop all violent deaths from occurring on our campuses, we can at least demonstrate to our students and faculty and staff members some better ways of communicating and caring for one another by exhibiting appropriate attitudes, beliefs, values, and skills that can be applied throughout life. Suicide prevention is violence prevention, and compassionate and caring campus communities are crucial.

Counseling centers are but one facet of a total response. Maintaining safety and security on campuses is everyone’s responsibility — not just that of campus security and the student-affairs office. Only by clarifying policies and procedures, and engaging key individuals and groups who communicate regularly and well with one another, can we begin to provide the safety net that we all wish to have in place.

Morton M. Silverman is a senior adviser to the Suicide Prevention Resource Center at the Education Development Center Inc. and senior medical adviser to the Jed Foundation. He is also a clinical associate professor of psychiatry at the University of Chicago, where he previously served as director of student counseling and associate dean of students.

http://chronicle.com Section: Commentary Volume 54, Issue 32, Page A51