It was the worst possible outcome: A college student in need of mental help killed 32 people before committing suicide.

What befell the Virginia Tech campus is a sensational story among countless cases of students living with mental illness. Researchers and therapists say the demands on college mental health services have been increasing for years.

But how big the problem has grown, no one knows.

“There is no really objective data that is able to document trends in mental health in college students,” said Ben Locke, psychologist and assistant director of research and technology at the counseling center at Pennsylvania State University in State College.

Locke coordinates a national effort to standardize the data that college counseling centers collect, to improve clinical service. So far, that undertaking – called the Center for the Study of College Student Mental Health – has about 120 centers interested in participating.

With such information, “perhaps the net would be just a little bit more complete and might have caught (the Virginia Tech shooter) or other individuals, whether they’re a risk to themselves or somebody else,” Locke said, adding that the recent killings emphasize that “mental health issues need to be attended to as a first priority, rather than when they become a crisis.”

Administrators and counselors express the same sentiment, especially as they note the rising demands on their own centers.

In the late 1980s, Robert P. Gallagher, then-director of the University of Pittsburgh’s counseling center, observed a shift.

“I began noticing at that time that the students coming into our center were bringing in more serious concerns,” such as depression, suicidal thoughts and panic attacks, he recalled. “So I began asking directors whether they were noticing similar things.”

They were. Pittsburgh’s annual survey of center directors, which Gallagher still conducts, found 56 percent of the directors in 1988 felt their centers were spending more time on students with more severe psychological problems. That rose to 92 percent last year.

“Most of those students can be treated in the counseling center within the time limits available and existing treatment,” Gallagher said. “But about 8 percent of them have problems so severe that they just can’t remain in school and can only do so, some of them, with extensive psychological or psychiatric help, frequently more than centers are able to provide.”

Directors also have reported more students on medication for psychological problems. In 1994, 9 percent of center clients took such medication. Last year, it was a fourth.

When Dr. Leslie Lawrence, a family physician, left private practice to begin a career in college health six years ago, he expected to treat relatively carefree students.

“I was shocked that the most frequent medication I prescribed isn’t the (birth control) pill,” said Lawrence, now medical director at the student health center at Rensselaer Polytechnic Institute in Troy, N.Y. “It’s Prozac, and then Zoloft and Wellbutrin and all the antidepressants,” used to treat both anxiety and depression.

This generation of college students has grown up with more effective treatments and medications such as Prozac, which hit the market in 1988, the year many of today’s freshmen were born.

Counselors say such medication has had a dual effect: It has made college students of teens who wouldn’t ordinarily be able to handle the stresses of admission.

But when these students get to campus, some can’t manage the pressures of college life.

There is the added complication of having the student, for the first time, in charge of managing his or her treatment.

“A lot of these kids, their parents take them to the doctors; they monitor the meds; they buy the meds; they get their prescriptions filled,” said Jerilyn Ross, president and chief executive officer of the Anxiety Disorders Association of America in Silver Spring, Md. “You’re leaving it up to a young kid to be doing all this, and a lot of them just don’t bother.”

A March report from Ross’ association said that nearly all schools it surveyed saw more students using counseling services over the last three years: 29 of 33 (89 percent) liberal arts colleges and 35 of 36 (97 percent) national universities. Some schools related increases in the severity of student problems and in students already taking psychiatric medications.

What is causing these increases isn’t clear, and the theories are hard to prove.

Some believe numerous forces are converging: higher pressure in schools, advances in diagnosis and treatment, and the ability of young people to research their ailments on the Internet.

“Students are a lot more savvy about these things, because there’s so much more information out there,” said Mike Malmon-Berg, staff clinical psychologist at the wellness center at Ohio’s College of Wooster. Plus, he said, the stigma of mental illness seems to have softened among young people. Some talk to each other about counseling experiences, even about their medications.

The spring 2006 National College Health Assessment report from the Baltimore-based American College Health Association said that nearly 15 percent of students surveyed indicated they had been diagnosed with depression, up from about 10 percent in spring 2000.

Those same semesters, close to 50 percent of female students and almost 40 percent of male students said they had felt “so depressed it was difficult to function” at least once within the previous school year.

Many come to college already stressed.

In 1985, 18.1 percent of incoming freshman said they felt frequently overwhelmed by all they had to do, in a University of California, Los Angeles, annual, nationally representative survey. That figure peaked in 1999 at 30.7 percent, slipping to 28.7 by 2006.

Also in 1985’s survey, 8.6 percent of incoming freshman said they had felt depressed frequently. The high, 10.6 percent, came three years later. In 2006, it was 7.3 percent.

Freshmen have reported increased expectations to get counseling, with fluctuations along the way, since 1989. That year, 3.5 percent said they planned “to seek personal counseling,” though the survey does not specify what kind. Last year, 7.8 percent did.

“It’s very likely that it could be some other form of counseling” than psychological, said Victor B. Saenz, a research manager at UCLA’s Higher Education Research Institute. “If anything, though, it is an indication of students’ willingness to report that they are needing some assistance in some capacity, so you don’t want to be dismissive of that, of course.”


(Michele M. Melendez can be contacted at michele.melendez(at)


AP-NY-04-20-07 1536EDT

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