College counselors, and students, lack resources for mental illness treatment

CHICAGO – As new details emerged Wednesday about the alarming behavior of the student behind the Virginia Tech massacre, college mental health experts said they will re-examine ways to help disturbed students and protect those around them.

Classmates described gunman Cho Seung Hui, who killed 32 people before killing himself, as sullen and withdrawn. A professor, concerned by Cho’s writings, had referred him to counseling. In 2005, a magistrate ordered him to a psychiatric hospital because of concerns he was suicidal.

Combined, the warning signs point to something being terribly wrong. But college counselors – who every year see more students suffering from depression, anxiety and stress – say it’s not that simple.

College officials don’t always share information with each other, because of confidentiality concerns or simply poor communication, and counseling centers may be so overwhelmed that students have to put their names on a waiting list before they’re seen. Universities generally don’t have psychiatrists on hand who specialize in detecting potential criminal behavior, nor do they have in-patient facilities or round-the-clock counselors.

Looking at the tragedy in Virginia, David Hayes, a clinical psychologist and director of the psychology training program at Louisiana State University’s student health center, gave a succinct assessment: “Every university in the country knows that could have been them.”

But he questions whether the counseling center at the university – or at any university for that matter – would have been able to properly diagnose and treat Cho, a 23-year-old senior.

“Mental health centers at universities are trained to deal with the normal problems of living – depression, anxiety,” Hayes said. “I just feel any university counseling center would probably get a referral like this and want to help and do what they could. But they’d be so outmatched.”

College mental health experts predict that after the horror at Virginia Tech, some colleges may refer their more severe cases to off-campus psychiatric treatment facilities. Other campuses may mandate counseling, rather than recommend it. And some may lift limits on the number of therapy sessions a student can receive.

“There will be changes. We will be little better at listening to what teachers have to say. We will probably train resident advisers a little more forcefully about when to make referrals,” said Peter Sheras, a clinical psychologist at the University of Virginia. “Hopefully, we will train whole student bodies that if somebody is suffering or having problems, they’ll let people know about it who can help.”

Nationwide, nearly 18 percent of college students say they suffer from depression, while 12 percent report experiencing anxiety disorders. About 9 percent said last year that they had seriously considered attempting suicide, according to a 2006 study by the American College Health Association.

That means that colleges and universities are “shifting from having these sleepy little therapy centers to doing more general mental health and crisis work,” said Dr. Thomas Kramer, director of the Student Counseling and Resource Service at the University of Chicago. Last year, the U. of C. counseling center saw 2,100 of the campus’ 14,000 students, up from 1,900 the year before.

College counselors have varying policies when working with students in crisis, but laws of confidentiality and privacy generally prevent them from sharing information unless there is a direct threat of danger to the student or others.

Just weeks ago, Virginia became the first state to pass a law that prevents public colleges and universities from dismissing or punishing students because of concerns about their mental health, including those who have attempted suicide.

Bob Gallagher, author of an annual survey of college counseling centers, has been watching the trends in college mental health for more than two decades. He said that not only are more college students being treated for mental health problems, but their problems – including depression, bipolar disorder and learning disabilities – are more severe than in the past.

In the 2006 National Survey of Counseling Center Directors, 92 percent of counseling directors said the number of students with severe psychological problems has increased in recent years. Several experts attribute the increase in part to more students with a history of mental illness going to college, helped by new medications and improved psychotherapy. They also said students are under more pressure to achieve than their peers were in the past.

“Treatments for behavioral disorders have gotten so much better that people who would never have gone to college are now getting treatment and are in school,” said Kramer, of the University of Chicago.

But once in school, students generally cannot be forced into counseling unless they have broken the law and are ordered to do so by a court, or if there is a university policy.

“Your hands are really tied unless you feel that there’s some sort of imminent danger,” said Richard Kadison, chief of mental health services at Harvard University.

Kadison, who has researched trends in mental health, said a recent Harvard survey found roughly 45 percent of the student body had experienced debilitating depression, and 10 percent had considered suicide.

“There can be a whole range of triggers,” he said. “Basically the big issue is really educating the whole community to know what some of the warning signs are to indicate a student’s in trouble.”

Still, there may be times when even the best mental health interventions can’t prevent a tragedy, experts said.

“In the same ways that you treat cancer, you can recognize it, see that it is there, and people will still die,” said Sheras, the University of Virginia psychologist. “We want to affix blame because we feel so darn powerless. We want people to say we missed something obvious so it doesn’t happen again.”

Karoun Demirjian of the Chicago Tribune’s Washington Bureau contributed to this report.
” We want to affix blame because we feel so darn powerless. We want people to say we missed something obvious so it doesn’t happen again.”