Shedding stigma to stop suicides on college campuses

Colleges are trying to help students learn to cope while also addressing mental health issues.

Story highlights

  • Increase in number of college students who seriously considered suicide, per report
  • More than 1,000 college students kill themselves every year
  • Schools and universities are training students, faculty and staff in suicide prevention

Kelly Wallace is CNN's digital correspondent and editor-at-large covering family, career and life. Read her other columns, and follow her reports at CNN Parents and on Twitter.

(CNN)Just a handful of days into the new semester at Penn State this fall, a student came to the counseling center in the throes of a panic attack, crying and upset, said Ben Locke, associate director of clinical services for the school's Center for Counseling and Psychological Services.

The student tried to get support from family and was turned away. "There's no question that the services we will give to (the student) will change (the student's) life ... and reducing stigma for those people is absolutely important and critical," said Locke.
As that story suggests, mental health needs on campus are real and serious. They're also growing, which is why as the first weeks of classes get underway at colleges and universities across the country, institutions are ramping up operations to try to keep their students safe.
The statistics are alarming.
Nearly 31% of students -- almost one out of three who sought counseling in the 2013-2014 academic year -- have said they seriously considered suicide at some point in their lives. Five years ago, it was 25%, according to the most recent annual report by the Center for Collegiate Mental Health at Penn State.
Equally concerning is the significant increase in the percentage of students who have purposely harmed themselves, such as engaging in cutting, hitting, burning and hair pulling, without intending to kill themselves. Almost 24% of college students who sought counseling in 2013-2014 had injured themselves at some point during their lifetimes compared to 21% five years earlier.
"When you put those two together, what they're really reflecting is students are more willing than ever to articulate being overwhelmed and to take that out on themselves, either through self-injury or through talking about the possibility of suicide or thinking actively about that and that plays out in all areas of university life," said Locke, who is also executive director of the Center for Collegiate Mental Health.
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"So universities are coping with the consequences of these kinds of behaviors and thoughts in ways that we haven't necessarily seen historically on a much greater scale."
At the same time, there has not been a significant increase in the number of students who have attempted suicide. That number has remained relatively flat, with 8% of students who sought counseling in 2008 reporting a suicide attempt at some point in their lives, compared to just under 9% five years later.
But still, that means nearly one out of 10 students who went to counseling on campus said they tried to kill themselves at some point. More than 1,000 college students kill themselves every year and suicide is the third-leading cause of death for people ages 15 to 24, according to a report by Emory University. Colleges and universities are constantly evaluating and updating their suicide prevention efforts to try to get their students the mental health help they need.

What schools are doing to help

From conversations with more than a half-dozen counseling professionals at schools around the country, it's clear that a main area of focus is training faculty, staff and students on suicide prevention.
During orientation at The Ohio State University, first-year students learn how to recognize warning signs of suicide, how to empathetically engage a person in distress and how to ask directly about suicide.
"We're big proponents on 'It's OK to ask the question.' We need to be able to ask the question, 'Are you struggling with depression? Are you struggling with suicidal thoughts?' " said Matthew Fullen, program manager for Ohio State University's Suicide Prevention Program.
Students are then taught how to help students access care and treatment.
"What we do talk about in our trainings with students as well as staff and faculty is that suicide is preventable and one of the ways that we prevent it is by encouraging students who are struggling with depression and anxiety to seek help early on," Fullen said.
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Ohio State is one of a number of colleges and universities that received a Garrett Lee Smith Memorial Act grant from the the Substance Abuse and Mental Health Services Administration. The grants are named in honor of former Sen. Gordon Smith's son, who died by suicide while in college.
Before Ohio State received a grant in 2007, 12.6% of its students answered that they received education or training in suicide prevention, according to the American College Health Association. That number jumped to 41.8% in 2014, which means that more than 27,000 students out of a student body of nearly 65,000 have received information about suicide prevention, according to the university.
"We really are interested in how many students, faculty and staff are receiving messages, outreach and education in anti-stigma and suicide prevention, and those numbers are very encouraging," said Darcy Haag Granello, project director of Ohio State's Suicide Prevention Program.
At Western Michigan University, a grant recipient in 2006, productions by the school's Theatre for Community Health program are performed on campus during new student orientation and typically include scenarios such as a roommate of a student who becomes depressed.
Another focus, as in most schools, is on training and educating the resident advisers who live among the students. They're often on the front line when it comes to witnessing signs of concern and persuading students to get the help they need.
"One of the things we've worked on with the RAs is how to have the conversations with the students so that it helps the students, if they have some internal stigma about getting help for an emotional difficulty, that they know it's OK. In fact, there is help available and a lot of students don't realize there are real, effective treatments for depression and anxiety," said Kathryn Lewis Ginebaugh, director of Western Michigan University's Suicide Prevention Program.
Boston University used its Garrett Lee Smith Memorial Act grant in 2009 to help build a "culture of caring" on campus, with the goal of spreading the message that "BU is listening, BU cares," said Dori Hutchinson, director of services for the Center for Psychiatric Rehabilitation at Boston University.
"We're listening because there's so much student distress out there and we know from the research ... two-thirds of the students, when they're really struggling, they don't go to campus mental health professionals or faculty or even their parents. They go to each other," Hutchinson said. "So we knew that we needed to provide gatekeeper training at the student level."
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Getting faculty and staff to recognize the warning signs of depression, anxiety and suicide, and how to guide students to seek the help they need, are paramount as well, she said.
"Faculty and staff often don't know what to do and they feel like, 'Well is it my job to be interfering, observing or commenting on someone's distress?' and I feel quite strongly that it is," Hutchinson said. "We can care about the students in our classroom. We can say, 'I notice that you can't keep your eyes open in class, now what's going on? I'm worried about you,' or 'You haven't been in class,' or 'You seem really distracted' and then letting students know there are resources on campus for them to use."
At the University of Massachusetts at Amherst, faculty and staff receive what's called the "maroon folder," which details very specifically how to recognize students' distress, what crisis resources are available and who within the administration should be notified.
"We've given over 5,000 copies of these out, we can't hold onto them," said Harry Rockland-Miller, director of the Center for Counseling and Psychological Health at the University of Massachusetts-Amherst. "I go around the campus and see faculty members having it clipped to their clipboard."
At Cornell University, which, like a number of schools, has dealt with a cluster of suicides on campus in years past, the school's leaders share their own stories of struggle in a video that all incoming students and grad students watch as part of orientation.
"We've had leadership statements from our (former) president saying, 'If you learn anything at Cornell, learn to ask for help. When I was in school, I struggled, went to a counselor (and) it was really helpful,' " said Gregory Eells, director of counseling and psychological services at Cornell University.
"I've been amazed at how many students have said, 'Wow, President Skorton went to see a counselor. He's doing OK.' " (David Skorton, who just left the university, is now the secretary of the Smithsonian.)
Humor can also be very effective, said Eells, noting a popular shirt made by Cornell students. It reads, "Cornell University: where your best hasn't been good enough since 1865."

Removing the stigma

Whatever the mechanism -- humor, peer-to-peer training or faculty and staff awareness -- something all colleges and universities are trying to do is remove the stigma about seeking mental health services.
"There is enormous shame around mental health and so many people feel like if they're struggling, it's a shameful experience," said Hutchinson of Boston University. "And so we're trying to peel that way and say, 'No, everyone struggles. It's part of the human condition. It's OK to ask for help because everyone needs it at some point in time.' "
Mental health stigma is keeping people from accessing the care they need, said Fullen of Ohio State. Combating that requires getting the entire campus community on the same page, he said.
"Not only is the student who is struggling able to seek help without stigma but hopefully their friends and classmates are also able to support their friend getting the help that they deserve and need," he said. "We really try to think about 'Why is it that with mental health we stigmatize people for getting help but with other sorts of physical ailments, we would be very concerned if people didn't go and seek treatment?'"
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To truly remove the stigma will require a culture shift, said Lewis Ginebaugh of Western Michigan, who is also an associate professor and licensed psychologist in the school's college of health and human services.
"With smoking, people used to smoke everywhere all the time and that changed amazingly in 20 years and so there are people trying to make a culture shift around mental health and suicide as well," she said. "It's a little bit slower, unfortunately, but I think it's starting to happen."

More students seeking help

If you look at the numbers of students seeking mental health counseling this year, there may be some evidence that efforts to remove stigma are paying off.
At Penn State, in the first week back, there was more than a 50% increase in the number of students scheduling a screening to evaluate their needs, said Locke. "Our numbers were up for week one last year and the year before and the year before," he said.
Said Rockland-Miller of Amherst, "All of us seem to be seeing more students in our counseling centers. This a national trend and certainly anxiety and depression are two of the most frequent presentations."
Reduction in stigma is likely part of the increase in demand, the counselors said. So is the fact that more students who enter counseling on campus already have a history of mental health care treatment.
There are also questions of whether students are less resilient or less able to cope on their own than in the past, said Locke. In fact, anxiety is now the top issue among college students seeking counseling, according to the Center for Collegiate Mental Health.
That is why more and more colleges and universities are focusing on resilience training on campus.
"How do you reframe how people think about their stress? How do you get them to think in a more adaptive way?" said Eells of Cornell. "I like to use the phrase, 'How do you learn how to fail better?' Because when we fail, that's how we learn, that's how we improve."
Hutchinson, of BU, said they're training faculty and staff to share the message that everyone struggles. Without it, students "don't see struggle as being productive," she said.
While promoting mental health awareness, some counselors said they don't want to build a culture of people who can't be resilient in the face of relatively minor failures.
"You will fail, things won't work out well and that's not necessarily a mental health problem," Locke of Penn State said. "We, as a society, not just higher education, need to be investing in this idea of building resilience, building coping and helping students, helping our children not view failure as the end but as a lesson and what do you learn from that."

A message for parents

Across the board, the campus mental health experts I spoke to said they believe there are things parents can do to help their children learn how to cope in college -- and when to realize it's time to step in and take action.
Our children don't necessarily have to fail miserably, but they can struggle and we should let them, said Hutchinson. She cites stories about parents calling their 18-year-olds to wake them up for class in college, or a dad putting sunscreen on his college freshman son.
We're so anxious about whether our kids are doing well, "We are checking, checking, checking and they begin to rely on that when there's a problem," she said. "Rather than, 'OK, what do I do?' (they're asking) 'Mom, what do I do?' "
Struggle is a natural part of the college experience, said Eells of Cornell.
"Going to college is like learning to walk in some ways," he said. "You've got to let them wobble a bit ... but you don't let them wobble out in the middle of the highway or street. ...You have to notice if things are really changing."
If they're not sounding like themselves, if they're feeling down, if they're feeling overwhelmed, if they're isolated, if they're not connecting, you reach out, talk to the counseling service, talk about ways to get them help, he said.
"As a parent, if you're conveying the message, 'I really care about you, I just want you to get help, I don't want to know what's going on, I just want to make sure you're OK, get help, there's hope,' that's what you can do," Eells said. "I think, developmentally, that's what's appropriate here, not making it all perfect, because college is about challenge but it's about conveying that sense of hope."
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What do you think can be done to reduce the stigma when it comes to college students seeking mental health support? Share your thoughts with Kelly Wallace on Twitter @kellywallacetv or CNN Parents on Facebook.