In the aftermath of the Aurora, Colorado, movie theater shootings, the issue of students and mental health is again in the spotlight.
Kristine Bertini, Psy.D., senior psychologist, University Health and Counseling, University of Southern Maine, says since Columbine, threat assessment and follow-through has been more closely examined at academic institutions across the country.
Bertini says it’s important to spread the word about warning signs. “People need to know what to look for and how to make a referral to a professional.”
USM has trained faculty and staff in both areas, with an emphasis on a “warm transfer” to counseling services. “In a warm transfer, the faculty person will say, ‘Why don’t you wait until after class, and I’ll walk you over to the counseling office?’ or ‘Let’s make the call together from my office for an appointment,’” she says.
Dan L. Jones, Ph.D., ABPP, president of the Association for University and College Counseling Center Directors and director and chief psychologist of the Counseling & Psychological Services Center at Appalachian State University, says the majority of U.S. universities and colleges have some type of threat assessment or behavioral assessment team. He says academic institutions have done a good job of increasing outreach and training, but the side effect is that services are overloaded. With the economic downturn, there’s less funding and resources, he says.
In addition to counselors, intervention teams can include a variety of school, community and law enforcement members who help serve as “eyes and ears” on campus, says Monica Osburn, Ph.D., president of the American College Counseling Association and director of the counseling center at North Carolina State University.
“Therapy can help a lot of things, but if we are dealing with housing-related issues or homelessness or academic concerns, there’s a lot of other resources that can be plugged in,” Osburn says.
Craig Piers, Ph.D., director of education and training, Psychological Counseling Services at Williams College in Massachusetts, which has been active in the New England College Health Association, says it’s important for colleges to develop “a community of concern and care,” and train faculty and students to recognize and assist someone who may be of concern.
“You can have people who aren’t in the field but will have training of how to talk to someone if you are worried about them, how to encourage them to see someone,” Piers says, noting that his college increasingly offers formal education for deans, faculty and students.
Among college students, incidents of mass violence are an anomaly, Jones says. “The fact that it is so rare means that the base rate is so low that there’s not enough data to have a scientific way of predicting such violence.”
Piers says common problems for this age group include stress related to studies, relationship issues, poor decisions fueled by alcohol, eating disorders and identity issues.
“It’s the first time they’ve been away from home,” Piers says. “Their reliance on peers is very high.”
Jones says the majority of people at imminent risk are more likely to be harmed by someone else than they are to harm someone.
“A lot of students that come to our attention are strange or unusual or bizarre and make people uncomfortable, but there are lots of people like that,” Jones says. “People have a right to be eccentric.”
Aside from unusual behaviors, mental health professionals would want to know if the student tried to obtain weapons and would look for “leakage,” Jones says.
“Most of the school shooters have told somebody what they are going to do or they put it on their Facebook,” Jones says. “So a lot of times when we are worried about somebody, we check their Facebook or social media.”
In Colorado, suspected gunman James Holmes allegedly asked a friend if she had “heard of” dysphoric mania and warned her to “stay away.”
“That would be considered leakage, and something we would look for,” Jones says.
Holmes had been seen by several mental health professionals at his University of Colorado Denver campus during his time as a neuroscience Ph.D. student. One school psychiatrist allegedly notified campus police about Holmes and his name was brought to the attention of a university threat assessment team.
However, Holmes dropped out of school and Osburn says one question that may come out of this incident is, “Where does the university’s responsibility end?”
“At what point, once referrals are made or whatever follow-up care is initiated, is the school no longer responsible?” she asks. “I think that’s probably where we’re going to spend some good quality think time going forward because most of the other incidences were with students who were active students.”
Increasingly, universities are coming up with innovative methods to reach students.
USM has undertaken several initiatives through a Substance Abuse and Mental Health Services Administration (SAMSHA) grant, including adding a full-time person to work with high-risk students and facilitating an electronic email cohort system. The students are divided into cohorts of 400, in various categories, such as athletes, new students, veterans, etc. Every few weeks, the counseling department sends a different cohort an email, asking students if they’d like to take a mental health assessment electronically. “Many of our students are more apt to be online, rather than wanting to do a face to face meeting,” she says.
Each cohort is assigned a therapist. “Those who are at highest risk, the counselor will try to get to come in face to face,” Bertini says.
“We’ve been very successful in reaching students we may not have reached otherwise,” she says.
The SAMSHA grant also funds a peer student training program. “That has really gotten a lot more students in to the office because the peer connection is so much more profound than if a faculty person or another adult asks a student if something is wrong,” she says.
Piers says the counseling center at Williams has continued to increase its presence on campus, and he believes the stigma of mental health issues is dropping.
“I think people are using services more readily, they are more comfortable,” he says. “In every year I’ve been here, the number of students we see has grown. We will have seen almost 40 percent of a graduating class by the time they graduate.”
Williams also has an At Risk Committee – comprised of members of the Dean’s Office, Psychological Services and the health center – that is activated for more serious cases, such as suicide attempts, to help them create a plan. “It’s very important to know who those students are and not let them fall through the cracks and have some follow-up on it,” he says. “It’s been very helpful for students to kind of turn things around. For some students, something will happen and they feel it has no impact. That can create a sense of isolation, but also can put them at risk to do it again. If they see the college community is active and there, and ‘here’s the resources we’re going to provide you,’ I think it’s helpful to them.”
By Pamela Berard