The Dean of Students Office

Creating a Culture of Care

Students in Distress FAQs

Are more students coming to college with mental disorders?
Probably yes. Caution is required because increases in counseling center visits and use of psychotropic medications may mean contemporary students are more willing to seek help for mental illness. In any event, college health center directors have been calling particular attention to larger numbers of students reporting the characteristics of clinical depression. A 2004 American College Health Association study found that forty-five percent of the students surveyed “felt so depressed” that it was “difficult to function.” Nearly 1 in 10 students reported that such feelings occurred “9 or more times” in the past school year. Likewise, about 10% of college students report they “seriously considered suicide” and about 1.4% reported they had attempted suicide (Morton Silverman, Clinical Associate Professor of Psychiatry at the University of Chicago; 2006 presentation at the University of Vermont Conference on Legal Issues in Higher Education).

How widespread is suicide among college students?
Multiple studies have found that college students commit suicide at half the rate of their non-student peers. One of the most cited surveys “found an overall student suicide rate of 7.5 per 100,000, compared to the national average of15 per 100,000 in a sample matched for age, race and gender” (Silverman, et al.,l997, “The Big Ten Student Suicide Study: A 10-year study of suicides on Midwestern university campuses,” Suicide and Life Threatening Behavior 27[3]:285-303).
Generally, the national suicide rate for teenagers and young adults has been declining- after an extraordinary increase since the 1950s. More baseline studies pertaining to college students are needed, but experts believe the suicide rate in that group has been declining as well.

Shouldn’t we routinely remove depressed students, especially if they report suicidal ideation?
No, unless a threat or act of violence is involved. A 2006 article by Paul S. Appelbaum, Professor and Director of the Division of Psychiatry, Law, and Ethics at the Columbia University College of Physicians and Surgeons (and a past President of the American Psychiatric Association) highlights some the practical issues involved:

No matter how uncommon completed suicides are among college students, surveys suggest that suicidal ideation and attempts are remarkably prevalent. Two large scale studies generated nearly identical findings. Roughly 10 percent of college student respondents indicated that they had thought about suicide in the past year, and 1.5 percent admitted to having made a suicide attempt. Combining data from the available studies suggests that the odds that a student with suicidal ideation will actually commit suicide are 1,000 to 1. Thus policies that impose restrictions on students who manifest suicidal ideation will sweep in 999 students who would not commit suicide for every student who will end his or her life- with no guarantee that the intervention will actually reduce the risk of suicide in this vulnerable group. And even if such restrictions were limited to students who actually attempt suicide, the odds are around 200 to 1 against the schools having acted to prevent a suicidal outcome. (Psychiatric Services: “Depressed? Get Out” July 2006, Vol. 57, No.7, 914-916).

Aside from unjustified removal of thousands of individuals-including some of our best and most creative students-routine dismissals for reported depression or suicidal ideation would also discourage students from seeking professional help. Good policy, good practice, and adherence to state and federal laws protecting people with disabilities require professional individualized assessment and a fair procedure before students or employees can be removed on the ground that they have a mental disability that poses a “direct threat” to themselves or others.

Is there an association between mental illness and violence?
Research shows some association between severe mental illness and violence, especially when mental illness is accompanied by substance abuse. The 1994 American Psychiatric Association “Fact Sheet on Violence and Mental Illness contains the following observation:
People often fear what they do not understand, and for many of us, mental illnesses fall into that category. This fear …[often] stems from the common misconception that the term ‘mental illness’ is a diagnosis, and that all mental illnesses thus have similar symptoms, making all people who suffer with them equally suspect and dangerous … Recent research has shown that the vast majority of people who are violent do not suffer from mental illnesses. However, there is a certain small subgroup of people with severe and persistent mental illnesses who are at risk of becoming violent.

The U.S. Department of Health and Human Services document “Understanding Mental Illness: Fact Sheet” (April20, 2007) contains the observation that “[c]ompared with the risk associated with the combination of male gender, young age, and lower socioeconomic status, the risk of violence presented by mental disorder is modest.” Such a “modest” correlation won’t be sufficient to draw conclusions about the future behavior of any particular student. Again, individualized assessment will be imperative, focusing on a specific diagnosis, demonstrable behavior, compliance in taking prescribed medications, patterns of substance abuse, and any recent traumatic events or stresses, among other factors.

How can I identify potentially violent students?
This is not a task to be undertaken alone. Expertise is available on campus to help. See the contact information below and in our first answer.
It is important to resist the temptation to try to “profile” potentially violent students based on media reports of past shootings. The 2003 National Research Council [NRC] report Deadly Lessons: Understanding Lethal School Violence (a project undertaken by the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine) contains the following guidance:

One widely discussed preventive idea is to develop methods to identify likely offenders in instances of lethal school violence or school rampages … The difficulty is that … [t]he offenders are not that unusual; they look like their classmates at school. This has been an important finding of all those who have sought to investigate these shootings. Most important are the findings of the United States Secret Service, which concluded:

  • There is no accurate or useful profile of ‘the school shooter.”
  • Attacker ages ranged from 11-21.
  • They came from a variety of racial and ethnic backgrounds.
  • They came from a range of family situations, from intact families with numerous ties to the community to foster homes with histories of neglect.
  • The academic performance ranged from excellent to failing.
  • They had a range of friendship patterns from socially isolated to popular.
  • Their behavioral histories varied, from having no observed behavioral problems to multiple behaviors warranting reprimand and/or discipline.
  • Few attackers showed any marked change in academic performance, friendship status, interest in school, or disciplinary problems prior to their attack.

A more promising approach is ”threat assessment,” based on analysis of observable behavior compiled from multiple sources and reviewed by a trained threat assessment team. The report “Threat Assessment in Schools: A Guide to Managing Threatening Situations and to Creating Safe School Climates” (developed by the U.S. Secret Service and Department of Education in 2002) contains the following overview:

Students and adults who know the student who is the subject of the threat assessment inquiry should be asked about communications or other behaviors that may indicate the student of concern’s ideas or intent. The focus of these interviews should be factual:

  • What was said? To whom?
  • What was written? To whom?
  • What was done?
  • When and where did this occur?
  • Who else observed this behavior?
  • Did the student say why he or she acted as they did?

Bystanders, observers, and other people who were there when the student engaged in threatening behaviors or made threatening statements should be queried about whether any of these behaviors or statements concerned or worried them. These individuals should be asked about changes in the student’s attitudes and behaviors. Likewise, they should be asked if they have become increasingly concerned about the student’s behavior or state of mind.
However, individuals interviewed generally should not be asked to characterize the student or interpret meanings of communications that the student may have made. Statements such as “I think he’s really dangerous” or “he said it with a smile, so I knew that he must be joking” may not be accurate characterizations of the student’s intent, and therefore are unlikely to be useful to the threat assessment team … (p. 52).

Proper threat assessment is a team effort requiring expertise from experienced professionals, including law enforcement officers. Threat assessment on our campus is done by the Behavioral Assessment Team, headed by Chief Paul Lester, 334-5963 and Dean of Students Brett Carter, 334-5514. Faculty and staff members should contact UNCG Police whenever they believe a student may pose a risk of violence to self or others. If in doubt submit an online Concerning Behavior report. In an emergency, contact the University Police immediately 334-4444.

Should I talk with a student about my concerns?
Exercise judgment on a case by case basis, preferably after consultation with colleagues, perhaps including the Threat Assessment Team.
An effort at conversation is generally advisable. Students are often oblivious to the impressions they make. Careful listening and courteous dialogue-perhaps with participation by a department chair or academic advisor-will often resolve the problem. At a minimum, the discussion may prove valuable in any subsequent threat assessment process.
Please do not give assurances of confidentially. A student who appears to pose a threat to self or others needs to be referred for help and supervision. Professors should not abrogate their traditional role as guides and mentors, but they must not assume the responsibilities of therapists or police officers.

If you feel uncomfortable talking directly with a student, another tool for your use is the Starfish for Faculty and Staff.    Starfish EARLY ALERT is an early warning and student tracking system at UNCG that will take a more holistic approach to student success rather than concentrating solely on students with classic at-risk characteristics. Starfish relies on reporting by the campus community to identify students who need additional academic support. A staff member will follow up with each student.

One danger in the aftermath of the Virginia Tech shootings would be a climate of fear and distance between professors and students, especially students who seem odd, eccentric, or detached. Research on violence prevention suggests schools and colleges need more cross-generational contact, not less. The NRC report stated that:

In the course of our interviews with adolescents, we are reminded once again of how “adolescent society,” as James S. Coleman famously dubbed it 40 years ago, continues to be insulated from the adults who surround it … The insularity of adolescent society serves to magnify slights and reinforce social hierarchies; correspondingly, it is only through exchange with trusted adults that teens can reach the longer-term view that can come with maturity. [W]e could not put it better than the words of a beloved long-time teacher [at one of the schools studied]: ”The only real way of preventing [school violence] is to get into their heads and their hearts.

Getting into the “heads and hearts” of students goes beyond individual conversations. It entails fostering a community of caring, defined not by codes of silence or barriers of indifference, but by an active sense of mutual responsibility. This critical endeavor depends upon the faculty and staff. Now more than ever they must demonstrate skills in reaching outward, not retreating inward.
The UNCG Cares Program seeks to create the ‘community of caring’ by training faculty and staff to engage students through active listening, recognition of signs of distress, and appropriate referral. To sign up for the training or to have the training brought to your department, please contact the Dean of Students Office.

Our University has a wealth of resources to assist students. Please don’t hesitate to make use of them in addressing concerns.
Many thanks to Gary Pavela of the University of Maryland for much of the language and expertise contained in this document.    Used with his permission, August 2007.

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