New York Times (12.03.04).

Worried Colleges Step Up Efforts Over Suicide.

By KAREN W. ARENSON

Nicole Thompson was required to take a leave from Columbia after talking to friends about hurting herself.

Nicole Thompson had been at Columbia University for only a few weeks when she went out drinking with a group of friends downtown last year and became separated from them. She had skipped her medication for bipolar disorder. Now it was 3 a.m. and, crying and in a panic, she called friends; she told them, she said, that she "just wished the traffic would take me out."

Although she made it back to campus safely, her friends had already notified Columbia that they were worried about her. For Columbia officials, it was the first clue that Ms. Thompson faced any kind of mental health problems.

"I wasn't on Columbia's radar at all," said Ms. Thompson, who is back on campus now after being forced to take a medical leave.

Increasingly, college officials and mental health experts have come to realize that many of the most vulnerable students - the ones prone to self-injury and suicide - are like Ms. Thompson: they never go near the counseling centers or reveal anything about their experience before college. As a result, colleges are stepping up efforts to find them and to get them into treatment, sometimes forcing them to leave temporarily.

The goal is to help students like Ms. Thompson. But colleges have more at stake. Suicide - the second-biggest cause of death among college students - can be costly, injuring reputations and prompting litigation. The suicide of a student at the Massachusetts Institute of Technology, Elizabeth Shin, in 2000, and strings of suicides at New York University, George Washington University and the University of Illinois, have drawn wide attention. There has also been a rise in lawsuits involving student suicides.

Ann H. Franke, a vice president of United Educators, a company that insures 1,200 universities, colleges and schools, said suicide prevention had risen in priority as claims had risen; her company, Ms. Franke said, now has a "handful" of claims, up from none six years ago.

"They can be very severe claims financially," Ms. Franke said, "not to mention the emotional and reputational impact they can have on a school."

In a closely watched case, the family of Elizabeth Shin has sued M.I.T. for $27 million.

One study of suicides on college campuses, based on a dozen universities in the 1980's, found a rate of about 7.5 per 100,000 students, which is about half the rate for young adults not in college and represents about 1,100 suicides a year for the entire college population. Although there have not been comparable studies since then, most mental health experts say they believe the rate has remained at about that level.

To address the problem, Emory University and the University of North Carolina are inviting students to fill out anonymous mental health questionnaires. Duke University is asking faculty members to be alert to changes in behavior - noticing, for example, when a student suddenly becomes sullen or quiet, or stays away from class. Columbia, New York University and Cornell now place counselors in residence halls. The University of Illinois and the University of Puget Sound in Tacoma, Wash., are requiring any student who threatens or attempts suicide to attend counseling sessions.

But the best way to reach these students remains unclear, and students do not always welcome the intervention. Some experts fear that forcing students to enter treatment or to take a medical leave can dissuade others from asking for help and discourage their friends from sounding the alarm, even though students who take such leaves generally come back and graduate.

The recent forced withdrawal of a freshman at N.Y.U. was front-page news in the student newspaper, Washington Square News. The student, Sue Schaller, told the paper that although she had been briefly hospitalized for depression and suicidal thoughts, she felt much better when she returned to campus and wanted to stay in school, but that the university would not let her.

An editorial in the newspaper called for the university to "do everything it can, including requiring therapy and regular check-ins, to ensure that troubled students who wish to remain on campus can stay and that they pose as little risk as possible," adding, "Pushing those students out of the university community is not the answer."

In retrospect, Ms. Thompson, the Columbia student, said she had mixed feelings about how the university treated her. She said she still felt wounded by the process - she called it a "charade" - that ejected her from school.

Even with things going smoothly, Ms. Thompson, whose dark hair is tinted purple and who speaks with energy and humor, said her mind sometimes wandered to what she missed last year, while she was on leave, and to the possibility of running into new trouble.

"I am so scared about screwing up," she said, "and of being sent home again."

Columbia officials declined to comment on Ms. Thompson's case. They said that the university did not keep statistics on how many students were forced to go home, but that there were few of them.

For years, colleges and universities have been grappling with a growing flood of students with histories of mental illness. Most have expanded the number of counselors and the hours they are available.

But now they are going further. Some are turning to the Internet as a way to bring troubled students in for help. The American Foundation for Suicide Prevention has developed an anonymous online mental health questionnaire and a program to steer troubled students to counseling, which is being tested at Emory and the University of North Carolina. Those involved say the initial results seem promising.

At Emory, which started using the program in 2002, only 8 percent of the students who received the survey filled it out, but 85 percent of those students were deemed at moderate or high risk of suicide or other severe problems based on their responses to the questionnaire. They are encouraged to speak to a counselor on or off campus, or to consult anonymously with a counselor online.

"The yield is relatively small," said Ann Haas, research director for the suicide-prevention foundation. "However, we are absolutely convinced that those kids would not have gotten into treatment. We think we are reaching the right kids."

Many campuses, including Duke and M.I.T., are asking faculty and staff members and students to tell a dean or the counseling office if they see students who show signs of depression or potential suicide.

At Duke, when faculty members or parents relay concerns about students to Larry Moneta, the vice president for student affairs, he and members of the residence hall staff check up on the students, sometimes surreptitiously.

"Many times I've called the residence hall staff and asked if they can dispatch a paraprofessional to inadvertently drop by a student's room as if it were a casual encounter," Dr. Moneta said. "I do that all the time."

After Ms. Shin's suicide, M.I.T. began running training sessions for faculty members, departmental administrators, athletic coaches, dormitory personnel, fraternities and sororities to help them spot people showing signs of problems - one of several steps recommended by a mental health task force created after the suicide.

Cornell is making a special effort to reach out to Asian and Asian-American students. Of 16 students there who have committed suicide since 1996, 9 were of Asian descent. The university created a task force to explore those students' experience at Cornell and how to help them when they have problems, since they do not use Cornell's counseling services at the same rate as their classmates, said Susan H. Murphy, the university's vice president for student and academic services. Often when they do seek help, "they are in real crisis," Ms. Murphy said.

Colleges are also leaning more heavily on students who show suicidal tendencies to enter counseling. Several are examining or adopting a program developed by the University of Illinois at Urbana-Champaign, requiring any student who threatens or attempts suicide to attend at least four counseling sessions.

Paul Joffe, the program's director, said the results had been good: all but one of nearly 2,000 students in the program over 20 years remained at the university during the counseling sessions, and none committed suicide. And although the university has had suicides among students not in the program - including six in the last academic year - it says its suicide rate is about half of what it was before the program started.

While some college officials question whether students should be forced into counseling, others favor the heavy-handed approach. The University of Puget Sound, one of the campuses that recently began using the Illinois approach, bluntly describes the program as "a public statement that suicide is unacceptable here."

"We don't know what it is about that model that is so effective," said Donn Marshall, director of counseling, health and wellness services at Puget Sound. "Is it that somebody stands up and says suicide is unacceptable? Or is it that somebody says, 'I care'? Or is it something about what happens in the four sessions with a psychologist?"

When Ms. Thompson arrived at Columbia last year from Nashville, she had been struggling with bipolar disorder and problems with drinking and drugs, and she had a cabinetful of medications. She had planned to contact the counseling service to find someone to talk to, but three weeks into the school year, she had not gotten around to it. She said she had arrived confident she could succeed.

"There was a big to-do before I went to school to ask my doctors if I was ready," she said. "They all said yes." What most put her off about the way Columbia handled her case, she said, was the quick interview with a university psychologist that she thought was intended to figure out what she needed to do to stay at school, but that she later learned was to decide whether she should be allowed to remain.

She said she had been totally candid in talking to him, because "I've talked to a lot of psychologists, and realized that if you tried to butter them up, you don't get the help you need."

But she said she did not believe the university had been equally candid. "He worked for the school, not the patient," she said. "If they don't tell you that, you lose trust. The kids they are dealing with are smart enough to understand the dynamic after the fact."

Margo D. Amgott, assistant vice president for health services at Columbia, said the university tried to make sure students understood that the interview was for the university's evaluation purposes and even required that they sign a document saying they understood.

Ms. Thompson said that while she did indeed signed papers, she had had no choice, and thought that the decision to stay or leave would still be up to her and her family. But when she and her father talked about lining up support for her in New York, they learned that it was not their call, and she was given four days to move out of her room.

Being sent home to Nashville just three weeks into her freshman year made her feel worse rather than better, she said, and she ended up in a psychiatric hospital.

She said that now that she was back at Columbia, she was doing well. She is majoring in anthropology and has a late-night radio program, "Zombies vs. Ballerinas," that features groups like Mogwai.

And while she is in regular touch with a college adviser assigned to her, she has not sought psychological help, either at Columbia or outside.

"Last year's treatment was so expensive that it has driven my father into debt," Ms. Thompson said. "It makes me feel guilty."