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MENTAL HEALTH

Colleges on alert for warning signs

Cynthia Hopkins, who once worked with professor Liviu Librescu, visited a memorial to those killed at Virginia Tech. (sam dean/the roanoke times via associated press)

In recent years, universities have been trying to weave stronger nets to catch students who are potentially dangerous to themselves and others. But even so, college officials and mental health specialists say that some -- like Virginia Tech's Seung-Hui Cho -- may still slip through.

From big-name private colleges to small public schools, universities are focusing on student mental health as never before. At MIT, every faculty member last fall received a pamphlet on how to help students in distress. UMass-Lowell administrators held a faculty dinner two months ago to discuss warning signs of mental illness and have followed up with workshops on the challenges of the current generation of students .

Mental health services that used to serve largely as career counseling centers now often assess or treat many students with real psychiatric illnesses. Colleges try to train parents, roommates, and faculty in the signs of suicide and sources of help when a student seems to be going off track.

Typically, when a student appears to be having psychiatric problems, teachers or dorm-mates report their concerns to an administrator, who then brings in mental health professionals to determine what should be done. The student may end up staying on campus or leaving for a while; in Cho's case, he was reportedly hospitalized briefly in 2005 after complaints that he had stalked two women and might be suicidal. Upon his release, he returned to campus.

But, for all the added attention and resources devoted to mental health, colleges are also highly constrained in the actions they can take when a student seems ill.

"You can identify someone as being at risk" for suicide or other violence, "but if they're not doing anything illegal, you can refer them to the college counseling center and so forth, but you can't force them" into treatment, said Gerald Koocher , dean of the School of Health Studies at Simmons College and a past president of the American Psychological Association.

Privacy considerations can also hamper schools' actions. Unless a student exhibits signs of imminent harm to himself or herself or others, colleges need a student's permission before talking with parents, professors, or others on campus who could help.

"We are always walking the delicate balance of doing everything we can for a student while protecting the privacy rights of a student," said Larry Siegel , dean of student affairs at the University of Massachusetts at Lowell.

On the other hand, university mental health workers say privacy laws are essential in helping students, even if they limit the scope of intervention.

"Unless people know they can speak in a confidential way, they won't come to us," said Harry Rockland-Miller, director of mental health for university health services at the University of Massachusetts at Amherst. "Confidentiality is the foundation that allows us to do the work we do."

In Virginia last month, the Legislature passed a groundbreaking law that forbids colleges from expelling or otherwise punishing a student for attempting suicide or reporting suicidal thoughts.

Further, the most potentially dangerous students are also the likeliest to resist medication or therapy, said Dr. Michael Brody, media committee chair for the American Academy of Child and Adolescent Psychiatry.

The type of person who commits a mass shooting, he said, is "a very paranoid individual." And "if you're paranoid, you're probably the most dangerous and probably the least receptive to treatment, and that's the problem."

It can also be tremendously hard to determine which distressed students are likely to pose true dangers, psychiatrists say. The known risk factors for suicide and homicide are largely similar. Warning signs include isolation, trauma, drug and alcohol use, a history of trauma or family violence, and a tendency to be impulsive. But the biggest warning sign is a history of committing violence in the past; Cho apparently had no such history, though he had been accused of sending unwanted e-mails to two women.

And a student's troubled past might be inaccessible to college counselors since schools don't always have access to medical records.

"Essentially, you are starting with a clean slate and trying to predict behaviors based on a student's time in college," said Ken Garni , director of the counseling center and chair of the department of psychological services at Suffolk University.

At MIT, students and staff are encouraged to trust their intuition about whether someone might need help, said Alan Siegel, the university's chief of mental health. Still, Siegel said, "when push comes to shove, you're not going to be able to predict with scientific precision" who poses a danger.

Even with the added emphasis on prevention and intervention, some students who commit violent acts never appear on a university's radar screen.

At UMass-Lowell, Nikhil Dhar, 24, was a student government leader, well known on campus, and appeared well adjusted. But on Dec. 22, 2005, he followed his hematology class professor to her home in Cambridge and confronted her over a failing grade. He feared the grade would cause him to be deported to his native India, according to published reports.

Dhar allegedly hit her and stabbed her in the neck. Police found a note in his pocket which read in part: "I'm sorry I'm having to do this. But I have no options left. . . . I have nothing to lose." Dhar pleaded guilty to charges of armed assault with the intent to murder and assault and battery in Middlesex District Court on Tuesday and was sentenced to four to five years in prison.

From the psychiatric point of view, the Virginia Tech shooting may not have been preventable, said Dr. Alvin Rosenfeld, a member of the board of governors of Harvard's Center on Mental Health and the Media. But if college mental health services are improved, he said, "I think that of the 1,000 kids who jump off bridges, 350 of them are preventable."

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