Depression and Suicide Intervention Programs on College Campuses with Laurie Davidson, M.A.
Laurie Davidson, M.A., manages campus programs at the Suicide Prevention Resource Center (SPRC) at Education Development Center, Inc. She has worked for more than a decade to help campus administrators and staff across the country develop and implement effective health promotion and prevention programs. In her present role at SPRC, she oversees 50 campuses receiving suicide prevention grants from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. She has presented at state and national conferences and in webinars on a variety of topics, including the public health approach to campus health problem prevention, best practices in suicide prevention, and principles for sustaining prevention programs. Before joining SPRC in 2005, Davidson directed the Campus Alcohol Prevention and Intervention project, funded by the Robert Wood Johnson Foundation, aimed at organizing statewide approaches to alcohol, drug, and violence prevention in higher education. She also served as an associate director of the U.S. Department of Education's Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention and an associate director of the Center for College Health and Safety. Before joining EDC, Davidson served a number of organizations in the business, higher education, and nonprofit sectors. She has an M.A. in counseling and worked for eight years as a clinician in community mental health centers.
Which groups of students have a higher risk of depression or suicide?
Risk factors for depression and suicide include relationship troubles, mood disorders, and barriers to accessing mental health care. For suicide, easy access to lethal means, like poisonous chemicals or firearms, is a risk factor. A lack of social support may also be a risk factor. Students who are somehow "out of sync," as Dr. Mort Silverman says, with the rest of the campus community may be at risk. For example, in their Big 10 Suicide study, Dr. Silverman and colleagues found that older female students were at higher risk for suicide than other students at the schools. So it might make sense to look at transfer students and graduate students for increased risk for depression and suicide.
In the University of Michigan Healthy Minds study, men and women who were screened for depression showed about equal risk. A very interesting finding from this study is that students with financial difficulties, either during childhood or at present, were more likely to screen positive for depression or report suicidal thoughts. These students were also substantially less likely to receive mental health services. This data tells us that we might be able to prevent mental health problems by helping students work through their financial difficulties.
How do you recommend training staff about identifying, referring, and assisting at-risk students?
There are a lot of training options, including one that's called Campus Connect, created specifically for colleges and universities by the staff at Syracuse University. It's important for people on the frontline with students to know how to intervene when they see students exhibiting warning signs or risk factors for mental health problems or suicide. For more information, visit the Suicide Prevention Resource Center.
Most campuses that are conducting these trainings target faculty as a primary audience, along with RAs and student affairs staff. There are less obvious people who may have even more contact with students than faculty, such as teaching assistants, administrative assistants in academic departments, tutors, and financial aid advisors.
Clinicians in the counseling center and health center should also receive training in assessing and managing suicide risk. There is a very good collaborative program about identifying and treating depression in primary care that was piloted at NYU in recent years. Participating students demonstrated improved functioning and fewer symptoms at the end of the pilot.
There are different entry points on campus where a student can get help (health services, counseling services, RA, advisor, coach). What's the best way for a college to ensure coordinated care?
Many campuses have case management teams or student-at-risk response teams, which are designed to keep students from falling through the cracks. Core team members usually include someone from the counseling center, health services, resident life, student affairs, campus safety, and sometimes faculty. These teams meet to identify students who may be at risk, and to figure out different ways to assist them. This type of case management program is a growing trend on college campuses.
How are campuses responding to the increase in reported depression and mental health issues?
There's some disagreement as to whether there has been an increase in depression or simply an increase in reported cases. There is a serious gap between the number of students who report being depressed and those who are actually receiving treatment. For example, the Healthy Minds study shows that only 50% of the students who screened positive for depression reported receiving treatment.
Can you share some examples of successful depression or suicide intervention programs?
There is no one program or intervention that is going to take care of all the complex issues associated with depression and suicide. However, campuses are doing a number of things to identify students who may be at risk and provide them with quality services. Ultimately, successful program development depends on a school's understanding of its students and their risk factors for depression and suicide. Many schools are now using a comprehensive, multi-level approach developed by the Suicide Prevention Resource Center and the Jed Foundation, which recommends seven program strategies:
- Identify students at risk.
- Increase help-seeking behavior.
- Provide mental health services.
- Follow crisis management procedures.
- Restrict access to potentially lethal means.
- Develop life skills.
- Develop social connections.
St. Peter's College in New Jersey, for example, created a customized program for their predominantly local Hispanic student population. The college reached out to the families of these students to teach the parents how to reduce parent-child conflicts; according to data, parent-child conflict is a factor in suicidal behavior among adolescent Hispanic females.
Arizona State University also developed a comprehensive program using many of the seven areas of strategic intervention; the goal was to create an overall protective environment and identify students in distress. ASU has a social marketing campaign in place to encourage help-seeking behavior, and supports a chapter of Active Minds, a national student organization that works to reduce the social stigma of mental health problems. In addition, the school offers an online mental health assessment tool, provides a mental health/life skills group for students called Think Different and Feel Better, and offers stress management training.
What are some solutions to overcome barriers (personal, environmental, or cultural) of an at-risk student seeking depression help?
A couple of different groups, such as ‘Feel Better Fast' and ‘Think Different and Feel Better', are designed with the student in mind; the help-seeking process is modified to provide easier access for the student. Programs like these offer students a chance to receive counseling without being stigmatized.
It's also important to think about barriers to help-seeking that are less obvious. For instance, many people assume that students don't seek help due to social stigma, which may be a factor. But further exploration of barriers may reveal something else. For example, the counseling center is in a very exposed location, and its hours may not be conducive to a student's schedule. If campus data shows that students with mental health problems or suicidal ideation are not seeking help, it's important to go a step further and ask students why they don't seek help.
Cultural beliefs may also play a role in whether or not a student seeks help. Most campus mental health services endorse a Western psychology that is not shared by many other cultures. Trying to encourage students from some cultures to go to the counseling center may not be a useful approach. Instead, campuses need to think about what those students need and where they would feel comfortable talking about their problems.
What about depression screening programs?
There are several screening program options. For instance, the JED Foundation offers a free program called ULifeline. It's an online resource where students can use the screening tool and learn ways to help themselves and their friends with emotional issues.
The American Foundation for Suicide Prevention offers a more involved screening program called the College and University Screening Project. This web-based program uses a three-tiered assessment method in which a trained online clinician encourages at-risk students to seek help.
Finally, most people are familiar with National Depression Screening Day, coordinated by Screening for Mental Health, Inc. The company also has a program called College Response, which includes a year-long online screening that can be customized for specific campuses.
Are there any online resources that you would recommend for someone who would like to learn more?
The Suicide Prevention Resource Center's website http://www.sprc.org
National Suicide Prevention Lifeline http://www.suicidepreventionlifeline.org
Campus Mental Health Action Planning webinar series put on by the Jed Foundation and Education Development Center, Inc. http://www.jedfoundation.com/professionals/programs-and-research/campusMHAP-webinars
Active Minds http://www.activeminds.org
American Foundation for Suicide Prevention (AFSP) College and University Screening Project http://www.afsp.org/index.cfm?page_id=05967029-BC0C-603D-5A32D68043B9D7A8
College Breakthrough Series http://www.nyu.edu/shc/pdfs/Action-CBS-D-spring08-web.pdf
Screening for Mental Health, Inc. http://www.mentalhealthscreening.org/Back