The shooting rampage that devastated the Virginia Tech community in April and the subsequent reports of gunman Seung-Hui Cho's many "red-flag" mental health issues prompted the media and the public to ask repeatedly: "How could he have fallen through the cracks?"
But researchers who study college mental health issues and those who struggle to provide services to college students in need of such services say the more appropriate question would have been: "How could he not?"
The gap between the need for psychiatric services on college campuses and the ability of campus counseling centers to meet that need is wide and growing. In one retrospective study by researchers at Kansas State University, Manhattan, the proportion of students who sought mental health services for depression at the university counseling center increased from 21% between 1988 and 1992 to 41% between 1996 and 2001 (Prof. Psychol. Res. Pr. 2003;34:66-72).
In addition, the investigators observed significant increases in student psychopathology in 14 out of 19 areas. For example, the rate of depression among students doubled during the 13-year period, while the number of suicidal students tripled.
Similar trends were observed in a 2003 study in which 85% of the directors of college counseling centers participating in a national survey reported seeing increases in the numbers of students with severe mood disorders, self-injury incidents, eating disorders, and alcohol and drug abuse (NASPA Journal 2003;41:167-81).
The findings from a 2004 nationally representative survey of more than 47,000 college students by the American College Health Association paint an especially bleak picture. The survey shows that more than 40% of college students reported feeling so depressed that they had trouble functioning, and 15% suffered from clinical depression. About 45% reported episodic binge drinking, and 10% said they had seriously considered suicide--the second leading cause of death among college students, according to the association (www.acha.org/newsroom/pr_ncha_11_18_04.cfm).
The fact that so many college students are struggling with mental illness should not come as a surprise. In many ways, the conditions in which these young adults find themselves are ripe for such an outcome, said Dr. Kristine A. Girard, associate chief of mental health services at the Massachusetts Institute of Technology (MIT), Cambridge.
Many studies have shown that the peak onset of symptoms of mental illness in the general population is during adolescence or early adulthood. Add to that the stress of living away from home for the first time, the pressure to succeed academically, the desire to fit in socially, and the geographic and emotional distance from established support networks, and it's easy to see why the prevalence of mental illness among college students eclipses that observed in the general population, Dr. Girard said at the annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP).
And today's students often don't have the life skills or the common sense skills to seek the help they need, she said.
One of the obstacles that keeps students from asking for help is the stigma associated with mental illness, according to Dr. Richard D. Kadison, chief of mental health services at Harvard University Health Services at Holyoke (Mass.) Center, and coauthor of "College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It" (San Francisco: Jossey-Bass, 2004). For this reason, education and outreach are critical components of a comprehensive mental health services program, he and coauthor Theresa Foy DiGeronimo wrote. Without appropriate planning, however, successful education and outreach endeavors can lead to further service barriers.
For those who do seek on-campus help, college counseling centers are often too overwhelmed to adequately meet their needs, Dr. …