June 28, 2017

A Broader View

The way to prevent violence, observes Victor Schwartz, dean of students at Yeshiva University, is not to try to design a way to prevent violence, but to provide good, comprehensive health services for all medical and emotional problems.

“You can’t focus on a specific problem,” Schwartz said in a conversation after the Columbia meeting. “You do it by forming a good medical community and good medical care, picking out the kids who are anxious, depressed, involved in substance abuse.” An effective health and counseling service that is known and trusted by the community will offer the best chance to identify troubled and potentially dangerous people before they become an active threat to themselves or others. “You want to head them off at the pass by providing good treatment, social support,” Schwartz explained. “You’re never going to catch everybody, but providing good networks of care, good community resources, well publicized and well integrated — that puts you in the best position.”

Columbia’s Paul Appelbaum expressed the same view. Seeking to target counseling services only at prevention of severe violence, he said, is likely to be a fruitless approach, because “identifying potentially violent students and intervening with them effectively are very difficult tasks. We are more likely to be effective in reducing violence in campus, violence toward self and toward others, if we focus on providing needed mental health treatment to troubled students.”

Adequate mental health services can be the “the least problematic … the easiest fix” for a range of legal and ethical problems, including those concerning confidentiality and information sharing, Appelbaum commented in his presentation at the Columbia conference. Strengthening those services is thus a concrete policy alternative for university administrators concerned about safety on their campuses. But in an era of financial stress and tight budgets, that approach has not always been adopted, despite heightened awareness and concern after the Virginia Tech and Northern Illinois University shootings. Mental health programs have been expanded on some campuses but demand has also risen, and access to counseling may actually be declining for many students, as utilization grows but funding does not keep pace. (Paradoxically, one possible reason for greater pressure on mental health service at the college level, Appelbaum pointed out, may be that there is more and better treatment of emotional problems among elementary and high school age students. As a result, youngsters who in the past would have been too troubled to finish high school now succeed and make it into college.)

Colleges have not been standing still on this problem. A 2008 report in the Chronicle of Higher Education noted that “over all, support for students with a range of disabilities and emotional issues has grown precipitously over the last 15 years,” but despite those efforts, colleges still “cannot keep up with the rising demand for mental health services.”

In recent surveys by the Association for University and College Counseling Center Directors and the American College Counseling Association, the heads of counseling programs were almost unanimous in reporting that “the number of students with significant psychological problems is a growing concern” on their campuses. Large majorities felt that the population of seriously troubled students has been increasing. (Those trends appeared to be even stronger in larger institutions.) In the comment section of AUCCCD’s 2008 survey report, one director noted: “The psychiatric epidemiological data on persons of traditional college age in the U.S. make it clear that the existing need far outstrips the available treatment resources, on and off campus.” Another wrote: “Somehow the leadership needs to better influence administrators and legislators when it comes to staffing. Tragedies lead to anxiety which leads to finger-pointing but everyone overlooks how short-staffed so many of us are. What is truly amazing is how many tragedies we avoid with the staff sizes we have!”

Two-thirds of respondents in the ACCA survey expressed concern about “the growing demand for services without an appropriate increase in resources” and three-quarters said that an “increase of students with severe psychological problems” is creating administrative issues for their centers. Fewer than a third of ACCA’s respondents, however, reported any increase in counseling staff or psychiatric consulting hours.

With stretched resources, university and college counseling centers typically provide relatively short-term care — on average, five or six visits, after which students needing more extended treatment (which would presumably include those with the most serious problems) are often referred to off-campus providers. Those who need psychiatric care in many cases have to find it off-campus from the start, since nearly one-third of college and university centers do not offer any psychiatric service at all. Even where psychiatrists are available, fully half of center directors reported they could not offer enough psychiatric hours to meet the need. For students who have to get treatment beyond what is available on their campuses, a lack of health insurance coverage may shut them off from the help they need, since, as the Chronicle of Higher Education report pointed out, “many types of counseling and medication that were covered even a few years ago are no longer affordable for students.”[1]

Faced with those pressures, counseling centers on many campuses will need to become stronger advocates for more adequate and better care, and administrators will have to become more aware that better health services will make their schools safer. The need goes beyond just offering help for troubled students. A broader effort is also needed to develop a healthier campus culture with a stronger communal bonds and formal and informal mutual care and support among all students, staff and faculty. When people care about each other and feel their institution cares about them, the odds of detecting someone who is emotionally disturbed and intervening before a tragedy occurs become much better. Frank Ochberg, an eminent psychiatrist and a key creator of the field of critical incident analysis, put it this way: “We’re trying to have healthy campuses, and we’ve learned that with respect to violent outcomes and loss of life, the healthiest campus is one in which kids treat each other in a decent way, and warning signs of destructive behavior are brought to the right resources, to individuals who are good at therapy and good at mentoring.”

Counseling centers cannot change campus culture by themselves, but they can be a catalyst. As Yeshiva University’s Victor Schwartz noted, counselors and student affairs staff members can help teachers and academic advisers “to think beyond students’ academic work, think about them in a more human, holistic way.” To get that message out, he added, he and the head of the university’s counseling service “meet with academic advisers couple of times a year, they hear how we are thinking about cases, trying to put together a picture…. We are constantly speaking with deans. You have to get to faculty meetings, you really have to be in people’s faces, continuously having these conversations. You are modeling an approach that is more holistic, based on looking at things therapeutically. It requires work and commitment.”

As several participants in the Columbia conference pointed out, special outreach efforts will be needed to draw in groups that may not be strongly connected to campus life, such as adjunct faculty and commuter and continuing education students. Communication and education must be designed to reach “people who are not experts” in behavioral science or public safety, Schwartz commented, so that faculty members and students will be more attuned to the needs of troubled students and more aware of the resources available. Outreach will also have to be continuous, since the population of a college or university community is always changing. And, as Fordham University’s Christopher Rodgers told the meeting, there is a constant need for better and more realistic training and for concrete planning on who will respond and how when someone is identified as a potential risk to others’ or his own safety.

No system can guarantee absolute security. Human nature, mental illness and circumstances are simply not predictable enough. Campuses, like the rest of human society, have to live with a certain amount of risk. An additional ambiguity in conceiving and designing prevention strategies is that their effectiveness can never be definitively measured, because there is no way to identify or count or analyze incidents that don’t happen. When prevention fails, of course, the failure is obvious. Sometimes, looking back at a violent tragedy can pinpoint specific precautions that could and should have been taken to keep it from happening. But more often, trying to find a particular barn door that was left unlocked is not the most useful response. A better approach is to build a better barn. That means a prevention plan that guards against common risks, rather than the sensational ones that are much less likely to occur; that relies on a network of collaboration and clear communication, and that contributes to campus-wide awareness and a sense of community, trust, and meaningful human connection.

[1] See Robert Rando & Victor Barr, Annual Survey, 2008; Robert Rando, Victor Barr, Bryan Krylowicz, & Evelyn Winfield, Annual Survey, 2009, (c) 2009 and 2010, The Association for University and College Counseling Center Directors; and Robert P. Gallagher, National Survey of Counseling Center Directors, 2009, sponsored by the American College Counseling Association, published by International Association of  Counseling Services, Inc., Monograph Series No. 8R; Elizabeth F. Farrell, “Counseling Centers Lack Resources to Help Troubled Students,” Chronicle of Higher Education, Feb. 29, 2008.