Education Update - July 2002

17emale)Suicide Prevention On College CampusesBy MOLLY WALLACESuicide is the second leading cause of deathamong college aged students. In his 2001 bookNoonday Demon, Andrew Solomon wrote that“Someone in a first depressive episode is particularlylikely to attempt suicide.” Many experiencetheir first bout of depression in college. Asa result, college counseling services and administrationsare crucial to preventing suicide.“When we’re talking about suicide among collegestudents, generally we’re talking aboutmental illnesses,” says Dr. Laura Smith, Directorof Barnard College Counseling Services.Confirming Dr. Smith’s comments are Solomon’sstatistics from the National Institute of MentalHealth : 90-95 percent of suicides, especially atthe college age, are the result of mental illnesses,the most prevalent being depression. Studies citedin Kay Redfield Jamison’s noteworthy book onsuicide Night Falls Fast (reviewed in this issue),depressives are at approximately twenty times thesuicide risk of the general population. Those whohave previously attempted suicide are at thirtyeighttimes the risk: “Contrary to popular myth,those who talk about suicide are the most likely tokill themselves,” states Solomon’s book.Targeting these populations can cut suicide rates.Dr. Smith contends that peer support and studentgroups play an invaluable role in raising awareness,de-stigmatizing the seeking of help and helpingothers recognize depression in themselves.There is less stigma attached to therapy than thereonce was, Dr. Smith explains, but still not everyone who needs help seeksit. Some want to provethat they can handle theindependence that comeswith college withouthelp. Others, especially athighly selective institutions,are used to succeedingon their own andlooking for help simplydoes not occur to them.For those adjusting tocollege, or who are underacademic or other formsof stress it can be difficultto draw a line betweenwhat is an appropriateresponse and what constitutesymptoms ofdepression. In these casesstudent groups can helpby having students beingopen about their experienceswith counselingand referring students tothe services they need.Jamison writes of ayoung man who took hisown life, “Drew’s family,whose warmth andunderstanding of himwould have been, in afairer world, more thansufficient to keep himalive, could not competewith a relentless andruinous disease,”explaining that all thekindness and supportshown to a suicidal personis not necessarilyenough. As AndrewSolomon points out,“Illness of the mind isreal illness…and itrequires treatment.”So what do collegeReprinted with permission from Childhood Revealed by Harold S. Koplewicz and Robin F. Goodman.counseling services do once a patient is in theirhands? Both Dr. Smith and Dr. Paul Buckingham,Director of Counseling Services at Brigham YoungUniversity (BYU) Hawaii explain that there is notextbook response to how to handle a severelydepressed or suicidal patient. Each case must beevaluated on an individual basis. Doctor/patientrelationships remain confidential unless the student’ssafety is at risk. Students at both institutionsare encouraged to contact family members, ifappropriate, and generally they are willing. If itwere necessary and appropriate, family memberscould be contacted without consent of the patient.If the situation calls for it, students can be hospitalized.Dr. Smith observes that generally studentswho bring themselves in know they are struggling,and in that sense they are better off than those whoare brought in by others. The latter tend to requirehospitalization more often.“Colleges are not equipped to be mental healthcenters,” says Dr. Buckingham justifying the hospitalizationof students. At BYU Hawaii suicide isan honor code violation. Consequently, if a studentis talking about suicide and refuses treatmenthe or she can be forced to leave the school inorder to get treatment. In such a case acceptanceis guaranteed with reapplication provided that thestudent includes a letter from a mental health professionalstating that he or she has been treatedsuccessfully. Hospitalization also has the advantageof taking pressure off friends. Dr. Smithemphasizes that although it is important for studentsto have peer support, friends of depressedpatients need to put their own well-being first.Dr. Smith’s statistics show that around 23% ofBarnard students use counseling services (numberswent up after September 11th), and Dr.Buckingham’s numbers show that at BYU Hawaii8%-12% of students do. Few of these cases aresevere enough to require hospitalization. Both Dr.Buckingham and Dr. Smith say that a large numberof people who come in complain of depression.The causes range from academic stress to familyproblems to romantic problems, and at BYUHawaii where a large part of the student populationis international, adjustment difficulties. Both doctorssay treatment for less severe cases of depressionvary. In some cases medication is suggested.“We would never put a student on medication,without following through with therapy,” says Dr.Smith. In other cases only therapy is used.The University of Illinois, Urbana–Champaignhas a successful suicide prevention program thatfollows up every suicidal gesture or attempt with anincident report and four weeks of mandatory assessment.Approximately 1,500 students have gonethrough this program in seventeen years. None havecommitted suicide. Considering the high risk thatthese students were at, this is a remarkable feat.Another program called Columbia Teen Screen,researched at Columbia University under DirectorDr. David Shaffer, has been successful in highschools. The program has four steps: obtaining permission,then completing a questionnaire. If the participantscores positively on the first screening, theyare more thoroughly assessed by a computerizeddiagnostic interview called the Voice-DISC(Diagnostic Interview Schedule for Children). TheDISC allows for youth to complete the interviewindependently and eliminates the cost of havingtrained interviewers. Those who are identified by theVoice-DISC as meeting criteria for a disorder areevaluated by a mental health professional. The clinicianmay then recommend further evaluation and/ortreatment to the child and the child’s parents after discussingthe results. The advantage of this program isthat it catches young people before they attempt suicidethereby helping to predict or prevent depressionlater in life. Dr. Ted Greenberg, a coordinator of theprogram says, “it should be used in colleges”.AWilderness Camp Helps HealBy POLA ROSEN, Ed.D.By the time Jacqueline Danforth, a Dalton student,was fifteen years old, she was into drugs,gangs, and alcohol. It was time for drastic action.Her mother, Barbara Walters, researched differentoptions and Jackie entered the RockyMountain Academy, a 3-year degree-granting(high school diploma) wilderness school inIdaho. After 3 and 1/2 years, Jackie graduatedwith much more than a high school degree. “Itwas a place where people cared, where peopleunderstood and were honest.” Although notagreeing with certain techniques used such assleep deprivation, the program helped her andothers achieve self-esteem and feel good aboutthemselves. Jackie did not return to her home inNew York, a place she had not had much happiness.Instead, she lived with older students fromthe school in Oregon, then Washington state,finally enrolling in a marine biology program atthe University of Maine. Feeling uncomfortableand isolated at the age of thirty, in a collegecommunity of 18 year-olds, she soon decided toopt for establishing her own wilderness camp fortroubled teenage girls, ages 13-17. NewHorizons Wilderness Camp, completing its firstyear, “is an unlocked, nurturing and caring environment,”says Danforth. Her husband, a registeredMaine guide, is a vital part of the program.Along with hiking, canoeing, camping and cookoutsin summer and snow-shoeing, cross-countryskiing and cabin life in winter, the girls get “freshair, time and peace and the freedom to be yourselffor 8 weeks.” Danforth’s message is “It’s youand me; I really want to help you!”There are 4-5 staff per group of 7 girls, and twotherapists to supervise. Group discussions areinterwoven throughout the day and may last 1-3hours depending on the needs of the girls.Danforth feels that computers make kids sociallyinept. “Kids, especially women, need companionship.”On a typical day, girls wake at 7 am, wash up,cut and gather wood, cook meals with the staffover a fire, and then do journal writing. They areonly allowed to receive letters from home, notGirls enjoying the wilderness experiencephone calls. Danforth explained, phoning canlead to shouting and disruption. The girls thenpack up, canoe to the next site and have lunch.After a group session, they set up camp, havedinner and do more journal writing. Readingcomes next. Books on hand are, for example,Reviving Ophelia.The girls work on different values each week.Truth (what is the truth about you?), friendship,forgiveness, transition, acceptance. Each phasedeals with them, their families and peers.Horizons provides excellent food and all clothing.Currently there are 55 girls who are trackedfor four years after they leave the program.Who benefits from this program? Girls who aredepressed, mildly self-abusive, have poor bodyimage or are bipolar (who are stabilized on medication).“Borderline personality disorders aretough” said Danforth. “They take a lot of attention,and are disruptive to the point of hurting theothers because they want all the attention.”For suicidal girls we make a contract. Sheagrees to come and talk to us before she doesanything. The contract gives her a measure ofcontrol.There are also contracts for self-mutilationand running away. Said Danforth, “We setboundaries; that leads to a set of values and selfrespect.”To the question, what role do you play in thecamp, Danforth answered, “A big sister.” Shetalks to the girls about her own experiences,about adoptive issues and is a resource personwho has “been there, done that.” Her vision forthe future is to run a school that will be separatefrom the wilderness program. “It will be a threeyear program with individual and group therapy.There will be no home visits; the girls will go onexpeditions in the first year and gradually tapertherapy and include more home visits by the thirdyear. There will be high quality academics andnon-competitive sports like yoga, ballet and martialarts.”The high points of Danforth’s life are the “hugsand embraces whenever a girl leaves and sayshow wonderful we are and that she wants tocome back and work for us.”#Programs like the University of Illinois’ andColumbia Teen Screen’s only exist in a few communities.In 1997 Senate resolution #84 thatdeclared suicide a national problem, passed unanimously.In 1998 a similar resolution (HouseResolution #212) passed unanimously in the Houseof Representatives. The Surgeon General has alsomade suicide one of his priorities. All these are signsthat help is on the way. Part of the senate resolutionstates, “the Senate acknowledges that no single suicideprevention program or effort will be appropriatefor all populations or communities,” pointing outhow important it is for every community to take itsown initiative. Organizations such as the AmericanFoundation for Suicide Prevention, and theAmerican Association of Suicidology have alreadybeen established to provide such initiatives with thenecessary resources, and to encourage networking.#Molly Wallace is a student at Barnard Collegeand an intern at Education Update