Watching the disaffected

Cornell University is observing its students very closely. With an enrolment of 13,510, it is the largest school in the prestigious Ivy League and it sends social workers and psychologists across its campus to academic buildings, student centres and even dormitories to meet anyone who wants to talk - no appointment is needed. Cornell trains faculty to look for signs that students might be struggling with personal problems. And it periodically convenes an "alert team" of campus police officers, mental health counsellors and psychologists to discuss the most worrying cases.

Just a few years after a series of high-profile suicides drew criticism that US universities were doing far too little to monitor their students' mental health, a series of deadly shootings now has them poking, prodding and poring over their campuses for signs of trouble.

At Cornell, if a student is suspected of planning violence against himself or herself, or others, a small team is quickly brought together to assess the situation. The team consists of the director of psychological services, the campus police chief and the university attorney. It is empowered to remove the student and help him or her find appropriate professional assistance, somewhere else.

"There have been students who through this process have left the university," says Gregory Eells, director of counselling and psychological services. "It doesn't necessarily mean that it's safer. But I know we have identified people who may have posed a threat."

After shooting sprees resulted in the death of 33 people, including the gunman, at Virginia Tech in April 2007, in the deadliest such rampage in American history, and six people, again including the gunman, at Northern Illinois University in February this year, many US schools have set up "threat-assessment groups" of deans, administrators, campus police and mental health officials to discuss whether troubled students need professional help or should be expelled.

"I think universities are seeing more clearly that you can't have an institution devoted to the life of the mind without attending to the health of the mind," says Eells, who is also president of the Association of University and College Counseling Center Directors (AUCCCD).

The turnaround has been swift. "Essentially, every campus has a threat-assessment team in place at this point in one way or another," says Kaaryn Sanon, a spokeswoman for the National Association of Student Personnel Administrators (Naspa), which represents university administrators in charge of student affairs. "Many of these were in place prior to the more recent violent tragedies on various campuses, but they have been formalised and put in place almost everywhere that lacked such a system."

Virginia Tech was one of the first universities to set up a formal threat-assessment group, which it established in October 2007. Such teams have also been formalised at Boston University, the University of Illinois-Chicago, the University of Kentucky and the University of Utah.

The groups have taken up cases involving student harassment of faculty or classmates, online threats and antisocial conduct.

"There aren't really profiles (of students prone to violence or suicide), but there are characteristics you can look at: depression, suspiciousness, grandiosity, social isolation," Eells says. "Another thing you might see is fantasies of revenge. That's a key piece (of the motivation of such people), the sense of being an avenging angel. It's rare, but sometimes people with paranoid psychoses kill in what they think is self-defence."

The Virginia Tech gunman, Seung-Hui Cho, had been diagnosed with and treated for severe anxiety disorder in secondary school, but the school was forbidden by law from disclosing this to Virginia Tech without his permission, and so the information was not passed on.

But university faculty, staff and students had witnessed odd and threatening behaviour by Cho. A year and a half before the attack, one of his professors had him removed from her course because Cho had submitted violent and obscene poetry and photographed the legs of female classmates under their desks. She urged Cho to seek psychological counselling, but there is no evidence that he did. She also alerted her department head, who informed the campus police, but they responded that they were unable to take any action unless Cho had made specific threats.

By then the university knew that he had been accused of stalking female students three times and the campus police had twice given him verbal warnings to stop. A few months later, after a third incident, university police went to Cho's room and escorted him to a local mental health treatment centre. Cho was diagnosed as mentally ill and in need of hospitalisation, a decision that was upheld by a judge, who ordered him to undergo mental health treatment. Yet the university took no action to remove him or to require ongoing treatment.

Steven Kazmierczak, the Northern Illinois gunman, on the other hand, was under the care of a psychiatrist and taking anti-anxiety and antidepressant drugs, according to his girlfriend, who said she never saw him exhibit violent tendencies.

The campus shootings served only to accelerate a trend to increase campus vigilance. Threat-assessment teams were created after a series of court decisions that set a precedent for families of students who committed suicide to sue universities. Parents and other critics had argued that universities repeatedly ignored signals that students were a danger to themselves.

The best-publicised case involved an undergraduate at the Massachusetts Institute of Technology, who set herself on fire in her room at the school in 2000, killing herself. Her parents sued the university for $ million (£13.6 million).

In a decision that surprised higher education experts, a judge ruled in 2005 that the case could proceed on the grounds that MIT officials had had reasonable grounds to believe that the woman would try to hurt herself. She had been previously hospitalised for a drug overdose, had been known to cut herself, she had told MIT psychologists and administrators of her suicidal thoughts and she had told two classmates that she intended to kill herself that day.

Even as she finally succeeded in taking her own life, a group of administrators and psychiatrists were meeting to discuss her case. MIT has since settled with the family for an undisclosed amount of money.

The new campus threat-assessment groups can order a student to undergo treatment or bar the individual from contact with particular people. If the student's behaviour is illegal or violates written university rules that prohibit verbal or physical violence towards people or property, he or she can be suspended or expelled from the institution.

Legal protections and privacy laws, which always worry US universities, can still come down on the side of the student and slow this process. For instance, a student of George Washington University who was barred from the campus and threatened with expulsion after checking into a hospital with depression successfully sued the university, which was forced to pay him an undisclosed settlement.

But many mental health professionals said that George Washington's snap judgment could discourage other students from seeking psychological help when they needed it, as the student who sued had done. They have also warned against taking up more drastic suggestions in an attempt to pre-empt problems on campus, such as introducing psychological screening for all incoming students.

The AUCCCD, for example, issued a policy paper saying that completely preventing campus violence is impossible and pointing out that even the US secret service has concluded that there is no accurate psychological profile for people who might commit violent acts.

"The problem is with false positives," Eells says. "In an instance where you know someone has been violent, you can find these things. But you can also find all these things in people who 99.9 per cent of the time are not going to be violent."

He points out that many of the problems leading to campus violence go far beyond university campuses. There are cultural issues at work, he says, citing, among other things, last month's US Supreme Court decision to overturn the restrictions that had finally begun to be imposed on buying guns.

Naspa has launched a campaign called "Enough is Enough", in which university psychologists, who are typically part of on-campus health centres, will reach out to secondary schools and parents to try to reduce violence.

In the meantime, universities such as Cornell have decided to err on the side of caution. New students are urged to report anything they notice that could be construed as suspicious. Faculty and staff are also being trained to watch for unusual behaviour, and universities are making it easier for faculty to consult with campus mental-health workers.

The response, Eells says, has been universal. "Faculty are trained to do research and teach, not to be psychologists," he says. "But post-Virginia Tech, yeah, that made it harder to think: 'This is not part of my job.' We're all in this together."

IT'S GOOD TO TALK

Mental health services are provided by a majority of US universities as part of their on-campus medical centres, but such facilities are now being expanded.

This has occurred largely in response to incidents of mass shootings but also because of the legal liabilities that arise as a result of student suicides.

Cornell University, the largest of the prestigious, and high-stress, Ivy-League institutions, is one of those that is now providing an extended service for students.

Its counselling and psychological services department has become more aggressive in reaching out to students, particularly minority and international scholars, who, for cultural reasons, are less likely to seek out mental health services.

Under the university's "Let's Talk" programme, counsellors are made available without appointments for students, not only at the campus medical facility but also in dormitories, student centres and campus buildings.

Cornell's psychological experts now also train faculty and staff how to spot students who may be threats to themselves or to others and how to intervene.

A postcard-sized list is distributed to all Cornell employees listing people to whom they can refer such students, including deans, counsellors, academic advisers, chaplains and students trained as peer counsellors.

There is also a programme to help faculty and staff who are under stress themselves.

A website offers a guide to the signs of student stress staff should look out for, such as missed assignments, repeated absences, a deterioration in the quality of coursework, and the people at Cornell to contact with concerns.

Like an increasing number of American universities, Cornell has assembled an "alert team" of administrators and staff that meets weekly to discuss students who may be troubled. A smaller sub-committee can be called together quickly to remove a student believed to pose an imminent threat.

In a survey of Cornell students carried out in 2006 after the introduction of enhanced services, 44 per cent reported feeling too depressed to function properly. Some 13 per cent (175 students) said that they had tried to commit suicide, while 11 per cent admitted that they had seriously considered it.

Now, the university reports, 13 per cent of all Cornell students seek out or receive mental health or psychological counselling.

www.gannett.cornell.edu/campushealth/Network/Signs_Distress.html.