DEALING WITH DEPRESSION

On the long list of worries that Mom and Dad have when a child goes to college--grades, homesickness, partying--there's a new issue gaining prominence: the apparent rise in mental illness on campus. More than 1,100 college students commit suicide each year, according to estimates by mental-health groups. And even when students aren't in acute distress, they're suffering in surprisingly large numbers. In a 2003 survey by the American College Health Association, more than 40 percent of students reported feeling "so depressed it was difficult to function" at least once during the year. Thirty percent identified themselves as suffering from an anxiety disorder or depression.

While there is debate over why the numbers seem to be rising, there's also concern that colleges aren't dealing with the problem adequately. In January 2004 the Crimson, Harvard's student newspaper, published a widely discussed five-part series which concluded that "an overwhelming majority" of Harvard undergraduates experience mental-health problems, and that the university's shortcomings in helping them were creating "a pervasive mental-health crisis" on the campus.

Given that kind of assessment, it's inevitable that mental-health issues are starting to filter into admissions conversations. One counselor at an East Coast private high school says that during the 2003-04 admissions cycle, officials from two colleges confided they were particularly focused on admitting a class that was "rock solid" emotionally--both to help prevent suicides and to reduce the toll on overbooked school therapists. MIT Admissions Dean Marilee Jones says she's looking to enroll "emotionally resilient" students. "If we think someone will crumble the first time they do poorly on a test, we're not going to admit them," she says. "So many kids are coming in, feeling the need to be perfect, and so many kids are medicated now. If you need a lot of phar-maceutical support to get through the day, you're not a good match for a place like MIT."

Since the admissions process requires students to appear flawless, many families avoid disclosing a child's history of emotional problems, especially before they get an acceptance letter. However, parents are starting to ask tough questions about just which kind of mental-health services they can expect from schools. Those inquiries become particularly acute at colleges that suffer high-profile student suicides.

At NYU, after four students fell to their death from buildings during the 2003-04 school year, the university took several steps to help students cope. Among them is a 24-hour "wellness" hot line; when talking on the phone doesn't seem to help, the hot line--with the student's acquiescence--will dispatch a counselor or the campus police to the student's residence.

In addition, families of all incoming NYU students are receiving letters asking for information on special needs, including whether a student is taking medication or seeing a therapist. The university's therapists now make weekly trips to residence halls for one-on-one appointments. By going to dorms, administrators hope, counselors will increase their visibility and make sessions more convenient.

NYU's door-to-door approach may be extreme, but it illustrates the range of support that colleges can offer. While nearly every school has a counseling office, almost half lack a full-fledged staff psychiatrist, according to Robert Gallagher, a University of Pittsburgh professor who conducts an annual survey of college counseling offices. That means it may be difficult for a student to receive prescription drugs to treat depression or anxiety, and that students with serious problems may be referred off campus for treatment. "Not only are the [on-campus] services more accessible, but the people providing the services are more familiar with college pressures," says Gallagher. And while some schools offer unlimited therapy for students, others restrict them to eight or 10 appointments a year. That may be fine for the average student, who often sees a counselor just once or twice to discuss homesickness, a bad grade or a relationship breakup. For those with more serious problems, such limits may mean rushed care.

Experts cite a mix of reasons that campus therapists' offices are so crowded. Harvard provost Steven Hyman, former director of the National Institute of Mental Health, says that until a few years ago teenagers with mental illness weren't as likely to get good treatment, leading many to stay home after finishing high school. "These kids very likely underperformed [academically] and may not have been able to attend college at all, let alone a challenging, selective institution," says Hyman. Today, with drugs and earlier intervention, many can. While Hyman thought the Crimson's examination of Harvard's health-care system was unfairly anecdotal and negative, he says he is pleased it's a topic of conversation on campus, because it signals a new openness about mental illness. Until recently, he says, "depression was so stigmatized, people were so ashamed they just toughed it out. As the stigma diminished, treatment became more acceptable, and now more students are coming forward."

But the cries for help appear to have other causes, too. The quest to get into a top college has grown so cutthroat for many that more students are emerging from it emotionally damaged. "Kids are burning out sooner and sooner," says Leigh Martin Lowe, director of college counseling at Roland Park Country School in Baltimore. "They're not being allowed to enjoy their teenage years, and many of them end up in college and they don't have the energy or stamina to really turn it on." At MIT, Jones, the admissions dean, gives preference to students who are "self-driven" (read: not being pushed by their parents), based on her belief that self-motivated students are better able to cope with failures. "Our culture has become insane--we're making people sick," Jones says.

The strategies used by MIT to deal with its troubled students are at the heart of a closely watched court case. In April 2000 MIT sophomore Elizabeth Shin of Livingston, N.J., fatally set herself on fire in her dorm room. The family is suing the school for $27 million, claiming that despite Shin's repeatedly telling MIT administrators, psychiatrists and dorm mates that she was suicidal, the school failed to place her under intensive psychiatric care, inform her family of her troubles or take adequate steps to prevent her death. "If a student is acting out because of drugs or alcohol, there's no hesitation to bring in the family," says David Deluca, the Shin family's attorney. "We've not gotten to the same point when it comes to mental-health care." (MIT has denied the allegations, saying it treated Shin adequately and kept the family informed.) If the Shin family prevails, other colleges may rethink how they communicate with parents about a student's problems.

For students with mental illness, college counselors and therapists say that fact should play some role in their college search. Andrea Rifkin, a college counselor in Santa Barbara, Calif., routinely asks her clients if they have any health issues or are taking medication. When the facts spill out, she asks: "Are you feeling healthy enough to go away to school?" Indeed, psychiatrists agree that students with serious mental illness are often best off attending a college where family is nearby. "It doesn't necessarily have to be near the parents' home--it might be near a brother, sister, aunt or uncle, somebody they can turn to and see on a regular basis," says Robert Hendren, chief of adolescent and child psychiatry at the University of California, Davis. Hendren says parents of students with particular conditions (such as bipolar disorder) can network through online support groups to get other parents' views on how well individual colleges deal with disabilities. Another tip: families should find a local therapist and arrange for prescription delivery to the child's school before he or she arrives.

There may also be benefits in choosing smaller schools. At Grinnell College in Iowa, where the student body numbers 1,350, two students committed suicide during spring 2003. Since then the administration has made therapists more accessible and created systems so anyone--faculty members, coaches, RAs--who sees a student flailing knows whom to call for help. While there's no proof that smaller colleges like Grinnell are better equipped to spot and treat students' emotional problems, there is evidence they have more resources. According to the University of Pittsburgh study, at colleges with 2,500 or fewer students, health centers had one counselor for every 818 students. At colleges with more than 15,000 students, the counselor-to-student ratio jumped to 1 to 2,426.

The trickiest task faces parents whose children seem 100 percent healthy when they leave for college. Donna Satow of New York had sent two children to college by the time her third, Jed, went off to the University of Arizona. In 1998, as a sophomore, he committed suicide. Today Satow and her husband run the Jed Foundation, which helps colleges develop strategies for dealing with student depression. She'd like all colleges to screen incoming students for depression, the same way they make sure they've had all their immunizations. Satow advises parents of every student to become informed about mental-health services at their child's school. "You don't ask, 'What kind of support do you have in case my youngster gets in trouble?' " But in a world where families agonize over finding the cushiest dorm room and the perfect meal plan, it's a question that deserves to be asked.