Early Warnings: Spotting Mental Illness on Campus

In retrospect, there were plenty of warning signs. Cho Seung-Hui was a young man with no apparent friends, a history of violent writings, a diagnosis of mental illness and a prescription for psychiatric medication. But for college mental health professionals, none of those factors is, by itself, all that unusual. It's only when viewed in combination, and in retrospect, that the Virginia Tech tragedy may appear to have been so preventable.

By all accounts, in the last decade the number of students arriving on campuses with a history of mental illness has increased. According to the latest survey conducted in 2005 by the American College Health Association, four out of 10 college students reported having "felt so depressed it's difficult to function" during the prior 12 months. One in 10 had "seriously considered suicide." Experts cite a litany of causes for the apparent increase. Adolescence seems more stressful today, some say, with students facing more academic and social pressure. Some claim a generation raised by "helicopter parents" seems somehow less independent and less resilient than the students who arrived on campuses in decades past. And perhaps the key driver of this trend: today more effective treatments for mental illness, using both medication and counseling, makes it possible for many troubled students who'd once have forgone college to now seek admission. "There's been a ratcheting up of the seriousness of the disorders," says Hara Estroff Marano, a contributing editor at Psychology Today who's written widely about campus mental health issues.

On campuses, counselors have worked hard to keep up with the increasing demands. Each year Robert Gallagher, an adjunct professor at the University of Pittsburgh, conducts a survey of university counseling center directors. In his latest survey, done in 2006, 95 percent of center directors reported the number of students who arrive at college who are already taking psychiatric medication has increased in recent years. On average, the number of students being hospitalized for psychological problems has increased, from an average of 5 students per school in 2001 to 8 students per school in 2006.When it comes to suicides, the survey suggests that often counselors have little opportunity to intervene. Out of 154 reported suicides at the colleges in the survey, 127 of the students-or 82 percent-had no contact with the school counseling office prior to taking their life.

In addition to boosting the size of their counseling staffs or offering more walk-in hours, many campuses have focused on training faculty and residence hall advisers to become more adept at identifying students suffering from emotional problems. Indeed, what's striking in details that have emerged about Cho Seung-Hui's time at Virginia Tech is how many warning signs the Virginia Tech community was able to spot. According to widespread media accounts, Cho's writings for English classes caused at least two Virginia Tech faculty members to alert administrators to his fascination with violence. In 2005, female classmates reported him to authorities for harassment, and a roommate reported concerns that Cho might have been suicidal. These events led to a court-ordered, overnight psychiatric evaluation, which failed to find cause for Cho to be involuntarily committed. "I think there were a lot of things that were done right, actually," says Gary Pavela, who teaches at the University of Maryland and publishes a newsletter on higher education legal policies.

Although the details of Cho's case will continue to emerge in the coming days, it's already apparent that the biggest failure was one of communication. While various faculty members, administrators, roommates, campus police and counselors may have spotted individual warning signs, there wasn't enough information being exchanged between them to allow someone to look at the data holistically, and to observe the pattern that, in retrospect, appears so troubling.

Some of this failure is the result of privacy laws and Americans with Disabilities-style protections, which prevent discrimination against a person suffering from depression. Russ Federman, who heads the counseling office at the University of Virginia, says a case like Cho's fits into "this gray area of someone who is obviously very disturbed, who does not want help, and who has not directly been in violation of any specific behavioral codes of conduct." It's these sorts of cases, Federman says, that are a particular nightmare for administrators.

For mental health professionals, the Cho case also provides a grim reminder of the limitations of their ability to help the mentally ill from harming themselves--and others. "What happened at Virginia Tech is an incredibly rare, rare event that's the kind of thing that could elude the most comprehensive and collaborative and well-orchestrated set of services," says Ben Locke, cofounder of the Center for the Study of College Student Mental Health at Penn State University. "There are people out there, students and nonstudents, who will not accept services offered to them, and don't do anything [illegal] prior to a certain event."

It's a reminder that even with ample warning signs, some tragedies can be very difficult to prevent.