TAKING DEPRESSION ON

On the long list of worries Mom and Dad have when a child goes to college--grades, homesickness, partying--there's a new issue: 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; 30 percent said they were suffering from an anxiety disorder or depression.

While there's debate over why the numbers seem to be rising, there's also concern that colleges aren't dealing with the problem. In January the Crimson, Harvard's student newspaper, published a widely discussed five-part series concluding that "an overwhelming majority" of Harvard undergraduates experience mental-health problems. The series further stated that the university's shortcomings in helping students were causing "a pervasive mental-health crisis."

Given that assessment, it's inevitable that mental-health issues are starting to filter into admissions conversations at various colleges. One counselor at an East Coast private high school says that during the 2003-04 admissions cycle, officials from two colleges confided they were 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 pharmaceutical 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 can become loudest at colleges that suffer high-profile suicides.

At NYU, after four students fell to their death from buildings during the last school year, the university took several steps to help students. 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. Families of incoming NYU students are also 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 may be on the right track with its door-to-door approach, but many colleges face obstacles to providing good on-campus care. 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 many students may be referred off campus for treatment, which may not be ideal. "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. But for those with more serious problems, such limits may mean rushed care.

Experts cite a mix of reasons why campus therapists are so busy. 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 high school. "These kids very likely underperformed and may not have been able to attend college at all, " he says. Today, with drugs and earlier intervention, many can. While Hyman thought the Crimson's examination of Harvard's health-care system was unfairly anecdotal, he says he's pleased it signals a new openness about mental illness.

But the cries for help appear to have other causes, too. The process 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. At MIT, Jones 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.

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 and inform her family of her troubles. "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.

For students with mental illness, therapists say the search for the right college should be tailored to that fact. Andrea Rifkin, a college counselor in Santa Barbara, Calif., routinely asks clients if they are taking medication. When the facts spill out, she asks: "Are you feeling healthy enough to go away to school?" Psychiatrists agree that students with serious mental illness are often best off attending a college where family is nearby. Another tip: families should find a local therapist and arrange for prescription delivery before the student arrives.

The trickiest task faces parents whose children seem 100 percent healthy when they leave for college. Donna Satow of New York City 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 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 all parents to ask colleges such things as "What kind of support do you have in case my youngster gets in trouble?" In a world where families agonize over finding the cushiest dorm room and the perfect meal plan, it's a question that could save a student's life.