Suicide Clusters

It’s Mardi Gras week in New Orleans, and students at Tulane University are busy prepping for the weekend’s celebrations. But for some students, getting into the party spirit this year is proving difficult.

"Students are trying to stay positive, and of course many of them are excited for Mardi Gras weekend,” Dusty Porter, Tulane’s vice president of student affairs, said. “But it’s balanced by students struggling through some really unexpected losses.”

This is especially so, Porter said, within the university’s law school, where one student shot and killed another -- his girlfriend -- before killing himself last week. The murder-suicide brought the total number of student deaths at Tulane this year to seven. Four of the deaths have been suicides.

The cluster of students committing suicide, in particular, has rattled the Tulane campus and has left a university with a seemingly robust approach to mental health clambering to do more. “It’s a challenging time,” Porter said. “But hopefully we’ll be better in terms of our services after it’s all said and done. We’re trying to mourn the loss of the students, but also trying to take stock of what we’re doing.”

In the last year, the university has strengthened its communication efforts to students about what counseling services exist, organized webinars for students and parents, and hosted mental health fairs on campus. A 24-hour hotline that can put students directly in touch with licensed counselors and psychologists no matter the time of day will begin taking calls in the next week or so, Porter said.

The new services join the university’s existing efforts to prevent suicide, including training programs for faculty and staff. In 2013, Tulane received a federal three-year, $300,000 grant to hire a “campus coordinator for suicide prevention training programs” and to increase outreach to students. Later that year, Tulane was awarded the JedCampus seal, which recognizes colleges that exhibit "comprehensive mental health promotion and suicide prevention programming," from the Jed Foundation, a nonprofit organization that works to prevent suicide among college students.

Tulane’s counseling and psychological services have seen a 40 percent increase in students seeking their services this year.

“It’s difficult to attribute causality,” Porter said. “It’s maybe because we're moving through a challenging time right now. It’s maybe because those challenges and our efforts are raising awareness and helping to fight stigma. Or it could be more of larger change among this generational cohort. I do think we are seeing a generation where students are experiencing greater anxiety and depression."

A report released last week by the Cooperative Institutional Research Program at the University of California at Los Angeles found that the emotional health of incoming freshmen is at its lowest point in at least three decades. According to the American College Health Association, 32 percent of students say they have felt so depressed “that it was difficult to function." Even so, the rate of suicide among college students is much lower than that of the general population. Somewhere between 6 and 8 percent of college students report having serious suicidal thoughts, but only between 1 and 2 percent of students will actually attempt suicide each year.

Those percentages are, of course, an average, said Victor Schwartz, medical director at the Jed Foundation. A university could go years without a student committing suicide, he said, then experience a cluster of them in quick succession. In 2010, Cornell University had gone nearly five years without a student committing suicide, only to have at least six instances occur in two semesters.

This year, Tulane is not alone in having such a cluster. Since September, nine students have died at Appalachian State University, as has a student who recently dropped out. Three of the deaths were ruled suicides, including that of a student who went missing in September.

Like Tulane, Appalachian State has also seen a sharp increase in students using its counseling and psychological services, according to a report provided to the university’s Board of Trustees in December. Since 2009, initial interviews with students have increased by 65 percent and individual therapy sessions have risen by 50 percent.

The number of students who say they have thoughts of ending their lives has increased by 118 percent, to 400 students this past fall, according to case reports assembled by the counseling center. The students who committed suicide this year were not in counseling, said Dan Jones, director of the university’s counseling center.

“Some students are struggling more and some are just more aware and more willing to seek counseling,” Jones said. “We’re always trying to break down that stigma and advertise and promote these services.”

Jones has been working to prevent suicide on campuses for more than 25 years, and in 2011, he was awarded a lifetime achievement award from the Association for University and College Counseling Center Directors. He is also the chair of the Higher Education Mental Health Alliance. 

In November, the alliance released a guide to assist colleges with their responses to campus suicides. Called "Postvention: A Guide for Responses to Suicide on College Campuses," the 26-page booklet offers suggestions as to how colleges can best facilitate the grieving and adjustment process, stabilize the campus environment and reduce the risk of other negative behaviors.

The detailed guide includes suggestions such as forming a "postvention" committee that includes staff from campus behavioral intervention teams, the communications department, the legal department, the campus chaplaincy and student affairs leadership; implementing postvention plans after an alcohol or drug-related death, as it may not be immediately known whether the death was intentional or accidental; and having the university public relations office work with counseling leadership when reporting a campus suicide.

It's one potential road map to preventing the type of situation currently unfolding at Appalachian State and Tulane.

“There can be this contagion effect when there is a suicide death in a contained community,” Schwartz, who also contributed to the guide, said. “It creates almost a permission. It’s less remote and less frightening. This connection can happen in an unconscious way, but if there’s a large enough at-risk population, unfortunately it may be enough to capture one or two people that may have otherwise not acted.”

It’s not just suicide deaths that can beget more suicides on a campus, he said. Death of any kind can act as a contagion. Like Tulane, Appalachian State has lost about as many students to other tragedies this year as they have to suicide. The student's disappearance in September cast a pall over the campus that still hasn’t lifted, Jones said. Since then, students have also died in car accidents and from a drug overdose.

“I think that first death has served as a magnifying glass for all these subsequent tragedies,” Jones said. "It’s magnified people’s feelings and emotions and fear and even anger. There’s a sadness among some students, and a numbness among others. And there’s a tendency to want to blame someone. They’re thinking ‘Why didn’t someone do something?'”

Appalachian State has several ways of trying to help students before they harm themselves or others, Jones said, including an “early intervention team,” which gently questions a student about his or her well-being if he or she is struggling in class, appears disheveled when they normally are not or seems to be drinking frequently. There’s also a “care team,” led by the dean of students, that intervenes in more dire situations, and a “threat-assessment team” that responds to students who make threats against others or the university.

All levels of the university’s intervention efforts often end with a student being referred to counseling. This year, the university added four additional counselors to its staff. But Jones said even with the extra efforts, it’s still impossible to identify every single student who needs help.

“The students who committed suicide were kind of out there on their own,” Jones said. “They were kind of out there in the wilderness.”