In the year since Seung Hui Cho killed 32 students and faculty at Virginia Tech, colleges dramatically have expanded efforts to catch dangerous students in a safety net before they crash and take innocent victims down with them, school officials say.
"It's a different world since Virginia Tech," says Gwendolyn Dungy, executive director of the National Association of Student Personnel Administrators.
Colleges are trying to reduce the chances of violence by creating or beefing up risk assessment teams that typically include faculty, residence advisers, psychologists, administrators and police, college administrators say. The teams meet often to review reports on students who seem disturbed. The reports are submitted by professors, residence advisers, police and students.
About 20 percent of colleges had assessment teams before the Virginia Tech murders, says Keith Anderson, a veteran counselor at Rensselaer Polytechnic Institute in Troy, N.Y. "Now I don't know any college that hasn't either created a team or strengthened the one they had," Dungy says.
Although troubled students rarely attack classmates -- suicide is a far more common problem -- more students have mental disorders, and their problems are getting more serious, experts agree.
The percentage of students diagnosed with depression was 15% in 2007, up from 10 percent in 2000, according to surveys by the American College Health Association. And 23 percent coming to campus counseling centers are on psychiatric medicine, up from 9 percent in 1994, another survey shows.
The shift to more rigorous monitoring of students' lives comes as experts agree there is no sure way to prevent shootings.
"Anyone who wants to get a gun in this society can get a gun," says Richard Bonnie, a specialist in psychiatry and law at the University of Virginia School of Law.
An independent report in August on the Virginia Tech shootings recounts in chilling detail how many people noticed Cho's disturbing behavior and how little they communicated with one another. The risk teams provide a central place to lodge concerns.
"Very often, trouble with a student who's becoming psychotic or manic will surface in several areas at the same time -- athletic staff, sorority sister, professors will see changes," says Joan Whitney, counseling center director at Villanova University outside Philadelphia.
Many schools are training professors and staff members to look for troublesome signs, Dungy says. More professors and others on campus are consulting with counseling centers about "students of concern" since Virginia Tech, according to 66 percent of center directors in a new survey of 272 colleges.
"We coach professors in how to deal with students, and usually students welcome the attention," Whitney says. "They'll often say, 'Yes, I'm having trouble. I think I'm depressed.' Sometimes there's a painful breakup or another problem. It's rare that there's nothing going on when professors see students they're concerned about."
If there are serious problems, a student may be asked to get treatment. Parents may be informed if college officials are concerned, counselors says.
At Virginia Tech, Cho's parents were never told he was judged by a psychiatrist to be mentally ill (and ordered in a court hearing to outpatient treatment, which he never received). Now many colleges, including Virginia Tech, according to spokesman Larry Hincker, say they're making sure they follow through on troubled students asked to get psychological help.
Most legal scholars agree that colleges have the right to expect students to get mental health evaluations and treatments if there is cause, to contact parents and to ask students to withdraw if there is a documented concern about safety, says Bonnie, the University of Virginia law professor.
Medications have improved, allowing people who have bipolar disorder (manic depression) and even some with schizophrenia to get an education.
"Before, they would have stayed home," says John Greden of the Depression Center at the University of Michigan.
It can be a rough transition.
"They leave home, lose their support systems. If they had therapy at home, it's gone. Their workload increases, sleep is erratic, and they may be exposed to lots of alcohol."
Depression and bipolar disorder often surface for the first time during college, Greden says.
Students who feel they have nobody to confide in are most vulnerable to mental health problems, suggests a new study by University of Michigan researcher Daniel Eisenberg. Men are more at risk than women, though fewer men come to counseling centers, and minorities tend to be more isolated, his study shows.
Pressure Is Turned Up
Competition has turned ferocious for college-bound kids of every race, and that also is triggering mental health problems, suggests Susan Lipkins, a psychologist practicing in Port Washington, N.Y.
"They burn themselves out through high school trying to have a résumé much more impressive than adults have," Lipkins says. "It's become a culture of winner vs. loser, reflected in the reality shows. There's just more acceptance of demeaning, humiliating behavior if you're a loser."
Lipkins says the reported rates of students on psychiatric medicine, high as they are, are underestimated. "Most don't even tell the schools they're on meds," she says.
Susan Putnins, a senior at Harvard, came to college on medication for bipolar disorder and didn't tell anyone at the school.
"The transition was really hard. The biggest difference was, I had a fantastic support system of friends in high school. At Harvard I didn't." She has gradually made friends and learned to curb stress during exams.
In new surveys, students say they're most likely to share their anxieties and depression with other students. Efforts to raise students' awareness of mental health problems and the value of treatment are underway.
For example, cable channel mtvU has teamed with the Jed Foundation to run more than 8,000 public service announcements on the widely watched college network, says Courtney Knowles of the foundation.
They're also airing videos of popular musicians, such as Mary J. Bilge, talking about their mental health at halfofus.com. Troubled students can find links to counseling centers at a site created by Jed Foundation, ulifeline.org.
Active Minds, Inc. (activeminds.org) is a student group that sponsors activities to inform students about mental disorders and decrease stigma. Executive director Alison Malmon, 26, who founded the first chapter in 2001, says chapters are on 119 campuses.
Emily Parsons, 21, started a chapter at Central Michigan University in Mt. Pleasant in November. Depression had disabled her so much, she couldn't go away to college after high school. During the next spring she felt a surge of energy, her thoughts raced, and she started spending lots of money. After not sleeping for four nights, she began hallucinating. Parsons was hospitalized and diagnosed with bipolar disorder. "It's a real shocker to get a diagnosis like that when you're 18."
By taking medicine and staying in close touch with doctors, she has been able to go away to college.
"One thing that helps me a lot is ceramics. It's such a stress reliever, it keeps me centered."
She has become philosophical about her illness: "This is not going to go away. I know I need to take good care of myself."
The Stigma Deepens
Students need to stay on their medicine or reduce amounts only under a doctor's care, "but there's still a learning curve for young people. They want so much to be like everyone else," says Joy Himmel, director of the health and wellness center at Pennsylvania State University-Altoona.
Steven Kazmierczak, who killed five students and himself at Northern Illinois University in February, had stopped Prozac abruptly because of side effects, his girlfriend told CNN.
After the Virginia Tech and Northern Illinois shootings, too many people are drawing a link between mental illness and murder, says Lucas Ebaugh, 26, a student at the University of Colorado-Colorado Springs.
He has depression and an anxiety disorder, "but I am not a violent person. I know a lot of people with mental illness, and they aren't violent, either. This false equation just contributes to stigma."
Most mentally ill people are not violent, says Edward Mulvey, an expert on mental disorders and violence at the University of Pittsburgh Medical School.
The best predictor of violent behavior is prior violence, says Mulvey, but Cho had no record of physically attacking people. "Massacre killings are almost impossible to predict," he says.
Horrific as they are, such mass campus shootings are rare, says James Alan Fox, a criminal justice professor at Northeastern University in Boston. With about 16 million U.S. college students, "the chances of being murdered on campus are about as likely as being fatally struck by lightning," he says.
Nobody knows whether the vigilance with troubled students will prevent mass murders. But colleges must try, says Richard Kadison, chief of mental health services at Harvard. "The pendulum is swinging away from being laissez faire. ... If you're going to make a mistake, it's better to err on the side of keeping students safe."