Stanford University has agreed to change its involuntary leave of absence policy, mental health staffing and training to better accommodate students facing mental illness crises, including those who have been hospitalized following a suicide attempt. The decision is the result of a settlement agreement with a group of students who filed a class action lawsuit to reform allegedly discriminatory policies affecting student in mental health crises.
This development is timely as it directly addresses concerns over global suicide trends.
Suicide rates continue to increase across all age groups in America, but the rising youth suicide epidemic, which has progressively increased since the 1950s, is particularly concerning among those who study it.
Suicide is the 10th-leading cause of death across the U.S. population, but is second-most among college-aged students.
"We are facing a national mental health crisis, and college campuses are reflecting what’s going on in society at large," Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a nonprofit that aims to prevent suicides among young people, said in an interview with ABC News.
Dr. Doreen Marshall, vice president of programs at the American Foundation for Suicide Prevention, agreed: "We hear from college and university counseling centers, they are seeing more students coming in reporting that they have some current or past suicidal ideation, which is a signal that this is a time that students are really struggling."
According to the CDC, suicide rates across all ages increased in nearly every state between 1999 and 2016, and suicide rates went up more than 30% in half of states since 1999.
Independent of college, statistics reveal a spike in suicidality between the ages of 15 and 25. Until the age of 25, rational thinking and the ability to regulate emotions and impulses are still developing. The biological risk factors coupled with the inevitable challenges of acclimating to a new environment make college students more vulnerable to experiencing anxiety and mental health issues regardless of their mental health history.
"It’s often their first time living independently and living away from their family, and a change in terms of access to their usual support networks from family and parents," said Marshall.
Dr. Stephanie Samar, a clinical psychologist at the Child Mind Institute, added that college students' lifestyle choices can aggravate depressive symptoms and stress.
"Many college students aren’t taking care of their bodies. Many are experimenting with substances and not eating very well, or sleeping very well, in a way that would support them to meet all these new challenges," Samar said.
College students today also face challenges that are particular to their generation, such as greater financial stress and an increasingly digital world that replaces face-to-face connection and may contribute to sensations of loneliness and isolation.
Sepp Panzer, a junior at Columbia University has experienced these anxieties first hand -- having struggled with depression throughout his childhood and attempting suicide in high school.
"My primary support was gone, and the pressure to succeed was such a strain and drove me back to depression," Panzer told ABC News, of going to college.
Panzer recalled not wanting to get out of bed and said his suicidal thoughts resurfaced during his second year at Columbia.
"I felt suicidal and alone," he said. "Going through the day depressed you always think everything in your life is your fault, you automatically resort to the fact that I’m not good enough or I don’t have what it takes."
Working to change his mindset and connect with those on campus, Panzer thinks that colleges need to promote quicker access to counseling services.
"In this state of crisis, students can’t wait three weeks for an appointment. Changing that time frame will stop people from going over the edge," said Panzer.
College counseling services face a particular challenge in developing protocols that can effectively triage and recognize students at higher risk.
Schwartz noted that college campuses can sometimes be a protective factor, since many colleges students can see a clinician faster than they can in their hometowns. Nevertheless, set up primarily as an educational institution, colleges are not always equipped to provide extensive mental health counseling that meets the needs of a heterogenous student body.
Dr. Anitha Iyer, chief clinical officer and vice president of Vibrant Emotional Health, the organization that runs the National Suicide Prevention Lifeline, emphasizes that the most important step is creating "spaces and opportunities for students to connect with one another" in order to engage students and parents in an ongoing and active dialogue around mental health before they have even stepped foot on campus their freshman year.
On college campuses, that means taking a more comprehensive approach and fostering a culture of wellness that originates from the highest administrative level. It means equipping professors and students alike with the skills to support and empower one another so that the toll doesn’t fall only on the counseling centers.
"It would also be good to have a metric to see if colleges can compare themselves to others and themselves," Dr. Jane Pearson, chair of Suicide Research at the National Institute of Mental Health, said in an interview with ABC News.
This may mean developing better methods to compare the mental health services across U.S. campuses and keeping track of suicide attempts and deaths.
After Wendell Tang's son, Luke, died by suicide during his sophomore year of college in 2015, he began urging parents to check in with their kids.
"Kids cannot be independent overnight," Tang told ABC News. "Talk to them and try to understand their challenges. Sometimes they are very lonely and we don’t even know."
Marshall also stressed the importance of peer relationships.
"This generation is talking more openly about their mental health and many in this age group will talk to one another long before they talk to an adult mental health professional," she said.
National suicide prevention organizations have spearheaded peer-to-peer educational campaigns like "Seize the Awkward" and #BetheOneTo, which are providing students with the tools to talk about mental health among their social circles and recognize early warning signs of suicide.
Panzer recalled that support from his peers and especially his partner helped him overcome his suicidal tendencies and depression.
"Sometimes it just takes that one person to make you understand it is not your fault, someone in your corner to remind you that things will get better," the Columbia student said.
And colleges are moving in the right direction.
"In the 25 years I have worked here we have had success stories," Dr. Jacqueline Pistorello, director of counseling services at the University of Nevada, Reno, said in an interview with ABC News. "We were actively trying to lower stigma around mental health services and encourage students to seek help. These two things have happened."
Now, they are trying to reach students before they even step into their offices, by stationing mental health counselors at tables around busy campus areas for students to take just five minutes to talk, by visiting classrooms and running outreach programs across academic, Greek life and residential bodies. They even have a mandatory mental health counseling fee included in students’ tuition.
These initiatives help prevent major tragedies and build resilience across the student body. For many college students it’s not the desire to be dead that leads them to contemplate suicide, but the lack of tools to solve the problems they face. Efforts invested in college students transcend the college campus and can positively impact the global suicide crisis at large.
"Suicide is preventable and mental health is treatable," said Iyer. "Mental health and suicide prevention is everybody's problem. We all have to partake in helping our society."
If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741-741.
Eden David is a senior at Columbia University majoring in neuroscience, matriculating into medical school in 2020 and a member of the ABC News' Medical Unit.