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Mental Health, College, and the Threat of Violence

Are college campuses (and students) dangerous? Seperating facts from headlines

Several of the highly disturbing mass shooting incidents of recent years, including the Virginia Tech carnage five years ago and the latest killings at the movie theater in Aurora, Colorado, are linked in some way to college students and campus life. The Virginia Tech shooting of course took place on campus. The Aurora shootings were off campus, but the alleged killer was a graduate student who had apparently been using the mental health services on campus prior to embarking on his deadly rampage. I am a university professor and hence interested in issues related to campus life, including mental health and safety concerns, which often appear to be linked, albeit not in simple ways. Recently I received an email from a dean at our university with information relating to these issues that I thought deserved a wider audience.

The following are excerpts from that email. They are quoted from a recent edition of The Pavela Report, written by Gary Pavela, a Fellow of the National Association of College and University Attorneys. The Pavela Report is disseminated by College Administration Publications, Inc., and features advice and information related to legal aspects of college life. It asks and answers some important questions about violence and mental health. In the process, it does solid work separating fact from fiction with regard to campus violence and proposing sound paths toward possible solutions. In doing so, it also reminds us that our individual and societal response to extreme, outlandish violent events, on or off campus, should not be based on mere perception, hearsay, or commonly accepted pre-set narratives but rather on systematically observed data and verified facts, set in context.

 

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1. How frequent are homicides on campus?

The magnitude of the Virginia Tech shootings (32 people killed) is highlighted by the fact that murders on American college campuses (approximately 4,200 institutions enrolling 19.7 million students) average about 20 a year (see "Toward a Safer Campus," U.S.News and World Report April 30, 2007 p. 49, citing S. Daniel Carter, vice president of Security On Campus Inc.). Researchers at the University of Virginia Youth Violence Project report that "[m]urders on college campuses represent far less than one percent of the total homicides in the United States" and that "the average college can expect to experience a murder on campus about once every 265 years" (see related testimony by UVA professor Dewey G. Cornell before the U.S. House Committee on Education and Labor, given just after the Virginia Tech shootings).

Recent research continues to support the Youth Violence Project findings.  See the 2011 study, "Leading Causes of Mortality Among American College Students at Four-Year Institutions," summarized in the publication UVa today (November 4, 2011):  

[F]indings also suggest that campuses provide much safer and more protective environments than previously recognized. When compared to the mortality of 18- to 24-year-olds in the general population, college student death rates are significantly lower for such causes as suicide, alcohol-related deaths and homicide.

2. Isn't violence becoming increasing common in schools? 

No. A February 22, 2012 Bureau of Justice Statistics Report (Indicators of School Crime and Safety, 2011) states:

Between 1992 and 2010, the total victimization rates for students ages 12-18 generally declined both at and away from school. This pattern also held for thefts, violent victimizations, and serious violent victimizations.

In the most recent period between 2009 and 2010, the total victimization rate against students ages 12-18 at school declined from 43 victimizations per 1,000 students to 32 per 1,000, and the rate of violent victimization at school declined from 20 per 1,000 students to 14 per 1,000. 

3. How dangerous is college teaching?

A March 2011 federal report on crime in the workplace ranks college faculty members just behind preschool teachers as the safest occupations studied (for comparison, the rate of workplace violence for college teachers was 1.9 per 1,000 employed persons, while the rate for physicians was 10.1). See the Bureau of Justice Statistics Report "Workplace Violence, 1993-2009." BJS reports that "of the occupational groups examined, law enforcement occupations had the highest average annual rate of workplace violence (48 violent crimes per 1,000 employed persons age 16 or older), followed by mental health occupations (21 per 1,000)."

Overall, the BJS documents a 51% drop in workplace homicides between 1993 and 2009; the rate of nonfatal workplace violence declined by 35% from 2002 to 2009, following a 62% decline from 1993 to 2002.

4. School shootings are often suicides. How widespread is suicide among college students?

Multiple studies have found that college students commit suicide at rates "significantly lower"  than 18- to 24-year-olds in the general population (see the 2011 study cited in answer number one, above). One of the most cited surveys found an "overall student suicide rate of 7.5 per 100,000, compared to the national average of 15 per 100,000 in a sample matched for age, race and gender" (Silverman, et al. , 1997, "The Big Ten Student Suicide Study: a 10-year study of suicides on Midwestern university campuses," Suicide and Life Threatening Behavior 27[3]:285-303). Additional support for the "Big Ten" study can be found in one of the most comprehensive studies of college student suicide now available--published in the journal Professional Psychology: Research and Practice ("New Data on the Nature of Suicidal Crises in College Students: Shifting the Paradigm," David J. Drum, et. al., 2009, Vol. 40, No. 3, 213-222) (based on "[d]ata . . . collected from over 26,000 undergraduate and graduate students at 70 colleges and universities").  

5. Are more students coming to college with mental disorders?

Probably yes. Caution is required because increases in counseling center visits and use of psychotropic medications may mean contemporary students are more willing to seek help for mental illness. In any event, trying to screen out such students (not a practical or legal alternative in any event), conflicts with educational objectives.

6. Is there an association between mental illness and violence?

Research shows some association between severe mental illness and violence, especially when mental illness is accompanied by substance abuse. However, a 2006 Institute of Medicine report stated that "[a]lthough studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population" (University of Washington, Coalition for Mental Health Reporting, Facts About Mental Health and Violence).  

The U.S. Department of Health and Human Services document "Violence and Mental Illness: The Facts" contains the observation that  "[c]ompared with the risk associated with the combination of male gender, young age, and lower socioeconomic status, the risk of violence presented by mental disorder is modest." Such a "modest" correlation won't be sufficient to draw conclusions about the future behavior of any particular student. Again, individualized assessment will be imperative, focusing on a specific diagnosis, demonstrable behavior, compliance in taking prescribed medications, patterns of substance abuse, and any recent traumatic events or stresses, among other factors.

7. Shouldn't we remove depressed students if they report suicidal thoughts?

No, unless a threat or act of violence is involved. A 2006 article by Paul S. Appelbaum, Professor and Director of the Division of Psychiatry, Law, and Ethics at the Columbia University College of Physicians and Surgeons (and a past President of the American Psychiatric Association) highlights some the practical issues involved:

No matter how uncommon completed suicides are among college students, surveys suggest that suicidal ideation and attempts are remarkably prevalent. Two large scale studies generated nearly identical findings. Roughly 10 percent of college student respondents indicated that they had thought about suicide in the past year, and 1.5 percent admitted to having made a suicide attempt. Combining data from the available studies suggests that the odds that a student with suicidal ideation will actually commit suicide are 1,000 to 1. Thus policies that impose restrictions on students who manifest suicidal ideation will sweep in 999 students who would not commit suicide for every student who will end his or her life-with no guarantee that the intervention will actually reduce the risk of suicide in this vulnerable group. And even if such restrictions were limited to students who actually attempt suicide, the odds are around 200 to 1 against the school's having acted to prevent a suicidal outcome" (emphasis supplied).

("Depressed? Get Out!" Psychiatric Services, July 2006, Vol. 57, No. 7, 914-916).

Aside from unjustified removal of thousands of individuals--including some of the best and most creative students-routine dismissals for reported depression or suicidal ideation would also discourage students from seeking professional help. Good policy, good practice, and adherence to state and federal laws protecting people with disabilities require professional individualized assessment and a fair procedure before students or employees can be removed on the ground that they have a mental disability that poses a "direct threat" to themselves or others.

8. How can I identify potentially violent students?

It's important to resist the temptation to try to "profile" potentially violent students based on media reports of past shootings. The 2003 National Research Council [NRC] report Deadly Lessons: Understanding Lethal School Violence (a project undertaken by the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine) contains the following guidance (p. 332):

One widely discussed preventive idea is to develop methods to identify likely offenders in instances of lethal school violence or school rampages . . . The difficulty is that . . . [t]he offenders are not that unusual; they look like their classmates at school. This has been an important finding of all those who have sought to investigate these shootings. Most important are the findings of the United States Secret Service, which concluded:

There is no accurate or useful profile of "the school shooter" (emphasis supplied) . . .

  • Attacker ages ranged from 11-21.
  • They came from a variety of racial and ethnic backgrounds . . .
  • They came from a range of family situations, from intact families with numerous ties to the community to foster homes with histories of neglect.
  • The academic performance ranged from excellent to failing.
  • They had a range of friendship patterns from socially isolated to popular.
  • Their behavioral histories varied, from having no observed behavioral problems to multiple behaviors warranting reprimand and/or discipline.
  • Few attackers showed any marked change in academic performance, friendship status, interest in school, or disciplinary problems prior to their attack . . .

A more promising approach is "threat assessment," based on analysis of observable behavior compiled from multiple sources and reviewed by a trained threat assessment team. The report "Threat Assessment in Schools: A Guide to Managing Threatening Situations and to Creating Safe School Climates" (developed by the U.S. Secret Service and Department of Education in 2002) contains the following overview) (p. 52):

Students and adults who know the student who is the subject of the threat assessment inquiry should be asked about communications or other behaviors that may indicate the student of concern's ideas or intent. The focus of these interviews should be factual:

  • What was said? To whom?
  • What was written? To whom?
  • What was done?
  • When and where did this occur?
  • Who else observed this behavior?
  • Did the student say why he or she acted as they did?

Proper threat assessment is a team effort requiring expertise from experienced professionals, including law enforcement officers.

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I would add in response to this last statement, that the science of psychology does not yet possess the ability to accurately predict the behavior of individuals, particularly if that prediction concerns rare and extreme behaviors. We can make fairly good predictions involving differences between groups, for example, that--all else being equal--a group of depressed individuals will experience a higher suicide rate than a non-depressed group. But we cannot predict well which individual within the depressed group will in fact kill themselves. In fact, developing the ability to predict individual behavior, and with it the ability to assess the threat posed by an individual (to themselves or others) is one of the most important and challenging future frontiers of psychology.  

Noam Shpancer, Ph.D., is a professor of psychology at Otterbein College and a practicing clinical psychologist in Columbus, Ohio.

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