The rampage carried out nearly a year ago by a deranged Virginia Tech student who slipped through the mental health system has changed how American colleges reach out to troubled students.
Administrators are pushing students harder to get help, looking more aggressively for signs of trouble and urging faculty to speakup when they have concerns. Counselors say the changes are sending even more students their way, which is both welcome and a challenge, given that many still lack the resources to handle their growing workloads.
Behind those changes, colleges have edged away in the last year from decades-old practices that made student privacy paramount. Now, they are more likely to err on the side of sharing information - with the police, for instance, and parents - if there is any possible threat to community safety. But even some who say the changes are appropriate worry it could discourage students from seeking treatment.
Concerns also linger that the response to shooters like Seung-Hui Cho at Virginia Tech and Steven Kazmierczak, who killed five others at Northern Illinois University, has focused excessively on boosting the capacity of campus police to respond to rare, terrible events. Such reforms may be worthwhile, but they don't address how to prevent such a tragedy in the first place.
It was last April 16, just after 7 a.m., that Cho killed two students in a Virginia Tech dormitory, the start of a shooting spree that continued in a classroom building and eventually claimed 33 lives, including his own.
Cho's behavior and writing had alarmed professors and administrators, as well as the campus police, and he was put through a commitment hearing where he was found to be potentially dangerous. But when an off-campus psychiatrist sent him back to the school for outpatient treatment, there was no follow-up to ensure he got it.
People who work every day in the campus mental health field - counselors, lawyers, advocates and students at colleges around the country - put the changes they have seen since the Cho shootings into three broad categories.
Identifying troubled students. Faculty are speaking up moreabout students who worry them. That's accelerating a trend of more demand for mental health services that was already under way beforethe Virginia Tech shootings.
Professors "have a really heightened level of fear and concernfrom the behavior that goes on around them," said Ben Locke, assistant director of the counseling center at Penn State University.
David Wallace, director of counseling at the University of Central Florida, said teachers are paying closer attention to violent material in writing assignments - warning bells that had worried Cho's professors.
"Now people are wondering, 'Is this something that could be more ominous?''' he said. "Are we talking about the Stephen Kings of the future or about somebody who's seriously thinking about doing something harmful?'''
Mississippi State and the University of Kentucky are among the schools creating teams involving people such as resident advisers, teachers, administrators and campus police to try to identify troubled students. Others, including Virginia Tech, that already used such "care" teams have added another layer to deal with those identified as potentially threatening.
"People who have been really depressed and are thinking about hurting themselves, these folks I think are coming to our attention a little bit earlier,'' said Keith Anderson, staff psychologist at Rensselaer Polytechnic Institute. "Because it's been a kind of national awakening, we have a sense of hope people will refer folks before something gets out of control.''
The downside is officials may be hypersensitive to any eccentricity. Says Susan Davis, an attorney who works in student affairs at the University of Virginia: "There's no question there's some hysteria and there's some things we don't need to see."
That's a problem because counseling centers already had their hands full. A survey last fall by the Association for University and College Counseling Center Directors found colleges on average have just one counseling staffer for every 1,941 students. Those ratios could decline given that some colleges are adding staff - Virginia Tech has added four, with plans for three more - but in many states the ratios are still well above the nationally recommended guideline of one counselor per 1,500 students.
Meanwhile, a recent MTV/Associated Press survey found 12 percent of college students found "life was not worth living" at least sometimes. About 10 percent have considered suicide in the last 12 months, according to the American College Health Association, and more than 1,000 commit suicide annually.
"At Wake Forest, every year we see more people, every year the demand increases," said Marianne Schubert, director of the university counseling center. But, "I don't think people are being paranoid. I think given the circumstances of what has happened (at Virginia Tech) and the culture and society we live in, I think it's appropriate."
Privacy. In Virginia, a measure signed into law Wednesday by Gov. Tim Kaine requires colleges to bring parents into the loop when dependent students may be a danger to themselves or others. Even before Virginia Tech, Cornell University had begun treating students as dependents of their parents unless told otherwise - an aggressive legal strategy that gives the school more leeway to contact parents with concerns without students' permission.
In Washington, D.C., meanwhile, federal officials are trying to clarify privacy guidelines so faculty won't hesitate to report potential threats.
"Nobody's throwing privacy out the window, but we are coming out of an era when individual rights were paramount on college campuses,'' said Brett Sokolow, who advises colleges on riskmanagement. "What colleges are struggling with now is a better balance of those individual rights and community protections.''
The big change since the Virginia Tech shootings, legal experts say, is colleges have shed some of their fear of violating the federal Family Educational Rights and Privacy Act (FERPA). Many faculty hadn't realized that the law applies only to educational records, not observations of classroom behavior, or that it contains numerous exceptions for potential safety threats.
In any case, colleges have concluded it's better to risk a mistake on FERPA than miss the danger signs in a student like Cho.
"You have to choose your lawsuit,'' said Ada Meloy, general counsel of the American Council on Education, the Washington D.C.-based umbrella organization that represents colleges.
Still, while conversations with therapists almost always stay private, some worry about the perception that confidentiality is no longer the top priority. There's no way to measure how many students aren't getting treatment.
"The real balancing act is, are you chilling the mental health treatment you want these students to receive?'' said UVA's Davis. "Are they going to stop going to these centers because there's this state law out there that says you have to call mom and dad?''
Stigma. As news of the Virginia Tech shootings broke, Erica Hamilton was one of many people who worried the violence could prompt a backlash against the mentally ill, discouraging treatment and leading to misguided new laws.
"I was really nervous,'' said Hamilton, a student at the University of North Carolina-Greensboro who works with Active Minds, a mental health advocacy group with chapters at 127 colleges. "It shined a negative light on people who have mental illness.''
On balance, Hamilton says that hasn't happened. But the tone of some of the debate remains a concern.
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"In general, the attention to campus mental health was desperately needed,'' said Alison Malmon, founder of the national Active Minds group. But some of the debate, she added, "has turned in a direction that does n
ot necessarily support students.'' All the talk of "threat assessments'' and better-trained campus SWAT teams, she said, has distracted the public from the fact that the mentally ill rarely commit violence - especially against others.
"I know that, for many students, it made them feel more stigmatized,'' Malmon said. "It made them more likely to keep their mental health history silent.''
The media has often drifted toward coverage of campus police training and emergency text-messaging systems. Malmon isn't saying money spent on those areas was wasted. She just doesn't want anyone to think it will prevent another Virginia Tech.
Sokolow, the risk consultant for colleges, estimated in the aftermath of the Virginia Tech and NIU shootings, the schools he works with spent $25 on police and communications for every $1 on mental health. Only recently has he seen a shift.
At Florida's public universities, the board of governors last month approved an $18 million request to the legislature to fund police and emergency warning systems that a state task force called for. The board also approved recommendations of a task force on mental health care, which found Florida schools needed 92 more counselors to reach the recommended ratio. But there has been no funding request yet. The report suggested the state lift caps on student fees.
Bill Edmonds, a spokesman for Florida's board, said it recognizes the need for more counselors and is exploring ways to fund them.
"Campuses come to me, they want me to help them start behavioral intervention systems,'' Sokolow said. "Then they go to the president to get the money and, oh, well, the money went into the door locks.''
Phone messaging systems and security are nice, he said, but "there is nothing about text-messaging that is going to prevent violence.''