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Suicide Prevention in Institutional and Geographical Context: Perspectives from a University Student and Professor

Suicide is the second leading cause of death among college students. According to a 2017 American College Health Association survey, over half of college students feel hopeless, almost two-thirds overwhelming anxiety, and over one in ten have seriously considered suicide. Among those who receive mental health services, over one-third have seriously considered suicide and one in ten have attempted suicide (Center for Collegiate Mental Health, 2018). In response, university administrators and health directors across the country are increasingly breaking their silence and taking action to address mental health and prevent suicide on their campuses. This article presents the perspectives of a Cornell student and a Cornell alumna and Clinical Assistant Professor at the University at Albany School of Public Health.

Brett R. Harris, DrPH

Brett R. Harris, DrPH

Perspective from Catherine Choi, Senior, Cornell University – At Cornell University where I attend as an undergraduate, the campus health center announced a plan to increase flexibility for the Counseling and Psychological Services (CAPS) program this past year, thereby increasing its accessibility for all students. This demonstrates, at the very least, that administrators are listening to students’ growing demands. Cornell also offers in-person and telephonic peer counseling via its Empathy, Assistance, and Referral Service (EARS). Yet mental wellness is regularly treated as merely an afterthought, and data suggests the same for other schools. This comes as no surprise to the student body. We all undergo both the good and the ugly of the hyper-productive, pre-professional, and sometimes lonely student experience. The troubling symptoms that result are neglected, justified by a pervading mindset that mental health can wait in line; there are other more pressing matters that take precedence.

In addition to campuses simply acknowledging the importance of mental health, there must be supports for students – as well as faculty and staff – to seek help. While it is a substantial step in the right direction to normalize conversations about mental health, normalizing prevention, intervention, and treatment to achieve the ultimate goal of mental wellness is an entirely separate and equally convoluted process.

One barrier to help-seeking is personified in my classmate, Kristi Lim. A fellow student at Cornell, she writes that “no external figure should strip from an individual the autonomy to make the final call,” and described a suicide intervention training program as an “illusion” for “anything more than a facilitatory step in a longer, idiosyncratic process” in an opinion piece she titled: Why I’m Choosing Not to Seek Professional Mental Health Care. Despite sparking immediate backlash, Lim’s article suggests that some students undermine medical treatment and participating in evidence-based training, willingly opting for an independent path to mental wellness instead.

Another barrier is a more recent phenomenon, wherein de-stigmatization on a college campus adopts desensitization as well. In this case, discussing mental health and illness is normalized but unproductive. Desensitization normalizes mental illness itself. This can manifest in both apathy and a “struggle Olympics”-type campus culture where students compete as to who has it worse or whose struggles are more substantial. The following are some ways to normalize and promote mental wellness and prevent suicide on college campuses:

Start Talking about Mental Health and Provide Access to Services and Resources. In both the administrative and student spheres, colleges should continue their work in streamlining mental health initiatives. Within different campus organizations, students can put mental health on their agenda and provide information and resources for seeking help. Faculty should add information about mental health resources on their syllabi and provide accommodations for mental health reasons. Administrators, meanwhile, have the authority to increase access to services and resources on campus, promote their availability, and encourage students to use them. One such service is Crisis Text Line, a free, 24/7 texting service in which students, faculty, and staff can anonymously text with at trained counselor about issues related to depression, anxiety, suicidal ideation, substance misuse, relationship problems, domestic violence, and stress and anxiety resulting from the COVID-19 pandemic by simply texting “Got5U” to 741-741. Administrators, faculty, staff, and students may promote the availability of these services with publicly available, college-specific marketing materials. Administrators can also choose to add Crisis Text Line information along with other campus-specific resources on the backs of student ID cards so that these resources are readily available to all students at all times.

Train the Campus Community to Identify Suicide Risk and Refer to Services – Students, faculty, and staff are all gatekeepers alike, coming in contact with others on a daily basis who may be at risk of suicide. Evidence-based trainings such as Question, Persuade, and Refer (QPR) are designed to educate people about the myths of suicide, warning signs, and ways to persuade suicidal individuals to seek help. The online, self-paced QPR course is available free of charge to campus communities across New York State. Lim’s conclusions, while perhaps well-meaning, contradict the facts. Everyone has a role to play in preventing suicide. Increasing access to training will provide students, faculty, and staff with the knowledge and skills required to make an impact.

Practice Intersectionality – Certain groups are at higher risk for suicide including those identifying as Lesbian, Gay, Bisexual, or Transgender (LGBTQ+), Native Americans, and veterans. In addition, suicide attempts among Black adolescents increased 73% between 1991 and 2017 (Lindsey et al., 2019), and Black Americans have seen a spike in depression and anxiety following the recent tragedy of George Floyd earlier this year. Asian Americans are the least likely racial group to seek mental health services. Understanding the weight of overlapping risk factors will help not only to develop intersectional solutions but also to build community and empathy.

Provide Virtual Access to Services and Resources – The COVID-19 pandemic has changed day-to-day life, emphasizing the need for virtual services and resources that support mental health. This has already been demonstrated in the shift towards telehealth through college health centers. In addition to this, it is important to ensure that other services and resources remain available to students in a virtual environment including club connections and faculty/staff mentorship. And again, raising awareness of the availability of Crisis Text Line and how simple it is to text “Got5U” to 741-741 for immediate, 24/7 support can play a central role in this strategy.

Perspective from Brett Harris, DrPH, Clinical Assistant Professor, University at Albany School of Public Health –  As an alumna of Cornell University, I am very familiar with the role that colleges and universities play within their larger geographical communities. Cornell, located in Tompkins County, is the central hub of the county along with Ithaca College and TC3. When I was a student at Cornell, I worked on a longitudinal research project with a professor for which I traveled a two-hour radius from Cornell to interview adolescents and their parents in their homes. As a student insulated within a largely diverse, almost metropolitan university setting, it was eye-opening to see how only a few minutes’ drive from campus, and for hours thereafter, the demographic makeup, population size, and geography changed to vastly rural and low-income.

Rural areas are disproportionately impacted by suicide. According to data from the Centers for Disease Control and Prevention, the suicide rate in rural New York is significantly greater than the state average (13.1 vs. 8.3/100,000) and increased at a greater rate between 2000 and 2018 (47% vs. 40%). To explore ways to support rural communities across New York, I assembled a research team at the University at Albany School of Public Health – including interns Catherine and Juliana Rich from Cornell – to conduct a New York Rural Mental Health Listening Tour. The overall goal of the project is to increase our understanding of the unique characteristics of rural communities that may contribute to mental health concerns and increased risk of suicide. Through conversations with local Directors of Community Services, other behavioral health stakeholders, and general community members, we have learned that no statewide or regional approach will sufficiently mitigate the risk of suicide. Each county faces unique challenges – which is why it is critical to listen to each community and work to understand the varying forces at play.

Our listening tour consists of two forums per county: one with behavioral health stakeholders and one with community members at-large. We have forums planned in multiple counties this fall including Essex, Clinton, Franklin, St. Lawrence, and Wyoming, andYates counties and plan to recruit additional counties in the spring. Once each set of forums is complete, we will develop a county-specific report and set of recommendations that we will share and discuss with each county.

Conclusion: Suicide is a significant public health problem that is often amplified by context. We presented the institution of higher education and the rural geographical context in this article, but there are many others that underscore the importance of a comprehensive approach to suicide prevention. What we know, what gives us hope, and what drives our efforts is that suicide is ultimately preventable. This alone can guide us in overcoming challenges and striving toward mental wellness within our communities.

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 “Got5” to 741-741.

Catherine Choi is a student at Cornell University and Brett R. Harris, DrPH, is Clinical Assistant Professor at the University at Albany School of Public Health. For questions or comments related to this article, please address correspondence to Brett Harris, DrPH at bharris@albany.edu.

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