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10 years after Virginia Tech: New tools for suicide prevention

When Virginia Polytechnic Institute senior Seung-Hui Cho shot and killed 32 people and wounded 17 others before taking his own life on April 16, 2007, it was a wakeup call about shortcomings in the way colleges and universities approached student mental health.

Cho had a history of depression and anxiety disorders dating back to middle school and had exhibited alarming behavior on campus, including stalking two female students and submitting disturbing creative writing assignments that prompted at least one professor to urge him to get counseling. Yet he slipped through the cracks, in part because of a lack of communication between different campus constituencies that were aware of his conduct.

One of the enduring legacies of the Virginia Tech tragedy has been an effort by campuses nationwide to augment their mental health and suicide prevention programs. Initiatives have ranged from establishing interdisciplinary teams to share information about students demonstrating signs of emotional instability, to integrating communication between health and counseling services, to training gatekeepers such as residence hall staff, academic advisors, faculty and students to recognize and respond to students in crisis.

Growing emphasis on gatekeeper training has also led to the development of innovative new tools like Kognito At-Risk [1], an online role-play simulation that has been adopted by more than 350 schools to date. The program utilizes a combination of gaming technology, the science of learning, and interactive conversations with emotionally responsive virtual humans to help students, faculty, staff and administrators build the knowledge, confidence, and real-life conversational skills to approach and connect troubled students to mental health resources.

“The Virginia Tech shootings made it clear many students do not reach out for help when they are in distress. That’s why gatekeepers who have close personal contact with individual students can play such an important role,” said Dr. Victor Schwartz, clinical associate professor of Psychiatry at the NYU School of Medicine and chief medical officer of The Jed Foundation. “People need to have enough information and confidence in their ability to recognize a student or classmate in distress and help get them into care, and that’s where gatekeeper training comes in.”

New Approach Needed

Suicide is the second leading cause of death for college students in the US, outstripped only by accidents. As many as 1,400 students die by suicide every year, according to Schwartz. Thousands of others – 6 percent of undergraduate students and 4 percent of graduate students – seriously consider taking their own lives, according to the American College Health Association’s National College Health Assessment.

Many students grapple with other mental health issues as well. Surveys by Healthy Minds Network indicate that 32 percent are dealing with a mental illness, with 5 percent screening positive for panic disorders, 6 percent for anxiety disorders, 9 percent for major depression, and 15 percent for self-injuring without thoughts of suicide at any given time.

Yet only 40 percent of students with mental illness seek professional help, and the Virginia Tech rampage was a stark illustration that the usual lectures, in-person workshops and Power Point-style online courses designed to raise awareness of mental health issues were falling short in helping get more students in need into treatment.

Schools needed to engage the entire campus community in a way that would do a better job of motivating students suffering from conditions like extreme depression to seek help. Student training in particular became a high priority, given that 67 percent of college students tell a friend they are feeling suicidal before telling anyone else.

“In the wake of the Virginia Tech shooting, we decided to apply our simulation technology to address this urgent need. We recognized that without providing faculty with practice in leading these critical conversations, they would be unlikely to build the skills and confidence to engage in and lead similar conversations in real life,” said Ron Goldman, CEO and co-founder of Kognito. “We wanted to go beyond building awareness and knowledge to changing real-life behaviors in order to increase the number of at-risk students who get help as early as possible.”

(Next page: Digital simulations for campus suicide prevention; seeing results)

The Power of Conversation

That decision led to the development of two companion digital simulations: At-Risk for Faculty & Staff in 2009 followed by At-Risk for Students in 2012.

Users assume the role of a student or faculty member who selects from a menu of dialogue choices to have an interactive conversation with several virtual students exhibiting signs of psychological distress. The virtual students react to each choice with lifelike facial expressions, body language and verbal responses, closely replicating a face-to-face discussion.

In the faculty/staff version, for example, users meet and talk with three students exhibiting signs of distress. Gwen has good grades but worries about her performance. Jared seems distracted and recently turned in a disturbing writing assignment. Alberto’s grades and attendance are getting worse, and he isn’t turning in his assignments at all.

Through these interactions, users increase their knowledge about mental health and suicide prevention, learn to identify warning signs of psychological difficulties, and practice initiating and leading real-life conversations that help motivate students to seek help.

Kognito technology adjusts the conversation path based on the user’s selections, and virtual coaches give feedback along the way – all while enabling users to try different approaches to see what works best.

Making a Difference

All indications are that these practice conversations are paying off.  A study of 1,151 students from multiple schools who were surveyed three months after completing the At-Risk simulation found a 70 percent increase in the number of classmates approached to discuss concerns about their psychological state and 53 percent increase in referrals to school support services. A separate study of 3,352 faculty and staff at the same three-month mark showed improvement with 47 percent and 42 percent increases, respectively.

Studies at individual schools have yielded similar results, and the program is now listed in the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP).

“Over 90 percent of the people on our campus who have gone through the Kognito simulation say they feel more comfortable approaching and having a conversation with a student they’re concerned about,” said Michele Cooper, Suicide Prevention coordinator at the University of Arkansas. “I think one of the reasons is that people can go through the program in the privacy of their own home without the anxiety of a facilitated role-play in front of a group.”

“We started using Kognito five years ago to train our RAs and student mentoring groups, and now it’s also part of a course for incoming freshmen,” added Melissa Griffin, manager, Health Promotion, at Northern Arizona University. “Our students like the avatar technology because it meets them where they’re at. It’s relevant, familiar and engaging to them, and it’s become an integral part of our multidisciplinary approach to student mental health.”

Beyond Suicide Prevention

From improved gatekeeper training to other strategies designed to strengthen student mental health programs in the wake of the Virginia Tech shootings, colleges and universities are finding that the benefits extend beyond suicide prevention to increased student performance, improved student retention and even better campus safety.

The reason is that students’ mental and emotional problems can have a negative impact in all of these areas. Consider:

Cultivating a culture of campus wellness increases the likelihood that students struggling with mental and emotional problems will seek help before those problems spin out of control; that in turn can yield a significant return on investment not only in the areas mentioned but also on a school’s bottom line. Indeed, a 2014 study by the Healthy Minds Network found that delivering mental health treatment to 100 depressed students could result in averting six dropouts during a school year.

Nothing can bring back the lives of those who died in the Virginia Tech massacre, but the expanded mental health initiatives undertaken by campuses across the country in response to the tragedy are improving the lives of students experiencing problems ranging from academic stress to severe depression today.

Increased awareness, new gatekeeper skills, earlier intervention, care teams and other changes are building healthier campuses.