In the quest to tackle student mental-health issues on university campuses, psychology experts say student isolation and confidentially laws continue to stand as major roadblocks.
After revelations that Cho Seung-Hui - the gunman who took 33 lives, including his own, last week at Virginia Polytechnic Institute - showed warning signs of violent behavior, "all college campuses are beginning to look at ways to facilitate access to care," Penn Psychiatry professor Anthony Rostain said.
Experts say ease of access is essential in a college environment, where it can be hard to tell when someone needs help and privacy regulations can limit administrative responses.
For example, federal statutes often prohibit universities from notifying parents of mental issues without a student's permission.
"Privacy needs to be protected or else people won't go for help," Rostain said in justification of strict confidentiality laws.
And, of course, it's up to the student to decide whether to utilize a counseling service.
"You can't force treatment on people unless and until they show clear signs of dangerousness," Rostain said.
Still, there may be ways to more effectively address mental-health issues.
"I'm not sure that colleges should be keeping information about students private when there are things causing concern," said Rostain, who added that he believes some policies on college campuses need to change.
Alison Malmon, a Penn graduate who is the founder and executive director of Active Minds, said colleges should take steps to improve disclosure, such as asking students to sign waivers at the beginning of college that would legalize the release of information to parents.
But another challenge is harder to tackle: In a college setting, it is especially difficult to know when a strange behavior crosses the line to mental illness.
It is these grayer areas that partly explain why some students do not receive help, even if warning signs exist, said Miles Ladenheim, a psychiatrist at the Girard Medical Center in Philadelphia.
According to the 2006 American College Health Association's National College Health Assessment, 18 percent of students reported feeling depressed within the last school year, 9 percent said they had seriously considered attempting suicide, and 1 in 100 had attempted it.
And some say Joseph Cho, a former Penn Law student who has been declared incompetent to stand trial for the attempted murder of two Drexel University students in January, had unaddressed mental-health issuess similar to those of Cho Seung-Hui.
Several law students have said Joseph Cho was antisocial and suffered hallucinations, but both students and Penn Law officials say they believe he never reached out for help.
In those types of cases, professionals say, it may be up to peers to take control of the situation.
"We know that, at times, you need to have pressure put on the person," Rostain said.
Penn Counseling and Psychological Services Director Ilene Rosenstein agreed.
"Friends are our number-one referral service," she said.
Rosenstein added that the confidentiality of CAPS records makes students feel secure about seeking treatment, a view echoed by Rostain.
Drexel University psychology professor Kirk Heilbrun said the violent behavior displayed at Virginia Tech and by Joseph Cho, who allegedly fired nearly 15 shots into the door of the Drexel students' apartment, is rare.
Still, he added that he hopes the incidents will serve as reminders to look out for harmful behavior and emotional withdrawal.
"If we help one another in that sense, we prevent the very rare extreme violence and do a lot of other good," he said.
