Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Each week our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #02: Mental Illness and Campus Life Transcript

IAN VO DOWN & UP INTRO

The Down & Up Show on Depression Is Real.org. A show dedicated entirely to the subject of depression, and the reality that there is hope for people dealing with this disease. Now, your host, Dr. Ellen Frank.

DR. ELLEN FRANK INTROS DR. Dr. David Shern, PRESIDENT & CEO MENTAL HEALTH AMERICA

Welcome to another episode of Down and Up on depressionisreal.org. Today, we’re going to discuss what is currently a very difficult topic, mental illness and campus life. We watched with horror as the news of the Virginia Tech shooting unfolded and could only ask why or how could such a thing happen.

Our hearts went out to the victims, their families, even to the gunmen as we learned later about his troubled life. A number of questions arise out of this tragedy, including those surrounding violence and mental illness, the safety of university environments and schools options in helping troubled students. And we have with us today Dr. David Shern, President and CEO of Mental Health America to help us answer some of these questions. Dr. Shern, thank you so much for being with us today.

DR. ELLEN FRANK / DR. DAVID SHERN INTERVIEW

ELLEN FRANK QUESTION:

AS YOU WERE WATCHING THE COVERAGE OF THE EVENTS AT VIRGINIA TECH, AT WHAT POINT DID YOU WONDER OR KNOW THAT MENTAL ILLNESS MIGHT BE INVOLVED?”

DAVID SHERN ANSWER:

Well, of course, I wondered about that from the very first moment that, you know, we became aware of this horrible tragedy there. But tried to sort of reserve judgment until we learned about the specifics of this individual case.

ELLEN FRANK QUESTION:

THE GUNMAN WAS REPORTED TO HAVE BEEN TAKING SOME KIND OF PSYCHIATRIC MEDICATION. COULD … AND POSSIBLY ANTI-DEPRESSANTS. COULD DEPRESSION BE CONSIDERED A CAUSE OF SUCH ACTS?

DAVID SHERN ANSWER:

It certainly would not be a typical consequence of a person having a depression at all. And, you know, again the relationship between someone taking anti-depressant medication and violence is essentially non-existence. There are, of course, very, very, very, very, very rare side effects.

But I think as the story unfolded, it seemed much less about that in this particular individual’s life about really issues that we had had over a many, many year period.

ELLEN FRANK QUESTION:

WHAT ROLE DO WE THINK MENTAL ILLNESS PLAYS IN THIS KIND OF EXTREME VIOLENCE?

DAVID SHERN ANSWER:

Well, when you look at cases like this, I have a colleague who did a very intensive study of 37 school shooting incidents which culminated in Columbine. The Columbine shootings motivated the study. It was done to take a look at predictability and stress assessment. An important point they make is that mental illness played a very, very minor role in the vast majority of those school shooting incidents.

We know that, number one, we talk about mental illness. We talk about a huge spectrum of disorders that go from very mild to very severe. And that we know for people who have more severe mental illnesses, illnesses like schizophrenia, that in community samples we see that there is an increased risk of violence for persons who have those kinds of conditions.

But a very, very small component of all of the mental illnesses and a minisculy small component of the general population. Interestingly, when another really landmark study followed people with severe mental illness out of the hospital and back into the community using a comparison group, called a case control methodology and public health.

And that study showed no real increase in violence for persons with mental illnesses. So what we … my conjecture from the results of those two studies is if you look at those two studies is if you look at a community sample of persons we know about, the rate of treatment is not where we need it to be.

And in those persons, we saw an increase in violent behaviors. When you look at a group of people who’ve been treated and you see no increase, that there maybe an important story here about the treatment of people who have … who have mental illnesses.

ELLEN FRANK QUESTION:

YOU KNOW, AS I WAS LISTENING TO THE COVERAGE, THERE WERE MANY PEOPLE REFERRING TO THE GUNMAN AS A MONSTER. HIS ACTIONS AS EVIL. AS A MENTAL HEALTH ADVOCATE HOW DO YOU RESPOND TO THOSE KINDS OF CHARACTERIZATIONS?

DAVID SHERN ANSWER:

We were seriously considering … we had lots and lots of media contacts following this shooting as you might imagine. And we were seriously considering refusing to go on any media outlet that portrayed … that used language that you just repeated for us like, you know, mad monster, et cetera, et cetera.

You know, the real … the danger here, of course, is continuing to underline uninformed and ignorant attitudes about the connection between having a mental illness and violence or public safety concerns in general. Those are the kinds of things that drives people from care that inspire feelings of shame if a person has a legitimate illness.

And so among all that we saw, I think some of those portrayals are the things that I think were most damaging and for me extremely distasteful.

ELLEN FRANK QUESTION:

LET’S TURN NOW TO THE BROADER QUESTION OF MENTAL ILLNESS ON CAMPUS. A SURVEY CONDUCTED BY THE AMERICAN COLLEGE HEALTH ASSOCIATION FOUND THAT 8 1/2 PERCENT OF STUDENTS HAD SERIOUSLY CONSIDERED SUICIDE. FIFTEEN PERCENT WERE DIAGNOSED WITH DEPRESSION.

ARE THE COLLEGE YEARS A TIME WHEN WE’RE PARTICULARLY VULNERABLE TO DEPRESSION?

DAVID SHERN ANSWER:

Well, you know, we’ve increasingly learned that the age of onset for many of the most common types of mental illness is adolescence, even early adolescence. But these disorders since they typically are unrecognized and untreated often times really start to manifest themselves most dramatically in young adulthood.

So that’s, of course, when young adults are leaving high school and leaving home and entering sort of the brand new world of college life where they encounter a whole new set of challenges and unpredictable situations that can be stressful and can further complicate problems that they might have.

ELLEN FRANK QUESTION:

IT SOMETIMES SEEMS AS IF THERE ARE MORE EMOTIONALLY TROUBLED YOUNG PEOPLE THAN EVER GOING TO COLLEGE. IS THAT JUST A PERCEPTION? OR IS THERE REALLY A CHANGE?

DAVID SHERN ANSWER:

Well, to the … I just finished a book by another Dr. Frank, Richard Frank, and Sherry Glead, in which they try to sort of characterize the history of mental health in the United States for the last fifty years. And they did the best they could to kind of compare the different community epidemiological surveys that had been done across that time.

And their conclusion overall was that there was no net increase in terms of the rates of mental illness in our country. Now, that being said, having more people in college situations who are expressing and being identified as having mental health problems and who hopefully are in the main supported, appropriately served and remain in college might account for this apparent increase.

So in other words, it might actually be a good sign. You know, for many years if a person had a mental health problem in college, they would be either expelled or counseled to leave school in order to reduce stress ostensibly for their own best interest.

But as people explained that experience to them, it was pretty much being counseled to give up on your major life’s dreams and aspirations. And that in itself has very damaging potential effects, particularly on young adults who are really at this stage of life where they’re launching their … their adult life.

So my hope is that more colleges are becoming enlightened to the importance for people with mental health problems of staying on their life course. And that with appropriate treatment and support, they can … they can manage their illness. They can get better. And they can … they can succeed in college and ultimately in their adult life.

ELLEN FRANK QUESTION:

DO YOU HAVE ADVICE AT THIS POINT TO OFFER PARENTS, SCHOOLS OR STUDENTS ABOUT DEALING WITH DEPRESSION AND OTHER MENTAL ILLNESSES DURING THE COLLEGE YEARS?

DAVID SHERN ANSWER:

Yes, I do. And I’m trying to think … I’m trying to think about the best way to sort of … to sort of formulate this. I think it is critically … number one, we know that these problems are very common. And we know that in the vast majority of instances, students with mental illnesses can and will be successfully treated if they access care and … and fully kind of engage and participate in their treatment.

So the good news … the bad news is these are common problems. The good news is that they’re in the main quite treatable if someone reaches out and receives care. And I think it’s critically important that we base our public policy on our best science. And our best science tells us about the prevalence that these are likely … these are common disorders, but that they’re also … also quite treatable.

And those should be the rule rather than the exception. In those rare exceptions where people are having an extraordinarily difficult time and are presenting a threat to themselves or others, then I think it is necessary for us to compel them into treatment in one way or another.

But ultimately for that to work for them, that’s going to have to be a strategy that makes sense for them. I applaud colleges in terms of all of the efforts that they have undertaken over the last ten years or so to be … to be more supportive and inclusive.

And I so hope that they don’t experience in a very small number of cases untowards consequences in terms of their own legal liability or God forbid something like the Virginia Tech incident that causes them to become less tolerant and less accepting of people who have these illnesses.

Because they play a critical role in supporting them and keeping these young adults on their life course.

ELLEN FRANK THANK YOU:

DR. SHERN, THANK YOU FOR YOUR INCREDIBLY THOUGHTFUL ANSWERS TO THESE QUITE DIFFICULT QUESTIONS.

DR. ELLEN FRANK OUTRO (Music up half way through)

We know that the effects of this tragedy are effecting people across the country. We hope people know there are many resources that can help us cope with this event. Please visit our website at depressionisreal.org for a list. If you have any questions or comments while listening today, please call us at 1-888-973-HOPE, thatÕs 1-888-973-4673.

For the Depression is Real Coalition, IÕm Ellen Frank. Join us next week for another episode of the Down & Up Show on depressionisreal.org. [music]

IAN VO CLOSE

Thanks for listening to the Down and Up Show. For more information, log onto www.depressionisreal.org. You can find us there and at I tunes. And remember stay subscribed.

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