Neha Kapadia

321 Terrace Avenue

Jersey City, NJ 07307
December 5, 2011
Jill Richards, Psy.D
Director of CAPS
17 Senior Street
New Brunswick, NJ 08901
Re: Increasing Mental Illness Treatment and Suicide Prevention at Rutgers University through a
Comprehensive Suicide Prevention Plan
Dear Dr. Jill Richards,
First and foremost, I would like to thank you for coming to my presentation. In response to your interest
about my plan, I here attach my proposal for a comprehensive suicide prevention plan at Rutgers
University. I am sure you can agree with me about the necessity of recognizing and treating mental
illnesses through a variety of different ways on campus. The increase of mental illnesses on college
campuses is no secret, and numerous surveys indicate this as well. Untreated mental illnesses have social,
emotional and physical impacts on students. It becomes difficult for them to function properly and can
really affect students daily lives. Furthermore, they have academic and societal impacts that affect the
university (i.e. lost tuition dollars and lawsuits from completed suicides) (Kadison 3).
As a freshman three years ago, I noticed some changes in my behavior and feelings that I never attributed
to a mental illness. When I did realize, the stigmas that surround therapy and counseling always deterred
me from seeking help at the CAPS center. We consider mental illness to be a taboo topic, and therefore
feel uncomfortable addressing it. But as statistics show, the steady rise in mental illnesses needs to be
fought through a system that covers the many different aspects of mental illness (Kitzrow) Therefore, I
am proposing a three phase, comprehensive suicide prevention plan. Phase one of my project is to reduce
stigma and increase knowledge on campusmake students feel confident in seeking services and put
them at ease about mental illnesses. Phase two is recognition and increase accessibility to mental health
services. Many students do not even know they have a mental illness. In fact, fewer than one-third of
adults receive treatment for their illness in any given year (NAMI). My last and final phase is creating a
comforting environment for students providing students with resources they need to be successful. The
plan is designed to be cost-effective, with most of the money going towards hiring professionals to
actually implement significant parts of the plan. The results if successful will be an increase in students
recognizing the existence of a mental illness, increase in seeking help, and an increase in referrals made to
the CAPS center.
This proposal will develop on points that I mentioned in my presentation including, the increase of mental
illness on campus, the consequences of this increase, the necessity for a comprehensive plan and other
successful programs that inspire my proposal for Rutgers University.
Thank you again for your continuous support throughout this project. If you have any comments,
concerns or want to discuss a topic further, please feel free to contact me. You can reach me at (201) 9936893 or nehaa.kapadia@gmail.com
Sincerely,
Neha Kapadia

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Rutgers Comprehensive Suicide

Prevention Plan

An effort to increase mental illness education and reduce stigma

through a comprehensive suicide prevention plan

Submitted to:
Jill Richards, Psy.D
Director of CAPS
17 Senior Street
New Brunswick, NJ 08901
ii | P a g e

Submitted by:
Neha Kapadia
321 Terrace Avenue
Jersey City, NJ 07307

Abstract
The increase in mental illnesses on campus is no secret, about ninety-one percent of counseling
center directors agree, that there is a significant surge of students coming into college with
mental illnesses (Kitzrow). According to the National Mental Illness Alliance, Mental illnesses
are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others
and daily functioning they result in a diminished capacity for coping with the ordinary
demands of life. About one in every four Americans experiences a mental illness in a given
year, which means 57.7 million Americans. Many of those Americans are teens from 18-21 years
old, right around the college years. As a consequence there are social, emotional and physical
health impacts, because they result in an increased feeling of loneliness as well as the inability to
focus on tasks at hand (Kadison 7).
The idea is to use existing resources including personnel and programs and create a
comprehensive system that works in unison to reduce the prevalence of mental illnesses. The
plan is consisted of three parts in which the first includes educating students on mental illnesses
as a way to reduce stigmas associated with seeking mental health counseling. Mental health
education has proven to have lasting effects on students and therefore is included in the plan.
Phase two of the plan includes increasing accessibility to mental health services (Sharp 420).
This proposal will look into an Interactive Screening Program to screen students anonymously
for mental illnesses as well as create drop-in hours at the counseling center for students who
cannot wait for appointments (Haas 15). Lastly the proposal seeks to create a comforting
environment for students, as research shows that when students feel connected to their school,
risk behavior decreases significantly (Blum 7). This purpose of this proposal is to evaluate
different successful programs that fit into different components of the JED: Model for
Comprehensive Suicide Prevention and Mental Health Promotion. The purpose is to also
evaluate the costs and benefits of implementing a comprehensive plan such as the one mentioned
above.

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Table of Contents
Abstract......iii
Table of Contents...iv
Table of Figures......v
Executive Summary.....vi-vii
Introduction......1-2
Literature Review....3-4
JED Comprehensive Model .....2
Barriers to Seeking Help...4
Interactive Screening Program......4-5
Care, Assess, Report, Empower (CARE) 5
Mental Illness Needs Discussion Sessions (MINDS) ..5-6
School Connectedness: Improving Students Lives 6
Plan..7
Phase one.......8-9
Phase two.9-10
Phase three.....10-11
Budget..12-13
Discussion/Complications...14-15
References....16-17
Appendix A..19-22

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Table of Figures
Figure 1.....1
Figure 2...2
Figure 3.......4
Figure 4...........................7-8
Figure 5.......9
Figure 6.....................12
Figure 7....12-13
Figure 8.....13

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Executive Summary
Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, and
ability to relate to others and daily functioning they result in a diminished capacity for coping
with the ordinary demands of life (NAMI). Now more than ever, universities such as Rutgers
should be concerned about the student population that may have a mental illness. About ninetyone percent of counseling center directors have seen a rise in students who come in with mental
illnesses over the last five years (Kitzrow). This is alarming, and there are many different reasons
for it. Students today are experiencing more stress in their social lives and more competition in
their academic lives, than ever before. Furthermore, there is a mix of social, biological and
psychological factors that play a role in causing mental illnesses (UHS). With a variety of issues
that cause mental illnesses, the solution must also be multi-faceted.
In an online survey taken by one-hundred ten Rutgers University students, 58% felt
overwhelmed by all they had to do and 28% felt very lonely. The most alarming was that 3% or
three students had actually considered suicide in the last two weeks (Kapadia, Appendix A 1922)! With 38,900 students attending Rutgers University, three percent translates to about 1,167
students seriously considering suicide (IPEDS). Furthermore, that means about 22,562 students
feeling overwhelmed by all they had to do, and 10,892 feeling very lonely. These statistics were
taken from a general population of Rutgers University students and are indicative of the problem
we face here today.
There are many barriers that prevent students from actually seeking help. Many students
are unaware that Rutgers even has a CAPS center to help with cope with mental illnesses,
actually 39% of those 110 students surveyed, were unaware of the CAPS center (Kapadia). If
students do not know there is help out there they cannot seek it. Also, there is a stigma attached
to seeking counseling that many times deters those who actually need help. Lastly, many
students do not even know they have a problem, many believe that high levels of anxiety and
stress are a part of growing up. Twenty-five percent of students who took the survey believed
their problem was not serious enough to seek counseling. These three problems become serious
barriers for students to actually seek the treatment they need.
Since mental illnesses are multi-faceted, the solution must also be comprehensive enough
to take into consideration all the different effects. My plan is called the Rutgers University
Comprehensive Suicide Prevention Plan and it has three phases. Phase one is to actually change
the mood of the campus towards accepting mental illness is to teach students about it and to
reduce the stigmas. This consists of disseminating information on campus advertising the CAPS
center and the free services they provide. Classroom presentations are a big portion of this phase
because they ensure that students will be listening. They will provide students further
information on different mental illnesses, signs to look for and facts to decrease the stigma
associated with mental illnesses. The Speak Up campaign would be similar to the PATHs
See Something, Say Something campaign to target terrorism. In this case, students and faculty
members would be able to call a number in case they were considered about a particular student.
Students will then be contacted to see if they would like to come in for a consultation, it will help
reach the target population. Lastly part of phase one is to train Gatekeepers, literally those
vi | P a g e

individuals (professors, RAs) who are in daily contact with students who can prevent them
from getting too deep into their illness. These gatekeepers would receive special training on how
to treat at-risk individuals and what to do in the case of an emergency. So phase one is education
(Suicide Prevention Resource Center).
Phase two is about increasing access to facilities once students have accepted that they
may need help. The most important part of phase two is implementing the online screening
program. This program will help screen out student who are at risk and provide them with a
counselor who will speak to them online to increase the possibility that they will open up. Also,
creating counselor office hours in dormitories will increase access to services that students need
in case they are not ready to physically go to counseling. In the privacy of their own dorms,
students may feel more comfortable opening up. Lastly, it is important for the CAPS center to
start having walk-in hours for students at any time. Currently, they are only for students who
need immediate attention. By increasing access to the CAPS center without having to wait for
days before getting a phone call back, the center may be more effective in treating certain
students.
The last phase is creating a more comforting environment for students. Rutgers
University is a very large school and it is easy to get lost in it. It is hard to find a faculty member
who has the time to listen to you or who actually knows your name. Thus, phase 3 creates the
student advocacy center and assigns students personal guidance counselors. The student
advocacy center is a group that works for students, they help cut down the bureaucracy involved
in going to such a big school. They point students exactly where they need to go, as mentioned
before 58% students are overwhelmed by all they had to do. They could really benefit by having
a guidance counselor they can speak to who already knows about them. This would help students
feel at home and at ease knowing there are faculty members who are there to help.
Tackling just one issue will prove to be ineffective because mental illness is a
complicated situation. By using a comprehensive plan, Rutgers University will do a better job at
serving the population of students who are at risk and who severely need help. The measure of
success would be how many students actually speak to gatekeepers to accept their referrals for
CAPS and actually seek help.

vii | P a g e

Introduction
According to the National Alliance on Mental Illness (NAMI), one in four Americans on 57.7
million Americans experience a mental illness in any given year, this translates to about 9,400
Rutgers University students (IPEDS)! NAMI defines mental illness as a medical condition that
disrupts a persons thinking, feeling, mood, ability to relate to others and daily functioning,
which results in a diminished capacity for coping with ordinary demands of life (NAMI). Mental
illness has many causes; it is mainly a combination of biological factors, social factors and
psychological factors (UHS 6).
Seeing numbers like the ones above, and understanding the implications of mental illnesses on
Americans and specifically students, this is concern that needs attention. The myths, stigmas and
taboos surrounding mental illnesses are a few of the barriers this proposal looks to overcome.
Many students and even faculty members at Rutgers University find it nerve-racking to confront
a peers or students about a possible mental illnesses. Thus, Rutgers University needs a
comprehensive plan to solve a multi-faceted problem. With rise of mental illnesses on campus
there is no better time than now to start making changes.

Rise of Mental Illness on College Campuses

Of the 57.7 million Americans who are struggling with a mental illness each year, less than onethird of adults are actually receiving any treatment (NAMI). This means that only 3,113 of the
9,400 students who actually need treatment are receiving it. Studies show that there is a rising
trend in mental illnesses on campus. According to the National Survey of Counseling Center
Directors at 247 university institutions, 91% of directors report an increasing trend of students
with severe psychological problems (Kitzrow 2). This trend can also be seen in a comparison
between a 2003 and 2010 National College Health Assessment done by the American College
Health Association. As the chart below shows in 2003, 6.3% of students felt overwhelmed by all
they had to do, and then 2010 the number increases by 8-fold to 83% (American College Health
Association). Furthermore, in 2003, 28% of students felt so depressed it was difficult to function,
the number nearly doubled in 2010 to 55% (Kadison 239).
Figure 1:

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American College Health Association

Mental Illnesses at Rutgers University

In a survey of 110 Rutgers University students in October of this year, 86% of students answered
None of the Above when asked, Within the last 12 months, have you been diagnosed or
treated by a professional for the following? As seen in figure 2, many of the major mental
illnesses were listed, and most students selected none of the above. There is a major gap
between detection and treatment for students. 25% of students felt so depressed it was difficult to
function, yet only 10% of students are being diagnosed or treated by a professional (Kapadia).
Furthermore, about 64% of students felt overwhelming anxiety sometime in the last 12 months,
yet only 3% of students were treated or diagnosed for panic attacks and obsessive compulsive
disorders (they two of the major types of anxiety disorders) (NAMI).
Figure 2:

The Problem Here at Rutgers University

The CAPS center and the Suicide Prevention Taskforce is doing a great job at getting different
resources together to help students in need. But there is still a disconnect between students who
need the help and who are receiving the help they need. Currently, about ten-percent of Rutgers
students are receiving counseling from CAPS, but as statistics show one in every four people
struggle with mental illness in any given year (Richards, personal communication, October,
2011). This means here at Rutgers, 15% or 5604 students have mental illnesses which are
undetected and undiagnosed (IPEDS).
In the survey of 110 Rutgers University students, about 39% of students do not even know that
the CAPS center exists (Kapadia). This means they are not aware that Rutgers CAPS center
provides universal health care for all students; it also provides long-term and short-term
counseling for those who need it. Furthermore, 39% of students are unaware of the group
counseling that is available to all students.

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Literature Review
JED: Model for Comprehensive Suicide Prevention and Mental Health
Promotion (5)
Mental illness treatment and suicide prevention are both problems that need attention from
different angles and resources. Since there is no single solution but JEDs Model for
Comprehensive Suicide Prevention and Mental Health Promotion states seven strategies that
must be present together to promote positive mental health. The first strategy includes
identifying students at risk. It is proven that students who are actually at-risk for suicide do not
actually ask for help. Thus, it is extremely important for universities to have outreach programs
such as online health screenings and asking students questions about mental health history. The
second component includes increasing help-seeking behavior, because once students can
perceive the need for help they are more likely to seek that care. Students are often aware of the
resources available to them and furthermore the stigmas of mental illnesses provide a barrier to
actually getting help (SPRC). Associated with this is providing mental health services, once
students are aware they have a problem there must be institutional programs in place to help
them. Accessing mental health services should be simple and universities should institute sameday appointments for those in need. Every university and college should have a crisis
management procedure in place so all faculty members know what protocols to follow in the
case of an emergency (SPRC). This information should be readily accessible to all individuals
who have a role in the safety of students (Resident Assistants, Professors, Teaching
Assistants). An important aspect of suicide prevention is restricting any lethal means at-risk
students can get to. By restricting access to poisonous chemicals and roofs of buildings, the risk
of suicides can become significantly less (SPRC). This comprehensive model also includes the
idea of helping students develop life skills such as physical well-being and time-management
before they need to go to the counseling center. JED proposes that students should understand
school is about more than just academics and should be taught life lessons that can put them at
ease before developing serious mental health problems (SPRC). Lastly, all universities should
promote different and diverse social networks because it is proven multiple times that loneliness
and isolation are risk factors for mental health problems. By encouraging students to join
different organizations, it helps them develop a sense of belonging and can eliminate feelings of
loneliness (SPRC).
The JED Model is based on the US Air Force suicide prevention programme that is a program,
which focuses on early prevention by intervening when signs of dysfunction first appear (Knox
1). The program also looks to enhance detection and treatment for those who are already in
danger (Knox 1). The program has had a 33% risk-reduction in completed suicides during the
five year study between 1997 and 2002 (Knox 2). Furthermore, the program reduced homicide
by 51% and severe family violence by 54%; both are results of mental illnesses (Knox 3). The
US Air Force implemented eleven initiatives that were aimed at strengthening social support,
promoting effective coping skills, and creating policies that would increase help-seeking
behavior (Knox 2).

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Figure 3:

(Knox 3)

Barriers to Seeking Help

Mental Health Education: An evaluation of a Classroom Based Strategy to Modify Help Seeking
for Mental Health Problems, is a study done by William Sharp et al. that looks into the barriers
of help-seeking behavior. Research has indicated that personal experiences and anecdotal
evidence from family are two important sources of mental health information individuals
receive. Media also plays a role in shaping mental illness for individuals. Movies and news
reports have a tendency to report negative aspects of mental illnesses such as violent crimes and
drug use (Sharp 420). Another barrier includes the strong stigma attached to mental illness.
Stigma is characterized by fear, mistrust, dislike, and (at times) violence against the mentally
ill (Sharp 421). It has been reported that the mentally ill are often perceived negatively and
rejected by others (Sharp 421). The risk of isolation and being judged is enough to deter at-risk
students from seeking professional help. The third barrier includes concerns and fears about the
nature of treatment. Individuals also have low expectations about counseling that may influence
their ideas of treatment (Sharp 422). Research has shown that help seekers and non-help seekers
have different perceptions of the effects of treatment. Thus, in order to help decrease the
prevalence of the previously mentioned barriers, students need to be educated on the facts of
mental illnesses.

Interactive Screening Process (ISP)

The Interactive Screening Process is a program created by the American Foundation for Suicide
Prevention. In a 2002 to 2005 study of two universities, 1,162 students participated and of those
who completed the screening questionnaire, 84.4% of students were categorized as high or
moderate risk. Furthermore, 19.4% of students consented to an in-person evaluation with an ISP
counselor (Haas 15). Students who utilized the online dialogues with counselors were three times
more likely to go for an evaluation and seek treatment.
The ISP is designed reach a larger group of at-risk students through an anonymous screening
process. When students receive an email about the program they are encouraged to complete the
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depression screening questionnaire, which is based on the 9-item depression scale of the Patient
Health Questionnaire (PHQ-9). Once they complete the anonymous screening they are placed in
one of three tiers. If students were placed in Tier 1 or 2 they were considered high risk and
moderate risk, respectively and were urged to call or email a counselor to set up an in-person
evaluation. In addition, students were given the opportunity to participate in an online dialogue
with ISP counselors (Haas, A.P. 16). Tier 3 students were encouraged to discuss any issues they
may have through the online dialogue. The anonymous, online dialogue seemed to be very
helpful for students as a way of initiating dialogue without worrying about identity issues or
repercussions of mentioning something illegal (Haas, A.P. 17).

Care, Assess, Report, Empower (CARE):

CARE is part of the Substance Abuse and Mental Health Services Administrations national
registry of evidence based practices. The program uses brief interventions and social network
influences to decrease suicidal behavior. CARE is designed to empower youth by connecting
them to a caring person in their personal lives or a favorite teacher. Parents are involved in the
process to give them information on how to deal with their child during this time period. CARE
reduces risk factors by increasing a participants personal and social assets (Office of Justice
Programs).
The program includes a two-hour, computer-assisted suicide assessment, which is then followed
by a two-hour motivational counseling session. The counseling session is designed to deliver
empathy and reinforce help-seeking behaviors (SAMHSA). Students are then connected to a
favorite teacher or school-based caseworkers who continuously check in with the student and
offer a safe place to talk about problems. Nine weeks later there is a follow-up reassessment and
a booster motivational counseling session. CARE was originally designed for youth 13-17 years
old, but has now been expanded to young adults 18-25 years old (SAMHSA).
After the ten-month counseling period, students showed significant progress in the decrease of
risk-related ideology. Suicide risk factors decreased by at least 25% in more than 85% of
students (SAMHSA). Males and females both showed equal progress in the reduction of these
risk factors, findings did not vary by gender. The severity of depression symptoms decreased by
25% in more than 65% CARE participants (SAMHSA). Feelings of hopelessness were decrease
by 25% in more than 60% of students who participated in the program. More than 65% of
participants showed a 25% decrease in anger control problems (SAMHSA). Nearly half of
CARE participants perceived stress decreased by 25%. Most importantly, there was a 20%
increase in sense of personal control. This meant students were confident about eventually
feelings better (SAMHSA). Connecting with a faculty member proved to be a help methods of
suicide ideation in these students.

Mental Illness Needs Discussion Sessions (MINDS):

In a 2006 study, researchers assessed the impact of a brief psychoeducational intervention on
participants attitudes towards seeking professional help. They found that a brief, classroombased program is a hopeful method to alter help-seeking attitudes and negative stigmas
associated with mental illnesses (Sharp 419). Lack of help-seeking behavior can be attributed to
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stigma (negative or inaccurate information about mental illnesses), low expectations and
fearfulness or counseling, and lack of knowledge regarding options for treatment they may have
(Sharp 428). Through this study researchers found that an educational program helps in
improving attitudes towards seeking professional help, and this change within individuals lasted
at least a month after the educational intervention. Research also found that participants
experienced a significant decrease in the view that the mentally ill are dangerous and should be
controlled, meaning this type of education was successful in reducing some stigmas associated
with mental illnesses (Sharp 435).
MINDS is a classroom-based program designed for teenagers and young adult. They conduct
seminars that last 1-1 hours, and their curriculum includes a hands-on look at a model brain,
discussion of the symptoms of mental illnesses, and interactive activities that allow students to
participate actively throughout the seminars (MINDS). The program helps bring awareness to
students about mental illnesses and tries to de-stigmatize the disorders. During the seminars
students are given two brochures; one describes symptoms of different mental illnesses and the
other provides a guide to local, state, and national help life, referral agencies, organizations and
other services (MINDS). The program has proven to equip students with the knowledge they
need in times of crisis while educating breaking down stigmas that they held.

School Connectedness: Improving Students Lives

Written by the Bloomberg School of Public Health, School Connectedness: Improving
Students Lives, attempts to explain the importance of having students feel connected to the
school. As the research explains, School connection is the belief by students that adults in the
school care about their learning and about them as individuals (Blum 3). Four requirements that
are critical to ensuring this connectedness are: support for learning, positive adult-student
relationships, and physical and emotional safety (Blum 3). Studies have shown that youth that
feel school connectedness are less likely to exhibit violent behavior, experiment with illegal
substances, appear emotionally distressed, and consider or attempt suicide (Blum 7). When
students feel they belong to their school they are likely to be successful in their educational
careers. This is because school connection decreases absenteeism, bullying and vandalism while
it promotes educational motivation, academic performance, school attendance and completion
rates (Blum 3). The key here is understanding that fostering relationships with faculty members
and university institutions are key to making students feel connected to the school. In a large
university like Rutgers, it is sometimes difficult and thus the school needs to work towards
accessibility to faculty members and such institutions.

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The Plan
As mentioned previously, in order to successfully detect and treat mental illnesses, a university
must adapt a comprehensive plan. As evidenced in the literature review, there are five important
factors: reducing stigma, educating students on mental illnesses, increasing early detection of
mental illnesses, increasing accessibility to mental health services, and creating a comforting
environment for students (SPRC). The following will outline the initial Rutgers University
Comprehensive Suicide Prevention Program in three phases. This plan is and should be subject
to revision as different organizations get involved and add their knowledge and information.
In order for the Rutgers University Suicide Prevention Program to work efficiently, the first step
would be to develop a taskforce; a group of individuals across university disciplines who can
bring in unique information and ideas.
Figure 4:
Name

Francesca M. Maresca, Ph.D.

Jill Richards, Psy.D.

Mary Kelly

Matthew Zielinski

Department
Coordinator,
Promotion
(H.O.P.E)

Campus Responsibilities
Health Outreach, Responsible for the dissemination
and
Education of health and wellness information
to the entire Rutgers community.
Dr. Maresca coordinates peer
education, assesses the health and
wellness of students. She is key to
disseminating information such as
the mental illness awareness
video.
Director, Couseling, ADAP & Provides leadership and oversight
Psychiatric Services (CAPS)
for all aspects of the CAPS center.
One of her expertise includes
youth adults who struggle with
severe mental illness concerns.
She
is
key
to
altering
administrative issues within the
CAPS center (i.e. walk-in hours).
Staff
Psychologist/Suicide She works on community
Prevention Specialist, CAPS/ approaches to suicide prevention.
Director of Mental Health With her knowledge on suicide
Education and Suicide Prevention prevention, she is a key member
on the taskforce.
Coordinator of Special Programs, He works to improve residential
Residence Life
experience for college students.
He is the main contact for
dormitory programming. He is
key to mental health awareness
programming in residence halls.

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Susan McNeely

Four Clinical Psychologists

Assistant Director of Training and She provides the education hall

Personnel
directors and resident assistants
need to be successful in their
positions. She is key to the gatekeeper trainings.
Interactive Screening Program They will be the direct contacts
Counselors
for students who are screened
through the ISP program.

http://ruoncampus.rutgers.edu/staff-and-contacts/residence-life-contacts

This task force will consist of members from different disciplines and departments at Rutgers
University and will serve as the drivers for this program. They will meet once a month to discuss
the progress of the program, issues they are facing, and other alternatives to methods of success.
Their support will be essential to carry out the three phases of program.

Phase One: Reduce Stigma and Increase Knowledge on Campus

In order to convince at-risk students that they need help it is first important to reduce the barriers
that surround seeking help. As evidenced in the literature review, mental health education
improves attitudes towards seeking professional help, and these changes in attitude are
noticeable even after a month of the intervention (Sharp 435). The first component to phase one
will be to have classroom presentations. The key is to show these presentations in classes that are
mandatory for all Rutgers University students to take. Two such classes are Basic Composition
and Expository Writing. All incoming students must take one of these two classes their first
semester at Rutgers University and therefore presentations should be given in these classes. The
video will be created by the taskforce and will include information about the medical causes of
mental illness and it will work towards addressing the three barriers mentioned previously. The
video will also highlight mental health resources on campus including the CAPS center and the
programs it offers. This is important because about 40% of Rutgers University students are
unaware that the CAPS center exists (Kapadia).
The second component is to disseminate information around campus about the CAPS center and
its services. Aside from those students who are introduced to the mental health video in class,
there are many other students who remain untapped. By disseminating flyers on school buses,
dining halls, libraries and dormitories the percentage of students who see the information
increases drastically (SPRC). These flyers will advertise the CAPS center as a service free to all
Rutgers University students and will explain the programs it offers. Again, 40% of students are
unaware of the CAPS center and these flyers will inform students that this service is available to
them (Kapadia).
Also part of phase one is the Speak Up campaign which is very similar to the PATHs See
Something, Say Something campaign. This would require posters around campus asking
students, professors and faculty to refer students they are concerned about. Many time students
and faculty members notice a peer or student acting different but they are unaware of what to do
about it. These posters would include the CAPS phone number, the Scarlet Listeners phone
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number and the National Suicide Prevention Hotline number. The poster would also list signs
and symptoms to look out for. By making the contact information readily available students may
be more likely to refer students anonymously.
Lastly, and he most important part of phase one is training the gatekeepers. Gatekeepers are
those individuals who have constant contact with students and are responsible for their safety.
Gatekeepers include professors, resident assistants and peer mentors (Suicide Prevention
Resource Center). They quite literally gatekeepers, because they make sure students do not pass
the point of severe mental illness. Training gatekeepers means to give them information about
what signs and symptoms to look for in at-risk students. These individuals will also be trained by
the taskforce, in crisis management and will have specific protocol to follow depending on the
type of crisis. Training those who have a role in the safety of students is key to a comprehensive
program (SPRC). Resident Assistants are key to training because they encounter students in their
natural habitats, and can see when students are most distraught (SPRC). These gatekeepers will
receive packets of information about mental illnesses and protocols and they will have direct
access to members of the taskforce for any help or questions.

Phase Two: Increase Accessibility to Mental Health Services and

Recognition
If phase one is successful in educating students and decreasing the stigmas of mental illnesses,
students will need to have access to quality mental health care. The first component to phase two
is the implementation of American Foundation for Suicide Preventions Interactive Screening
Program. With the purchase of the program from the AFSP, year one costs include: initial
website development and training of staff members. The four clinical psychologists will receive
training in the ISP program, and will be called ISP counselors. Once the Rutgers University ISP
website is created and the ISP counselors have been trained the next step is to go live with the
program. The AFSP recommends sending the link out to a target group, but in this case there is
no method to select such a
Figure 5:
group (Haas, A.P. 7). So,
all students (undergraduate
and graduate) will receive
a link to the online
assessment. Each time a
student is assessed a
notification will directly
go to one of the four ISP
counselors.
Counselors
will
review
student
responses, and respond
according to the Tier 1
(high risk), 2 (moderate
risk), or 3 (low risk)
protocols. Generally, for
Tier 3 students, counselors
9|Page

offer the online dialogue and answer any questions. For Tier 1 and 2, counselors urge students to
come for an in-person consultation. If students refuse to come in, counselors will suggest the
online dialogue, to get students to open up about their problems (Haas, A.P. 7).
In conjunction with the ISP launch, ISP counselors will have dormitory office hours. This will
help make counseling more accessible to students who are not ready to commit to counseling at
the CAPS center. The four ISP counselors and Mary Kelly, the Suicide Prevention Specialist,
will each take one day out of the week to visit the five Rutgers University campuses. They will
start visiting only the freshmen dormitories, and depending on their success will expand in the
future (Kelly, M, Personal Comunication). These counseling sessions will take place in
dormitory study lounge, which will be inaccessible to other students during drop-in hours.
Each session will last about hour and be designed as a short-term counseling session. The goal
is to get students to talk in an environment they are most comfortable, and it provides them
accessibility when they suddenly feel sadness, stress or pressure. Counselors will work towards,
helping students who need help in the short-term, but suggest the CAPS center to those students
who they believe to need it most. Students will be able to sign up for these sessions by emailing
their dormitory counselor, which will be advertised through residence assistants.
Also in conjunction will be drop in hours at the CAPS center. Suicidal ideation can often be
impulsive and short-term, understanding this, it is key to have drop in hours for students to
who need help suddenly (NAMI). Currently, when students make appointments with the CAPS
center, they must way two to three days for a phone screening, and then an additional two or
three days to get an appointment with a counselor. In the time of crisis, this process can have
detrimental effects. These walk-in hours would be daily from 9 A.M. when the CAPS center
opens to 5 P.M. when the center closes. The four ISP counselors and Dr. Mary Kelly will
provide support for students who utilize these office hours on days they are not scheduled to
make dormitory visits. Each walk-in session will be 30 minutes, and will provide short-term
support for students until they get an appointment with a counselor for regular sessions.

Phase Three:
Often in a large university such as Rutgers, it is difficult for students to navigate around the
bureaucracy. When students have questions about a particular class, requirement or major it is a
daunting task trying to figure who to contact. Also, students do not have one contact person they
can regularly check in with to make sure they are one track with requirements, or to build a
nurturing bond with. Thus, phase three of the program calls for creating a comforting and
welcoming environment for students. The first part this is to create a Student Advocacy Center.
To keep costs low, the Student Advocacy Center will reorganize a team of deans (Office of
Student Life). Currently, Rutgers University has advising centers on four campuses. The College
Avenue advising center is located in Millerdoller Hall, and deans and staff members offer
students advice on a walk in basis. Currently, the structure of the College Avenue advising center
is students walk up to the counter and ask their questions. The Advocacy Center would still
allow students to ask questions, but it would also let students sit with counselors to discuss any
in-depth issues. The Advocacy Center will consist of the same deans that work in the advising
center right now. Goals would be modified to work towards informing students about university
10 | P a g e

regulations; treating each student as an individual case and working to make sure their concerns
are efficiently tended; and to offer student alternative solutions to their problems while using
university resources (Office of Student Life). The center will be open from 9 AM to 5 PM as the
advising center previously was, and it will be a walk-in office for easy accessibility.
The other component to phase three is to assign all students to a university contact, most likely a
dean. Similar to high school, these deans will serve as guidance counselors. Each student will be
assigned a dean according to their last name, and this dean will serve as their guidance counselor
for their term at Rutgers University. Students will be required to meet with their dean at least
twice as semester (once in the beginning and once in the end). Deans will provide students
support with choosing classes, learning about different organizations on campus, choosing a
major and other issues students will have. In such a large school, again it is difficult to find the
right dean or the correct university contact for different problems, and thus this dean will serve
as a primary contact and direct students to where they need to go. Rutgers University already
runs such a program for Equal Opportunity Fund (EOF) students, in which low-income students
are given a counselor for their term at the university, whom they check in with once a month. For
the purposes of this proposal and to keep costs low, deans will serve as the guidance counselors
(EOF). The importance of this connection is evidenced in the literature review, and essential to
the success of this program (Blum 3).

11 | P a g e

Budget
Figure 6:
Line Item
Personnel
Clinical Psychologist(s) (bls.gov)
Director of Mental Health Education
and Suicide Prevention
Videographer (NYC Video Production
Company)
Sub-Total:
Advertising
DVDs (staples.com)
Fliers
1000/.15
Posters (printplace.com)
Sub-Total:

Cost
$256,560
0
$2,500
$259,060
$22.99.
$150
$223
$395.99

Programs
Gatekeeper Training (sprc.org)
Interactive
Screening
Program
(sprc.org)
Initial Start-Up Fee
Yearly Fee
Sub-Total

$2,500
$5,000
$2,500
$10,000

The Rutgers University Suicide Prevention Program is designed to utilize all existing resources
and personnel already on campus. Therefore, all those in the task force will not be considered a
cost for this program. Dr. Mary Kelly who is currently the Suicide Prevention Specialist will fill
the position of Director of Mental Health Education and Suicide Prevention, she is also an
employee of Rutgers University and her salary will not be included in the expenses of this
program. She will take on the lead role for this program and serve as the director and primary
contact for any concerns. Working with her will be four new clinical psychologists. The yearly
salary of clinical psychologists is about $64,140, and will cost the University $256,560. They
will serve as ISP counselors, provide dormitory office hours, and provide support during CAPS
walk-in hours. Lastly, we will need to hire a videographer who will create the video that will be
presented in classrooms. The price for the videographer and production of the short video will
cost about $2,500.
Figure 7:
Line Item
Office Space

Cost
$0

Office Supplies
Office Desk(s) (staples.com)
5/129.99 each

$649.95

12 | P a g e

Desktop(s) (walmart.com)
5/379.00 each
Legal Writing Pads (staples.com)
12/pack, 1 every 2 months
Pens (staples.com)
12/pack, 1 every month
All-In-One
Wireless
Printer
(walmart.com)
Black Office Chair (s)
5/129.00 each
Sub-Total:

$1,895
$49.74
$21.48
$49
$645
$3,310.17

This program will work through the CAPS center, which is located on 17 Senior Street. There is
currently office space available and thus, the office for the ISP counselors and the director will
be located within the CAPS center. Since the program will use pre-existing office space that will
not be an additional cost.

Budget Tally and Justification

Figure 8:
Budget Tally
Total Cost
After SAMHSA Grant*

Cost
$272,766.16
$170,766

Yearly Budget (Total Cost minus

on time costs)
Initial ISP Start-Up Fee
$165,766
Yearly Budget with Grants

$165,766

Without any additional grants, the cost of the Rutgers University Suicide Prevention Program
will be $272,766.16. Although this may seem like a large amount, The largest cost is hiring five
new personnel, the rest of the costs are low because the program is utilizing existing resources.
Similar to other large universities, we spend nearly $3.5 million dollars on student health and
counseling services each year this includes outreach programs, emergency care and personal
counseling (Emory Counseling Center). The proposed amount for this program is only a fraction
of what the university spends on these services currently. By spending this amount early on, the
university can save thousands of dollars on unused counseling services and emergency care.

13 | P a g e

Discussion
Mental illness detection and suicide prevention are key to a healthy, thriving student community.
Mental illnesses have social, emotional and physical impacts to students that leave students with
the inability to work, learn and enjoy daily life. They also have academic impacts, with 5% of
students prematurely leaving college because of a mental illness this translates to 2,000
Rutgers University students! Furthermore, untreated mental illnesses have fiscal impacts on the
university. The university ends up spending more money on emergency care, lawsuits from
completed suicides, negative publicity and lost tuition fees. According to my survey, out of 110
students 58 students felt overwhelmed by all they had to do and 29 students felt things were
hopeless. It is the universitys responsibility to help alleviate some of these negative feelings.
Using a comprehensive program, Rutgers University will be able to tackle all different aspects of
mental illness. Before we can treat mental illnesses, students have to learn about the causes,
effects, and facts about mental illnesses. Once students are rid of stigmas and misconceptions, it
is important for students to have easily accessible services, especially because these feelings can
be very impulsive. Lastly, in conjunction Rutgers University needs to make faculty and offices
far more accessible, the university is too large to navigate most times. This plan offers a wide
range of changes that should be made at Rutgers, thus there will be various measures of success.
One measure of success will be seen in how many students are referred to the CAPS center by
gatekeepers and peers and how many students actually come in for an evaluation. If students
come in for an evaluation who previously did not contact the CAPS center, we can assume that
one of the following was the catalyst: gatekeeper advice to seek counseling; outreach by the
CAPS center through a referral; or reduced stigmas through classroom presentations. Another
measure of success is to use students who are screened through the ISP program. Once students
are screened, with their consent, their progress will be tracked throughout one semester. ISP
counselors will give students information about different resources on campus (i.e. the Student
Advocacy Center) and pair them up with a guidance counselor whom they will meet with a few
times during the semester. Furthermore, those students will be asked to fill out a before and after
survey about their ideas about mental illness after watching the classroom presentation. Lastly,
students will be asked if they would use walk-in hours and dormitory office hours. These
responses will all provide a measure of success to see if the new policies and institutions have
had an effect. The third measure of success will be a questionnaire sent to all individuals who
received gatekeeper training, and it will ask them questions such as:
1) Have you ever had to use your training on your students or residents?
2) Do you feel the gatekeeper trainings prepared you for dealing with a crisis situation?
3) Did you refer the student or resident to the CAPS center?
4) Do you know if they followed through with the counseling sessions?
5) What could we teach to prepare you better?
With gatekeeper responses we will have a better understanding if these trainings are working and
the success they have had.
The general population consider mental illness to be a very private issue and hesitate having to
ask someone of they are okay. According to Dr. Mary Kelly, In all the years I have been doing
14 | P a g e

this, no one has ever gotten mad at me for asking, I rather ask and be wrong, then have never
asked at all. This is an issue many students and professors will run into when dealing with an atrisk student, but the assumption is that the gatekeeper trainings and classroom presentations will
help individuals understand it is okay to ask such questions. Another issue is the low response
rates of the ISP program. In many cases online surveys have very low response rates, and in our
case to combat this instead of sending the ISP link to a target population, it will be sent to the
entire university. This will ensure everyone has a chance to understand the program and respond
if they find it necessary.

15 | P a g e

References
American College Health Association. American College Health Association-National College
Health Assessment II: Reference Group Executive Summary Fall 2010. Linthicum, MD:
American College Health Association, 2011. Print.
Blum, Robert, School Connectedness: Improving the Lives of Students.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 2005.
Eisenberg, D., E. Golberstein, and S. E. Gollust. "Help-Seeking and Access to Mental Health
Care in a University Student Population." Medical care 45.7 (2007): 594-601. Print.
Emory Counseling Center (Emory University Student Health and Counseling Services). FAQs:
Emory Universitys New Mental Health and Counseling Fee.Print.
EOF (Equal Opportunity Fund). "NJ EOF Program." Rutgers Undergraduate Admissions.Web.
December 1, 2011 <http://admission.rutgers.edu/costs/financialaid/njeofprogram.aspx#5>.
Garlow, Steven J., et al. "Depression, Desperation, and Suicidal Ideation in College Students:
Results from the American Foundation for Suicide Prevention College Screening Project at
Emory University." Depression & Anxiety (1091-4269) 25.6 (2008): 482. Print.
Haas, A. P., and M. Mortali. Interactive Screening Program Manual 2011-2012. New York, NY:
American Foundation for Suicide Prevention, 2011. Print.
Haas, Ann, et al. "An Interactive Web-Based Method of Outreach to College Students at Risk for
Suicide." Journal of American College Health 57.1 (2008): 15. Print.

16 | P a g e

IPEDS Fall Enrollment Report. New Brunswick, NJ:, 2010. Print.

Kadison, R., and T. F. DiGeronimo. College of the Overwhelmed: The Campus Mental Health
Crisis and what to do about it. San Francisco, CA: Jossey-Bass, 2004. Print.
Kapadia, Neha. Have You Ever... Online Survey ed. New Brunswick, NJ:, 2011. Print.
Kitzrow, Martha Anne. "The Mental Health Needs of Today's College Students: Challenges and
Recommendations." NASPA Journal (Online) 46.4 (2009): 646-60. Print.
Knox, Kerry L., et al. "Risk of Suicide and Related Adverse Outcomes After Exposure to a
Suicide Prevention Programme in the US Air Force: Cohort Study." BMJ: British Medical
Journal (International Edition) 327.7428 (2003): 1376. Print.
MINDS (Mental Illness Needs Discussion Sessions). Minds: Shining Light on Mental Illnesses.
2008.Web. November 2, 2011 <http://mindsprogram.org/program-information.aspx>.
NAMI (National Alliance on Mental Illnesses). What is Mental Illness: Mental Illness Facts.
National Alliance on Mental Illnesses. Web. November 2, 2011.
Office of Justice Programs. "Program Profile: Care, Assess, Respond, Empower (CARE)

." Crime Solutions.Web. November 1, 2011

<http://crimesolutions.gov/ProgramDetails.aspx?ID=201>.
Office of Student Life. Student Advocacy Center.Web. Ohio State University. November 10,
2011 <http://studentlife.osu.edu/advocacy/>.

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SAMHSA. CARE (Care, Assess, Respond, Empower)., 2007. Print.

Sharp, William, et al. "Mental Health Education: An Evaluation of a Classroom Based Strategy
to Modify Help Seeking for Mental Health Problems." Journal of College Student
Development 47.4 (2006): 419-38. Print.
SPRC (Suicide Prevention Resource Center). "Model for Comprehensive Suicide Prevention and
Mental Health Promotion." SPRC/Jed Foundation Comprehensive Approach. Ed. JED
Foundation. Web. SPRC. <http://www2.sprc.org/collegesanduniversities/comprehensiveapproach>.
Suicide Prevention Resource Center. Comparison Table of Suicide Prevention Gatekeeper
Training Programs. Newton, MA:, 2011. Print.
U.S. Department of Health and Human Services (UHS). Mental Health: A Report of the Surgeon
GeneralExecutive Summary. Rockville, MD: U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Washburn, Cheryl A., and Michael Mandrusiak. "Campus Suicide Prevention and Intervention:
Putting Best Practice Policy into Action." Canadian Journal of Higher Education 40.1
(2010)Print.

18 | P a g e

Appendix A:
110 Student Survey Responses
How would you classify yourself?
Undergraduate student
Non-traditional
undergraduate student

105 95%
0

0%

Graduate student

3%

Not a Rutgers student

2%

What is your gender?

Male
Female

37 34%
73 66%

I do not wish to disclose 0 0%

What is your age?

18-21 106 96%
22-25 3 3%
26-29 1

1%

30+

0%

Felt things were hopeless

No, Never
23 21%
No, not in the last 12 months 13 12%
Yes, last 2 weeks

32 29%

Yes, last 30 days

14 13%

Yes, in last 12 months

28 25%

Felt overwhelmed by all you had to do

No, never

2 2%
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No, not last 12 months 5 5%

Yes, last 2 weeks

64 58%

Yes, last 30 days

16 15%

Yes, in last 12 months

23 21%

Felt very lonely

No, never
25 23%
No, not last 12 months 17 15%
Yes, last 2 weeks

31 28%

Yes, last 30 days

17 15%

Yes, in last 12 months

20 18%

Felt so depressed that it was difficult to function

No, never
52 47%
No, not last 12 months 20 18%
Yes, last 2 weeks

13 12%

Yes, last 30 days

4 4%

Yes, in last 12 months

21 19%

Felt overwhelming anxiety

No, never
28 25%
No, not in last 12 months 11 10%
Yes, last 2 weeks

28 25%

Yes, last 30 days

15 14%

Yes, in last 12 months

28 25%

Seriously considered suicide

No, never

83 75%

No, not last 12 months 16 15%

Yes, last 2 weeks

3 3%

Yes, last 30 days

1 1%

Yes, in last 12 months

7 6%

Intentionally cut, burned, bruised, or otherwise injured yourself

No, never
90 82%
No, not last 12 months 13 12%
Yes, last 2 weeks

1 1%

Yes, last 30 days

0 0%
20 | P a g e

Yes, in last 12 months

6 5%

Within the last 12 months, diagnosed or treated by a professional for the following:
Attention Deficit and Hyperactivity Disorder 4 4%
Bipolar Disorder
3 3%
Depression

11 10%

Insomnia

1 1%

Obsessive Compulsive Disorder

1 1%

Panic Attacks

2 2%

Schizophrenia

0 0%

Substance abuse or addiction

1 1%

Other mental health conditions

1 1%

None of the above

95 86%

Other
3 3%
People may select more than one checkbox, so percentages may add up to more than 100%.
Within the last 12 months, any of the following been traumatic or very difficult to handle:
Academics
Career-related issue

59 54%
21 19%

Death of family member or friend 12 11%

Family problems

33 30%

Intimate relationships

28 25%

Other social relationships

27 25%

Finances

27 25%

Personal appearance

29 26%

Personal health issue

15 14%

Sleep difficulties

23 21%

None of the above

28 25%

Other
4 4%
People may select more than one checkbox, so percentages may add up to more than 100%.
Were you aware the Rutgers University has CAPS (Counseling, ADAP & Psychiatric Services)?

21 | P a g e

Yes 67 61%
No 43 39%

Have you ever felt the need to visit CAPS but were deterred by the following?
The stigmas of going to counseling
My problem is not that bad, I can handle it

1 1%
27 25%

I'm too scared to go speak to someone about it in person 1 1%

I have never considered going to CAPS

56 51%

I have already gone to CAPS

14 13%

Other

11 10%

Number of daily responses

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