Nearly half of the largest U.S. public universities do not track suicides among their students, despite making investments in prevention at a time of surging demand for mental health services.
Tabulating student suicides comes with its own set of challenges and problems. But without that data, prevention advocates say, schools have no way to measure their success and can overlook trends that could offer insight to help them save lives.
"If you don't collect the data, you're doing half the job," said Gordon Smith, a former U.S. senator from Oregon who became a prevention advocate after his son, Garrett, took his life in 2003 while attending college. "We need information in mental health if we're actually going to be able to better tailor health and healing."
The Associated Press asked the 100 largest U.S. public universities for annual suicide statistics and found that 43 currently track suicides, including 27 that have consistently done so since 2007. Most others said they don't track suicides or could provide police reports for only a few cases known among campus administrators.
Schools that don't track suicides include some of the nation's largest, including Arizona State University and the University of Wisconsin. Officials from those schools declined to comment, but both have dealt with student suicides in the recent past, according to news reports, including at least two at Arizona State in 2017.
Some others refused to provide records, citing student privacy concerns, including North Carolina State University.
The issue has come to the fore as some schools report today's students are arriving on campus less prepared for the rigors of college. Many schools have increased spending on mental health services to counter what the American Psychological Association and other groups have called a mental health crisis on campuses.
Surveys have found increasing rates of anxiety and depression among college students, but some experts say the problem only appears to be worsening because students who might have stayed silent in the past are taking advantage of the increasing availability of help.
"It's unfortunate that people are characterizing this outcome as a crisis," said Ben Locke, who runs a national mental-health network for colleges and leads the counseling center at Penn State. "It's counterproductive because it's criticizing the exact people we've encouraged to come forward."
Adding to the skepticism is that young adults in college have been found to have lower suicide rates than their peers. But they are also at an age when disorders including schizophrenia and bipolar depression often start to develop.
Federal health officials have sought to encourage data collection as part of a grant program named after Smith's son, which has awarded $76 million to more than 230 colleges since 2005. Schools have separately spent millions on their own, often adding programs that teach basic life skills, and training staff across campus to identify students in need.
The U.S. Education Department asks colleges to collect data on student deaths but not suicides specifically, and a variety of factors can discourage schools from tracking it.
Often it's difficult to confirm the cause of death, and medical examiners don't always notify universities when a cause is determined. There are concerns about legal liability. Some families prefer to keep it private. Even schools that collect data differ on whether they count suicides that occur away from campus or during breaks.
And if the statistics become public, some schools fear it could damage their reputations.
"No school wants to be known as a school with multiple suicides. It's not good for business," said Nance Roy, chief clinical officer for the Jed Foundation, a nonprofit that works with colleges and high schools on prevention.
Advocates in at least three states have pushed to require universities to collect suicide data - in New Jersey, Pennsylvania and Washington - but without success so far.
After the 2014 suicide of freshman track star Madison Holleran at the University of Pennsylvania, one of her former teachers in her hometown of Allendale, New Jersey, was surprised to learn many universities don't report suicide statistics. He pushed for a law that would have required the state's public universities to collect and publicize annual numbers, but it never made it to a vote amid pushback from schools.
"He felt that it was something that the public had every right to know," said Pam Philipp, a New Jersey mental-health advocate who lobbied for the legislation along with Holleran's former teacher, Ed Modica, who died in 2017 at age 66.
A similar proposal by a state task force in Washington was sidelined amid budget woes last year, while lawmakers in Pennsylvania have yet to vote on recommendations to improve data collection.
National studies have found that suicide rates are on the rise in the United States, reaching 13 per 100,000 among all Americans and 12.5 among those ages 15 to 24. Much of the data on suicide comes from the Centers for Disease Control and Prevention, which does not specifically track college suicides.
The gap in information led Dr. James Turner to seek funding for a national reporting system for student deaths in 2009 when he was president of the American College Health Association, but the National Institutes of Health didn't see the value, he said, and it never happened.
"I became puzzled, because we as a society are so interested in the health of college students," said Turner, who is now retired from the University of Virginia. "Why is it we don't have a comprehensive way of approaching this?"
The NIH declined to comment for this article.
A total of 27 schools provided statistics to the AP that they say were consistently tracked from 2007 through 2016, amounting to an overall suicide rate of about 4 per 100,000, although numbers from some universities were so low that experts including Roy at the Jed Foundation questioned their accuracy. The University of Arizona, for example, averaged more than 40,000 students per year over the decade but reported just three suicides, a rate of 0.7 per 100,000.
Earlier studies have found average rates between 6.5 and 7.5 per 100,000 among college students. Schools that provided data to the AP had rates ranging from 0.27 to 8. Because of the inconsistency in responses, The Associated Press is not publishing figures for colleges that provided data.
Schools that do track suicides, however, often use their data to refine prevention efforts.
After Clemson University started gathering more data in 2015, campus officials noticed an increased suicide rate among transfer students. The school is now redoubling efforts to connect those students with campus services.
Data at other universities have led officials to secure access to certain rooftops.
Among the oldest examples is at the University of Texas at Austin, where officials in the 1990s installed iron barriers atop a clock tower that had previously been closed following several student suicides. The 10-year rate on that campus is in line with averages found in earlier studies, its data show, and has decreased in the second half of the past decade, even as national rates increase.
But Chris Brownson, the counseling center director who analyzes the university's suicides, said it's hard to celebrate success when every new case brings so much pain.
"One death is one death too many," he said, "and that's why we come to work every day - to do the things that we do here to try to prevent any of those from happening."
The National Suicide Prevention Lifeline is 800-273-8255. If you are in crisis, you can also reach out to the Crisis Text Line by texting 'Home' to 741741.