After missing class for days, a student walked into Marybeth Ayella's office at St. Joseph's University to explain that she had migraines. But as the conversation progressed, Ayella realized that it was something more.
"I can recall I was scared," said Ayella, an assistant professor of sociology. The student was depressed. "I was worried that she might consider suicide."
Ayella suggested that they call the counseling center together, and the student was told that she could come over immediately. Ayella wanted to walk her over, but the student refused. So Ayella waited 20 agonizing minutes for a phone call from the counseling center, about a mile away, confirming that the student had arrived.
"Today, I don't think I'd let a student go alone," Ayella said. But that episode took place nearly 10 years ago. "I didn't know back then how widespread an issue [mental illness] was."
Over the last decade, the percentage of college students seeking mental-health care has nearly doubled, a study from Boston University found. And the proportion of students with a diagnosed mental-health condition jumped from 22 percent in 2007 to 36 percent in 2017.
As the mental-health needs on campus outpace the growth of college counseling centers, professors are feeling pressure to address the topic both in and outside of the classroom. They're seen as another resource in preventing suicide, which is the second-leading cause of death for college students, after accidental injuries.
But not all faculty members want to take on the responsibility. Many already feel overextended and fear that they are unprepared to handle such issues. Others are reluctant to intrude in students' lives or worry that opening the conversation will lead students to use mental illness as an excuse to delay assignments.
Even professors who go the extra mile to help students academically will often feel different when it comes to emotional and mental support, said Janine Mariscotti, chair of the social work department at La Salle University.
She wants to maintain boundaries with her students, too, "but because we're seeing such an uptick in students' distress, I'm not sure we can keep avoiding it," she said.
Though most colleges have counseling centers, students don't always go. They may think that their troubles aren't serious enough or fear the stigma of being seen as mentally ill.
"Where we see their distress is in the classroom, in an assignment they've written," Mariscotti said. That puts professors in prime position to recognize a problem.
Ayella at St. Joseph's dedicates a section of her syllabus to mental-health resources on campus and hands out magnets in class with phone numbers to call in an emergency. She also advises a mental-health awareness club and sits on the university's suicide-prevention committee.
The simplest thing she does is take attendance. Not for grades, but to recognize patterns. If students repeatedly misses class, she sends them a two-line email expressing concern and offering help.
"It's not taking 10 hours a week talking to people," she said. "Little things matter to students."
Mariscotti, who has been at La Salle for 30 years, makes it a point on the first day of each semester to let students know they can talk to her if they're in crisis. Many have taken her up on the offer.
Former La Salle student Ryan Ridley disclosed to her his severe anxiety and depression his freshman year. After that, any time he felt overwhelmed or plagued by thoughts of a friend's tragic death — from which he suffers post-traumatic stress disorder — he would drop by Mariscotti's office.
"She'd say, 'You want to just talk about him?'" Ridley recalled. "Other times, we'd just talk about what I could do just to get through the day. She did a really good job making sure I had a plan."
Ridley graduated from La Salle earlier this year. Now 28, he has landed a job as director of social services for a nonprofit in Germantown.
"I don't think I would have been able to finish college without the support Janine and my counselors gave me," he said.
A 2018 survey found more than 50 percent of faculty don't feel prepared to recognize a student in distress, and two-thirds don't feel prepared to approach at-risk students to discuss their concern.
Many universities are trying to change that by training faculty to talk about suicide.
On a recent Friday at La Salle, a dozen administrators, professors, and campus safety officials gathered in a small classroom in the business school from 8 a.m. to 5 p.m. to learn QPR — a national curriculum on suicide prevention, built on the three steps: question, persuade, refer.
It was a deeply personal topic for at least half of the attendees who had lost a friend or family member to suicide. Some had lost students.
The training, which costs the university about $4,500, is part of a three-year suicide prevention grant La Salle received from the federal Substance Abuse and Mental Health Services Administration in 2017. In the three years before that, five students died by suicide or drug overdose, and the university saw an increase in the number of students taken to a nearby crisis response center.
A prominent component of the training is to get people comfortable asking about suicide. Don't call it the "s-word," instructor Govan Martin III said. Ask it directly: Are you thinking of killing yourself?
"People are scared to do that," said Martin, who also chairs the board of directors for Prevent Suicide Pa. Some worry that asking will put the idea of suicide in someone's head, even though research has debunked that.
For Kate Ward-Gaus, assistant vice president of student wellness at La Salle, training faculty and staff is just as important as having counselors. Not everyone needs a therapist, she said, but everyone needs someone who cares. "There are some students who could and would do better if they had one conversation with a trained person," she said.
Several local colleges conduct similar training. At the University of Pennsylvania, more than 2,500 faculty, staff, and students have gone through suicide-prevention training. In a 2017 survey, nearly 70 percent said they had used the tools to ask someone whether they were considering suicide.
At St. Joseph's, 300 people were trained last year. "It becomes a communitywide mission" to prevent suicide, said counseling center director Gregory Nicholls.
Other schools, such as Rowan University, offer web training options.
Studies have shown that training increases the knowledge and skills of attendees, but evidence is still limited on how well it decreases rates of suicide.
But for some professors, the training provides more tools to address a problem they see every day.
Peggy McCoey, an assistant professor of math and computer science at La Salle, received crisis training from the campus counseling center six years ago. She says she doesn't hesitate to ask students about suicidal thoughts.