Just three months into her freshman year at the University of Pennsylvania, Sophia Griffith-Gorgati encountered a friend in crisis.
The girl in the bathroom was having a panic attack. She said she'd been raped just minutes earlier, Griffith-Gorgati recalled.
At first, Griffith-Gorgati was overwhelmed. What could she say? How could she help her friend?
"But then it was like having a flashback," she said. "I remembered I'd been here before. I can do this."
The flashback wasn't to another crisis. Instead, Griffith-Gorgati was remembering university-led training she had taken just a few months earlier. The training, called I Care, aims to give students, faculty, and staff the skills to recognize and support students experiencing mental-health problems.
During the role-playing component, Griffith-Gorgati had acted as the friend of someone who had just been sexually assaulted. As she comforted her friend in the bathroom that November, she thought back to the exercise.
Don't automatically jump to giving advice, she recalled. Ask open-ended questions about how people are feeling. Use eye contact. Validate their feelings.
"If I hadn't been in that training, I don't think I would have been able to do or say anything right," said Griffith-Gorgati, who graduated in the spring. "I would have been a total wreck."
Training that prepares college students to recognize and respond to signs of mental distress among their peers is now found at hundreds of universities across the nation. College counselors say a growing number of students like Griffith-Gorgati are opting to learn how to help address issues ranging from sexual assault to depression, anxiety, and suicidal thoughts. It's one of many ways students are stepping up to take on mental illness on campus.
In recent years, demand for mental-health services on college campuses has surged, with counseling center use increasing 30 percent to 40 percent while enrollment increased by only 5 percent, according to the Center for Collegiate Mental Health. Resources at many university counseling centers are stretched thin, forcing students to wait weeks for an appointment. And that's just the start: A 2009 study found fewer than half of students who seriously considered attempting suicide sought any professional help.
Suicide is the second leading cause of death among college students — a statistic that local universities have experienced firsthand in recent years. More than a dozen Penn students have died by suicide since 2013, including Olivia Kong, whose death at the SEPTA 40th Street station in 2016 brought renewed calls for action to address mental health concerns on campus. Temple freshman Richard Dalcourt died after falling from a sixth-floor dorm last October, and Drexel student Stevens Glemaud's death was ruled a suicide after his body was found in the Schuylkill in 2012.
Researchers have found that two-thirds of students who disclosed their suicidal thoughts first chose to tell a peer, putting college students at the forefront of this crisis. They're not licensed professionals and are not being trained to replace college counseling centers. But there's a growing recognition that students are uniquely suited to be a kind of early warning system. They can complement university services by noticing problems with peers who aren't reaching out for professional help, students who have had training say.
"Students have a huge role to play," Griffith-Gorgati said. "We're around each other all the time — studying, cooking, taking classes, living together. We have the responsibility to take care of ourselves and one another."
Since the training was started after several suicides at Penn in 2013 and 2014, the university says, more than 2,500 faculty, staff, and students have gone through the program. Although there are no data on how this has affected suicide rates, a survey found that after training, two-thirds of participants had asked someone if they were considering suicide and referred them to counseling services. Several national studies have shown that training similar to Penn's help increase students' preparedness to help a friend.
St. Joseph's University has run a similar suicide-prevention training for the last 10 years, said Greg Nicholls, director of the school's counseling services. He attributes part of the increase in counseling referrals to the program's success.
As rates of anxiety and depression continue to climb, St. Joseph's is growing its program. In the last year, it doubled the number of trainings, reaching 300 community members, up from about 150 the previous year.
Nicholls said one of the most crucial aspects of the training is teaching students to ask peers directly: Are you thinking of hurting or killing yourself? It's a difficult conversation to have, Nicholls said. But students have the opportunity to address this issue head-on with each other, which can make a big difference in identifying those at risk.
"The goal of that training is expanding the eyes and ears of the university community," Nicholls said. "It makes sense to focus on students for that."
Sharon Mitchell, president of the Association of University and College Counseling Directors and senior director of counseling at the University at Buffalo, said she's seen the power of student action firsthand. Most referrals to her counseling center come from other students, rather than parents or professors. "Students are going to be more aware of what's going on in their friends' lives than faculty or staff members," she said. "That means they're on the front lines to be helpful as well."
A recent study found even more general student efforts, like running a mental health organization on campus, can make a big difference. Researchers studied members of Active Minds, a mental health awareness organization that started at Penn in 2003 and has since grown to include more than 450 college chapters. Across a dozen California colleges, they found the organizations can improve awareness of mental health issues, reduce stigma, and increase the number of students providing emotional support and connecting peers to services. "Such organizations can complement more traditional programs and play an important role in improving the campus climate with respect to mental health," the study authors noted.
Most students are trained to refer peers to university counseling services. But Max Schechter, co-director of Penn's in-person peer counseling network Penn Benjamins, says university counselors have asked how they can refer students to him.
"What we've heard from [university counseling] is some of the students they see don't need to specifically see them," Schechter, a rising senior, said. "If they need academic guidance or social guidance, that's something we can handle… Then the counselors can focus on more severe cases."
Penn Benjamins consists of about 45 student volunteers who hold free and confidential counseling hours five nights a week on campus. The student counselors undergo semester-long training developed in conjunction with university counseling staff, focused on listening skills and referring students to the proper resources. It's modeled on a peer counseling network at Washington University called Uncle Joe's. At Penn, they decided to change the name to Benjamins to reflect the school and city's ties to Ben Franklin.
As peers who've gone through many of the same struggles, Schechter said the Bens — as the student counselors are called — can offer a unique level of understanding. "We can provide validation that everyone gets lonely and that grading in college really is harder than high school," he said.
The network is off to a slow start, with just over 180 student interactions in the last three years, many of which were with freshmen overwhelmed by academics or social pressures. But Schechter said many students don't know about the service yet. The group has a marketing division working to increase its presence on campus and clearly establish what types of problems it can assist with. Schechter said they've been particularly helpful for students who are too scared to approach university counselors, for fear they'd be judged about substance use or word would get out to their professors.
Drexel University offers anonymous and confidential peer-counseling helpline staffed by about two dozen volunteer students. People can call in to discuss relationships, academics, drug use or more. The helpline, which has been running since 2002, typically receives about 20 calls per semester, though it saw a spike in numbers this past spring. Although usage numbers are generally low, the university said the goal of the program is to offer students one more option among various counseling services. It's not meant for crisis intervention.
Some worry about students blurring the lines between compassionate listening and professional counseling. Mitchell, of the counseling center directors association, said students should never try on their own to deal with a seriously troubled peer. "It's great that students are interested in helping," she said, "but they really do need to have partnerships with professionals who can help them identify that this is your lane."
Even in less severe cases — for instance, a roommate conflict — students might benefit from speaking to an unbiased professional who is separate from the campus environment, she added. Another concern is student volunteers becoming overwhelmed by caring for someone else, so it starts affecting their own mental health. There need to be boundaries, Mitchell said.
Griffith-Gorgati agreed. "No student should ever have to be their friend's therapist," she said. "But if every single person at Penn took that training and was a little better about supporting their friends, I think the entire campus culture would be turned on its head."