After the deaths this semester of five students, including three who apparently committed suicide, officials at Tulane University are working to get the Uptown campus talking about mental health. They also are trying to remove social barriers that may keep some students from seeking help as they adjust to college life.

The untimely deaths began in late August, when a 20-year-old junior from Pennsylvania who suffered from epilepsy died at an off-campus residence, apparently of natural causes. Within weeks, two more students died, having apparently committed suicide: a 19-year-old sophomore from Maryland, who was found in a residence hall, and a 33-year-old graduate student from Virginia, who died off-campus.

Two months later, a 20-year-old sophomore from San Francisco fell from a second-floor campus balcony in the early morning hours, dying of a head injury days later. Not long afterward, a 19-year-old sophomore from Texas apparently committed suicide at an on-campus address.

The spate of deaths at the campus of 13,500 students — particularly of those who took their own lives — is a stark reminder of the challenges college administrators face in trying to identify risk factors and warning signs for what’s become the third-leading cause of death for young adults.

According to a 2013 survey by the Association for University and College Counseling Center Directors, nearly 345,000 students sought mental health treatment at the almost 400 schools that responded. Nearly half of them reported feeling anxiety — the predominant complaint — which was up slightly from the year before. That was followed by reports of depression, which also was on the rise.

In 2011, a survey by the American College Health Association found that 30 percent of college students reported feeling “so depressed that it was difficult to function” at some point in the preceding year.

Michele Many, an assistant professor of clinical psychiatry at the LSU Health Sciences Center New Orleans, said college students — typically away from home for the first time — can be especially vulnerable. They “face a number of stresses, particularly if they’re coming from another location, which many of our students at Tulane are, living on-campus or nearby and have moved from other areas,” potentially contributing to feelings of loneliness or isolation, she said.

“They’re having to adapt to a new city and make new friends and kind of develop a social circle along with the cognitive demands and the academic demands of the school,” she said. “Any time we’re thrown into a new situation, it can feel overwhelming. Normally, when we have to adjust to a new situation, we will have some sort of our support system in place to assist us — changing jobs, even, or if we’re divorcing, we still have other parts of our lives in place. They’re having to adjust from a global level.”

Help with grieving

Experts say it’s key for college officials to confront campus tragedies head-on. The Higher Education Mental Health Alliance last month released new guidelines on strategies for colleges to effectively respond to student deaths. They highlight the need to assist students with grieving to minimize the potential for additional suicides, partly by teaching coping skills and other ways of dealing with trauma and sorrow, and managing emotional and mental reactions to a crisis.

Dr. Victor Schwartz, medical director for the Jed Foundation, a nonprofit suicide-prevention group that focuses on college campuses, said the emotional toll caused by the death of a college student can spark a range of emotions, particularly anxiety.

“It feels like it’s going against a natural order of things, and that can be distressing and shocking in its own right,” Schwartz said. “When somebody dies by suicide, obviously it raises a whole other issue around anxiety and fears about what can happen to people.”

The notion of someone taking their own life often hits home especially hard in a closed community like a small town or a college campus.

Dusty Porter, Tulane’s vice president for student affairs, said having five students die in one semester was unusual. “We’re trying to wrap our hands around what are we experiencing, and how can we effectively respond based on what we know about these five circumstances,” he said.

Tulane President Michael Fitts, in his first year at the New Orleans school, issued messages to the campus community in the wake of some of the deaths, but some students said they felt that wasn’t enough and that school officials could have done more. Since then, though, some feel the lines of communication have improved after two more students died last month.

“This is a difficult time for the entire Tulane community — a moment when phrases such as ‘the Tulane family’ and ‘the university community’ must be translated into actions that can help comfort and heal us all,” Fitts said in a message last month announcing the death of the 19-year-old woman. “I urge each of you to take advantage of our counseling and support services. We are committed to ensuring that the most expert resources are available to you so that you can receive the support and assistance you may need.”

Raising awareness

Earlier this month, Tulane sponsored a range of activities aimed at raising awareness of mental health issues, including a gathering at a campus park, a series of webinars promoting mental well-being and a candlelight vigil.

“Our primary focus has been predominantly around the fact that three of the deaths were suicides,” Porter said last week. “We’re working with our community to help raise awareness of mental health issues among the college population, particularly around trying to destigmatize the need of students to ask for help or to talk with someone in their lives — whether that’s a friend or a faculty member — if they’re experiencing some type of depression or anxiety that might lead to suicidal alienation.”

Porter and others who study mental health say the challenge is getting students to ask for help, which they blame on stigmas that aren’t unique to colleges. One problem, some experts say, is that it’s largely the extreme circumstances of the mentally ill that are portrayed in the news or on TV, such as after a fatal shooting or a high-profile suicide.

That contributes to a hesitancy to seek help, Schwartz said.

“Many of our images are of the most challenging and most troubling cases and circumstances rather than recognizing it just like physical illness,” he said. “But there’s a whole array of both mental illnesses and physical illnesses that come up day to day that are extremely manageable and treatable.”

At Tulane, Porter is optimistic about “increasing the knowledge of the prevalence of the issue and helping folks understand that they should not be ashamed to seek those services.”

The outreach efforts may be showing early results: Tulane’s Counseling and Psychological Services Center has seen about 40 percent more students this semester than last year. Porter said that uptick may be attributed to more awareness, or it may simply show that students are trying to process grief during an emotional semester.

“It will probably take awhile to really get a sense of whether we are making some headway in helping students,” he said.

A view from abroad

At first, Renata Voci, a Tulane junior who is studying abroad this semester, didn’t feel the university was doing enough.

“It just seemed like, ‘OK, they’re going to send out the same numbers every single time, but is there anything being done?’ ” said Voci, 20. “Are we looking into our system critically and thinking, ‘What can we do better?’ It didn’t seem like anything was being done. It didn’t feel right.”

Voci helped start a letter-writing campaign directed at Fitts, allowing current and former Tulane students a chance to discuss their own experiences and offer ideas on how services could be improved.

“It’s weird, because I’m so separate from it physically, but I still feel like I’m right there with all my classmates as far as dealing with the deaths and suicides emotionally,” she said about hearing the news from overseas. “I was just feeling very helpless, because I didn’t feel like I had any control over what I could do, and I wanted to try to help in some way.”

After a few weeks, nearly four dozen pages of letters have been submitted, many touching on themes of being unsure where to turn for help or critiquing the on-campus counseling services. Some wrote that counselors mean well, but that it often takes too long to get an appointment to see one.

“Mental illness is an issue everywhere. However, if Tulane wants to make an effort to help these who seek help, the school needs to do it as a community,” wrote one person who described herself as a Tulane senior. “My experience at Tulane is mostly negative than positive because of my mental illness. No one really cares if you’re sad.”

Sam Rich, a Tulane sophomore who is involved in student government, said Tulane’s efforts to raise awareness have gotten students talking.

“Even just at the dining hall, a common subject of conversation is how the university has responded to it and what we, as students, can do to help the situation,” he said.

Rich said open dialogue is “something that’s been needed for a really long time,” and he believes the school would benefit from having more counselors on staff.

Not a full-time ward

But Porter said that can be difficult for colleges like Tulane.

“I think part of our challenge is that we’re not set up at a university to be kind of a full-time mental health ward, so we have to really work on helping students in a short-term way,” he said.

Generally speaking, Schwartz worries that a rash of suicides in a closed community can “for some small number of people lower that threshold just a little bit” and make killing oneself seem more like a realistic idea for dealing with a difficult situation.

“It might not necessarily point to a problem in a student body or a problem in the academic system,” he said. “But any time when you have a series of deaths or suicides, the school needs to be looking at what it’s doing and see if there are areas where it can tighten its support areas.”

Many, of the LSU Health Sciences Center, believes the stigma around mental health issues is lessening, but she said it remains an obstacle.

“There’s a sense that this is not something that you talk about with people. Generally, you might talk to very close friends or family members, but it’s not really the way. Let’s take asthma: You can talk about the fact that you’re having an asthma attack and you need your inhaler, but you can’t talk about the fact that you’re depressed and you need to go on Wellbutrin.”

Now that people are talking, though, Voci is optimistic the conversation will continue to evolve.

“It’s going to be very interesting,” she said. “I’m excited to see what kind of campus I’ll be coming back to. I really hope that this doesn’t turn into a one-time thing, that one time when they had events and something changed, but it was only that one year. I just hope that I come back to a campus where it’s not a fad.”

Follow Richard Thompson on Twitter, @rthompsonMSY .