This story is part four of our four-part series, "Stressed And Depressed On Campus." Read part one here, part two here, and part three here.

Since 2004, every incoming student at New York University has had to watch a musical called “The Reality Show” during freshman orientation.

Written, performed and produced by NYU students, undergrads sing and dance, performing sketches. The goal? To advertise a suicide prevention hotline number:

"Call us! 212-443-9999."

"You need to talk? We got the time! Drop us a line, pick up and call us!"

The hour-long production is part of NYU's response after, according to the school, six students took their own lives in a 12-month period beginning in 2003.

Some college leaders say what NYU did in the aftermath stands as a model for taking steps to prevent suicides and respond to the mental health issues of students. The administration acted after heavy media coverage of the deaths.

"These were all our students, and they were public,” said Zoe Ragouzeos, executive director of counseling and wellness services at NYU. “Students who didn’t know each other were choosing to express their pain by first of all attempting suicide and, secondly, by using the same method as other people had.”

Administrators soon realized, Ragouzeos said, the university was facing “a contagion of suicides.”

They first erected barriers on balconies inside NYU's main library on the Lower East Side, a 12-story symbol of academic stress. They also established a 24-hour hotline that students can call and talk anonymously about their problems.

“One of the ways that you can get more people through the door is if they don’t have to immediately say who they are,” Ragouzeos said.

In 2018, the hotline got 27,000 calls. Some college leaders consider the hotline and its anonymity as models. NYU counselors answer calls during the day and evening. At night and on weekends, calls roll over to a third-party service.

Currently, 19 percent of NYU's 50,000 students receive some form of campus mental health services. While some students still express discontent that they wait days or weeks for an appointment, NYU reports the average wait time is 15 minutes for a drop-in session and two weeks for a scheduled appointment.

Over the past three years, the budget for NYU's Wellness Center has increased by 18 percent.

Ragouzeos said all these interventions have mitigated the problem. Although NYU would not say how many students have taken their own lives since 2004, the school acknowledged in 2009 that another one had.

“I really do think we succeeded in curtailing a contagion,” she said. “We were relentless in our outreach to students. We made sure that if they weren't coming through the door, we would be calling them."

The federal Centers for Disease Control and Prevention found in a 2017 study that one in 12 college students has had suicidal thoughts. Nationwide, suicide is the second-leading cause of death among college students after accidents. Administrators across the country are scrambling to provide more mental health services on campus.

"It is a crisis for college administrators,” said Marjorie Malpiede, executive director of the Mary Christie Foundation based in Lexington, Mass., which studies behavioral health issues in young adults.

Malpiede says schools like NYU cannot hire enough administrators to keep pace with demand as the stigma surrounding mental illness lessens and more students seek help.

"Addressing the campus mental health crisis by hiring more counselors is a little like trying to solve Boston's traffic problem by building more roads," she said.

Child psychologists argue selective schools — with their high admissions standards and skyrocketing costs — may be responsible, in part, for the mental health issues they’re trying to address.

At Harvard, a recent survey found rates of depression and anxiety among graduate students were significantly higher than those of incoming freshmen.

The survey, conducted by Harvard University Health Services in 2017 and 2018, discovered that while depression and anxiety rates have climbed to 30 percent among graduate students in some departments, incoming freshmen self-reported anxiety and depression rates of 8.5 and 7 percent, respectively.

“Schools have to change,” said David Gleason, a clinical psychologist in Concord, Massachusetts. “We are responsible for the cultures we create.”

When students struggle in school with anxiety, depression or self-harm, Gleason said, adults are too quick to send them to psychologists, social workers and mental health providers.

"We say, 'Here, you manage your emotions better. You take medications. You get the help you need. You change.’ We don’t look in the mirror and say, 'What changes do we have to make to make these environments healthier for our kids?'" Gleason said.

To help do that, Gleason suggests high schools and colleges make drastic cultural and academic changes, but he worries that without financial incentives, they won’t.

“They’re afraid that if they do make changes — that means like, less homework or more balanced curriculum or giving kids more time to sleep — they’re afraid that they will lose their reputation as elite schools,” Gleason said.

The incentives may be shifting slowly, though.

A new survey by the Mary Christie Foundation finds more than half of parents say access to mental health resources is important when choosing a college.

The survey also finds 70 percent of parents agree that when it comes to mental health, it’s important to be informed of their child’s well-being. But Daniel Medwed, legal analyst for WGBH News, says federal law is designed to safeguard students’ privacy.

“If you think that everything you say to your counselor is going to be disclosed to your parents, you as a student might not be forthcoming,” Medwed said, adding that the law does allow students to waive their right to privacy and disclose their mental health records to their parents.

Medwed, also a law professor at Northeastern University, says that puts administrators in a bind.

“Absent a waiver from the student, they don’t necessarily know when it’s appropriate to disclose these items, because it could be subjecting them to potential litigation and liability,” he said.

It’s something NYU is guarding against.

Inside a small classroom this month, Ragouzeos trained anthropology professors on how to respond if they think a student is depressed or considering suicide.

"We are asking that you be able to notice a student in distress," Ragouzeos said, flipping through a PowerPoint presentation. "The only wrong thing to do is to do nothing — is to expect somebody else will notice, somebody else will intervene, because in those cases we find that students fall through the cracks."

Sitting in her office before the training, Ragouzeos said counselors and faculty members want to work with parents.

"The best way to ensure somebody's safety is to partner with the families," she said.

For now, NYU is urging students struggling with mental health to sign a consent form if they are in distress.

Three years after she saw “The Reality Show,” senior Brittany Du Bois from Baltimore says it still sticks with her.

"What I remember is, first of all, knowing the wellness center number so you know exactly who to call in case anything happens,” Du Bois said. “They reiterate that number so many times to the point where the people are singing it back to the cast members."

Du Bois says administrators have stepped up to make it easy for students to seek help.

"They do have the number on the back of our ID cards that tell us where we can call if we need to talk to someone immediately," Du Bois said.

If you or someone you know is having thoughts of suicide, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or use the Crisis Text Line by texting “Home” to 741741. More resources are available at