This spring, a group of college students will go about their usual campus routines, but with a voice only they can hear calling them names and making other distracting, disturbing sounds.
In their case, the voice will come from a recording playing through earbuds as part of a research study. But researchers say the exercise could ultimately help increase awareness and break down the stigma that prevents those who suffer from auditory hallucinations and other symptoms of mental illness from getting the help they need.
"Many of the folks who need help get lost somehow," said Jason Schiffman, an associate professor of psychology at the University of Maryland, Baltimore County who is heading the study. "There are so many kids and young adults who slip through the cracks."
Among those, apparently, was Darion Marcus Aguilar, the 19-year-old who fatally shot two skate shop employees at The Mall in Columbia in January before turning his gun on himself. Last week, Howard County police Chief William J. McMahon said Aguilar had told a doctor that he was hearing voices but did not follow through on the physician's recommendation that he see a mental health professional.
It is this kind of scenario, in which a troubled person for whatever reason doesn't get the help he needs, that prompted Maryland to fund a new $1.2 million initiative last year. Called the Center for Excellence on Early Intervention for Serious Mental Illness, it was created in the aftermath of a number of mass shootings in which the perpetrator was found to have suffered from psychiatric problems.
McMahon speculated that the stigma surrounding mental illness contributed to Aguilar's reluctance to speak to his mother about his problems or to seek treatment.
"When kids are suffering from mental health issues, there seems to be a reluctance," McMahon said. "There's a stigma attached. … I think that's the more critical question for society in general."
Schiffman has long been interested in early intervention and de-stigmatization programs for those suffering mental health problems, but more recently, his work is benefiting from a new focus on the role such illnesses may have played in some shootings.
Last year, Maryland enacted one of the nation's strictest gun laws after the Sandy Hook Elementary School shootings in Newtown, Conn., but also opted to focus on mental health issues by creating the center for early intervention.
The center brings together existing clinics and labs at the University of Maryland School of Medicine, the university's Medical Center and UMBC. The programs are geared toward treating and researching people who have suffered psychosis — some kind of break with reality, such as delusions or hallucinations. Psychosis can be a symptom of severe mental illnesses that include schizophrenia, bipolar disorder and severe depression.
At the university medical school, for example, the First Episode Clinic serves those who have recently experienced psychotic episodes. And at UMBC, Schiffman heads a number of research and clinical programs aimed at young people. Mental disorders often first manifest themselves in the patient's youth.
Advocates say it's critical to focus on people in their late teens and early 20s — what mental health professionals call the transition-age youths. It's a time of life changes, which can exacerbate existing mental disorders, experts say, and also a time when they are at greater risk of not receiving the help they need.
"They're shifting from being kids under the protection of parents to being adults," Schiffman said.
"At 18, the school system changes dramatically. Before, you're in school and there are people always around you. You might have seven teachers who see you daily. Then you graduate, and that changes."
Ann Geddes, who directs public policy for the Maryland Coalition of Families for Children's Mental Health and specializes in transition-age youth, agrees.
"At 18, they're legally autonomous," she said. "They're no longer connected to school-based mental health services. By the time they're 18, you've lost them."
At UMBC, Schiffman's students plan to launch a study this spring to help address issues in dealing with mental illness among members of this age group. The study has two components: listening to the tape that simulates the voices that those with psychosis hear while trying to complete tasks; and watching a video in which UMBC students talk about their personal experiences with mental illness.
Researchers will then study how the 200 subjects, who will be recruited from psychology classes at UMBC, respond to the experience. Does listening to the tape increase their empathy for those who have auditory hallucinations, for example, and does the video help them realize that having a mental illness doesn't prevent people from functioning normally in other aspects of their lives?
Danielle Denenny, a doctoral candidate at UMBC leading the study, said the goal is to see if the tape and video can help break down the stigma that surrounds mental health.
"We want to show portraits of young people who really look a lot like their peers," Denenny said of the video. "It counters the pervasive message that we get, that anyone in counseling for mental illness is severely struggling, weak or unstable."