July/August 2013 Issue

College Mental Health Initiatives —  Outreach to At-Risk Students
By Jennifer Van Pelt, MA
Social Work Today
Vol. 13 No. 4 P. 26

Late adolescence and early adulthood have their unique challenges. Additional stressors of adjusting to college life can leave some young people particularly vulnerable to developing mental health conditions, but efforts are under way to identify and support those students.

“Make the most of the next four years, they will be the best of your life,” say many parents as their children head off to college. And while choosing partying over studying used to be the primary concern of students and parents, now coping with a mental illness is one of the new norms for many college students.

According to epidemiological research, most mental health disorders emerge between the ages of 14 and 24 (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). So, in addition to adjusting to college life, many freshmen also must manage the onset of anxiety, depression, bipolar disorder, and/or schizophrenia. And mental disorders in college-age students also are increasing in severity.

In a 2012 survey of 765 college students from 48 states and Washington, D.C., the National Alliance on Mental Illness (NAMI), the largest grassroots mental health advocacy organization in the United States, documented the following diagnoses: depression (27%); bipolar disorder and dysthymia (24%); other, including borderline personality disorder, eating disorders, obsessive compulsive disorder, schizoaffective disorder, and autism spectrum disorder (12%); anxiety (11%); schizophrenia (6%); PTSD (6%); ADHD (5%); and substance abuse disorder (1%).

Statistics from Counseling and Psychological Services (CAPS) at Stony Brook University in New York show a 28% increase in initial consultation and treatment for college students from five years ago and an 88% increase from 10 years ago, according to Jenny Hwang, PhD, associate dean and director of CAPS, and Judy Esposito, LCSW, assistant director for CAPS assessment, triage, and case management.

“Evidence suggests that the mental health problems of students are more severe now than they have been in the past, and that a greater number of students are seeking help,” says Daphne C. Watkins, PhD, an assistant professor of social work at the University of Michigan.

Watkins coauthored a study of mental health services on college campuses that surveyed directors of campus psychological counseling centers, who all reported a significant increase in severe psychological problems among their students compared with prior years. Administrators reported more difficult long-term mental health issues; the emergence of less prevalent conditions, such as Tourette’s and Asperger’s syndrome; and greater numbers of students coming to college already taking psychiatric medication and/or expecting mental health services when they arrive (Watkins, Hunt, & Eisenberg, 2012).

“Due to changes to the student population compared to years prior, institutions are now faced with increasing numbers of students with severe emotional problems, students and families who look primarily to universities to provide mental health and other support services for their students, and budgetary cutbacks that make growth in mental health staffing difficult,” Watkins notes.

In this economic climate, handling a burgeoning student population with mental health needs is challenging. “More and more students are going to college with mental health issues, and schools need to be ready for that,” says Darcy Gruttadaro, JD, director of the NAMI Child & Adolescent Action Center.

Incoming freshmen without an existing mental health diagnosis are susceptible, too. “Two common mental health conditions among college students are anxiety and depression, and they become more prevalent there due to environmental factors and not just biological factors,” notes Sonya Weisburd, MSW, senior chapter manager for Active Minds, an organization working to reduce mental health stigma with student-based advocacy. Stressors associated with transitioning into college life are numerous and almost all are new to incoming freshmen, she says, including the following:

• living away from home for the first time;

• making new friends in an uncontrolled environment;

• experiencing more rigorous academic expectations than high school;

• having a significant financial burden, especially since many students must work to afford tuition; and

• dealing with feelings of isolation and loneliness.

Esposito confirmed that Stony Brook University’s CAPS sees students primarily experiencing symptoms of depression and/or anxiety. Contributing factors in addition to those listed above include pressure to choose a major that will lead to a job rather than a major they actually are interested in, parental expectations of quick employment, and romantic relationships (or lack thereof), she says. As supervisor of the CAPS clinical triage service, Esposito sees many students experiencing suicidal thoughts that evolve from feelings of losing control of their lives and attempts to deal with emotional pain.

Suicide is the second leading cause of death among students at four-year institutions in the United States, a statistic that exists in part because of the abovementioned factors, according to Weisburd. “While our society tells students that ‘college is the best time of your life,’ in reality, college life is significantly more complicated. The stress of college definitely contributes to increased rates of psychiatric distress,” she says.

Dealing With the Stigma
Added to the typical college stressors is the stigma that students with mental health issues face from peers, faculty, and other college staff. “From our survey respondents, we learned that stigma remains the No.1 barrier to students accessing mental health services and supports,” Gruttadaro notes. Fear of this stigma prevents students from disclosing their mental health diagnosis, according to the NAMI survey. Since disclosure is legally required to receive mental health assistance and accommodations, students who hide their mental health issues may be less successful, or even drop out. The NAMI survey revealed that 45% of students who dropped out of college for mental health reasons did not receive accommodations, and 50% did not access mental health services and supports.

“The fact that half of respondents did not disclose their mental health status to their college because they feared the impact it would have on college experience is telling,” Gruttadaro says. “Surveyed students expressed that there are still negative myths and stereotypes that pertain to students with a mental illness. The fact they we are still fighting the stigma, myths, and stereotypes is very concerning.”

“College mental health issues are as varied as young people themselves, and a large majority of them go undiagnosed and untreated,” Weisburd says, in part because of the associated stigma. “As a society, we are generally unaware of the level of struggle that college students face with regard to mental health. While there is definitely increased attention to the topic in the media now, the average person still doesn’t know how many college students—with or without a diagnosis—struggle with their mental health.”

With their holistic approach, social workers can contribute valuable efforts to educate students and their support networks, especially regarding the prevalence of mental health struggles and campus resources available to students with mental health issues, she emphasizes. “College students may seem like a privileged segment of the population to many social workers, but we need to be cognizant of this group and their unique challenges.”

Student-run on-campus advocacy groups sponsored by Active Minds seek to decrease the stigma associated with mental health issues, increase help-seeking behaviors, and educate students about campus mental health resources. “Some of our greatest achievements have been in changing campus climates to include mental health in conversations about student wellness, institutionalizing programming that focuses on student mental health, and getting positive messaging about student mental health into local media,” Weisburd says. She believes student-based advocacy in combination with on-campus mental health professionals produce optimal results.

With roughly 24,000 students, Stony Brook University is one institution that is successfully providing on-campus mental health services. “We are extremely fortunate to have unparalleled support from our university administration so that we provide our students with varied services,” Esposito says.

She helped develop and implement a real-time clinical triage service that manages walk-ins without initial prescreening appointments, as many other institutions require. “If a student can muster up the courage to walk in to CAPS, because we respect that courage, we want to be able to provide them with an opportunity, at that moment, to speak to why they are here, conduct a risk assessment to ensure that they and others are safe, and determine what the next step should be. We want students to leave CAPS feeling some sense of hopefulness for change—that their situation can be better,” Esposito explains.

Other services offered at Stony Brook include groups for mindful meditation and trauma, on-campus psychiatric staff for psychopharmacology treatment, “psychoeducation 101” classes to make sure students are aware of available resources, and depression screenings.

Watkins’ interviews also suggested that at least some college administrators are aware of and addressing the challenges associated with an increasing student population with mental health needs. However, the NAMI student survey indicates that not all colleges are effectively meeting their students’ mental health needs. Simple resources, such as having information available on the college website about hours of service, contacts, warning signs, and how to help friends, were missing at many colleges, Gruttadaro says. “When survey respondents were asked if their college websites include information about mental health, 64% responded ‘no’ or ‘do not know.’ This needs to change,” she says.

More troubling was the lack of awareness and training among college faculty and staff—even staff in mental health services, Gruttadaro says. Survey respondents reported that college disability resource centers did not understand mental illness as well as they should, she notes. “Though they handled developmental and physical disabilities effectively, for mental health conditions, staff were not trained in some of the resources and accommodations students with mental health issues need,” she explains. This lack of education and awareness occurs even with the ready availability of information from organizations such as NAMI and Active Minds, according to Gruttadaro and Weisburd.

Gruttadaro believes future efforts should focus on ensuring that more institutions understand the importance of informing and training their disability resource center staff about the accommodations and supports students living with mental health conditions need. Students surveyed by NAMI indicated that relatively simple accommodations, such as excused absences for treatment, adjustments in test setting and time, homework deadline extensions, and increased availability of academic advisors, were important for their success in college. According to the NAMI survey, successful disability resource centers included mental health counselors and friendly supportive staff who checked in with students and understood mental health issues, provided assistance in developing a plan for addressing mental health issues while at school, and helped students communicate with faculty about accommodations. On the negative side, many students reported that faculty were not educated about mental health issues and student needs. Some faculty did not follow accommodations or penalized students requiring accommodations for mental health conditions.

At Stony Brook, Esposito says faculty and staff serve as one of the most important resources for identifying students who may be in distress. “We meet regularly with various faculty/staff groups to provide education on what to look for and how to connect students with what they need. We encourage them to call CAPS when they are unsure of a possible mental health situation,” she notes.

Watkins found in her administrator survey that awareness of shifting mental health needs on campus resulted in more outreach to faculty and students as well as a reduction in stigmas that led to expanded mental health services.

College and Community
No amount of awareness can combat the decreased funding affecting many educational institutions in the current economy. While some colleges are fortunate enough to obtain grants or private funding for mental health services, others have difficulties securing staffing for crisis and counseling services to meet growing demands. The NAMI survey revealed that on-campus counseling was limited in duration and scope at many colleges. “A full mental health system is not expected on every college campus, but they do need to have basic services and supports for students,” Gruttadaro says. “They also need to have an effective link to the community mental health system,” she adds.

For larger universities, such as Stony Brook, hospitals often are in close proximity and can provide mental health treatment support. “We have the university hospital right across the road, which allows for seamless access to a higher level of psychiatric services, such as evaluation at the psychiatric emergency room and/or inpatient psychiatric admission, when needed,” Esposito says. But colleges in smaller communities cannot rely on resources off campus when many communities do not have adequate capacity in their mental health system to handle community needs, let alone a college population, Gruttadaro says.

The increasing number of young adults with mental health needs must be addressed beyond the college community, she emphasizes. “Coming out of the Newtown tragedy, there is a lot of discussion nationally about building a more effective community mental health system, and we need to make that happen,” Gruttadaro says.

According to Watkins, college administrators tied recent violent tragedies on college campuses, such as the Virginia Tech incident, to major challenges for their mental health service providers. Though one administrator reported using such tragedies to advocate for and obtain specialized training for faculty and staff, others reported mounting pressures to deal with the risk, unpredictability, and threat from students with more severe mental disorders (Watkins et al).

Teamwork and collaboration across the college student body and staff and in the community will be increasingly important to effectively address the risks associated with certain mental health conditions and the ongoing societal controversy over gun control. Stony Brook already has implemented a disaster mental health service to respond to potential large-scale incidents. Esposito organizes and facilitates staff training for disaster mental health, such as psychological first aid and trauma counseling. She also chairs the university’s threat assessment team.

“In this capacity, I report directly to the vice president of student affairs and meet with him weekly—or more often depending on the case—to discuss cases and keep him apprised of our case management recommendations and strategies,” she explains. This team includes representatives from CAPS, university police, community liaisons, campus residence, disability support services, the dean’s office, faculty, and academic advising. “Our goal is to identify as early as possible any student that may be in distress and/or causing disruption and, through a coordinated, consistent, and thoughtful process, assess and intervene in situations that pose or may pose a threat to the student or anyone within the campus community,” she explains.

NAMI recently launched a major initiative to support colleges in response to the increasing prevalence of mental health issues. Called NAMI On Campus, the program provides detailed information on mental health conditions, crisis response and intervention, accommodations for students, and student-based awareness/advocacy clubs.

“Even though our surveyed students reported that some schools did very well in providing mental health information and support, we still have a long way to go,” Gruttadaro says.

— Jennifer Van Pelt, MA, is a freelance writer based in Reading, PA, and a frequent contributor to Social Work Today.

Active Minds Accomplishments
Active Minds, a nonprofit organization that is one of the voices of student mental health advocacy, currently sponsors more than 350 campus chapters. Some of these chapters recently achieved important advances in the handling of college mental health issues:

• Active Minds at George Washington University was closely involved in a campaign that overturned fees for counseling sessions so that all students now have access to six free counseling sessions. A certain number of free counseling sessions are an industry standard, yet the university was in a small minority not offering this resource to its students.

• Active Minds at the University of Maryland successfully petitioned the university senate to pass a bill granting students with mental health conditions formal rights to retroactively withdraw from a semester of classes so that cumulative GPA and graduation are not affected.

• Active Minds at the University of Dayton in Ohio convinced school officials to start printing a crisis hotline number on all university-issued IDs.

— JVP

References
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

Watkins, D. C., Hunt, J. B., & Eisenberg, D. (2012). Increased demand for mental health services on college campuses: Perspectives from administrators. Qualitative Social Work, 11(3), 319-337.