College Mental Health Crisis

STAFF REPORT—

When I look back at college, I can say with utter certainty that “these were among the best days of my life.”

I was “independent” and “free” (both words I enjoyed using) and I considered myself unfettered by parental monitoring.

I forged new relationships.

I stayed out late.

I had meaningful and existentially provocative conversations with classmates.

I fell in love.

What’s not to like?

Ironically, it turns out that these very features of college – the unfettered independence and developmental exploration that I relished – can make college great for some young people, and at the same time can make college absolutely miserable for others.

When I was in college, there wasn’t much room for the miserable part.  Universities acted like the emotional hardships of being away from home were unusual and rare and administrations largely ignored these issues.

Today, things have definitely changed.

Colleges acknowledge that students experience profound emotional struggles, but colleges have remained largely ill-equipped to help these students.

Let’s look at the good, the bad and the ugly of the college mental health universe.

The Good

There are more opportunities for developmental growth than ever before. Colleges actively recognize the immense variety of ways that young people come of age. There are academic and extra-curricular offerings for people to explore who they are and what values they hold dear. This is especially the case for special programs designed to support women and minorities, programs that we never dreamed would occur as recently as 20 years ago.

The Bad

We’re also seeing increasing drop-out rates, more powerful distractions from the online world, and greater academic and social expectations for students.  Add to this the ever-growing financial challenges for students and parents and the decreased certainty of finding a job, and we have the cliché of the “perfect storm” for the emotional stress of higher education.

The Ugly

As we said above, despite great strides, colleges remain largely ill equipped to negotiate these complex psychosocial waters.

As students in the United States head back to college for the winter term, we’d like to address some of the greatest psychological challenges facing universities and their students. This week we’re going to tackle the most disturbing and unsettling issue in college mental health – the possibility of deliberate self-harm and even suicide among university students.

We don’t want to be too alarmist.  Although suicide attempts on college campuses do appear to be increasing, it is not the case that simply being in college means that someone will more likely consider suicide.  However, because many psychiatric illnesses have their natural onset among college-aged individuals, students are at higher risks when these illnesses coincide with the college-related stressors we’ve outlined above.

Consider these statistics:

  • There are more than 1,000 suicides on college campuses each year – That’s 2-3 deaths by suicide every day
  • Suicide is the second leading cause of death among college-age students
  • More than half of college students have had suicidal thoughts, and 1 in 10 students seriously consider attempting suicide
  • Most importantly: 80-90% of college students who die by suicide were not receiving help from college counseling centers

These are of course alarming statistics. Some have even called this a crisis.  The most important question to ask, therefore, is this:

What can we do to improve the situation?

To answer this question, let’s start by looking at what we know about college suicide.

Attempts at suicide and death by suicide are most common in college students who:

  • Are depressed
  • Are either under the influence of substances, or have a substance use problem
  • Have made a previous attempt
  • Have a family history of a mood disorder such as depression or bipolar disorder
  • Are struggling with a history of trauma

We also know that students often tell others when they’re emotionally struggling, and that teachers, peers and resident assistants are more adept at recognizing emotional distress among struggling students.

Nevertheless, suicidal students often feel helpless, hopeless, and trapped. Some of these students resist seeking help because they’re ashamed.  They might fear a “black mark” on their record or being judged by others.  Even if they don’t have these concerns, they often don’t know what services are available.

Obviously, this is a complex and multi-faceted issue.  We won’t be able to rectify this trend overnight.  But there are steps we can take to ameliorate the risks.  These include:

1.  Establish new educational platforms about depression and suicide.  Key to prevention and early intervention is education about mood disorders and suicide risk.  Some educational initiatives include live and online modules that can be used in a wide range of forums on campus – from dorms to the classroom to campus-wide events. These modules are not just for students; parents and faculty benefit as well.  We also need to be more creative in our educational approaches. For example, a film series on depression and suicide followed by discussion groups could be an incredibly powerful way to educate the community.  There are a number of very informative online sites that can serve as adjuncts to these educational efforts.  Chief among these are Griffin Ambitions, the American Foundation for the Prevention of Suicide and the Jed Foundation.  Another important component includes making students aware of what they can and should do if they are worried about a friend or fellow student. In fact, everyone on campus needs to know where to go and what to do when there are safety concerns.  Each college campus should have a user-friendly website or app that features a clear description of the risk factors for suicide and self harm and explicit advice about how to approach a student about whom there are question

2.  Increase access to mental health services.  Every member of the university community as well as parents and family should know how to seek help on and off campus.  A college website can house all the needed information about these services, including information about clinicians and the nature and coverage provided by insurance.  This information should also include clear directions about how to access the best emergency departments either on campus or in local hospitals if serious concerns are warranted

3.  Support community forums.  Most students struggling with a mental illness or emotional crisis feel alone and frightened.  Study after study tells us that we feel better and safer with social supports.  Providing community forums on a regular basis, and throughout the campus, sends a key message: You are not alone, and something can be done about your suffering.

4.  Foster peer counseling.  Depressed and suicidal students are often more likely to talk with friends than parents, teachers or advisors.  We have seen this demonstrated in the success of the programs like AA for substance use disorders and in support groups for all sorts of emotional and behavioral difficulties.  Organizations such Active Minds, tailored to college students, have been highly effective in the mission of peer counseling.

5.  Decrease the stigma of mental illness.  Perhaps the greatest barrier to seeking help is the fear of being judged or ridiculed. Many individuals still do not believe that depression and mood disorders are illnesses and feel that suicide is a sign of deep personal weakness.  Colleges need to take the lead in dispelling these false beliefs. Treatments for depression are effective, and the entire college community needs to be aware of this fact.

6.  Promote means for increasing student wellbeing.  Depression is often prevented by a number of activities – regular exercise, good sleep habits, substance use awareness programs, group discussions, cognitive behavioral techniques, expressive arts, and discussion groups have all proven helpful. These activities should be encouraged and fostered on college campuses.

Because each college is unique, colleges must tailor these initiatives to their own circumstances, but the benefits of taking action cannot be underestimated.  Colleges can literally save lives. They just have to act.

This blog was originally posted on The Clay Center for Young Healthy Minds at Massachusetts General Hospital and includes a podcast reviewing the college mental health crisis.

For additional information please see:

From the Clay Center

When Kids Leave Home: Part 1

When Kids Leave Home: Part 2

Examples of college webpages:

Counseling & Psychological Services – University of Pennsylvania

Mental Health and Well-Being – Cornell University

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Dear Teachers & Professors,

An open letter to those in education

Dear teacher(s)  professor(s),

TO WHOM IT MAY CONCERN:

I am a person living with mental illness. Odds are, I’m not the only person in your life who faces this — whether you know it or not. Your knowledge about mental illness may be limited to what the media says, or what society says. With the alarming amount of college students with mental illness these days, I would hope you’ve educated yourself on this topic.

I am a person living with mental illness. I’m also a good student. Yes, I may have missed class, not participated in a discussion or turned something in late, but if that’s all you see then you’re not seeing the whole picture. I’m not asking for excuses or looking for a way to get out of assignments or rules. I would love to be able to adhere to everything without a problem. But I can’t. I have a disability, and even the department that provides accommodations for disabilities doesn’t help much. Aside from the scars on my body and physical symptoms of panic attacks, my illnesses are invisible.

When I don’t come to class, you may see a student who is lazy or didn’t feel like coming. But what you don’t see is the restless night I had tossing and turning with my insomnia. You don’t see the black mass encompassing my entire being some days. You don’t see the fight in my mind between staying alive or giving up. I’m not just lazy. It’s not because I didn’t finish the homework. I wasn’t in class because I couldn’t get out of bed today. I could not face the light of day because my depression had chained me to the darkness of my room.

I had a teacher tell me once it wouldn’t be fair to the people who always made it to class if my absences didn’t affect my grade. At the time, I understood. But looking back now, I realize that makes no sense. Accommodations exist for people with disabilities for a reason. By “understanding” but still penalizing me for something caused by my mental illness, you are keeping me at a disadvantage. It’s not fair to expect I be on par with other students who don’t have the added obstacle of an illness. I promise I’m giving it my all. I’m balancing my recovery and my education at the same time, and I shouldn’t feel like I have to choose. I shouldn’t feel like I can’t do both.

I’m not asking you to never expect me in class or constantly give me extensions. I’m not saying to just let it slide. I’m asking you to be empathetic, understand that I’m a student facing an illness and help me succeed. I’m asking you to not give me a low grade solely because my mental illness prevented me from having a perfect attendance. I’m asking that you look at me as a whole person. I’m asking that you care, and if you can, that you advocate for students like me. I’m a person living with mental illness, and there are so many of us who need your understanding.

-JACOB M. GRIFFIN
BALL STATE UNIVERSITY
FOUNDER OF GRIFFIN AMBITIONS LIMITED, A HOOSIER BASED 501c/3 NON-PROFIT
FOUNDER OF ACTIVE MINDS AT BALL STATE UNIVERSITY

 

A Pertinent Mental Health Agenda

The new President and a confident, conservative Congress will create grave threats to America’s mental health system—if they succeed in repealing the portions of the Affordable Care Act that increased access to mental health services, if they succeed in changing Medicaid from an entitlement to block grants, and if they succeed in changing Medicare to a voucher system.

Given these threats to the current, inadequate mental health system, this is clearly a time for unified action by all mental health advocates—action both to prevent erosion and to press for progress.

Why is it so important to protect current resources and to seek more?

• Of those who get treatment, less than 1/3 get minimally adequate treatment.

5-6% of American adults have a serious mental illness; about 2% have disorders that are long-term and disabling, contributing to very high rates of unemployment and poor living conditions.

30-40% of homeless adults and 15-20% of people in jails and prisonsin the United States have a serious mental illness. This is often accompanied by substance abuse problems in both these populations.

• As many as 10% of children have a serious emotional disturbance, contributing to school failure and other serious problems.

• There will also be massive growth of minority populations, and the mental health system already has a tremendous shortage of culturally competent personnel.

A 10-Point Agenda of Goals

1. Preserve Current Capacity: The Affordable Care Act has resulted in health and behavioral health insurance coverage for 20 million people who did not previously have health coverage at all and an additional 12 million people who did not have behavioral health coverage. We should demand that these people continue to be covered.

2. Increase Capacity and Improve Access: Since fewer than half of the people who could benefit from behavioral health service get it, there needs to be a multi-year commitment to increase service capacity, including rehabilitation services and a broad range of community supports—especially housing— for those with the most serious disorders as well as treatment interventions for the broader population of people with less severe disorders.

Proposals for growth must be based on realistic estimates of the scale of needed expansion. Given the fact that treatment for mental health and substance abuse services now costs over $220 billion per year, current behavioral health reform proposals barely scratch the surface of the need for expansion. Only Medicaid and Medicare are major sources of funding increases.

3. Preserve Medicaid and Medicare As Entitlements: Growth of the mental health system over several decades has come primarily from Medicaid. And over the past decade Medicare has grown as a funder of mental health services from paying 7% of all costs to 14%, an almost proportionate share. Loss of these programs as entitlements would virtually cut off increased funding for mental health and substance abuse services.

4. Remove barriers to access: In addition to increasing service capacity, efforts need to continue to remove barriers to treatment. Full implementation of parity requirements is essential as are increased efforts to overcome stigma.

Improving quality of care requires major changes in both the preparation of the behavioral health workforce and in the structure of service delivery. These changes include:

• Increased biomedical, clinical, epidemiological, and services research and the translation of research findings into practice and

• Enhanced integration of physical and behavioral health services.

Overall, improving quality will require continued modifications of practice, organization, and finance models.

Critically important are complex changes in the relationship between providers of service and those who use behavioral health services to make these services “person-centered” and “recovery oriented”.

6. Reduce the suicide rate: Although today’s mental health headlines are about rare instances in which a person with a serious mental illness commits a mass murder, in truth they commit only 4-6% of homicides, (about 800 per year). They are far more likely to be victims than perpetrators. And they are far more likely to kill themselves (about 40,000 per year). The nation must redouble its efforts to prevent suicide, including restricting access to lethal means.

7. Enhance substance abuse policy: Substance abuse, including the recent rise in opioid addiction, results in high rates of avoidable deaths, serious health conditions, incarceration, and lost human potential. Prevention and treatment must be at the center of the nation’s efforts to address substance abuse problems.

8. Enhance criminal justice policy: Sadly, encounters between people with serious mental illness and the criminal justice system sometimes result in avoidable deaths. In addition, hundreds of thousands of people with serious mental illness are unnecessarily incarcerated in jails and prisons, often for minor offenses. Improved police intervention, expansion of diversion programs—such as mental health courts—and a re-working of the American bail system are needed.

9. Build a hopeful future for children and adolescents with mental health problems: In addition to increasing service capacity and improving quality of care, there must be:

· Far greater attention to the social determinants of mental and/or substance use disorders—especially poverty and violence in families and neighborhoods

· Earlier identification and intervention

· Improved collaboration among child serving systems—behavioral health, health, education, child welfare, and juvenile justice.

10. Prepare for major demographic changes: Over the coming decades there will be two major demographic shifts in the United States. Minority and immigrant populations will gradually become the majority, and people 65 or older will grow to about 20% of the population, roughly equal to the population of children under 18.

For minority populations the critical need is to build a culturally competent behavioral health system. This includes culturally sensitive practice, efforts to address lingering racism and discrimination, and inclusion of more minorities as treatment providers, managers, planners, and policy makers.

For older adults, the critical need is to build a generationally competent behavioral health system with an emphasis on helping older adults to live in the community, despite physical and mental disabilities. Particularly important are appropriate residential settings, mobile services, integration of physical and behavioral health care, improved care for people with Alzheimer’s and other dementias, and support for family members, who provide 80% of the care for older adults with disabilities.

Avoid ideological disputes that paralyze change: This 10-point agenda to protect and improve America’s mental health system is challenging and complex. Efforts that have focused on constructing comprehensive behavioral health service delivery systems and financial models to support them have been stymied not just by stubborn divisions between the political parties, but also by vituperative ideological differences within the mental health community. Effective joint action will require putting aside debates fueled by ideological differences regarding coercive interventions, return to asylums, confidentiality, priority populations, and gun control so as to focus instead on the critical issues about which virtually all advocates agree.

We must put aside our differences and work together for preservation and improvement of our nation’s mental health system. The cost of failure is far too high.