Alleviating SILENT Suffering
MEET THE MILLENNIAL STUDENT. SHE is busy, goal oriented, and perhaps stressed. She might be depressed too. Depression made it difficult for nearly half of students to function in 2005, according to the 2006 American College Health Association National College Health Assessment, which surveyed more than 94,800 students. Anecdotally and in other surveys, most campuses point to a slow and steady increase in the number of students seeking mental health services and a concurrent increase in the severity of needs among students seeking help.
Today, mental health sits front and center on the administrative radar at many college and university campuses, in large part because campus violence has made college administrators hyperaware of the link between mental health and student safety. "<b>Virginia Tech</b> opened administrators' eyes to reality," says Gary Robinson, director of counseling at <b>Hartwick College</b> (N.Y.). The issue transcends safety and impacts the bottom line via the retention rate, notes Keith Anderson, staff psychologist at <b>Rensselaer Polytechnic Institute</b> (N.Y.). Depressed students tend to have a hard time functioning when they aren't in treatment, which can precipitate a downward spiral ending in withdrawal.
Higher ed institutions are tackling the challenge in many ways. Many IHEs are employing a comprehensive, holistic approach, focusing on educating faculty, staff, and students about signs and symptoms of depression; involving the community in mental health programming; and using the web to inform students about mental health and identify those needing help.
The increase in depression and anxiety among college students stems from several factors. Today, more students arrive on campus with diagnosable disorders, including not just depression and anxiety but substance abuse and others. Treatment for mental illness has improved substantially, so students who might not have made it to college in the past are enrolling in larger numbers. In fact, approximately 25 percent of students who visit campus counseling centers present with psychiatric prescriptions.
Matriculation is not always a smooth transition for students with diagnosable disorders, says Joseph Scardapone, director of the Community Services Center at <b>Hofstra University</b> (N.Y.). College often removes or reduces the support structures that help students with mental illness through high school.
Other students find it difficult to adjust to campus life. Millennials tend to possess fewer coping strategies and need more mental health support than previous generations, says Megan McGlone, director of student counseling at <b>Mount Marty College</b> (S.D.).
There is no magic bullet approach to curing campus depression and anxiety, but there are some common characteristics of sound programs. The passive approach of the past-involving distributing pamphlets and offering phone consults for troubled students-has been replaced with a proactive model that engages faculty, staff, and students in awareness, prevention, and identification. New tools include websites, online surveys, and sophisticated marketing campaigns.
Adding resources and increasing counseling staff is part of the solution, says John Guthman, director of counseling services at Hofstra. Increased funding, however, is not a solution in itself.
"Schools need to ask how they can best allocate funding to help their students," states Todd Sevig, director of counseling and psychological services at the <b>University of Michigan</b>. For example, when Michigan students requested an interactive mental health website as part of the Michigan Healthy Community Initiative, Sevig's department complied. "We knew the website, a cross between Facebook and WebMD, would reach thousands of students," explains Sevig. An additional counselor might not reach the same number of students.
But sometimes hiring is in order. Rensselaer, for example, recently added a new counselor to bring its full-time counseling staff to four. The school redefined the position, however, with the newest counselor spending half her time away from her desk, conducting outreach programming in residence halls, fraternities, and sororities and planning events such as National Depression Screening Day (sponsored by Mental Health America).
Rensselaer also has plans to hire a full-time psychiatrist. Similarly, Hartwick added a psychiatric nurse practitioner to its staff. Psychiatric specialists can handle the more complex cases that are becoming increasingly common and thus free counselors and nurses for other health needs.
Although macro trends are clear, institutional leaders must adapt universal models to their own student body. Take the University of Michigan, which gathers longitudinal data about its students via an annual mental health survey. During the initial survey in 2004, counselors learned that international students were less likely to seek help for mental health issues. Over the following two years, the center formed liaisons with the international center on campus and targeted that population.
The strategy worked. The next survey showed that nearly 20 percent of international students sought help for mental health problems, compared to less than 10 percent initially. "We would not have taken that approach without the data from the survey," says Sevig.
Mount Marty College employs a different approach. The small, rural school of approximately 1,100 students tends to attract kids who may need some hand holding, says McGlone, so counseling staff focus on prevention and awareness. The three-day freshman orientation includes a healthy dose of mental health workshops focused on signs and symptoms of depression, drug and alcohol awareness, and sources for help. Additional mental health workshops continue through the school year.
Leaders at many institutions, like Mount Marty and Hartwick, convene weekly case meetings to discuss individual students who have been identified as needing help. The team-which includes counselors, student safety and residential life staff, campus ministry staff, and others-meets to discuss at-risk students. Whoever has the strongest relationship with the student approaches him or her to check in and make a referral to counseling if necessary.
As counselors strive to identify and help depressed students, they are taking the tools of their trade on the road and online. Rensselaer offers web-based surveys that students can complete anonymously without visiting the counseling center. "It gives them a quick score to see if they may need further help," says Anderson.
Hartwick College publicizes an anonymous hotline that any campus member can call to report non-emergency academic, stress, or personal concerns. The counseling center director follows up on all mental health calls, usually by bringing the student's name to the weekly case conference.
Because depression tends to peak in October, Mount Marty holds a Depression Screening Day, with counselors providing a quick assessment to any interested member of the campus community. Elevated scores are discussed on the spot, and most at-risk students make an appointment at the counseling center for follow-up.
The University of Michigan counseling team hosts several mental health marketing extravaganzas annually. Students are lured in with free T-shirts and hats, and staff try to engage them by asking five questions about mental health topics. The programs not only help identify students who may need counseling services, but they also teach students how to identify peers in trouble. The programs usually generate a bang and reach up to 1,500 students in two days.
Another characteristic of the new era is community involvement. Campus counseling centers see only a small fraction of the student population, so they need to tap the campus community's eyes and ears. "Faculty are in the best place to identify students potentially suffering from mental distress and refer them to appropriate services," says Ron Goldman, CEO of Kognito, a company that markets training software to help faculty learn how to engage students in conversation and determine if a mental health referral is needed.
Students and other campus staff are similarly positioned to extend the counseling center's reach. Hartwick College developed the 50/50 Peer Helping Service as a paraprofessional support and referral program. Work study students are trained to listen and assist others in sorting through issues and deciding on an appropriate course of action. "It's very cost-effective and runs the school about $1,000 per year," says Robinson. Plus, peer influence may help reluctant students seek counseling services.
Many IHEs match proactive services with new levels of intrusiveness, striving to define the line between "Big Brother" and under-involvement. Risk management has been redefined. "Most universities would rather be sued for over-involvement than under-involvement," says Scardapane. Hartwick shifted its policy and now strongly recommends that students on anti-depressants attend counseling sessions. Other schools take a similar strong stance with students voicing suicidal ideation.
Over the last 20 years, suicide rates at Big Ten schools have hovered around 7.5 deaths per 100,000 students every year. But one of the Big Ten, the <b>University of Illinois at Urbana-Champaign</b>, reports a lower suicide rate, 3.78 per 100,000 students.
The difference maker is a 1984 policy shift from inviting and encouraging anyone in the campus community to report suicidal behavior to mandating four sessions of professional counseling for students who threaten or attempt suicide. Consequences for failure to comply include mandatory withdrawal. The program grew from research completed by Paul Joffe, counselor and director of suicide prevention at the school. Two-thirds of the 19 student suicides there between 1975 and 1983 occurred after a public threat or attempt. Only one of the 19 students had seen a counselor.
Every year, the counseling center receives about 150 reports of suicide threats or attempts from police, residential life staff, or counselors. After the report, the Suicide Prevention Team explains the four-session policy, and most students comply. In fact, only one student of nearly 3,000 since the inception of the program withdrew rather than participate in counseling. The model is spreading, with ten other schools implementing a similar program, says Joffe.
Mental health program costs are a serious issue for some IHEs. In Milwaukee, the 700-student <b>Wisconsin Lutheran College</b>, for one, struggled to contain the high costs of its program. The school had contracted with a local counselor for students who needed services and absorbed the costs of each $100 hour-long session. Students worry about the costs of counseling, notes Jeff Weber, director of health services.
When the Wisconsin Association of Independent Colleges and Universities (WAICU) offered member schools a supplementary health plan with coverage for counseling services, Weber seized the opportunity. "It's a way to get students the confidential help they need," he says. The school mandates WAICU Student Health Plan participation, wrapping the $340 cost into tuition.
Weber estimates that the number of students accessing counseling services has nearly doubled since the plan was added in 2006-2007. The college has incurred no financial burden.
Other institutions, like Hartwick, rely on a form of self-insurance, wrapping counseling costs into tuition and fees as a way to avoid charging students for counseling. "If you want to discourage students from getting help, start billing them," cautions Robinson.
Meeting the needs of students with mental health issues is a critical challenge. Every campus can expect to continue to see higher numbers and more severe needs. The treatment consists of a range of programs and services that best fit the campus community and meet students' needs. It is an investment well worth making, as it can aid retention and make for a healthier campus climate.
<em>Lisa Fratt, a former institutional advancement specialist, specializes in writing about health care, education, and technology for trade magazines.</em>