Comments on Mental Health on Campus

• Another Perspective
• Posted by Frizbane Manley on April 21, 2009 at 10:30am EDT

• A preface and two points …

  Because I am very much interested in suicide from a personal perspective(see Part 2), I read and was very disappointed in Scott’s report. I thought “how can he say so little about a major new initiative focused on studying suicide amongst college students?” So I clicked on the link he provided, read the report (with lots of photos proving that college students are either wonderfully happy or terribly depressed and with no in-between) and was surprised to learn he captured the essence of the pilot study fairly well. There simply isn’t much there.

  Part 1

  The introduction to the study tells us much more about data collection procedures than it tells us about suicide. There is a nice ad for Titanium Software and a strange flow diagram that explains how data will flow from the usual (and obvious) sources into CSCMH (“a multi-disciplinary research center including faculty, staff, and students from departments such as Counseling & Psychological Services, Counseling Psychology, Clinical Psychology, Psychometrics, Information Sciences & Technology, and more”).

  While residing at CSCMH, the data will be massaged, with refined “data products” (I assume they will be in the form of tables, graphs, and unnecessary statistical analyses) flowing back into the counseling centers … and with the quite wonderful, career-enhancing residual “products” in the form of professional publications and grant proposals.

  It’s the sort of report in which “data” is singular and “impact” is a verb, and after reading it you pray, “Omigod, I hope I’m never a discussant on a panel at which this study is central to the discussion.”

  Just by way of example, there are data on n = 28,000 students; the authors make a point of the fact that the data constitute, not a sample, but the entire population; and they’re using completely unnecessary and irrelevant two-sample t-tests (or z-tests) to demonstrate “truisms” like …

  “Although it is a rare event, suicide is the most severe of negative mental health outcomes; it is the second leading cause of death among 20–24 year-olds, and the lifetime suicide rate peaks among young adults. Again, with an average time between assessments of just 6 weeks, the data indicate that the treatment received in counseling centers leads to a statistically significant reduction in suicidal ideation.”

  Whew! And by the way – and I’m certain you anticipated this already – the “data products” are called “mental health informatics.”

  Part 2

  [Note: The authors of the report of the pilot study are careful not to associate action verbs with “suicide. Personally, I prefer to use “chooses” suicide, knowing that “commits” suicide is the pejorative verb of choice of the psychiatric community.]

  I realize the “inspirations” for choosing suicide are broad-ranging. I, myself, am a big fan of suicide in almost any circumstance ... even as a solution to “life‘s problems.” Indeed, I would say the probability is much greater than 0.70 that I will meet my end at the time and place of my choice via that route. I am somewhat angry -- irritated may be a better choice of words -- that my government has gone to some pains to make the process much more difficult for me ... and probably much more violent as well. I think the political and societal circumstances that put Jack Kevorkian behind bars border on being “criminal” at best, uncivilized at worst.

  About me ... I am male, early 70s, I am healthy, very active (and frequently do way more than hold my own with 4.0 tennis players in their twenties). I have two very successful adult sons with terrific wives, and I have two beautiful grandchildren. My attitude about suicide has been a very sore point with my oldest son and his wife, and it has led to their not wanting me to have an on-going relationship with their children. I think that makes sense for them, but how can I change a thought-through philosophical perspective based on someone else‘s decision about a marginally related matter? I admit that it saddens me. I am atheist, but I’m confident if I ever came to terms with the existence of an Unmoved Mover, it will not be a personal god, for example, like the one who is so important to Christians.

  I essentially believe we’re all going to check out sometime anyway, so, since I have lived an interesting and full life up to this point; my choosing to end my life at a time of my choice will be a matter of very little consequence in the scheme of things. I understand the theory that suicide is a selfish act that seriously affects the lives of those who love you and are “left behind,” but I have always thought I could explain my decision in a manner that would help my family understand that, for me, it was a thoughtful and positive decision. Truth be known, I am confident the “selfishness theory” is bogus anyway ... it is often those who are left behind who selfishly want the one choosing suicide to conform to their needs and expectations, and, when s/he doesn’t, they attempt to transfer their selfishness to the one who chose suicide.

  Please don’t misunderstand my thoughts about suicide ... although I have seriously considered it several times in the past and am almost certain I will die by taking my own life, I have never been all that close to “going there” ... I have never gotten out a climber’s rope, cut it to an appropriate length, and fashioned a hangman’s noose … nor do I have one stored in my closet just in case. I don’t have a supply of a lethal substance hidden in my medicine cabinet to use when the mood strikes me.

  Will I admit that when I have been “closest” to choosing suicide I have been “depressed” in some manner or other? Yes. Will I admit that being drugged will probably alter my state of depression? Yes. But -- and this strikes me as being an important point -- my infrequent states of depression are not random events brought on by unknown forces (chemical imbalances); they are reactions to “life’s problems.” Will the problems go away when I am drugged? No. So, I suppose, were I to take the preferred action of a psychiatrist, I would be a drugged individual who is less reactive to the life’s problem that caused the “depression” in the first place. Of course a psychiatrist would say that, once drugged, I am better prepared to deal with the problem, the typical rationalization that keeps them in business and prescribing more drugs. It is the psychiatrists’ self-fulfilling prophesy based on their circular logic that suicide is a consequence of either mental instability or depression. Nonsense. I love Mary Pipher’s remark that “no one cries out for his therapist on his deathbed.”

  I do agree that suicide considerations for someone like me are different from suicide considerations for someone the age of a college student. But I am concerned that strategies for “combating” a young person choosing suicide frequently miss the point by a long shot because the “therapist” always seems to be working – as the authors of this report do – from the perspective that suicide is a mental health issue that is almost invariably a consequence (causality noted) of academic difficulties, a propensity toward violent behavior, alcohol or substance abuse, body image issues and eating disorders, military training and experience, or religious belief. I happen to believe there is waaay too much correlation here that is mistakenly interpreted as causality.

  Now, before being “bent out of shape” by my thesis that there are more than a few quite rational individuals choosing suicide— and I haven’t even got to suicide for those either in great pain or terminally ill — read about Carolyn Gold Heilbrun’s decision to end her life by suicide.

  http://www.newyorkmetro.com/nymetro/news/people/n_9589/

  I’ll add my prejudice that if we could end the psychiatric stranglehold on virtually every aspect of suicide — where are the biologists and chemists when we need them? — we could probably initiate some first-rate studies of the phenomena absent the starting point that only the depressed and mentally ill choose it.

• mental health services
• Posted by Tiny but Tough , Tutor Coordinator Student Advising and Learning at UC Merced on April 21, 2009 at 1:00pm EDT

• I was informed, two weeks ago, that the acceptable ratio of mental health counselors to students is one counselor per 1200 to 1500 students. What are the outcomes in a situation like this where it is clear that students are at risk for serious self-endangerment?

• good question
• Posted by karl laves , assistant director, counseling and testing center at WKU on April 21, 2009 at 1:30pm EDT

• The acceptable ration you describe isn't so much acceptable as it is realistic. Maybe one in ten college students consider using counseling services, even fewer actually use the services, and fewer still really need the services. So the ratio is more of an administrative illusion used to argue for more or less staff. And when was the last time you heard any department on a campus ask for fewer staff? Think of a campus like a small town. Who in a small town screens its citizens to determine risk for violence? And who is responsible for detaining violent people? It isn't the professional mental health people, that is for sure. In most all the shooter scenarios on campus the violent person had already run afoul of the legal system; usually incidents of stalking or domestic violence. While I would appreciate more psychologists and counselors on campus (since I am one) my concern is that we are caught up in a poor solution. More counselors will not prevent violent acts. Violent people rarely come to the attention of counseling centers, they are rarely clients of a counseling center.

• Social cohesion and psychological support
• Posted by R.J. O'Hara on April 21, 2009 at 2:45pm EDT

• "I was informed, two weeks ago, that the acceptable ratio of mental health counselors to students is one counselor per 1200 to 1500 students."

  Numbers like these don't necessarily tell us anything of importance. What makes one a "counselor"? An M.Ed. in counseling? A network of friends may be far more valuable. Depressed? Maybe having a weekly conversation over lunch with an older adult (like a faculty member) is what you need. Anxious? Maybe you need to spend more time with older students, rather than living in a officially-segregated freshman-only building so you will be surrounded by student-examples to emulate. ("Be not solitary, be not idle," advised Burton.)

  *Of course* there are situations that require medical intervention, and there always will be. But to medicalize large chunks of human experience does nothing but feed the medico-therapy-industrial complex.

  It's easy to imagine two campuses set up in a US News-style table, the first with one counselor per 1200 students and the second with one counselor per 1500 students, leading to the banner ad on the college website, "Ranked best for counselors-per-student!" But does this tell us anything? The campus with the "worse" ratio might have an exceptionally cohesive and supportive culture throughout the institution, and the one with the "better" ratio may be the archetypal factory college where people are nothing but numbers.

  Much better to support the development of a decentralized, stable, humane, cohesive institutional culture over all, rich in social capital, where people look after one another with courtesy. Far too many universities "see like a state" -- stripping away all the particularities of experience that lie at the core of success and failure. Particularities are messy, but they are what make the difference. Unfortunately, from the central planners' offices they are usually invisible.

  Related thoughts:

  http://collegiateway.org/news/2003-social-cohesion

  http://collegiateway.org/news/2003-managerialism

  http://collegiateway.org/news/2007-isolation-on-campus

• Lets not forget
• Posted by Counselor-educator on April 21, 2009 at 5:45pm EDT

• A person at a University is often away from his local-home circle of support. With quite a few freshmen, it is the first time away from home. Often his friends leave or transfer to another college after the first semester. The student is not near his normal medical and theraputic caregivers.

   

  Counseling services provides a point that help is avaliable. We also have to be mindful that for counseling to work, it has to be used by the student.

   

• use
• Posted by Tiny But Tough , Tutor Coordinator at UC Merced on April 22, 2009 at 1:30pm EDT

• If we demonstrate an appropriate concern for our students, and they are not attending counseling, surely we must inquire as to why, and what are we doing to encourage students to consider counseling. For example, are faculty, advisers, residential staff and student support services aware of the counseling programs that are available? What are the protocols on the campus for advising a student to seek assistance? Just this morning a student, one who heard that I am sympathetic to student needs, stopped by my office for a referral to a support group. I had to suggest Community Mental Health Services in the city. If the student did not have a car, she would have difficulty finding a way to the group. This is an indication that on-site services are not available and should be. The impact of the lack of familiarity with on-campus services and the lack of sufficient services, makes it clear that we need more attention to counseling services and more counselors. (Note: on our campus PsyD is considered the qualifying degree)