The Costs of Overpromising

It is impossible to identify and treat all the college students who experience anxiety and depression, and we must determine which groups we can effectively assist, argues Billie Wright Dziech.

October 8, 2019
 
 
Istockphoto.com/tetiana lazunova

One of the irrationalities of higher education that has perplexed me for years is its tendency to assume responsibility and competence for solving convoluted and often insurmountable challenges. The latest of those is the campus mental health crisis that has attracted the attention of not only students and the higher education establishment but also the news media and the public.

Without question, an unprecedented number of collegians are reporting anxiety, stress, depression and ideations of suicide and self-harm. Research from Penn State’s Center for Collegiate Mental Health has reported that the number of students using college and university counseling centers increased by an average of 30 to 40 percent from fall 2009 to spring 2015.

The center’s annual report found that “college students seeking treatment -- and the professionals who treat them -- continue to identify anxiety and depression as the most common concerns for seeking treatment, among dozens of other concerns. For the first time in five years, anxiety did not increase in prevalence, whereas depression increased slightly again … As with past years, the 2018 report found that self-reported lifetime prevalence rates of ‘threat-to-self’ characteristics (self-injury, suicidal ideation, suicide attempts) increased for the eighth year in a row.”

Whatever students’ reasons for seeking help, their willingness to do so is a positive sign. Decades ago far fewer would have been willing to admit the need for support amid academic and personal pressures. And yet two problems with this crisis deserve more consideration than they have received thus far.

The first challenge is that we have oversimplified the crisis. Given the constraints of Institutional Review Board research, along with the limited resources and time available, how much reliable and valid information do we have, and how much can we accurately discover, about students who frequent college mental health facilities? The complexities of dealing with the diverse students and the immense costs of doing so are multiple.

An observation by Ben Locke, executive director of the Penn State center, captured a crucial point: “Effectively addressing [the health crisis] will require a range of large-scale efforts aimed at helping the general student body successfully navigate the developmentally normative experiences of anxiety and depression common to this age group while also making more intensive treatment available to those in need.”

There are enormous differences between students experiencing serious mental disturbances and those who undergo normal periods of “anxiety and depression common to” college students. Anyone who has spent time working with collegians recognizes the elusiveness of the terms “stress,” “anxiety” and “depression.”

Some students have endured agonizing personal experiences or have verifiably serious mental health issues for which they seek help, while others need support but refuse to pursue it. Some with temporary challenges seek it, and a few may even invent mental health issues as excuses for special treatment. Still others may exaggerate, self-diagnose and turn to counseling as part of the collegiate cultural experience.

It is impossible to identify and treat them all, and sooner rather than later, we must determine which groups we can effectively assist. The one mistake we cannot make is being so blinded by grave need that we promise more than we are able to do.

What Are Our Obligations?

Amid all the institutional angst and media frenzy about coping with a mental health crisis, a second challenge exists, something I suspect college administrators and many of us faculty members on the “front lines” of higher education are too reluctant to address for fear of seeming heartless.

Here’s the concern: the National Center for Education Statistics projected that, in fall 2019, approximately 19.9 million students would enroll in American colleges and universities. The vast majority of those young people have come to college with academic, personal and financial pressures and dreams of their own. Yet they will somehow struggle through. What is higher education’s responsibility to the millions pursuing degrees in medicine, education, law, business and humanities who face multiple challenges and retain or discover the resiliency to move forward on their own? How are they affected by this crisis? And how much attention have the media and we directed to that concern?

In fact, anecdotes from some students tell a troubling story about their experiences with other students who are demanding mental health accommodations. Security dogs that can frighten. Peers who won't work in groups or disappear and leave others to take responsibility for assigned class presentations. A student who refuses to sit near males because they “cause stress.” Another who is intimidated by the smell of perfume. Yet another who demands that, in classrooms where they’re permitted to do so, classmates be prohibited from bringing lunches that involve “crunching” sounds because they “create anxiety.” The reasons for most mental health accommodations are undoubtedly sound and occasionally apparent, but to what extent should they be permitted to interfere with the learning process for others?

Art therapy can work well for those with anxiety, but how can other students appropriately deal with a situation in which a student sits in class and slings around two feet of bendable polymer clay, then cuts it with an instrument resembling a butcher knife? Peers indicate they are frightened, but what is the instructor’s recourse? The behavior is sanctioned by the institution as a calming strategy, so it has to be permitted in spite of other students’ concerns.

Of course, we have a duty to support troubled young people. But how far does that go, and what are our obligations to other students as they too make their way through classroom environments, academic demands, contacts with faculty members, dormitory life and concerns about rising tuition?

In addition, articles about “cash-strapped” institutions abound as colleges wrestle with the goal of providing resources to those experiencing mental challenges. But what do we owe to excessively pressured “rich kids” who may suffer from anxiety and stress as much as their peers and yet determine to go it on their own? To first-generation students and children of poverty who see higher education as a step up and need our time and support? To the children of the middle class who are increasingly unable to shoulder the exorbitant costs of higher education and are working long hours in addition to attending classes?

Presumably most of the public is unaware of the enormous amount of funding being devoted to mental health priorities. In 2019 alone, college presidents reported spending 72 percent more money on mental health concerns than in the previous three years. What services to all kinds of students might be neglected in order to cover those expenses?

An Insurmountable Burden

Professors, advisers and counselors compelled to cope with the diverse demands and needs of troubled young people also face an insurmountable burden. In my experience, those students turn to faculty members who are the most readily available and approachable. Not only does the burden of caring exact its toll, but it can rapidly become a drain on an individual’s personal and professional resources, as students make excessive time claims that limit peers’ access to the teacher.

Workshops for faculty and staff members on mental health concerns are admirable but limited in scope, as they concentrate on the troubled student. They disregard legal threats and emotional costs posed by the popular assumption that professors and advisers are trained to recognize and respond to varied types of personality disorders or predict the circumstances leading to a student’s suicidal ideation.

A 2018 ruling by the Massachusetts Supreme Judicial Court addressed this point. The court determined that neither the Massachusetts Institute of Technology nor its faculty members could be held liable for the suicide of Han Nguyen, a graduate student who ended his life after years of suicidal ideation. The ruling asserted that “non-clinicians (academicians) cannot be expected to probe or discern suicidal intentions that are not expressly evident.”

The mental health challenges confronting some students are absolutely important, and no professional should disregard them. But how to deal with them is another matter. For years, colleges were able to provide short-term care funded by student service fees and staffed primarily by psychological counselors rather than clinical psychologists. But currently, students with limited or no insurance and those with serious mental health needs turn to higher education.

Unfortunately, colleges too often seem cavalier in assuming accountability for crises they did not create. The painful reality is that students do not arrive on campus like Rousseau’s blank slate. The hardships and traumas of a postadolescent are decades old. They belong primarily to individual young people, their families and other actors in the years before they entered a college classroom.

The Massachusetts ruling rightly acknowledged that, in some circumstances, institutions do have a duty of care to provide prompt and professional treatment to students threatening or attempting suicide. Clearly, this responsibility also applies in instances where students with mental issues might threaten others. And when institutional personnel are guilty of disregarding confidences or behaviors of students who indicate or demonstrate troubling behavior, students and families certainly have ethical and legal rights to hold them accountable.

But the ruling also observed that “there is universal recognition that the age of in loco parentis has passed,” that universities cannot be expected to monitor and control every aspect of students’ lives. The point is there are no easy one-size-fits-all solutions to how colleges and universities can or should offer support for the multiple types of emotional and psychological mental health issues students report.

Most and possibly all campuses have long provided academic support services to students, but the new demands are different. And the danger is that when institutions overpromise, the costs can be enormous -- not simply in economic but also in human terms. We will never be able to estimate and treat accurately the number or kinds of help sought by members of this new generation. When mistakes in care fail, they may be catastrophic. And like it or not, few educational institutions have the funds or personnel to operate as professional health clinics any more than they can minimize their obligations to young people with other kinds of need.

I have experienced the horror and pain of losing a student to suicide and wondering irrationally what I had missed, what I could have said or done to prevent that terrible loss. He is one among so many. And every year I remember him as I look out at a new set of faces and recognize that each one brings distinct needs, seldom verbally disclosed, but always there, shaping the time we will spend together.

Bio

Billie Wright Dziech is professor of English at the University of Cincinnati.

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