Survey suggests that increasing student demand for mental health services -- spurred by prevention and awareness campaigns -- may be leading colleges to focus less on ongoing treatment in order to respond more rapidly to high-risk students.
Submitted by Sarah Lyon on January 5, 2016 - 3:00am
Student Mental Health
Mental illness exists on any type of campus -- urban or rural, public or independent, prestigious or relatively unknown. Students of all class years, ethnicities, majors and socioeconomic backgrounds are susceptible. Thus, it is now time for every one of our colleges and universities to implement orientation seminars dedicated to educating new students about the campus resources and support systems available with regard to mental health. This effort can be particularly important in preventing campus suicides, now the second leading cause of death for youth between the ages of 18 and 24, according to the Centers for Disease Control and Prevention.
Recently, the state of Texas has made strides in this area. As a result of a bill passed this past June, Texas now by law “requires universities to show students a live presentation or video with information about mental health and suicide as part of their orientation.” But the concept of dealing with mental health within the collegiate setting is nothing new -- so why haven’t such orientation seminars been required all along?
Historically, mental health resources were not always well received. As one historian notes, “The stigma associated with admitting mental health problems, together with tight budgets and the wish to focus only on academics, has often constrained … the development of services.” Still, the historian explains, by the mid-20th century, half of colleges and universities had mental health-related programs on campus. Why, more than 60 years later, are we not giving these resources the full credit they deserve by emphasizing their benefits during the orientation period?
It should be noted that campus health programs came about even earlier than the 1950s. Princeton University is credited with having established the first on-campus resource in 1910 -- the service was formed to tackle the issue of strong students withdrawing from the university “because of emotional and personality issues.” Harvard University and Yale University both hired campus psychiatrists in 1925, and other institutions had done so even earlier. The mental hygiene movement, which one scholar referred to as “a movement whose aim is the promotion and preservation of mental health,” was one factor connected to the establishment of such resources at the time.
Unfortunately, today’s students are still abandoning higher education for reasons similar to those who left Princeton over a century ago. In 2012, the National Alliance on Mental Illness (NAMI) released results from a survey of 765 college students experiencing a mental health condition, noting that 64 percent of respondents left college as a result of their condition. The survey findings indicate that half of the students who left an institution “did not access mental health services and support,” later noting that 24 percent of respondents cited a lack of information as one reason that they did not take advantage of such resources. In general, those students who left college cited “connecting with mental health providers earlier” as one factor that may have prevented them from withdrawing.
What’s more, over the years, students’ needs for mental health care have become more pressing. For instance, a 1998 paper found that the concerns of contemporary college students “include both the normal college student problems … as well as the more severe problems, such as anxiety, depression, suicidal ideation, sexual assault and personality disorders.”
All of the above findings underscore the need for exposure to mental health-related services upon students’ arrival to campus. NAMI, too, advocates for orientation and campus tours to include information about mental health resources.
First-year orientation programming often includes sessions on alcohol use and abuse, sexual violence, and other topics pertaining to student health and lifestyles. In examining future programming, college administrators should make every effort to include a seminar detailing the resources that are available to those battling depression, anxiety and other forms of mental illness. It is still important to consider the issue of stigma; as the NAMI report notes, “Stigma remains the No. 1 barrier to students seeking help.” Thus, a key benefit of making such seminars required for all first-years is that it eliminates any implication that any one student is personally facing a specific issue.
At such orientations, students can have the opportunity to practice asking each other difficult questions, such as, “Do you have thoughts of harming yourself?” They will learn how to delicately decipher why a friend seems upset and engage in sample conversations with peers. They can watch simulations that demonstrate how to respond to a friend who appears to be in distress.
These are all the same tactics that the University of Pennsylvania’s Counseling and Psychological Services (CAPS) counselors incorporate into their own training sessions. CAPS offers free workshops throughout each semester, during which students, faculty members and staff members have the opportunity to gain awareness of the university’s many resources designed to support individuals. Likewise, this type of workshop demonstrates how to be an ally for a peer suffering from mental illness. Ensuring students’ mandatory attendance to such a workshop during orientation will pave the way for a more supportive campus community as a whole.
By addressing mental health during the orientation period, students will begin their college careers with knowledge of the various challenges they or their peers may face at the present moment or at some point throughout their college career. With anxiety, depression, relationship problems and thoughts of suicide among the most common mental health concerns plaguing college students, it is imperative that our nation’s colleges and universities address this serious issue.
Sarah Lyon is a master’s candidate in higher education at the University of Pennsylvania and a 2013 graduate of Colby College in Waterville, Me.
The most recent American Freshman Survey found that the emotional health of incoming freshmen is at its lowest point in at least three decades -- a finding that should be of concern to all of us in higher education. Similarly, according to the National Survey of College Counseling Centers, 94 percent of counseling and psychological services (CAPS) professionals report that “recent trends toward greater numbers of student with some psychological problems continue to be true on their campuses.”
What can be done to alter these dire statistics? To help students prepare to meet the increased psychological demands required in modern life, colleges must provide additional support -- and not only from counseling professionals but also undergraduate advisers and faculty members.
Just ask any counseling and psychological services professional in your college or university and he or she will tell you that your students are not well emotionally, psychologically and physically, and those most responsible for their well-being -- advisers and faculty members -- have not been provided with a way to look at and help solve the problem. As one vice president of student affairs at a Big Ten university declared recently, “CAPS is receiving higher incidences of anxiety and depression” with “more so than usual behavior issues, where needs continue to grow each year and there is a long, growing waiting list.” He concluded, “We are not going to find enough money to remedy the situation.”
This is a sad commentary that expresses the depth of resignation among college and university leaders that anything can be done to reverse such a troubling situation.
Institutional leaders, frontline advisers and faculty members have been led to believe that if college students do well academically -- and take advantage of internships and student activities or develop a scholarly relationship with a close faculty mentor -- then they will also be happy, healthy and flourishing in higher education and life. That is a false belief that we should not perpetuate.
Senior administrators need to view students, the academic advising relationship and the broader college experience through a new lens that focuses much more on students’ overall well-being and not just on academics and traditional extracurricular activities alone. Today’s faculty members and academic advisers are just not taught to think this way. They don’t have a way to look at the problem, nor do they have a definition of what constitutes “well-being” to guide their prevention and education programs.
Well-being is not simply the absence of mental or physical illness. Rather, it is the more positive connotation of how well your life is going. Well-being encompasses, among other things, emotional health, vitality and satisfaction, life direction and ability to make a difference, the quality of one’s relationships, and living a good life.
What is required in higher education today is a systematic process that helps students achieve their educational, career and personal goals by concentrating on areas of talent and engagement, dreams and passions. Such a student success strategy will stimulate and support students in their quest for an enriched quality of life. That will, in turn, result in higher student satisfaction, increased retention and graduation rates, and, at the most fundamental level, young adults who are fulfilled and psychologically healthy.
In fact, some institutions are already exploring some proven best practices that effectively infuse well-being approaches beyond counseling and psychological services into academic advising, curricula and career counseling.
For example, one university where I was both a dean and professor applied an approach that we called Self Across the Curriculum (SAC). We required all students at the beginning of a new 16-week course to discuss with their professor how the course could help them better understand their distinct purpose in life. Faculty members designed weekly lesson activities that allowed students to design real-world projects that allowed them to work, for example, on ways to stop bullying in middle schools. Students became engaged in their learning by being intrinsically motivated to use their talents and skills to deal with real problems. Further, they encouraged and moved each other by revealing their highest hopes and dreams for a better world where children and people treated each other with kindness and love.
Retention rates increased by 26 percent for the entire institution, with student satisfaction scores going up by almost 40 percent -- demonstrating that students feel empowered to persevere and are happier about who they are and their course work when they learn about themselves and see the tangible contributions they can make.
In addition, academic advisers at that same university then applied the scientifically based Integrated Self (iSelf) model, an assessment and intervention tool that links four functional areas that are crucial to student success: academic advising, career services, personal counseling and student engagement. This model measures multiple facets or attributes of psychological well-being, including: emotional and socioemotional intelligence; self-esteem, self-efficacy and self-understanding; personal identity and beliefs; and intrinsic motivation.
Through the iSelf model, the university offered a short, three-session workshop to help students understand their life purpose and dreams, then choose their academic program based upon that life purpose and those dreams, and then select a potential career path and internships that would manifest such expressions of themselves.
The result? The students in the class in general did whatever it took to remain in college and found new and creative ways to finance their education after taking the workshop. Further, they took it upon themselves to take ownership of their well-being and future direction -- resulting, for instance, in reduced levels of substance abuse that often accompanies anxiety and depression.
For example, one student who had limited financial means to even attend college expressed an interest in a “practical” career to satisfy her parents’ demands. As such, she was just going through the motions of attending classes and was not emotionally engaged in her expensive education. Through the workshop, she transformed her understanding of who she was and what she was meant to do with her life -- the distinct difference she could make.
She changed her academic major from Spanish to Social Policy and International Relations, and she then actively found and accepted an internship in Peru. She went on to empower inner-city people to make their communities and neighborhoods safer and cleaner and to improve their personal health by reducing obesity rates. Her self-esteem and confidence soared, giving rise to a dynamic personality that had lain dormant.
This university is just one example of how institutions can use new assessment and intervention tools to create a student-success model that is based on the latest research in the psychology of well-being and student-centered learning. The occasional seminar or mental health event, or worse, allowing CAPS to passively wait for students to voluntarily sign up for counseling, is simply not enough. Our colleges and universities need to actively offer educational prevention programs and to infuse the teaching of self-understanding and well-being throughout the curriculum.
At the very least, academic outcomes will go up. At best, we have happier, healthier, more productive young adults.
Henry G. Brzycki is the president of The Brzycki Group and the Center for the Self in Schools. His next book, co-authored with Elaine J. Brzycki, Student Success in Higher Education, will be published in June 2016. He can be contacted at: Henry@Brzyckigroup.com.
The family of a black Harvard graduate who committed suicide creates an organization in his honor that seeks to "improve the support for the mental health and emotional well-being of students of color."
Recently, a nonacademic friend asked, “If you were teaching William Butler Yeats’s ‘Leda and the Swan,’ would you use a trigger warning?”
“Leda and the Swan” is a vivid account of Zeus, in the form of a swan, raping a young woman named Leda. I hadn’t read that poem since high school, and after rereading it, I can’t say for certain what I would do as an English professor. I probably would take an approach similar to the one I use as a professor in sociology as well as women’s, gender and sexuality studies.
The concept of a trigger warning has become quite controversial in recent years, with some people on campuses encouraging or demanding its use, and others discouraging it -- such as the Faculty Senate at American University, which recently passed a resolution citing the potential negative impact on academic freedom. As a faculty member who regularly teaches course content on trauma, I take more of a middle ground.
The term “trigger warning” has come to refer to introductory statements on web postings of graphic descriptions of rape, eating disorders and self-harm. They are used to alert readers who may be struggling with post-traumatic stress disorder (PTSD) related to those topics so that they can choose whether to continue reading. The purpose of using a trigger warning in the classroom is to let students know that the material that their professors have assigned may cause physiological or psychological reactions as a result of past traumas.
I started teaching in 2000, before the term was regularly used in academe or had received any news media attention. I now teach many of the same topics I taught then, about rape, violence, trauma and eating issues.
My approach on the first day of class, when I discuss the purpose of the course and learning goals, is to review the syllabus, pointing out topics that may be emotionally difficult, such as trauma and eating issues. I explain the content in the texts and any films that I plan to show in class.
In the past two years, I've also said something like, “I can’t predict what material may trigger someone suffering from post-traumatic stress disorder or what will upset people for other reasons. If you are concerned or uncertain about this course, please closely review the course materials and decide whether you want to continue taking it.”
I tell students that I’m available to meet with them to discuss any questions they may have about any aspect of the course. Typically, the week before we engage content that explicitly depicts violence or trauma, I remind students about the upcoming material.
If a student cannot view a film or discuss raw readings in the class setting, they are still responsible for that material, just as is a student who cannot attend class because they have a fever or other illness. I do not change my expectations or assessments concerning quizzes, exams, papers and so on -- regardless of the reason a student misses class. In the handful of cases when a student (typically a rape victim) has met with me to tell me that she cannot attend an upcoming class because the material is too emotionally charged, I tell her that she can use one of the two allotted absences that I give all students for any reason, such as if they are sick or need to attend a family event. I also tell her about the mental-health resources available to her to encourage her to seek help if she has not yet done that. I’ve never had students tell me they cannot read the course material because they are dealing with PTSD. (The reality is that some students don’t read all course material for a variety of reasons.)
The intent of a trigger warning is to acknowledge that some students may need to prepare themselves before engaging with explicit texts or films that might otherwise catch them off guard. But what preparing oneself looks like differs based on where each specific student is in the healing process. As noted by Mental Health America, people can have very different reactions. One student may need to seek counseling, while another may need to focus on mindfulness techniques and other strategies before coming to class. And yet another may need to skip class altogether.
How professors should use the phrase “trigger warning” is a source of contention. Students often do not have an accurate understanding of what it means, so they need an explanation of PTSD to appreciate the warning’s purpose. They may not realize there is a difference between course content that they will find emotionally disturbing for reasons other than trauma, and course content that is triggering due to PTSD. Some types of course content are upsetting for most students, such as films that depict genocide or natural disasters. Not all students who become visibly emotional are reliving memories of trauma (unless, of course, they have direct, traumatic experiences with genocide or natural disasters).
Then there’s the issue of whether to use trigger warnings at all. Discerning whether material is potentially triggering due to PTSD is arguably a slippery slope. And no professor can warn students about all possible triggers that might occur in their classroom.
I certainly don’t have all the answers when it comes to the debates about trigger warnings, but I never only use the term “trigger warning,” if I use it at all. If we as professors incorporate the phrase “trigger warning,” we should include more information than those two words, whether in a syllabus or before showing a film. I’m not trained about all possible PTSD triggers, so I risk misleading students by labeling some material as triggering and overlooking other content altogether. Instead, I continue to prefer course content overviews and reminders about upcoming content on violence and trauma.
All that said, things can get especially complicated in an academic setting. Outside of academe, a person with PTSD who is learning how to manage triggers may successfully avoid news, films or other potentially difficult stimuli. What is distinct about college is that students may be enrolled in courses that require them to read, watch or discuss content that graphically depicts violence or trauma.
Sexual assault, in particular, is associated with a greater risk of developing PTSD symptoms, and a new survey among 27 universities finds that cis women, transgender and gender nonconforming students experience the highest rates of sexual assault and misconduct during their college years.
So, whether using the term “trigger warning” or not, I strongly believe that professors should say something about that content before requiring students to engage it. Here’s an example of a time when I regret that I didn’t do that.
In a senior sociology seminar, I showed a clip from The Invisible War, a documentary about sexual assault in the military. I described the film’s content, but I did not specify that the clip we were about to view included distraught, first-person interviews. One segment showed a young woman shaking as she described a rape’s impact on her life. The film then cut to her father weeping about his failed attempts to reassure her that she is still a virgin.
A student became agitated. She shifted in her chair, wiped away tears and left the room for a few minutes while we wrapped up the clip.
After class, I sent an email to check in with her. She wrote back first thanking me for covering these issues in class rather than avoiding them. Then she said that she wished that I had better prepared the class for the content of this particular film. Watching first-person accounts of rape is much more difficult to absorb in a class setting than academic readings on the same topic. Not acknowledging that difficulty risks leaving sexual assault victims in the classroom feeling more isolated than they already do.
I had unexpectedly received a copy of the film, and I could have sent an email giving a more detailed description of the film before we met in class that day. And I wish I had.
Higher education cannot identify all possible topics or classroom moments that might trigger students suffering from PTSD. Professors may decide to abandon the language “trigger warning” altogether to avoid the impression that they have drawn a bright line between material that is and is not triggering. But let’s not forgo giving students advanced descriptions of course content on violence or trauma. Whether it’s a content alert or a preparatory overview, professors have a responsibility to let students know about such content.
Not giving students a heads-up risks a return to the status quo of intellectualizing violence and trauma as something that happens only outside the classroom. And those in the classroom who have suffered such trauma may needlessly suffer even more.
Julie A. Winterich is an associate professor of sociology and the director of women’s, gender and sexuality studies at Guilford College.
As I got ready to turn in my spring semester grades this week, I was depressed to realize I would have to fail two students who hadn’t finished the work in my classes.
I say “depressed,” but I wasn’t really. I’m using this word as a shorthand to describe my gloomy sense of wishing I had been a better teacher. The students were the ones who were actually depressed, which was precisely the problem.
As someone who teaches disability studies, I think a lot about how to make my classes accessible to students with a range of learning styles and physical abilities. I present material in varied formats and offer different options for completing assignments so that students can produce work that best reflects what they’ve learned and what they are capable of doing. Because of their subject matter, my courses attract students with disabilities, and I’m used to accommodating them.
But I find students with depression among the hardest to accommodate. Students who are depressed tend to withdraw and vanish rather than to ask for help. When they do show up to class or office hours, they are unmotivated and joyless. The very nature of their illness often makes the professor into an antagonist rather than a source of support.
Tania, a student who -- ironically enough -- failed my class on disability studies, didn’t respond to my email messages about an upcoming presentation. She showed up in my office 15 minutes before class looking exhausted, her skin covered in an angry rash. “I didn’t do the work, OK?” she said in a despairing tone. “I know you’re going to yell at me, so why don’t you just do it?”
Putting aside my dismay over the missing presentation, I asked how I could help. Tania dissolved into tears: she was depressed and having trouble getting her work done. She hadn’t bothered to register with our Office of Disability Services because she felt so confident at the beginning of the semester. I made sure she had seen a therapist and gave her the chance to make up for the missed presentation. I urged her to stay in touch and ask for my help rather than vanishing if she continued to struggle. I also suggested that she contact the ODS to help her get accommodations for her other courses. (Do I even need to say that I did not yell at her?) After that day’s class, I never saw her again. She didn’t do the presentation or turn in a final paper. When it came time to turn in my grades, I had no choice but to give her an F.
My other student, Aurora, did register with ODS late in the semester after sitting silently during seminar discussion for most of the term and then missing a series of classes. Through ODS, she asked for extra time on her final paper and the opportunity to make up for her lack of participation. The deadlines we had set came and went, I was unable to reach her, and she too failed the class.
Tania and Aurora are hardly unique. In The Noonday Demon, Andrew Solomon writes that depression is the leading cause of disability in the world’s population over age 5. Up to 19 million Americans (3 percent of the total population) suffer from depression, while manic depression affects 2.3 million people and is the second leading killer of young women, the third of young men. “Worldwide, including the developing world,” Sullivan writes, “depression accounts for more of the disease burden, as calculated by premature death plus healthy life years lost to disability, than anything else but heart disease.”
College students are particularly vulnerable, and rates of depression are on the rise. College creates an environment of high expectations, constant evaluation and deadlines that can heighten stress and anxiety. A 2008 study from Columbia University found that up to 50 percent of college students experience psychiatric disorders, although fewer than 25 percent seek treatment. Students suffering from psychiatric illness are less likely to attend class, complete assignments and graduate from college. They are more prone to engage in substance abuse. Suicide rates among college students have nearly doubled since the 1950s.
An elite residential university like mine is especially likely to produce or exacerbate depression. Students are especially susceptible when they are living away from home for the first time, often with less experiences and resources for coping with adversity than older adults. A rising senior at my university blogged recently that my university is “a place of unimaginable wealth, privilege, cruelty, pressure and stress…. Depression is normal, but here, it’s the norm.”
I know some of my colleagues see the rising incidence of disability among their students as evidence of the medicalization of our culture. The problem is not that more students are experiencing learning, mood and behavior disorders, they tell me, but that we live in a society that is too quick to diagnose and medicate conditions that, in the past, would be considered ordinary human behavior. So too, they argue, privileged students often use diagnoses as an excuse to get accommodations that give them an unfair advantage over their peers.
Given the stigma surrounding disability, there is little incentive for students to claim disability for the purposes of personal gain. It is far more likely for students to avoid getting treatment than to deliberately pursue a diagnosis to get a competitive edge. Indeed, research shows that less than 25 percent of students suffering from psychiatric illness seek treatment.
Depression is a real disability that needs to be accommodated, in the same way we accommodate students who use wheelchairs or have vision impairments. Beyond the minimum requirements stipulated by the Americans With Disabilities Act, colleges and universities need to do all they can to help students with disabilities by providing adequate counseling and accommodations.
But we also need to face the unfortunate fact that sometimes college, especially a highly competitive, residential college like the one where I teach, is an unhealthy environment for students with more severe forms of depression. Maybe depression is one disability I’m not able to accommodate. And maybe my students, in vanishing from class, are making that decision for themselves.
Rachel Adams is a professor of English and American studies at Columbia University, where she also directs the Center for the Study of Social Difference. Her most recent books are Raising Henry: A Memoir of Motherhood, Disability and Discovery and Keywords for Disability Studies.