College mental health: a system in transition
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Comment 254 www.thelancet.com/psychiatry Vol 1 September 2014 For more about The Jed and Clinton Foundation Health Matters Campus Programme see http://www.myhealthyu.org College mental health: a system in transition Every year, surveys completed by counselling centre directors at US colleges and universities report growing concern around the care of increasing numbers of students with severe mental illness on campus. The most recent surveys from the Association for University and College Counseling Center Directors 1 and the International Association of Counseling Services 2 report that college counselling services are treating slightly more than 10% of their student body yearly and having other contact with 33% of the students enrolled, predominantly through outreach and educational programmes. 25% of students seen at the counselling service are already on psychiatric drugs when they come for treatment and schools report an average of two psychiatric admissions for every 1000 enrolled students in the past year. 73% of counselling centre directors report an increase in the number of students experiencing behavioural crises requiring immediate response, 66% report increasing numbers of students with problems related to psychiatric drugs, and nearly a half report increasing problems related to drug use on campus. 2 In 2004, Steven Hyman, who was then provost at Harvard University (MA, USA) and had formerly served as director of the National Institute of Mental Health, noted that colleges were seeing an influx of students with severe mental illness because improved care of teenagers made it possible for more young people with severe illness to attend college. 3 We have argued that problems in the mental health-care system in the USA have driven more students into school-based counselling centres for care. 4 The result is that mental health services for students that were never intended to provide comprehensive clinically focused mental health care to the college community are required now to do so. 5 These challenges have required a shift in models of both service and care, and implementation has forced universities to consider expansion of budgets and staffing. Nearly a third of reporting institutions acknowledged an increase in counselling centre staff in the past year. 2 In view of the increase in those students matriculating with previous psychiatric diagnoses and in many cases taking psychotropic drugs, it is concerning that only about 60% of counselling centres reported having access to psychiatric services on campus. 1,2 Even with increased resources, schools cannot provide all the mental health care and services required for their students who have high levels of anxiety, depressive symptoms, stress, and substance use. And many students in need of services either will not present or do not realise that they need help—eg, only 15–50% of students with symptoms of depression seek help. 6,7 Colleges and related groups have been responding to these clinical and resource pressures in creative and innovative ways. For example, The Jed Foundation, in concert with the Suicide Prevention Resource Center, developed a Framework for Mental Health Promotion and Suicide Prevention 8 that addresses prevention and resiliency, early identification of troubled students, early intervention, clinical and emergency services, and restriction of means to self-harm to reduce risk of suicide. The US Federal Government adopted this approach as the basis for a college suicide prevention grant programme. Leading policy experts have suggested that this framework seems to have applicability for towns and communities as well as for college campuses. 9 The Jed Foundation, in partnership with the Clinton Health Matters Initiative, has integrated substance abuse prevention and programming in addition to mental health and suicide prevention activities into the framework, and developed a campus assessment and technical assistance programme based on the model. This programme leads schools through a self-study Babak Tafreshi, Twan/Science Photo Library Published Online September 2, 2014 http://dx.doi.org/10.1016/ S2215-0366(14)70334-7
Transcript of College mental health: a system in transition
Comment
254 www.thelancet.com/psychiatry Vol 1 September 2014
For more about The Jed and Clinton Foundation Health
Matters Campus Programme see http://www.myhealthyu.org
College mental health: a system in transitionEvery year, surveys completed by counselling centre directors at US colleges and universities report growing concern around the care of increasing numbers of students with severe mental illness on campus. The most recent surveys from the Association for University and College Counseling Center Directors1 and the International Association of Counseling Services2 report that college counselling services are treating slightly more than 10% of their student body yearly and having other contact with 33% of the students enrolled, predominantly through outreach and educational programmes. 25% of students seen at the counselling service are already on psychiatric drugs when they come for treatment and schools report an average of two psychiatric admissions for every 1000 enrolled students in the past year. 73% of counselling centre directors report an increase in the number of students experiencing behavioural crises requiring immediate response, 66% report increasing numbers of students with problems related to psychiatric drugs, and nearly a half report increasing problems related to drug use on campus.2
In 2004, Steven Hyman, who was then provost at Harvard University (MA, USA) and had formerly served as director of the National Institute of Mental Health, noted that colleges were seeing an infl ux of students with severe mental illness because improved care of teenagers made it possible for more young people with severe illness to attend college.3 We have argued
that problems in the mental health-care system in the USA have driven more students into school-based counselling centres for care.4 The result is that mental health services for students that were never intended to provide comprehensive clinically focused mental health care to the college community are required now to do so.5
These challenges have required a shift in models of both service and care, and implementation has forced universities to consider expansion of budgets and staffi ng. Nearly a third of reporting institutions acknowledged an increase in counselling centre staff in the past year.2 In view of the increase in those students matriculating with previous psychiatric diagnoses and in many cases taking psychotropic drugs, it is concerning that only about 60% of counselling centres reported having access to psychiatric services on campus.1,2 Even with increased resources, schools cannot provide all the mental health care and services required for their students who have high levels of anxiety, depressive symptoms, stress, and substance use. And many students in need of services either will not present or do not realise that they need help—eg, only 15–50% of students with symptoms of depression seek help.6,7
Colleges and related groups have been responding to these clinical and resource pressures in creative and innovative ways. For example, The Jed Foundation, in concert with the Suicide Prevention Resource Center, developed a Framework for Mental Health Promotion and Suicide Prevention8 that addresses prevention and resiliency, early identifi cation of troubled students, early intervention, clinical and emergency services, and restriction of means to self-harm to reduce risk of suicide. The US Federal Government adopted this approach as the basis for a college suicide prevention grant programme. Leading policy experts have suggested that this framework seems to have applicability for towns and communities as well as for college campuses.9 The Jed Foundation, in partnership with the Clinton Health Matters Initiative, has integrated substance abuse prevention and programming in addition to mental health and suicide prevention activities into the framework, and developed a campus assessment and technical assistance programme based on the model. This programme leads schools through a self-study Ba
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Published OnlineSeptember 2, 2014
http://dx.doi.org/10.1016/S2215-0366(14)70334-7
Comment
www.thelancet.com/psychiatry Vol 1 September 2014 255
with feedback and guidance process, and will provide consultation and guidance for schools to continue to enhance and assess their mental health programming.
Mental health services in colleges sometimes struggle with their peripheral position in the college enterprise, yet it has become clear that for students to be success-ful, college mental health should become a priority. Successful completion of higher education has been proven to have life-long benefi ts including increased lifetime earning power, reduced unemployment, and improved health outcomes.10 Untreated mental illness in college students has been linked to decreased ability to complete college.11
Students of higher education do their best when their institutions provide mentoring and supportive programmes.12 The provision of mental health care to students is a fi duciary responsibility of all universities and ensures student retention and academic advancement.
*Victor Schwartz, Jerald KayNew York University School of Medicine, New York, NY, USA (VS); The Jed Foundation, New York, NY 10001, USA (VS); and Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA (JK)[email protected]
We declare no competing interests.
1 Reetz D, Barr V, Krylowicz B, The Association for University and College Counseling Center Directors Annual Survey, 2013. http://fi les.cmcglobal.com/AUCCCD_Monograph_Public_2013.pdf (accessed May 19, 2014).
2 Gallagher R. National Survey of College Counseling Centers 2013. The International Association of Counseling Services Inc, 2013. http://www.iacsinc.org/2013%20Survey%20Section%20One%204-yr%20%20Directors%20%20%28Final%29.pdf (accessed May 19, 2014).
3 McGinn D. Dealing with depression. Newsweek (London), July 31, 2004. http://www.newsweek.com/dealing-depression-130363 (accessed May 19, 2014).
4 Schwartz V, Kay J. The crisis in college and university mental health. Psychiatr Times 2009. http://www.psychiatrictimes.com/articles/crisis-college-and-university-mental-health-0 (accessed May 19, 2014).
5 Barreira P, Snider M. History of college counseling and mental health centers. In: Kay J, Schwartz V, eds. Mental health care in the college community. Chichester: Wiley, 2010.
6 Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental health problems and needs in a college student population. J Aff ect Disord 2009; 117: 180–85.
7 Garlow SJ, Rosenberg J, Moore JD, Haas AP, Koestner B, Hendin H, Nemeroff CB. Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depress Anxiety 2008; 25: 482–88.
8 The Jed Foundation. For campus professsionals: comprehensive approach. https://www.jedfoundation.org/professionals/comprehensive-approach (accessed Aug 22, 2014).
9 Schwartz V. College mental health on the cutting edge? J College Stud Psychother 2013; 27: 96–98.
10 Baum S, Ma J, Payea K. Education pays 2013: the benefi ts of higher education for individuals and society. http://trends.collegeboard.org/sites/default/fi les/education-pays-2013-full-report.pdf (accessed June 26, 2014).
11 Eisenberg D, Golberstein E, Hunt J B. Mental health and academic success in college. BE J Econ Anal Policy 2009; 9: 40.
12 Devi M R R, Devaki PR, Madhavan M, Saikumar P. The eff ect of counselling on the academic performance of college students. J Clin Diagn Res 2013; 7: 1086–88.
WHO launches the fi rst world suicide reportIn WHO’s Mental Health Action Plan 2013–20, WHO member states have committed themselves to work towards the global target of reducing the rate of suicide in countries by 10% by 2020.1 After the World Health Assembly resolution in May 2013,2 and when confronted with the devastation and far-reaching eff ects suicide has on families, friends, and communities even long after people dear to them have died, WHO is launching its fi rst World Suicide Report.3 The objective of this report is to prioritise suicide prevention in the global public-health and public-policy agendas and to raise awareness of suicide as a public-health issue.
Suicide prevention should be a global imperative. Every year more than 800 000 people die from suicide, and it is the second leading cause of death in people aged 15–29 years worldwide. Studies suggest that for every adult who died from suicide there were more than 20 others who were likely to be attempting suicide.3 Millions of people experience suicide bereavement every
year.4 According to WHO projections, 836 000 deaths will be from suicide by 2015, and 1 007 000 deaths by 2030, with suicide predicted to remain as the 15th leading cause of death and contribute to 1·4% of all deaths worldwide.5
However, the quality and availability of data for suicide and suicide attempts globally is poor, posing a major barrier and challenge for the prevention of suicide. This data problem is not unique to suicide, but in view of the sensitivity that surrounds this subject—and the illegality of suicidal behaviour in some countries—under-reporting and misclassifi cation are probably greater problems for suicide than they are for most causes of death. Suicides are mostly misclassifi ed as deaths of undetermined intent, accidents, murders, or of unknown cause.6,7 The 39 high-income countries with effi cient vital registration data account for 95% of all estimated suicides in high-income countries, but the 21 low-income and middle-income countries with reliable data for vital registration account for only 8% of all estimated deaths by suicide in
Published OnlineSeptember 5, 2014http://dx.doi.org/10.1016/S2215-0366(14)70336-0
