N a t i o n a l C o n f e r e n c e of S t a t e L e g i s l a t u r e s

The Forum for America's Ideas

MENTAL HEALTH IN SCHOOLS

Two-Part Webinar Series

MENTAL HEALTH IN HIGHER EDUCATION

Friday, June 5 at 2:00 PM EDT

This webinar is part of the Coordinated State Leadership for Better Mental Health project funded by the generous support of the MacArthur Foundation.

Speakers:

Lynn Carter, MSW, LCSWDeputy Director of Missouri

Department of Mental Health

Paul Barreira, MDDirector of Behavioral Health and Academic Counseling at Harvard

University Health Services

Moderator:

Robin RichardsonPolicy Associate at NCSL Forum for

State Health Policy Leadership

For technical assistance throughout the webinar, call:

866 - 779 - 3239

College Mental Health: Challenges College Mental Health: Challenges and Opportunitiesand Opportunities

•• Paul Barreira M.D.Paul Barreira M.D.•• Director of Behavioral Health and Director of Behavioral Health and

Academic Counseling at Harvard Academic Counseling at Harvard University Health ServicesUniversity Health Services

•• Associate Professor of Psychiatry Harvard Associate Professor of Psychiatry Harvard Medical SchoolMedical School

ChallengesChallenges

•• Reduce StigmaReduce Stigma•• Reduce StigmaReduce Stigma•• Adequate Resources on CampusAdequate Resources on Campus•• Coordinate Care: Counseling, Campus Coordinate Care: Counseling, Campus

Safety, Administration, Residence, Safety, Administration, Residence, ChaplainsChaplains

ChallengesChallenges

•• Introduce new students and international Introduce new students and international students to healthcare systems students to healthcare systems

•• 75% of students get healthcare 75% of students get healthcare information from their parentsinformation from their parents

•• Educate entire community (including Educate entire community (including parents) about common problems/ parents) about common problems/ symptomssymptoms

ChallengesChallenges

•• Legal Issues (Shin Case, Hunter and GW Legal Issues (Shin Case, Hunter and GW cases, Va. Tech): shared responsibility for cases, Va. Tech): shared responsibility for wellwell--beingbeing

•• What to do with high risk students?What to do with high risk students?•• Confidentiality is being challengedConfidentiality is being challenged•• Increased demand for prescribingIncreased demand for prescribing

Academic SuccessAcademic Success--ImpedimentsImpediments

Stress 31%

Sleep Difficulty 21%

Cold/Flu/Sore Throat 18%

Internet Use 16%

Relationship Issues 15%

Depression/Anxiety 14%

Alcohol and Drugs 10%

Youth Risk Survey 2005 Youth Risk Survey 2005

•• 28.3% sad or hopeless almost every 28.3% sad or hopeless almost every day> 2 wks stopped some activity due to day> 2 wks stopped some activity due to symptomssymptoms

•• 19 percent of students reported that they 19 percent of students reported that they seriously considered attempting suicide seriously considered attempting suicide

•• 14.8 percent had made a specific plan to 14.8 percent had made a specific plan to attempt suicide. attempt suicide.

•• 8.8 percent had attempted suicide in the 8.8 percent had attempted suicide in the previous year previous year

College Data ACHA and Kansas College Data ACHA and Kansas StateState

•• Depression Doubled, Suicidal Ideation Depression Doubled, Suicidal Ideation Tripled, Sexual Assaults quadrupled over Tripled, Sexual Assaults quadrupled over 13 years 13 years

•• 45% students self report depression45% students self report depression•• 10% report serious suicidal ideation and 10% report serious suicidal ideation and

44% binge drink44% binge drink•• These are the best years of your lifeThese are the best years of your life

Berkeley Grad Student Survey Dec. Berkeley Grad Student Survey Dec. 20042004

•• 45.3% respondents experienced emotional 45.3% respondents experienced emotional or stress related problem SIGNIFICANTLY or stress related problem SIGNIFICANTLY affected well being/ academic affected well being/ academic performanceperformance

•• 9.9% seriously thought about suicide9.9% seriously thought about suicide•• 52% considered using counseling less 52% considered using counseling less

than 33% did usethan 33% did use•• 25% unaware they were available25% unaware they were available

Longitudinal Harvard StudyLongitudinal Harvard Study

•• Inner city kids and Harvard Grads over 40 Inner city kids and Harvard Grads over 40 yearsyears

•• Relationships/ Connections more Relationships/ Connections more important than health or wealthimportant than health or wealth

•• Staying connected with people and not Staying connected with people and not drinking too much provides only clear drinking too much provides only clear predictors of satisfaction and happiness in predictors of satisfaction and happiness in life. Make time for relationships and restlife. Make time for relationships and rest

WHY DO STUDENTS NOT SEEK WHY DO STUDENTS NOT SEEK HELP?HELP?•• 320/729 (44%) REPORTED NEEDING BUT 320/729 (44%) REPORTED NEEDING BUT NOTNOT SEEKING HELPSEEKING HELP

–– 97 97 -- negative expectationsnegative expectations–– 78 78 –– too busy/no timetoo busy/no time–– 63 63 –– shame or stigmashame or stigma–– 40 40 –– bizarre structurebizarre structure–– 16 16 –– privacy concernsprivacy concerns–– 13 13 –– appointment scheduling a hassleappointment scheduling a hassle–– 1111-- too long to get an appointmenttoo long to get an appointment–– 1111-- too depressed to seek helptoo depressed to seek help–– 1010-- inaccessible hoursinaccessible hours

Herbstman C’07 Herbstman C’07 Barreira, M.D.Barreira, M.D.

To whom do students turn for advice when To whom do students turn for advice when sad, depressed, or anxious?sad, depressed, or anxious?

70.2 66.461.7

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Student ParticipationStudent Participation/ Engagement/ Engagement

•• Key for Successful OutreachKey for Successful Outreach•• Peer Counseling/ Education ProgramsPeer Counseling/ Education Programs•• Wellness representatives in the dormsWellness representatives in the dorms•• Mental Health Advocacy Group: “Active Mental Health Advocacy Group: “Active

Minds”Minds”•• Involve in screenings and educationInvolve in screenings and education

What What Must WMust We do?e do?

•• Engage our students in the community: Engage our students in the community: Life is richer and more satisfying for Life is richer and more satisfying for students who are engaged in learningstudents who are engaged in learning

•• Stress Health and Wellness on campus Stress Health and Wellness on campus and create opportunities for connectionsand create opportunities for connections

•• Connections are most highly correlated Connections are most highly correlated with life happiness and reduce risk for with life happiness and reduce risk for suicide.suicide.

OpportunitiesOpportunities

•• EAT SLEEP AND EXERCISEEAT SLEEP AND EXERCISE•• Prepare for expected stresses and Prepare for expected stresses and

normalize themnormalize them•• Teach Balance in LifeTeach Balance in Life•• Have adequate counseling resources. Have adequate counseling resources.

Retention Data says it saves moneyRetention Data says it saves money

RetentionRetention

•• 562 students asking for counseling followed over 562 students asking for counseling followed over 2 year period2 year period

•• 0 sessions 65% 10 sessions 65% 1--12 79% >13 83%12 79% >13 83%•• Several studies followed people over 5 years all Several studies followed people over 5 years all

showed dramatically higher retention rates, showed dramatically higher retention rates, averaging more than 10% for students who averaging more than 10% for students who used counseling servicesused counseling services

Steve Wilson, Terry Mason, Evaluating the impact of receiving unSteve Wilson, Terry Mason, Evaluating the impact of receiving university based counseling services on iversity based counseling services on student retentionstudent retention

Journal of Counseling Psychology 1997 vol 44. no 3 p. 316Journal of Counseling Psychology 1997 vol 44. no 3 p. 316--320320

Sleep ProblemsSleep Problems

•• 35% of adult population experience 35% of adult population experience insomniainsomnia

•• 11% of college students get a “good 11% of college students get a “good night’s sleep”night’s sleep”

•• Loss of cognitive functioning, drivingLoss of cognitive functioning, driving•• Increased risk of depressionIncreased risk of depression•• < 7 hours yields sleep deprivation< 7 hours yields sleep deprivation

Coordination of CareCoordination of Care

•• Handbook expectations: who gets notified Handbook expectations: who gets notified about hospitalization/ returnabout hospitalization/ return

•• Identifying highIdentifying high--risk studentsrisk students•• How is residence involved with worrisome How is residence involved with worrisome

students?students?•• Eating Disordered or Substance Abusing Eating Disordered or Substance Abusing

students in residence, what happens?students in residence, what happens?•• Contracts: When to invoke themContracts: When to invoke them

Lessons from Virginia TechLessons from Virginia Tech

•• Violence is very rare and difficult to Violence is very rare and difficult to predict (prior violence best predictor)predict (prior violence best predictor)

•• There must be a community effort to There must be a community effort to reduce stigma, recognize risk factors, and reduce stigma, recognize risk factors, and find portals to care. Educate everyonefind portals to care. Educate everyone

•• Counseling and Health Services can and Counseling and Health Services can and should provide consultation to the should provide consultation to the community (students, faculty and staff)community (students, faculty and staff)

Lessons from Virginia TechLessons from Virginia Tech

•• Schools must find ways to respect medical Schools must find ways to respect medical privacy, but coordinate concernsprivacy, but coordinate concerns

•• FERPA and HIPAAFERPA and HIPAA•• If students can’t expect privacy, they If students can’t expect privacy, they

won’t seek carewon’t seek care•• There must be communication, sometimes There must be communication, sometimes

one way, between faculty, administration, one way, between faculty, administration, family, counseling and campus safetyfamily, counseling and campus safety

Advice for the Campus CommunityAdvice for the Campus Community

•• Don’t worry alone and don’t suffer too Don’t worry alone and don’t suffer too longlong

•• Campus resources for academics, health, Campus resources for academics, health, and emotional welland emotional well--being are there to being are there to make college a successful experiencemake college a successful experience

•• Talk to friends and take risks getting to Talk to friends and take risks getting to know one anotherknow one another

Wellness ActivitiesWellness Activities

•• Engage Students in communityEngage Students in community-- study study breaks, hikes, encourage student groupsbreaks, hikes, encourage student groups

•• Teach yoga, sleep hygiene, mindfulness, Teach yoga, sleep hygiene, mindfulness, relaxation response relaxation response

•• Have annual “wellness or caring events” Have annual “wellness or caring events” “maximize academic potential, minimize “maximize academic potential, minimize stress”stress”

•• Screenings with giveawaysScreenings with giveaways

Web InformationWeb Information

•• Online screenings: Online screenings: Mentalhealthscreening.org; ULifeline.orgMentalhealthscreening.org; ULifeline.org

•• Information about alcoholInformation about alcohol•• Student made DVD to incoming studentsStudent made DVD to incoming students•• Information about resourcesInformation about resources•• Many good web resources (JED (Ulifeline), Many good web resources (JED (Ulifeline),

Mystudentbody.com, Alcohol.edu)Mystudentbody.com, Alcohol.edu)•• Many bad web resources Many bad web resources

Opportunities For ParentsOpportunities For Parents

•• Check out resources during applicationCheck out resources during application•• Once admitted, get supports in place for Once admitted, get supports in place for

any preany pre--existing problems. Invite more existing problems. Invite more detailed medical information/ needsdetailed medical information/ needs

•• Parents talk about transition and stresses Parents talk about transition and stresses with students and parentswith students and parents

•• Stay in touchStay in touch

June 5, 2009

Show-Me Partnership:

Higher Education & Mental Health Collaboration in Missouri

Brief History

• Virginia Tech• Governor-appointed task force in Missouri

– Short-term study group– Interdisciplinary leadership and involvement– Report to Governor in August 2007 with

recommendations to address safety and security concerns on Missouri’s 56 public and private college and university campuses

Guiding Principles Emerged• Value of interdisciplinary collaborations &

solutions• One size does not fit all!

– Diversity of campuses– Diversity of resources and needs– K-12 solutions may not be same as higher

education solutions

• All-hazards planning and preparedness• Importance of meaningful involvement of

stakeholders

www.dps.mo.gov/CampusSafety/

CSTF Report Themes• Dedicated

Leadership• State of the Art

Resources• Preparedness

Culture• Consistent Protocols• Responder Support• Government Actions

Mental Health-Related Recommendations

• Access to 24/7 mental health services for campuses

• Prepare campus law enforcement to work with mental health-related situations

• Campus emergency plans should address crisis-specific mental health functions in emergency response and recovery

• Involve mental health representation in emergency planning, training related to emergencies and with the State Emergency Management Agency to improve preparedness on higher education campuses

State Leadership for a Preparedness Culture

• Higher Ed Subcommittee (HES) of Missouri’s Homeland Security Advisory Council (HSAC)– Continuing interdisciplinary focus– Support for implementing recommendations and

building a preparedness infrastructure– Continuing attention and visibility

Higher Ed Subcommittee Goals

• Creating safe learning environments on Missouri college and university campuses through interdisciplinary partnerships

• Communication and information sharing• Resource development

– Evidence-based practices/toolkits– Enabling legislation

• Data-informed decision-making and research

Higher Ed Subcommittee Accomplishments

• Website development & maintenance• Missouri’s Annual School Safety

Conference expanded to include higher education

• Mental Health Seminars• Mental Health First Aid • Partners in Prevention

– Substance Abuse– Suicide– Violence

• Legislation• Information about privacy laws

– HIPAA– FERPA– 42 CFR privacy re: substance abuse treatment– State statutes– Case law (Tarasoff decision & others)

• Integrating Higher Education representative on interagency steering committee for Transforming Mental Health Systems in MO– Mental health prevention & early intervention– Workforce Development– Research

Higher Ed Subcommittee Accomplishments

http://campussecurity.missouri.org/

Higher Education Subcommittee of the Homeland Security Advisory Council Website

http://www.dmh.mo.gov/diroffice/disaster/documents/finalguidebookwCov.pdf

Questions?

• Type your question into the box on the right-hand side.

• Participants asking questions will not be identified.

Additional Resources

• Missouri Department of Mental Healthhttp://www.dmh.missouri.gov

• Bazelon Center for Mental Health Lawhttp://www.bazelon.org/pdf/SupportingStudents.pdf

• Mental Health America, Back to Campushttp://www.nmha.org/go/backtocampus/links

• NCSL Mental Health http://www.ncsl.org/Default.aspx?TabID=160&tabs=832,100,358#832

• NCSL Higher Education http://www.ncsl.org/Default.aspx?TabID=756&tabs=951,64,218#951

For More Information

Contact:

• Robin Richardson, NCSL Forum for State Health Policy Leadership

• Robin.Richardson@ncsl.org

• 202 - 624 - 3583

• Yilan Shen, NCSL Education Program• Yilan.Shen@ncsl.org

• 303 - 364 - 1560

N a t i o n a l C o n f e r e n c e of S t a t e L e g i s l a t u r e s

The Forum for America's Ideas

MENTAL HEALTH IN SCHOOLS

Two-Part Webinar Series

MENTAL HEALTH IN K-12 SCHOOLS

Friday, June 12 at 2:00 PM EDT

REGISTER NOW: http://ecom.ncsl.org/public/registration/mtg_reg.htm