Jon Brunner, Ph.D.Director, Counseling and Health Services

FGCU Health and Wellness Services

Student Health ClinicCounseling Center (CAPS)Adaptive Services for Students with DisabilitiesPrevention & Wellness Services (health

education)Testing Center

Millennial Students: The Good, the Bad, and the Ugly(Born between 1982 through to today)

They tend to: not to learn from failure.

idealistic—hopeful of the future have increasing levels of stress and anxiety be more nurtured than previous generations.

parents tend to be overprotective and highly involved exposed to more structured upbringing Greater expectation for personal and immediate resolutions

have been raised by parents believing in the importance of self-esteem 

have been pushed to study hard and succeed to choose careers that “pay off” nicely

multi-task well having juggled sports, school, and social interests as children

Millennials contd. be quite interdependent (i.e. on friends, family, teachers/role-

models) be more inclusive and tolerant of religions, ethnicity and sexual

orientations have exposure to vast information but go less in-depth acknowledge and respect positions, titles, and rules

however, see it as a challenge to find a way around the rules. value peer bonding (e.g. organized team sports, church groups,

clubs) banding together to date and socialize rather than pairing off work well in groups, preferring this to individual endeavors

be quite technologically savvy (self-taught from experimenting and exploring)

computers, internet, smart phones, pocket pc

American College Health Association (ACHA)National College Health Assessment (NCHA)

The largest known and most comprehensive data set on the health of college students

Initiated in 2000Revised in 2008 (NCHA II)Last given at FGCU, Fall 2009

The Top 10 Impediments to Academic Performance According to Students 2000-2007Stress- 32% (32.4%)Cold/Sore Throat- 26% (20.7%)Sleep Difficulties- 24% (27%)Concern for Family or Friend- 18% (21.2%)Depression/Anxiety- 16% (14.3%)Relationship Difficulty- 15.5% (17.6%) Internet/ Games- 15% ** (12%)Sinus Infection- 8.5% (8.5%)Death of Friend/Family- 8.5% (11%)Alcohol Use- 7% (4.5%)

ADHD 6%

The NCHA II Top 10 Impediments to Academic Performance According to Students 2008-Present

Stress- 27.3% (19.5%)Sleep Difficulties-

19.6% (19.5%)Anxiety- 18.4%

(19.9% #1) Cold/Sore Throat-

17.3% (16.4%)Work- 13.3% (16.4%)

Depression- 11.3% (13.9%)Internet/ Games- 11.1%

(10.3%)Concern for Family or

Friend- 11.0% (8.2%)Extracurricular Activities-

10.6% (6.5%)Relationship Difficulty-

10.5% (8%)ADHD- 6.7% #9

NCHA II Survey - Mental Health2008-Present, Incidence in Last 12 Months

46.3% felt hopeless once during the year (50.2%)

48.4% felt overwhelming anxiety (49.8%)

38.1% felt overwhelming anger (44.1%)

30.3% reported being “so depressed that it was difficult to function” (31.0%)

6.2% seriously considered suicide (6.0%)

81% felt exhausted (not from physical activity) (84.5%)

5.3% intentionally injured themselves (3.5%)

NCHA II Survey - Mental Health continued75.1% of students found some aspect of their life

being traumatic or very difficult to handle in the last 12 months (77.3%)44.9% reported Academics (47.5%)27.3% reported Family problems (30.7%)32.3% reported Intimate relationships (36.5%)35.4% reported Finances (43.6%)24.4% reported Sleep difficulties (31.6%)

NCHA II Survey - SleepOnly 58.6% of students reported getting enough

sleep to feel rested in 3 or more mornings of the past 7 days (56.8%)

60.5% of students reported feeling tired, dragged out or sleepy during the day for 3 or more days of the past 7 days (63.5%)

NCHA II Survey - Stress

50.7% of students rated their level of stress as above average or tremendous within the last 12 months (51.2%)

NCHA II Survey – Violence & Abusive Relationships2008-Present, Incidence in Last 12 Months

21.7% reported receiving a verbal threat (25.6%)10.6% reported unwanted sexual activity (8.4%)10.0% reported an emotionally abusive intimate

relationship (15.1%)

NCHA II Survey – Sexual Behavior68.0% had a sexual partner in the last 12

months (72.3%)

NCHA II Survey – Alcohol & Other Drug Use2008-Present

Number of drinks consumed that last time students “partied” or socialized – Median of 4 (4)

33.1% of student reported binge drinking (five or more drinks per sitting) within the past 2 weeks (27.9%)

Substance Used (within last 30

days)

Actual Use Perceived Use

Alcohol 63.7% (62.9%) 94.3% (97.1%)

Marijuana 14.0% (9.8%) 78.2% (88.9%)

All Other Drugs 13.6% (12.9%) 76.6% (87.9%)

CORE SurveyDeveloped by the Department of EducationPublished by the CORE Institute University Southern IllinoisMeasures alcohol and drug usage attitudes,

related events and perceptions of studentsCompleted online

CORE Survey Forms

CORE Alcohol and Drug Survey-Long Form (Core Survey)

Survey of Students’ Perceptions of Campus Alcohol and other Drug Norms (Norms Survey)

2004 Both Surveys Special Question n=640

“ I feel comfortable in situations where alcohol is consumed.”

Always – 20.9%

Often- 37.4%

Sometimes- 24.8%

Rarely- 11.3%

Never- 5.8 %

Norm Survey: Alcohol Use

General Student

Perceived Norm

Binge Drinking 54%

Average Drinks 5.8

Consumed

Abstinence from 17.8%alcohol

Actual Norm

38%

3.2

17.3%

Norm Survey:Attitude Toward Alcohol

Response Options:a. Drinking is never a good thing to do b. Drinking is all right but a person should not get

drunkc. Occasionally getting drunk is OK as long as it does

not interfere with academics or other responsibilities

d. Occasionally getting drunk is OK even if it does interfere with academics or responsibilities

e. Frequently getting drunk is OK if that’s what the individual wants to do.

Norm Survey:Attitude Toward Alcohol

Response Options:a. Drinking is never a good thing to do (.3%)b. Drinking is all right but a person should not get

drunk (5.0%)c. Occasionally getting drunk is OK as long as it

does not interfere with academics or other responsibilities (52.1% - median)

d. Occasionally getting drunk is OK even if it does interfere with academics or responsibilities (20.5%)

e. Frequently getting drunk is OK if that’s what the individual wants to do (22.1%)

Student Perceptions of Alcohol Use

77.2% breaks the Ice75.6 % enhances social

activity74.4% gives people

something to do68.7% gives people

something to talk about62.3% allows people to

have more fun61.8% facilitates a

connection with peers59.1% facilitates male

bonding

53.9% facilitates sexual opportunities

48.4 % facilitates female bonding

27.7% makes women sexier

17.8% makes men sexier17.5% makes me sexier

2001 2004 2008 Reference Group

Consumed alcohol in past year

85% 81% 83% 84%

Consumed alcohol in past 30 days

72% 69% 64% 72%

Under age consumed in past 30 days

68% 65% 54% 68%

Binge drinking in previous 2 weeks

36% 38% 37% 47%

Average # drinks a week

3.6 3.2 4 5.8

Driven Under the influence

31% 18% 27% 26%

FGCU CORE Survey Comparison

2008 CORE SurveyIllegal Drug Use (2004 Comparisons)

Marijuana 28.7 % used in past year (30.6%) 14.8% used this past 30 days (17.5 %) 11.4% used illegal drug other than marijuana

in past year (16.0%) 4.2% used illegal drug other than marijuana

in past 30 days (5.3%)

Student Health Services (SHS)Location: Wellness Center

Hours: **8:30am – 5:30pm Mon.-Thurs**9:00am-4:30pm Fri

**Hours subject to change per semester

Phone: 590-7966

Appointments are strongly recommendedwalk-ins accepted

Health Center Services All Services are Free and ConfidentialSHS uses EMRProvide Routine Medical CareGeneral PhysicalsHealth EducationWomen’s HealthVaccinationsBirth Control/MedicationsHIV Orasure TestingAfter Hours Service through NURSE RESPONSESupplies e.g. band-aids, crutches, condoms)

Student Health Services Rendered (last year/outside of routine care)

Nearly 50% of FGCU students use SHSFlu Shots-2602Women’s Exams- 214STD Tests-529

TOP Five Diagnostic Reasons Students Seek Health Services

Upper Respiratory InfectionContraceptive ManagementReproductive Health IssuesDermatological IssuesGenital/Urinary Issues12,449 student visits in 2009

Student Health Services Staff and InsuranceStaffed by:

Medical Doctors Nurse Practitioners Registered Nurses

Voluntary Student Health Insurance through Academic Health Plans (not needed to receive health center services and available for year or semester)

Under age students need parent approval (forms available)

Parent TipsIf your student is sick, tell them to go to the health center

first (its free, accessible and good first response)If they are told to take pain relievers, drink fluids, and get

plenty of rest, tell them that is a good thingRemind them about Nurse Response for non-service

hoursRemind them there are cost recovery charges for tests

and medicationsRemind daughters to keep up with female health examsAsk them if they are keeping up with sleep and dietary

needs (remind them there are free nutritionist services)

2009-10 Student Survey of Health Services

* 77% agreed the Student Health Center is their usual source of care and/ or primary care provider while enrolled at FGCU

* 85% was satisfied with the ease of scheduling an appointment that meets their needs

* 89% was satisfied with the efficiency of the check-in and check-out process

* 91% was satisfied that the provider listened carefully to their concerns

* 94% was satisfied that their confidentiality and privacy were carefully protected

* 83% was satisfied with their overall visit at Student Health Services

* 84% agreed they are very likely to recommend the health service to another student

Prevention and Wellness Services (PWS)

Health Education ProgrammingMYSTUDENTBODY (online for all students and

parents)Alcohol and Drug EducationPeers Care (Student group)Health Fair and Guest Speaker ServicesPrevention Extension (Gazebo)Graduate Student AssistantshipsNutritionist CareMassage Therapy

Prevention and Wellness ProgramsMen’s mental health (emotional issues)Cookies, cokes and conversation series (housing 6 weeks series)Weight loss myths (healthy weight loss)Walking Wednesday (noon time walk for all)Social hosting (for Greeks)Health Fair (all campus event)3Cs of Stress (stress management)Sexual Jeopardy (sexual health)  What’s in your lunch? (nutrition)  McDreamy or McNightmare? (relationships)  Party Smart (alcohol)  Fitness-tips-to-go (physical health)  Free 10 minute massages (stress relief)Total number of programs=322 Participants=6940

Counseling and Psychological Services (CAPS)

Located: Second Floor Howard Hall

Hours 8:00 – 6:00 Mon.-Thurs.8:00 - 5:00 Friday

Phone: 590-7950

Provides 24 hour Emergency Services

CAPS ServicesPersonal Counseling & TherapyCareer CounselingPsychiatric ServicesConsultationReferralCase ManagementEmergency On-call (24/7 availability)Outreach ProgramsAssessment Services (neuropsych testing for LD/ADHD)Website http://studentservices.fgcu.edu/Counseling/

(mental health screening and other electronic resources)

Top 8 Reasons Students Come to CAPS (2008-2010)

1. Anxiety2. Stress3. Depression4. Self Esteem5. Relationship6. Academic7. Dating/Marriage8. Family

5,626 Sessions in 2009

The National Survey of Counseling Center Directors (NSCCD) of 2009

Conducted since 1981Data provided by administrative heads of

college and university counseling centers in the United States & Canada

Designed to stay abreast of current trends in counseling centers

NSCCD 2009 Survey HighlightsThe 302 centers surveyed represent 2.6 million

students who are eligible for counseling services at their institutions.

6.1% of centers charge for personal counseling, down from a peak of 17.2% in 1996. Only 1.7% of centers collect third party payments.

10.4% of enrolled students sought counseling in the past year. This represents approximately 270,000 students from the surveyed schools.

The ratio of counselors to students in 1 to 1,527.The average number of counseling sessions for all

students is 6.2 sessions per client.61% of the surveyed directors have access to on-

campus psychiatric consultation.

2009 NSCCD Findings93.4% of directors report that the recent trend toward

greater number of students with severe psychological problems continues to be true on their campuses.

Directors report that 48.4% of their clients have severe psychological problems. 7.4% of these have impairment, so serious, that they cannot remain in school or can only do so with extensive psychological/psychiatric help

40.9% experience severe problems but can be treated successfully with available treatment modalities.

60.6% increased the amount of time training faculty and others to respond in a helpful way to students in trouble and to make appropriate referrals.

53% expanded external referral networks.

2009 NSCCD Findings continued48.7 % provide psycho-educational assistance on

center websites.47.4% increased training for staff in working with

difficult cases.28.5% increased counseling center staff.260 centers hospitalized an average of 8.5

students per school (2,200 students in all) for psychological reasons. The average number of hospitalizations per 1,000 students was 1.5.

73% of directors describe their centers as primarily a mental health/psychological services center.

2009 NSCCD Findings continued

Directors reported 103 suicides in the past year.95.5% of centers maintain the right to refuse treatment to a student whose problems appear to be beyond the capability of the center to handle. However, 46% of responding directors report that they would not deny service in such cases if the student refused an outside referral and demands to be seen at the center.

87% contribute to freshman orientation programs

An article written by Twenge, J. M., Gentile, B., DeWall, C. N., Ma, D., Lacefield, K., &

Schurtz, D. R.

and published in Clinical Psychology Review, 30, 145-154 (2010).

Birth Cohort Increases in Psychopathology Among Young Americans, 1938-2007:

A Cross-temporal Meta-analysis of the MMPI

Purpose of the study:

Use quantitative research with a large sample size to explore 2 important questions:

Is mental illness on the rise in emerging adults?

What model might best explain such a rise in mental illness?

Meta-Analysis What is a meta-analysis?

A research method that combines the results of several studies to address related research hypotheses.

This meta-analysis used mean scores that are reported as T-scores on the MMPI measures.

This meta-analysis looked at data from the MMPI, MMPI-2, and MMPI-A for the years 1938 through 2007 (1951-2002 for the MMPI-A).

In total, this study included 117 samples of 63, 706 college students and 14 samples of 13,870 high school students.

High school students were included to confirm data found in college populations and attempt to rule out population changes in college samples.

While the study may have included students who were seen at counseling centers, to be included in the meta-analysis, a study had to report means for all students, not those chosen for high/low scores, being current clients, or otherwise indicating maladjustment.

What is the MMPI (MMPI-2, MMPI-A)?The MMPI is a widely used personality inventory that is

designed to assess individual personality structure and psychopathology.

It was first published in 1943 and was originally developed to aid psychologists and psychiatrists assign appropriate diagnostic labels.

One of the most commonly used personality tests in the United States.

Items were chosen because they differentiated “normals” from clinical groups.

The MMPI was revised and updated norms were calculated for the MMPI-2, published in 1989.

The current meta-analysis looked at data in reference to 8 clinical scales, 2 non-clinical scales, and 3 validity scales:

Scale 1(Hs): persistent preoccupation with the body and fears of illness and disease.

Scale 2(D): poor morale, lack of hope for the future, general dissatisfaction with one’s life situation.

Scale 3(Hy): disruption in mental, or other, functionality

Scale 4(Pd): delinquent behavior, sexual promiscuity, excessive drinking, etc.

Scale 6(Pa): feeling of persecution, suspiciousness, grandiose self-concepts, etc.

Scale 7(Pt): excessive doubts, compulsions, obsessions, unreasonable fears.

Scale 8(Sc): bizarre thoughts or experiences, misinterpretations of reality.

Scale 9(Ma): overly elevated mood, accelerated speech, irritability, etc.

Scale 5(Mf): sexual identity development.

Scale 0(Si): tendency to withdraw from social contacts and responsibilities.

L Scale(Lie Scale): used to detect attempt to present oneself in unfavorable light, malingering.

F Scale(Infrequency): used to detect deviant or atypical ways of responding, such as not reading items or random responding.

K Scale(Correction Scale): measures tendency to obscure symptoms, faking good or faking bad.

Hypotheses and ModelsThe authors believed they might find

increases in psychopathology based on findings of previous research.

If those increases were indeed found, the authors wanted to test three potential explanatory models:

The extrinsic versus intrinsic goals model The economic cycles model The response bias model (psychopathology is more

socially acceptable)

Results *Keep in mind a mean of 50 and a SD of 10 for the MMPI; 2 or more

SD above the mean is considered clinically significant.*

MMPI clinical scale scores rose steadily between 1938 and 2007 – US college students scored more than a SD higher on the F scale, Pd, Pa, Sc, and Ma scales.

US college students score more than ¾ of a SD higher on Hy, D, and Pt scales.

US college students scores .45 of a SD higher on Hs.In 1938, 1 – 5% of students scored above a 70 on the

clinical scales (this represents a significantly elevated score, 2 SD above the mean)…by 2007, 40% scored above 70 on Ma, 33% on Sc, 28% on Pd, 19% on Pt, 19% on F, 18% on Pa, 10% on Hy, 8% on D, & 6% on Hs.

These results were confirmed in the high school sample.

In plain language:(Ma) – more students are characterized by

unrealistically positive self-appraisal, overactivity, and low self-control.

(Sc) – more students feel isolated and misunderstood.(Pa) – more students may be described as sensitive

and sentimental.(Pd) – more students are narcissistic, self-centered,

and antisocial or do not follow the rules and standards of society.

General symptoms of anxiety are on the rise.(D, Hs, Hy, & Pt) – more students report worry,

sadness, and dissatisfaction, and may express these through physical symptoms.

(F) – more students are predicted to experience moodiness, restlessness, dissatisfaction, and instability.

Which model best fits the data?The extrinsic versus intrinsic model -- linear increase in

MMPI scores…each successive generation showed an increase.

This suggests that a shift in American culture toward materialism, individualism, unrealistic expectations, and unstable relationships may account for the increase in psychopathology in young people.

-Young American’s focus on extrinsic goals is increasing. -Developing a meaningful philosophy of life is less important.-Divorce is indirectly impacting our young people.

“At the very least, college campuses now have a larger percentage of students with more serious mental health problems”

Suicide Facts in the General Population

In America 30,000 die from suicide Every day 80 Americans take their own livesEvery day 1,500 Americans attempt suicide 11th Leading cause of death3rd Leading cause of death among 15 – 24

year old group

Center for Disease Control and Prevention (CDC)Developed National Violent Death Reporting System

(NVDRS)Over 50,000 violent deaths in the US annuallyStarted out with 7 states (up to 18 this year)First data from 2003Majority (56.6%) of deaths were suicide (latest data

from 2007 and 16 states)Followed by homicides at 28%Most frequent method was firearmsOccurred at higher rate among males, native

Americans, non-Hispanic whites and persons ages 45-54

College Student Suicide Facts

Suicide is the 2nd Leading Cause of Death for College Students

According to JED Foundation and NMHA over 1,000 College Students Die Each Year from Suicide

Rate of Suicide is 7.5/100,000 Students

Do’s and Don’ts

DO:Stay in touch; encourage; be realistic; allow space

DON’T:Panic; tell them what to do; take over and assume Responsibility; insist on frequent visits or phone

calls; press your child on what they will do after school

Remember the Developmental IssuesFor Parents:1.Competence-trusting your student2.Redefining yourself-role change from caretaker to

mentor3.Separation-mange your anxiety4.Intimacy-staying close without being over involvedFor Students:1.Achieving confidence and identity2.Separation and independence3.Managing emotions and achieving intimacy

Parent Tips (developing the supportive partnership)If your student has had psychological issues that

required counseling/therapy and/or psychiatric medication, refer them to CAPS from the start

Find out if going to college is fulfilling their goals. Are they happy?(monitor don’t over react)

Ask about what they are discovering in terms of a career (it is OK to change)

Ask about how their relationships are going.Ask them how they are eating and sleeping

(seriously!).Ask about the pressure and stress they are feeling.

Try to help them see through it and be supportive

Parent Tips (cont’d)Suggest they go to the CAPS website and take

whatever screening they think is relevant to how they feel.

Normalize the idea of seeking help let them know it is not a sign of weakness

Suggest they go see a counselor or therapist in CAPS. They can come just once to consult with a CAPS professional to see what we think or might suggest.

Tell them you understand college students drink, but that you would hope that it does not interfere in their academic or social life or put them or their friends at risk (explain what you mean)

When should I be concerned about my student’s mental and emotional health?Social WithdrawalMarked change in appearance, self care, hygieneExcessive self criticismTearful calls outnumber the othersTalk of hopelessness Loss of motivationExcessive fatigue or lethargic moodExtreme increases in energy, rapid speech and thoughts Inability to think and concentrate, dramatic change in

gradesReferences to self harm or suicide

2006-10 Student Survey of CAPS Counseling Services96% agreed they were comfortable using CAPS services,

would use them again and would refer others to CAPS92% agreed that their counselor honestly cared about them86% agreed they were better able to understand

themselves88% agreed they were able to better deal with their

concerns/problems86% agreed counseling had a positive effect on their

overall campus experience **64% agreed that counseling made them better able to focus

on academic and study requirements62% agreed that counseling made it possible for them to

continue as a student at FGCU**