Unpacking the Bags of Student Mental Health

Eunie Alsaker, MSSW, LICSW & Lynda Brzezinski, PhD, LP

November 8, 2012

Objectives for PresentationProvide an overview of mental health challenges

seen at universities and collegesDiscuss risk and developmental factors of college

populationProvide Collegiate Registrars and Admissions

Officers:Tools for recognizing students in distressStrategies for responding to student distress

Share ideas

Common Mental Health Concerns in the University Setting

AnxietyDepression

StressPanic Attacks

ADHD PTSD

Anorexia or BulimiaBipolar Disorder

Substance abuse or addiction

Within the last twelve months, students who report being diagnosed or treated by a professional for the following….

Anxiety 11.6%Depression 10.6%

Sleep Issues 6%Panic Attacks 5.5%

ADHD 4.6%Anorexia or Bulimia 2%Bipolar Disorder 1.5%

Substance abuse or addiction 1.1%(ACHA/NCHA, S-2012)

Within last twelve months…42.5% report a higher than average rate of stress9.7% report a tremendous rate of stress

46.5% report academics very difficult to manage34.4% report finances very difficult to manage

16.6% report the death of a family member or close friend which was difficult to handle

(ACHA/NCHA, S-2012)

Depression

10.6% current diagnosis of depression, 18% sometime in lifetime (ACHA/NCHA, S-2012)

31.6% reported “feeling so depressed it was difficult to function” at some point withinthe last year (ACHA/NCHA, S-2012)

Compared to 1988, twice as many college students now struggle with depression (Kadison & DiGeronimo, 2004)

SuicideCompared to 1988, three times as many college

students seriously considered suicide (Kadison & DiGeronimo, 2004)

7.5% of students seriously considered suicide with 1.2% attempting within last twelve months (ACHA/NCHA, S-2012)

Suicide 2nd leading cause of death among college students

(Marano, 2006)

50% of those with untreated bipolar disorder attempt suicide at least once

Substance Use35% reported at least one episode of binge

drinking within last two weeks (ACHA/NCHA, S-2012)

6.9% said alcohol or drug use negatively impacted academics (ACHA/NCHA, S-2012)

1,825 college student died in 2009 from events related to alcohol use, mostly traffic accidentsNational Institute on Alcohol Abuse and Alcoholism

Barriers to Academic Performance

Stress 30.5%Sleep Difficulties 22%Anxiety 21%Internet use/Computer games 14.2%Depression 12.8%Concern for troubled friend/

family member 11.7%Relationship Difficulties 10.9%

(ACHA/NCHA, S-2012)

Changes Seen - MedicationMental health medications hold top three spots

among all medications prescribed for college students8% of students currently taking

medication for depression (Boynton, 2010)

6% currently taking medication forother mental health issues (Boynton, 2010)

23% of counseling center clients are on psychiatric medication; up from 9% in 1994 and 20% in 2003 (National Survey of Counseling Center Directors, 2011)

SeverityStudents placed on medical leave for

psychological reasons at a midsize college or university: mean=34

Directors report: 37.4% of clients with severe psychological problems

Of these, 5.9% cannot stay in school or can do so only with extensivepsychological/psychiatric help (National Survey of Counseling Center Directors, 2011)

Why Rate Increases?

Decreased stigma

“Prozac Payoff”Better assessment and

treatmentAmerican with Disabilities Act

Millennial student pressures

Millennial Generation

ProtectedUsed to praise“I am special”Instant communicationConfident or narcissistic?High expectations of self – lofty goalsGrew up during anxious age

Twenge, 2006

Developmental Risk FactorsVulnerability of college yearsInvincibilityDevelopment of

prefrontal cortexSocial skills and

emotion-regulation skills difficulty

Past trauma and abuse

Academic ImpactPsychological distress significantly related to academic

performance (Brackney & Karabenick, 1995)Lower academic motivationIneffective use of learning strategiesLower academic performanceLower academic confidenceLess effective time managementLess effective use of study resourcesIncreased test anxietyDecreased persistence in collegeDecreased academic assistance seekingImpairment in information-processing skills (Randall & Dobson in

Kitzrow, 2003)

Academic Impact (cont.)National Comorbidity Survey Replication (Breslau, Lane,

Sampson, & Kessler, 2008)Students with impulse control disorders and substance use

disorders most likely to quit collegeStudents with panic disorder and bipolar disorder also had

increased risk of quitting collegeThree or more psychiatric diagnoses had higher rates of

quitting college

Signs of Distressed StudentsDisorganized thoughts or speech Inability to concentrate/focus on conversation or activity High levels of irritability or aggressive behaviorIntense emotion Bizarre or strange behavior inappropriate to situationExtreme difficulty making decisionsThreats of harm to self or othersStatements of hopelessness or helplessnessSudden change of mood, demeanor or hygiene Change in quality of work/repeated absences

Guidelines for Response Remember not to fear students with mental health

concerns Reduce stimulation Listen carefully Show/express concern and interest Stick to “I statements”Repeat back the essence of what student saidAvoid judgment and criticismAllow student to express emotions including anger

Guidelines for Response (cont.)Tell student you are not willing to accept abusive behavior Stick to institutional rules and guidelines Help student understand consequences of current actionsBe clear, concrete, and consistent Set boundaries around personal space Quick check-out (excuse self)Get help if necessary Involve yourself only as far as you feel comfortableFamiliarize self with campus/community resources Document the interaction

Less Helpful Responses ArguingDisputing illusionsPressing for explanations about current behaviorUse of “Why?” Looking away and not dealing with the situationPhysical response or entering their personal space Statements that could be taken as threats

Emergency Responses• Emergency situations: hostility, violence, loss of contact

with reality (e.g., seeing/hearing things that are not there), suicidal thoughts, homicidal thoughts

• Response:• Safety first!• Stay calm• Try not to leave the student alone• Walk-in/crisis hours at Counseling Services• Call Campus Security• Call 9-1-1

Know Your Resources• Counseling Services

• Walk-in /Crisis Counseling • Health Services• Disability Services• Security• Dean of Students • BAIT teams • Off-campus options • 9-1-1

Making a Referral Suggest not mandate counseling so student feels in

control Normalize and provide hope Call Counseling Services with student present and have

student make appointmentWalk student to Counseling ServicesCall to consult

“I think there is a general sense that we are seeing much sicker people in college now, we are

hospitalizing more people, and people are demanding more

attentive psychotherapy services.”(Kadison, as cited in Arehart-Treichel, 2002)

Summary Increasing rates on college campuses –

numbers and severityBe Prepared

Recognize signs of distressKnow campus resourcesKnow how to referPlan for safety

Know Your Limits

Thank you!

Eunie Alsaker, ealsaker@winona.eduLynda Brzezinski, lbrzezinski@winona.edu

Winona State UniversityCounseling and Wellness Services

507.457.5330

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from http://www.acha-ncha.org/pubs_rpts.html American College Health Association. (2012). American college health association national college

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Arehart-Treichel, J. (2002). Mental illness on rise on college campuses. Psychiatric News, 37(8). Retrieved October 15, 2007 from http://pn.psychiatryonline.org/cgi/content/full/37/6/6

Banyard, V. L., & Cantor, E. N. (2004). Adjustment to college among trauma survivors: An exploratory study of resilience [Electronic version]. Journal of College Student Development, 45(2), 207-221.

Boynton Health Services, Regents of the University of Minnesota. (2010) 2010 College Student Health Survey Report: Health and Health-Related Behaviors. Retrieved October 13, 2012 from http://www.bhs.umn.edu/surveys/index.htm

Brackney, B. E., & Karabenick, S. A. (1995). Psychopathology and academic performance: The role of motivation and learning strategies. Journal of Counseling Psychology, 42(4), 456-465.

Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research, 42, 708-716.

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from http://www.iacsinc.org/2011%20NSCCD.pdfKadison, R., & DiGeronimo, T. F. (2004). College of the overwhelmed. San Francisco: Jossey-Bass. Kitzrow, M. A. (2003). The mental health needs of today’s college students: Challenges and

recommendations. NASPA Journal, 41(1), 165-179.Marano, H.E. (2002). Lessons from college: College life sets many students adrift without the tools to

cope. Retrieved October 15, 2007, from http://psychologytoday.com/articles/pto-20030501-000006.html

Marano, H.E. (2006). Crisis on the Campus. Retrieved October 15, 2007, from http://www.psychologytoday.com/articles/pto-20030501-0005.html

Marsh, K. (2004). Emerging trends in college mental health. In G. C. Buckley (Ed.), Student Health Spectrum (pp. 3-7). Boston, MA: The Chickering Group.

National Institute on Alcohol Abuse and Alcoholism (2007). A snapshot of annual high-risk college drinking consequences. Retrieved April 17, 2008 from http://www.collegedrinkingprevention.gov/StatsSummaries/snapshot.aspx.

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Twenge, J.M. (2006). Generation Me: Why today’s young Americans are more confident, assertive, entitled – and more miserable than ever before. New York, NY: Free Press.