Mental Health Needs and Recommendations
There has been substantial changes in the stated missions of college counseling centers all over the United States with discussions in literatures often addressing the boundaries of the counseling centers as a mental health care provider(Mowbray et al.,2006).Mental and behavioral disorders remain the primary leading causes of disability for young adults, and the majority of lifetime mental disorders have early ages of onset (Hunt & Eisenberg, 2010).
Considering the significant increased demand for mental health services on campuses in the united states and limited funding for campus mental health services,individuals have concluded that colleges in the united states might just be approaching another mental health crisis.Decades ago when counseling centers were instituted, they had a focus (e.g., providing guidance, and insight to students mental health problems), however over the years, these institutions have shifted focus to providing predominantly reparative services for minor and semi-major psychological problems(Mowbray et al.,2006).Effective and efficient mental and behavioral health frameworks on our campuses can improve the academic performance of students and accelerate their resilience/mental stamina, and their ability to handle common day to day stress.This will in turn decrease suicide rates, substance abuse, and eating disorders. Studies have shown that students with mental health disabilities continue to face barriers to accessing counseling services on campus and in receiving disability-related accommodations that are necessary to help them participate in their education on an equal footing with students without disabilities, for which many university counselors believe they do not have either the tools/ skills and training necessary to serve the population of students on campuses presenting with significant psychological or psychiatric distress. Some individuals are of the school of thought that offering treatment to students with serious mental health problems is totally unethical and unwarranted since counseling centers have insufficient funds and resources to provide adequate or proper care.It is however crucial for Colleges to develop available,effective and efficient responses to the mental health needs of the entire students on campuses. Suicideparasuicide threats and psychological emergencies demand immediate care in order to manage symptoms effectively, however, not all counseling centers offer crisis emergency appointments or after hours and weekend access to care for students.
Most counseling centers offer limited minutes to hours of sessions resulting in long waits for only short appointments. Some periods of the year when student stress is high(shortly before final examinations)are usually know to experience high turnover rate of students, resulting in longer waitlists, just when students need services most. Lack of appointments offered outside class hours can further complicate access of counseling centres to college students on campuses.. Another complication of the campus mental health system is that multiple campus offices often provide duplicative mental health or counseling services. Sometimes where psychotropic drugs, psychiatrist visits, and/or individual psychotherapy are not provided by campus agencies, students may not be able to afford the cost of treatment. This burden is often in addition to financial concerns (e.g., educational loans, personal debt), which are common in students with psychiatric disabilities (Malakpa, 1997)
A mental illness is based on having a diagnosable psychiatric disorder (based on criteria of the Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association,1994), lasting least a year, and producing an impairment significant enough to be considered disabling.Mental health professionals, college administrators, researchers, and the popular press have raised concerns about the inadequacy and inaccessibility of campus mental health services.Some of the concerns cited include lack of properly trained staff ,inconsistent use of diagnostic and assessment tools, poor referral procedures, lack of treatment planning. College students with mental illnesses need continuity of care to help manage their chronic disability and assist them in achieving their academic goals. Also, the stigma and stereotypes associated with the psychiatric disabilities make many campuses less likely to put these service issues on the forefront for funding and policy decisions.University administrators have expressed concerns that providing services for students with mental illnesses will attract large numbers of such college students.
The economic burden on counseling centers have led to the development of limits on services (e.g., maximum allowed numbers of counseling session) or the introduction of brief psychotherapy as a practice model on most campuses. Counseling centers on campuses are currently experiencing increases in waiting time before a student can initially be seen and decreases in the number of therapy sessions available. These demands limit the availability of treatment resources and place students at greater academic risk (Stone & Archer, 2006). In addition, many counseling centers do not have psychiatrists on staff, so if students need medication they are referred to community mental health agencies If counseling centers do have a psychiatrist on staff, the wait list to be evaluated tends to be 3 to 6 weeks (Collins & Mowbray, 2005). This leaves an extended amount of time for psychiatric symptoms to exacerbate during which the student falls behind in academic preparation and may be placed at risk of having to withdraw for the semester (Collins & Mowbray, 2005).
A great majority of students are insured through their parents' medical coverage. However, some students, especially students of color and the underserved population, are afraid to submit mental health service claims to their parents' insurance company because they are worried their parents will find out about the mental illness. Sometimes parents do not want mental health treatment claims on their insurance because of fears of what a record of mental illness will mean for their children's future.
Recommendations
At risk college students (i.e., adolescents with prior episodes of serious mental health problems and/or family histories of mental illness) and their families should be well-educated about early warning signs or symptoms and create awareness on campus-based mental health services and how to access them. This means that colleges should present such information in a well written format during the orientation sessions.
All faculty and staff should be knowledgeable as to the early warning signs of mental illness, especially concerning severe depression and suicide risk,schizophrenia and Mania, and about when and how to refer students to counseling services or other campus resources as well as confidentiality and legal issues.
Universities should assign to a specific component of student services on campus, such as counseling centers, responsible for providing outreach to the college campus to help students, faculty and staff identify symptoms and warning signs of psychiatric illness.
There must be easy access and “no wrong door†to entry for assessment and treatment of mental health problems. Access to mental health services should reflect a “no wrong door policy†to provide ease of entry and overcome barriers presented by prevailing attitudes toward mental illness and difficulties coping when experiencing psychiatric symptoms.
On-campus mental health services should be fully accessible to all students—. This means that:
The services should be centralized geographically, but in locations that do not publicly expose the individuals accessing these services.
Mission statements that clearly states the intention to serve student mental health needs (not just needs for personal, professional, or educational adjustment) as well as the limits to such services.
Universities should provide widespread notification of services and short written guides about services and their accessibility, which are distributed to staff, students, and faculty through multiple channels
.Directions on how to access campus mental health services for problems of any magnitude should be highly visible, for example, as a first level branch, on every university/college website.
Service hours should include regular evening and weekend hours (Bishop,1991).
Support staff who provide reception, information, or referral should receive substantial initial and ongoing training to be maximally helpful and supportive to students requesting their assistance.
Notifying parents or other responsible parties following a student's psychiatric crisis. This could be handled by getting informed consent for notifying parents of chronic, acute, life-threatening conditions that affect their students' mental or physical health.
Students accessing campus-based mental health services should be provided information, in writing, and a clear explanation of what disorders are served and for what duration. Individuals in need of urgent care should be seen no matter what their situation. Beyond the initial appointments, however, depending on university policy, individuals may need to be referred to quality providers off campus.
University practices should include referral systems to appropriate, quality mental health services external to the campus and improved communications with these providers. to assure a seamless transition and the best treatment for the student's needs. For example, an identified staff can serve a liaison function, to oversee client referrals, to see that no one “falls through the cracks,†and to assuage worries of community mental health being overrun by campus needs.
There should be an organized system of follow-up contacts to ensure that referrals were completed and that care received is satisfactory.
There needs to be procedures and mechanisms to ensure partnership between campus-based disability services and the community-based mental health agency providing longer term services.
Planning and coordination efforts with community-based mental health services should be in place to assure the availability of appropriate and needed longer term and/or specialized mental health services to the university community to meet the demands (Bishop, 1991), for example, insurance acceptance and billing procedures, policies regarding counting students as catchment area residents, coordinating funding requests to expand services, and so forth.. Schools have a responsibility—but they do not have all of the responsibility. To appropriately meet the needs of students with mental illnesses, academic institutions and mental health programs need to form collaborations, where they clearly spell out who will do what, and not shirk the necessary responsibilities or pretend that the problem does not exist.
As of today, there is no single best model for this collaboration. We believe that it would be a future herculean task for a single best model to emerge, because of the varying mental conditions and limited resources of colleges, as well as the needs and preferences of students, which vary from college to college. However, there is emerging knowledge of how to better address and serve the needs of students with mental illnesses, and that knowledge can be used to build successful models that are responsive to the specific needs of local colleges and communities.