Midway through Blake’s senior year of college, everything fell apart. He stopped hanging out with his friends, got into arguments with his girlfriend, and lost a lot of weight, because he often forgot to eat. He drank a lot, though—sometimes 10 or 15 drinks a night, enough to make him black out on more than one occasion. He was still doing well in his classes, staying on track to graduate with an A average, but nothing else seemed to be going right. And increasingly, he thought about escaping his problems by taking his own life.
Situations like Blake’s have become far too common on college campuses across the nation, according to Jerald Kay, M.D., professor and chair of the Boonshoft School of Medicine’s Department of Psychiatry. While suicide among college students remains rare, the incidence of depression and other significant mental health issues is on the rise.
In 2008, a survey of more than 80,000 students by the American College Health Association found that within the previous year, more than 90 percent had felt overwhelmed or exhausted, 63 percent felt hopeless, and 45 percent experienced depression so severe it was difficult for them to function.
In addition to depression, college students may seek help with making the transition to a new location or way of life, the loss of an important relationship, problems with alcohol or other drug use, or experiences with sexual assault or other forms of violence or trauma. In addition, most psychiatric disorders, including schizophrenia and personality, anxiety, panic, bipolar, and eating disorders, tend to manifest in a patient’s late teens or early 20s.
Mental health issues among college students are also growing more severe. A 2008 survey by the American College Counseling Association (ACCA), which included nearly 300 college counseling center directors serving more than 3.4 million students, found that 95 percent reported seeing patients with more serious problems than in previous years.
“The need for college mental health services is extraordinarily high,” Kay confirmed. “We’re seeing not only a large number of students who are seeking services for the first time, but also a lot of students who matriculate with a fairly significant mental health history.”
A guide to college mental health services
Kay’s insights into college mental health are based on more than his years of experience working directly with patients like Blake. He also oversees psychiatric services provided by his faculty and residents for Wright State undergraduate, graduate, and medical students, as well as students at the University of Dayton. More recently, he learned a great deal about the prevalence of mental health issues among college students nationwide, as well as the range of services available to help them, in developing a groundbreaking new textbook, Mental Health Care in the College Community published by John R. Wiley and Sons.
In addition to writing multiple chapters, Kay co-edited the book with Victor Schwartz, dean of students at Yeshiva University and clinical associate professor of psychiatry at Albert Einstein College of Medicine in New York. The book also includes chapters by authors from universities around the country, including Harvard, Yale, Duke, MIT, Cornell, University of Michigan, Wright State University, and Columbia, as well as Cambridge University in the United Kingdom and organizations such as the Bazelon Center for Mental Health Law and the Jed Foundation, a nonprofit organization devoted to preventing suicide among college students and improving student mental health care.
Kay realized the need for this kind of book several years ago when he accepted an appointment to the American Psychiatric Association’s committee on college mental health, for which he ultimately served as chairperson. To complement his firsthand experience, he looked for a wide-ranging, introductory guide to college mental health and found nothing to meet his needs.
“There wasn’t a comprehensive overview to the field,” Kay said, “nor did I find anything that was really good for graduate students in clinical fields such as psychiatry, social work, psychology, counseling, and perhaps nursing.”
Raising awareness, reducing stigma
In addition to serving students, practitioners, and educators in various clinical fields, Kay hopes the new book will raise awareness among students, faculty, administrators, government leaders, and members of the college and surrounding communities. Despite a growing need for student mental health services, many colleges and universities devote minimal resources to providing them. In fact, according to the 2008 ACCA survey, only 60 percent of campuses provide access to any form of psychiatric care, and such care is often quite limited.
In contrast, Kay and many of his co-authors advocate for an integrated, multidisciplinary approach to college health and wellness services.
“It must be a campus community effort,” Kay said, pointing out that even the title of the book reflects this emphasis. “One of the things the book advocates for is an approach that more closely approximates the community mental health center model, including a public health philosophy, where there are clinicians from many disciplines—psychiatry, social work, psychology, nursing, counseling, and even case managers” to coordinate services for students with the greatest need.
At Wright State, Kay has worked with Robert Rando, Ph.D., associate professor of psychology and director of Counseling and Wellness Services (CWS), to make psychiatric services available for students. Kay feels that under Dr. Rando’s leadership, the CWS has become a more comprehensive asset to the Wright State community. The counseling center offers consultations with a faculty psychiatrist or with senior resident physicians in the medical school’s Psychiatric Residency Program.
Even on campuses where a broad range of mental health services is available, students and faculty may not be aware of them. Students also may hesitate to seek help due to concerns about how their fellow students will react, or even a fear that they will be asked to leave school.
Education and outreach are essential, Kay explained, “to destigmatize mental health services so students feel that it’s okay to ask for help.”
“A new lease on life”
Kay strongly believes college mental health can be as rewarding—for both patients and care providers—as it is essential. Whether students seek help for issues that have been diagnosed previously or for a new problem, the benefits of psychiatric help are often both immediate and profound.
“There are many normal developmental forces in young adults that make it a great time for brief kinds of treatments,” Kay said. “By and large, students are resilient and reasonably bright. Many are often quite introspective, and they’re great patients to work with. You can utilize interventions in ways that are very gratifying for the students and their families, as well as for the clinicians.”
In addition, Kay insisted, “Institutions of higher education have fiduciary responsibility to care for their students. That is a part of the university mission, to improve the students’ experience and help them learn, and if anything is interfering with their learning, and their developing as young people, we need to be able to help them with it.”
Kay practiced this philosophy in working with Blake, the senior who experienced dramatic behavior changes. Along with prescribing medication, Kay met with Blake for a series of psychotherapy sessions to uncover some of the reasons for his depression. He found that Blake’s crisis, like many experienced by college students, was rooted in vulnerabilities from much earlier in life. Kay is a nationally recognized advocate for integrating psychotherapy and psychopharmacology and a proponent of psychotherapy in psychiatric education and training.
From a young age, Blake, an only child without nearby extended family, had watched his parents struggle with serious medical conditions. He was able to stay in close contact and help them during college, but with graduation looming, he was torn between his desire to attend law school in another state and his guilt at leaving home. He feared his parents’ health would continue to decline in his absence, and that they would resent his departure. With no way to resolve this conflict, he had become paralyzed and increasingly self-destructive.
Kay was able to help Blake come to terms with these issues and discuss both his goals and fears with his parents. With their encouragement and reassurance, he was able to graduate, enroll in the prestigious law school he had dreamed of attending, and do exceptionally well.
“Without therapy, he would have continued to be depressed, was on his way to serious alcoholism, and could have taken his own life” Kay said.
Being able to make a difference for a person like Blake is what Kay finds profoundly rewarding about working in college mental health, and it permits him to use his skills as a general psychiatrist, child and adolescent psychiatrist, and psychoanalyst.
“These are young people with their entire adulthood ahead of them,” he said, “and if you make the right intervention, you can give them a new lease on life.”
He is passionate about training a cadre of young psychiatrists who will someday work in college mental health.
Visit the Counseling and Wellness Services website at www.wright-counseling.com for more information on student mental health services available at Wright State University.