College Mental Health: A Different Diagnosis

By Annie Robinson, October 14, 2009

Icarus Project\'s Spring \'09 Creative Release event.

Student struggles with college mental health services are leading to some important changes.

Upon entering Yale as a graduate student in fall 2006, Alicia turned to the counseling center "to seek help for a variety of issues." The psychiatrist immediately put her on Zyprexa and, despite a brief period of relief, things soon went further downhill. Side-effects of the meds made her lethargic, overweight and tremulous. Subsequently, creative writing became impossible and she did poorly in school. Maintaining friendships also became difficult.

Alicia sought further help from the school's mental health staff, only to receive the distinct feeling that she should be ashamed of her thoughts. "They never explained anything to me," she recollects. "[They just] repeatedly suggested I should go to the hospital," despite her strong disinclination to do so.

Student mental health is a hot topic, but also a confusing one. The broader psychiatric framework often equates "psychic difference" (a term used by some mental health activists to describe a mental/emotional/spiritual experience and distinguish it from a medical diagnosis) or emotional distress with "mental illness."

Getting to the root of what constitutes student wellness is not easy, especially when taking into account the variance in services among colleges or universities. Most schools offer some kind of mental health services, ranging from a few professional counselors to a 24-hour hotline to opportunities for group therapy.

But students across the country are making their voices heard, drawing attention to campus mental health services that are inadequate, under-funded or harmful. In her presentation on college mental health at the 2006 National Association for Rights Protection and Advocacy conference (NARPA), Karen Bower, an attorney with the Bazelon Center for Mental Health Law, stated that colleges are a "climate of unmet mental health needs."

So what do students want?

Those interviewed for this story said they wanted better access to qualified counselors, peer support groups and the creation of safe spaces for students to openly discuss problems they are dealing with.

College mental health counselors also agree that there is much room for change. While the International Association of Counseling Services (IACS) recommends a counselor to student ratio of 1 to 1,000-1,500, the average ratio is 1 to 1,698. A 2008 National Survey of Counseling Center Directors (PDF) conducted by IACS found that one third of college mental health directors believe that psychiatric consultation is "woefully inadequate or non-existent on their campuses."

Low Priority

School health providers are supposed to act in the best interests of the student. But who it is that gets to define these "best interests" is a subject for debate among students and counseling staff.

According to Bower, these trickier, more complex questions (involving clinical judgment and treatment options) concern how emotional, social and psychological experiences are increasingly classified in medicalized and even criminalized language. As she stated at the NARPA conference, this language of "illnesses,' disorders,' 'endangering behaviors' and 'violations' only perpetuates students' problems."

Students interviewed for this story reported that mental health seems like a low priority on campus. Alexa at New York's Westchester Community College notes, "Mental health seems to be something that people really keep to themselves." She describes her community college's scarce resources as consisting of one social worker and a two-by-three inch bulletin board in the upstairs of the student center. "I only realized it was there while waiting for three hours in the hallway to register for classes."

Access to services -- such as individual and group therapy, consultation and referrals, support groups, medication monitoring and crisis hotlines -- varies from school to school. However, most college campuses would benefit from improvement and expansion of their mental health facilities and services. Students are generally granted a few free counseling sessions, but due to increasing financial restrictions, the number of sessions can be scant -- as few as five visits per student.

Another hurdle can be the difficulty in getting to a center. For example, at New York's Pace University, the center is on one of their three remote campuses and thus largely inaccessible to students without cars. Another common stigma that prevents students from seeking help is shame. For Rose at Oberlin College in Ohio, admitting to a friend that you've gone to the counseling center was a sensitive, almost taboo topic. "Even amongst my closest friends, any discussion of depression, bipolar or eating disorders is taboo or made into a joke."

What Is Available?

Even when students do pursue school counseling services, they do not necessarily receive useful help. Typically, school health centers offer short-term counseling and referrals to outside mental health professionals, and some provide call-in hotlines. College counseling staff across the country note shortages and burnout, and point to financial constraints (PDF) limiting on-campus services.

As more students arrive at college already having been diagnosed and/or prescribed medications, school services are becoming more centered around the campus pharmacy, and psychopharmacological management. Adub, a junior at the University of Idaho, notices his health center is "quick to prescribe medication without completely understanding the individuals case and without offering [or] suggesting alternatives to medication."

Leighton C. Whitaker, PhD, author of Pharmacological Treatment of College Students with Psychological Problems, identifies "promiscuous prescribing" as a growing trend at colleges. According to the 2008 National Survey of Counseling Center Directors (PDF), 93 percent of directors believe there is an increase in the number of students arriving at colleges already on psychiatric medication. An increase of 17 percent from 1994 to 2008 means that 26 percent of college students are now being prescribed psychiatric medication.

Nic, a junior at a private university in Connecticut, describes how bringing problems to school counseling centers can exacerbate students' issues instead of resolving them. At first, she was overextended and suicidal. Nic's session with the psychologist was unproductive and she left with no concrete advice, plans or resources.

"I indulged my will to self-destruct through risky behaviors, which led to our second meeting -- I had been assaulted and was requesting a medical leave [of absence]." With a trace of skepticism, the psychologist signed her release form and offered no resources.

Adub was told she needed long-term therapy, which her school could not provide. With mental health not widely discussed on her campus, and no options proffered from her encounters with the counseling center, she recalls downward spirals that led her into very dark places. "I ended up feeling really isolated on campus, and have since met others that experienced something similar."

Students in stressful emotional situations may request a medical leave of absence (either by their own initiation or mandated by the school), or a scaling back of their course load. However, reducing academic commitments is not always possible, especially at rigorous schools like Oberlin where, according to junior Rose, students are "encouraged to overextend themselves."

Discouraging Options

New York University experienced a spate of suicides, starting in 2003. This made mental health a hot topic on campus. According to former and current NYU students, suicide, depression and related matters became widely but quietly discussed. Suicide is still a highly sensitive issue for NYU's administration who are likely concerned with the institution's legal liabilities.

"The result has been more of an overbearing concern about self-harm than a nuanced discussion of preventative steps and resources," observes Sam, a senior at NYU. She describes how on any visit to the student health center, whether it's related to emotional and mental well-being or not, students are asked if they've been feeling "'down, depressed, or unhappy' lately." According to Sam, students are frequently mandated to fill out a 'questionnaire' rating their happiness, apathy, energy, eating, self-injurious and suicidal levels on a one-to-five scale.

Sam and others who have undergone this inquisition describe the care as reductive, ineffective and sterile. Sam says, "It seems focused on determining how much of a liability one is to the institution." Students interviewed for this story say they would prefer safe, non-institutional spaces with unbiased information and open discussion where they can express their distress without fearing being sent to the hospital, punitive measures or expulsion.

At the 2006 NARPA conference, Bower described how such "wrong-headed" responses from schools can have the effect of increasing the risk of suicide, creating additional stress, stifling students' disclosure of their struggles and fundamentally sending students the message that "something [is] wrong with you, that you did something wrong, that you're not good enough, you're a failure, that you don't belong here."

Campus mental health professionals Dr. Lloyd Sederer, medical director at the New York State Office of Mental Health and adjunct professor at Columbia University's School of Public Health, and Dr. Henry Chung, executive director of NYU's Student Health Center, admit frustration with the fact that "the way a school defines an emergency is all over the map." They even seem to recognize the problem with framing students' experiences in medical terminology, as when Dr. Sederer acknowledged in an interview with Brian Lehrer: "There is a difference between an illness and an adjustment."

Healthier Alternatives

While, overall, the medical model rules at college mental health programs, a growing number of students are demanding a change. They are employing recovery-model, peer-support alternatives and developing them in their own imaginative ways. Mutual support can consist of individuals forming social clubs, advocacy or activist meetings, or support groups to collaboratively explore what kinds of approaches, activities and interactions they find most helpful and sustaining.

Such alternatives allow students to sidestep some of the most damaging aspects of the "disease model" (also known as the biomedical model), the dominant perspective in contemporary culture that alleges biological variables and chemical imbalances exclusively determine one's mental health. There are actually a variety of alternative models that can be employed and in peer-based settings these other ways of seeing oneself and one's experiences can feel more accessible and acceptable to many students. They enable participants to counter the issues of public silence, shame and isolation intrinsic to traditional medical model services.

One alternative is Campus Icarus, the student-led initiative of the radical mental health collective The Icarus Project. (Full disclosure: the author is currently a collective coordinator with The Icarus Project and was previously a student organizer with Campus Icarus at NYU). Campus Icarus -- organized entirely by students, for students -- endeavors to provide a supplement to existing campus mental health services through peer-support, educational, arts, activist and community-building events. It has been referred to as a meta-therapy: A therapy for therapy, and one for "ill" campuses.

Groups like Campus Icarus spark dialogue about definitions, about valuing and playing around with labels. They intend to create a safe space in which students can connect with peers around too-often taboo issues. Participants are simultaneously supportive, supported and aligned whilst respectful, mindful and appreciative of everyone's unique experience.

Students at University of Idaho started a Campus Icarus group this fall. One student organizer describes the campus atmosphere as unique, especially for Idaho, with many people open to supporting the group. "I feel like The Icarus Project on campus is an important link that bridges the gap between students that may be dealing with or even interested in mental health/wellness issues."

In addition to Campus Icarus, other groups and initiatives are committed to changing how student mental health is supported and perceived. Organizations like Mad Students Society based in Canada and MindFreedom International's Youth Campaign offer support and solidarity.

"Maybe we would all care a little more and get ourselves a little more motivated if we had a place where we could really start to try to realize how much all of us have to offer the world," remarks Alexa. "We can start to see things in each other that we had too difficult a time recognizing in ourselves."

Annie Robinson is the Education/Outreach Coordinator for The Icarus Project, and currently lives in Manhattan. She graduated this year from NYU's Gallatin School of Individualized Study, where she designed a concentration incorporating narrative theory, philosophies and politics of health, creative therapies, and social activism. Robinson is also a labor doula, supporting and empowering women throughout their birth experience.