Strains on College Mental-health Centers

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Tragic events this past week in Arizona, involving Jared Lee Loughner, have once again brought to public awareness the question of treatment for seriously disturbed people who live in our midst, and in particular the issues concerning what to do when one of them is a college student and his or her behavior is a concern to others. In the New York Times last month, a story on the college mental health center at the New York State University at Stony Brook highlights the daily functioning and many issues faced by college counseling centers. Many students at college experience severe psychiatric issues. They are away from home and may have stopped treatment with an earlier mental-health provider, and may be reluctant to seek mental-health attention within the confines of the college itself.

What goes on in a college mental-health center? The article in the Times shows how staff activities may include not only mental-health sessions but activities such as checking out an ominous Facebook posting, following up on concerns expressed by friends when a student takes a large quantity of a prescription drug, or referring and even accompanying a student who may be suicidal to the emergency room. One reason there my be more severe mental-health issues to handle in college counseling centers may be because of the effectiveness of modern psychiatric drugs: allowing persons who would not have been able to attend college the ability to do so when taking medication.
The counseling center at Stony Brook staffs 29 professionals including psychiatrists, clinical psychologists, and social workers:

“Stony Brook is typical of American colleges and universities these days, where national surveys show that nearly half of the students who visit counseling centers are coping with serious mental illness, more than double the rate a decade ago. More students take psychiatric medication, and there are more emergencies requiring immediate action.

““It’s so different from how people might stereotype the concept of college counseling, or back in the ’70s students coming in with existential crises: who am I?” said Dr. Hwang, whose staff of 29 includes psychiatrists, clinical psychologists and social workers. “Now they’re bringing in life stories involving extensive trauma, a history of serious mental illness, eating disorders, self-injury, alcohol and other drug use.”

“Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting.

“There is also greater awareness of traumas scarcely recognized a generation ago and a willingness to seek help for those problems, including bulimia, self-cutting and childhood sexual abuse.

“The need to help this troubled population has forced campus mental health centers — whose staffs, on average, have not grown in proportion to student enrollment in 15 years — to take extraordinary measures to make do. Some have hospital-style triage units to rank the acuity of students who cross their thresholds. Others have waiting lists for treatment — sometimes weeks long — and limit the number of therapy sessions.

“Some centers have time only to “treat students for a crisis, bandaging them up and sending them out,” said Denise Hayes, the president of the Association for University and College Counseling Center Directors and the director of counseling at the Claremont Colleges in California.

““It’s very stressful for the counselors,” she said. “It doesn’t feel like why you got into college counseling.”

“A recent survey by the American College Counseling Association found that a majority of students seek help for normal post-adolescent trouble like romantic heartbreak and identity crises. But 44 percent in counseling have severe psychological disorders, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent a decade ago.

“The most common disorders today: depression, anxiety, suicidal thoughts, alcohol abuse, attention disorders, self-injury and eating disorders.

“Stony Brook, an academically demanding branch of the State University of New York (its admission rate is 40 percent), faces the mental health challenges typical of a big public university. It has 9,500 resident students and 15,000 who commute from off-campus. The highly diverse student body includes many who are the first in their families to attend college and carry intense pressure to succeed, often in engineering or the sciences. A Black Women and Trauma therapy group last semester included participants from Africa, suffering post-traumatic stress disorder from violence in their youth.”

In the days and months ahead, there is almost certainly going to be a great deal of analysis and discussion concerning the role of college counseling centers and severe-emotionally disturbed children who come to their attention.

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