Nilda E. Hernandez , Associate Professor of Social Work, The College of New Rochelle
My interest in the mental health of college students stems from my 25 years of clinical social work experience, and 15 years as faculty interacting with several students with psychological, emotional, and social problems. When these impinging conditions negatively affect students’ academic performance, it is imperative to notify student services, as well as the Dean’s office that ultimately is responsible for academic/disciplinary decisions. With the increasing number of students with academic, social, and emotional problems, the collaborative relationship between faculty, administration staff, and student services is essential to the student’s academic well-being.
The number of college students with mental disorders has increased and therefore calls into question not only their mental health, but its impact on higher education as it relates to policies that address incidences of violence, aggression, suicide, and disruptive behavior (Gately, 2005; Schaeffer, 2006). Moreover, Title II of the 1990 American with Disabilities Act and Section 504 of the 1973 Rehabilitation Act, have implications for college policies, and faculty decisions with respect to grading practices, academic/disciplinary decisions, and safety issues as higher education institutions struggle to identify and appropriately provide reasonable accommodations to students with mental disorders. Students with documented mental disorders cannot be denied admission to higher education institutions unless reasonable accommodations are not available, or the student poses a threat to self or to others (Liebert, 2003). These accommodations allow students equal opportunity to participate in all aspects of college life, but should not provide unfair advantage over other students or fundamentally alter the nature of courses (Simon, 1999). College-wide polices that address these issues are therefore dependent on the coordinated and collaborative efforts of students, faculty, administration, and student services.
From small colleges to large universities, the number of college students in distress has grown. Newspaper headlines increasingly report alarming rates of deaths due to substance abuse, homicide, murder-suicides, and suicide among college students (O’Connor, 2001; Hoover, 2003, Gately, 2005, Schaeffer, 2006). USA TODAY analyzed 620 deaths of four year college and university students from 2000 to 2005 based on published reports and public records (Davis and DeBarris, 2006). They found that freshmen accounted for more than one-third of undergraduate deaths with 40% due to suicide, and half of all deaths were due to falls from windows, balconies, and rooftops usually related to drug and alcohol abuse.
According to Arehart-Triechal (2002), the U.S. Department of Education reported increases in college related arrests due to liquor (4%), drugs (10%), and murder (45%) between 1999 and 2000. In a 2001 national survey across 300 U.S. colleges and universities, 45% directors of counseling centers reported increases in alcohol abuse, 49% other illicit drug use, 71% learning disabilities, 37% eating disorders, and in the number of students seeking counseling for sexual assault, stalking and obsessive behavior between 1991 and 2001 (O’Connor, 2001).
The National Postsecondary Student Aid Study reports that between 1995 and 1996 of the 6% of 21,000 undergraduates with disabilities, 29% reported learning disabilities (Horn and Berktold, 1999). However, between 1999 and 2000, the National College Health Assessment Survey indicates that 10.3% of 16,024 students across 28 campuses self-reported they were diagnosed with depression, and had experienced mental health problems one to ten times during the academic year (American College Health Association, 2001; Arehart-Treichel, 2002). Researchers at Kansas State University found that between 1989 and 2001 students with documented depression doubled, students on psychiatric medication increased from 10% to 25%, and suicidal students tripled (Hoover, 2003).
Findings from a sample of 47,202 students across 74 college campuses between 2003 and 2004 reveals that compared to 10.3% in the Spring 2000, 14.9% students were diagnosed with depression, 25.2% were in therapy, 38% took medication for depression, 15% suffered clinical depression, one in ten seriously contemplated suicide, and 40% males and 50% females reported they had trouble functioning throughout their four years of college (Fisher, 2004; Gately, 2005; American College Health Association, 2006). Information from the National Center for Education Statistics (Horn and Griffith, 2006), indicates that while 11.3% of 91,000 undergraduate, graduate, and first profession students enrolled in 1400 post secondary institutions from 2003 to 2004 reported health related disabilities (51.4%), 21.9% reported mental illness or depression, 10.9% attention deficit disorders, 7.4% learning disabilities, 0.4 speech disabilities, and 7.8% unidentified disabilities. Interestingly women were more likely to report mental illness, depression, and health disabilities, whereas men more often reported attention deficit disorders.
College students have difficulty adapting to college life, competing, and handling their new found freedom with minimal adult supervision. As they transition from high school to college, anxiety increases as they leave behind the support of family, friends, and familiar surroundings which may place them at risk for academic, personal, and social difficulties. Moreover, some studies suggest that adolescent drinking and suicide ideation are associated with stress (Hicks and Miller, 2006), that transitions in relationships may be related to mental health issues that develop in young adulthood, and that mood and substance disorders are linked to relationship stability and change (Overbeek, et al., 2003).
Non-traditional students encounter many of the same challenges faced by traditional aged students when they begin or return to college, and are less likely to complete their education usually due to social conditions (U.S. Department of Education, 2002). In a study of 80 adults with mental disorders they felt optimistic about being accepted by faculty and peers, but ambivalent about their emotional ability to cope with the pressures of college and possible failure (Stein, 2005).
Mental health specialists assert that the onset of mental illness often occurs during early childhood or adolescence, and may be compounded by the stress and anxiety of attending college, leaving home, developing new relationships and the pressure to succeed (Liebert, 2003; Gately, 2005). Many first incidences of mental illness occur in college. The Chief of Mental Health Service at Harvard University states that “lifetime incidence of depression is 20%, and the peak age of onset is around college age” (Arehart-Treichel, 2002). Fisher (2004) claims that clinical depression most often appears in adolescence, and mood disorders are more likely to occur in college and may be life threatening.
According to Kadison and DiGeronimo (2004) college students predominantly manifest eating and sleep disorders, depression, alcohol and drug abuse, and impulsive behaviors that include self-mutilation, sexual promiscuity, and suicide. They assert that since 1988 the number of students with depression has doubled, the number with suicidal ideation has tripled, and sexual assaults have quadrupled.
Although the aforementioned studies refer to students with documented mental disorders, but there is no data available for students who are undiagnosed or not in treatment. Untreated depression can lead to suicide, which is believed to be the second-leading cause of death among college students, claiming 1,100 lives a year (American Psychological Association, 2005; American College Health Association, 2006). Approximately 31,000 deaths in the U.S. are due to suicide each year, it is the third leading cause of death in the U.S. for people aged 15 to 24 is suicide, and it is the second leading cause of death for adolescents in Canada (Zastrow and Kirst-Ashman, 2007).
In addition to depression and anxiety, students are diagnosed with bipolar disorder, schizophrenia and psychosis that may interfere with their reality testing, impulse control, aggression, interpersonal relationships, and their overall ability to function. These disorders require close monitoring, medication, and may result in intermittent or long-term psychiatric hospitalization. Some students have a history of psychiatric hospitalization prior to entering college or may have to take leaves for psychiatric hospitalizations. The Director of Counseling at Dartmouth College Health Services states that in the past five years college counseling directors have reported a 35% increase in the number of psychiatric hospitalizations of college students (Arehart-Treichel, 2002).
The increase in the number of students with mental disorders suggests that early diagnosis and treatment may promote their stability and functioning in college. In fact some suggest that earlier diagnosis may lessen the stigma associated with mental illness, increase the likelihood that families will seek mental health resources for their children, and reinforce students’ willingness to accept help. On the other hand, it also forces colleges and universities to attempt to meet the needs of college students diagnosed with varied mental disorders (Arehart-Triechel, 2002).
Faculty are not trained to conduct mental status examinations, determine whether or not medication is required, or identify when a student is acting out or exhibiting symptoms of mental illness. Hernández and Fister (2001) suggest there is a difference between disruptive behavior that is intentional, and unintentional disruptive behavior due to mental disorders. But how does faculty know the difference? Can a student with severe and persistent mental illness become so agitated that students and faculty feel threatened? Who has responsibility for controlling these behaviors, and are faculty equipped to do so? The reality is that faculty is not and should not be in this position, but then who is? Nonetheless, regardless of whether or not faculty want to know about students’ personal lives, invariably their issues may spill over into the classroom and may be manifested in inappropriate and disruptive behaviors that may include opposition, defiance, and belligerence; disrespect for faculty and peers, falling asleep, seeming disinterest, or more dramatically in anger, aggression, suicidal gestures, or substance abuse.
Another issue to consider is what are the perceptions of administration and faculty of students with mental disorders. Some studies suggest that fears of the mentally ill by faculty and administration “are seeded in myth than in reality” (Liebert, 2003). Several studies indicate that faculty felt it was more important to view verification of learning and psychiatric disabilities, than physical and sensory disabilities. Others concluded that faculty related difficulties of students with mental disorders to their unwillingness to ask for or receive help because of the stigma of disclosing their mental health problems. In some cases faculty felt that students with mental disorders will not succeed in college, others were not uniformly positive or knowledgeable about mental illness, some faculty lacked information about the services and benefits available to students on campus, and others doubted that students had mental disorders because they did not display symptoms of the disorder (Mowbry, et al., 2005).
Higher education institutions traditionally provide counseling services to the entire student body to help them adjust and cope with the pressures of college life. Today’s counseling centers, however, must increasingly provide services to students with obsessive-compulsive, posttraumatic stress, personality, sleep and eating disorders; stress and anxiety, depression, suicidal ideation, schizophrenia, learning disabilities, sexual assault/abuse, drug and alcohol abuse, as well as relationship problems, identity issues, social phobias, and grief and loss issues (Arehart-Treichel, 2002; Kadison and DiGeronimo, 2004). In addition, students may exhibit acting out behavior in the classroom that may include chronic lateness, talking in class, arguing with instructors and peers, or more serious behavior such as stalking, inappropriate erotic attachments, or challenging authority.
Given the seriousness of the mental disorders experienced by some college students, what is the effect of the Americans with Disabilities Act and Rehabilitation Act on faculty grading practices, provision of reasonable accommodations, and implementing academic and disciplinary measures when students diagnosed with mental disorders do not fulfill their academic responsibilities, are disruptive in the classroom, or whose interpersonal skills negatively interferes with the faculty-student and/or student-student interaction?
Several obstacles and challenges are faced by students, faculty, administration, and student services. These include unclear disciplinary policies when mentally ill students are disruptive; how faculty should handle inappropriate and disruptive behavior in the classroom, faculty concern that failing a student may result in reprisal or suicide, limited services in counseling centers that makes it difficult to meet students’ mental health needs; lack of full-time credentialed mental health professionals to provide treatment, manage, and monitor medication; inadequate psychiatric coverage or overuse of hospital psychiatric emergency rooms; lack of health coverage; lack of knowledge about mental disorders; cultural values and beliefs that stigmatize mental disorders, treatment, and perceptions of mentally ill as dysfunctional, and dangerous; concern about lawsuits; and confidentiality issues that prevent disclosing mental disorders or contacting parents of students in crisis without written permission.
The millennial college student is generally considered to be have been born beginning in 1982 presumably they began their college education around 1999. They were born to baby boomers, and for the most part have had many advantages and have been raised with all the technological advances available. However, they are also the most pressured to study hard, succeed, attend college, and choose a well-paying career that reflects their success. They also seem to be the generation with the most documented learning, substance abuse, and mental health problems. Nonetheless, having a mental disorder should not prevent students from successfully completing their education. In order for mentally ill students to succeed, they must maintain good mental health which can only occur if they are in treatment. Being in treatment is important because students can seek help that reinforces a healthy mind and a healthy life.
When students experience academic difficulties because of mental disorders retention and graduation are affected. To help students with mental disorders succeed in college, higher education institutions must be aware of their needs and have the resources to provide coordinated and collaborative services. Providing comprehensive mental health services to students can help them better adjust to college life and provides the support to enable them to achieve their personal, academic and career goals.
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