Psychiatrists Can Help Growing Number of Students Who Need MH Help

This year, more than 20 million students are enrolled in colleges and universities in the United States. This population of students has grown by 5 million since 2000 and is changing in its composition, as there are more women, full-time, underrepresented minority, and international students than in the past. Student health centers are also experiencing a dramatic uptick in requests for care, especially for mental health services, as increasing numbers of students have mental health needs.

Student health centers have stretched to meet these needs and requests. Many centers now provide traditional psychiatric, psychological, and counseling services; health promotion and well-being services; addiction services; and specialized services for LGBTQ students and students who are victims of sexual violence. Leaders of colleges and universities are struggling to define practices and policies to foster health, to prevent suicide and violence on campus, to promote a safe and constructive culture, and to support positive emotional development on campus for their students. The recent controversies surrounding “safe spaces” and “trigger warnings,” strategies to lessen sexual assault and violence on campus, and policies for alcohol and marijuana use are reflective of the current and tremendously difficult challenges faced in higher education.

Over the course of my career, I have cared for undergraduate, graduate, and professional students at three academic institutions. In these contexts, I have observed firsthand the challenges that students experience when they seek health care, especially when their health needs may be stigmatizing. Students often feel vulnerable, as they may be inexperienced in accessing health services and in advocating for themselves. Too often, students are faced with a lack of sleep and a lack of social support, combined with too much stress and too much academic pressure. Students worry about grades, about debt, and about their friends’, teachers’, and parents’ expectations. Students learn and practice new relationship skills and new skills for independence. Typically, students in college, graduate school, and professional school are not only of reproductive age but also of an age when they may be at risk for the onset of mental illnesses and addiction disorders. It is not an easy path, the path of students.

Inspired by my personal experience as both a patient and medical student when my first child was born, I have performed a series of empirical projects with colleagues examining the health issues and self-care behaviors of students. My early work on medical student and resident health care demonstrated that trainees are reluctant to seek care for mental health or reproductive health needs. Not only do students struggle to find the time, money, and access to services, but medical students and residents also express concern that seeking care will jeopardize their careers, especially if it is known that they need health care for mental illness, addiction, sexual health, or relationship concerns.

More recently, Maurice Ohayon, M.D., D.Sc., Ph.D., and I presented analyses from an empirical study of more than 19,000 young adults in the United States. We documented that depressed mood, not unexpectedly, was found to be relatively common among undergraduate students. We also found that many students had lost loved ones in the prior year, which greatly influenced their sense of well-being and stress. The study also showed that depressed mood and depression were far more common among students who were working part time and going to school and among young adults who were not engaged in school or work. Young adults enrolled in school and living on campus in the dormitories experienced far less depression, according to our findings, than comparison individuals without such supports. Encouragingly, the results of the study suggested that being a student conferred protective effects for transitional age youth who might otherwise be at risk for developing mental health issues.

Psychiatrists can play an important role in improving the health of students who have chosen to pursue their education and seek a better life and future. Psychiatrists who serve as scholars, advocates, population scientists, and public opinion leaders have the opportunity to strengthen understanding of the importance of student mental health and well-being in higher education institutions across the country. Emphasizing resilience and the natural developmental tasks of young adulthood is important, as is creating evidence-based strategies for addressing mental illness, addiction-related conditions, and consequences of trauma, such as sexual assault. Psychiatrists also have the opportunity to help directly—by providing care and by volunteering as mentors for students. Psychiatrists may also assist local city and community colleges as well as prominent national universities by offering perspective, expertise, and advice on issues that are central to our professional world but may be novel or unsettling for academic leaders and administrators.

These efforts will bring better services, especially those related to mental health, to the millions of students who carry the future on their young shoulders. ■

References

National Center for Education Statistics. Fast Facts. Available here. Accessed March 9, 2018

Benton SA, Robertson JM, Tseng WC, Newton FB, Benton SL: Changes in counseling center client problems across 13 years. Professional Psychology: Research and Practice. 34:66-72, 2003

Lane-McKinley K: Creating a culture of belonging, respect, and support on campus, in Student Mental Health: A Guide for Psychiatrists, Psychologists, and Leaders Serving in Higher Education. Edited by Roberts LW. Washington, DC, American Psychiatric Association Publishing, 2018

Wilson HW, Miu AS: Response to survivors of campus sexual assault, in Student Mental Health: A Guide for Psychiatrists, Psychologists, and Leaders Serving in Higher Education. Edited by Roberts LW. Washington, DC, American Psychiatric Association Publishing, 2018

Ogbonna CI, Lembke A: Alcohol and substance use and co-occuring behaviors, in Student Mental Health: A Guide for Psychiatrists, Psychologists, and Leaders Serving in Higher Education. Edited by Roberts LW. Washington, DC, American Psychiatric Association Publishing, 2018

Roberts LW, Hardee JT, Franchini G, Stidley GA, Siegler M: Medical students as patients: a pilot study of their health needs, practices, and concerns. Acad Med. 71:1225-32, 1996

Roberts LW, Warner TD, Carter D, Frank E, Ganzini L, Lyketsos C: Caring for medical students as patients: access to services and care-seeking practices of 1,027 students at nine medical schools. Acad Med. 75:272-7, 2000

Moutier C, Cornette M, Lehrmann J, et al: When residents need health care: stigma of the patient role. Acad Psychiatry. 33:431-41, 2009

Roberts LW, Kim JP: Informal health care practices of residents: “curbside” consultation and self-diagnosis and treatment. Acad Psychiatry. 39:22-30, 2015

Ohayon MM, Roberts LW: Links between occupational activities and depressive mood in young adult populations. J Psychiatr Res. 49:10-7, 2014