Psychiatrist Focuses Attention on Often Overlooked Group

During her rotation at CMU, Serrato counseled students as a PGY-3 resident. She worked with students who sought psychiatric treatment for a host of reasons, such as issues related to mood, suicidal ideation, self-injury, anxiety, posttraumatic stress disorder, panic disorder, eating disorders, and drug and alcohol use disorders.

At CMU, Serrato encountered a number of students who were highly motivated and had great expectations of themselves, but who often faltered under significant academic pressure, she said.

Serrato met with students for one-hour sessions and provided psychodynamic psychotherapy and medication management. She valued her experience treating CMU students, she said, because it was an opportunity to hone her psychotherapy skills and spend significant amounts of time with the students, helping them deal with mental health issues that may have been impeding their academic performance.

Serrato spent her PGY-4 at the University of Wisconsin Hospital and Clinics, where she worked at the university's Counseling and Consultation Services. For part of that time, she evaluated students with eating disorders and made treatment recommendations for them in conjunction with a treatment team. She also worked in the general psychopharmacology clinic.

During a year of fellowship in child and adolescent psychiatry at the University of Wisconsin, Serrato said she “enhanced her understanding of human development and its pertinence to treating a college-aged population,” and became more familiar with the role that stressors play in young adulthood and how they interfere with normal processes of identity development and interpersonal relationships. It was at the University of Wisconsin that Serrato learned about a unique opportunity—the chance to become a fellow in college mental health.

According to experts interviewed for this article, there are only a few academic centers that offer fellowships in college mental health—one is based in the Department of Psychiatry at Ohio State University (OSU) and the other is at the University of Chicago. Yale University's Department of Psychiatry also offers a fellowship in college mental health in some years, and during others arranges for PGY-3 and PGY-4 residents to rotate through its campus Mental Health and Counseling Center.

Serrato joined OSU's Counseling and Consultation Service's yearlong psychiatry fellowship in 2006. There, she assessed and treated OSU students on a full-time basis.

Serrato spent up to 60 percent of her time providing psychotherapy and medications to students during 30-minute sessions and was supervised by three psychiatrists employed by the counseling center, she said.

Throughout the training, Serrato participated in various didactic seminars and a weekly case conference with other mental health trainees, she said. She also participated in the Clinical Services Committee, where she learned about the administrative issues handled by counseling-center staff and worked as a psychiatric consultant to general medical providers in OSU's student health services.

Before accepting a position at the counseling center at the University of Illinois at Chicago, Serrato worked at Florida Gulf Coast University Counseling and Psychological Services with another psychiatrist.

She noted that she saw most students there for psychiatric treatment once every two to three weeks and then at decreasing frequency depending on the progress of their treatment. Each student who received psychiatric treatment was required to meet with a therapist for individualized psychotherapy.

Part of her work at student counseling centers entails collaborating closely with center therapists to engage students in their treatment plans and ensure follow-up care. She also maintains communication with clinicians working with students who seek treatment for nonpsychiatric medical problems.

“Students may have comorbid medical problems that are affected by psychiatric treatment,” she explained.

In some cases, students need to access treatment off campus, so Serrato maintains contact with clinicians in the community. Examples of specialized treatment include drug and alcohol programs, inpatient or partial hospitalization programs, or intensive outpatient services. She added that when students receiving treatment graduate or move out of the area, she contacts the counseling centers in the area where the students relocate to get the names of psychiatrists and mental health professionals to whom they can be referred for any necessary follow-up care.

Serrato emphasized the importance of specialized training in college mental health for a variety of reasons, including the unique issues that affect students on U.S. campuses, including academic, social, and career-oriented challenges. She cited the value of training in the assessment of suicide, eating disorders, and substance abuse as especially valuable in the treatment of college students.

Serrato noted that college campuses are composed of students from diverse racial and ethnic backgrounds, and each student may differ in the way he or she responds to medications for this reason.

Cultural beliefs also affect the way students communicate emotional distress and perceive treatment, she noted. Therefore, “training experiences that teach effective communication and awareness of cultural issues” need to be a focus of treatment.

She also noted that specialized training is likely to provide psychiatry residents or fellows with an interdisciplinary team experience they may not find in other settings.

“Psychiatrists working in counseling centers may be under the directorship of a psychologist,” Serrato said, which could be a difficult adjustment for some to make. “It has been my experience that we learn from one another in these instances, and such professional liaisons require mutual understanding, respect, and acceptance of differing treatment perspectives.”

One of Serrato's goals is to work with other psychiatrists to define a common mission in terms of college mental health as a field.

“I'd like to strengthen our identity so we can become a stronger voice in advocating for the needs of our students—this can happen only if we expand on opportunities for psychiatry trainees to receive specialized training in college mental health,” she said. ▪