Transcript College of the Overwhelmed

Staying Healthy at Tufts
Student Mental Health and
Success
Richard Kadison M.D.
Chief, Mental Health Service
Harvard University Health Service
Challenges
• Reduce Stigma, Manage Stress
• Convince Universities that health and
counseling resources are wise investments
• Coordination of care between health,
counseling, residence, faculty, and
administration
• Integrating Cultural Sensitivity and
competence into our work
Current issues
• Integration of Academic Work with
student health and development
• EVERYONE on campus is responsible
for student well being.
• Coordination of care
• More serious mental health problems on
campus. Helping high risk students
Stress on Staying Healthy
• Eat, Sleep, Exercise
• Stay connected with friends/ community
• Provide tools to manage stress
• Educate community to reduce stigma thru
education about common problems and
how to recognize warning signs.
• Create multiple portals of entry to care
Staying Healthy
• Stressing Personal and professional
Development
• Service Opportunities: Engaged Learning
• Health Education and Information (MRSA)
• Alcohol and Nutrition info: (BAL + BMI)
• Complementary Services: Acupuncture,
Massage, Yoga, Mindfulness
Student Participation/ Engagement
• Key for Successful Outreach
• Peer Counseling/ Education Programs
• Student Health Advisory Group
• Wellness representatives in the dorms
• Mental Health Advocacy Group/Active
Minds
• Involve in screenings and education
Getting Care
• Multiple ways to access care
• Chaplains, Advising system, residence
system
• Information about resources and warning
signs for parents and families
• Stress relieving events and workshops at
high stress times (massage, food,
activities/ workshops)
Access to Care
• Triage system: Who needs to be seen
today
• Inside vs. Outside Care
• Community Resources
• Hospital and Medical Leave, Reentry
• When should students go home? How to
decide
• Teach Wellness: Eat, Sleep, Exercise
Lessons from Virginia Tech
• Students in distress often don’t seek or
avoid care
• When students are mandated for
“assessment”, there must be follow up and
clear consequences
• When students return from hospital care,
a careful internal review process is critical
Lessons from Virginia Tech
• Violence is very rare and difficult to predict
(prior violence best predictor)
• There must be a community effort to
reduce stigma, recognize risk factors, and
find portals to care. Educate everyone
• Counseling and Health Services can and
should provide consultation to the
community (students, faculty and staff)
Lessons from Virginia Tech
• Schools must find ways to respect medical
•
•
•
privacy, but coordinate concerns
If students can’t expect privacy, they won’t seek
care
There must be communication, sometimes one
way, between faculty, administration, family,
counseling when concerns arise about a student
FERPA and HIPAA
Youth Risk Survey 2001
13,600 HS students
• 28.3% sad or hopeless almost every
day> 2 wks stopped some activity due to
symptoms
• 19 percent of students reported that they
seriously considered attempting suicide
• 14.8 percent had made a specific plan to
attempt suicide.
• 8.8 percent had attempted suicide in the
previous year [Grunbaum et al 2002].
College Data ACHA and Kansas
State
• Depression Doubled, Suicidal Ideation
Tripled, Sexual Assaults quadrupled over
13 years
• 45% students self report depression
• 10% report serious suicidal ideation and
44% binge drink
• These are the best years of your life
ACHA College Data
• 9% seriously consider suicide 1% attempt
• Depressed 52-42% 2000/2006
• No Sexual partners 40% vs. 5% perceived
• Medication for depression 36-42%
Graduate Students
• Often at higher risk, higher suicide rates
• Economically in worse shape, many have
no insurance.
• Berkeley Graduate Student Mental Health
Survey Dec. 2004 showed similar findings
to undergrad surveys
Berkeley Grad School Survey
• 45.3% respondents experienced emotional
or stress related problem SIGNIFICANTLY
affected well being/ academic
performance
• 9.9% seriously thought about suicide
• 52% considered using counseling less
than 33% did use
• 25% unaware they were available
Learning from Each Other
• Peter Leviness undergraduate student
survey engaged students to highlight and
address campus stress U. Richmond
• Jan Collins-Eaglin 1st. Generation,
multicultural students need language for
therapy, Wayne State
• Ron Chapman Pre and post counseling
GPA changes- increased 1.0 BYU
Stories to Spread the Word
• Educate the community to reduce Stigma:
College Wide Events
• Being Depressed at HBS
• Walk the walk of the student on your
campus: illness in family, high fever,
serious alcohol problem. How do you get
help? Web?
Healthcare 2007
• BIG changes in the last decade
• Severity of Problems of students making it
to college
• Managed Care= Shorter Hospital Stays
and more alternative treatments
• Reduced outpatient community resources
• Higher insurance costs for students
Impediments to Academic Success
• Stress 32.4%
• Cold/Flu 25.6%
• Sleep Problems 24.6%
• Depression 15.3%
• Internet Use/ Games 13.4% (3-6% of
students addicted to internet
pornography; 20% are women)
Sleep Problems
• 35% of adult population experience
insomnia
• 11% of college students get a “good
night’s sleep”
• Loss of cognitive functioning, driving
• Increased risk of depression
• < 7 hours yields sleep deprivation
Common Problems
• Developmental Adjustment, Relationships
• Depression
• Anxiety
• Eating Disorders
• Bipolar Disorder
• Acute Psychosis
• Substance Abuse
High Risk Issues
• Eating Disorders
• Dual diagnosis Substance Abuse/
depression
• Bipolar Illness and Psychosis
• Reentry from Hospitalization
Eating Disorders
• Anorexia, Bulimia, EDNOS
• 1% Anorexia, 3-5% Bulimia, 15-20% DE
• 5-15% mortality from anorexia
• 1/3 of people don’t improve from serious
anorexia
Substance Abuse
• Binge Drinking- 5 or more drinks one
sitting in past 2 weeks
• 44% meet criteria in national surveys
• 41% did something they regretted
• 31 % forgot what they did
• 9.7% unprotected sex
• 17% physically injured
Substance Abuse
• Don’t stigmatize medical services.
Separate from Judicial
• BASICS: Motivational interviewing and
education shows best results with
reducing high risk drinking
• Consistent enforcement policies and
consequences for students with identified
AODS team on campus
Stimulant Abuse
• 900% increase in production of
methylphenidate (Ritalin) 1990-2000
• 3-7% school age kids ADHD
• 50% carries over into college
• 16% use recreationally by mouth,
snorting or by injection 30% share
Suicide
• Long Term Risk factors
• Prior attempts
• Feelings of hopelessness
• Suicidal plan, isolation, prior attempts
• 10% attempters die over 10 years
• 45 of 76 suicides occurred during first
week post hospitalization
Legal Issues
• Shin case settled but issues unresolved
• Virginia Tech: Refusal of care by student
• George Washington, Hunter College
student dismissals
• Allegheny College Suicide
Legal Issues
• Handbook Language for Notification/LOA
• Medical Privacy Laws very strict
• FERPA (Family Education Rights and
Privacy Act); HIPAA
• Prohibits disclosure of education records
• Permits disclosure gained through
observation
• Permits disclosure of safety emergency
Leave of Absence and Return
• Students rarely want to take time off, but
may need to
• When students return, important to review
their readiness to be back at school
internally
• Contracts and Riders
Retention
• 562 students asking for counseling followed over
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2 year period
0 sessions 65%
1-12 79% >13 83%
Several studies followed people over 5 years all
showed dramatically higher retention rates,
averaging more than 10% for students who
used counseling services
Steve Wilson, Terry Mason, Evaluating the impact of receiving university based counseling services on
student retention
Journal of Counseling Psychology 1997 vol 44. no 3 p. 316-320
Retention
• Social Isolation single most important
determinent of dropout rates
Pascarella and
Terrazini, 1979
• Emotional- Social Adjustment items
predicted attrition better than academic
items Gerdes and Mallinckrodt 1994
• 5 year study of Berkeley students and
those making use of counseling had
higher graduation rates Frank and Kirk 1975
Medication
• Polarized attitudes of students and staff
• Antidepressants: benefits and risks
(bipolar) and side effects
• Sleep Medications
• Anxiety Medications
• Stimulants: Newer preparations
• Role with disabilities and judicial issues
Medication
• Antidepressant and Stimulant Safety
Controversy
• Reduction of 20% in prescribing since
black box warning
• Most prescribed medications on college
campuses: 12% of pharmacy budget for
antidepressants
• Side Effects: Kiss of death
Multicultural Students
• Present emotional problems physically
• Metabolize medications differently
• May be more comfortable with Pastoral
Resources: follow path of least resistance
• Vulnerability in language/cultural
adjustment and symptom presentation
• Staff sensitivity to cultural beliefs
Diversity Considerations
• Create a culturally competent community
• Learn and respect different values and
cultures
• Celebrate the diversity of your community
by events that encourage sharing; art,
music, and other traditions.
• Diversity may be via culture, race,
ethnicity, sexual orientation, economics
Coordination of Care
• Handbook expectations: who gets notified
about hospitalization/ return
• Identifying high-risk students
• How is residence involved with worrisome
students?
• Eating Disordered or Substance Abusing
students in residence, what happens?
• Contracts: When to invoke them
Parents
• 70-80 % of students get their health
information from their parents
• They often feel they are supposed to let
go of students and need help staying
engaged without being intrusive
• Help “helicopter parents” teach their
students to fish and become “emerging
adults”
What Must We do?
• Engage our students in the community:
Life is richer and more satisfying for
students who are engaged in learning
• Stress Health and Wellness on campus
and create opportunities for connections
Wellness Activities
• Engage Students in community- study
breaks, hikes, encourage student groups
• Teach yoga, sleep hygiene, mindfulness,
relaxation response
• Have annual “wellness or caring events”
like this one or “maximize academic
potential, minimize stress”
• Student Wellness Reps.
Coordinating Board
• All stakeholders: Students, Financial and
Student Service Deans, Residence, Public
Safety, Ministry, Health, Counseling,
Disability
• Community wide programs for education
from top down and bottom up; set
priorities!
Coordinating Board
• Advisory to Counseling/MH
• Strategic, Realistic Planning
• Community vs. Individual needs:
Insurance
• Consider having regional meetings with
shareholders in other area schools to
share good ideas and increase leverage
with local medical/ community resources
Web Information
• Online screenings:
Mentalhealthscreening.org; ULifeline.org
• Information/education about alcohol
• Student made DVD to incoming students
• Information about resources
• Many good web resources (JED (Ulifeline),
Mystudentbody.com, Alcohol.edu)
• Launching mentalhealth.edu
Summary
• Emotional and Physical Well-Being are
crucial for Academic Success
• We all have to work together
• Focus on Staying Healthy and Learning
Healthy Lifestyles: Eat, Sleep and Exercise