Transcript Mental Health and the Campus Setting Terri L. White, MSW Commissioner Oklahoma Department of Mental Health and Substance Abuse Services.

Mental Health
and the Campus Setting
Terri L. White, MSW
Commissioner
Oklahoma Department of Mental Health
and Substance Abuse Services
Higher education students and their families increasingly look to college
and universities to provide mental health and behavioral health services
for their students, thus leading to a growing demand for supportive
services on college campuses. Tragic events such the Virginia Tech
shooting underscore the necessity to address the significant increase in
the mental health needs of this population. Understanding the best
practices for behavioral health services in colleges and universities is a
crucial step in establishing the necessary comprehensive campus-wide
approach to address the multifaceted needs of college and university
students.
The college experience is not isolated to the classroom; therefore, colleges
and universities are called upon to shift and expand their priorities to
address the behavioral health needs of a diverse student population.
2
 Both mental illness and addiction are real medical
conditions, just like diabetes, cardiovascular disease and
heart disease.
 In terms of addiction, although initial substance use
might be voluntary, drugs of abuse have been shown to
alter gene expression and brain circuitry, which in turn
affect human behavior. Once addiction develops, these
brain changes interfere with an individual’s ability to
make voluntary decisions, leading
to compulsive substance abuse,
seeking and use. (Natl. Institute on Drug Abuse)
3
The brain scan on the left reflects normal activity; the scan
on the right shows a person affected with schizophrenia.
Source: PBS.org
4
5
In March, SAMHSA released a national report showing Oklahoma ranks second
nationally in prevalence rates of both “serious” mental illness and “any” mental
illness among adults over age 18. This represents more than 630,000 adults, and
doesn’t include children and those with substance abuse issues.
6
 In Oklahoma, mental disorders are the third leading cause of chronic
disease – behind only pulmonary conditions and hypertension – and
more prevalent than heart disease, diabetes, cancer and stroke.
 More than 245,000 Oklahomans above the age of 12 abuse or are
dependent on alcohol or illicit drugs; and underage drinkers consume
just over 20% of all alcohol sold in Oklahoma.
 10% of youth have a mental illness; an additional 10% have substance
abuse issues.
 Deaths due to suicide are increasing, jumping from 567 in 2009 to 618
in 2010. Oklahoma ranks 13th nationally in terms of suicide rate.
 Between 1-3% of all Oklahomans are problem or compulsive
gamblers and in need of intervention.
 In 2010, Oklahoma had the 4th-highest unintentional overdose death
rate in the nation (17.9 deaths per 100,000 population).
7
 In 2010, 618 Oklahomans died by suicide, up from 567 in 2009.
 Oklahoma ranks 13th nationally in terms of suicide rate.
 Suicide continues to be the most common manner of violent death in
Oklahoma.
 For ages 15-34, suicide is the
second leading cause of
death in Oklahoma.
the
 Suicide rates in rural counties
are generally higher than rates
in urban counties. The rate
increased 10% in rural counties
and 7% in urban counties from
2004-2009.
Oklahoma Violent Death Reporting System, 2004-2010
8
Mental, emotional, and behavioral (MEB) disorders are a major health threat
and are as commonplace today among young people as a fractured limb – not
inevitable, but not at all unusual.
 One in five young people have one or more MEB disorders at any given time.
 Half of all mental illnesses occur by age 14 and 75% by age 24.
 Clear windows of opportunity are
available to prevent MEB disorders and
related problems before they occur.
Risk factors are well established,
preventive interventions are available,
and the first symptoms typically
precede a disorder by two to four
years.
9
 20% of college students experience a mental illness, and increasing numbers of
students arrive on campus having received mental health services prior to
starting their college careers. (Suicide Prevention Resource Center)
 More than 50% of college students experienced "overwhelming anxiety" at some
point in the past year, 32% reported feeling "so depressed that it was difficult to
function", and 8% reported seriously considering suicide. (American College
Health Association, 2013)
 In addition, alcohol and substance abuse are major issues on college campuses.
Half of all full-time college students binge drink, abuse prescription drugs and/or
illegal drugs, and almost 1 in 4 of the nation’s college students (22.9%) meet the
medical criteria for substance abuse or dependence. (The National Center on
Addiction and Substance Abuse at Columbia University)
 Of the approximately 20% of students who had been diagnosed or treated for a
mental health or substance use condition in the past year, the most common
conditions were depression, anxiety, panic attacks and ADHD. (ACHA, 2011)
10
Prevention Recommendations:
Mental Health Training
School-Based Prevention/Screening
 Mental health is not well understood by the general public or even
among certain professionals who interact with populations at risk.
 The vast majority of people with a mental illness are NOT violent.
Serious mental illness contributes very little to the overall rate of
violence in the general population; an estimated 3-5% - much lower
than that associated with substance abuse. (In fact, people with no
mental disorder who abuse alcohol or drugs are nearly seven times
as likely as those without substance abuse to commit violent acts.)
 Better identification of mental health risk factors or warning signs
prior to or at the first onset of first symptoms can aid in averting the
development or escalation of more serious illness or problems.
 Primary care providers and school personnel must be trained on this
essential information.
8
Mental Health First Aid
 MHFA is an evidence-based training program that trains school personnel to
recognize signs of mental illness and substance use within the student
population so they can intervene early to prevent a crisis or act to de-escalate
a crisis once one develops. Course participants gain the skills, resources and
knowledge necessary to help an individual in crisis connect with appropriate
professional, peer, social, and self-help care. ODMHSAS recently launched a
pilot project making an eight-hour training available for K-12 teachers,
administrators and staff at school districts across the state upon their request.
 It is now available to Oklahoma colleges and universities upon request.
 MHFA provides an ideal forum to engage groups in discussing the signs and
symptoms of mental illness, the prevalence of mental health disorders, the
effectiveness of treatment and how to engage troubled young people in
services.
 For more information, call Dane Libart at (405) 522-1440.
16
 School-based screening can help prevent the
development of psychological and behavioral
problems, which interfere with school performance.
The Institute of Medicine recommends universal
screening procedures be targeted for the purpose of:
 Improving school success with struggling students
 Preventing bullying and student harassment
 Improving teacher and peer relationships
 Increasing school safety and security, or
 Learning to regulate and control behavior
14
Suicide Prevention
 ODMHSAS contracts with the State Regents to provide behavioral
health screenings on campuses, with an emphasis on suicidal ideationrelated questioning. The accord also involves increasing “Question.
Persuade. Refer.” gatekeeper trainings. Key gatekeepers include a
variety of college personnel who are in a position to recognize the
warning signs that someone may be contemplating suicide.
 ODMHSAS also will be launching the JED Healthy Campus Certification
across Oklahoma. JED is an evidence-based behavioral health/
substance abuse survey and rating similar to a healthy business
designation, which allows prospective students and families to quickly
assess what types of behavioral health and substance abuse services
will be available to them during their time at school.
http://www.jedcampus.org/learn-about-jedcampus
15
AlcoholEdu
AlcoholEdu is an evidence-based alcohol prevention program
available to all Oklahoma high schools at no cost through a
partnership between the ODMHSAS and the Oklahoma Department
of Education.
 19% of Oklahoma youth report that they had their first drink of
alcohol, other than a few sips, before the age of 13. (YRBS, 2011)
 74% of 12th graders have used alcohol. (OPNA, 2010)
AlcoholEdu has been shown to increase alcoholrelated knowledge, undermine acceptance of
underage drinking, reduce underage drinking,
and reduce riding with an intoxicated driver.
16
Screening for Depression and Suicide
Within the Primary Care Setting
 Training providers to recognize and treat depression decreases suicidal
ideation and completed suicides in patients. It is essential to screen for
suicidality if there is any suspicion that a patient might be suicidal.
 Screening tools such as the nine-item scale
of the Patient Health Questionnaire
(the PHQ-9) can be an effective and time-efficient
way to screen patients. The PHQ-9 is based directly
on the diagnostic criteria for major depressive
disorder in the Diagnostic and Statistical Manual
Fourth Edition (DSM-IV).
 These screenings can be conducted in a campus
health-clinic setting, and patients who need more extensive treatment
receive referrals to specialty care. For more information: 1-877-724-7865.
14
Brief Alcohol Screening and Intervention
for College Students (BASICS)
BASICS is a prevention program for college students who drink alcohol heavily and
have experienced, or are at risk for, alcohol-related problems. Following a harm
reduction approach, BASICS aims to motivate students to reduce alcohol use in order
to decrease the negative consequences of drinking. It is delivered over the course of
two 1-hour interviews. Based on principles of motivational interviewing, BASICS is
delivered in an empathetic, non-confrontational, nonjudgmental manner, and is
aimed at revealing the discrepancy between the student's risky drinking behavior and
his or her goals and values. The intervention is delivered by trained personnel.
Studies show that students receiving BASICS had significantly greater reductions in
drinking frequency over the first 2-year period than students in the no-treatment
control group, with the greatest impact between baseline and 6-month follow-up and
1-year follow-up. The intervention group also reported drinking significantly less
frequently at 1-year follow-up than the control group.
For more information: 1-877-724-7865.
15
Treatment Works
 The good news is this: TREATMENT WORKS!
 Mental illness and addiction can be diagnosed and effectively
treated. In some instances they are preventable.
 The sooner a mental or addictive disorder is diagnosed and
treated, the better the outcome is for all involved, just as is the
case with diabetes, cancer or heart disease when diagnosed
early.
 Success rates for heart disease treatments range from 41-52%.
The treatment success rate for schizophrenia is 60%.
 More than 80% of people with depression can be treated
successfully with medications, psychotherapy or both.
 Substance abuse treatment has similar positive outcomes if
people can access appropriate treatment and follow-up care.
19
Treatment Works
In FY13, ODMHSAS provided services to approximately 80,000
individuals. Nearly 64,000 received mental health services and 19,000
received substance abuse treatment services, with some overlap.
ODMHSAS programs have been proven to help people:
 Reunite with their families
 Increase employment prospects and monthly income
 Stay out of jail/reduce involvement with the criminal justice system
 Reduce homelessness
 Break the cycle of addiction
 Achieve numerous other successful outcomes, such as obtaining
higher educations, increasing productivity on the job, stopping
tobacco use, etc.
20
Conclusion
To be successful, any discussion about increasing school safety must
address the issue of mental health. As nearly half of all lifetime
mental illnesses start by age 14, the importance of prevention and
early intervention cannot be overstated.
Just as we screen our young people for asthma and other physical
illnesses, we also must screen them for such illnesses as depression,
anxiety or other behavioral health issues.
The sooner a mental or addictive disorder is diagnosed and treated,
the better the outcome is for all involved, just as is the case with
diabetes, cancer or heart disease when
Website:
diagnosed early.
www.odmhsas.org
Facebook:
The good news is that help and there is hope.
www.facebook.com/ODMHSAS
Twitter:
@ODMHSASINFO
21