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Column: Cracking the Stigma Barrier at College

To learn more and to help build a supportive community in Alexandria, come to an In Our Own Voice presentation by Peter and Lauren, two young adults who experienced the signs and symptoms of mental health conditions as college students. This free community event is co-sponsored by the National Alliance on Mental Illness (NAMI) of Northern Virginia, Friends of the Alexandria Mental Health Center, The Alexandria Community Services Board and the Partnership for a Healthier Alexandria's Anti-Stigma HOPE Campaign. It will be held on Tuesday, March 19 at 7 p.m. At the Lyceum, 201 S. Washington Street, Alexandria. For more information, contact Friendsofamhe@gma...

In Our Own Voice is a public education program developed by NAMI in which two trained speakers share compelling personal stories about living with mental illness and achieving recovery. These presentations foster understanding among individuals, families and community members while providing an opportunity for those who have struggled with mental illness to gain confidence and to share their individual experiences of recovery and transformation.

The bad news confirmed by two recent studies is that mental illnesses, including severe mental illness, are more common among college students than they were at the turn of this century. The good news is that there are more such students, because they have been identified earlier, helped earlier and not barred from pursuing an education. Those who succeed in getting degrees and finding and keeping professional jobs are rarely noticed or written about. Those who fail are also not noticed unless murder or suicide is involved.

Their success depends on two things, the quality of help offered by the college and the attitude of staff and fellow students toward mental illness. Stigma still remains the largest barrier, so bad in some places that students do not reveal their illnesses to anyone, fearful that it will go on their record and that their records will not be kept confidential. Just as earlier generations of students with ailments like diabetes or epilepsy kept it secret, so too these students struggle alone.

In 2010, a study was discussed at the national convention of the American Psychological Association in San Diego. The study was done by John C. Guthman and Laura Iocin, both PhDs from Hofstra University in Hempstead, N.Y. on Long Island and Despina D. Konstas, PhD of Hellenic American University in Athens, Greece. The study looked at the records of 3,526 college students who accessed college counseling support between September 1997 and August 2009 at a mid-sized private university. Students, both graduates and undergraduates, were screened for mental disorders, suicidal thoughts and self-injurious behavior. In 1998, 93 percent of students coming into the clinic were diagnosed with one mental disorder. In 2009, the percentage rose to 96 percent. Most were diagnosed with mood and anxiety disorders as well as adjustment disorders or problems associated with significant impairment in functioning. There were no significant age or class differences.

Guthman noted that the percentage of students with moderate to severe depression has gone up from 36 to 41 percent and that this change may contribute greatly to the misperception that the average student is in distress. He said when presenting the paper that more students were coming to college with pre-existing mental health difficulties and that the number of students on psychiatric medicines increased more than 10 percentage points. In 1998 11 percent of those in the clinical sample used psychiatric medications, mostly for depression and ADHD. By 2009, 24 percent of those attending counseling reported using medications.

Sign Up for Mental Health First Aid

In early May a new class called Mental Health First Aid for Youth will be offered in Alexandria. It will provide eight hours of specific training for individuals who work with youth 12 to 18 years of age. The regular 12- hour Mental Health First Aid classes for March and April are nearly filled but more classes for citizens will be offered in May. Contact Donielle.Marshall... for information and to sign up.

Since many serious mental illnesses begin in adolescence, both high schools and colleges need to be offering services to the students and education to their staff. According to findyouthinfo.gov, a U.S. government website, 8.1 percent of youth age 12 to 17 and 8.7 percent of adults between the ages of 18 and 25 had at least one depressive episode. At least six percent of 12 to 17 years olds and 5.4 percent of 18 to 25 years olds had at least one major depressive episode with severe impairment. Suicide is the third leading cause of death for youth between the ages of 10 and 24, resulting in 4,513 deaths in 2008.

The most frequently diagnosed disorders for young people are substance abuse disorders, anxiety disorders, depressive disorders and attention deficit hyperactivity disorder (ADHD).

The most important voices in all of this are those of the students themselves and the National Alliance on Mental Illness (NAMI) conducted a national survey in 2011 of college students living with mental health conditions to hear directly from them about whether their needs were being met and how schools needed to improve.

They too verified that colleges throughout the United States reported large increases in the prevalence and severity of mental health conditions experienced by students attending their schools. In many ways this is progress for those with serious mental health conditions can now achieve academic success and hopefully employment and financial independence.

Students from 48 states responded. Thirty seven percent were between 18 and 22, 26 percent between 23 and 27, 15 percent between 28 and 32 and the rest 33 and older. Most (82 percent) were white, most female (82 percent) and most straight (78 percent.) The types of illnesses varied with 27 percent reporting depression, 24 percent bi-polar disorder, 11 percent anxiety, six percent schizophrenia, 6 percent PTSD, five percent ADHD. Another 12 percent were classified as other which included borderline personality disorder, eating disorders, autism spectrum disorder, obsessive-compulsive disorder, schizoaffective disorder and dysthymia.

As for status, 59 percent were attending four-years private or public colleges, 19 percent, community colleges and the rest online, technical or specialty schools.

When those who had dropped out were asked if they were no longer attending college because of a mental health related reason, 64 percent said yes. One student commented “A depressive episode made it impossible for me to go to classes and I did not get help until it was too late and I was withdrawn and I could never afford the cost to go back because I lost my scholarship for being withdrawn.” Losing financial aid and scholarships was a frequent reason for why students dropped out, and didn't return, particularly if they were not allowed to change to part time status. According to the survey, more than 45 percent of those who stopped attending college did not receive accommodations and 50 percent did not access mental health services and supports even if they were available.

One of the biggest reasons for not seeking help or accommodations was the fear that their information would become part of a permanent record and reviewed negatively. They also worried that it would change how students, faculty and staff perceived them and did not believe their medical information would remain confidential. Fifty percent of those with mental health conditions did not disclose them. One of the most interesting facts teased out was the perception by students that stigma ran high in mental health degree programs.

The students surveyed noted that while college websites provided a great deal of information, information about mental health services was hard to find and often the students themselves did not realize that disability resource centers, present on most campuses, were there to serve those with mental illnesses and disabilities as well as physical. Better communication, peer support and adequately trained mental health providers were what those who were dissatisfied sought. Those who found services good, praised the coordination of services, the qualifications and caring attitude of staff and supportive fellow students and faculty.

One college newspaper, the Whitman College Pioneer, published the results of their own survey earlier this year, a survey that mirrored national surveys on the issue of mental health and attitudes toward mental illness. More students are coming to college with mental illness diagnoses, their estimate was one in four of those at Whitman that took the survey. Counseling staff said more students were coming to them with more severe problems and almost all of those surveyed said they kept their feelings hidden. Those who did try to discuss their depression or self-injurious behavior with fellow students said they were often misunderstood or told to get over it or stop being negative. Again as in national studies, the most common illnesses reported were depression, anxiety, PTSD or a panic disorder.

Many colleges, particularly public ones have had to deal with shrinking budgets in recent years at the same time as the need for more health services has grown. Here in Virginia we have moved closer to improving services at public colleges by improving the links between these colleges and mental health services in the community.

One piece of legislation that passed this session, a bill by Del. Scott Surovell of Mount Vernon, would require the State Board for Community Colleges to develop a mental health referral policy that would require community colleges to designate at least one individual at each college to serve as a point of contact with an emergency services system clinician at a local community services board or another qualified mental health services provider for screenings and referrals of students who may have emergency or urgent mental health needs. Northern Virginia Community College, one of the largest in the country with eight campuses and 78,000 students already had an understanding with local community service boards signed about four years ago.

Mike Gilmore, executive director of the Alexandria Community Services Board, noted that “The five Community Services Board executive directors in Northern Virginia (Alexandria, Arlington, Fairfax, Loudoun and Prince William) recently renewed our memorandum of understanding with Northern Virginia Community College that addresses much of the intent of this legislation. We welcome the opportunity to strengthen this agreement and extend it to George Mason University and other four year colleges in the area. Mental illness often becomes apparent at the age when many young people are in college so it is important for community providers to do all we can to develop strong ties to colleges.”

Another pair of bills by state Sen. Chap Petersen and Del. Timothy Hugo also passed. These would affect four-year public colleges. The legislation provides that the governing board of each public college may establish written memoranda of understanding with its local community services board or behavioral health authority and with local hospitals and other local mental health facilities in order to expand the scope of services available to students seeking treatment. The bill requires each memorandum to designate a contact person to be notified when a student is involuntarily committed or when a student is discharged from a facility and consents to such notification. The bill also require each memorandum to include the institution in the post-discharge planning of a student who has been committed and intends to return to campus, to the extent allowable under state and federal privacy laws.

These laws when signed by the governor should strengthen the communication between community services and colleges, particularly emergency services. While it won't change student or staff attitudes, it will provide one more layer of services for students who at the same time are working to learn and working to recover from illness.