Mental Health Issues and the University Student

Epilogue. Student Emotional Well-Being: Looking toward the Future

Upon learning where I work, a first-year medical student recently told me, with some surprise, that at her Ivy League undergraduate school, one in five students supposedly used counseling services. She evidently considered this remarkably high. I asked whether it would it surprise her to learn that the majority of students had used the health center. Of course not, she said. I pointed out that just as “physical” health problems exist on a continuum, from the common cold to isolated injuries, such as a broken bone, to heart disease to cancer, so mental health difficulties encompass everything from adjusting to a new school in a new country to the grief of a broken heart to schizophrenia. She admitted that she, as both a student and a future health care provider, is still unintentionally stigmatizing mental health, and that the dichotomy between mind and body persists. But she rapidly recognized the issue and noted that her medical school does focus more on student well-being, including emotional well-being, and that she intends to learn to do that too. Although the growth in numbers of students seeking mental health services during college and grad school may alarm university administrators from a resource management perspective, it presents wonderful opportunities. Emerging adults bring to college many of the problems they’ve grown up with—the lingering effects of domestic violence, combat, or other traumatic experiences; Epilogue Student Emotional Well-Being Looking toward the Future 218  Mental Health Issues and the University Student the drinking habits or inattention to health that they’ve seen modeled at home or among their peers; and the tendencies to put extreme pressure on themselves in some areas while neglecting self-care or relationships. They bring their genetic vulnerabilities and complicated family dynamics. But they also bring great resilience and an eagerness to learn, and even the most depressed and seemingly hopeless among them step onto campus with some degree of hope that they are entering a new and better phase of life. They are at a crossroad . Their time on campus is a perfect window of opportunity to intervene and potentially change the course of their lives. Clearly, the most effective interventions for this population are slightly different in some cases, and quite different in others, from ones we might employ with other populations and from those most psychiatrists learn during psychiatric residency. The most effective clinicians understand the emerging adult developmental framework, are familiar with generational trends, and strive to continually update their understanding of the multiple identities and diversity of backgrounds that students bring to school. Psychiatrists have much to offer emerging adult students, but not if we’re narrowly focused on psychopharmacology or can’t engage in sensitive, empathic, collaborative treatment planning. The most meaningful work will incorporate psychotherapeutic principles and techniques, many of which can be fit into either a brief framework or one of intermittent treatment. The isolation faced by psychiatrists who worked with students as recently as 20 years ago is diminishing. Although many university counseling centers are still psychiatrically understaffed, there are trends toward growth. Some universities are starting new comprehensive counseling centers with plans to include psychiatric staffing. Others, such as Ohio State University, are offering psychiatric fellowship training in college mental health. The American Psychiatric Association recently re-established a College Mental Health Caucus. The University of Michigan hosts an annual “Depression on College Campuses” conference. And the National Network of Depression Centers formed a College Mental Health Task Force that is working toward facilitating research in this population as well as attempting to identify best practices. New digital forums allow unprecedented communication among college psychiatrists, and we are raising questions, sharing best practices, and encouraging collaborations that will all improve the quality of the care we provide. Colleges are systematizing their referral networks, creating relationships with psychiatrists and other therapists in the communities around them who have Epilogue  219 experience and expertise treating emerging adults. Because of the range of issues students bring to us, best care will always involve an interdisciplinary approach, where psychiatrists, psychologists, social workers, and nurse practitioners collaborate and support one another, both on campus and off. Healthcare is undergoing tremendous change, and mental health care in particular has become fragmented and often difficult to access across the United States. This can be particularly true for students who need mental health services . Attending productively to the mental health needs of this...