1	College Student Mental Health: A Blueprint for Action Laurie Davidson, M.A. Center for College Health and Safety Morton M. Silverman, M.D. Suicide Prevention Resource Center Education Development Center, Inc./ Jed Foundation Partnership
2	Agenda What do we know about problems and solutions? Scope of the problem Prevalence Blueprint for action: A comprehensive, collaborative approach Assess, plan, evaluate
3	Synthesis and Dissemination Project Literature review Best practices solicitation Framework publication Training, technical assistance, conference presentations
4	Literature Review Scope of the problem Correlates (tend to focus on individual) Programs and practices at all levels Interpersonal Institutional Community State, federal, private organization policy
5	Scope of the Problem Prevalence data National State Multi-campus studies Single campus studies Other
6	National College Health Risk Behavior Survey 10.3% thought seriously about suicide 1.5% attempted Students 18-24 (11.4%) more likely than older students (8.3%) to have seriously considered Black students were more likely than white students (3.4% vs. 1.0%) to have attempted
7	National College Health Survey -- ACHA Felt so depressed it was difficult to function 49% females 40% males 10% seriously considered suicide 1.4% attempted suicide
8	National College Health Survey -- ACHA 14.9% received diagnosis of depression 35.8% in last school year 38% taking medication 25.2% in treatment 15.4% report effects on academic performance
9	National College Health Survey -- ACHA 10.9% got enough sleep 0 days 57.4% got enough sleep 0-3 days Sleep difficulties hinder academic performance
10	National College Health Survey -- ACHA Effects on academic performance Stress (32.2%) Sleep difficulties (24.6%) Relationship difficulties (15.9%) Depression (15.4%) Internet/computer games (13.4%) ADD (6.3%) Eating disorders (1.5%)
11	National Survey on Drug Use and Health 4.1% of undergraduates have co-occurring disorder 2.99% of graduate students
12	Harvard College Alcohol Study 4.8% reported poor mental health/depression More likely to be female, nonwhite, and from low SES families More likely to report drinking to get drunk More likely to report drinking related harm
13	Research Consortium of Counseling & Psychological Services in Higher Education 2002 Non-Clinical Sample Study 4.6% presently receiving psychological counseling 27.3% received some time in past 6.1% taking medication 11.8% took medication in the past 8.1% treated for physical and mental disability Females reported significantly more distress than males
14	Surveys of Counseling Center Directors Stone et al 1999 Adjustment, anxiety, mood disorders most likely to be treated 41% of CCs had no formal follow-up procedures “Brief” therapy format typical
15	Surveys of Counseling Center Directors Gallagher et al 2003 81.4% report seeing more students with serious problems 9.8% of students sought counseling assistance 40.7% of clients have severe problems 2,136 students hospitalized 160 suicides
16	State Surveys Washington 45% felt so depressed/difficult to function 31.6% report past year dx of depression 18.4% of those in therapy 37% on medication 8.4% considered suicide 9.3% got enough sleep 0 days 66.8% females at healthy weight; 61% want to lose weight Utah 6.2% depressed 18.8% males/27.5% females need treatment Relationship to academic achievement
17	Multi-campus Studies Depression 53% vs. 81% 10+ years ago Suicide Overall student suicide rate of 7.5/100,000 Older students at greatest risk No differences in terms of selectivity, competitiveness, or prestige of school
18	Multi-campus Studies Eating disorders NCAA athletes ADHD symptoms 2.9% of U.S. men, 3.9% of women Psychiatric disabilities 30% to 100% increases in students served
19	Single-campus Studies Disordered eating 17% of women found to have eating disorders 94% of women prefer an ideal weight < current 20% of men displayed eating disorders or disordered eating Ethnic differences High school to college
20	Single-campus Studies Gambling 2.9% in “pathological” range 18% of men and 4% of women reported gambling to lead to problem gambling 42% gambled in last year, 2.6% weekly “Drinking to cope” 42.3% reported using alcohol to cope
21	Single-campus Studies Sleep 11.5% report symptoms of DSPS 70% reporting some type of sleep difficulty on a regular basis 15% with poor sleep quality
22	Single-campus Studies Student help-seeking attitudes Compared to general public, students better understand mental health, but… More reluctant to consult professionals, except for specific problems Illegal drug use for ADD 17% of men, 11% of women 44% knew someone
23	Single-campus Studies Counseling center estimates No change in specific composite concerns ‘89 - ‘95 No change in general distress levels ‘86 - ’91 Increases in prevalence of more complex, and severe problems Third-party involvement, self-reported urgency, and current meds usage predicted severity
24	Other Indicators High school to college 17% males, 21% females entering college disturbed 5-7% of college students obtain help for MH problems Canadian data 30% of undergraduates suffered from elevated psychological distress Prescriptions SSRI’s most frequently prescribed class of drug - 11.3%
25	Student Health Insurance Claims % of Total Services Two Years (4/1/99 – 3/31/01) (N=1,069,000) 191,000 Students/5,200 Dependents Neurotic Disorders = 7.5 Normal Pregnancy = 6.4 Adjustment Reaction = 3.71 Affective Psychoses = 3.3 Unspecified Disorder of Joint = 3.0 Special Investigations and Exams = 2.9 Unspecified Disorder of Back = 2.9 Symptoms of Abdomen and Pelvis = 2.6 PSYCHIATRIC DISORDERS = 14.5%
26	What should campuses do?
27	Assumptions Problem is one of the entire campus and community Include prevention and treatment Effective prevention is comprehensive Addresses multiple contributors At both individual and environmental levels Using multiple initiatives
28	Public Health Approach: Social Ecological Framework Intrapersonal Interpersonal Institution Community Society/public policy
29	Three Levels of Risk Community/campus/environmental Clinical/student services Administrative/policy/procedural
30	Community Level Risk Factors When self-injurious behaviors and warning signs go: undetected unheeded When protective factors go: unrecognized unsupported
31	Clinical Level Risk Factors When thoughts, behaviors, and warning signs are not: identified responded to diagnostically managed acutely monitored over time
32	Administrative Level Risk Factors When there is inadequate attention being paid to: patterns of distress and dysfunction reactions to campus events crisis management policies and procedures medical leave policies academic counseling/tutoring programs transitions
33	Prevention and Treatment
34	Prevention and Treatment
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36	Comprehensive Approach Screening Crisis management Educational programs Mental health services Social marketing Means restriction Life skills development Social network promotion
37	Screening Identify high-risk and potentially high-risk students Provide landscape of mental health on campus Proactively work (programs, treatment) with identified students
38	Crisis Management Establish policies and implement programs (including medical leave and re-entry) that respond to suicide attempts and high-risk behavior Respond with comprehensive post-vention program Create interface between disciplinary process and counseling/MHS
39	Educational Programs Train gatekeepers and students to: identify signs of individuals in distress take the steps that get them help Train personnel on confidentiality, notification, and legal issues
40	Mental Health Services Train MHS providers to identify and treat depression, threats of suicide, and other emotional disorders Refer cases as appropriate Institute procedures (e.g., intake form) Enhance accessibility of MHS Engage in prevention & outreach activities
41	Social Marketing Stimulate campus-wide cultural change that de-stigmatizes mental health, removes barriers, and encourages help-seeking behavior Target both high-risk students and general campus community
42	Means Restriction Limit access to potentially lethal means
43	Life Skills Development Improve students’ management of the rigors of college life Equip students with tools to recognize and manage triggers and stressors
44	Social Network Promotion Reduce student isolation and promote feeling of belonging Encourage the development of smaller groups within the larger campus community
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48	Step 1: Problem Analysis/Needs Assessment Incidence/prevalence, risk and protective factors What are the range of emotional disorders present on a particular college campus? What is the mental health profile of the first-year class? Who are the students at-risk for suicide? Internal/external surveys What do students think about the offerings of the counseling service on their campus? How do the offerings of the college counseling center compare to those of peer institutions (e.g., number of FTE, range of services offered, etc.)? Assess campus and community resources and assets
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50	Step 2: Design a Program Organize a task force to look at the market research findings Determine areas of weakness Prioritize Allocate resources Assess campus and community readiness for prevention Ensure coordination and communication across various departments and organizations on campus
51	Step 3: Implement & Evaluate Implement programs to address risks, enhance protection, and fill gaps Monitor data to evaluate Policy Funding Program development
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54	EDC/Jed Foundation Partnership David Litts, SPRC dlitts@edc.org www.sprc.org