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Campus Mental Health and Public Safety

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Title: Campus Mental Health and Public Safety


1
Campus Mental Health and Public Safety
  • Richard Kadison M.D.
  • Chief, Mental Health Service
  • Harvard University Health Service

2
Challenges
  • Reduce Stigma, Manage Stress
  • Coordination of care between health, counseling,
    residence, public safety, faculty, and
    administration
  • Integrating Cultural Sensitivity into our work (
    Police and Counseling trouble)

3
Orientation for Students and Parents
  • Should include counseling and public safety
    information
  • Normalize Common Problems (help with alcohol,
    depression)
  • Contact information and resources on Website

4
Mental Health Staffing Challenges
  • Counselors need time to provide consultation,
    education, and outreach to other campus agencies.
    Staffing is a challenge on most campuses. How
    much care for whom?
  • Coordination with student health, admin.
    Residence
  • Insurance and support for prescriptions

5
Public Safety Challenges
  • Marketing Part of team to support students, not
    the enemy
  • Fear of consequences, put into role of punitive
    parents
  • Sorting out Bad Behavior from Mental Illness (Not
    unusual to have both)
  • Consequences

6
WHY DO STUDENTS NOT SEEK HELP?
  • 320/729 (56) REPORTED NEEDING BUT NOT SEEKING
    HELP
  • 97 - negative expectations
  • 78 too busy/no time
  • 63 shame or stigma
  • 40 bizarre structure
  • 16 privacy concerns
  • 13 appointment scheduling a hassle
  • 11- too long to get an appointment
  • 11- too depressed to seek help
  • 10- inaccessible hours
  • Herbstman C07, Senior Thesis

7
Current Issues
  • Integration of Academic Work with student health
    and development
  • EVERYONE on campus is responsible for student
    well being.
  • Coordination of care Need to Know
  • More coordination with campus safety

8
Current Issues
  • Diverse Needs for diverse campuses (large vs.
    small, urban vs. rural, 1st. Generation students)
  • Drunk Can I trust the Man, Judicial vs.
    Counseling
  • Managing High Risk Students with support and
    consequences

9
DONT WORRY ALONE
  • Response to 9/11 Setting alarm off
  • Roommate of Drunk Student called HUPD to bring to
    Clinic
  • Scared Dean calls Counseling after hostile email.
    Counseling calls HUPD
  • Weird Behavior Crosses Boundary into disruption

10
Collaboration
  • Meetings with Counseling, Public Safety,
    Residence and Administration to have dialogue
    about concerns
  • Student altercation with female, assaulted campus
    police, arrested, required to withdraw. What is
    reentry process?
  • Christmas involuntary hospitalization

11
Collaboration
  • Mental Health vs. Judicial
  • Consistent Policies underage drinking, hazing,
    alleged sexual assault
  • Campus alerts for Assault, Robbery, etc.
  • Criminal behavior vs. Judiciary
  • Courts decide first, then school

12
Sexual Assault
  • Mandatory Reporting Educate Staff about steps to
    be taken and information needed
  • Campus safety part of residence training
  • Evidence collection vs. taking action
  • Female officers and clinicians for support
  • Explanation of Legal Options

13
Learning from Each Other
  • Beg, Borrow or Steal any good idea from other
    campuses
  • Joint efforts across campuses for screenings,
    progress ( BHM 20, OQ45), suicide prevention (
    JED foundation site), gatekeeper training, 1st.
    Gen and diversity
  • Talk with peer institutions

14
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

15
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

16
Sleep Problems
  • 35 of adult population experience insomnia (11
    of college students get a good nights sleep)
  • Loss of cognitive functioning, driving
  • Impairs immune system, Increased risk of
    depression

17
Sleep Hygiene
  • Great educational opportunity
  • Dark Cool room
  • No caffeine after 2 PM (soda also)
  • Wind down 45 minutes prior to bed time (no bright
    LCD screen) melatonin
  • If not sleeping, get out of bed until tired
  • Exercise during the day

18
Student Participation/ Engagement
  • Key for Successful Outreach
  • Peer Counseling/ Education Programs
  • Student Health Advisory Group
  • DAPA Drug/Alcohol Peer Advisers
  • Mental Health Advocacy Group/Active Minds
  • Involve in screenings and education

19
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

20
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

21
First Generation/Diverse Students
  • Parents BA 82 H.S. 54
  • Finish College (BA) 68 vs. 24 parents with
    less than H.S. degree
  • Challenges new culture, isolation, financial
    challenges, pressure on job choice, continue to
    support family

22
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)

23
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
    (Hunter/ GW)
  • Teach Wellness Eat, Sleep, Exercise

24
Retention
  • 562 students asking for counseling followed over
    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

25
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

26
Youth Risk Survey 2006 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 .

27
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

28
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

29
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

30
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

31
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

32
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)

33
Helping Students Help Themselves
  • In the Dormitory
  • In the Classroom
  • At Social Events
  • Teaching Fishing, not Providing Fish
  • Best of Intentions, but Sometimes..

34
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

35
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

36
Common Problems
  • Developmental Adjustment, Relationships
  • Depression (SADs)
  • Anxiety
  • Eating Disorders
  • Bipolar Disorder
  • Acute Psychosis
  • Substance Abuse

37
High Risk Issues
  • Eating Disorders
  • Dual diagnosis Substance Abuse/ depression
  • Bipolar Illness and Psychosis
  • Reentry from Hospitalization

38
Eating Disorders
  • Anorexia, Bulimia, EDNOS
  • 1 Anorexia, 3-5 Bulimia, 15-20 DE
  • 5-15 mortality from anorexia
  • 1/3 of people dont improve from serious anorexia

39
Bipolar Disorder
  • Onset often in college, sometimes triggered by
    antidepressant trial
  • Get careful family history (strong genetic)
  • Students reluctant to see it as problem
  • Depressive symptoms can be intractable,
    complicated medication management (multiple drugs
    and side effects, lamictal)

40
Bipolar Disorder
  • Symptoms very labile moods, euphoria, no sleep,
    impulsive (spending, sex, travel, very impaired
    judgment)
  • Grandiose ( academic work perfect, win Nobel
    prize)
  • Paranoid, highly irritable, poor social judgment

41
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

42
Substance Abuse
  • Dont 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

43
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

44
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

45
Lessons from Virginia Tech
  • Students in distress often dont 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

46
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)

47
Lessons from Virginia Tech
  • Schools must find ways to respect medical
    privacy, but coordinate concerns
  • If students cant expect privacy, they wont seek
    care
  • There must be communication, sometimes one way,
    between faculty, administration, public safety,
    family, counseling, when concerns arise about a
    student
  • FERPA and HIPAA

48
Legal Issues
  • Shin case settled but issues unresolved
  • Virginia Tech Refusal of care by student
  • George Washington, Hunter College student
    dismissals
  • Allegheny College Suicide

49
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

50
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

51
Contracts
  • Very helpful to have expectations for return when
    leaving for psychological issues
  • Contract should come from residence/administration
    with counseling input
  • Contracts based on behavior, not diag.

52
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

53
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

54
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.

55
Coordinating Board
  • All stakeholders Students, Admin. Residence,
    Public Safety, Ministry, Health, Counseling,
    Disability
  • Strategic, Realistic Planning
  • Community vs. Individual needs Insurance
  • Community wide programs for education from top
    down and bottom up set priorities!

56
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

57
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
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