A Different March Madness: College Mental Health

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COMMENTARY

As the NCAA “March Madness” basketball tournament reached its emotional peak, thousands of high school students and parents experienced a March madness of their own as they awaited college acceptance decisions—and ultimately decided upon a school. This is a process that is by turns demanding and emotional, exhilarating and frightening, affirming and deflating.

What college a student ultimately attends will indelibly influence their future, personally and professionally—so as University Admissions Officers pore over reams of applications, student applicants and their parents engage in a vetting process of their own. They will carefully research and weigh several factors in their decision: the university’s reputation, tuition cost, curriculum quality, campus environment, social life—even the caliber of the sports teams.

But one of the most crucial factors in determining a student’s college success or failure, and ultimately safety, is also one of the most highly overlooked: the quality of the school’s mental health services.

Nearly every metric indicates that the risks to student mental health are rising. During the 2020-2021 school year, more than 60% of college students met the criteria for at least 1 mental health problem, according to the Healthy Minds Study, which collects data from 373 campuses nationwide.¹ In another national survey, over half of students reported moderate or severe psychological distress.² In addition, the number of enrolled college students who are taking psychotropic medication, or will require them at some point while in college, exceeds 30%.

The college years closely coincide with the onset of many mental disorders—from anxiety and substance use disorders, to eating disorders to depression and schizophrenia. Additionally, the circumstances and stresses of today’s college experience, including independence from parental oversight, rigorous academic demands, and exposure to drugs and alcohol, further compounded by social media and the COVID-19 pandemic—place a substantial population of students at risk for mental illnesses that may require care during their college years. Yet despite the rising tide of mental health problems among students, most schools lack adequate, much less optimal, mental health services and remain ill prepared to meet the manifest needs of their students.

In the course of my career, I have seen many young patients whose education and lives were derailed by the onset of mental illness while in college, where it was not adequately managed. Among the worst cases were first episodes of schizophrenia that befell class valedictorians and resulted in outcomes of life-long disability and psychotic symptoms, or even worse, suicide or violence.

More commonly students suffer from depression and anxiety, which in some instances can impel them to risk-taking or even self-harmful behaviors. A recent incident described a 21-year-old Yale co-ed who, following a suicide attempt in the wake of a sexual assault, awoke in the emergency department (ED) with the fearful thought: “What if Yale finds out?”³ She recalled a fellow Yalie, Rachel Rosenbaum, who had killed herself 3 months earlier after the school advised her to leave school due to her inability to perform academically while suffering from depression. Fearing the consequences, she begged the ED staff not to contact university officials but was told that they must. Upon speaking to the Director of the Student Mental Health Service, she was advised to take a medical leave after which she could reapply for admission.

To say that university administrators and trustees have not fully embraced the responsibility of providing comprehensive mental health services to appropriately handle students’ increasing mental health challenges is an understatement. The uncertainty and ambivalence, largely due to the cost and liability entailed in meeting this responsibility, have caused universities to deliberate and dither over this complex and critical question.

Given this disappointing and hazardous reality, parents and students would be well advised to take the initiative to confirm the mental health care means and resources offered by a university should the need arise.

-What is the discipline (psychiatrist, psychologist, social worker) and training of the school’s director of mental health services?

• Number and composition of the staff
• Number of psychiatrists and their level of effort (consultant, part time, full time)
• Relationship to medical school and department of psychiatry

-What is the school’s policy toward managing mental illness in students?

-How many sessions can the school receive?

-If a student needs additional mental health care, what is the referral process?

-How are the professionals on their referral roster vetted?

-What is the policy on medical leaves of absence?

The most common form of treatment provided by Student Mental Health Services is crisis counseling and psychotherapy. However, to provide the requisite evaluative and treatment services, universities must employ trained personnel including psychiatrists, psychologists, and social workers in adequate numbers, and with training in substance abuse and suicide prevention.

In this increasingly complex modern age, as we evaluate the quality of a school’s information technology services or its social media policies, so too should we be carefully evaluating the school’s mental health care services and policies as an important, if not lifesaving, criterion.

Dr Lieberman is professor of psychiatry at Columbia University, past president of the American Psychiatric Association, and author of Shrinks: The Untold Story of Psychiatry (Little, Brown and Company, 2015) and MALADY OF THE MIND: Schizophrenia and the Path to Prevention (Charles A. Scribner-Simon and Schuster, 2023).

References

1. Lipson SK, Zhou S, Abelson S, et al. Trends in college student mental health and help-seeking by race/ethnicity: findings from the national healthy minds study, 2013-2021. J Affect Disord. 2022;306:138-147.

2. American College Health Association National College Health Assessment III: Fall 2021 Reference Group Executive Summary. American College Health Association; 2022. Accessed April 11, 2023. https://www.acha.org/documents/ncha/NCHA-III_FALL_2021_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf

3. Wan W. ‘What if Yale finds out?’ Washington Post. November 11, 2022. Accessed April 11, 2023. https://www.washingtonpost.com/dc-md-va/2022/11/11/yale-suicides-mental-health-withdrawals/