Staying Healthy at Tufts Student Mental Health and Success

2. Staying Healthy at TuftsStudent Mental Health and Success Richard Kadison M.D. Chief, Mental Health Service Harvard University Health Service

3. Challenges • Reduce Stigma, Manage Stress • Convince Universities that health and counseling resources are wise investments • Coordination of care between health, counseling, residence, faculty, and administration • Integrating Cultural Sensitivity and competence into our work

4. Current issues • Integration of Academic Work with student health and development • EVERYONE on campus is responsible for student well being. • Coordination of care • More serious mental health problems on campus. Helping high risk students

5. 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

6. 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

7. Student Participation/ Engagement • Key for Successful Outreach • Peer Counseling/ Education Programs • Student Health Advisory Group • Wellness representatives in the dorms • Mental Health Advocacy Group/Active Minds • Involve in screenings and education

8. 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)

9. 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 • Teach Wellness: Eat, Sleep, Exercise

10. Lessons from Virginia Tech • Students in distress often don’t 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

11. 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)

12. Lessons from Virginia Tech • Schools must find ways to respect medical privacy, but coordinate concerns • If students can’t expect privacy, they won’t seek care • There must be communication, sometimes one way, between faculty, administration, family, counseling when concerns arise about a student • FERPA and HIPAA

13. Youth Risk Survey 2001 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 [Grunbaum et al 2002].

14. 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

15. 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%

16. 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

17. 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

18. Learning from Each Other • Peter Leviness undergraduate student survey engaged students to highlight and address campus stress U. Richmond • Jan Collins-Eaglin 1st. Generation, multicultural students need language for therapy, Wayne State • Ron Chapman Pre and post counseling GPA changes- increased 1.0 BYU

19. Stories to Spread the Word • Educate the community to reduce Stigma: College Wide Events • Being Depressed at HBS • Walk the walk of the student on your campus: illness in family, high fever, serious alcohol problem. How do you get help? Web?

20. 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

21. 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)

22. Sleep Problems • 35% of adult population experience insomnia • 11% of college students get a “good night’s sleep” • Loss of cognitive functioning, driving • Increased risk of depression • < 7 hours yields sleep deprivation

23. Common Problems • Developmental Adjustment, Relationships • Depression • Anxiety • Eating Disorders • Bipolar Disorder • Acute Psychosis • Substance Abuse

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

25. Eating Disorders • Anorexia, Bulimia, EDNOS • 1% Anorexia, 3-5% Bulimia, 15-20% DE • 5-15% mortality from anorexia • 1/3 of people don’t improve from serious anorexia

26. 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

27. Substance Abuse • Don’t 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

28. 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

29. 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

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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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”

41. What Must We do? • Engage our students in the community: Life is richer and more satisfying for students who are engaged in learning • Stress Health and Wellness on campus and create opportunities for connections

42. 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.

43. Coordinating Board • All stakeholders: Students, Financial and Student Service Deans, Residence, Public Safety, Ministry, Health, Counseling, Disability • Community wide programs for education from top down and bottom up; set priorities!

44. Coordinating Board • Advisory to Counseling/MH • Strategic, Realistic Planning • Community vs. Individual needs: Insurance • Consider having regional meetings with shareholders in other area schools to share good ideas and increase leverage with local medical/ community resources

45. 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

46. 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