Case for reform: College needs to reexamine mental health care (Part II)

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GRAPHIC BY KAYLA PAYNE / THE FLAT HAT

Consider these facts about college students. There are over 1,100 suicides of college students each year. That’s three deaths every day. Except for car accidents, suicide is the most common cause of death among college students. Over half of college students have thoughts about killing themselves. One in 12 students plans to commit suicide at some point while in college. Women are more likely than men to attempt suicide, but men are more likely to die by suicide. Twice as many young men as young women die by suicide (ages 20-24).

In an essay last week, I explained that the College of William and Mary’s current system of student mental health care is crippled by serious problems. In this opinions article, I outline a reform. Of course, in this limited space, I can only offer a synopsis of a reform proposal. Supporting materials will be posted at the website of a non-profit I co-founded this year, Syntiro, which is dedicated to promoting faculty support for student mental health care nationwide (https://www.syntirohealth.org/).

A reformed system will incorporate three fundamental changes to bring the College’s mental health care into line with existing best practices.

The first is to introduce a programmatic component explicitly aimed at suicide prevention. It is worth noting that we are now in the fourth year following four student suicides in one year and the university has yet to implement an initiative that recognizes suicide as a campus-wide concern.  The Counseling Center offers on its homepage only the phone number of the National Suicide Prevention Lifeline and a link to the associated website. There is no discussion anywhere on the College website of suicide or suicide prevention. Very well-known and highly regarded resources that educate students about the causes of suicide, alerting them to its risk factors and warning signs, and even empowering them to help prevent it, such as the American Foundation for Suicide Prevention, the National Action Alliance for Suicide Prevention and Be the One To Save a Life, are not mentioned on the College’s website. The Counseling Center’s self-help page offers only two resources that concern suicide: “Friends for Survival of Suicide Loss” and “Healing for Survivors of Suicide.”

Second, in aligning the College’s mental health care system with current best practices, the university should adopt programs and policies that take a public health, or epidemiological (or ecological), approach to mental health care. Such an approach focuses on risk factors, preventive factors, and warning signs for mental health disability and suicide. This shift is needed to align university practices and deliberations with the national framework shaped today largely by Federal policy.

A third important change to bring adequate modernization to the College’s mental health care system would be to alter the paradigm of care so that the prevention of suicide and support for emotional well-being become campus-wide responsibilities. The College’s current health and wellness approach, in delegating all responsibility for mental health care to administrative units, is outdated. Of course, in a reformed system, key administrative centers will continue to play an important, and indeed central, role. But so will other constituencies, such as students.

The specific reform proposal I advance here, with advice from physicians at Chippenham Hospital and Trinity Mental Health in Richmond, takes advantage of the College’s strengths and is fine-tuned to fit current circumstances at the College. I arrived at the College 34 years ago, and while I have not been in the classroom in three years, I still spend my days working on university projects. It is an exciting time for students to be at the College. There are four constituencies that I have kept in mind in developing the ideas that follow and who I believe will find these ideas congenial: The Board of Visitors; President Rowe (the administration); the Division of Student Affairs; and students (both graduate and undergraduate). I explain this judgment on the website mentioned above.

The proposal has two components: a student peer organization and a mental health task force.

One might think that having a broken system would be an obstacle to progress, but actually, the reverse is true. The reason is that there is an ideational vacuum of sorts regarding mental health care on campus, and this creates an opening for students to step forward and take a decisive leadership role.

A now-famous RAND Corporation study published just six months ago documented the effectiveness of the group Active Minds. (the College is one of approximately 600 schools with a chapter.) Active Minds works with student advocates to encourage their peers to learn about, talk about, and seek help for mental health issues just as they would for a physical issue — without shame. RAND wrote:

“Overall, we found that increased familiarity and involvement with Active Minds were associated with increases in mental health knowledge and decreases in stigma over time. Through a combination of educational, contact-based, large-scale programs, and small-group activities initiated and led by peers on campus throughout the year, student peer organizations can meaningfully influence the behavior of students within a single academic year.”

The RAND study noted that these programs and activities create and sustain a supportive climate toward mental health issues on campuses. This is important because students with mental health problems are more likely to receive needed services if they feel the climate on their college campus is positive with respect to mental health.

RAND strongly urged universities to consider student-led mental health programming in their efforts to support student mental health. Student peer organizations, they concluded, can play an important role in addressing the unmet mental health needs of college students.

The other component of reform would be a Student Mental Health Task Force, which would have responsibility for policies and decisions that shape the overall architecture of mental health care on campus. It might have, say, 18-24 members who would represent all constituencies and groups within the campus community. The Task Force would take up four assignments, each to be pursued both interactively and iteratively: agenda setting, planning, implementation and evaluation.

Whatever direction the Task Force pursues with reform, the university should adopt a philosophy of community empowerment. The key to its success is to structure interaction so that each constituency believes others are giving its views appropriate consideration and feels its interests are adequately acknowledged.

The dual track student-peer-organization/mental-health-task-force approach would work at just about any university. The specifics of implementation would differ from one school to another, depending on factors specific to each school. For the College, I can say with high confidence that this system has the greatest potential if the Division of Student Affairs takes the lead institutional role and if the Active Minds Chapter works assiduously to coordinate with Student Affairs and take direction from it where asked to do so.

Thus, the Chair of the Task Force should be the Vice President for Student Affairs. At Virginia Commonwealth University, another senior administrative officer might be just as good or better. But at the College, given the way the school works, and given the centrality of the operations of Student Affairs to student life, the Vice President for Student Affairs must be given the lead role. For what it’s worth, I can say that I worked with Ginger Ambler in 2014 and 2015 on both sexual assault issues and mental health care, and I can assure you, students have never had at the College a more talented or tireless advocate and leader than Vice President Ambler.

A senior physician at Tucker Psychiatric Clinic in Richmond remarked to me, after I had discussed with him a range of research results relevant to student mental health care, that if you were going to design a university to take advantage of those results, it would look something like the College: our size, residential character, internal overlapping membership structures, and student excellence all play in the College’s favor. His point was clearly right. It is safe to say that, regardless of what specific choices students and administrators make in moving forward toward an improved system, the future of student mental health care is very bright indeed at the College.

Email David Dessler at dadessler@gmail.com.