College Students in Distress

A Resource Guide for Faculty, Staff, and Campus Community

Bruce Sharkin

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135797355
• Edition: 1
• Topic: Psychologie
• Subtopic: Entwicklungspsychologie

Be prepared to deal with campus situations that involve students in emotional crisis College Students in Distress provides college personnel with invaluable information on how to identify and refer emotionally troubled students for professional counseling. Dr. Bruce S. Sharkin, a staff psychologist at Kutztown University in Pennsylvania, addresses general warning signs of student distress, symptoms of specific psychological problems such as anxiety and depression, guidelines for interventions, and methods of making a referral for counseling. The book also examines current mental health issues for college students and provides an overview of common campus policies and procedures, such as psychological emergencies, withdrawal and readmission, and mandatory counseling. College Students in Distress provides the answers you need to manage difficult—and potentially dangerous—situations on campus. Case examples based on real-life experiences give you a clear sense of what can happen when responding to students in emotional distress, particularly when dealing with specific issues and student populations, and will help in your efforts to review and/or revise the current practices of your school. This unique book is essential as a resource and referral guide that raises awareness of this growing national problem without being limited to the characteristics of a particular college or university. Topics examined in College Students in Distress include:

• the impact of mental health problems on academics
  
• the roles and functions of college counseling services
  
• indicators of emotional disturbance
  
• suicidal behavior
  
• self-inflicted harm
  
• eating disorders
  
• guidelines for intervention
  
• accommodations for students with psychological disabilities
  
• and much more

College Students in Distress is a must-read for faculty and staff members, particularly those working in residential life, student health, and public safety, and for administrative offices within student services and student affairs.

Chapter 1

Overview of Current Issues in College Student Mental Health

Working as a college counselor over the past fifteen years has been quite a learning experience. I have counseled hundreds of college students and encountered almost every type of problem situation imaginable. In addition to individual and small group counseling work, I have responded to many crisis calls and emergency situations, including calls from concerned parents, professors, and others on campus. I have even made some emergency dorm calls over the years. One fact that has become quite apparent to me from these experiences is that anyone who works in a college setting is likely to encounter emotionally troubled and distressed students. Unlike college counselors, noncounseling college personnel are really on the front lines in terms of spotting troubled students and enlisting assistance for them. However, dealing with distressed students can be anxiety producing for noncounseling professionals because they may be uncertain about what to do or how to respond.

Because most colleges have counseling or mental health services available on campus, it would seem that any situation involving a student in distress could easily be deferred to these services. Yet, in my years of experience, this does not always go smoothly. In some cases, concerned others try to handle matters themselves until the situation becomes too burdensome or seemingly beyond their capacity to help. Indeed, some situations can become extremely problematic and complicated. Numerous times I have been asked to intervene at a point where it seemed as if I was helping or “rescuing” the concerned person more so than the student. Even if someone is able to get a troubled student over to the campus counseling center, this does not necessarily mean that the referring person will no longer need to deal with the

College Students in Distress
© 2006 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/5228_06

Student. The Student may not follow through with counseling after an initial appointment and may continue to behave in ways that pose concern.

It is my contention that college personnel who have any type of contact with students need to be well informed and prepared for situations that involve students in distress. This is imperative now more than ever because of accumulating evidence that suggests increasing numbers of students are experiencing serious psychological problems. Problems that might have been considered relatively rare among college students in the past such as mood and anxiety disorders are now believed to be much more common. The number of students who come to college with a history of psychological problems and mental health treatment, including psychiatric medication use, appears to be growing. Hence, the odds may be greater today for anyone who works in a college setting to encounter emotionally troubled students.

This guide is intended to help college and university personnel understand and handle situations involving students in distress. It is important to note that I do not intend to impart basic counseling skills or suggest in any way that noncounselors take on a pseudo-counseling role. Even situations that appear fairly innocuous at first (e.g., a student upset about failing a test) could potentially become much more troublesome and complex. I learned long ago in my counseling work that the severity of a student's problem is not always readily apparent in the first few counseling sessions. Thus, I believe that non-counselors should maintain clear role boundaries and avoid assuming counseling-like roles even on a limited basis. In my opinion, it can be much harder to make a referral to a professional when someone has been serving as a surrogate counselor. This book offers suggestions for responding to students primarily with the goal of referring students to counseling professionals.

Before proceeding with the task of showing how college personnel can identify and intervene with distressed college students, it is important to first discuss recent trends in college student mental health and how today's students are believed to be more prone to serious emotional and psychological difficulties. I will discuss societal changes and other factors that might account for changes in the mental health of today's college students. In addition, I address how mental health problems can have a negative impact on academic and social functioning. I also touch on the issue of how much responsibility colleges and their personnel, as opposed to parents, need to assume for the mental health care of students. Finally, I provide some background on the roles and functions of college counseling services. This material is intended to provide a context for understanding the nature and complexity of college student problems and the role of university personnel in responding to and helping emotionally troubled students.

ARE TODAY'S STUDENTS MORE EMOTIONALLY TROUBLED?

The issue of college student mental health has garnered considerable attention in recent years. There have been several articles in popular magazines such as Time (Kirn, 2003) and U.S. News and World Report (Shea, 2002) as well as prominent news outlets such as The New York Times (Goode, 2003) regarding concerns about the prevalence of mental health problems among today's college students. Some of this attention resulted from high-profile cases of student suicide (Sontag, 2002; Tavernise, 2003). Today's college students have been portrayed as generally afflicted with more serious mental health problems than students in the past. But is this an accurate characterization of today's students? My best answer to this question is yes, but with some reservations. Some evidence does suggest that growing numbers of college students are experiencing emotional problems of a serious nature, but much of the evidence is based on the perceptions of college counselors. In this section, I will examine some of the concerns raised about college student mental health and whether these concerns are justified.

The Contention of Increasing Severity of Student Problems

Since the 1980s, college counselors have been reporting a steady rise in the severity of presenting problems of students who seek counseling (O'Malley, Wheeler, Murphey, O'Connell, & Waldo, 1990; Stone & Archer, 1990). Many college counselors claim that they see fewer cases of students who present with traditional developmental straggles and many more cases of students who present with serious psychological problems.

This issue has received considerable attention in the counseling literature. Several years ago, I conducted my own review of the research (Sharkin, 1997) and raised concerns about the validity of the research findings. The issue still remains unresolved. Findings from two studies (Cornish, Kominars, Riva, McIntosh, & Henderson, 2000; Pledge, Lapan, Heppner, Kivlighan, & Roehlke, 1998) published after my earlier review did not provide empirical support for the purported trend of increasing severity. Findings from a recent large-scale study (Benton, Robertson, Tseng, Newton, & Benton, 2003) were believed to provide support for the trend, but I subsequently challenged that conclusion because the researchers failed to adequately assess for problem severity (Sharkin, 2004). The lack of research evidence regarding the trend of increasing problem severity may be due to inadequacies in the research (Sharkin & Coulter, 2005). The only true conclusion that we can make at this point is that there has been a perception among college counselors that the severity of problems has been on the rise.

Although the question of whether the mental health problems of today's students are more serious than they were a decade or two ago remains unclear, some indications do suggest that today's students might be particularly susceptible to certain forms of distress. Even the transition and adjustment to college, a common developmental straggle during the first year at college, may be becoming more stressful than ever for many students. The results of a survey conducted by the UCLA Higher Education Research Institute (as cited in Bartlett, 2002) suggest that the first year of college may take a big toll on the emotional and physical well-being of students. More than 3,600 first-year students at fifty colleges were surveyed during orientation and then again at the end of their first year. When their responses from the two different time periods were compared, some startling results emerged. First, there was a marked decline in the ratings of emotional and physical health. Second, there was a significant increase in the number of students that reported feeling depressed. Third, there was a significant increase in the number of students that reported feeling overwhelmed.

Other reports indicate that a significant number of today's students experience depression. In a survey conducted by the American College Health Association (as cited in Voelker, 2003), a high percentage of students reported feeling hopeless and depressed to the point where they could barely function. Researchers at Kansas State University (Benton et al., 2003) found that the number of students who came for counseling because of depression increased significantly between 1988 and 2001, though the specific level of depression in these cases was not reported.

There is research evidence to suggest that today's students may experience anxiety at higher levels than ever before. Twenge (2000) found that anxiety seems to be experienced more intensely among students today compared with several decades ago. Using meta-analytic techniques in which data were gathered and analyzed for college student samples between the years 1952 and 1993, Twenge determined that what would have been considered a high level of anxiety in the 1950s would be considered only “average” in the 1990s. Changes in how students experience anxiety can have important implications for overall mental health because high levels of anxiety are known to contribute to physical ailments, substance abuse, depression, and impaired cognitive functioning. This apparent rise in anxiety level was attributed largely to decreases in social connectedness and increases in environmental dangers (e.g., violent crime).

Although the psychological problems of college students today are believed to be more prevalent and serious than in years past, it is not as if students did not experience serious mental health problems in the past. Cases of diagnosable psychiatric disorders and serious emotional disturbance among students were observed many years ago (Reifler & Liptzin, 1969; Selzer, 1960). Indeed, the age of onset for many major mental disorders is during the traditional college-age years (eighteen to twenty-four); thus, a certain percentage of students have always first experienced serious mental health problems while in college. But many who work in college counseling believe that diagnosable conditions such as mood and anxiety disorders are now much more prevalent, at least among students who seek professional counseling help on campus.

Concern has also been raised about increasing numbers of students coming to college already having a history of psychological problems. College counseling center directors have reported seeing greater numbers of students with a history of treatment for mental health problems (Bishop, 2002). From my own experience, it certainly seems as if increasing numbers of students who seek counseling for the first time in college have already been in some type of treatment for serious mental health problems such as clinical depression, self-injurious and suicidal behavior, psychotic disorders, substance abuse, eating disorders, and other diagnosable disorders. The nature of prior treatment can range from brief counseling to inpatient hospitalization. Sometimes these earlier treatments date back to a student's pre-teen or early teenage years. Not surprisingly, students with preexisting mental health problems will often exhibit problematic behavior once in college, largely in response to the stress and pressures of campus life. An influx of students with such histories will place an additional burden on colleges, particularly in terms of providing counseling and other support services.

Although I have been critical of research methods used to assess for increasing severity of student mental health problems (Sharkin, 1997, 2004), I share the perception that more students seem to present in counseling for problems of a severe nature. By severe, I mean problems that cause significant disruption to a student's ability to function within the college environment and may require mental health care beyond the capacity of the average campus counseling service. I also have the impression that students today seem to be generally more afflicted with mental health problems and less equipped to cope effectively with the everyday problems of college life. There may be various reasons for why this might be so, some of which will be discussed later. It seems evident to me from my experience of observing and counseling college students over the past several years that more and more students seem to get overwhelmed by the day-today frustrations and disappointments of college life, be it a poor grade on a test, not getting into a fraternity or sorority, or problems in dating and relationships.

The Proliferation of Psychotropic Medication Use

There have been reports of increasing numbers of college students taking psychotropic medication (Young, 2003). Based on a sample of students seen in the counseling service at New York University over a ten-year period, Grayson, Schwartz, and Commerford (1997) provided evidence for a rise in psychotropic medication use, particularly antidepressants such as Paxil and Zoloft. Some students are started on medication before they even get to college. Indeed, more children and adolescents are being treated with psychotropic medications for mood and behavior problems (Kluger, 2003). Medications are increasingly used to help young people cope with depression, bipolar disorder, acute anxiety, panic attacks, social anxiety, and other emotional disturbances. For college students in particular, the movement toward brief treatment models in college counseling (largely due to the high demand for services) has resulted in a greater reliance on medications as a form of treatment.

Concerns have been raised about students being placed on medication too quickly and generally relying on medication to help students cope with problems of everyday life (Carter & Winseman, 2003). Today's students have grown up in a culture in which medication use for psychological troubles is common, and many have seen their parents use such medications. Some students may now see medication as a quick fix and easier alternative to counseling. Use of medication is more socially acceptable than in the past, and students may be less inclined to hide their use of medication from their peers. Indeed, use of medication may seem almost trendy in today's world.

Although medication may make it possible for more students to attend and remain in college, medication use among college students does have costs and consequences. For example, students may experience troubling side effects from medications that can interfere with academic and social functioning. In addition, college students may not properly monitor their medication use and may be vulnerable to misuse, dependency, or various forms of alcohol or substance abuse while on medication (Whitaker, 1992). Additional concerns were raised in 2004 when the Food and Drug Administration (FDA) ordered that all antidepressants carry warnings that they increase the risk of suicidal thinking and behavior in children and adolescents. This followed from a health advisory that depression and suicidal behavior could actually worsen when psychopharmacological treatment is first initiated or changes in dose are made (Stein, 2004). These concerns may be tempered somewhat by recent research findings (Simon, Savarino, Operskalski, & Wang, 2006) showing that the risk of suicide actually decreases after treatment with antidepressant medication is initiated.

Influence of Societal Changes on Student Mental Health

If indeed college students today are presenting with more serious psychological problems than students from fifteen to twenty years ago, how might we account for such changes in the mental health of students? One potential factor is the passage of the Americans with Disabilities Act (ADA, 1990). This allows more people to attend college who might otherwise not have been able to before the act was passed. The definition of disability includes mental as well as physical impairments. Hence, students diagnosed with mood disorders, anxiety disorders, personality disorders, schizophrenia, eating disorders, and pervasive developmental disorders can not only attend college but also may qualify for special assistance and reasonable accommodations. Although this has helped many more young people obtain a college education, it has also placed a tremendous burden on colleges to assist such students. Most campuses must now provide services exclusively devoted to students with mental as well as physical disabilities. The need to provide special accommodations to students with mental disabilities can affect and involve faculty, counselors, residence hall personnel, and other students.

As already noted, the use of medications for treating psychological disorders has contributed to more students with diagnosed disorders being able to attend college. Some students who qualify under the ADA may be allowed special accommodations because of the side effects of medication if they interfere with academic functioning. For example, students might be excused from having to attend class on a regular basis if their medication causes them to feel fatigued. Again, with situations such as this the burden will fall on the college to accommodate or assist students throughout their college years.

Another factor that may account for differences in students today versus the past is the enormous pressure on today's college students to achieve academic success. Some counselors believe that the pressure to succeed academically has never been higher. These days, just getting into college, particularly the more elite schools, is an extremely stressful endeavor. Once accepted, students feel pressure to excel and show that they are worthy of having been accepted. Because the cost of college has skyrocketed over the past several years, students feel intense pressure to achieve academic success to justify the financial commitment, whether through mounting student loan debt or the assistance of their parents. I have heard many students express despair over not doing well in college, especially because they felt that they were disappointing their parents who were spending a lot of money for college or because the students themselves were getting into significant debt. It is hard enough these days to deal with the increasing cost of college, but it becomes even more important to show good results for all of the money spent.

In general, there may be more financial stress on today's students. In contrast with students in the past, today's students are prone to accumulate credit card debt while...

Table of contents

• Cover
• Half Title
• THE HAWORTH PRESS
• Full Title
• Copyright
• Contents
• Preface
• ABOUT THE AUTHOR
• Acknowledgments
• Chapter 1. Overview of Current Issues in College Student Mental Health
• Chapter 2. General Warning Signs
• Chapter 3. Recognizing Specific Problems
• Chapter 4. Approaching a Student with Your Concerns
• Chapter 5. The Referral Process
• Chapter 6. Specific Issues and Populations to Consider
• Chapter 7. Campus Policies and Procedures Related to Student Mental Health
• Conclusion
• References
• Index