Everything parents should know about college mental health, but don't
Have a plan in place before a mental-health crisis emerges while a student is away at college. Here are some tips for parents of new college students - whether or not they've had prior mental-health issues.
Many parents are unaware that U.S. colleges are grappling with a mental-health crisis of epidemic proportions, and college counseling centers are struggling to meet the skyrocketing demand for services.
Almost half of all college-age adults have a diagnosable psychiatric disorder, and college students are seeking psychological help in unprecedented numbers. According to the Center for Collegiate Mental Health's (CCMH) 2016 Annual Report, there was a 5 percent increase in college enrollment, nationwide, accompanied by 30 percent increase in demand for mental-health services, between 2010 and 2016.
According to the CCMH report, of those students in treatment at college counseling centers, approximately:
1 in 2 has received psychological services in the last five years.
1 in 10 has been hospitalized before for psychiatric issues.
1 in 4 report engaging in self-injuring behavior (e.g., cutting).
1 in 3 has seriously considered suicide.
Many forms of mental illness first emerge during the college years, often coinciding with young adults' first time living away from home. Mental illness appears to be increasing in college-age adults, and more than 1 in 3 college students reporting about being "so depressed that it was difficult to function." This is a significant public health issue, particularly because suicide is the second most common cause of death among this age group.
It's much easier to have a plan in place before a mental-health crisis emerges while a student is away at college. Here are some tips for parents of new college students – whether or not they've had prior mental-health care:
For all parents…
Make sure your child knows the crisis number(s) to call or text in case of an emergency. For example, New Jersey mandates that all residential colleges in the state provide students with 24/7 access to individuals trained in mental-health issues and suicide prevention, either by phone or in-person.
If your child will be out of state for college but still under your health insurance, review your insurance coverage in advance and familiarize yourself with out-of-network benefits. Learn what student health insurance options are available through the college, being mindful that your child may need coverage near home during the long winter and summer breaks.
Know whether your insurance plan has a preferred hospital near campus, should your child require urgent care. Share this information with your child.
Determine whom to contact at the college should you observe concerning changes in your child's behavior (dean of students, residence advisor?).
Educate yourself about consent, sexual assault, and substance abuse; talk openly about these issues before your child leaves home.
Familiarize yourself with the college's code of conduct and leave of absence policies.
Learn the state laws relevant to your child. States such as Illinois have laws to facilitate colleges' sharing mental-health information with parents.
Parents should also remember that the vast majority of college students are legal adults, which means they have a federal right to privacy of their health information. Many parents are surprised to learn that colleges do not generally share academic or health information with them — regardless of who's paying the tuition bill. Federal law generally permits colleges to contact parents in case of emergency but what constitutes an emergency isn't always clear.
A homemaker from New Jersey, who did not want to be identified to protect her daughter, discovered this first-hand. The woman said she was stunned when her daughter, who was at college out of state, admitted that she had recently been in the hospital for severe alcohol intoxication. "I was even more shocked to realize that the college had known all along, because it was the residence advisor (RA) in her dorm who had called the ambulance. Yet, as a parent, I was never notified. My daughter was under our health insurance, so she knew I would eventually find out when I received the 'Explanation of Benefits' insurance paperwork."
For the many parents whose children have had past mental-health treatment, leaving home presents a set of challenges, as they suddenly lose the ability to regularly observe and monitor their kids.
If your child has received prior mental-health care…
If your child has received treatment in the last year, college may not be the best time to discontinue treatment, even if the issue appears resolved.
If college is close to home, strongly consider continuing treatment with the current provider. If college is hours away, find a treatment provider at school before, or soon after, your child leaves home. Brief treatment or "booster sessions" during the first year can focus on maintenance and relapse prevention.
For mental-health issues such as eating disorders, it may make sense to create a "contract," in consultation with your child and the treatment provider(s), preemptively spelling out what circumstances would necessitate medical leave or withdrawal from school (e.g., inability to maintain a minimum healthy weight). Present this in a caring and non-punitive way.
Talk to your child about signing a bidirectional release of information to facilitate communication between "home" and "college" therapists. Students can specify on the release what information they do or not want shared with their parents. Roger McFillin, a clinical psychologist and partner at Center for Integrated Health in Bethlehem, cautions that when a college student in treatment refuses to share information with a parent, "it's an important issue to address in treatment, as it may speak to something problematic in the parent-child relationship." Convey your respect for your adult child's legal right to confidentiality.
Consider transferring mental-health records to the center to facilitate continuity of care. Contact the counseling center for the best method and time to do this.
Mental illnesses can be "hidden disabilities." If your child's mental-health problem hinders academic functioning, know that your child is entitled to reasonable accommodations (e.g., quiet testing conditions) under federal law.
If your college student should need mental-health care while away at school, college counseling centers and/or off-campus clinicians can provide necessary treatment. Here's what you need to know about both facilities:
College counseling centers
Most colleges will have a counseling or wellness center with its own webpage offering detailed information. Find out what services they offer, including psychiatry, and what issues/disorders they do and do not treat. if there is a "session limit" (maximum number of sessions a semester) or a co-pay. If the college counseling center can't meet your child's needs, ask for a referral.
Come late September, many parents and students are surprised to learn that the college counseling center has a wait list that is weeks, if not months, long. Most college counseling centers are open during the summer. Students may have quicker access to services by scheduling an appointment before fall semester starts.
Off-campus treatment
If the counseling center isn't the best option, consider finding a private mental-health clinician near campus. If possible, schedule multiple appointments in advance to avoid scheduling difficulties that can disrupt ongoing care.
Make sure your child has reliable transportation to appointments. First-year students are commonly prohibited from having a car on campus. If public or campus transportation isn't an option, some colleges may grant parking accommodations for medical reasons. If applicable, contact the parking office to see whether they have a medical necessity policy, and what documentation they would need. Lyft or Uber may be feasible alternatives.
Finally, for all parents, communicate that your child's health and well-being take priority over academic achievement, always. Express your unconditional love; let your children know they can come to you with any mental-health and/or substance-abuse concerns. College isn't a race, and taking a break for needed care doesn't foretell an unsuccessful future.
To learn more about the soaring demand for college mental-health services, see the Center for Collegiate Mental Health 2016 Annual Report.
Get involved in protecting the mental health of teens and young adults at jedfoundation.org.
Stacey C. Cahn, Ph.D. is a licensed psychologist and clinical associate professor of psychology at Rowan University. David Rubenstein, Psy.D. is vice president for health and wellness at Rowan University.