Students Rate Mental Health Services

More than 62 percent of students who withdrew from college with mental health problems did so for that reason, a new national survey shows.

The survey, released today by the National Alliance on Mental Illness, aims to gauge, based on student perceptions, whether colleges are meeting students' mental health needs and how they can better support those students' academic experience. The results are mixed.

From August to November 2011, the NAMI surveyed 765 people diagnosed with a mental health condition who are currently enrolled in college (68 percent were) or were enrolled within the past five years. The vast majority -- 71 percent -- attended public or private four-year colleges, while 19 percent attended community colleges (the others were online, trade or technical and specialty colleges). Eighty-two percent of respondents were white and the same percentage were female (women are much more likely than men to seek counseling on campus), and more than 60 percent were between the ages of 18 and 27 (with 37 percent in the traditional college ages of 18-22). Nearly eight in 10 identified as straight.

Consistent with other national surveys, depression is one of the most common problems for students, with 27 percent reporting it as their primary diagnosis. Twenty-four percent had bipolar disorder, 11 percent reported anxiety (which has surpassed depression as the most common problem among students in surveys of college counselors), and 12 percent had other conditions such as eating disorders, autism and obsessive-compulsive disorder. (The respondents' diagnoses -- and the high reporting of bipolar disorder in particular -- may have been skewed by the fact that NAMI distributed the survey primarily through its own state and affiliate organizations, and it treats patients with these conditions more than the typical college health center would.)

The context is not particularly heartening: Students are seeking collegiate mental health services in record numbers, with more reporting severe psychological problems. More students say they've thought about suicide, other surveys have found, even as counselors say they lack the resources to keep up with their needs. To top it all off, many health centers are dealing with shrinking or stagnant budgets.

That 62 percent figure is "kind of a sign that we're not doing a very good job for some students," said Darcy Guttadaro, director of the Child and Adolescent Action Center at NAMI. "I think [the survey] really provides schools with an important look at what are students asking for when they come to school or develop a mental health condition. It's no longer OK for schools to just not address these issues -- it's really become an issue that has to be addressed."

Most of the students who withdrew because of mental health problems suffered from depression, bipolar disorder or post-traumatic stress disorder. Forty-five percent of them did not receive academic accommodations (such as tutoring, books on take, lower course loads or help communicating with professors), though it is unclear whether they asked, and half did not make use of mental health services and support -- in some cases, because they were unaware of such services. Thirty-eight percent of all respondents, regardless of whether they dropped out, said they did not know how to access accommodations.

"It sends a signal that we need to drill down and figure out why did these students not receive accommodations," and support services, Gruttadaro said. The "recurring theme" of faculty and staff awareness points to a need for greater education for them.

For some respondents, the lack of accommodations contributed to their decision to drop out; low grade point averages or changing to part-time course loads led to their loss in financial aid or scholarships. But to legally receive such accommodations, students must disclose their conditions to the college. Half of students -- and 38 percent of those who identified as lesbian, gay, bisexual or transgender -- did not disclose, for various reasons: fear of people's perceptions, having no opportunity to disclose, or not knowing disclosure could help secure accommodations.

Those who did talk to their college's disability resource center and found it unhelpful said staff focused too much on physical disabilities, did not listen to student needs and concerns, or did not proactively inform students about available resources. Some said professors would not honor approved accommodations (the most crucial of which were excused absences for treatment, course withdrawals without penalty, adjustments in test settings and deadline extensions, students said).

Most students (33 percent) who knew about mental health services found them through the college's website, but many (27 percent) also found them through the student health center. Yet even when students did find information through the website, 42 percent said the source was only "somewhat helpful," and 13 percent said it was either "not very helpful" or "not at all" helpful.

The biggest thing colleges can do to raise awareness about mental health is to train faculty and staff on the issues, students said. Also rated as extremely important in the survey was hosting suicide prevention activities, sponsoring student organizations, providing mental health information during orientation, and providing peer-to-peer support and mentoring. (Unhelpful websites did not provide information on how to access resources or how to manage a mental health condition, or explain the college's policies and procedures related to mental health issues.)

While stigma is still the number one barrier for students seeking mental health help, 16 percent of respondents cited a long wait. Nearly 40 percent of students reported a wait time of more than five days, with 18 percent saying one day and the rest falling somewhere in between.

"Stigma was a bit surprising, because I feel like we've made so much progress with stigma and with education, yet it remains as the number-one barrier," Gruttadaro said, adding that the impact of long wait times might depend on how severe a student's condition is. "Five days for a student who's kind of holding on and doing pretty well is still a long time. But if a student is really at a crisis level of need and they still have to wait, that can be very, very problematic."

The most critical services and supports for success, students said, are a walk-in health center, individual counseling, crisis services and a 24-hour hotline.

Although 73 percent of respondents said they experienced a mental health crisis while in college, only 35 percent said their health center knew about it. One student said, "I was scared to let anyone know about my crisis because I did not want people to worry, did not know who I could turn to and did not want to get in trouble."