Hot Topics, Young Adults
College is quite a milestone in family life. For parents and college-bound youth, it represents the real beginning of adulthood. Prospects of autonomy, independence and REALLY leaving home come to mind. It’s an incredibly exciting and long-awaited achievement.
Though thrilled to get going, most new college students are also more than a tad stressed. Many ponder: ‘Will I fit in?’ ‘Will I make friends?’ ‘Will I be able to do the work without Mom or Dad to help?’ ‘And, whom will I turn to for advice?’ Of course, few openly express these concerns. Most are so excited to be out on their own, the anxiety pales in the face of what seems to be unbound freedom.
Most parents are nervous as well. ‘Will she be OK—REALLY OK? Not that she talked with us all that much in high school, but who will be looking out for her now? At least we were there and knew when things were good or bad!’ Most parents believe that colleges will do the looking out for their kids. The old notion of colleges being “in loco parentis” (roughly meaning, “serving in the role of parents”) is a common belief—and one promoted by most colleges, eager to recruit students. Sadly, it’s not the reality at most.
That which no one seems to talk about much at all is that the dangers of mental illness and emotional problems are very real, and very common—and, for most parents and students, very hidden. The fact is, that most kids get through college a-okay, but there exist incredible perils in the college years that many parents and students are clueless about because they were not informed by high school personnel, or by college leadership. Just think about your near misses and how little you knew before college! Sadly, most college counselors, teachers, and administrators know about the high risks for kids at this age, but seem to avoid them.
Let’s Start With Some Concerning Facts:
- 50-60% of college students have or will have a psychiatric disorder during the college years. Mental illness peaks in ages 18-21. Common problems include anxiety disorders, depression, alcohol and drug use (especially binge drinking), eating disorders, attention deficit disorder and learning problems, relationship difficulties, among others.
- 1 in 5 college students report an attempted or completed sexual assault. Post-traumatic stress disorder is not an uncommon result.
- Suicide is the second leading cause of death among college-age youth—over 1,000 deaths per year.
- While we think of college students as “adults,” neuroscience tells us that the adolescent brain does not reach maturity until at least age 23. The biggest problem is that the 18-21-year-old brain is still developing; it’s prone to impulsive actions without appreciating consequences, and incredibly receptive to peer pressure. College-age students are not adults, even though at age 18 they can vote or even go to war. They need guidance.
- Only about 25% of college students get help for mental health problems. This small number is due to factors such as reported lack of time, privacy issues, stigma (‘I don’t want this on my permanent record!’), financial issues, poor mental health education resulting in failure to see the need for help, insurance limitations, and restrictions on what colleges can provide for assistance.
- While the numbers of kids with psychiatric problems are very high, the ration of paid mental health counselors to students is astoundingly low (about 1:650 for small schools; 1:1,800 for mid-size schools; and 1:2,700 for large universities).
- The numbers of local mental health providers is not much better. There are about 7,000 child and adolescent psychiatrists in the nation to care for about 30 million youth with mental illness (including college students), and only about 6,000 child psychologists. We graduate about 300 new child and adolescent psychiatrists a year in the United States—hardly enough to care for the needs of our kids. And, if we include general psychiatrists (many of which are not all that qualified to take care of late adolescents), the number is about 35,000 for the entire country.
- Insurance coverage for mental health is pretty awful everywhere. And, college coverage has a double whammy—many plans only cover an evaluation and handful of therapy visits for problems that often require much more help, AND they are severely short in qualified professionals.
- Few, if any, colleges provide education for parents, students, faculty, dorm leaders, or administrators on the huge mental health problems on campus. So, most parents, students and college staff are pretty much in the dark about psychiatric issues.
This last point is key—we all need information about what to expect and where to get help, if we need it!
Let me give you a real story. When I took my daughter to a superb liberal arts college in the Midwest, there were a number of tables geared for freshman parents. I wandered over to the one that had a sign labeled “College Mental Health.” What I found was a small table with a number of thin brochures littered on it. There was one on “depression,” one on “alcohol and substance abuse,” one on “college stress,” and others. I asked, naively, “What table is this?” A very young, perhaps junior faculty member or senior student said, “This is the mental health table.” When I asked about what services were available for my kid, she said, “I’m not really sure, but most can go to the student health center where we have a nurse. If problems get really bad, your daughter can also go into the city.” As a mental health professional, I was beyond stunned.
With all this in mind, what should parents know in preparing for their kids to go off to college?
Tips For Parents (And Some Guidance):
- Be prepared. It’s likely that your kid will experience a mental health problem, or encounter one in a roommate or classmate. Discuss this, and talk about what to do if it happens. You might say, “Talk with an adult to get advice. This could be me, a dorm advisor, or a mental health counselor. Don’t think things will just pass—they could get worse.” Inform your kids about the alarming mental health risks.
- Get information about mental health and illness. Some colleges have great websites on mental health services—they just don’t promote them, or educate parents and students about the signs and symptoms of psychiatric problems. No college wants to be known for its students’ mental health problems (as one orientation leader said about the rate of sexual assault when asked by a student: “We don’t want to be known as ‘rape central’”). Nor do they want to reveal the scary statistics about the dangers in college, and the lack of services. This is not good PR! However, you need information. Some colleges may have information online, or you can go to other sites with trusted resources about college student mental health—even if they’re other colleges (good examples include Cornell, MIT, University of Pittsburgh). You can also go to your state psychiatric association’s website (branches of the American Psychiatric Association or the American Academy of Child and Adolescent Psychiatry), which may be more helpful in getting you detailed information.
- Learn about college mental health services. Call the counseling center at your kid’s college, and ask about the kind of coverage, professional staff, and range of services available. Talk with the highest staff member you can. The person answering the phone may know little to nothing about what REALLY is available.
- Find out about your insurance coverage. Think about your own coverage! The mental health system can be very complicated. First, find out the insurance carrier, and call to ask about the number of office visits per year. Ask how many are JUST for medications, and how many are for therapy. Many insurance companies will say that they have unlimited visits for biological conditions, but this basically means “unlimited 15-minute visits for medication management.” If the coverage is obtained through the college, ask if it also covers visits off-campus.
- Learn about local mental health services on and off campus. Many college mental health services will be limited. See what may be available on-campus, and compare this with off-campus services at a local counseling center or hospital. You can call a local medical school with an associated department of psychiatry to see what facilities are recommended; if there is no department of psychiatry, call the nearest teaching hospital for a medical school in the state, even if it’s not right near the college. All states also have branches of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, which are wonderful statewide resources.
- Don’t worry about stigma. 1 in 4 people will have a psychiatric disorder during the course of their lifetime. Worry that this will be a black mark on your child’s record is unfounded. Many individuals who are highly successful have had psychiatric treatment, and this does not interfere with success in their careers, or in their relationships. Quite the contrary! Help may prove invaluable for functioning in life.
- Tall with your kids about mental health and illness. It’s one thing for us as parents to get the best information about psychiatric problems, relationship issues, and dangers in this age group. But, your kids also have a thirst for this same knowledge! Let’s face it: They are living with this, see their friends in trouble, and have the interest and capacity to learn. Involve them in all of the tips described here. You will be surprised how much they want to know, what they have seen, and their receptivity. Engage them in conversation; opening this door will serve them well, and is more likely to help them feel comfortable talking about themselves, and their experiences without feeling judged.
- Get help early! The earlier your kid gets services for any emotional, behavioral, or learning problems, the better! Most psychiatric disorders can be successfully treated. The key is early intervention and prevention of complications.
Mental illness is uniformly poorly understood in our society. This sad fact promotes stigma, confusion and poor access to care. Considering they’re such common problems, it’s a shame that we’ve been so lax in our awareness of and care for psychiatric issues.
Colleges do their best, but are sorely lacking in resources, and frankly, wary of putting such stigmatized problems on the front burner. Despite this, we can do a lot on our own to help our kids have sound and productive emotional, relational, and intellectual lives.
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