We had the privilege of interviewing Stan Possick, M.D. who is a board-certified psychiatrist and psychoanalyst, clinical teacher, and an associate clinical professor of psychiatry at Yale University School of Medicine. Mental health is such a huge issue on college campuses and we are grateful to him for answering our questions.
College Students and Mental Health
What can parents of first-year students do to help prepare their children for college?
The preparation has probably been going on for years. The transition from high school to college is difficult for both students and parents. There is usually a sense of excitement about the future, but also some fears experienced by parents and students. This is natural. I think it is helpful for parents to understand the mixed feelings that everyone has about the transition, and to try to be appropriately encouraging and supportive of the student.
If the parent is aware of difficulties that the student is likely to have starting college, then these matters should be addressed in a forthright manner. For example, if the student has a history of a learning problem and requires untimed tests, then the college needs to be aware of this, and the appropriate student support services need to be put in place.
Are there common issues raised by first-years?
Entering college as a first-year student is also associated with a new level of freedom and responsibility for oneself. Students may experience social and/or internal demands to become engaged in activities that they may not be ready to handle.
Drinking and increased sexual activity are two common concerns here. Often the student is just not ready to cope with such activities but is fearful that not getting involved will lead to one’s feeling ostracized by new peers. These are both issues with which parents can be quite helpful to their children.
Many colleges now send along pamphlets about alcohol use along with their pre-matriculation packages to incoming first year students and their parents to review and discuss together. Once students arrive at college, discussions about sexual concerns, alcohol and other drugs are part of their orientation. In addition, faculty advisors help with planning courses as well as with helping the beginning student access any needed assistance relating to all aspects of their college experience.
Although first year college students may present to college mental health clinics for assistance for a plethora of reasons, a few situations are common triggers for them to seek assistance. These include: the first set of mid-term exams about six or seven weeks into the semester
- the first set of final exams, usually in December
- genuine academic difficulties
- romantic concerns, especially the break-up of a relationship, which can feel devastating to both people in the couple
- feeling home-sick
Parents may be most helpful by listening to their first-year college students in a sympathetic, supportive and problem-solving manner.
What are the signs that a first-year student may not be thriving? What should parents look for? What should parents ask?
It is important to remember that the first-year college student is usually faced with many new challenges during the early weeks at school. The following symptoms may be signs that a student is having some difficulty:
- significant change in appetite or sleeping habits, level of energy, or mood
- decreased interest in school and other activities
- lack of motivation or difficulty focusing on academic work
- social withdrawal
- poor academic performance
- the use of alcohol or other substances
Typically, colleges will have a parents’ weekend within the first six or seven weeks of the fall semester. This offers parents a chance to spend time with their child, and often changes in the child’s demeanor, mood, sense of engagement with the parents and the community may be readily apparent to them. Also, Thanksgiving break offers another chance to spend time with one’s child, and to see how the newly matriculated college student is doing in a familiar setting with family and high school friends.
If parents notice anything that seems different in a concerning way when speaking, e-mailing or connecting with a child, parents should point out their observations to their child. If the child seems willing to discuss parental concerns, that is a good sign. This creates an atmosphere in which it becomes possible to assess the significance of each person’s observations and heightens the possibility of developing a strategy for helping the student deal with whatever problem may have arisen.
If a parent is deeply concerned about unusual changes in their child, especially if there is worry about the student’s safety, then it is incumbent upon the parent to notify the appropriate person at the school about one’s concerns. This might mean contacting the student’s dean, an advisor, or, if the person in being treated for any type of mental health problem, the student’s mental health provider. Any of these people will welcome parental observations and concerns.
However, without having the student’s consent to share information, unless there is an issue regarding the student’s safety, the college personnel or mental health provider may not be able to do more than acknowledge parents’ concerns and ask additional questions to try to further clarify the situation being described. Parents should, however, expect that their concerns and observations will be looked-into quickly and competently. Typically, the person with whom the parent has spoken will try to get the student’s permission to speak with the concerned parents and will also ask the student to do so as well.
Some students feel unhappy with their college choice or feel that they really aren’t ready to begin college. If this occurs, the student, college personnel and the parents need to try to work out the most beneficial way of dealing with the student’s concern that considers the student’s wishes and possible distress.
What is the best way for first year college students to find out about mental health services on their college campuses?
Colleges usually send out material about their student health, including mental health, services prior to the student’s arrival on campus. This material may be included with forms for the student’s pre-matriculation physical exam, which is most often completed by the student’s physician at home.
Usually colleges will send a brochure at that time which describes the specific medical and mental health services offered to students. Typically, the brochure will list phone numbers to call to set up appointments for each type of service desired.
If students need ongoing mental health treatment when they are not on campus, for example when they are home for the summer, how is that situation best addressed by the student and their parents?
The discussion about the student’s need for ongoing mental health treatment during the summer or during other long periods away from school ideally would take place, at least initially, between the student and the clinician. The most important questions are: “Does the student have a need to be in treatment while away from school?” and “Does the student wish to be in treatment during this period of time?”
If possible, it would make sense for the parents to speak with the mental health clinician working with their child during the academic year so that the parents might obtain a full and accurate a picture of what type of mental health services their child might need and why. I mention this because the parents will most likely play a central role in finding a mental health provider for their child when the child is at home.
If it is clear by the student’s spring vacation that ongoing mental health care will be necessary during the summer, setting up a few meetings with local practitioners during that vacation time would be useful.
This allows the student to decide which clinician will be the best fit, and it will also give the clinician treating the student who is away at school a chance to speak with the clinician in the student’s home town well before the summer vacation period. Again, the parents will need their child’s permission to undertake referrals to new clinicians.
What have you observed from students seeking treatment?
There has been a significant increase in the number of college students seeking mental health services at colleges throughout the country during the past several years. First-year students and seniors in college seem to seek mental health services more often than sophomores and juniors. This may be linked to the fact that one’s first and last years at college are most associated with major life transitions, e.g. leaving home for school as a first-year student, and then preparing to leave college upon graduation.
Feelings of sadness or anxiety are the most common presenting symptoms, and many students feel better quickly as they sort out whatever is causing them to feel off kilter. Alcohol use is a significant issue for many college students, but this group of students is not likely to seek help unless they are required to do so.
If a first-year student has never been in counseling, or other mental health treatment, prior to college, what do you recommend as the first steps towards getting help? How can the student be involved in finding a caregiver who is competent and a “good fit?”
If a student has never had to utilize mental health services or counseling prior to college matriculation and decides at some point after arriving at college that it would be wise to meet with a mental health professional, then contacting the college’s student health service would be the first step for the student to take.
Typically, psychological evaluations are provided by the college’s mental health center or clinic. The first issue they will try to determine with the student is “Why now?” That is, what is going on in the student’s life that makes the student feel it is necessary to talk with a mental health clinician at that time?
Most often, the student is trying to adjust to life away from home and to the various academic and social pressures felt at school. Often if the student can discuss these concerns with a knowledgeable clinician, a meaningful approach to the student’s worries can be developed by the clinician and the student over the course of a few meetings.
Some college mental health and counseling centers may offer extended treatment, especially if the student requires medication. Other college mental health clinics may offer each student a limited number of meetings there, e.g. six, and, if additional mental health services are needed, then refer the student out to mental health services in the community. Typically, the mental health counselors will know which community practitioners are both skilled and experienced mental health practitioners with college-age students.
Should parents expect to be in touch with the student’s mental health provider? What should parents expect their level of involvement to be in their college-age child’s mental health care?
A student’s involvement with one’s therapist, psychiatrist or other mental health provider is privileged. That means that the provider cannot talk with parents about their child unless the clinician has been given permission by the student to do so. It is not unusual for clinicians to ask the student for permission to talk with parents during the evaluation process.
In my experience, students generally comply with such a request. The clinician would like to learn as much about the students’ history to place current concerns in their proper context. If a clinician feels that a student is not safe for any reason, a decision can be made to get the parents involved against the expressed wishes of the student.
Have the concerns frequently raised by first-year students changed?
Some of them have. More students talk openly about their gender identity and sexual orientation. Lesbian, gay, bisexual, queer, and transgender individuals talk more freely about their lives, relationships and feelings of acceptance or non-acceptance in the college community.
Students from a variety of different racial and ethnic groups talk more frankly about their sense of alienation, a feeling that they don’t fit in. The sense of not belonging because of gender, ethnic, socioeconomic and racial differences is a topic first year students often bring to their mental health clinicians.
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Stan Possick, M.D. is a board certified psychiatrist and psychoanalyst, who is an associate clinical professor of psychiatry at Yale University School of Medicine. An expert in mental health and developmental issues confronting late adolescents and young adults, he treated a wide range of college students for four decades. Dr. Possick has remained active as a teacher, and has been recognized by Yale, by the American Psychiatric Association and by the American Psychoanalytic Association for his excellence in teaching.