Staying Healthy at TuftsStaying Healthy at TuftsStudent Mental Health and Student Mental Health and

SuccessSuccess

Richard Kadison M.D.Richard Kadison M.D.

Chief, Mental Health ServiceChief, Mental Health Service

Harvard University Health Harvard University Health ServiceService

ChallengesChallenges

• Reduce Stigma, Manage StressReduce Stigma, Manage Stress• Convince Universities that health and Convince Universities that health and

counseling resources are wise counseling resources are wise investmentsinvestments

• Coordination of care between health, Coordination of care between health, counseling, residence, faculty, and counseling, residence, faculty, and administrationadministration

• Integrating Cultural Sensitivity and Integrating Cultural Sensitivity and competence into our workcompetence into our work

Current issuesCurrent issues

• Integration of Academic Work with Integration of Academic Work with student health and developmentstudent health and development

• EVERYONE on campus is EVERYONE on campus is responsible for student well being.responsible for student well being.

• Coordination of care Coordination of care

• More serious mental health problems on More serious mental health problems on campus. Helping high risk studentscampus. Helping high risk students

Stress on Staying HealthyStress on Staying Healthy

• Eat, Sleep, ExerciseEat, Sleep, Exercise

• Stay connected with friends/ communityStay connected with friends/ community

• Provide tools to manage stressProvide tools to manage stress

• Educate community to reduce stigma thru Educate community to reduce stigma thru education about common problems and education about common problems and how to recognize warning signs.how to recognize warning signs.

• Create multiple portals of entry to careCreate multiple portals of entry to care

Staying HealthyStaying Healthy

• Stressing Personal and professional Stressing Personal and professional DevelopmentDevelopment

• Service Opportunities: Engaged LearningService Opportunities: Engaged Learning

• Health Education and Information (MRSA)Health Education and Information (MRSA)

• Alcohol and Nutrition info: (BAL + BMI)Alcohol and Nutrition info: (BAL + BMI)

• Complementary Services: Acupuncture, Complementary Services: Acupuncture, Massage, Yoga, MindfulnessMassage, Yoga, Mindfulness

Student ParticipationStudent Participation/ / EngagementEngagement

• Key for Successful OutreachKey for Successful Outreach

• Peer Counseling/ Education ProgramsPeer Counseling/ Education Programs

• Student Health Advisory GroupStudent Health Advisory Group

• Wellness representatives in the dormsWellness representatives in the dorms

• Mental Health Advocacy Group/Active Mental Health Advocacy Group/Active MindsMinds

• Involve in screenings and educationInvolve in screenings and education

Getting CareGetting Care

• Multiple ways to access careMultiple ways to access care• Chaplains, Advising system, residence Chaplains, Advising system, residence

systemsystem• Information about resources and Information about resources and

warning signs for parents and familieswarning signs for parents and families• Stress relieving events and workshops Stress relieving events and workshops

at high stress times (massage, food, at high stress times (massage, food, activities/ workshops)activities/ workshops)

Access to CareAccess to Care• Triage system: Who needs to be seen Triage system: Who needs to be seen

todaytoday

• Inside vs. Outside CareInside vs. Outside Care

• Community ResourcesCommunity Resources

• Hospital and Medical Leave, ReentryHospital and Medical Leave, Reentry

• When should students go homeWhen should students go home? How ? How to decideto decide

• Teach Wellness: Eat, Sleep, ExerciseTeach Wellness: Eat, Sleep, Exercise

Lessons from Virginia TechLessons from Virginia Tech

• Students in distress often don’t seek Students in distress often don’t seek or avoid careor avoid care

• When students are mandated for When students are mandated for “assessment”, there must be follow “assessment”, there must be follow up and clear consequencesup and clear consequences

• When students return from hospital When students return from hospital care, a careful internal review care, a careful internal review process is criticalprocess is critical

Lessons from Virginia TechLessons from Virginia Tech

• Violence is very rare and difficult to Violence is very rare and difficult to predict (prior violence best predictor)predict (prior violence best predictor)

• There must be a community effort to There must be a community effort to reduce stigma, recognize risk factors, reduce stigma, recognize risk factors, and find portals to care. Educate and find portals to care. Educate everyoneeveryone

• Counseling and Health Services can Counseling and Health Services can and should provide consultation to the and should provide consultation to the community (students, faculty and staff)community (students, faculty and staff)

Lessons from Virginia TechLessons from Virginia Tech

• Schools must find ways to respect medical Schools must find ways to respect medical privacy, but coordinate concernsprivacy, but coordinate concerns

• If students can’t expect privacy, they If students can’t expect privacy, they won’t seek carewon’t seek care

• There must be communication, sometimes There must be communication, sometimes one way, between faculty, administration, one way, between faculty, administration, family, counseling when concerns arise family, counseling when concerns arise about a studentabout a student

• FERPA and HIPAAFERPA and HIPAA

Youth Risk Survey 2001 Youth Risk Survey 2001 13,600 HS students13,600 HS students• 28.3% sad or hopeless almost every day> 28.3% sad or hopeless almost every day>

2 wks stopped some activity due to 2 wks stopped some activity due to symptomssymptoms

• 19 percent of students reported that they 19 percent of students reported that they seriously considered attempting suicide seriously considered attempting suicide

• 14.8 percent had made a specific plan to 14.8 percent had made a specific plan to attempt suicide. attempt suicide.

• 8.8 percent had attempted suicide in the 8.8 percent had attempted suicide in the previous year [Grunbaum et al 2002]. previous year [Grunbaum et al 2002].

College Data ACHA and Kansas College Data ACHA and Kansas StateState

• Depression Doubled, Suicidal Ideation Depression Doubled, Suicidal Ideation Tripled, Sexual Assaults quadrupled Tripled, Sexual Assaults quadrupled over 13 yearsover 13 years

• 45% students self report depression45% students self report depression

• 10% report serious suicidal ideation 10% report serious suicidal ideation and 44% binge drinkand 44% binge drink

• These are the best years of your lifeThese are the best years of your life

ACHA College DataACHA College Data

• 9% seriously consider suicide 1% 9% seriously consider suicide 1% attemptattempt

• Depressed 52-42% 2000/2006Depressed 52-42% 2000/2006

• No Sexual partners 40% vs. 5% No Sexual partners 40% vs. 5% perceivedperceived

• Medication for depression 36-42% Medication for depression 36-42%

Graduate StudentsGraduate Students

• Often at higher risk, higher suicide Often at higher risk, higher suicide ratesrates

• Economically in worse shape, many Economically in worse shape, many have no insurance.have no insurance.

• Berkeley Graduate Student Mental Berkeley Graduate Student Mental Health Survey Dec. 2004 showed Health Survey Dec. 2004 showed similar findings to undergrad surveyssimilar findings to undergrad surveys

Berkeley Grad School Berkeley Grad School SurveySurvey

• 45.3% respondents experienced 45.3% respondents experienced emotional or stress related problem emotional or stress related problem SIGNIFICANTLY affected well being/ SIGNIFICANTLY affected well being/ academic performanceacademic performance

• 9.9% seriously thought about suicide9.9% seriously thought about suicide

• 52% considered using counseling less 52% considered using counseling less than 33% did usethan 33% did use

• 25% unaware they were available25% unaware they were available

Learning from Each OtherLearning from Each Other

• Peter Leviness undergraduate student Peter Leviness undergraduate student survey engaged students to highlight and survey engaged students to highlight and address campus stress U. Richmondaddress campus stress U. Richmond

• Jan Collins-Eaglin 1Jan Collins-Eaglin 1stst. Generation, . Generation, multicultural students need language for multicultural students need language for therapy, Wayne Statetherapy, Wayne State

• Ron Chapman Pre and post counseling Ron Chapman Pre and post counseling GPA changes- increased 1.0 BYUGPA changes- increased 1.0 BYU

StoriesStories to Spread the to Spread the WordWord

• Educate the community to reduce Educate the community to reduce StigmaStigma: College Wide Events : College Wide Events

• BeBeing Depressed at HBSing Depressed at HBS

• Walk the walk of the student on your Walk the walk of the student on your campus: illness in family, high fever, campus: illness in family, high fever, serious alcohol problem. serious alcohol problem. HHow do you ow do you get help? Web?get help? Web?

Healthcare 2007Healthcare 2007

• BIG changes in the last decade BIG changes in the last decade

• Severity of Problems of students making Severity of Problems of students making it to collegeit to college

• Managed Care= Shorter Hospital Stays Managed Care= Shorter Hospital Stays and more alternative treatmentsand more alternative treatments

• Reduced outpatient community Reduced outpatient community resourcesresources

• Higher insurance costs for students Higher insurance costs for students

Impediments to Academic Impediments to Academic SuccessSuccess

• Stress 32.4%Stress 32.4%

• Cold/Flu 25.6%Cold/Flu 25.6%

• Sleep Problems 24.6%Sleep Problems 24.6%

• Depression 15.3%Depression 15.3%

• Internet Use/ Games 13.4% (3-6% of Internet Use/ Games 13.4% (3-6% of students addicted to internet students addicted to internet pornography; 20% are women)pornography; 20% are women)

Sleep ProblemsSleep Problems

• 35% of adult population experience 35% of adult population experience insomniainsomnia

• 11% of college students get a “good 11% of college students get a “good night’s sleep”night’s sleep”

• Loss of cognitive functioning, drivingLoss of cognitive functioning, driving

• Increased risk of depressionIncreased risk of depression

• < 7 hours yields sleep deprivation< 7 hours yields sleep deprivation

Common ProblemsCommon Problems

• Developmental Adjustment, Developmental Adjustment, RelationshipsRelationships

• DepressionDepression

• AnxietyAnxiety

• Eating DisordersEating Disorders

• Bipolar DisorderBipolar Disorder

• Acute PsychosisAcute Psychosis

• Substance AbuseSubstance Abuse

High Risk IssuesHigh Risk Issues

• Eating DisordersEating Disorders

• Dual diagnosis Substance Abuse/ Dual diagnosis Substance Abuse/ depressiondepression

• Bipolar Illness and PsychosisBipolar Illness and Psychosis

• Reentry from HospitalizationReentry from Hospitalization

Eating DisordersEating Disorders

• Anorexia, Bulimia, EDNOSAnorexia, Bulimia, EDNOS

• 1% Anorexia, 3-5% Bulimia, 15-20% 1% Anorexia, 3-5% Bulimia, 15-20% DEDE

• 5-15% mortality from anorexia5-15% mortality from anorexia

• 1/3 of people don’t improve from 1/3 of people don’t improve from serious anorexiaserious anorexia

Substance AbuseSubstance Abuse

• Binge Drinking- 5 or more drinks one Binge Drinking- 5 or more drinks one sitting in past 2 weekssitting in past 2 weeks

• 44% meet criteria in national surveys44% meet criteria in national surveys

• 41% did something they regretted41% did something they regretted

• 31 % forgot what they did31 % forgot what they did

• 9.7% unprotected sex9.7% unprotected sex

• 17% physically injured17% physically injured

Substance AbuseSubstance Abuse

• Don’t stigmatize medical services. Don’t stigmatize medical services. Separate from JudicialSeparate from Judicial

• BASICS: Motivational interviewing BASICS: Motivational interviewing and education shows best results and education shows best results with reducing high risk drinkingwith reducing high risk drinking

• Consistent enforcement policies and Consistent enforcement policies and consequences for students with consequences for students with identified AODS team on campusidentified AODS team on campus

Stimulant AbuseStimulant Abuse

• 900% increase in production of 900% increase in production of methylphenidate (Ritalin) 1990-2000methylphenidate (Ritalin) 1990-2000

• 3-7% school age kids ADHD3-7% school age kids ADHD

• 50% carries over into college50% carries over into college

• 16% use recreationally by mouth, 16% use recreationally by mouth, snorting or by injection 30% sharesnorting or by injection 30% share

SuicideSuicide

• Long Term Risk factorsLong Term Risk factors

• Prior attemptsPrior attempts

• Feelings of hopelessnessFeelings of hopelessness

• Suicidal plan, isolation, prior attemptsSuicidal plan, isolation, prior attempts

• 10% attempters die over 10 years10% attempters die over 10 years

• 45 of 76 suicides occurred during first 45 of 76 suicides occurred during first week post hospitalizationweek post hospitalization

Legal IssuesLegal Issues

• Shin case settled but issues Shin case settled but issues unresolvedunresolved

• Virginia Tech: Refusal of care by Virginia Tech: Refusal of care by studentstudent

• George Washington, Hunter College George Washington, Hunter College student dismissalsstudent dismissals

• Allegheny College SuicideAllegheny College Suicide

Legal IssuesLegal Issues

• Handbook Language for Notification/LOAHandbook Language for Notification/LOA

• Medical Privacy Laws very strict Medical Privacy Laws very strict

• FERPA (Family Education Rights and FERPA (Family Education Rights and Privacy Act); HIPAAPrivacy Act); HIPAA

• Prohibits disclosure of education recordsProhibits disclosure of education records

• Permits disclosure gained through Permits disclosure gained through observationobservation

• Permits disclosure of safety emergencyPermits disclosure of safety emergency

Leave of Absence and Leave of Absence and ReturnReturn

• Students rarely want to take time off, Students rarely want to take time off, but may need to but may need to

• When students return, important to When students return, important to review their readiness to be back at review their readiness to be back at school internallyschool internally

• Contracts and RidersContracts and Riders

RetentionRetention

• 562 students asking for counseling followed 562 students asking for counseling followed over 2 year periodover 2 year period

• 0 sessions 65% 1-12 79% >13 83%0 sessions 65% 1-12 79% >13 83%• Several studies followed people over 5 years Several studies followed people over 5 years

all showed dramatically higher retention all showed dramatically higher retention rates, averaging more than 10% for rates, averaging more than 10% for students who used counseling servicesstudents who used counseling services

Steve Wilson, Terry Mason, Evaluating the impact of receiving university based counseling Steve Wilson, Terry Mason, Evaluating the impact of receiving university based counseling services on student retentionservices on student retention

Journal of Counseling Psychology 1997 vol 44. no 3 p. 316-320Journal of Counseling Psychology 1997 vol 44. no 3 p. 316-320

RetentionRetention

• Social Isolation single most important Social Isolation single most important determinent of dropout rates determinent of dropout rates Pascarella and Pascarella and Terrazini, 1979Terrazini, 1979

• Emotional- Social Adjustment items Emotional- Social Adjustment items predicted attrition better than predicted attrition better than academic items academic items Gerdes and Mallinckrodt 1994Gerdes and Mallinckrodt 1994

• 5 year study of Berkeley students and 5 year study of Berkeley students and those making use of counseling had those making use of counseling had higher graduation rates higher graduation rates Frank and Kirk 1975Frank and Kirk 1975

MedicationMedication

• Polarized attitudes of students and staffPolarized attitudes of students and staff

• Antidepressants: benefits and risks Antidepressants: benefits and risks (bipolar) and side effects(bipolar) and side effects

• Sleep MedicationsSleep Medications

• Anxiety MedicationsAnxiety Medications

• Stimulants: Newer preparationsStimulants: Newer preparations

• Role with disabilities and judicial issuesRole with disabilities and judicial issues

MedicationMedication

• Antidepressant and Stimulant Safety Antidepressant and Stimulant Safety ControversyControversy

• Reduction of 20% in prescribing since Reduction of 20% in prescribing since black box warningblack box warning

• Most prescribed medications on Most prescribed medications on college campuses: 12% of pharmacy college campuses: 12% of pharmacy budget for antidepressantsbudget for antidepressants

• Side Effects: Kiss of deathSide Effects: Kiss of death

Multicultural StudentsMulticultural Students

• Present emotional problems physicallyPresent emotional problems physically

• Metabolize medications differentlyMetabolize medications differently

• May be more comfortable with Pastoral May be more comfortable with Pastoral Resources: follow path of least Resources: follow path of least resistanceresistance

• Vulnerability in language/cultural Vulnerability in language/cultural adjustment and symptom presentationadjustment and symptom presentation

• Staff sensitivity to cultural beliefsStaff sensitivity to cultural beliefs

Diversity ConsiderationsDiversity Considerations

• Create a culturally competent communityCreate a culturally competent community• Learn and respect different values and Learn and respect different values and

culturescultures• Celebrate the diversity of your Celebrate the diversity of your

community by events that encourage community by events that encourage sharing; art, music, and other traditions.sharing; art, music, and other traditions.

• Diversity may be via culture, race, Diversity may be via culture, race, ethnicity, sexual orientation, economics ethnicity, sexual orientation, economics

Coordination of CareCoordination of Care

• Handbook expectations: who gets Handbook expectations: who gets notified about hospitalization/ returnnotified about hospitalization/ return

• Identifying high-risk studentsIdentifying high-risk students• How is residence involved with How is residence involved with

worrisome students?worrisome students?• Eating Disordered or Substance Eating Disordered or Substance

Abusing students in residence, what Abusing students in residence, what happens?happens?

• Contracts: When to invoke themContracts: When to invoke them

ParentsParents

• 70-80 % of students get their health 70-80 % of students get their health information from their parentsinformation from their parents

• They often feel they are supposed to let They often feel they are supposed to let go of students and need help staying go of students and need help staying engaged without being intrusiveengaged without being intrusive

• Help “helicopter parents” teach their Help “helicopter parents” teach their students to fish and become “emerging students to fish and become “emerging adults”adults”

What What Must WMust We do?e do?

• Engage our students in the Engage our students in the community: Life is richer and more community: Life is richer and more satisfying for students who are satisfying for students who are engaged in learningengaged in learning

• Stress Health and Wellness on Stress Health and Wellness on campus and create opportunities for campus and create opportunities for connectionsconnections

Wellness ActivitiesWellness Activities

• Engage Students in community- study Engage Students in community- study breaks, hikes, encourage student groupsbreaks, hikes, encourage student groups

• Teach yoga, sleep hygiene, mindfulness, Teach yoga, sleep hygiene, mindfulness, relaxation response relaxation response

• Have annual “wellness or caring events” Have annual “wellness or caring events” like this one or “maximize academic like this one or “maximize academic potential, minimize stress”potential, minimize stress”

• Student Wellness Reps.Student Wellness Reps.

Coordinating BoardCoordinating Board

• All stakeholders: Students, Financial All stakeholders: Students, Financial and Student Service Deans, and Student Service Deans, Residence, Public Safety, Ministry, Residence, Public Safety, Ministry, Health, Counseling, DisabilityHealth, Counseling, Disability

• Community wide programs for Community wide programs for education from top down and bottom education from top down and bottom up; set priorities!up; set priorities!

Coordinating BoardCoordinating Board

• Advisory to Counseling/MHAdvisory to Counseling/MH• Strategic, Realistic PlanningStrategic, Realistic Planning• Community vs. Individual needs: Community vs. Individual needs:

InsuranceInsurance• Consider having regional meetings Consider having regional meetings

with shareholders in other area with shareholders in other area schools to share good ideas and schools to share good ideas and increase leverage with local medical/ increase leverage with local medical/ community resourcescommunity resources

Web InformationWeb Information

• Online screenings: Online screenings: Mentalhealthscreening.org; ULifeline.orgMentalhealthscreening.org; ULifeline.org

• Information/education about alcoholInformation/education about alcohol

• Student made DVD to incoming studentsStudent made DVD to incoming students

• Information about resourcesInformation about resources

• Many good web resources (JED (Ulifeline), Many good web resources (JED (Ulifeline), Mystudentbody.com, Alcohol.edu)Mystudentbody.com, Alcohol.edu)

• Launching mentalhealth.eduLaunching mentalhealth.edu

SummarySummary

• Emotional and Physical Well-Being Emotional and Physical Well-Being are crucial for Academic Successare crucial for Academic Success

• We all have to work togetherWe all have to work together

• Focus on Staying Healthy and Focus on Staying Healthy and Learning Healthy Lifestyles: Eat, Learning Healthy Lifestyles: Eat, Sleep and ExerciseSleep and Exercise