Reviewed by Anna Scheyett*
When speaking with administrators in higher education about their greatest challenges, the topic of students with mental health concerns usually rises to the top of the list. Colleges and universities educate, house, oversee, and are responsible for the safety of large numbers of young adults living together and sharing a number of mental health vulnerabilities. These include significant and taxing developmental challenges, environmental stressors, and increased risk for the development of serious mental illnesses such as schizophrenia and bipolar disorder. Such vulnerabilities can lead to painful and sometimes dangerous outcomes, which must be attended to by the institution.
Colleges and universities are faced with a number of barriers in meeting the mental health needs of their students. First, they often have little information about a student's prior mental health treatment beyond student self-report. This is compounded by the fact that the vast majority of students are legally adults, and thus protected by complex mental health state and federal confidentiality laws as well as federal law (FERPA) protecting their educational records. In this context colleges and universities struggle to provide services to address treatment needs that range from psychoeducation to therapy to medication.
A guide to help administrators in higher education navigate these complexities and provide quality mental health services to students has long been needed. Mental Health Care in the College Community fills this need. With chapters covering nearly every aspect of mental health care in higher education and written by experts in the field, the text provides administrators with a broad view of what must be considered if an institution is to provide quality mental health care to students.
The initial chapter establishes the scope of the problem, providing extensive information on the types and prevalence of mental health issues in college populations. Subsequent chapters explore the structure, policies, and essential components of a college mental health service, discuss both typical and best-practice collaboration between the mental health service and parents, the community, and academic programs, examine the needs of special populations within the college community, and provide recommendations regarding training and research.
Chapters in Mental Health Care in the College Community can each function as stand-alone resources; however a few important themes weave throughout the text, surfacing in multiple chapters. One theme is the difficulty mental health services have in addressing two very different types of student need--support in mastering developmental challenges and life changes, and treatment for serious mental disorders. Both require attention and care, but require quite different interventions, which can stretch a mental health service's capacities to its limits.
A second theme heard throughout the book is the importance of outreach and networks. College mental health services must reach out to academic leaders, community providers, emergency services, primary care services, and have protocols and student support teams in place to provide well-planned, seamless care to students. Outreach should also include education for the broader college community regarding mental health issues. A number of chapters refer to outreach using community mental health and public health models in conceptualizing and designing services. For example, one chapter describes the use of a public health risk and protective factors model to design a suicide prevention and mental health promotion program. This program works to enhance student strengths and protective factors by providing programming to increase students' social supports and develop their life skills, as well as increase their willingness to seek mental health help if needed. It also addresses risks for suicide by providing mental health services, identifying high risk students, and establishing strong crisis management procedures and services.
Students' perceptions of the ease of access to services, the quality of services, and the ability to receive services confidentially were also discussed in multiple chapters. Authors emphasized the importance of rapid response and multiple points of access such as student health services, campus ministries, and dean of students office. Additionally, they discussed how important it is that students perceive the mental health service as non-punitive and trustworthy, so they will seek services rather than avoid them for fear of repercussions in the classroom or elsewhere in the college community.
Several chapters in Mental Health Care in the College Community are of particular interest because of their quality and the unique topics they cover. A discussion of "Legal and Ethical Issues in College Mental Health" is among the clearest discussions of this topic I have read. It also manages to convey complex legal information while remaining focused on client needs and rights. One example is the excellent discussion of student confidentiality, where the authors address some of the common misconceptions about what makes up an educational record and under what circumstances one can legally share educational records with others.
Elsewhere are unique perspectives, discussing college mental health services as professional training sites for psychiatry residents, pre- and post-doctoral psychology students, and social work students. They identify the key elements of such training, with particularly sensitive and thorough discussion of the supervisory relationship. I did note that here, and throughout the text, the focus is more on psychiatrists and psychologists, with minimal mention of social workers and no discussion of psychiatric nurses, professional counselors, rehabilitation counselors, and other mental health professionals who may provide services in college settings. Given that each discipline has a slightly different philosophy and focus, the text misses the opportunity to discuss how a college mental health service negotiates potential difficulties when members of the team from different disciplines have different formulations and foci for the student's treatment.
Another chapter addresses another academic topic, conducting research in college mental health services. It provides a detailed discussion of the value and types of research best suited to this setting, such as intervention outcome research. It also explores the challenges faced when engaging in such research, including limited resources that may preclude engaging in research and difficulty obtaining support from university administration, particularly if researching topics that may be seen as sensitive or controversial such as sexual assault on campus or stressors experienced by LGBT students. It also provides a clear discussion of practical aspects of conducting research in a college setting.
One particularly useful section discusses considerations if mental health centers are exploring partnerships with university departments such as psychology or sociology. Important questions to ask include: Is the center being asked to collaborate simply because it is seen as a repository of easily accessed subjects? What kind of precedent will collaborating with a department set--should collaboration only occur with departments who place trainees at the center? How will client privacy and decisions regarding care be made for study participants? Will wait list controls, comparison treatment, no treatment groups be used? Perhaps most importantly: Does the research further the goals of the center itself?
Mental Health Care in the College Community deserves praise for its breadth of scope and discussion of unique topics such as training and research. Even so, I found myself wishing for more depth in a few areas. The collaboration between the mental health and academic "sides of the house" regarding students with mental disorders is complex, fraught with tension and the need for understanding and communication. Additional information on ways to negotiate this complex arena would have been helpful, including effective ways to educate faculty and administrators about student mental disorders. Outreach to students to provide mental health education is relatively straightforward, education to faculty and administrators who have competing time demands and vast autonomy is more difficult.
Two additional areas of omission in the text involve race/ethnicity and comorbid mental disorder and substance disorder. I was surprised to see no discussion of non-international racial or ethnic minorities under special populations. Cultural stresses and demands for adaptation to majority culture can be very difficult, and some information on culturally competent services would have been very valuable.
Substance misuse is a huge issue on college campuses. An estimated 45% of college students have reported consuming five or more drinks at one occasion in the past 30 days and nearly 38% report illicit drug use in the past year. Research indicates that substance disorders often coexist with mental health disorders. These comorbid conditions are particularly complex to treat, and some discussion of ways to do this in a college setting would have enriched the text.
In summary, though not exhaustively comprehensive, Mental Health Care in the College Community is an excellent overview of key aspects of college mental health service provision. It will be of great help to administrators as they evaluate their existing mental health services or plan for their improvement and expansion. This text does not provide the level of clinical depth needed for a clinician practicing in the field, but might also be of interest to family members or community providers who wish to understand more about recommended best practices in college mental health services.
*Dr. Anna Scheyett is the Associate Dean of Academic Affairs at the School of Social Work, University of North Carolina, Chapel Hill. In addition to research about psychiatric advance directives, she is engaged in research about serious mental illnesses, consumer rights and criminal justice.
She is the co-author of Helping College Students: PADs on Campus