Mental Health has become a critical issue on college campuses. Here at BU, Behavioral Medicine clinicians report that the number of students in crisis coming in for help has increased sharply—from 647 in the 2014–2015 academic year to 906 last year. And the number of students needing medical transports for psychiatric evaluation has also risen, from 120 in the 2014–2015 academic year to 134 last year.
In light of this alarming trend, this week BU Today is republishing a special three-part series, “Mental Health Matters,” that was originally published last October. We have updated the series to include new statistics and information.
Jon was taking an EMT class at BU two summers ago, when “I could suddenly feel my own heartbeat. I could feel it,” he says. “It was really weird. For some reason I kept focusing on it, and it seemed to be just pounding out of my chest.”
Pain in his left arm followed. The SAR physiology student (he didn’t want his last name used) wondered if he was having a heart attack. But Jon was young and healthy, and the symptoms abated when he got home. When they returned a week later, his father took him to a local hospital. Nothing was wrong, he was told. Then it happened again.
His family doctor “was the first one to say, ‘I think you just had a panic attack,’” says Jon. He was stunned. “In my head, I was like, ‘Crazy people get panic attacks. I didn’t have a panic attack.’”
“Students are reporting significantly higher levels of anxiety, depression, and stress-related problems than they have in the past.”
But after checking out the symptoms online and thinking about what his doctor had said for several weeks, Jon booked an appointment with staff at BU’s Student Health Services Behavioral Medicine, a step he says he found really relieving.
Jon is one of many. Across the country, college counseling centers and mental health clinics are reporting record numbers of students seeking help for issues such as anxiety and depression.
A 2014-2015 survey by the Association for University and College Counseling Center Directors found that 73.1 percent of counseling center directors reported an increase in the severity of student mental health concerns and related behavior on their campuses, while only 1.4 percent saw a decrease and 25.5 percent were unsure.
“The demand for service has absolutely increased and that’s a national trend,” says Carrie Landa, director of Behavioral Medicine. “Students are not only coming to school with preexisting mental health issues, but with additional stressors and anxieties about performance and fitting in socially.”
At BU, the number of students coming to Behavioral Medicine in crisis has more than doubled in the last four years, from 647 in 2014–2015 to 906 last year, a 40 percent increase. Last year, 134 students were transported to hospitals for psychiatric evaluation after reporting suicidal thoughts, attempting suicide, or being in the grip of mania or psychosis. That number is up from the 120 medical transports in 2014-2015.
The Healthy Minds Study, an annual national online survey of college students about mental health issues created by the University of Michigan, found that 67 percent of 2015-2016 BU students reported that there had been at least one day in the past month when emotional difficulty had impaired their academic performance, up from 53 percent in 2012, and 32 percent reported three or more such days. About 44 percent said they thought they’d needed mental health help in the past year, but only 48 percent of that group said they had received help.
Signs that a student may need help
- Withdrawal from social contact or an overall contrast in behavior
- Not taking care of themselves (hygiene, etc.)
- Sleeping all the time
- Signs of self-injury (cutting, etc.)
- Increasing substance abuse
- Giving away possessions
- Social media posts alluding to suicide (“I can’t go on this way…)
“If you look at the national data across a wide variety of different indicators, it’s a pretty strong conclusion that college students are reporting significantly higher levels of anxiety, depression, and stress-related problems than they have in the past,” says Gregg Henriques, a James Madison University psychology professor and director of its Combined-Integrated Doctoral Program in Clinical and School Psychology, who wrote about the topic for psychologytoday.com.
More seeking help for a complex matrix of causes
Landa says the number of cases of major mental illness such as bipolar disorder and psychotic disorders has remained fairly consistent, but in looking for causes to explain the recent climb in anxiety, she and others say today’s students seem less well-equipped to cope with problems that to a previous generation would have seemed normal.
The increase seems to have a complex matrix of causes, some of which simply reflect society at large, says Henriques. “But my short answer is, it does seem that there are a lot of developmental factors contributing to individuals not knowing how to relate to their emotional experiences, how to deal with adversity in a way that’s adaptive.”
Experts point to a range of issues, from the growing use of social media to helicopter parenting to the ever-increasing focus on preparing for a successful career as explanations for the growing number of students experiencing anxiety, depression, and other mental health problems.
College has always been a time of transition, as students learn for the first time in their lives to navigate living on their own, juggling the demands of course work and a social life, adapting to roommates, figuring out healthy eating and sleeping habits. “Stress is normal,” says Landa. “That is something I say 100 times a day, if not more.”
But if stress is normal, what accounts for the uptick in students with mental illness? Clinicians interviewed for this series say they’re seeing a generational change. “I think a lot of kids don’t know what productive struggle is,” says Dori Hutchinson (SAR’85,’96), director of services at BU’s Center for Psychiatric Rehabilitation and a Sargent College clinical associate professor. “When it’s hard, they think, ‘Why is it so hard? What’s wrong with me?’”
Clinicians say social media plays a role as well. Students carefully craft their public persona on Facebook, Twitter, and Instagram to make themselves appear happy and successful. Many students who spend time on social media experience the phenomenon known as FOMO (fear of missing out)—and those who are struggling already may look at others’ feeds and feel even worse about themselves.
BU MENTAL HEALTH BY THE NUMBERS
The number of students given a regular intake evaluation when requesting assistance from Behavioral Medicine barely changed, while the number of those triaged for urgent evaluation grew by 40 percent.
The instant nature of social media means there’s little time for problems to blow over or the pain of a romantic breakup to subside. Getting “a letter in the mail had a natural waiting period,” Landa says. “Now if someone doesn’t respond to your email or text right away, you’re devastated.”
Social media may also inhibit students’ ability to connect socially, because so much of their interaction now is electronic. “Students are afraid to talk to their professors because they don’t know how to have face-to-face interaction,” she says.
The trend of so-called helicopter parenting or snowplow parenting—where parents hover over teenage children and do much of their problem-solving for them—can also make it more difficult for students to learn to succeed on their own.
“I think parents’ reaction to their sons’ or daughters’ distress often sends a this-is-really-a-problem message as opposed to a this-is-a-normal-development one,” Landa says. “Homesickness is something that we’ve been experiencing for decades, but the reaction to it now is quite different.”
She says these social changes can exacerbate the major challenges that have always been there: a genetic predisposition to mental illness, a history of abuse, or the death of a parent or sibling.
Also, more students diagnosed with a mental illness are arriving at college than in years past. Advances in medication and care mean that young people who wouldn’t have made it to college or would have had to drop out because of their illness are able to have successful college careers.
Who’s most at risk?
Preethi (a pseudonym) says she started feeling overwhelmed just weeks into her freshman year. “I was high functioning, threw myself into work, involved myself in a lot of clubs, had a nice internship,” says Preethi (CAS’17), who began to suffer from anxiety and depression.
There were several factors that put her at risk. She had attended a small high school where she knew everyone in her graduating class. Arriving at BU, where the average freshman class hovers around 3,600, she felt she was failing to make friends or connections. She had trouble sleeping and noticed changes to her appetite, eating junk food like popcorn and ice cream for days at a time rather than healthful meals.
Her family’s cultural background (she comes from South Asia) made it difficult for her to talk about what she was experiencing. She says when she first told her mother about being depressed and anxious, her mother was reluctant to accept it.
Eventually, Preethi made an appointment at Behavioral Medicine, where she started seeing a psychiatrist and was later prescribed an antidepressant.
Other segments of the student population who have an increased risk of developing mental health issues are students who identify as LBGTQ. Despite all the positive movement around coming out and gender issues, not all families and not all communities are accepting of those who are LGBTQ, which can make life difficult for students who are coming to terms with their identity. “And what about an international student who comes to the United States and identifies as trans, but they’re Saudi and they don’t identify like that in their own culture—what happens then?” asks Landa.
International students are vulnerable because in addition to facing the same stressors as everyone else, they have to assimilate into a totally new culture and are far from their network of family and friends. Many feel increased pressure to excel because their families have sacrificed financially so they can study in the United States.
BU MENTAL HEALTH BY THE NUMBERS
Number of referrals provided by Behavioral Medicine to students for mental health treatment services in the community:
Minorities in general are less likely to get treatment, Landa says, in part because it’s often less accessible. There’s a cultural element for some minority and international students that makes talking about family problems akin to airing one’s dirty laundry in public.
While varsity athletes don’t have higher rates of mental health issues, Landa says, the way they manage them can be different from the way an average student does. “If you think about being an athlete, it’s about endurance and tolerating the pain,” she says. “Getting them to acknowledge they’re struggling and to get treatment can be really hard.”
Behavioral Medicine: the first stop for those in need
There are several resources on campus where students can find help. They are the Center for Anxiety & Related Disorders, the Center for Psychiatric Rehabilitation, the Danielsen Institute, and the Sexual Assault Response & Prevention Center. But for most students seeking counseling, therapy, and other mental health services, Behavioral Medicine is the first stop.
Treatment provided there is generally short term, ranging from a single appointment to a semester’s worth of care, although there is flexibility. Services are free. Those students needing specialized treatment or long-term care are often referred to one of the other centers on campus or to an outside provider, most of which are required by insurance to charge a copay.
Behavioral Medicine doesn’t maintain a wait list as do some centers at other schools. Appointments are booked from within a day or 2 to a week or 10 days out, depending on demand. The peak times of the year are early fall and the period from midterms to the end of a semester.
For psychiatric emergencies, Behavioral Medicine providers are available 24 hours a day, seven days a week at 617-353-3569; emergency triage and walk-ins are available daily. “If a student is in visible distress, saying they’re really struggling or they can’t wait for the next available appointment, then we triage that patient,” Landa says. In some cases, students are transported to a hospital for further evaluation and care.
BU MENTAL HEALTH BY THE NUMBERS
Number of students transported from BU to hospitals for psychiatric evaluation:
Landa says those struggling with serious mental illness while at school may still have to take a leave of absence—and the question of readmission and a derailed education can be a source of stress all its own. She chairs a University committee that has created a holistic readmission policy at BU. Now students who want to return after a medical leave—whether for an appendectomy or an episode of depression—will have their request brought to a review committee comprising representatives of the Dean of Students, the student’s college, and the University Service Center. The new process began last fall for students applying for readmission for spring semester.
For Jon and Preethi, contacting Behavioral Medicine was life-changing. Jon says that during his first counseling session, after he listed his symptoms, his therapist pulled out a copy of the Diagnostic and Statistical Manual of Mental Disorders. “He asked me to read the symptoms of panic attack out loud, and I was like, damn, that’s it,” Jon says. “Everything was there—the heart palpitations, the flushed feeling, sweating, dizziness. He confirmed my diagnosis.” Jon continues to see a therapist at Behavioral Medicine periodically and says he has learned how to help stave off the panic attacks that plagued him.
Preethi’s experience has turned her into an advocate for others suffering from depression and anxiety. She says that too many students feel stigmatized by mental illness and are reluctant to acknowledge that they’re experiencing difficulties. Her mantra? “If you need help, get it.”
Landa says that it can be hard to get students to take a break from the very things that are stressing them out. They don’t feel they can afford it.
“Play, live—it’s not all work,” she says. “Giving students the tools to give themselves permission to do that is sometimes what therapy is all about.”
Those seeking free, confidential mental health counseling can contact Student Health Services Behavioral Medicine (617-353-3569) (available 24 hours for psychiatric emergencies), the Center for Psychiatric Rehabilitation (617-353-3549), the Danielsen Institute (617-353-3047), and the Center for Anxiety & Related Disorders (617-353-9610). Faculty and staff with mental health issues can contact BU’s Faculty & Staff Assistance office (617-353-5381). The Samaritans of Boston suicide prevention hotline is 877-870-4673. The Active Minds student support group is best reached through its Facebook page. For crises related to crime and interpersonal or sexual violence, BU’s Sexual Assault Response & Prevention Center crisis counselors are available 24 hours a day, 7 days a week (617-353-SARP) (7277). If you, or someone you know, have questions about their drug or alcohol use, Wellness & Prevention Services can help (617-358-0485). Students who require academic or other accommodations for a psychological disability can also consult with BU’s Disability Services (617-353-3658). Accommodations and services could include testing modifications, reduced course load, developing skills in self-advocating with faculty, executive functioning coaching, and more. Services are free and confidential.
Next, in part two of our series “Mental Health Matters,” we’ll look specifically at depression and anxiety among college students.
October 3, 2016