Mental Health Care in the College Community (eBook)

Dr. Kay is a Fellow of the American College of Psychiatrists and Distinguished Life Fellow of the American Psychiatric Association and has served as the chair of the APA Committee on Medical Student Education, the Council on Medical Education and Career Development, the Vestermark Award Board, and the Committee on the Practice of Psychotherapy. He chairs the World Psychiatric Association Task Force on Undergraduate and Post Graduate Curriculum as well as the APA Committee on College Mental Health. Dr. Kay is the immediate past chair of the Psychiatry Residency Review Committee of the ACGME and the Founding Editor of the Journal of Psychotherapy Practice and Research and Associate Editor of the American Journal of Psychotherapy. He has published extensively on the topics of medical and psychiatric education, medical ethics, child psychiatry, psychoanalysis, psychotherapy, the neurobiology of psychotherapy, and psychosocial aspects of AIDS and of cardiac transplantation, and has edited numerous books. Dr. Kay serves as the Associate Director of the Comprehensive Neuroscience Center at Wright State University. He received the 2001 APA Seymour Vestermark Award for contributions to psychiatric education. Dr. Kay's current research examines fMRI in borderline personality disordered patients with self-harm behavior. Dr. Victor Schwartz is currently university dean of students at Yeshiva University and associate professor of clinical psychiatry at Yeshiva's Albert Einstein College of Medicine. He established and was director of the Counseling Center at Yeshiva. Previously Dr. Schwartz was for many years the medical director and chief psychiatrist at the University Counseling Service at New York University. He has also served as assistant director of residency training in psychiatry at NYU School of Medicine. He is a Distinguished Fellow, an original member of the Presidential Task Force on College Mental Health and a member of the Committee on College Mental Health, and co-chair of the working group on law and college mental health all of the American Psychiatric Association. He is also a co-chair of the Committee on the College Student of the Group for the Advancement of Psychiatry. He has written and lectured extensively on college mental health; particularly around the areas of the intersection of law, administration and college mental health, the management of mental health crises in colleges, psychiatric residency training in college mental health services and psychopharmacology practice in college mental health.

MENTAL HEALTH CARE IN THE COLLEGE COMMUNITY 1
Contents 7
Preface 17
List of contributors 21
1 The Rising Prominence of College and University Mental Health Issues 23
1.1 Introduction 23
1.2 How Prevalent are Emotional Disturbances and Mental Disorders? 23
1.2.1 Student Surveys 25
1.2.2 Counseling Director Surveys 29
1.2.3 Toward a More Rigorous Assessment of the Mental Health of College Students 30
1.2.4 Alcohol and Substance Use 32
1.3 Study Limitations 33
1.4 A Developmental Approach to College Mental Health 34
1.4.1 Psychosocial Developmental Considerations 34
1.4.2 Biological Developmental Considerations 35
1.4.3 Toward an Integrative Approach 37
1.5 Ethical and Legal Issues 39
1.6 Conclusion 39
References 39
2 History of College Counseling and Mental Health Services and Role of the Community Mental Health Model 43
2.1 Introduction 43
2.2 Early Development of College and University Counseling Centers and Mental Hygiene Programs: Pre-1945 44
2.3 Professionalism and Response to Increase in Student Enrolment 45
2.4 Formalization of Roles and Attention to Developmental Issues and Prevention 47
2.5 Community Mental Health Movement 47
2.6 An Example of the Early Application of Community Mental Health at Colleges and Universities: Dana Farnsworth 49
2.7 Potential Modern Applications of the CMH Model to Educational Settings 51
2.8 Conclusion 52
References 53
3 The Reporting Structure and Relationship of Mental Health Services with Health Services 55
3.1 Introduction 55
3.2 Review of Literature 56
3.3 Administrative Integration Issues 57
3.3.1 Staff Professional Identity 57
3.3.2 Mission and Vision 58
3.3.3 Accreditation 58
3.3.4 Scheduling and Electronic Health Records 58
3.3.5 Con.dentiality 58
3.3.6 Financial Support 59
3.4 Clinical Issues 59
3.4.1 Multidisciplinary Teams 59
3.4.2 Mental health Screening in Primary Care 60
3.4.3 Reporting of Psychiatry Services 61
3.5 Recommendations 61
3.6 Conclusion 62
References 62
4 Components of an Effective College Mental Health Service 65
4.1 Introduction 65
4.2 Leadership Philosophy and Staff Morale 66
4.3 Administrative Issues 66
4.3.1 Clinic Location 66
4.3.2 Clinic Layout 67
4.3.3 Scheduling and Record Keeping 67
4.3.4 Funding 68
4.3.5 Campus Consultation/Threat Assessment 69
4.4 Clinical Services 70
4.4.1 Triage/Screening 70
4.4.2 Case Management and Case Disposition 71
4.4.3 Coordination of Counseling and Psychiatry 71
4.4.4 Challenging Clinical Issues 72
4.4.5 Confidentiality 73
4.5 Working with Outside Community Mental Health Resources 73
4.5.1 Psychiatric Hospitalizations 73
4.5.2 Referrals to Community Providers 75
4.6 Conclusion 75
Appendix A: Triage Form (Adapted from Cornell University) 75
References 77
5 Essential Services in College Counseling 79
5.1 Introduction 79
5.2 Access to Care 80
5.3 Clinical Consultation, Treatment Planning and Referral 81
5.3.1 The Initial Interviews 81
5.3.2 Diagnostic and Extradiagnostic Factors in Treatment Planning 84
5.3.3 Implications of Phase of Life Issues for Treatment Planning 85
5.3.4 The Referral Process 87
5.4 Personal Counseling and Brief Psychotherapy 89
5.4.1 Solution-Oriented, Focused Treatment 89
5.4.2 The Counseling Relationship 92
5.5 Medication Services 94
5.5.1 Models of Care 94
5.6 Referring Students for Consultation 95
5.6.1 Medication Consultation 96
5.6.2 To Medicate, or not to Medicate 96
5.6.3 Talking to Students About Medication 97
5.7 Group Therapy in College Mental Health Services 99
5.7.1 Types of Groups 99
5.7.2 Considerations in Setting Up a Group Program 100
5.8 Psychological Testing and Assessment 101
5.8.1 Types of Measures 102
5.8.2 When to Use Tests and Other Measures 102
5.8.3 Interpreting Test Results 104
5.9 Community Outreach 106
5.10 Concluding Remarks 109
Appendix A: The Relationship Between Predictive Validity and Base Rate 109
References 111
6 The Counseling Center Team 117
6.1 Introduction 117
6.2 The Team 117
6.2.1 Director 117
6.2.2 Other Administrators 121
6.2.3 Therapists 121
6.2.4 Psychiatrists 123
6.2.5 Trainees 124
6.2.6 Others 125
6.2.7 Support Staff 126
6.3 Challenges to Morale and Teamwork 126
6.4 The Director's Responses 128
6.4.1 Hiring 128
6.4.2 Communications 129
6.4.3 Decision Making 129
6.4.4 Supportive Meetings 129
6.4.5 Supervision and “Schmoozing” 130
6.4.6 Relationships with Staff Members 130
6.4.7 Feedback 130
6.4.8 Forbearance 131
6.4.9 Rewards and Incentives 131
6.4.10 Evaluation 132
6.4.11 Professional Development 132
6.4.12 Major Problems 133
References 133
7 Legal and Ethical Issues in College Mental Health 135
7.1 Introduction 135
7.2 Conceptual Framework 135
7.2.1 Privacy/Autonomy 135
7.2.2 Campus Safety/Parental Involvement 136
7.2.3 Con.icting Incentives and Players 136
7.3 Legal Framework 137
7.3.1 Confidentiality 137
7.3.2 Liability for Suicide 145
7.3.3 Discrimination 149
7.4 Application 151
7.4.1 Dismissals/involuntary leaves of absence 151
7.4.2 Reasonable accommodations 154
7.4.3 Mandatory assessments and treatment 155
7.4.4 Discipline/safety 156
7.4.5 Student support committees/threat assessment 157
7.4.6 Parental communication/notification 157
7.4.7 Screening 158
7.5 Conclusion 160
References 160
8 Working with the Campus Community 165
8.1 Introduction 165
8.2 Some Developmental Considerations 165
8.3 The Evolution of the College Mental Health Service Mission 166
8.4 The College Mental Health Service and the University Community 168
8.5 Outreach Educational and Consultative Services to Students 169
8.6 Relationship of College Mental Health Service to the Faculty, University Administration and Deans of Student Life 170
8.6.1 Relationship to Faculty 170
8.6.2 Relationship with Campus Security Department 171
8.6.3 Responding to Campus Crises 172
8.6.4 Relationship to other Resources on Campus 172
8.7 Confidentiality 173
8.8 Conclusion 173
8.9 Appendix A: A Model “At Risk/Student Support Program” in a Small Residential Campus1 174
8.9.1 Student Services Component 174
8.9.2 Academic Component 175
8.9.3 Conclusions 176
References 176
9 Crisis and Crisis Intervention on College Campuses 179
9.1 What is a Crisis? 179
9.2 Crisis Intervention 181
9.3 Common Crises and Suggested Responses 184
9.3.1 Response to Traumatic Events 187
9.3.2 The Suicidal Student 189
9.4 When Does a Crisis Become a Psychiatric Emergency? 191
9.5 Disasters and Other Crises That Affect Multiple Students 193
9.5.1 Counseling Center Role in Crisis Response 194
9.6 Working with Campus Leadership to Prevent Crisis and Improve Mental Health 196
9.7 Conclusion 197
References 198
10 Working with Parents and Families of Young Adults 201
10.1 Introduction 201
10.2 Young Adult Development 202
10.3 Generational Effects 202
10.4 The Baby Boomers 203
10.5 Generation X 204
10.6 The Millennial Generation 204
10.7 Privacy Standards in Higher Education 205
10.8 In.uence of Case Law on Privacy 207
10.9 Privacy Meets Generational Attitudes 207
10.10 Privacy in the Transition from Secondary Schools to Higher Education 208
10.11 The Risk Management Team 209
10.12 Health Insurance 210
10.13 Family Therapy in the University Health Service 211
10.13.1 The Imposter Phenomenon 211
10.14 Required Medical Withdrawal 213
10.14.1 The Eating Disorders Team 213
10.14.2 The Students at Risk Committee in Action 214
10.14.3 Health Insurance Revisited 215
10.15 Behavioral Problems in the Residential Community 216
10.16 Mental Health Prevention 218
10.17 Crisis Management 219
10.18 Conclusion 221
References 222
11 Psychiatry Residency Training in College Mental Health Services 225
11.1 Introduction 225
11.2 Benefits to Services 225
11.3 Benefits to Trainees 227
11.4 Benefits to Training Programs 229
11.5 Characteristics of a Rotation 229
11.6 Centrality of Supervision 230
11.7 Didactic Curriculum 231
11.8 Developmental Psychopathology 233
11.9 Psychopharmacology 234
11.10 The Resident's Clinical Theoretical Framework 234
11.11 Increasing Visibility of Social Media 235
11.12 Fellowships in CMH 235
11.13 Conclusion 236
Appendix A: Helpful Hints for Supervisors 236
Appendix B: PGY IV (Postgraduate Year Four) Psychiatric Resident Rotation, Student Mental Health Rotations, Wright State University, University of Dayton 237
References 239
12 Psychology and Social Work Training in University Mental Health 241
12.1 Introduction 241
12.2 Administrative Matters 241
12.3 Ethical and Legal Considerations 242
12.4 Recruitment and Selection of Trainees 244
12.5 Running a Successful Training Program 245
12.6 From Theory to College Counseling Practice: CAPS Orientation for New Trainees 245
12.6.1 Orientation: Knowing the History, Mission, Setting, and Population 246
12.6.2 Knowing the History and Sociocultural Shifts 246
12.6.3 Knowing the Mission: The Importance of Outreach and Prevention 247
12.6.4 Knowing the Setting and the Population 247
12.7 From Theory to College Counseling Practice 248
12.7.1 The Seminar and Case Conference 248
12.7.2 Seminar Dynamics and Motivations 249
12.7.3 Sexual Attraction to Clients 250
12.8 Experiential Learning: Trainee Epistemology 251
12.8.1 Understanding Today's Student 253
12.9 Organization of Training 254
12.9.1 Principles of Experiential Learning 254
12.9.2 The Developmental Stages of Internship 255
12.9.3 Sequencing and Pacing of Training 256
12.9.4 Demystifying Psychotherapy in the CAPS Setting 256
12.10 Teaching the Intake Interview in the College Setting 257
12.10.1 The Student 257
12.10.2 The Trainee 257
12.10.3 Teaching the Initial Intake 257
12.10.4 Obtaining a Complete Initial Diagnostic Impression 258
12.11 Nurturing Competency, Addressing Deficiency 259
12.11.1 Nurturing Competence: the Supervisory Relationship 260
12.11.2 Nurturing Competence: Trainees Expectations of Treatment and of Themselves 262
12.12 Recognizing and Addressing Deficiencies 263
12.13 Social Work and Psychology Therapists-in-Training 264
12.14 Conclusion 264
Appendix A: Sample Syllabus for Counseling Center Trainees 265
References 266
13 Special Populations 269
13.1 Introduction 269
13.2 Athletes 269
13.3 International Students 271
13.4 Returning Students 273
13.5 Students with Chronic Illnesses 274
13.6 Graduate Students 276
13.7 Transfer Students 278
13.8 Lesbian, Gay, Bisexual, Transgendered and Questioning Students 279
13.9 Veterans 281
13.10 Victims of Sexual Assault 282
13.11 Conclusion 284
References 285
14 Using A Public Health Approach to Address Student Mental Health 289
14.1 Introduction 289
14.2 A Public Health Approach to Campus Mental Health 290
14.2.1 Risk and Protective Factors for College Students 291
14.3 Building Momentum and Infrastructure 293
14.4 Thinking and Planning Strategically 295
14.4.1 Describe the Problem and Its Context 295
14.4.2 Identify Priorities and Set Long-Range Goals 296
14.4.3 Consult the Literature to Identify Relevant Research, Theory, and Best Practices That Address the Targeted Problem 296
14.4.4 Select or Develop Programs 297
14.4.5 Develop an Evaluation Plan 298
14.4.6 Create an Action Plan 298
14.4.7 Implement Programs, Evaluate, and Make Improvements 299
14.5 Strategies for Promoting Mental Health and Preventing Suicide Among College Students 299
14.5.1 Promote Social Networks That Reinforce a Sense of Community on Campus and Strengthen Social Relationships Among Students, Faculty, and Staff 300
14.5.2 Help Students Develop Skills to Face Life Challenges in College and Beyond 301
14.5.3 Identify Students Who May Be at Risk for Suicide, Have Untreated Mental Health Problems, or Exhibit Early Signs of Mental Health Problems 302
14.5.4 Increase the Number of StudentsWhoSeek Help for Emotional Distress 303
14.5.5 Restrict Access to Potentially Lethal Means of Self-Harm and Suicide 304
14.5.6 Develop Policies and Procedures That Promote the Safety of all Students on Campus and Guide the Response to Campus Crises 305
14.5.7 Increase Student Access to Effective Mental Health and Other Support Services 306
14.6 Conclusion 307
References 308
15 Magnitude and Prevention of College Alcohol and Drug Misuse: US College Students Aged 18–24 311
15.1 Introduction 311
15.2 Methods: Calculating Changes in Alcohol-Related Mortality 311
15.3 Study Results 312
15.3.1 Heavy Episodic Drinking and Driving Under the In.uence of Alcohol 312
15.3.2 Alcohol-Related Traffic Deaths 313
15.3.3 Alcohol-Related Unintentional Non-Traffic Deaths 314
15.3.4 Total Alcohol-Related Unintentional Injury Deaths 315
15.3.5 Other Alcohol-Related Health Problems 315
15.4 Discussion: Estimates of the Magnitude of College Drinking Problems 316
15.5 Implications 317
15.6 Interventions to Reduce College Drinking 318
15.6.1 Individually-Oriented Interventions 318
15.7 Conclusions 335
References 336
16 Conducting Research in College and University Counseling Centers 347
16.1 Introduction 347
16.1.1 Research and Professional Development 348
16.1.2 Challenges to Conducting Research 348
16.2 Types of Research in University and College Counseling Centers 349
16.2.1 Data Collected from Counseling Center Clients 350
16.2.2 Center-Speci.c Data and Intake Instruments 350
16.2.3 General Intake Instruments 350
16.2.4 University and College Student Specific Intake Instruments 351
16.2.5 Outcome-Based Research 353
16.2.6 Multi-Center Outcome Research 353
16.2.7 Topic-Specific Research 355
16.2.8 Broad Surveys of Non-Clinical Student Populations 357
16.2.9 Surveys of Mental Health Providers 358
16.3 Practical Aspects of Conducting Research in Counseling Centers 359
16.3.1 Campus Collaborations 360
16.3.2 Ethical Considerations for Research at Counseling Centers 361
16.4 Future Directions and Conclusion 361
References 362
17 International Perspectives: College Mental Health in the United Kingdom 365
17.1 Introduction 365
17.1.1 A Brief `US–UK Dictionary' 365
17.2 Setting the Scene 365
17.2.1 A Brief History 366
17.2.2 Counsellor Training and Professional Bodies 367
17.2.3 Setting Standards for Professional Counselling Practice 368
17.2.4 Organizational Equivalents 369
17.3 Support Systems in UK Universities – Student Services 369
17.3.1 Brief Outline of Common Support Services 369
17.3.2 Counselling Services 370
17.3.3 Liaison Between Services 371
17.4 Student Mental Health – A Growing Issue 371
17.4.1 The Evidence and Universities' Response 373
17.4.2 UK Disability Legislation and Mental Health 376
17.4.3 The Impact of the NHS on University Counselling Services 377
17.5 The Experience of International Students in the United Kingdom 380
17.5.1 Culture Shock Applies 380
17.5.2 Accessing Support 381
17.5.3 For Students with Mental Health Problems 382
17.5.4 Access to NHS Medical and Mental Health Services 382
17.5.5 So, Is It Worth Coming? 384
17.6 Conclusion – Where Does This Leave University Counselling? 384
References 385
Index 387

"I would encourage any individual working at the college or university level that comes into contact with students to read Mental Health Care in the College Community" (Synergy, NASPA Newsletter, February 2011)

"I read this text with the same mantra running through my mind: "This book IS good for me, despite my reaction to its psychiatric lens." Indeed, this book is very, very good. There is a tremendous amount of information culled from a variety of sources (bear in mind that articles in this field are published in many different journals), and this information is seasoned well with the authors' clinical and administrative experiences ... offers a smorgasbord of pertinent, informed, and thoughtful chapters on working in the college setting." (Journal of College Student Psychotherapy, 2011)

"Mental Health Care in the College Community provides an enormous amount of valuable information on a number of diverse topics pertaining to the campus setting. Working with parents, different model of care, suicide prevention, training programs, and working with special populations are just a few..." (American Journal of Psychiatry, 2011)

"This thorough review and discussion of intervention studies could be helpful to student affairs departments (e.g., residential living, judicial affairs) in making decisions about which approach best fits their campus." (PsycCRITIQUES, November 2010)

"... 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." (MIWatch.org, 2010)

"... Mental Health Care in the College Community is an excellent overview of the key aspects of college mental health services provision. It will be of great help to administrators as they evaluate their existing mental health services or plan for their improvement and expansion ." (MIWatch.org, 2010)

"I would like to thank you and Dr. Schwartz for your excellent work on your book "Mental Health Care in the College Community." I am a psychologist who has held leadership roles in community mental health centers and hospitals for 20 years... Finding your book was a godsend in quickly bringing me up to speed on the issues...I look forward to joining the ranks of college counseling directors and furthering the development of this important field." (Gary Dunn, 2011)