Many people go to college between 18 and 22 years old—a timeframe that just so happens to coincide with the onset of most major psychological illnesses. “That's no one's fault; it just is,” says Stephanie Pinder-Amaker, a clinical psychologist and the founding director of the College Mental Health Program at McLean Hospital. Developmentally, the young adult years are when a person is most at risk for mental health disorders. It’s also when people tend to experience new mental health symptoms they’ve never felt before.
Studies and surveys show that mental health issues among college students are increasing; a study from this year found that one in three college freshman had symptoms of a diagnosable mental health disorder. One contributing factor, aside from genetics, is that it’s a period of change and stress in a young person’s life.
"Just think about the life of a college student and all the stressors that they might be facing—being away from home for the first time, academic stress, relationship stress, exposure to substances, and so on,” Pinder-Amaker says. “These make the college years an ideal time to be really aware of mental health issues and risk factors, and seeking additional professional support if needed.”
Luckily, nearly every university and college these days will have some kind of counseling center or network. But just because your school has therapists, there can still be barriers to access, or feelings of uncertainty about when to go. Here's a guide with insight from experts on how to use your school's mental services and when.
Know that there are usually options, even when mental health services are overcrowded at your school
Some schools are finding themselves understaffed, and there can be waitlists that prevent you from being seen for several weeks. Or, a limit on how many sessions you have with a counselor. This doesn’t mean that your school can’t help you, though.
Pinder-Amaker says there’s a wide recognition of this growing demand, and that a lot of schools are recognizing when needs spike—like the end of the semester or the end of the academic year. Many schools are now increasing their services during those times, and could have more hands on deck to help. If you went during an of time and were turned off by how busy the place was, try again during one of these potentially more-staffed time periods.
A lot of schools now have a referral systems, which can help you find a therapist that takes insurance nearby, for when sessions aren't available at school, says Gregg Henriques, a professor in the department of graduate psychology at James Madison University. You can ask if your school has “case managers." They are often social workers who can meet with you and help get you to a therapist quickly. Pinder-Amaker also mentions Thriving Campus, a website which can help students find providers near them. She thinks this kind of service is a trend that we’ll only see more of going forward.
If you do get a diagnosis of say, major depressive disorder or panic disorder or social anxiety disorder, you may be eligible for additional accommodations and supports and services through your school's disability services beyond the basic counseling center. This requires some follow up, but if you get diagnosed, there's no harm in asking.
Pick someone to keep mental-health tabs on you
If a counselor can’t see you right away, don’t give up. Have an accountability partner, suggests Marcia Morris, a psychiatrist who has been working with college students for more than 20 years at University of Florida, and the author of The Campus Cure.
This could be a parent, your roommate, a friend or partner—someone who knows that you’re trying to get into therapy and who will follow up and ask how it’s going. “It’s someone who's going to encourage you,” Morris says. “So that you’re not trying to do this alone." This works the other way too: If you notice that your roommate isn’t sleeping, or never going to class, reach out, Morris says. It can be difficult for a person in distress to initiate that conversation, so take the lead.
“You can say, ‘Listen. You look like you're really having a tough time. Let's go to the walk-in hours at the counseling center,’” Morris tells me. “Later, a roommate can check in and say, ‘Hey, did you make that appointment? How did it go?’”
This can also be a way to tackle the stigma of seeking out help for mental health. A recent study from UCLA found that students with suicidal thoughts were less likely to seek help if there were high levels of stigma around mental health at their schools. If you show the people around you support, you could be helping them get the treatment they need.
If you’re feeling like you can’t rely on a friend or roommate, look and see if there’s a mental health advocacy or support group on or near campus. One such group, Active Minds, started at University of Pennsylvania, now has chapters all over the country.
Also, Morris, says, many school are now offering group therapy, which could be a great place to find your accountability partner. “Group therapy can be a great way to explore that ," she says. "Group therapy can do two things. It can help you explore who you want to be, but also address problems and prevent them from building up.”
Note the signs that might mean you should see a therapist
Mental illness can creep up slowly, and its symptoms might not be always be obvious. Look for disruptions in your daily life and routines, says Pinder-Amaker, like changes in sleeping or eating—too much or too little of each—or changes in mood.
Feeling hopeless, sad, or losing interest in activities you once enjoyed are indications you've probably heard before. But emotions like guilt, rumination, and excessive irritability could also be signs that you’d benefit from a counseling session or two. You could also consider it if you’re having a hard time concentrating and focusing, and your mood is impacting your ability to do your assignments or study.
“There can also be a strong desire or an increase in a desire to withdraw and isolate from others,” Pinder-Amaker says. “Not wanting to socialize, not wanting to join friends for activities within the residence hall and that kind of thing, and wanting to be more alone and isolated from friends and others. That's a warning sign.”
But trust your instincts, Morris says. Even if these symptoms don’t match exactly how you feel, “It's still enough to say, "Something isn't right, I'm not feeling good. I'm not feeling myself,” she says.
Don’t let mental health symptoms go on for more than two weeks
Pinder-Amaker says that when she talks to students, she asks them how long they wait before getting help. “It's fascinating to hear," she tells me. "Sometimes they'll say two months, and sometimes students will say they'll wait through the semester, and they'll wait six months."
The actual amount of time she suggests before talking to someone? Two weeks. If your symptoms persist for longer than two weeks, it can’t hurt to check things out, and see if you can start feeling better faster. Pinder-Amaker says that the majority of students who do end up taking a leave of absence from school for mental health issues were ones who did not seek help sooner.
Know the difference between regular drinking and problematic drinking
Substance abuse can often go hand in hand with mental health issues. Henriques says to ask yourself: What are you drinking for and why? Drinking in social situations is one thing. But sometimes, he tells me, people use alcohol, weed, or other drugs to escape. They feel chronically anxious and imbibing makes them feel better, or they feel they can’t talk to new people at all if they’re not drunk. If you find yourself blacking out a lot, that could be another warning sign.
Importantly, Henriques says it might be a more serious issue if you’d like to curtail your drinking or other substance use, but have a hard time living up to the promises you make to yourself.
“This is when people tell themselves that they're not going to black out this weekend and then find they can't stick to it, especially in a really short period of time,” he says. “All of a sudden it's Saturday night, and you've had 12 drinks and you wake up Sunday forgetting [the night before]. That's certainly a good indicator of problems. Drinking for the right reasons in moderation, that's generally what you want in the college world. Drinking for the wrong reasons and drinking to excess; that's when we recognize it to be problematic.”
Get a lay of the land about sharing sensitive information—and how it will affect your academics and life
Students at Stanford have recently filed a class action lawsuit claiming that when they mentioned their depression, suicidal thoughts, and other mental health issues, the school pushed them out of their academic programs.
“The legal responsibilities or the counseling responsibilities are not easy to navigate and when lawyers get involved in the context of an aftermath of the case,” Henriques says.
This is a complex issue, the experts agree. If someone is considering suicide, it’s crucial that they get the help they need, and sometimes that includes things like medication, medical leave, and a hospital stay. But students may be discouraged from seeking help if they feel their lives will get derailed and they’ll be forced to leave school when they don’t want to.
If this is you, the best way to navigate this is to ask clear questions at the very beginning of your visit with a school counselor. If you have concerns, ask questions like: What do you do if somebody's suicidal? When are you obligated to contact my parents, or another third party? You should be able to ask anything you want before you’re officially a patient, and it can help you decide what you want to do. Perhaps you'll decide to seek a counselor outside of the university instead, or get peace of mind about what will and won't happen.
“Raise questions and concerns about what is going to result in the escalation of a matter to a crisis or at what point is a therapist going to be required to take whatever is said in confidence outside of that relationship," Pinder-Amaker says. "I would encourage students to ask their therapists those questions directly at the outset of their relationship."
Consider seeing a therapist even if you don’t have a mental illness
Problem with your relationship? Issue with your roommate? Not sure if your major will lead to a real career? These are all perfectly valid reasons to see a counselor, even if they’re not accompanied by severe mental health issues.
Henriques says that the college years are a time to form your identity and understand what kind of life you want. It can be helpful to have someone listen to those thoughts—even just once—and give feedback.
“The engagement in psychotherapy or counseling is really something that I would encourage virtually everybody to consider,” he says. “Spend some amount of time saying, ‘Hey, who am I? What do I believe? What do I want to do? Where am I? And do I know what I'm doing to be congruent with my long term goals?’ Those kinds of identity reflections are very appropriate for all young adults.”
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