Welcome to our special section, Thrive on Campus, devoted to covering the urgent issue of mental health among college and university students from all angles. If you are a college student, we invite you to apply to be an Editor-at-Large, or to simply contribute (please tag your pieces ThriveOnCampus). We welcome faculty, clinicians, and graduates to contribute as well. Read more here.
College students across America are facing significant mental health challenges, leading some to call the situation a “campus mental health crisis.” Many students are unaware and unprepared for these challenges. The social, academic, career planning, and financial pressures can all contribute to emotional stress. The high school to college transition alone can be challenging. There are ways to manage these challenges including effective coping strategies, professional treatment and accommodations. Yet, many students simply drop out when challenges become overwhelming and traditional alternatives fail. However, taking a medical leave may be the best short-term and long-term option. And fortunately, there are programs that can facilitate your return, like Fountain House’s College Re-entry Program.
Mental Health Challenges
According to the American College Health Association Fall 2019 National College Health Assessment, 27.6% and 21.5% of students experienced anxiety and depression, respectively, which can be overwhelming. A significant number of cases can worsen to a disorder when ongoing signs and symptoms cause frequent stress and compromise functioning. Co-occurring anxiety and depression disorders may make things even worse. Also, 50% of students experienced loneliness, which can lead to be isolation and withdrawal and be a risk factor for suicide, the second leading cause of death for college students. Indeed, college years are a critical time for mental illness development as 75% of all lifetime mental illness develops by age 24. College drinking rates are also high, which may also exacerbate a mental health condition. A mental health screening may help determine if professional care is appropriate.
Mental health problems and mental illnesses may be chronic, progressive, and/or debilitating, and they need immediate attention. They may impact physical health. They may also lead to relationship difficulties with friends and family, contributing to social isolation and withdrawal. The impact on academics may be significant. Mental health issues can affect a student’s energy level, concentration, dependability, cognitive ability, and optimism, hindering performance. In fact, a student who is struggling with their mental health is twice as likely to leave college without graduating.
Medical Treatment on Campus
The initial step to addressing a mental health concern is to seek treatment at a college counseling office. However, on-campus mental health treatment may be limited. Counseling center utilization has significantly increased in recent years. Yet, most counseling centers are working with limited resources with fewer therapists than recommended.
Academic accommodations may be an effective option to help manage the academic impacts of mental health challenges. The most important accommodations for many students are extra time on exams and/or assignments. The American with Disabilities Act (ADA) and the Section 504 of the Rehabilitation Act (“Section 504”) require college’s to offer reasonable accommodations. Information may be found at the college’s accommodations and disabilities office. Disclosure of a medical condition and documentation from a health care provider will be required.
Where available mental health treatment and accommodations have failed to adequately address mental health concerns, a voluntary medical leave or leave of absence may be an effective option. A student’s support team should be consulted, including the medical treatment team, family and academic advisors. During a leave, a student is not enrolled in classes, but intends to return. There are many potential benefits to taking a medical leave, but there are also important considerations. Above all, mental health should be prioritized.
Whether or not the leave is voluntary or involuntary, the A.D.A. and Section 504 may afford a student with certain rights and protections. Students with mental health concerns engaged in self-injurious behavior may be placed on involuntary leave, which may be treated differently than a voluntary leave. It is important for students to carefully understand a college’s policies, practices and procedures concerning a voluntary medical leave. The following are a few additional considerations for medical leave:
- Academic — There are many academic issues to consider. These include the treatment of completed work and whether academic records will note an incomplete or withdrawal. These are important as they may impact future applications for graduate school, scholarships, internships, and employment. Confidentiality and privacy concerns should also be considered.
- Financial — There may be many financial impacts if a student takes a leave, which should be carefully reviewed with university officials and public and private institutions granting scholarships and grants and lenders. Important considerations include:
- Will amounts paid for tuition, housing, and meal plans be refunded or prorated? Is there an existing tuition insurance policy?
- Will scholarships and grants be forfeited in part or in whole?
- Will student loans be subject to early repayment?
Inquiries on refunds, forfeitures, grace periods, accrual of interest, and deferments should be made. It may also be important to know if college health insurance will remain in effect. A college’s Financial Aid Office or Bursar may offer guidance.
- College privileges — It may be important to a student to maintain some form of connection with college friends. If allowed, continuation of student privileges such as access to college email accounts and student facilities may facilitate this.
- Return to School — A return to school should be contemplated and planned. A few important considerations are documentation, deadlines, and conditions. A key issue is if re-application will be required. If a school places unreasonable conditions on a return, a student may be able to file a grievance with the disability compliance officer.
While a voluntary medical leave may pose a number of challenges and risks, it may still be the best option. A few benefits, include:
- Best care possible — Due to college counseling limitations, the best care possible may be available off-campus and under the supervision of a familiar provider such as a former therapist or family doctor. This access may improve the chances of treatment compliance. Only 40% of students with mental illness seek help on-campus. Also, a strong support network, which may only be available at home, is important to overcoming mental health challenges.
- Academic performance — Good mental health can maximize academic performance. Bad mental health may lead to significant disruptions in work, incompletes, dropped classes, lighter course loads, and lower GPAs. It may even place a student at risk for a mandatory leave due to poor academic performance. An involuntary leave may have more negative repercussions than a voluntary leave. Worse, poor academic performance may impact future academic pursuits, employment prospects and earning potential. Scholarships may aid in the return to college. The Center for Reintegration‘s Baer Reintegration Scholarship Program offers scholarships for people living with serious mental illness.
- Social consequences — Social consequences are not as great as students may fear. During an absence a student may remain in touch with college friends. Good mental health may allow students to maintain better social relationships instead of the isolation and withdrawal so common when a person has mental illness. Many of these relationships are likely to continue even after a leave is taken and a student returns to college. In fact, at most public universities, only 19% of full-time students earn a bachelor’s degree in four years.
In deciding whether to take a leave, the most important consideration must be mental well-being as it can impact every aspect of our lives now and in the future.
Fortunately, there are programs that can help a student return with significantly greater chances of better managing a mental health condition and excelling academically. Fountain House’s innovative and ground-breaking College Re-entry Program is one such program.
Fountain House’s College Re-entry Program
The College Re-Entry program’s primary goal is to help students build self-confidence and develop the knowledge, skills, and abilities to succeed in school through academic, wellness, and social interventions. This, coupled with their ongoing, external clinical support, gives young adults the foundation they need to excel.
Through the College Re-Entry program, young adults ages 18-30 participate in a highly organized curriculum based on their unique needs. The program, which primarily serves students and families in the New York City tri-state area, focuses on engaging undergraduate college students who have withdrawn from their academic studies due to psychiatric disability (e.g. depression, anxiety, bipolar, and schizophrenia) by developing and implementing an action plan to return to college and providing the necessary skills and strategies to successfully reach their educational goals. The program is a non-clinical model working as a bridge between students’ clinicians and colleges while a student is on leave. Through the COVID crisis, the program now offers a virtual curriculum allowing College Re-Entry to extend its reach.
Attuned to the needs of young adults living with mental illness, and in the absence of a non-clinical approach addressing the growing needs of college students, Fountain House applied its community mental health model to develop the College Re-Entry program in 2014. Fountain House built the program based on the premise that it takes more than medication management and talk therapy to support a young adult student’s successful return to college after a debilitating mental health interruption. It is within this vein that they built a comprehensive curriculum that:
1) Encompasses classes aimed at strengthening academic skills.
2) Offers wellness workshops aimed at reducing stress and increasing resilience.
3) Creates social opportunities aimed at combating social isolation and anxiety.
The Core program operates on a trimester schedule and offers a structured 14-week curriculum consisting of 15 hours of in-house classes per week, one hour of one-on-one coaching, and several additional social activities. After the completion of the Core program, College Re-Entry offers an additional semester of support for students who are back in school, ensuring a higher rate of college retention. Throughout the Core program and continued support semester, students are further supported by their academic coach who can help with all of the administrative details for returning to college. Alumni of the program can continue to get support from their coach as needed.
In addition to this curriculum, each student is paired with an academic coach who helps guide them through the process, as well as looks at their academic goals and logistics for re-entry. The College Re-Entry Center was built as a peer-supported space near Fountain House’s main clubhouse to give young adults the opportunity to be around other college students who have had similar experiences. The College Re-Entry Center and the program itself mirrors a typical college environment and structure as much as possible, incorporating classes taught by college professors, along with spaces conducive to learning and socializing.
Impacting Student Lives
The College Re-Entry program has the capacity to dramatically change the lives of young adults living with mental illness. As a holistic early intervention program — the only one of its kind — College Re-Entry has been successful in keeping students engaged and getting them on the path to achieving their academic goals. In addition to helping 75% of students return to college, the program found statistically significant evidence showing that both self-efficacy and mental wellbeing improved for students after completing the program. Opportunity now lies in the expansion and replication of the College Re-Entry program on college campuses and in communities nationwide.
In the words of College Re-Entry Alumna Shannon Pagdon: “I was extremely fortunate with the group of people who went through the program with me; they all taught me a lot, and I am so appreciative of that. I also loved all the different subjects we covered, including notetaking, nutrition, budgeting, and self-care (and that is just a few things we covered!).”
The College Re-Entry program has been acknowledged as filling a critical need by educational partners, clinicians, and experts in the mental health field. Michael Birnbaum, M.D., Director of Early Treatment Program at North Shore, notes: “The early stages of mental illness interfere with precious periods of healthy development. Early intervention services, such as Fountain House’s College Re-Entry Program, are designed to minimize disability, reduce symptoms, promote recovery, and instill hope. These interventions can have positive impact lasting a lifetime.”
More and more students are experiencing mental health challenges in college, but these are not insurmountable. There are on-campus resources and tools that can help such as counseling offices and academic accommodations. However, sometimes this help is not enough. Some students may require additional support that may not be available on campus. There are a number of alternatives to consider. For example, a medical leave can allow students the time and focus to treat and manage their illness and develop the self-care and academic coping strategies that will allow them to return to school better able to perform academically. Fortunately, there are programs like the Fountain House’s College Re-entry Program that can help make this possible. They can help students pursue and achieve their dreams of earning a college education if threatened by mental illness. Unfortunately, many students simply do not know where to turn for help and what additional options may exist. Students who do not access available resources to address their mental health challenges may ultimately drop out. This outcome represents not only a personal loss, but a loss to society, that can be avoided.
Bazelon, Campus Mental Health: Know Your Rights, 2008
Healthy Minds, Investing in Student Mental Health, 2019
National Alliance on Mental Illness, College Students Speak, A Survey Report on Mental Health, 2012
Penn State, Center for Collegiate Health, 2017 Annual Report
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