One Hundred Years of College Mental Health

Abstract

Although the first student health service is credited to Amherst College in 1861, almost 50 years passed before Princeton University established the first mental health service in 1910. At that time, a psychiatrist was hired to help with student personality development. Although other schools subsequently established such services, the first 50 years of college mental health were marked by a series of national conferences. At the American Student Health Association's annual meeting in 1920, “mental hygiene” was identified as critical for college campuses to assist students to reach their highest potential. However, it took another 40 years before mental health and psychological counseling services became common on college and university campuses. The American College Health Association formed a Mental Health Section to serve mental health professionals in 1957, and most colleges and universities have now developed mental health and counseling programs commensurate with the size of their student bodies.     

Mental Health on the Campus Revisited

Abstract

The author briefly reviews Mental Health on the Campus: A Field Study, published in 1973, noting areas of consensus and points of tension or disagreement that were reported in that study. He then assesses the extent to which the current state of mental health on the campus is an echo of that report. These comparisons form the basis for anticipating the probable direction of future developments in campus mental health. The areas and issues considered include the increased diversity of the student body, the stable incidence of psychotic disorders, the increased prevalence of gender-related diagnoses such as sexual abuse and eating disorders, the continuing financial pressures bearing on campus mental health programs, and the forms of care and treatment that fiscal and other circumstances are imposing. The author concludes that although the resources available and the particular challenges that are faced may have changed, the traditional goals of a campus mental health program, as articulated 75 years ago when the American College Health Association was founded, remain valid, even if they are difficult to attain.     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

The Influence of Parent Expectations and Parent-Child Relationships on Mental Health in Asian American and White American Families

Previous studies have suggested that Asian parents’ high academic expectations can lead to negative mental health outcomes among Asian American youth. We explore this hypothesis by analyzing data collected in an affluent, suburban high school with a large Asian American population. We examine the relationships between parent expectations, students’ relationships with their parents, and mental health outcomes among Asian American (predominantly Indian American and Chinese American) and white youth. We find that the quality of parent-child relationships is associated with mental health outcomes and that the association between parent expectations and mental health outcomes is insignificant after controlling for these relationships. We discuss significant differences by race and gender. The findings presented expand our understanding of the influence of Asian parents. They suggest that focusing on improving parent-child relationships, as opposed to altering parents’ expectations, might lead to improved mental health outcomes for Asian American youth, particularly for those in affluent communities.     

Mental illness etiology beliefs among African American men with serious mental illness and their social support networks

Semi-structured qualitative interviews were conducted with 26 African American men with serious mental illness who were consumers of community mental health services and 26 members of their social support networks. All participants were asked what they believed had caused the consumers’ mental illness. Consumer participants most commonly identified chronic life stressors as a causal factor, while social supports most often identified intrinsic factors such as genetics or biology as causes of mental illness. Some support participants believed that unintentional drug use had precipitated the onset of mental illness or had no causal theories. The fact that some support participants could not identify a causal explanation may indicate failure on the part of mental health care systems to engage with consumers’ social support networks and provide education about mental illness and its causes. The implications of etiology beliefs on mental health service utilization are discussed.     

Mental Health Care for American Indians in Prison

Abstract

Based on an earlier finding that as many Native Americans in upstate New York received mental health care in prison as outside of prison during a 10-month period, this study was designed to investigate if prisons had become an alternative treatment option for Native Americans with a mental illness in New York State. The study was not able to answer this question due to the limited number of cases and to outside constraints. However, it is possible from the results to provide a picture of mental health needs and attitudes among Native American inmates which is surprising and instructive for those who provide psychiatric care to American Indians, either within or outside of prison walls. A noteworthy finding was the importance placed by these inmates on the use of culturally appropriate ceremonies to assist in their rehabilitation. Low rates of serious mental illness among the American Indian sample highlight the need for further study in this area.     

Can Health Care Reform End Stigma Toward Mental Illness?

This article addresses the destigmatization of mental health through health care reform by incorporating antistigma efforts—a destaining of mental illness—through prevention and early intervention in community-based programs that would be mandated and funded through the auspices of Patient Protection and the Affordable Care Act (ACA). Mental health care policies under the ACA and the Mental Health Parity Act are briefly described, following a definition of mental health stigma and its impacts. Recommendations for statutory mandates in stigma reduction at the community and federal levels and guidelines for mental health/behavioral health providers form the article’s conclusion.     

Making connections: Severe mental illness and closeness with other people

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.     

Implementation of a Mental Health Task Force in a collegiate-based emergency medical services organization

Abstract

Objective: A Mental Health Task Force (MHTF) was implemented in 2016 by a collegiate-based emergency medical services (CBEMS) organization to (1) improve mental health emergency response and to (2) address concerns for the mental health of CBEMS providers. Participants: Skidmore College EMS is a Basic Life Support First Response service staffed by volunteer undergraduate students. Methods: In coordination with faculty and staff, students in the MHTF developed trainings, peer support structures, community events, policies, and informational resources. Results: Sixteen students joined the MHTF within 1 year. Over 35 Skidmore College EMS members received training on mental health emergency response, peer-support, and self-care. Debriefing programs, mindfulness-based events, shift-length limitations, and access to informational resources promoted the mental health of Skidmore College EMS members. Conclusions: Implementing an MHTF is an innovative, student-led approach to coupling education on emergency response with programming that supports the mental health of CBEMS providers.     

No one is listening: Members of the Deaf community share their depression narratives

This exploratory case study conducted in Manitoba, Canada examined a unique social justice issue in the field of mental health, namely, how Deaf adults, all American Sign Language first-language users who were diagnosed with Depression, manage their symptoms in a mental health system that is based on spoken, not signed communication. Using in-depth individual interviews, and a hand-drawn Person and Environment Map, this study offers rich in-depth narratives of the experiences and challenges faced by members of the Deaf community seeking mental health assessment and intervention.     

Outcomes Measurement

SUMMARY

Outcomes measurement in health and mental health should be of vital concern to social workers since public support and financing will follow evidence of effectiveness. Social work in health and mental health requires a framework for conceptualizing outcomes measurement so that the profession can focus clearly on the work to be done in outcomes measurement. This framework should distinguish among the various ways that outcomes measurement can be used to advance policy, program and practice. This article discusses two applications of outcomes measurement, namely for improving policies and programs, and, second, for conducting outcomes research. Other dimensions that could be included in an outcomes measurement framework for social work in health and mental health are identified but not elaborated. The author's objective is to make a strong case for the role that outcomes measurement can play in both the improvement of social work policies and programs in health care, through performance measurement, as well as in advancing the healthcare knowledge base, through outcomes research.     

The Theory of Planned Behavior as it predicts potential intention to seek mental health services for depression among college students

ABSTRACT

Background: Between 9.5% and 31.3% of college students suffer from depression (American college health association national college health assessment II: reference group executive summary spring 2013. Amer. Coll. Health Assoc. 2013; Eagan K, Stolzenberg EB, Ramirez JJ, Aragon, MC, Suchard, RS, Hurtado S. The American freshman: national norms fall 2014. Higher Educ. Res. Inst.; 2015). Universities need to understand the factors that relate to care-seeking behavior. Objective: Across 3 studies, to relate attitudes, social norms, and perceived behavioral control to intention to seek mental health services, and to investigate barriers to care-seeking. Participants: University college students (N = 845, 64% female, 26% male, and 10% unspecified). Methods: New measures were created in Studies 1 and 2, and were examined using structural equation modeling in Study 3. Results: Partially consistent with the Theory of Planned Behavior (Ajzen, I, Fishbein, M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980), a model with an excellent fit revealed that more positive attitudes about care and higher perceived behavioral control directly predicted higher intention to seek mental health services. Conclusions: Educating college students about mental health disorders and treatments, enhancing knowledge about available services, and addressing limited access to long-term care might improve treatment rates for students suffering from depression.     

Working across borders to promote positive mental health and well‐being

World health reports highlight the increasing prevalence of mental health problems and the need to recognize that mental well‐being is a fundamental aspect of any health policy. The scale and cost of mental health problems mean that appropriate policies and strategies must be developed and implemented. In Ireland this is a period of substantial review and reflection on mental health policy and practice, but to date little consideration has been given to the development of a cross‐border strategy. Cooperation and collaboration has been largely dependent on the leadership of a number of individuals supported by short‐term European Union funding. This paper is informed by a study which was concerned with examining the issues associated with promoting mental health across the Irish border. Insights were provided by 38 individuals who were involved in the delivery of cross‐border mental health services in the North West region. The article argues that there is substantial support for working across borders and developing sustainable cross‐border health strategies. In the absence of a statutory all‐Ireland coordinated policy overseeing the development of mental health promotion, the sustainability of projects emerged as a key issue. The results suggest that whilst much innovative and creative work has been undertaken by committed individuals, what is now required is a strategic response from both the British and Irish governments which will ensure the needs of service users in these deprived border regions can be effectively addressed. Also, at a policy level this strategic development would be seen as a reflection of the value placed on promoting mental health and well‐being.     

Integrating creative art into a community-based mental health program for Asian American transition age youth

This paper advocates for the use of creative art as an adjunct in the delivery of mental health care for Asian American transition age youth in the United States. A case study of a participant in a community-based mental health program called Project FOCUS in Orange County, California details how art was used to assist a young woman to identify and achieve her personal goals, mitigate her emotional and behavioral problems, and reach a sense of overall well-being. The findings in this paper lay the groundwork for future research into how art can be systematically incorporated into community-based mental health programs to facilitate service utilization. Further, this study demonstrates that Asian American transition age youth face mental health challenges typical of their cohorts, despite being putative members of a “model minority.” The use of creative art transcends cultural and language barriers, and empowers Asian American transition age youth to explore their identity and express their emotions, which ultimately promotes their mental well-being.     

Supporting Vulnerable Families Through School-Based Mental Health Services: Results of Caregiver and Teacher Focus Groups

Family perspectives facilitate participation and positive outcomes in child mental health treatment. In schools, families and teachers must cooperate to best meet children's mental health needs, also making teacher perspectives important. In this study, caregivers and teachers participated in focus groups following the pilot year of a school-based mental health (SBMH) project. Participants noted successes and challenges of the project and suggested improvements. Although this study focuses on the SBMH project, many of the study implications are applicable to other school mental health programs and may be of value to school and community practitioners.     

From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.     

Voices of Children from Around the Globe; An International Analysis of Children's Issues at Child Helplines

Child helplines around the world are an important mental health resource for many children. In this study, an international database was analysed with a total of 25 million registered calls at a total of 111 helplines affiliated with Child Helpline International. The research was aimed at discovering if there are differences between the reasons for calling of children from different parts of the world, and if shifts in the studied 10‐year period can be observed. The data show that all child helplines are contacted by young people seek support with questions concerning abuse, sexual matters and school issues. The results from a mixed model also show significant differences in the reasons for calling between Africa, Asia, Europe, Latin America, North America, the Pacific region and the region Middle East and North Africa. Child helplines in Africa and other developing parts of the world received many calls related to safety and health (e.g. HIV/AIDS, commercial exploitation), whereas children and young people from Europe, North America and the Pacific more often discussed social and psychosocial issues with the helpline (e.g. mental health, peer and family relations). The reasons for calling were relatively stable for the studied period.     

Can Family Relationships Explain the Race Paradox in Mental Health?

Biomedical research consistently finds that Blacks have worse physical health than Whites, an expected pattern given Blacks' greater exposure to psychosocial stress, poverty, and discrimination. Yet there is surprising lack of consensus regarding race differences in mental health, with most scholars finding similar or better mental health outcomes among Blacks than Whites. Past research often attributes this “race paradox in mental health” to the notion that Blacks have stronger family networks than Whites, yet few studies have explicitly tested whether stronger family relationships among Blacks (if they exist) can account for these findings. Using data from the 2003–2005 National Survey of American Life (N = 4,259) revealed that minimal race differences in family relationships fail to explain the race paradox in mental health. The results have implications for mental health measurement, the provision of culturally appropriate mental health care, and how scholars understand the nature of family relationships among Black Americans.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.