Help Along the Way

Marjorie Malpiede / April 6, 2018

How mental health partners are supporting students and colleges

Ensuring the healthy development of teens and young adults is more important than ever. Economic, environmental and technological changes have altered the world in a relatively short time, bringing a host of new challenges to our next generation of leaders.

Over the last decade, and certainly over the last five years, the mental health of college students has become a national concern. The prevalence of students with mental health challenges on college campuses has increased significantly over this time-period, indicating some positive movement in the stigma around seeking help. But the surge in demand for campus counseling services continues to overwhelm the capacity of even the most well-resourced schools. And for every student who is proactive about their mental health, there are many more who are suffering in silence.

· According to the 2017 Healthy Minds Study at the University of Michigan, 35 percent of students have symptoms indicating a potential current mental disorder such as depression or anxiety.
· Three college students a day die by suicide and 2,000 college students die every year from alcohol or drug-related injuries
· Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association.
· More than half of students visiting campus clinics cite anxiety as a health concern, according to a recent study of more than 100,000 students nationwide by the Center for Collegiate Mental Health at Penn State.

The risks and consequences of not addressing the rising demand for mental health services, or reaching those who need help, include: lower graduation rates; litigation and reputation damage; as well as tragic loss of life. For distressed students, being within an institution that can’t meet their needs can feel like another reason to keep their problems to themselves. Experts are now calling this “the campus mental health crisis.”

The crisis may have caught many in the higher education community off-guard but it is not something they are taking lightly. Even schools that focus solely on academic performance appreciate the impact of mental health on their ability to graduate well-educated students. In a survey this year at Ohio State, just over half of the student clients said that counseling was instrumental in helping them remain in school. Many more institutions are viewing the crisis as a metaphorical crowbar to open up new opportunities for teaching to the whole person and infusing personal and emotional development into their core curriculum.

Higher education is where problems go to be solved, and it is not surprising that there are a number of innovative partnerships between colleges, non-profit organizations and industry associations that are making great strides in supporting students.

From the expanding safety network of The Jed Foundation (JED) to the data mining of Michigan’s Healthy Minds, to the student voices of Active Minds, these organizations are working together, and with partners in advocacy and policy, to bring a new way of thinking to the old way of addressing student emotional and behavioral health.

If you are a clinician or administrator interested in data on student mental health, there is one place you want to be in March and that is the University of Michigan. Here is where the Healthy Minds annual Research Symposium, followed by its Depression on College Campuses Conference, leads the conversation on how knowledge informs practice in the field of college mental health.

THE JED FOUNDATION
What sprung from the unanswered questions of a grieving family has become the most influential change agent in student mental health.

JED was launched in 2000 by Phil and Donna Satow who set out to ensure colleges and universities had a framework for how to support student mental health and prevent suicide, something that did not exist at the time their son Jed died by suicide at the University of Arizona.

Eighteen years later, JED can lay claim to the fact that over 195 colleges and universities, representing more than two million students, are now participating in JED Campus -- a nationwide initiative that helps colleges and universities assess and enhance their policies, programs and systems to support the emotional well-being of their students.

Launched in 2014 and based on a comprehensive, evidence-based framework, JED Campus includes an assessment to help schools identify gaps in student mental health and suicide prevention programming. JED provides schools and students with feedback, including recommendations, education and health promotion information to support their efforts.

JED Campus incorporates a public health approach, involving the entire campus community in supporting student emotional well-being with support from senior leadership.

Technical assistance is provided by a dedicated JED Campus Advisor throughout the 4 year program who assists in creating a school-specific strategic plan with concrete goals, objectives and action steps.

“Around 2011, 2012, we reflected on our work and asked ourselves ‘Are we an awareness organization or a change organization?,’ said JED Executive Director John MacPhee. “We were working hard to raise awareness of these concepts, but how do we help schools more directly implement these changes? That’s when we created JED Campus.”

MacPhee says the Foundation’s work is now focused in four areas. One is making sure that teens and young adults know how to take action to care for their own mental health: how to reach out for themselves or someone they know who may be struggling. The second area is promoting the importance of emotional readiness as preparation for life after high school which involves working with schools, students and parents on the transition to college and adult life. Three is making sure that everyone at a college or university attends a school which has a thoughtful, purposeful plan for how to support mental health and reduce the rates of substance abuse and suicide. Lastly, MacPhee says, is getting communities to support teen and young adult mental health more broadly.

These big picture goals are backed by action plans that include accelerated research efforts; multi-media awareness campaigns, and the continued expansion of JED Campus, both in numbers and in scope.
JED has recently begun a partnership with the Healthy Minds Network, the U Michigan-based student mental health research and advocacy organization to measure the impact of systems change through JED Campus on student outcomes.

All schools who participate in JED Campus now take specific modules in the highly-regarded Healthy Minds Survey, which tracks students’ attitudes, awareness and behaviors on emotional well-being and substance use issues.
Just as the school now takes the JED Campus Assessment at the beginning of their participation in JED Campus and again at the beginning of the final year of participation, students take the Healthy Minds survey at baseline and again at the end of the project. By mapping the JED Campus program, policy and systems changes with the Healthy Minds Study, schools are now able to evaluate the impact of systems change (via JED Campus) on student outcomes.

“For years we’ve been tracking improvements in policies, programs and protocols over time at our participating schools and it is evident that schools have made tremendous progress in enhancing their systems to support student well-being. With the addition of the Healthy Minds Study, we can now analyze the impact of this systems change on direct student outcomes – which is the most important piece of this puzzle,” said Nance Roy, JED’s Chief Clinical Officer.

“We’re looking at suicide prevention similar to the way the medical community looks at high blood pressure and hypercholesterolemia relative to preventing heart disease,” said Dr. Victor Schwartz, JED’s Chief Medical Officer. “We are helping schools identify people who are heading into risk rather than people in the middle of a crisis.”

This “up-stream” perspective is behind two of JED’s new educational initiatives. One is “Set to Go” -- an online resource for high school students and college freshman that helps prepare for the realities of college life. It is based on JED’s understanding of the issues college students face in adjusting to college and transitioning into adulthood.

Its content provides practical information on everything from roommate relationships to preparing a campus support plan for students with a history of mental illness.

MacPhee says the latter is becoming increasingly important as more students arrive on campus with acknowledged disorders, often unknown to their college due to a variety of reasons including confidentiality laws. The Foundation is helping parents understand that, while they want their son or daughter to have a fresh start, they need to be cognizant of the supports schools have available if their student begins to struggle.

The Foundation is developing additional Set to Go resources for teachers and other high school professionals as part of a larger effort to help high schools do a better job of preparing students emotionally for college.

The Foundation has also launched a major public awareness campaign with the Ad Council and the American Foundation for Suicide Prevention called “Seize the Awkward” – a digital platform and series of videos. With graphics and language that appeal to the average Snapchat user, Seize the Awkward helps kids overcome barriers to discussing mental health with their friends. Schwartz hopes the campaign will do for suicide prevention what the “Friends don’t let friends drive drunk” campaign did for drinking and driving.

“It introduces the idea that if your friend is struggling, it is part of your friendship identity to speak to them about it and, if necessary, help them get help,” he said.

As for expansion, MacPhee says JED can onboard up to 100 new schools a year in JED Campus which they hope will create a tipping point at which the practice of supporting student mental health will become the norm for colleges and universities.

“I think that collectively we can create a world where it would be unheard of for a university president to not list student mental health among their top three priorities,” he said.

Just as Phil and Donna Satow had hoped.

HEALTHY MINDS
The Healthy Minds Network for Research on Adolescent and Young Adult Mental Health (HMN), was launched here in 2005 by Daniel Eisenberg, a Professor of Health Management and Policy in the University of Michigan School of Public Health. Eisenberg leads the center with Dr. Sarah Ketchen Lipson and a multi-disciplinary team of experts in public health, education, medicine, psychology, and information sciences with a stated mission to “improve the mental and emotional well-being of young people through innovative, multidisciplinary scholarship.”

The JED Foundation’s Nance Roy calls them the “gold standard” of college student mental health research.

The organization is best known for the Healthy Minds Survey -- an annual population-level web-based survey that examines the mental health and mental health service utilization of college students. The Healthy Minds Survey began with a single random sample of Michigan students in 2005 and now includes over 200 colleges in the US and a handful of other countries. Over 200,000 students have participated in the survey.

“All along, we’ve had the dual goal of producing scholarly research that is going to increase understanding of student mental health while also providing data right back to the participating schools to help them assess their needs and priorities in this area,” said Eisenberg.

The findings, provided to participating institutions on an interactive data interface, can be used to evaluate existing programs on campus, assess the need for new programs or services, and raise awareness of mental health and campus resources. The survey provides schools with a sense of how they compare to their peers and is used by counseling center personnel to make the case for a stronger investment in student mental health – be it increasing staff or adding more preventative efforts.

Eisenberg has put together a widely-referenced economic argument for these investments with a return-on-investment (ROI) calculator that can identify how much money could eventually be saved through mental health programming.

“Our data suggest that a program that reduces depressive symptoms for 500 students (whether through treatment or prevention), can yield several million dollars in economic benefits while costing less than one million dollars,” a recent report cited.

This powerful use of data has led to numerous interactions with schools and non-profit organizations which was the impetus for the Healthy Minds Network which aims to foster collaboration among stakeholders and strengthen the link between research and practice.

With reports, conferences and webinars, and partnerships with groups like the JED Foundation and Active Minds, Healthy Minds is a leader among thought leaders in this field.

As he advocates for increased investment in student mental health, Eisenberg believes there needs to be other solutions to the college mental health capacity problem than hiring more counselors. Here’s where the organization’s public health approach comes in.

“There’s a whole population of students out there and you need to think of everyone at some point of time as being somewhere on a continuum of mental health.

“There’s maybe 10 percent of the population that ideally would receive in-person counseling but then there’s a much larger group – maybe 20 or 30 percent who have milder symptoms who may be struggling but not necessarily in a crisis. These students might do well with something less intensive than counseling.

“So the question is -- What goes in that middle space? And I don’t think schools have figured that out yet.”

The schools that do, are likely to use Healthy Minds data to get there.

ACTIVE MINDS
Active Minds brings to student mental health what no other national advocacy organization can – the voice of the young people who are affected by the way mental health is addressed on college campuses and acknowledged in society. Alison Malmon, is Active Minds’ Executive Director.

Now in her early thirties, Malmon started the organization in 2001 when she was still a student at Penn, the year after her beloved brother Brian died by suicide while a student at Columbia.

Active Minds is a non-profit young adult mental health education and advocacy group that opens up the conversation around mental health on college campuses, steering students to resources and reducing stigma around seeking help. Now in its fifteenth year, Active Minds has 450 chapters across the United States, mostly in colleges, though their high school chapters are growing.

When asked to describe the organization’s mission, Malmon talks about Brian. It is not out of a personal need to share the details of the devastating loss that changed her life. She tells Brian’s story because it is the story of thousands of young people who suffer in silence; who, despite their large numbers, think they are totally alone.

“Brian was at an Ivy League college, a Dean’s list student, president of the acapella group, sports editor of the newspaper – a typical star student who started struggling with mental illness his freshman year but didn’t tell anyone until he was a senior,” she said.

Brian was diagnosed with schizoaffective disorder – a type of schizophrenia that includes psychosis and depression but does not typically impair a person’s sense of reality. He left school to enter intensive therapy and psychopharmacological treatment which managed his psychosis but didn’t affect his depression which only worsened. Still, he hid his distress from his friends.

Malmon says, “The depression had created a space for him where he felt like he was the only one, that all of this was his fault.”

After he died, his friends came forward to say they had noticed changes in Brian but they wanted to respect the privacy he was holding on to so they didn’t intervene. It was only after he died that Brian’s family could tell his friends why he had been home from college.

Malmon went back to the University of Pennsylvania where she was a freshman and hoped to make sense of what had happened. Like Brian, she felt scared and alone though she soon realized that so many of her peers at Penn and beyond were impacted, sometimes tragically, by mental health.

“I came to realize that what had happened to Brian was happening to a lot of people – that mental illness starts at this age – that suicide is the second leading cause of death for college students. I realized this was really pervasive and the only way it was going to get better is if young people started talking about it.”
But still, nobody was. Malmon says when she started Active Minds, there were no role models, no celebrities standing up saying “yes, I have depression.”

She wanted to mobilize young people to be the initiators of that change.

Malmon started Active Minds as a student group at Penn. Its impact would grow as more students realized that others shared their concerns, heard their stories, and also wanted to talk. Their number one goal was to spread the word that seeking help is a sign of strength, not something to be ashamed of.

Malmon gives an example. “There we were at a table at the student activity fair right alongside the juggling club and the fraternities and sororities. But we were talking about mental health. So when freshmen would come in and hear that, they would think, ‘Wow, no one talked about this stuff in high school, I guess they do that at college. I guess its ok to talk about when I’m having anxiety, or when I’m dealing with depression, or the eating disorder I’ve been struggling with.”

When she graduated, she realized that the national void in addressing the mental health of young adults would go unmet unless people like her stayed with it. In 2003, she founded Active Minds as a national non-profit organization that seeds and supports college chapters across the country. She had offers to join well-established advocacy organizations but she wanted Active Minds to stay independent.

“I felt strongly that young adults deserved to have their own voice, their own space and their own identity because from what I was seeing they were going to be the ones that changed this for future generations.”

Active Minds grew faster than Malmon could have imagined, perhaps because of its straightforward mission. Though student-led, Active Minds is not a support group. Its job is to lead students to resources that schools have available, not to treat or counsel students themselves.

This collaborative relationship has allowed them to stay relatively conflict-free and in close partnership with college counseling centers. Every year, Active Minds bestows Healthy Campus Awards to colleges and universities that are working hard to improve how they support the mental health of their students.

One of the organization’s most powerful initiatives to date is “Send Silence Packing®,” a traveling exhibition displaying donated backpacks in high-traffic areas of college campuses, that represent the college students lost to suicide each year.

The exhibition aims to give a visual representation of the scope of the problem, raise awareness about the incidence and impact of suicide, and connect students to mental health resources.

As Active Minds continues to change the conversation on mental health, the organization is front and center in every important conversation on the topic, partnering with high-profile advocacy groups, making frequent media appearances and headlining national conferences.

Its message that mental health needs to be part of the public vernacular has resonated with organizations beyond higher education. Active Minds now has a partnership with the NFL Players Association which identified mental health as a major concern for professional athletes. The NFL’s “My Cause/My Cleats” initiative included two players who wore and donated their cleats to Active Minds.

Malmon believes the way the public views mental health today is vastly different from when Brian died, though barriers like stigma continue to thwart progress. She sees mental health as the final frontier of public health issues. Like breast cancer and AIDS in the 80’s and 90’s and LGBTQ issues in the 2000’s, she hopes society will make a collective shift in bringing suicide and mental health into the open.

“The good news is that this generation has identified mental health as their social justice issue – it is theirs to tackle because nobody else has done it.”