Preparing and Training the College Mental Health Workforce

More than 20 million individuals are enrolled in 2-year, 4year, graduate, and professional degree-granting institutions in the USA [1]. We refer to this diverse mix of primarily young people as college students and the broad range of services designed to attend to their mental and emotional health as college mental health. College students constitute a growing and critically important population in need of evidencebased mental health services [2]. The population is diverse in age, life experience, mental health history, socioeconomic status, and ethnicity. Students range from 18-year-olds entering 2or 4-year postsecondary education programs directly out of high school to older students heading to college after serving in the military, raising families, or working for several years. Other students choose to pursue advanced degrees, such as in law or business.Within these broad groups are special populations, such as students with chronic medical or mental health disorders, athletes, international students, and first-generation students. Each group brings to campus distinct strengths, vulnerabilities, and needs [3]. As Sood and Martel state, “Acculturation issues, differences in help-seeking behaviors, worries about families left behind, difficulties managing social situations, lack of support networks, discrimination, and post-traumatic stress reactions are just some of the concerns complicating an already stressful life transition” ([4], p. 70). Over the past 25 years, many factors have contributed to the increase in the number and diversity of college students, as well as their clinical needs [5]. For examp le , va r i ous i t e r a t i on s o f t he G . I . B i l l (Servicemen’s Readjustment Act of 1944) encourage, allow, and support veterans to return to school [6]. The percentage of enrolled minority students has increased with US population trends and various special programs [7]. Improvements in identification and early intervention of mental health problems in young children and adolescents allow many to attend college who were previously unable to do so [5, 8]. The Americans with Disabilities Act supports students with various physical, learning, and emotional disabilities to seek postsecondary education experiences [9]. Three-quarters of mental illnesses begin before age 24 [10], and mental illness, including substance abuse disorders, contribute the greatest proportion of disease burden in young people aged 10–24 years around the world [11]. The late maturation of the prefrontal cortices provide a neural basis for beginning to understand the impulsivity and risk-taking behaviors characteristic of transition age youth and young adults [12, 13]. The complex interrelationships among neurologic, psychological, cognitive, interpersonal, and psychopathologic development all contribute to their vulnerability. For youth with mental illness, the transition from child and adolescent to adult systems of care can add risk to vulnerability because the adult system is not generally trained to deal with the complex developmental issues that young adults present [14]. Copious data link dropping out of college with health, mental health, social, and economic problems later in life [15, 16], such that increasing college retention may itself be viewed as an important public health intervention. * Michelle Goldsmith mgoldsmi@stanford.edu