College Mental Health: A Vulnerable Population in an Environment with Systemic Deficiencies

From time to time, attention is brought to the status of mental health—or, rather, mental illness—on US college campuses. We thank Michelle Riba, Daniel Kirsch, Adele Martel, and Michelle Goldsmith for guest editing a special collection of articles on this topic for this issue of the journal. AMay 2015 article in theNew York Times [1] reported that nearly one in six college students was diagnosed with or treated for anxiety within the previous 12 months. The article also pointed out that anxiety has surpassed depression as the most common psychiatric diagnosis among college students, although rates of depression are also on the rise. It is well established that college students, often desperately in need of psychological and psychiatric services, find that these services are not always available on their campuses. Further, only a handful of students with psychiatric needs bring their concerns to the attention of professionals within their college-based systems of care. And we continue to be stunned by the numbers of suicides and sexual assaults at our own or nearby colleges. When these findings and tragic events are reported, everybody—students, parents, media, health professionals, and politicians—passionately talks about the inadequacy of current systems of care across US undergraduate programs. The help provided to US college students is widely insufficient. Stakeholders also often comment on the perpetual problem of educating students, families, and college personnel about the assessment of and treatment for mental health problems that are pervasive on college campuses. But these concerns do not lead to change. Typically, within a few weeks after a highly visible media report, the attention winds down. The college where an incident occurred continues to investigate. Then, the school perhaps institutes regulations or measures intended to prevent the reported serious mental health issue for other students in the future. Sometimes, the school provides an increase in support for mental health services but maybe only temporarily. Sadly, most of these measures are “patchwork” remedies that do not address the underlying substantial and systemic problems. Rarely does a comprehensive plan to address psychiatric, emotional, and behavioral problems on campus emerge. College mental health issues are much larger than recognized and seldom adequately addressed. As Riba et al. [2] point out, more than 20 million individuals are enrolled in US institutions of higher education. These are mostly people of a vulnerable age, in their late adolescence or early adulthood, which is frequently a time for a first episode of serious mental disorders. In 2008, Blanco and colleagues [3] estimated that almost half of college-aged individuals had a psychiatric disorder during the previous year and that the overall rate of psychiatric disorders was not different between collegeattending individuals and noncollege-attending individuals. There were some differences—college students had a greater risk of alcohol use disorders than their noncollege peers, yet lower risk for drug use disorders, nicotine dependence, and bipolar disorder. Fewer than 25% of individuals with a mental disorder sought treatment in the year before Blanco et al.’s [3] survey, and college students were less likely to receive treatment for alcohol or drug use disorders than their noncollege peers. A structured-interview study performed by Ohayon and Roberts [4] involving more than 19,000 young adults and nearly 2200 students living on a university campus found that * Richard Balon rbalon@wayne.edu