A Little Unwell

An era of senseless tragedies has begrudgingly brought to the fore issues of mental health and the fragility that often lies beneath the surface of sometimes high-functioning, seemingly “normal” people.

But what is normal, anyway?

Too often, society views mental health as a matter of polar opposites: well and unwell. The problem with this equation is, as with physical health, mental health considerations are much more granular. While we may consider ourselves to be in good health despite a scratch, rash or stomachache, so, too, might we consider ourselves emotionally stable despite a reactionary depression, a spate of anxiety or a nagging doubt about our aptitude for success.

Normative emotionality is a fluid rather than static construct. Many, if not most, individuals trace movement on the continuum of mental health in fairly small arcs, not deviating too wildly from our core. Yet for some those arcs are more pronounced and may require intervention and treatment.

And therein lies the boogeyman.

When we build into the equation a foreboding stereotype that seeking help signals weakness or worse, we disincentivize legitimate mental health care in a way that would be unimaginable with physical illness or injury, disease or defect.

Perhaps nowhere is the problem more vexing than among America’s ever-growing cohort of adolescents.

Why is this the case?

Both because of a long-running shortage of mental health professionals treating youth (Thomas & Holzer, 2006) and because, according to the National Alliance on Mental Illness (NAMI), mental health issues typically strike early in life, with half of all long-term mental illness emerging by age 14 and three-quarters by age 24 (Diehl, Douglas, Hart & Honberg, 2014). Stephen E. Brock, Ph.D., NCSP, president of the National Association of School Psychologists, a collaborating organization at the Center for Adolescent Research and Education (CARE), says 13-20 percent of children suffer from mental illness and points to a sharp rise – 24 percent between 2007 and 2010 – of inpatient admissions.

Significantly, NAMI reports, “Children and youth who receive prompt, effective mental health care demonstrate surprising resilience, overcoming major challenges to thrive in school, home and the community” (Diehl et al, 2006).

Which makes the stigmatization of treatment all the more troubling and the potential of treatment all the more appealing.

Of particular concern is access to mental health services on college campuses. Indeed, an April 3, 2015, article from Yahoo News, “Tulane’s Mental Health Meltdown,” tells a familiar tale. It notes three student suicides this academic year alone, an overwhelmed counseling center and a pressure-packed environment one student called a “very expensive death trap” (Goodwin, 2015).

Tulane is not alone. The article cites the National Survey of College Counseling Centers 2014 in stating that 94 percent of counseling directors say they’ve seen an increase of students with severe psychological disturbances (Gallagher, 2014).

While not all such disturbances end in suicide, the Centers for Disease Control and Prevention (CDC) report it is the second leading cause of death for youth between the ages of 10 and 24 (Sullivan, Annest, Simon, Luo & Dahlberg, 2015), resulting in more than 4,600 lives lost each year (CDC, 2015). More to the point, the Suicide Prevention Resource Center ranks suicide as a leading cause of death among college students (SPRC, 2014).

The CDC points out the importance of early prevention of suicidal thoughts and behavior and reducing the stigma associated with seeking help (Farley Steele, 2015).

Corey Gary, a sophomore at Tulane, told me, “It’s sad that mental health is taboo at many universities. With admissions incredibly competitive and cutthroat, I’m not surprised students enter Tulane having fought anxiety and/or depression. When people begin to burn out, things can go astray, especially around alcohol, marijuana and sex.”

Those outcomes were the subject of a 2012 study of first-year college students by the Center for Adolescent Research and Education (CARE) and the national SADD (Students Against Destructive Decisions) organization. “According to the survey, approximately one-third of young people are experimenting with risky behaviors – many for the first time – during their first semester at college. Roughly one-third of the students surveyed reported drinking alcohol (37 percent), engaging in intimate sexual behavior (37 percent), or having sexual intercourse (32 percent) in that time period. Among these students, one-quarter to nearly half report engaging in these behaviors for the first time” (SADD, 2013).

Unfortunately, there is a myriad of problems associated with self-medication, not the least of which is that it often doesn’t work. Which brings us back to the importance of access to adequate mental health services.

Cheryl Stumpf, a counselor and outreach coordinator at Susquehanna University in Pennsylvania, offered, “Part of the problem on campuses is it may be more socially acceptable to be engaging in high-risk behavior than to seek help at the counseling center. Another is that, at some schools, it may actually be easier to obtain alcohol and other drugs to self-medicate than an appointment for treatment.”

Farther south, James Plummer, a Florida university student who will serve as a residential assistant next year, recently said, “A friend began experiencing anxiety whenever he entered a classroom. He sought counseling at the health center but could not get an appointment for three weeks. In an educational environment, where stress and anxiety are prevalent, it seems senseless to not provide sufficient access to mental health care.”

More and more students arrive on campus already experiencing distress or disorders, according to the Yahoo News piece. This fact, along with the crushing demand for treatment, leaves some openly questioning the responsibility of colleges and universities to respond, though most seem inclined to try (Goodwin, 2015).

That may be a very good thing, especially if young people today are less resilient and possess fewer coping skills, as has been reported (Sifferlin, 2013).

Also resonant is a report by the American Psychological Association revealing, “Millennials are the most likely of all generations to say their stress has increased in the past year (36 percent versus 30 percent of Gen Xers, 24 percent of Boomers and 19 percent of Matures)” (APA, 2015).

In turn, stress levels may account for trends reported in the St. Louis Post-Dispatch “… that nearly half of the students who visit counseling centers are coping with serious mental illness, more than double the rate a decade ago” (Gabriel, 2010).

Sad that so many bright, upwardly mobile youth are more than a little unwell.

Stephen Gray Wallace is president and director of the Center for Adolescent Research and Education (CARE), a national collaborative of institutions and organizations committed to increasing positive youth outcomes and reducing risk. He has broad experience as a school psychologist and adolescent/family counselor and serves as senior advisor to SADD, director of counseling and counselor training at Cape Cod Sea Camps, a member of the professional development faculty at the American Academy of Family Physicians and American Camp Association and a parenting expert at kidsinthehouse.com and NBCUniversal’s parenttoolkit.com. For more information about Stephen’s work, please visit StephenGrayWallace.com.

Originally posted on April 16, 2015 in Stephen Gray Wallace’s column for The Huffington Post.

© Summit Communications Management Corporation 2015 All Rights Reserved

REFERENCES

American Psychological Association. (2015). Stress in America: Paying with our health.

February 4, 2015. American Psychological Association.

http://www.apa.org/news/press/releases/stress/2014/stress-report.pdf (14 April 2015).

Brock, S. (2015). Student success: mental health matters. Presented at the National Association of School Psychologists 2015 Annual Convention. Orlando, Florida. February 17-20, 2015.

CDC. (2015). Youth suicide. Injury Prevention and Control: Division of Violence Prevention. March 10, 2015. Centers for Disease Control and Prevention. http://www.cdc.gov/violenceprevention/pub/youth_suicide.html (14 April 2015).

Diehl, S., Douglas, D., Hart, J. and R. Honberg. (2014). State mental health legislation 2014. Trends, themes & effective practices. December 2014. National Alliance on Mental Illness.

http://www2.nami.org/Template.cfm?Section=Policy_Reports&Template=/ContentManagement/ContentDisplay.cfm&ContentID=172851 (14 April 2015).

Farley Steele, M. (2015). Teen suicides by hanging on the rise across U.S.: CDC urges doctors, others to look for warning signs. HealthDay News. March 5, 2015. U.S. National Library of Medicine. National Institutes of Health. http://www.nlm.nih.gov/medlineplus/news/fullstory_151302.html (14 April 2015).

Gabriel, T. (2010). College students, campus mental health centers feel more strain. St. Louis Post-Dispatch. December 19, 2010. http://www.stltoday.com/news/local/education/college-students-campus-mental-centers-feel-more-strain/article_a2e8ea9a-0bfc-11e0-a978-0017a4a78c22.html (14 April 2015).

Gallagher, R. (2014). National survey of college counseling centers. University of Pittsburgh and American College Counseling Association. 2014. http://www.collegecounseling.org/wp-content/uploads/NCCCS2014_v2.pdf (14 April 2015).

Goodwin, L. (2015). Tulane’s mental health meltdown. Yahoo News. April 3, 2015. http://news.yahoo.com/tulane-s-mental-health-meltdown-144028239.html (14 April 2015).

SADD. (2013). Survey investigating risky behaviors by first-semester college students points to path for prevention. SADD (Students Against Destructive Decisions) and CARE (Center for Adolescent Research and Education). January 9, 2013. http://sadd.org/press/presspdfs/CARE%20Survey%20First%20Semester%20January%20Release%2001-09-13.pdf (14 April 2015).

Sifferlin, A. (2013). The most stressed-out generation? Young adults. TIME. February 7, 2013. http://healthland.time.com/2013/02/07/the-most-stressed-out-generation-young-adults/(14 April 2015).

Suicide Prevention Resource Center. (2014). Suicide among college and university students in the United States. Sprc.org. Waltham, MA: Education Development Center, Inc. http://www.sprc.org/sites/sprc.org/files/library/SuicideAmongCollegeStudentsInUS.pdf?utm_source=Weekly+Spark+04%2F10%2F2015&utm_campaign=Weekly+Spark+April+10%2C+2015&utm_medium=email (14 April 2015).

Sullivan, E., Annest, J., Simon, T., Luo, F. and L. Dahlberg. Suicide trends among persons aged 10-24 years – United States, 1994-2012. Morbidity and Mortality Weekly Report. March 6, 2015. Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/pdf/wk/mm6408.pdf (14 April 2015).

Thomas, C. and C. Holzer III. (2006). The continuing shortage of child and adolescent psychiatrists. Journal of American Academy of Child and Adolescent Psychiatry. September 2006. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/App_Themes/AACAP/docs/Advocacy/federal_and_state_initiatives/workforce/continuing_shortage_of_cap.pdf (14 April 2015).