An increasing number of students are arriving on college campuses with mental health issues (Hunt & Eisenberg, 2010). It is not uncommon for students to experience varying degrees of stress, anxiety, and depression during their time in college, inasmuch as they encounter both academic and non-academic stresses during their college experience. Some examples of non-academic stressors include personal relationships, work life, and family. Even a major life transition such as moving away from home to college can aggravate existing mental illnesses or trigger new ones (Franklin, 2009). According one pilot study, 75 percent of lifetime cases of diagnosable mental disorders begin by the age 24 (CSCMH, 2009). For traditional students, this means many mental health issues will have emerged before or during college. Given that academic advisers work closely with students, they should be equipped to work with students who may be experiencing mental health issues. For advisers without counseling degrees or experience with these types of issues, trying to assist students with mental health concerns can be overwhelming. The purpose of this article is to offer some suggestions to academic advisers in identifying these students and referring them to appropriate campus resources.
Mental Health Issues among Today’s College Students
College student mental health issues have been on the rise, especially in recent decades. According to Hunt & Eisenberg (2010), this rise may be a reflection of increased willingness among students to report these types of issues, rather than an increase of mental health issues. An increased awareness about these issues may have reduced the stigma associated with seeking help. Improved identification of mental health issues coupled with better mental health treatment options mean that students whose severe mental health challenges may have precluded them from going to college in the past are now able to attend college. About 91 percent of college counseling center directors reported a rising trend of students with severe psychological problems on their campuses (Gallagher, 2010). According to Gallagher (2010), more than 70 percent of directors reported crisis issues that required immediate response, about 68 percent reported psychiatric medication issues, about 45 percent reported alcohol or drug use, and almost 40 percent reported self-injury issues. This increase in mental health issues means that academic advisers need to be prepared to recognize mental health symptoms in order to refer students with these concerns to the appropriate campus resources.
How can Academic Advisers Identify Students with Mental Health Issues?
While academic advisers may not be trained as professional counselors, they are ideally positioned to assist students in accessing mental health resources on campus. Behaviors that may indicate a student is grappling with mental health issues include excessive procrastination, poor class attendance, disruptive behavior in the classroom, and/or marked changes in appearance (Office of Student Life Studies, 2002). Advisers should also be on the lookout for overly dependent students who make frequent visits to their office and seem to be unable to make their own decisions (Office of Student Life Studies, 2002).
Advisers may observe behaviors that could indicate underlying mental health issues or students may self-report their own concerns about their behavior. In the latter case, it is important to listen to the student’s self-disclosure about concerns they have with their academics or other aspects of their life. Asking open-ended questions about students’ overall satisfaction may encourage them to disclose feelings they are having or discuss issues they are facing. And, of course, advisers need to be prepared to deal with behaviors and/or statements that indicate students may be planning to harm themselves.
How Do Advisers Address Mental Health Issues?
Probably the most important tool advisers have in terms of helping students with mental health issues is awareness of relevant campus resources. Most college campuses have a counseling center where students can meet with a professional counselor as a benefit of their tuition and fees. On some campuses, students have access to an unlimited number of counseling sessions, while other campuses limit the number of free sessions.
It is important for advisers to be able to articulate to students the services that campus counseling centers offer. For example, counseling centers may offer different types of counseling, including individual and group therapy options on a variety of issues ranging from anxiety to depression and eating disorders. For more severe issues, many counseling centers have emergency numbers or online forms for reporting incidents. For example, at the University of Maryland, College Park, the counseling center provides emergency counseling for students who have urgent mental health needs.
In order to make effective referrals to the counseling center, academic advisers would be well served to make an appointment to meet with a counselor or administrator in the counseling center to learn first-hand about the services offered on your campus. While there, advisers should inquire about the process that students must go through to set up a first-time appointment at the counseling center, because the process varies by institution.
Question, Persuade, and Refer (QPR) Theory
There are some campuses that have programs to educate faculty and staff on how to handle student mental health issues. More than 200 campuses have adopted the QPR (Question, Persuade, and Refer) program (Hunt & Eisenberg, 2010). This training program focuses on educating faculty and staff to be effective in terms of identifying and referring students with mental illnesses, specifically students who may be considering suicide (Hunt & Eisenberg, 2010). The QPR theory views professionals in contact with individuals who may be in distress as “gatekeepers” and considers them to be in a key role in preventing suicide (Quinnett, 2007). Academic advisers can certainly be viewed as gatekeepers in a broad sense and not only in terms of suicide prevention. As part of training for the Question step of the QPR method, gatekeepers ask clarification questions to help determine the meaning of indirect or coded messages (Quinnett, 2007). By confronting students to clarify their statements, advisers will be able to better understand the context of a student’s statement (Quinnett, 2007). Academic advisers can adjust this step to confront a student about having mental health issues in general. A question that an academic adviser might ask a student would be, "You mention that you have been feeling hopeless, withdrawing from friends and family, and spending a lot of time sleeping recently. Would you say you are feeling depressed?" This question repeats the student’s language and gives the student an opportunity to clarify.
The Persuade step focuses on persuading the individual to accept help or visit a mental health center with special attention given to timing, reluctance, and motivational interviewing (Quinnett, 2007). If the student agrees they have been feeling depressed, academic advisers may ask if the student has thought about seeking help. If the student is reluctant, academic advisers can explain that it is not uncommon for students to feel this way, and there are resources available on campus to help. It’s important to ask how the student feels about seeking help in order to gauge how likely they are to seek help. This leads to the third step in the QPR process.
The Refer step of the theory offers suggestions that academic advisers may also find helpful, such as accompanying the student to the resource and/or following up to see if the student utilized the resource (Quinnett, 2007). When referring a student, academic advisers might ask, "What can I do to make you feel more comfortable about seeking help?"
Conclusion
Due to the prevalence of students on college campuses reporting mental health issues, it is imperative that academic advisers equip themselves to effectively refer students to the appropriate campus resources. Academic advisers should not feel it is their responsibility to counsel students with mental health issues or to recommend treatment. Instead, advisers can observe students’ behavior and listen to self-disclosures, lend an ear, and refer students to the appropriate services available on campus. While this can be a difficult topic to confront, academic advisers should feel empowered by knowing they have the ability to aid in addressing mental health issues and could have a significant effect on a student’s future.