Marney A. White is an associate professor of psychiatry and chronic disease epidemiology at Yale University, on the faculty of the School of Medicine and the School of Public Health. She also served from September 2011 to June 2015 as associate director of the Yale Center for Anxiety and Mood Disorders, a position that put her in frequent contact with students.
By Marney A. White
Last January, an undergraduate student at Yale posted a suicide note to Facebook and jumped to her death. In her note, she stated that she knew she was depressed, but she was afraid of being forced to leave school as a result.
“Dear Yale: I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school…”
This example, while devastating, is not an anomaly. Suicide is the leading cause of death among
college students. Nearly half of all adults in the U.S. will develop a mental disorder at some point in their lifespan; nearly one in five college-aged adults currently have or will develop a mental health problem within the next year.
To responsibly address mental health on campus, we must adopt a public health approach focused on early identification and treatment. At its most aggressive, a public health approach would mandate screening programs and treatment for those students identified as at-risk of developing a serious mental disorder.
College is a particularly vulnerable time for the development of mental disorders, due to the unique stressors of being away from home and owing to basic lifestyle risk factors that compromise mental and emotional well-being. Excessive drinking, poor nutrition, sleep deprivation, chronic stress, and financial strain are all risk factors for developing mental disorder, and many of these are almost normative among college students.
So it should come as no surprise that we are seeing so many headlines today about mental health crises on campuses throughout the country. As a professor and as a clinical psychologist, I hear first-hand accounts of students’ unwillingness or inability to seek treatment. At Yale, some students believe that the campus mental-health system is flawed. They complain of long wait times, of being deemed not “severe” enough to be matched with a therapist, and of a fear of being labeled or at worst, kicked out of school. This is not a problem just at Yale – similar reports occur at other universities.
University health care systems may be understaffed, resulting in mental health clinics that must prioritize delivery of services. Meaning that those cases deemed most severe are rushed into treatment, while students with less critical difficulties are forced onto long wait lists or given a limited number of treatment sessions. The problems with the mental health systems on college campuses parallel those of the mental health system in general: insufficient resources to provide affordable, effective, and immediate services. Instead of providing care only in the case of crises, we should flip the emphasis – we need to provide mental health services early, before the onset of serious disorder, and we need to devote attention to mental health wellness campaigns.
There are effective ways to screen and identify students who are at-risk. Many universities offer optional screening programs, and then make treatment referrals when warranted. I propose that we extend this platform to require mental health screening on an annual basis. It is critical to point out that if caught early, subclinical mental disorders can respond readily to treatment. From a cost-effectiveness standpoint, it makes more sense to treat conditions in the beginning phases than to wait until a problem has worsened and potentially become chronic.
Screening and early intervention programs have been shown to be effective. One campus-based intervention program for eating disorders identified college women with significant weight concerns and provided an online treatment for body image dissatisfaction and unhealthy dieting. This program was found to be effective in reducing the incidence of eating disorders one year later. Similar programs could be implemented for depression and anxiety.
Students are required to attend mandatory alcohol awareness programs and workshops on sexual assault. Students at Yale are also required to attend health and sexuality workshops and seminars on campus safety. But there is no such analogue for mental health education or awareness. To ignore mental health awareness furthers a culture in which we stigmatize mental vulnerability by effectively sweeping it under the rug.
To be sure, some will argue that mandatory screening and treatment is a violation of students’ privacy and is paternalistic medicine. But we do this for medical conditions all the time. We screen for diabetes by taking blood glucose values, and when a test result indicates that someone is at risk for developing a more serious disease, we take steps to treat them. When a student is arrested or admitted to the ER for alcohol-related offense, we require substance abuse counseling. To not extend the same model to mental disorders is to perpetuate a cycle of stigma and fear, and ultimately leaves our students vulnerable. Few people question the ethics of medical screenings, since most understand that early intervention prevents the onset of a more serious condition. The same is true of mental disorders, but ignoring sub-threshold symptoms leaves students vulnerable, setting the stage for the development of a serious and potentially chronic problem. A problem that at its most extreme, might lead a student to withdraw from school. Or worse.
White is a public voices fellow with the Op-Ed Project.