Better Ways to Battle the Silent Epidemic on Campuses

Michael Morgenstern for The Chronicle

June 02, 2014

When people think of mental illness, they all too often associate it with extreme cases, including those involving higher education. Unfortunately, the intense media coverage of such tragedies, like the Virginia Tech shootings and the recent murders at the University of California at Santa Barbara, does little to reduce the stigma associated with mental illness.

Those rare examples aside, normalizing mental illness can serve to destigmatize it. If colleges were to recommend routine and universally available mental-health screening to students and make mental-­health education a compulsory part of the curriculum, campus mental-health services might be seen as a resource for more than those with severe problems.

The good news is that a growing number of colleges are providing some type of counseling or mental-health support service, and many institutions that cannot provide on-campus counseling are referring students to outside professionals.

The bad news is that these services are currently not dealing with the full extent of emotional and mental-health problems within the college population. A 2012 survey by the American College Health Association found that more than 30 percent of students over a 12-month period "felt so depressed that it was difficult to function." It also found that, over the same period, nearly 50 percent of students "felt overwhelming anxiety." But the survey also showed that only 11 percent of students had been diagnosed or treated for depression and only 12 percent had been diagnosed or treated for anxiety.

Certainly, one survey question does not a DSM-5 diagnosis make. However, from this survey we can tentatively infer that two in three students who may have or are at high risk of developing depression, and three in four students who may have or are at high risk of developing anxiety, have not been identified and are not getting the support they require. Whether it is on a campus or beyond it, the mental-health epidemic is largely a silent one.

The challenge is that we can’t help what we can’t see. The only real way to uncover and aid sub- and pre-clinical depression, anxiety, and other conditions is through some form of screening. Recently I argued in the British Medical Journal that introducing universal mental-health checks for schoolchildren could reap significant social, health, and economic benefits. The same argument applies to the college population. The earlier we identify burgeoning problems, the more likely we are to prevent them from developing into clinically diagnosable problems, the costs of which are far greater.

Such an idea is not without its detractors. Some people feel that mass screening programs encroach on individual liberty and are a contrivance of the "Nanny State," or that mental-health screening is simply a vehicle for the medicalization of the perfectly normal worries and woes that come with being a student.

However, what if the everyday worries and woes of life as a student were both normal and medical? What if, as the ACHA survey (and a number of others like it) suggests, a large number of students were experiencing mental-health problems but were not getting the support and treatment that they needed? Worse still, what if there were a whole group of students who had mental-health problems but were unaware that they had those problems or were unable to understand or articulate them?

Screening needn’t be something to fear. After all, it is really just a type of applied research. For human subjects’ research to be ethical, it needs to provide participants with the means to get follow-up information, and support or care where necessary, particularly in cases where the material covered is sensitive in nature. Offering routine mental-health checks across college campuses would not only provide opportunities to reduce the burden of mental-health problems in this population but would supply researchers with more-substantial data that more accurately reflected the extent of the problem.

The second thing we need to do is make mental-­health education and awareness part of the core curriculum. Some colleges offer it as an elective, but optional mental-health education is insufficient because it will not reach enough students.

We can point to diversity awareness as an example to follow. An increasing number of colleges require staff members and students to undergo mandatory diversity-awareness training. Like diversity efforts focused on matters of race, gender, and physical disability, mental-health destigmatization is an important social-justice mission within higher education.

Related to this, research has shown that racial and ethnic minorities, religious minorities, and people of low socioeconomic status are the least likely to seek mental-health help, even though they may be at greater risk for mental illness. So colleges should make a point of focusing on those groups.

But regardless of students’ risk factors, no mental-health course should be formally graded, because the anxiety caused by examinations could do more harm than good. Rather, the aim would be to encourage students to reflect on their self-concept and emotional self-awareness. That could be followed up with more widely available interventions, such as stress-­management programs and meditation sessions.

College students could benefit from routine mental-health screening—particularly because of the added pressures they face at this stage in their education. Although they are no longer children, they are still learning. This should include learning about their own mental health. It has long been acknowledged that an important part of college is about "finding" oneself. Finding oneself emotionally can and should take place in the lecture halls and classrooms as well as in the frat houses and dorm rooms.

Simon Williams is a research associate in the Feinberg School of Medicine at Northwestern University.