The public is well aware of what in recent years has come to be known as"
campus tragedies"—the Virginia Tech shootings, for
one—but another type of campus tragedy is not as well publicized: the
increasing incidence of mental health problems and the relative shortage of
psychiatric treatment available to students.
A survey conducted by the American College Health Association in 2006
revealed that 14.8 percent of 94,806 students at more than 100 colleges and
universities said they had been diagnosed with depression sometime in their
lives. Of those, 36.6 percent were taking an antidepressant, and 9.3 percent
had considered suicide during the last school year.
Findings from a study led by Carlos Blanco, M.D., Ph.D., and published in
the December 2008 Archives of General Psychiatry examined the
prevalence of mental health problems among people aged 19 to 25. Blanco and
colleagues analyzed the findings from two subsamples of the 2001-2002 National
Epidemiological Survey on Alcohol and Related Conditions—those who did
and did not attend college during the previous year.
Blanco found that about 20 percent of those who attended colleges or
universities met DSM-IV criteria for an alcohol use disorder,
compared with 17 percent of the participants not attending college.
He also found that college students were significantly less likely to
receive past-year treatment for alcohol or drug use disorders than were their
peers not attending college.
According to Jerald Kay, M.D., chair of APA's Committee on Mental Health on
College and University Campuses, these and other data point to the fact that
there are not enough psychiatric services available to students with mental
disorders. "Treatment resources [on college campuses] are not
forthcoming," he told Psychiatric News.
Just a little more than half of U.S. colleges or universities have even one
psychiatrist working with students on campus, he noted, and most of those have
a psychiatrist working only part time due to a lack of funding. Wait times for
students seeking psychiatric treatment on campuses has increased over the past
decade or so, Kay noted, and some students may not get treatment when they
Kay is professor and chair of the Department of Psychiatry at Boonshoft
School of Medicine at Wright State University.
He proposed that psychiatry residency training programs rotate PGY-4 and
PGY-5 residents through campus counseling centers both to alleviate the
shortage of psychiatric treatment available to students and to expand training
opportunities available to residents. College mental health rotations would
provide residents with the chance to work with younger and higher-functioning
populations, he noted, and provide a contrast to training in the public
sector, for instance.
"Many residency training programs are struggling with how to meet
psychotherapy requirements for residents—if you have really ill patients
who drop out of treatment, it may be difficult for residents to meet their
requirements," he noted. However, "residents who work with college
students learn how to administer medications and provide brief
Yale University rotates PGY-3 psychiatry residents through its Counseling
and Mental Health Center and has for decades, according to Lorraine Siggins,
M.D., chief of psychiatry at Yale's Mental Health and Counseling Center.
Siggins credits the rotation for providing psychiatry residents with a
well-rounded training experience.
"They get a good grounding in developmental aspects of late
adolescence and young adulthood," she noted, and they also get to work
with students with significant mental health problems such as bipolar
disorder, anxiety disorders, and eating disorders.
During the rotation, trainees also teach undergraduate residential advisors
to recognize the early warning signs for mental illness in their peers.
"Specialized training in college mental health is an essential
part of residency training," she noted. ▪