What advice would you give students who don’t believe they can attend college with mental health challenges or a psychiatric disability?

First, it is important to acknowledge that mental health challenges and psychiatric disabilities represent a broad array of disorders and disabilities. Mental health challenges typically make succeeding in college more of a challenge, depending on the nature of the mental health concern. For example, an anxiety disorder may make it difficult for one student to speak in public, whereas another student may experience anxiety primarily in social situations. Psychiatric disabilities significantly interfere with individuals’ functioning in one or more life activities potentially including living, working, and/or communicating. For convenience, I will refer to both as mental health concerns.

I encourage students with mental health concerns to consider attending college, and to explore their options before deciding they cannot attend. The Americans with Disabilities Act (ADA) requires postsecondary institutions to treat individuals with disabilities, including psychiatric ones, in a manner that does not discriminate and affords equal access to postsecondary programs and services. However, the ADA does not guarantee that students will be provided with accommodations related to their psychiatric disabilities. The disability services administrator makes the determination on a case-by-case basis, and receiving an accommodation in high school is no guarantee one will receive the same accommodation in college. Also, the decision whether to provide a specific accommodation for a mental health concern may vary from college to college. For this reason, it is a good idea to contact disability service administrators in advance of enrolling to find out whether accommodations are likely.

Nevertheless, college campuses are communities with highly skilled professionals who provide counseling and support services to students with mental health concerns. Colleges also provide the opportunity for students to learn and benefit from interaction with a diverse variety of students including other students with mental health concerns. Pascarella and Terenzini are researchers who have written extensively about the robust literature indicating that colleges promote the holistic development of students. For all of these reasons, I strongly encourage students with mental health concerns to attend college while also recognizing that the ultimate decision belongs to the individual.

What are some ways you suggest students start to build a long-distance support system if they are planning to attend college away from friends or family?

Students can begin planning well before they leave for college. Students might adopt the criteria represented by the acronym SMART in developing a plan for staying in contact with friends and family. That is, formulate goals that are Specific, Meaningful, Achievable, Relevant, and Time-Specific when building such a support system. Technology makes it achievable for students to communicate with friends and family using Skype, Facetime or a social media site. For some students, texting or talking by telephone might be more meaningful or relevant to their needs for support. It is important for the student to identify a specific timetable for connecting with significant others and to make this a priority. Sometimes students who live a long way from family may be able to visit members of their extended family who live in closer proximity when they are unable to meet with their family of origin. Another possibility is to select a mid-point between the college town and the hometown that is a relatively more convenient destination for all parties. With regard to being time specific, consult the college’s academic calendar well in advance in order to maximize opportunities for spending time together.

Can you recommend any resources for other students in a similar disability situation to help them with challenges during the application process? During college?

Students should begin by forming a relationship with their school counselor as early as possible. The importance of establishing a good relationship with this mental health professional cannot be overstated. A competent and supportive school counselor can help them not only navigate the application process, but also manage the transition from reliance on a secondary school counselor to reliance on a mental health counselor in a postsecondary setting. Students who have a positive experience with a counselor are more comfortable seeking help from a counselor in college. During college, some of the most important resources are the office of student disabilities, the student counseling center, and the student’s academic adviser. More and more, academic advisers are adopting a more holistic approach to academic advising that includes an interest in promoting the student’s successful adaptation to the college environment. Academic advisers receive training that prepares them for providing active listening, empathy, and referrals to appropriate student support personnel.

What do you feel are the most important attributes or characteristics a student with psychiatric disabilities or mental health challenges should consider when selecting a university experience and why?

I would encourage students to consider the overall climate of the university. Though it is important to consider the specific goals of a given student (such as attending a highly competitive university), some universities focus more on providing a supportive climate for students and are generally more student-centered. In addition, I think that it is important to consider the quality of an institution’s personnel support services including the offices of disability services, and counseling services. With regard to counseling services, it is important to know what type of professionals comprise the staff (counselors, social workers, psychologists, psychiatrists, etc.). How well does the makeup of the staff match the student’s specific mental health concerns? I recommend finding out whether the university provides free counseling sessions and if so how many sessions are provided per semester and per academic year. How does the counseling center help ensure that students who need more sessions are given appropriate referrals and related resources? Finally, what is the scope of available outreach and ancillary programming provided by the counseling center? Some examples include the provision of support groups, and the opportunity to communicate with counselors via email.

If a student does tour a campus, what are some questions they should consider asking the university?

I recommend asking questions regarding the location of offices related to student support services. Universities are moving towards a holistic wellness philosophy. In addition to counseling centers, there are centers with personnel and programs designed to support students during their first year of college. There are also wellness centers that are designed to promote optimal student functioning which might include preventive and holistic health programs. For example, wellness centers and related programs might teach students about nutrition and healthy eating habits. I also recommend asking where academic support offices such as the locations of the campus writing center and tutoring services.

Should students be up-front with universities about their disabilities during the application process? Or is this something students should bring up after they have been accepted and plan to attend that university?

If so, what are some strategies you have seen students successfully use to address their disability with universities during the application process?

The answer to this question may differ for each individual student. For example, a student who graduated at the top of her high school class with test taking anxiety might share this information in an application essay. While the ADA protects individuals from discrimination on the basis of their psychiatric disability, I recommend not sharing this information during the application process unless the applicant has a compelling reason for doing so, because it is impossible to predict how this information might affect perceptions of the student. The student is not obligated to share this information during the application process. Once accepted, the student should not waste any time in contacting the Office of Disability Services, becoming registered, and learning about the range of services and programs, including potential eligibility for accommodations.

What are the most significant roadblocks you have found students encounter once they attend college? What are some strategies/support resources to get through these situations?

Two of the most common significant roadblocks encountered by students are interrelated. First, students who encounter difficulties may keep things to themselves rather than talking with their adviser, professor, or a peer. Second, students get into trouble when they place too much emphasis on academics to the exclusion of getting involved in the life of the campus. It is important for students to recognize that social involvement on campus enhances academic performance and is a protective factor relative to feelings of isolation, loneliness, and depression.

A helpful strategy is for students to seek opportunities for meaningful social interactions with other students. Most colleges have a campus activity board or an extracurricular fair where students can learn about extracurricular organizations and opportunities to get involved. In addition, recreation or wellness centers commonly have programs related to holistic health. One example is sessions where students practice mindfulness meditation. These sessions are opportunities to connect with peers as well as participate in a holistic health practice on a regular basis. Finally, social involvement fosters the development of good relationships in which students feel comfortable communicating problems they are experiencing. These trusting relationships counter the tendency for students to keep their concerns bottled up inside.

Do you have advice for students on ways to interact with academic advisers and faculty who may not have the specific knowledge dealing with people who have mental health challenges or psychiatric disabilities?

As mentioned previously, part of the academic advisor's role is to listen to problems related to adapting to college. Academic advisers are prepared to listen and empathize regarding issues outside of the academic realm. If something is affecting or may eventually affect a student’s academic performance, then they should let professors know sooner rather than later. Faculty will appreciate a student letting them know in a timely manner, will view the student as responsible, and likely will attempt to help or refer the students to someone at the counseling center who can be of help. Communicate early when problems are usually more manageable and easier to resolve. Students should not feel like they need to solve their problem alone or “power through” a problem without support from an adviser, faculty member or counselor.

What are ways a college can successfully support students with mental health challenges or psychiatric disabilities? Where can students seek help/advice if an issue does arise?

A college can provide opportunities for students to meet with representatives of the counseling center, disability services, and academic advising prior to the start of the fall semester. One approach is provide an event during the summer where students and their parents can receive general information as well as the opportunities to speak one-to-one with counselors and advisers.

Another helpful approach is to provide outreach programming. For example, counselors from the university center might provide information sessions in the residence halls where students can learn about the purposes and services provided by the counseling center. This type of programming can help students gain familiarity with services provided by the university center. In addition, students can learn how to support a friend or roommate who they believe might benefit from counseling.

College counselors can meet with faculty and staff who have daily contact with students. For example, college counselors might attend faculty department meetings and let faculty know what to do if they have a student of concern. Sometimes faculty and staff on a college campus are concerned but unsure how they can help. Students who are seeking advice can talk to a faculty member, academic adviser or professional counselor. Faculty and advisers who are concerned about a student should encourage the student to go to the counseling center, and may even accompany a student to the counseling center if the student is distressed or in a state of crisis.

How do you suggest a student addresses stigmas that may be associated with mental health or psychiatric disabilities on a college campus?

To a certain extent, the campus climate, including whether mental disorders are stigmatized, is an aspect of the environment that students cannot control. Understanding that mental health concerns are prevalent among college students can help the student to recognize that they are not alone. Results of the 2016 American College Health Association survey showed that 23.2% of students reported that anxiety adversely affected their academic performance during the previous 12 months, and 15.4% reported their academic performance was hindered by Depression, and 20.7% were adversely affected in the same way by sleep difficulties. Resilience theory and Alexander Astin’s involvement theory indicate that it is important for students to cultivate a sense of belonging on a college campus. It is important to find a co-curricular club, activity, group or campus employment in order to facilitate one’s sense of belonging. Sense of belonging, or social integration, enhances a student’s academic success as well as persistence to degree completion.

What are tools you see students with these challenges using to succeed once they get to college?

I like to think of it more in terms of resources than tools. The most important resource appears to be a good relationship with a trusted other. Students appear to thrive if they are able to establish a relationship with at least one faculty or staff member they can trust. I have also seen a number of first year students benefit from having an emotional support animal living with them in the residence hall.

Any final thoughts for us?

As I mentioned previously, there is a tremendous amount of diversity among students with mental health concerns. It is important not to overgeneralize because each person is unique. I want to emphasize how important it is for students to seek a sense of belonging in their new college environment. A caring staff member or a friendship with a single peer can be enough to ensure that a student stays enrolled at that college and persists to graduation. Finally, I want to add that I enjoy working with college students with mental health concerns a great deal, and the primary reason is that I admire their courage.

Dr. Mark Scholl

Associate Professor, Counseling, Wake Forest University

Dr. Mark Scholl is an associate professor in the Department of Counseling at Wake Forest University and an expert in culturally responsive approaches to counseling and supervision, existential counseling and psychotherapy, constructivist approaches to counseling, and has experience with career counseling among the ex-offender population and individuals with disabilities. Additionally, he has done research on the counseling preferences of Native American college students and reasons that this population under-utilizes counseling services. He is passionate about increasing diverse students' participation in and engagement with mental health services.