According to the latest statistics from the National Alliance on Mental Illness, 43.8 million Americans, or 18.5% of the national population, experience mental illness every year. Mental illness is a broad term defined by the Mayo Clinic as any disorder that affects one's mood, thinking, or behavior. When mental illness influences family life, work, education, and other aspects of day-to-day life, the condition is known as a psychiatric disability.
43.8 million Americans, or 18.5% of the national population, experience mental illness every year.
Psychiatric disabilities are persistent conditions that may have a significant, lifelong impact. Those diagnosed with a psychiatric disability may mitigate the effects of their condition with medication and/or ongoing psychotherapy. Even with treatment, many psychiatric disabilities will persist in some form.
College students with psychiatric disabilities face unique educational challenges. Dedicated mental health counselors and disability coordinators are available on most campuses, and students can typically seek medical attention. Many students, however, do not know how to get help for their problems. To help students get the assistance they need, we have examined instructional strategies, course accommodations, and other campus services designed to serve this population. Our goal is to provide a comprehensive resource for college-bound high school seniors and currently enrolled postsecondary students who struggle with mental illness.
Types of Psychiatric Disability
First, let's explore some of the most commonly diagnosed psychiatric disabilities. This list is by no means exhaustive; there are more than 200 classified types of mental illness, and all of them can evolve into a psychiatric disability.
The National Institute of Mental Health (NIMH) defines depression as a serious mood disorder that impacts the way one processes thoughts, emotions, and daily activities (such as sleeping or eating).
Depression comes in many forms. Persistent depressive disorder, or dysthymia, is a depressed state that lasts two years or longer. Bipolar disorder is characterized by radical mood swings between depression and manic states. Psychotic depression occurs when depressed feelings are accompanied by delusions, hallucinations, or other forms of psychosis. Women who are pregnant or have recently given birth may be affected by perinatal depression, while seasonal affective disorder occurs periodically throughout the year.
COMMON SYMPTOMS OF DEPRESSION
- Prolonged sadness, anxiousness, and/or irritability
- Low energy or fatigue
- Insomnia or other sleep-related issues
- Changes in appetite
- Suicidal thoughts
- Physical problems, such as headaches or muscle stiffness
Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood condition that also affects adults; roughly 6.4 million Americans have been diagnosed. People with ADHD usually display chronic inattentiveness, hyperactivity, impulsiveness, or any combination of these behaviors. People with ADHD often struggle to focus on tasks or conversations. They may also regularly feel disorganized or forgetful. In the past, attention deficit disorder (ADD) was used to describe this condition; contemporary mental health experts consider the term obsolete.
- Anxiety Disorders
According to the NIMH, an anxiety disorder is characterized by levels of stress that significantly impact everyday life. Anxiety sufferers often ebb and flow between tense, high-strung moods and periods of fatigue. Other symptoms include persistent irritability, sleep problems, and physical pain. NIMH notes that most people have one of three common anxiety disorders.
Generalized anxiety disorder is defined by prolonged periods of unwarranted stress and worry. People with panic disorder experience sudden bursts of fear known as panic attacks that are supplemented with physical symptoms like heart palpitations, trembling, and dizziness. Finally, people with social anxiety disorder struggle with feelings of stress and insecurity in social situations, even casual ones like brief conversations and friendly group outings.
- Drug Abuse & Addiction
Addiction is defined as a "chronic, relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around them." Most mental health experts agree that addiction has three underlying causes: biology and family history, environment, and development. Addicts may be influenced by one or more of these factors. Addicts commonly seek certain drugs or substances, such as alcohol, cocaine, heroin, and methamphetamine. Nicotine, the substance found in tobacco products, is also highly addictive. Additionally, people may become addicted to sex, gambling, or other activities that can be harmful in large doses.
There are many societal misconceptions regarding substance abuse. A report by the National Institute of Drug Abuse notes that "it is often mistakenly assumed that drug abusers lack moral principles or willpower and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions or a strong will." Psychotherapy may help addicts control their compulsive urges, but treating the condition with extended rehabilitation and therapy is generally more effective.
- Eating Disorders
Much like addiction, eating disorders are commonly and incorrectly perceived as lifestyle choices. However, eating disorders generally begin as unhealthy obsessions about nutrition or weight that evolve into harmful patterns of dietary behavior. Three conditions are particularly common. People with anorexia nervosa often see themselves as overweight and unattractive. They dangerously restrict their daily caloric intake and experience health effects related to starvation and an incomplete diet. Bulimia nervosa is characterized by two common behaviors: chronic overeating, followed by a period of "purging" through vomiting or diuretic ingestion, fasting, or excessive levels of physical exercise. Binge-eating disorder is a separate condition defined by levels of chronic overeating comparable to bulimia without the purging, fasting, or excessive exercise phase.
The NIMH's official definition of Obsessive-Compulsive Disorder (OCD) notes it as a prolonged condition with two behaviors: obsessive thoughts and compulsive behaviors. Individuals with OCD are driven to repeat these thoughts and behaviors frequently, sometimes dozens of times per day. Specific symptoms include an irrational fear of germs, unwanted thoughts, excessive counting, and physical spasms. OCD affects a person's everyday life, and the lives of their family members, coworkers, and acquaintances. People suffering from OCD may lose their job or face a degree of social alienation.
According to the NIMH, Autism Spectrum Disorder (ASD) is a wide-reaching condition characterized by communicative struggles, social awkwardness, and repetitive or obsessive behaviors. Some people with ASD are barely affected, while others have multiple noticeable symptoms. Historically, the terms "autism" and "Asperger's syndrome" were used to describe two different conditions; today the American Psychiatric Association considers these to be part of the same behavior spectrum.
Disability in Colleges
Some psychiatric disabilities are more common than others among postsecondary students. A 2012 NAMI survey titled "College Students Speak" noted that:
- 27% of all respondents (male and female) said they lived with depression
- 24% said they lived with bipolar disorder
- 12% said they lived with "other conditions"; these include dysthymia, eating disorders, OCD and ASD
- 11% said they lived with anxiety
- 5% said they lived with ADHD
- 1% said they lived with substance abuse
In an article for Psychology Today, Gregg Henriques, Ph.D., notes that an increasing number of college students experience mental illness. He cites data from an NAMI survey, which found that half of all respondents did not receive any mental health education or evaluations prior to enrolling in college.
30% (of college students) struggled with schoolwork due to a mental illness, while one in four experienced suicidal thoughts, and one in seven engaged in reckless behavior.
Roughly 30% (of college students) struggled with schoolwork due to a mental illness, while one in four experienced suicidal thoughts, and one in seven engaged in reckless behavior. However, only 7% of parents surveyed believed their child was living with a mental health issue. An additional survey by the Association of University and College Counseling Center Directors found that 95% of the respondents believed the number of students with a mental illness and/or psychiatric disability was "a growing concern" at colleges. Henriques further noted that the suicide rate among 15 to 24 year olds has tripled since the 1950s.
Transitioning to College & Unique Challenges
Most college students struggle with the transition to some extent, but those living with a psychiatric disability face their own set of challenges and obstacles. Briana Boyington, of U.S. News & World Report, emphasizes the importance of selecting a college or university that offers all necessary services and accommodations. A student with OCD has different needs than one with ASD, and students should research whether their target schools have the services they need.
Boyington also highlights the need for supportive professors. Students who have been diagnosed with a psychiatric disability should meet with their current therapist or counselor to create a sustainable treatment plan. On-campus counseling and mental health services are also in place at most schools in order to help undiagnosed students.
How Schools Accommodate Students with Psychiatric Disabilities
Most academic experts agree that Universal Design of Learning (UDL) is key for integrating students with psychiatric disabilities into college classrooms. UDL seeks to address and modify course curricula that excludes any student, particularly those with a disability affecting their ability to learn and/or receive instruction in a class setting.
In order to create universally accessible courses, colleges must take the following steps to ensure their classes and campuses are completely inclusive:
- Allow students with special needs to complete coursework, give presentations, and take exams using alternative formats.
- Work with students with specific needs to gain access to adaptive software and technology that helps them learn effectively.
- Appoint individuals who can assist these students as note-takers, readers, scribes, or other essential roles.
- Offer students with special needs additional time for assignments and tests, as well as getting to class.
- Guide students with disabilities to specialized counselors, resource centers, and other on-campus services dedicated to assisting these individuals.
Colleges can further accommodate students with psychiatric disabilities by providing resources to help all students learn without distraction. Common assistive technologies include:
- Mp3 and CD Players
- Devices that play instrumental music or natural sounds can be helpful for students with social anxiety disorder or other conditions that cause them to struggle in large classroom settings. Mp3 and CD players can also serve as effective study aids for students with ADHD and other conditions that make focusing difficult.
- Electronic Planners
Students who struggle with organizational anxiety usually benefit from some sort of reminder system. Daily planner notebooks are helpful, and electronic or digital devices offer added convenience and portability. Students can use them to maintain a class schedule, organize assignments, and plan appointments with an easy-to-use interface.
- Digital Recorders
Students who have trouble focusing in class can use a digital recorder to capture lectures, notes, and course information. These devices are usually pocket-sized and capable of recording hours of material.
A "soother" is defined as any device that calms individuals prone to anxiety, stress, and other elevated moods. These may include Mp3 or CD players that transmit mellow music or sounds, but a soother could be something as simple as a small object or keepsake that provides emotional relief.
- Service Animals
Service animals (usually dogs) help students with psychiatric disabilities cope with new stimuli. These animals have been specifically trained to provide emotional support to people and to intervene when their owners are experiencing unhealthy levels of anxiety or psychotic episodes. Most college campuses allow service animals in classrooms.
Common Assistive Apps
|Self-Help for Anxiety Management: Nicknamed SAM, this highly rated app monitors anxious thoughts and behaviors in order to create sustainable long-term management plans.|
|Recovery Record: This app helps people with eating disorders by allowing them to create healthy meal plans, monitor their urges to binge, and create long-term management systems.|
|RescueTime: Ideal for people with ADHD and other conditions that affect focus, this app tracks the user's daily activities and offers strategies for balancing work, school, and leisure.|
|MoodPanda: This app tracks daily emotions using graphs, calendars, and other interactive displays to help students prone to depression, anxiety, and other mood-related disorders.|
|Panic Relief: This app features animated displays to discuss proper responses and procedures for panic attacks and other sudden bouts of anxiety.|
Summary & Wellness Strategies
The most important thing for students with psychiatric disabilities to remember is that they are not alone. Many students have strong support systems that include friends and family members back home, though not all are so fortunate. Thankfully, college campuses are required by federal law to offer counseling and therapy services to anyone suffering from a mental illness. These resources are especially crucial for students who attend school far from their hometown.
Faculty members also play a crucial role in the college experience of students with psychiatric disabilities. If students are comfortable discussing their condition, they should meet with each professor for a one-on-one consultation at the outset of each semester or quarter. They can explore strategies for attending class, completing assignments, sitting for exams, and performing other required tasks within the bounds of the student's psychiatric disability. Students should discuss any accommodations or assistive technologies they may need over the course of the term during these meetings.
Students living with a psychiatric disability should also ensure they are only participating in social activities that will not trigger the negative effects of their mental illness. Living situations are key: students should make sure they live in a comfortable setting with minimal stress. For some, that means living alone instead of in a dorm; others may prefer to have people around at all times. Students with prescriptions should also avoid excessive drinking and drug use, as these substances can counteract the therapeutic effects of their medication and, in some cases, can lead to a dangerous overdose.
Meet Psychologist Dr. Crystal Lee
Dr. Crystal Lee is a licensed psychologist in Los Angeles, California. She is passionate about launching adolescents and emerging adults into adulthood. She has specialized experience treating adolescents and emerging adults with neurodevelopmental disorders, particularly Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder.
Dr. Lee owns a private practice called LA Concierge Psychologist, where she provides “house calls” for her patients on the Westside; she also provides teletherapy to families all over California. As respected member of the mental health community, Dr. Lee is a board member of the Los Angeles County Psychological Association and presents at conferences and trainings for psychologists.
- What are the three most important attributes or characteristics a student with psychiatric disabilities should consider when selecting a university experience and why?
Besides all of the typical attributes that college applicants look at, it's really important for students with disabilities to know what kind of support the college has. Though the ADA covers all college campuses, there are definitely some schools that have more robust academic accommodations. Additionally, look at the mental health supports that the college offers. Most college campuses have a college counseling center, but the services and supports offered vary widely. Some colleges provide primarily group therapy; others may limit how many sessions you can access per year. If the college has limited mental health supports, then it's important to look at the community at large and see if there are available psychologists, therapists, or psychiatrists that can serve your particular needs.
Lastly, look at the campus culture. Some campuses embrace student differences and proudly destigmatize mental health struggles. Some colleges will even have student run groups (like Active Minds) where you'll be more likely to find allies. Do students generally seem supportive, or is the environment more competitive? Students with disabilities would likely do better on a campus that's more supportive.
- How important is a university's community and resources for students with psychiatric disabilities when deciding on a college?
Extremely! As I mentioned above, you definitely want to do some research and determine what resources the college supports. If possible, visit the campus' disabilities office and meet some of the staff. Get a feel for how friendly and supportive they seem. You'll probably want to steer clear of a campus that has a very disorganized disabilities office or one that feels unsupportive.
- What is the process like when working with university staff, professors and disabilities/mental health services?
Unlike high school where your parents and high school staff rallied around to support you, getting your accommodations and getting the support you need falls solely on your shoulders. You have to do the legwork in terms of getting set up with accommodations at the disabilities office, making sure you're communicating with the disabilities office and your professors, etc. In college, you are the engine that moves along everything you need to be successful. It's highly unlikely that someone else will remind you to schedule your extended time testing at the disabilities office or to renew your accommodations each semester.
- How do you suggest a student addresses stigmas that may be associated with psychiatric disabilities on a college campus?
I think the majority of college counseling centers are trying to contribute in the fight against mental health stigmas. Many campuses also have an Active Minds club, which has the mission of fighting mental health stigma. Most major cities have a chapter of the National Alliance on Mental Illness (NAMI), which also helps with fighting the stigma. Getting involved in these groups or their campaigns can help destigmatize mental health struggles.
- What are some strategies to approach professors or campus resource centers, if a student is feeling unsure?
It can be really difficult to take that first step in asking for help. Sometimes it helps to go along with a trusted friend for moral support. If a student is uncomfortable doing that, then it usually helps to go in with a few prepared questions or tasks that need to be accomplished. Usually this helps the student feel a little more prepared and confident; also, if they get flustered, the student can always reference the prepared points he/she made. Another strategy is to ask some peers who they've worked with that has been helpful. Sometimes just knowing that the person is already someone known to be friendly helps take the pressure off of meeting that person and asking him/her for help.
- What advice would you give to a student with a psychiatric disability who is considering college?
I would suggest that student work with his/her support system to prepare for college the spring and summer leading up to leaving for college. This is the perfect time to create a solid transition plan, learn any needed skills to be successful, and set up some supports so they're in place when fall semester starts. It's tempting to just try and wing it once you land on campus because the preparation can sometimes feel stressful or be time-consuming, but I would strongly advise against that. Transition planning will set you up for success so you can focus on enjoying the college experience!
- What advice would you give students who don't believe they can attend college with a psychiatric disability?
More and more students with mental health struggles are going to college; the highest number in history, actually. This is because colleges are getting better at supporting these students, and families are getting savvier about transition planning to set up their students for success. This is not to say it's a walk in the park; college is tough for students with and without disabilities, but it would be a shame if a student interested in college is deterred from applying just because of his/her disability.
- What are tools you see students with these challenges using to succeed once they get to college?
Depending on the specific strengths and areas of growth, students may need supports from any of the following people: a psychologist, a psychiatrist, an educational therapist, a subject-specific tutor, an executive functioning coach, a life skills coach, a college advisor, and a disabilities office counselor. I would encourage the student to have at least one trusted person on the college campus he/she can go to when he/she is struggling; this could be a college advisor, therapist at the college counseling center, resident assistant at the dorms, or disabilities office counselor.
There are some fantastic apps that students use to help them with everything from stress reduction to tracking their mood to scheduling. I would encourage students to start trying out different apps prior to fall semester (senior year of high school is a great time to test things out) so they land on campus with an arsenal of supportive tools.
- What are some of the ways family and friends can support students with psychiatric disabilities during this time of transition?
I cannot stress enough the importance of working on a transition plan the spring and summer before starting college. This is when family, friends, and supportive professionals can come together and figure out what specific supports the student needs to be successful in college. With some preparation, the inevitable curveballs and stressors of college will feel more manageable.
For example, if an area of growth for a student is that he struggles with making friends, the student can participate in a social skills program prior to college; if he has a friend going to the same college, the friend can act like a social coach to help the student meet new people and navigate tricky social situations. The student could continue to see a psychologist to reinforce the needed social skills and help the student cope with the social stressors of college.
- What are the ways a college should support students with psychiatric disabilities? Where can students go for help if an issue does arise?
Colleges that provide academic and mental health supports are doing what they can to support students with mental health struggles. Many colleges are doing more to train their professors on how to work best with students with disabilities, which is fantastic.
The disabilities office or the college counseling center are the best places for a student to go if an issue arises (depending on if it's more of an academic issue or social-emotional struggle). If the student has a trusted academic advisor, that person would also be a good person to reach out to.
- AAHD Frederick J. Krause Scholarship on Health and Disability
This one-time $1,000 award is available to college students who are currently enrolled in an accredited degree program. Applicants must provide a note from their physician or therapist to prove they have a disability; two letters of recommendation, college transcripts, and a few personal statements are also required.
- Business Plan Scholarship from Fit Small Business
Any undergraduate or graduate-level student with a physical or psychiatric disability is eligible for this one-time $1,000 scholarship. Applicants must submit a 500-1,000 word essay about their experience writing business plans.
- Google Lime Scholarship
This one-time $10,000 award is reserved for students with disabilities who are currently pursuing a degree in computer science. Candidates must submit three different essays about their passion for computer science and their career goals.
- Learning Disabilities Association of Iowa Scholarship
This $500 prize is awarded to three recipients per year. Candidates must have a learning disability, be members or children of members of the LDA-IA, and be enrolled or plan to enroll in an accredited two-year, four-year, or vocational training program.
- Margaret Howard Hamilton Scholarship
Offered through the Daughters of the American Revolution, this annual award provides $1,000 for up to four years of academic study. Only students with recognized learning disabilities are eligible.
- Michael Yasick ADHD Scholarship
This one-time $2,000 prize is awarded to as many as 55 recipients every year. Applicants must show proof of ADHD. Winners also receive one-year of complimentary ADHD counseling.
- National Center for Learning Disabilities
Students with ADHD, ASD, and other learning disabilities may qualify for four different awards offered through the NCLD. The amounts range from one-time, $2,500 scholarships to recurring awards of up to $10,000 over the course of a four-year program.
- NIMH Scholarship
Winners of the NIMH's annual, recurring scholarship will receive $20,000 per academic year for up to four years of postsecondary study. Recipients must attend the institute's 10-week summer workshop and serve at least one year at the NIMH laboratory after graduation.
- Organization for Autism Research Scholarship
The $3,000 OAR award is presented to applicants who have been diagnosed with ASD. Candidates must be enrolled full-time at an accredited school to be considered.
- RISE Scholarship Foundation
This one-time scholarship awards $2,500 to recipients who have been diagnosed with ASD or other learning disabilities that may or may not be linked to mental health. Only college-bound high school seniors are eligible.
National Institute of Mental Health (NIMH): The leading federal agency in the field of mental health research, NIMH is one of 27 branches of the National Institutes of Health. The NIMH website is a compendium of news, published reports, academic journals, data tables, and other academic resources.
National Alliance on Mental Illness (NAMI): Founded in 1979, NAMI is the nation's largest grassroots organization in the country that supports people living with mental illness. NAMI maintains a toll-free hotline to provide advice and medical referrals. Representatives from the organization also work closely with lawmakers nationwide to ensure fair and equal protection for people with mental health issues.
Treatment Advocacy Center (TAC): This nonprofit organization has worked to promote mental health treatment and fight social stigma related to mentally ill individuals for nearly 20 years. TAC also collaborates with researchers to publish the latest developments in medication and treatment for mental illnesses.
MentalHealth.gov: This website, maintained by the U.S. Department of Health and Human Services, maintains an up-to-date listing of toll-free hotlines accessible to people living with mental illness.
Shining a Light on Mental Illness: an Invisible Disability: This blog post from the World Bank explores various issues faced by people living with mental illness. Links to other related blogs and websites are included.
National Coalition for Mental Health Recovery: An organization of mental health consumers/survivors, leading the development and transformation of the mental health field through implementation of health care, mental health, and social policies.