Staying Healthy at Tufts
Student Mental Health and
Richard Kadison M.D.
Chief, Mental Health Service
Harvard University Health Service
• Reduce Stigma, Manage Stress
• Convince Universities that health and
counseling resources are wise investments
• Coordination of care between health,
counseling, residence, faculty, and
• Integrating Cultural Sensitivity and
competence into our work
Current issues
• Integration of Academic Work with
student health and development
• EVERYONE on campus is responsible
for student well being.
• Coordination of care
• More serious mental health problems on
campus. Helping high risk students
Stress on Staying Healthy
• Eat, Sleep, Exercise
• Stay connected with friends/ community
• Provide tools to manage stress
• Educate community to reduce stigma thru
education about common problems and
how to recognize warning signs.
• Create multiple portals of entry to care
Staying Healthy
• Stressing Personal and professional
• Service Opportunities: Engaged Learning
• Health Education and Information (MRSA)
• Alcohol and Nutrition info: (BAL + BMI)
• Complementary Services: Acupuncture,
Massage, Yoga, Mindfulness
Student Participation/ Engagement
• Key for Successful Outreach
• Peer Counseling/ Education Programs
• Student Health Advisory Group
• Wellness representatives in the dorms
• Mental Health Advocacy Group/Active
• Involve in screenings and education
Getting Care
• Multiple ways to access care
• Chaplains, Advising system, residence
• Information about resources and warning
signs for parents and families
• Stress relieving events and workshops at
high stress times (massage, food,
activities/ workshops)
Access to Care
• Triage system: Who needs to be seen
• Inside vs. Outside Care
• Community Resources
• Hospital and Medical Leave, Reentry
• When should students go home? How to
• Teach Wellness: Eat, Sleep, Exercise
Lessons from Virginia Tech
• Students in distress often don’t seek or
avoid care
• When students are mandated for
“assessment”, there must be follow up and
clear consequences
• When students return from hospital care,
a careful internal review process is critical
Lessons from Virginia Tech
• Violence is very rare and difficult to predict
(prior violence best predictor)
• There must be a community effort to
reduce stigma, recognize risk factors, and
find portals to care. Educate everyone
• Counseling and Health Services can and
should provide consultation to the
community (students, faculty and staff)
Lessons from Virginia Tech
• Schools must find ways to respect medical
privacy, but coordinate concerns
If students can’t expect privacy, they won’t seek
There must be communication, sometimes one
way, between faculty, administration, family,
counseling when concerns arise about a student
Youth Risk Survey 2001
13,600 HS students
• 28.3% sad or hopeless almost every
day> 2 wks stopped some activity due to
• 19 percent of students reported that they
seriously considered attempting suicide
• 14.8 percent had made a specific plan to
attempt suicide.
• 8.8 percent had attempted suicide in the
previous year [Grunbaum et al 2002].
College Data ACHA and Kansas
• Depression Doubled, Suicidal Ideation
Tripled, Sexual Assaults quadrupled over
13 years
• 45% students self report depression
• 10% report serious suicidal ideation and
44% binge drink
• These are the best years of your life
ACHA College Data
• 9% seriously consider suicide 1% attempt
• Depressed 52-42% 2000/2006
• No Sexual partners 40% vs. 5% perceived
• Medication for depression 36-42%
Graduate Students
• Often at higher risk, higher suicide rates
• Economically in worse shape, many have
no insurance.
• Berkeley Graduate Student Mental Health
Survey Dec. 2004 showed similar findings
to undergrad surveys
Berkeley Grad School Survey
• 45.3% respondents experienced emotional
or stress related problem SIGNIFICANTLY
affected well being/ academic
• 9.9% seriously thought about suicide
• 52% considered using counseling less
than 33% did use
• 25% unaware they were available
Learning from Each Other
• Peter Leviness undergraduate student
survey engaged students to highlight and
address campus stress U. Richmond
• Jan Collins-Eaglin 1st. Generation,
multicultural students need language for
therapy, Wayne State
• Ron Chapman Pre and post counseling
GPA changes- increased 1.0 BYU
Stories to Spread the Word
• Educate the community to reduce Stigma:
College Wide Events
• Being Depressed at HBS
• Walk the walk of the student on your
campus: illness in family, high fever,
serious alcohol problem. How do you get
help? Web?
Healthcare 2007
• BIG changes in the last decade
• Severity of Problems of students making it
to college
• Managed Care= Shorter Hospital Stays
and more alternative treatments
• Reduced outpatient community resources
• Higher insurance costs for students
Impediments to Academic Success
• Stress 32.4%
• Cold/Flu 25.6%
• Sleep Problems 24.6%
• Depression 15.3%
• Internet Use/ Games 13.4% (3-6% of
students addicted to internet
pornography; 20% are women)
Sleep Problems
• 35% of adult population experience
• 11% of college students get a “good
night’s sleep”
• Loss of cognitive functioning, driving
• Increased risk of depression
• < 7 hours yields sleep deprivation
Common Problems
• Developmental Adjustment, Relationships
• Depression
• Anxiety
• Eating Disorders
• Bipolar Disorder
• Acute Psychosis
• Substance Abuse
High Risk Issues
• Eating Disorders
• Dual diagnosis Substance Abuse/
• Bipolar Illness and Psychosis
• Reentry from Hospitalization
Eating Disorders
• Anorexia, Bulimia, EDNOS
• 1% Anorexia, 3-5% Bulimia, 15-20% DE
• 5-15% mortality from anorexia
• 1/3 of people don’t improve from serious
Substance Abuse
• Binge Drinking- 5 or more drinks one
sitting in past 2 weeks
• 44% meet criteria in national surveys
• 41% did something they regretted
• 31 % forgot what they did
• 9.7% unprotected sex
• 17% physically injured
Substance Abuse
• Don’t stigmatize medical services.
Separate from Judicial
• BASICS: Motivational interviewing and
education shows best results with
reducing high risk drinking
• Consistent enforcement policies and
consequences for students with identified
AODS team on campus
Stimulant Abuse
• 900% increase in production of
methylphenidate (Ritalin) 1990-2000
• 3-7% school age kids ADHD
• 50% carries over into college
• 16% use recreationally by mouth,
snorting or by injection 30% share
• Long Term Risk factors
• Prior attempts
• Feelings of hopelessness
• Suicidal plan, isolation, prior attempts
• 10% attempters die over 10 years
• 45 of 76 suicides occurred during first
week post hospitalization
Legal Issues
• Shin case settled but issues unresolved
• Virginia Tech: Refusal of care by student
• George Washington, Hunter College
student dismissals
• Allegheny College Suicide
Legal Issues
• Handbook Language for Notification/LOA
• Medical Privacy Laws very strict
• FERPA (Family Education Rights and
Privacy Act); HIPAA
• Prohibits disclosure of education records
• Permits disclosure gained through
• Permits disclosure of safety emergency
Leave of Absence and Return
• Students rarely want to take time off, but
may need to
• When students return, important to review
their readiness to be back at school
• Contracts and Riders
• 562 students asking for counseling followed over
2 year period
0 sessions 65%
1-12 79% >13 83%
Several studies followed people over 5 years all
showed dramatically higher retention rates,
averaging more than 10% for students who
used counseling services
Steve Wilson, Terry Mason, Evaluating the impact of receiving university based counseling services on
student retention
Journal of Counseling Psychology 1997 vol 44. no 3 p. 316-320
• Social Isolation single most important
determinent of dropout rates
Pascarella and
Terrazini, 1979
• Emotional- Social Adjustment items
predicted attrition better than academic
items Gerdes and Mallinckrodt 1994
• 5 year study of Berkeley students and
those making use of counseling had
higher graduation rates Frank and Kirk 1975
• Polarized attitudes of students and staff
• Antidepressants: benefits and risks
(bipolar) and side effects
• Sleep Medications
• Anxiety Medications
• Stimulants: Newer preparations
• Role with disabilities and judicial issues
• Antidepressant and Stimulant Safety
• Reduction of 20% in prescribing since
black box warning
• Most prescribed medications on college
campuses: 12% of pharmacy budget for
• Side Effects: Kiss of death
Multicultural Students
• Present emotional problems physically
• Metabolize medications differently
• May be more comfortable with Pastoral
Resources: follow path of least resistance
• Vulnerability in language/cultural
adjustment and symptom presentation
• Staff sensitivity to cultural beliefs
Diversity Considerations
• Create a culturally competent community
• Learn and respect different values and
• Celebrate the diversity of your community
by events that encourage sharing; art,
music, and other traditions.
• Diversity may be via culture, race,
ethnicity, sexual orientation, economics
Coordination of Care
• Handbook expectations: who gets notified
about hospitalization/ return
• Identifying high-risk students
• How is residence involved with worrisome
• Eating Disordered or Substance Abusing
students in residence, what happens?
• Contracts: When to invoke them
• 70-80 % of students get their health
information from their parents
• They often feel they are supposed to let
go of students and need help staying
engaged without being intrusive
• Help “helicopter parents” teach their
students to fish and become “emerging
What Must We do?
• Engage our students in the community:
Life is richer and more satisfying for
students who are engaged in learning
• Stress Health and Wellness on campus
and create opportunities for connections
Wellness Activities
• Engage Students in community- study
breaks, hikes, encourage student groups
• Teach yoga, sleep hygiene, mindfulness,
relaxation response
• Have annual “wellness or caring events”
like this one or “maximize academic
potential, minimize stress”
• Student Wellness Reps.
Coordinating Board
• All stakeholders: Students, Financial and
Student Service Deans, Residence, Public
Safety, Ministry, Health, Counseling,
• Community wide programs for education
from top down and bottom up; set
Coordinating Board
• Advisory to Counseling/MH
• Strategic, Realistic Planning
• Community vs. Individual needs:
• Consider having regional meetings with
shareholders in other area schools to
share good ideas and increase leverage
with local medical/ community resources
Web Information
• Online screenings:;
• Information/education about alcohol
• Student made DVD to incoming students
• Information about resources
• Many good web resources (JED (Ulifeline),,
• Launching
• Emotional and Physical Well-Being are
crucial for Academic Success
• We all have to work together
• Focus on Staying Healthy and Learning
Healthy Lifestyles: Eat, Sleep and Exercise

College of the Overwhelmed