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Saturday, April 18, 2015

Good Mental Health Away from Home Starts Before College

From The Wall Street Journal

By Andrea Petersen
April 13, 2015

When Eliza Lanzillo went off to college, she was excited to leave behind her old school, her old routines—and her old mental health challenges.

“I thought of it as a clean slate. Nobody knows my history. I could be a new person,” says the now 21-year-old junior at Brown University. “I didn’t want people to see me as the girl with anorexia.”

Ms. Lanzillo started struggling with the eating disorder and anxiety in high school. She had been doing so well the summer before college that she stopped therapy when she arrived for college in Providence, R.I. But a few months into her first semester, she relapsed.

Brown University junior Eliza Lanzillo had a relapse of anorexia
and anxiety during her freshman year. She advises arriving
students with mental health issues to find a therapist near campus
even if they think they won’t need one. Photo: Brittany Comunale

With high-school seniors deciding where they’ll be attending college in the fall, now is the time, psychologists and psychiatrists say, for teens and their parents to focus on how to maintain good mental health away from home. This is particularly vital for the growing number of teenagers who have already struggled with mental illness in high school.


A Different Kind of College Prep

Teens should be able to handle basic tasks on their own before college. Feeling comfortable with these tasks is particularly important for students with pre-existing mental health issues:
  • Make doctor/dentist appointments.
  • Get enough sleep—without parental prodding.
  • Make travel reservations and get to the airport or train station.
  • Advocate for themselves with teachers and other authority figures.
  • Manage a budget.
  • Manage emotional upheavals.
Source: Anne Marie Albano, Columbia University Clinic for Anxiety and Related Disorders


About 14.3% of college students were diagnosed with or treated for anxiety problems during the past year, and 12% were diagnosed with or treated for depression, according to a spring 2014 survey of 79,266 college students by the American College Health Association. That is up from 10.4% for anxiety and 10.2% for depression in the fall 2008 survey. Anxiety and depression are the most common disorders, according to the survey.

Why mental illness seems to be rising among college students is unclear. Better medications and therapies are likely making it possible for more young adults with even serious mental disorders to attend college. The growing number of outreach programs by colleges is likely bringing more young adults into treatment. Advocacy groups like Active Minds Inc., a nonprofit with chapters on 428 campuses, are trying to reduce the stigma around having a mental illness.

But many students arrive unprepared, experts say.

“What happens is everyone is under the impression that at the end of high school, magically college will be different,” says Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders in New York. “That once she or he gets away from the same old routine and the same old peers that never connected with him, and the teachers who were mean, it is going to be different. And it isn’t.”

Indeed, in a study published in JAMA Psychiatry in 2014 that followed 288 adolescents and young adults with anxiety disorders, nearly half relapsed within six years of treatment. Late adolescence is also when more serious illnesses such as schizophrenia and bipolar disorder often kick in.

Living away from home for the first time, making new friends and handling the rigors of college coursework can all make the transition to college difficult—especially when those are added on top of an existing mental illness.

“Even good change is stressful,” says Micky M. Sharma, a clinical psychologist and the director of the Office of Student Life Counseling and Consultation Service at Ohio State University. He says traffic in the counseling center surges in mid-October, around the time of the first midterm exams.

Psychologists and psychiatrists say it is critical for students to become as independent as possible during the months before school starts.

Parents are on the hook, too. Now is the time for them to learn to let go. They should move from doing things for teens to taking on the role of adviser or coach, experts say. That includes formulating strategies and weighing solutions to problems with children and—after they make attempts at independence—reviewing how things went.

This often means parents must confront their own anxieties about their children failing. Ideally, parents should be practicing letting go all along and not waiting until just before college starts.

Concerned adults should try to avoid becoming what Dr. Sharma calls snowplow parents: those who remain too involved at college. “They will just come in and knock me out of the way to make sure their son or daughter gets what they need. Just because you can text your son and daughter 10 times a day doesn’t mean that should be happening.”

Dr. Albano at Columbia runs a six-to-eight-week college readiness program for high-school seniors with anxiety disorders and depression. During “exposure” group sessions, teenagers role-play to practice talking to professors and meeting new people—and learn to deal with negative or anxious thoughts that arise.

Dr. Albano has Columbia colleagues act the part of skeptical professors. The teens practice asking for help or extensions on assignments. Students are also sent to cafeterias at local universities to practice getting food and approaching groups of peers.

A young woman attends a group meeting of Dr. Albano’s
Launching Emerging Adults Program at Columbia.
Photo: Brian Harkin for The Wall Street Journal

 Then, in periodic transition sessions, parents and teens meet together. The goal is to help parents ease up on any overprotection. Often, parents of children who have struggled with mental illness have responded by doing more and more things for them. Then the children “start falling behind their peers in developmental tasks,” Dr. Albano says.

Dr. Albano has compiled a list of young-adult milestones that include managing money responsibly and establishing emotional independence from parents as part of the overall program dubbed LEAP (for Launching Emerging Adults Program). Parents and teens fill out what she calls scaffolding forms that detail which life tasks the teens can do independently, which they can’t and which are in the gray zone—ones they sometimes do on their own, sometimes not. The families work on moving tasks from the dependent zone to the independent one.

Dr. Albano says college-bound students should go to yearly physicals by themselves. They should also take at least one out-of-town trip alone, including making travel reservations and getting to the train or plane by themselves. “If you end up on a train going to Boston instead of Baltimore, all the better,” Dr. Albano says. “They learn it is not a catastrophe to make mistakes.”

Students arriving on campus also need to make sure they can handle taking their medication and getting refills on their own. Louis Kraus, chief of child psychiatry at Rush University Medical Center in Chicago, suggests students get a seven-day pill pack and set a daily alarm on their smartphones to help remember medication. Dr. Kraus has frank discussions about drinking with students on stimulants and benzodiazepines, drugs that can be deadly when combined with alcohol.

If teens are stable, they may be able to continue working with their home psychologist or psychiatrist via phone or Skype sessions, Dr. Kraus says. But establishing a relationship with a doctor near campus is critical if there’s a risk of a relapse or medication changes. While college counseling centers often offer emergency sessions, waits to initiate regular therapy appointments can be several weeks long.

Many centers have caps on the number of sessions students can have. About ¼ of colleges have no access to psychiatrists except as a private referral, according to a 2013 survey by the Association for University and College Counseling Center Directors.

Still, these logistical problems are solvable. Ms. Lanzillo, the Brown student, found her equilibrium after finding treatment near campus.

The transition also proved tricky for Josh Ratner, a 21-year-old junior at the University of Maryland in College Park. He says not having some basic life skills made his move to college much more stressful. “A lot of parents don’t realize they’re babying their kids. When you have mental health issues, the really simple things become intimidating.”

Mr. Ratner, who struggles with ADHD and anxiety but says he is now doing well, recalls a time when his car broke down at school. “I didn’t know what tire I needed, what service station to go to,” he says. “I spent a whole day missing classes on the phone with my Dad.”

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