So I was reading a 2012 report by the National Alliance on Mental Illness (NAMI) recently. Over 750 college students were surveyed, with NAMI attempting to determine views of mental illness among young adults, and the quality of campus services. The report is located here (PDF).
Most interesting to me is the data on disability accommodations (pages 12-13). While there is a lot of current data on students and mental health, they usually focus on counseling services. In that area, the rate of students getting help has sharply increased, though college-age adults remain the group least likely to seek help. This isn’t a terribly good survey in terms of research design, but any information is good.
A couple key insights emerge, which I’m fairly confident would hold in a more rigorous study.
There is a substantial difference between how many people with mental health conditions who know about accommodations, and those that actually use them. About 20 points separate the two.
Disability resource centers are orientated to physical disabilities, and aren’t designed with psychological conditions in mind.
Among those that dropped out of college due to mental health issues, getting accomodations may have kept them in school.
The conceptualization of disability in the United States has created these conditions. This gap between physical and mental doesn’t emerge from modern disability law necessarily, where the definitions are broad and inclusive. Rather, society has yet to shift its perspective on mental illness. Some tendencies:
People discount any claimed disability that is not clearly visible to outsiders. When I served on a county disability commission a couple years ago, a long impromptu discussion broke out during a meeting about people being harassed for parking in the special spaces because they didn’t “look like they needed it.”
The stigma against mental illness and disability are different, and a sizable group of people accept their belonging in the former group but not the latter.
The type of assistance given to people with psychological conditions, including more time on exams, exams in a quiet room, and longer deadlines, may seem unearned by those who qualify. Accomodations otherize. If you take your exams in a different room, or have different deadlines than your classmates, there may be resentment.
Faculty treat psychological accomodations as less important than physical accomodations.
The disability office as an institution is caught in the crossfire. It can be a key part of students succeeding in college, but many people have no concept of mental illness as being connected.
This is part two of a series on UC mental health and the campaign to reform it. A previous post outlining areas of concern is located here.
The UC Students Association (UCSA) has released their evaluation of campus mental health resources, part of a new reform campaign (#HowAreYou) which was adopted last August. Three areas were measured: accessibility of the system, diversity of current staff, and extent and quality of outreach.
Results: not good. UC students would be appalled if their own academic grades were this bad. Campuses scored best on outreach, which is the least important of the three criteria. The core issue is accessibility. Diversity among counselors is only meaningful if students can get appointments within a reasonable amount of time- and are allowed a sufficient number of sessions per term. Outreach is key- it destigmatizes mental illness, and plays a key role in the increasing number of college students looking for treatment in the last fifteen years. But effective outreach magnifies accessibility issues. The more students who seek Counseling and Psychological Services (CAPS) or an equivalent service, the more meaningful staff to student ratios become. It’s clear that the rise in demand for counseling and psychiatry is outpacing general student growth and funding allocations.
The increased need by students for campus mental health services has resulted in an overtaxed delivery system at UC that falls significantly short of meeting the actual student demand and expectation for services
The cumulative toll of this shortfall in service capacity has had and continues to have a significant negative impact on all campus populations, including other students, faculty and staff; on the affected individual student’s academic performance; and on that student’s overall mental and physical well-being.
Further, it is the Committee’s considered view that this situation will not improve over time, and indeed given general societal trends can only further deteriorate, without aggressive intervention on the part of the institution. This intervention must include a systematic review of policy, enhanced communication mechanisms, and a renewed commitment to campus-wide collaboration along with an infusion of new resources commensurate with both the nature and magnitude of the challenge now facing the University.
As usual, the issue boils down to money. The reason is the corporate-like administrative structure that ties up over a billion dollars more than is needed to run the UC. A low-cost, high revenue structure will always underfund student services like counseling. This combines with the ‘progressive’ state government abdicating its duty to provide quality higher education. Thus we are told that any investment in students will raise tuition, because in 2016 there is increasingly little difference between private and public universities. Remember how K-12 is a right, but once you hit around 18 education becomes a paid-for privilege? Students and faculty are hostages of a mindset we see in corporations all the time, where investment in people makes the system uncompetitive.
With that out of the way, I’d like to talk about the disability services for students, in the context of mental health. There are several names for this office:
Office for Students with Disabilities at UC San Diego and UCLA;
Disabled Students’ Program at UC Berkeley and UC Santa Barbara;
Student Disability Center at UC Davis;
Student Special Services at UC Riverside;
Disability Resource Center at UC Santa Cruz;
Disability Services Center at UC Irvine; and the Disability Services Office at UC Merced.
When #HowAreYou was first presented in a public meeting at UCSD, I had issues with its depiction of a full coalition of groups and university services. I like the focus on collaboration- as improving mental health is not just about psychologists but peer mentors, wellness education, student groups, resource centers, etc. But mental illness as disability was never mentioned. Laws like 5150 involuntary commitment were mentioned, but the Americans with Disabilities Act (ADA) was conspicuous in its absence.
Under the ADA, the definition of disability (Section 12102) is broad and non-exhaustive. In public perception, the term “disability” has been strongly tied to physical disability. The International Symbol of Access is the image most closely tied to the concept of disability- part of an inherent bias towards conditions that others can perceive and verify. Part of stigma is how people may not perceive psychological issues as potentially chronic or severe.
So let’s turn the three branches of #HowAreYou– accessibility, diversity, and outreach. All of this is based on my own experience, the experience of many friends and people I come across, and hour-long meetings with a case worker who deals with the largest portion of students seeking help with psychological conditions, dedicated to talking about the mental health system.
Accessibility: There are many different accessibility issues inherent in psychological conditions being the basis of disability accommodations. Here are some that come to mind initially:
Especially in cases of mental health, there are few connections between disabilities office and other parts of the university. Professors rarely, if ever, talk about it or put information on their syllabi. It’s seldom a topic of conversation in student groups.
Documentation is difficult for someone with no prior experience.
The ratio of case workers to students leads to logjams early in each term as everyone is trying to get their accommodations set and given to professors.
Faculty may block accommodation requests, which the student must then solve by going back and forth between the office and faculty.
Diversity: The same issues exist here, as it does when talking about CAPS.
Case workers and staff must be equipped to deal with a very broad spectrum of disabilities (movement, deafness, blindness, learning disabilities, anxiety, depression, mood disorders, PTSD)
Students may lack confidence in a staff member without shared experience (for instance, a deaf person may feel their obstacles can’t be fully experienced, or a depressed student may feel their issues are being devalued because it’s not visible)
Students may come from cultural backgrounds that don’t talk about mental illness, and may stigmatize those who have problems. This is brought up frequently by Asian Pacific Islander (API) students, and is relevant with both CAPS and disability services.
Outreach: Stigma is a big factor here, but I’m very insistent here- the stigma of having mental health problems is very different from the stigma of having a disability. So campaigns launched by #HowAreYou will have limited effect if they are only talking about the direct stigma of mental illness.
The disabilities office, like CAPS, is given a very limited slice of time in orientation. With so much information in a day-long event, students are unlikely to follow up with the office if they had heard about it for the first time.
Faculty aren’t trained at all about disability accommodations. Thus they often treat accommodations as guidelines rather than legal rights. If faculty have to go out of their way to meet standards, they will often refuse to honor entitlements.
Many faculty are new to teaching, or from countries that do not have an equivalent to the ADA. So a large chunk of teachers every year will have no prior experience with the system.
Because mental health is usually placed in a therapy/treatment rather than disability context, anti-stigma campaigns rarely address that there are two stages of stigma of mental illness.
The disabilities office rarely has a robust outreach component. They will table at resource fairs and present at orientation, but there is rarely a push to get staff and student mentors in club meetings, classes, and hold events specifically about disability.
It should be said that everything here applies more to psychological disabilities than other types. Many people have no idea psychological conditions are legally disabilities.
So this concludes my second post about mental health in the context of the UCs and the #HowAreYou campaign by the UC Students Association. I welcome any information by those that have experience with disability services and mental health, especially outside UCSD.
My next post will be about the structure of how students give accommodations. An exchange with someone at a community college in Northern California shows that there are multiple ways to go through the process, and I think some are superior to others.
Sulome Anderson’s feature last week, “How Patient Suicide Affects Psychiatrists” is a great inversion of a big social problem. Most features on suicide and mental illness (including the great The Cost of Not Caring series by USA Today) tend to focus on the individual who committed suicide and the impact on their family and community. Anderson did quality journalism to create this feature, which helps humanize doctors who naturally become the bad guys in some of these cases.
Personally, last year someone I knew tried to end their life- I had talked to them the a few hours prior to the attempt, having a short conversation about family relations that turned out to be much more important in hindsight (they wanted to know if I had special insight on why I have a good relationship with my parents, and they had the opposite. I wasn’t helpful, though I tried to be). When I visited this person the following day, they were still attempting to die in the confines of the hospital room. Never have I seen desperation more fully realized. It’s profoundly disturbing, and the feature gets across that this sentiment crosses all lines of profession or experience. You don’t become truly adjusted to suicidal people in your life, even if you chose psychiatry as a profession.
Personally, I thought that my history of mental illness would help deal with this experience. I’ve never been particularly suicidal, but my choice to be an activist and socialize within the community has put me into contact with many people who are open about their past with suicide. Turns out that was all (I suppose) wistful thinking. It’s horrible to witness, even in the context I had, where I had some time to mentally prep.
This feature helped develop a three-dimensional picture of the tragedy, which I wish was available with all social problems. Everyone loses someone in a suicide, and we each lose a part of ourselves when someone we know personally attempts or completes it. And yes, as Anderson comes to- sometimes there is nothing that can be done. Zero suicides is an ideal to strive towards, but no free society can ever attain it.
We are all humans with flaws and we are not omnipotent. There is only so much we can do for those we love. All we can do is our best.