“Mom, why is it so hard to find a therapist or psychiatrist when you need one?” asks your daughter Emily, a college freshman. It is the week before Thanksgiving, she is feeling depressed most days, and she wants to restart therapy and medication. Emily had been treated for depression with therapy and an antidepressant during most of senior year of high school. After doing well for several months, she was able to stop treatment, but now her symptoms have returned.
Emily meets with a counselor for a consultation but is told that campus mental health services are not taking new patients. She is given phone numbers of therapists and psychiatrists in the community who accept her insurance. She has called them but they either have not returned her call or are full. What actions can she take to get help?
In sum, there are a number of data pointing to actual increases in rates of mental illness/distress. This massive rise is likely a function of both more accepting attitudes about reporting distress and seeking and receiving treatment, and actual increases in stress, anxiety, and depression and other related problems.
You may have thought the competition to get into college was fierce. But try finding a campus therapist or psychiatrist when academic stress is peaking. Your college student might be able to get a one-time meeting with a therapist for urgent problems, but many of the appointments for ongoing treatment are full by mid-November. In fact, some schools no longer offer any campus therapy and/or psychiatry services but instead refer students to off-campus providers. Have you ever been in a corn maze at a fall festival where you are constantly running into dead ends? That’s what it can feel like to your college student.
"You see much more of your children once they leave home." -Lucille Ball
In the last ten years, the rate of mental health treatment in college students has increased, but not enough to keep pace with mental health needs - something I have witnessed first-hand as a college mental health psychiatrist. According to a recently published study, the number of students seeing a therapist or taking psychiatric medication in the last year rose from 19 percent in 2007 to 34 percent in 2017. About a third of the students who received mental health services obtained them on campus .
Despite increased utilization of mental health services, only half of students who screened positive for depression or an anxiety disorder received any mental health treatment (therapy or medication) in the last year, according to data from the 2016-2017 Healthy Minds Study. While stigma might be keeping some of these students from seeking help, shortages in campus and community resources are significant barriers. Financial obstacles including high insurance co-pays and deductibles can also keep students from seeking services off campus.
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This maze of mental health care has an exit that leads to treatment, but students often need a guide along the way. Parents are the best navigators, offering emotional support and experience to work around service shortages and financial obstacles.
Here are options you can discuss with Emily to expedite treatment, before her symptoms escalate.
1. Other Campus Resources : Psychiatric medications can be prescribed by a psychiatrist, but also by a psychiatric nurse practitioner, primary care doctor, primary care nurse practitioner, and physician assistant (PA). Since psychiatry appointments are not available, Emily can ask if her primary care provider at the campus health service will restart her antidepressant.
Sarah Jessica Parker (mom to three son James and twin daughters Marion and Tabitha): “As a working mother high heels don’t really fit into my life anymore - but in a totally wonderful way. I would much rather think about my son than myself.”
2. Community Resources : Speak with a campus case manager to help you find therapy and psychiatry services off-campus. Case managers may work in the counseling center, the psychiatry clinic, or the dean of students office. Case managers are experts at finding services for students, matching them to providers who take their insurance or offer treatment at a reduced rate. If Emily’s college does not have a case manager, you and she can review her insurance plan to identify a covered provider. The counseling center may also have an online resource list to help her locate mental health services. She can call the therapist who saw her first and ask for additional referrals.
3. Hometown Resources : Emily can start treatment when home for the holidays and then transfer care to the school or college town when an appointment becomes available. Some schools give the whole week of Thanksgiving off, so Emily might be able to see her pediatrician or former psychiatrist to obtain psychiatric medication. She could also ask to meet with her former therapist. Some students continue treatment with their hometown therapists by telephone and see them during university vacations.
4. Telehealth : Options for online treatment by secure video for therapy and psychiatry are on the rise. I have seen some college students pursue these options and be satisfied with the results. There are certain clinical benefits to meeting face-to-face versus online, but telehealth is an option for some patients at a time when the supply of services is not meeting demand.
No college student should go without needed mental health treatment, and I would love to see college campuses offer more mental health services. However, until that time comes, parents and students need to creatively and assertively search for treatment. Never give up. As the holiday season approaches, I am thankful for parents who have worked tirelessly to help their children obtain the mental health care necessary for wellness and academic success.
Remember: Kids will be kids. Kids will make mistakes using media. Try to handle errors with empathy and turn a mistake into a teachable moment. But some indiscretions, such as sexting, bullying, or posting self-harm images, may be a red flag that hints at trouble ahead. Parents must observe carefully their children's behaviors and, if needed, enlist supportive professional help, including the family pediatrician.