The Kids are NOT All Right

The Board of Governors for Florida’s public state university system is asking for $28.5 million to fund counseling-center and police expansions on their campuses, the Miami Herald reports.

Mental health and crime make an unfortunate coupling, particularly because the vast majority of people with mental illnesses are no more likely than non-mentally ill individuals to commit crimes.

And yet, in Jacksonville, the pairing persists. The Duval County Jail is the largest provider of mental health services here.

Without romanticizing mental illness, it’s good to have a culturally familiar reference point for understanding its impacts.

Imagine that John Nash, the brilliant, prize-winning mathematician portrayed in the 2001 movie, A Beautiful Mind, had been born to a less fortunate family. Imagine that Nash, struggling and suffering with his schizophrenia, lived on the streets instead of at Princeton University. Imagine that he self-medicated with alcohol or opiates, as local woman Melissa Ann Jernigan did in response to her mental illness, according to the Florida Times-Union.

Imagine alternately that Nash, who entered graduate school in the 1940s, had been born at a time when he believed the voices he heard were emanating from his mother’s VCR, as local man Henry Sean Harriford did. While Harriford’s family tried to get him help, it didn’t come soon enough to prevent him from killing his mother.

If pairing mental illness with public safety is the only way to get political action, so be it. And while Jernigan and Harriford didn’t have their multiple, unrelenting breakdowns on college campuses, college campuses are, nonetheless, places where mental health professionals are educated. Many of them also begin their careers at university counseling centers.

Colleges are also places where lots of young adults come of age. And psychologists tell us, it’s that particular developmental time, young adulthood, when many severe mental illnesses emerge. Just ask Rick and Kathy Marquis, who have also shared their story with the T-U. Their son’s first psychotic break occurred after he left home for college. But one of the best reasons for expanding college counseling centers is that, by taking the strain off their personnel, professors and practitioners are more free to do what universities are good at: educating the rest of the community.

Short Supply, Increasing Demand
Jacksonville Community Council (JCCI), in its 2014 community-wide inquiry on mental health, reported severe shortages of both psychiatrists and beds available for hospital-based treatment of mental illnesses. JCCI reported that there is approximately one psychiatrist for every 9,200 adults in Florida, and only seven child psychiatrists for every 100,000 children in Florida. Statistics from the Associated Press illustrate the severity of the shortage of psychiatrists.

According to the American Medical Association, the total number of physicians in the U.S. increased by 45 percent from 1995 to 2013, while the number of adult and child psychiatrists rose by only 12 percent, from 43,640 to 49,079. During
that span, the U.S. population increased
by about 37 percent; meanwhile, millions more Americans have become eligible for mental health coverage under the Affordable Care Act.

And there’s evidence that the need for expanded university counseling services for our current cohort of students may be greater than for any previous generation.

Counseling center requests have risen tremendously, out of proportion with increases in enrollment. As Kristen M. Clark reported for the Miami Herald in 2015:

“Statewide enrollment grew 13 percent — from 297,700 students to 337,750 — between the 2008-’09 and 2013-’14 school years. During that time, counseling centers across the 12 universities saw a 48 percent increase in the number of clients and a 67 percent jump in therapy sessions — mostly spurred by cases of depression, anxiety and academic-related stress.”

If high school surveys are any indication, that demand is not going to abate anytime soon. Duval County data show that 27 percent of all middle school students and 19.7 percent of all high school students have seriously considered attempting suicide.

The local rise in teen depression mirrors a national trend.

Susanna Schrobsdorff, writing for Time, cites the journal Pediatrics in noting that, over the nine-year period that ended in 2014, the number of teens diagnosed with Major Depressive Disorder (MDE) increased 37 percent.

“Coddling,” in Context
Schrobsdorff’s research attributes the increase in child and adolescent depression to a few familiar factors. Parents like me will tell you that we’ve tried to raise our millennials in a culture of compassion, awareness and acceptance of individual differences.

But we’ve had to do it in the wake of Sept. 11, over the course of the War on Terror, against the background of innumerable school shootings, and amid the perspective-less and unrelenting world of social media. In our hyper-connected culture that makes every horror feel like it’s right around the corner, we don’t let our children ride their bikes all over town like our own parents let us do. Hell, we don’t even like them to be outside after dark.

And if they are, they’d better answer their texts.

Dr. Sarah Ravin, a Coral Gables psychologist, says the stressors of Sept. 11 resonate with her. Mere weeks into their Ph.D. training, Ravin and her classmates at American University were called to duty during the immediate aftermath of the 9/11 attacks because demands for mental health services were so high. Today, 90 percent of her practice comprises adolescent and young adult patients.

“With very good intentions,” Ravin writes in an email interview with Folio Weekly, “parents and teachers and other adults have shielded these kids from disappointment, failure, stress, responsibility and many of the realities of life that previous generations knew … .

“We have a generation of students who tend to be less resilient, but are entering adulthood in a world that feels much more threatening.”

The Age of Anxiety
As if the stressors of our new century and parental attempts to insulate their children weren’t enough, there are a host of other mental health risk factors for today’s college students. The biggest risk factor, as John Nash exemplified, is age.

“Many mental illnesses, including mood disorders, eating disorders, psychotic disorders, and substance abuse disorders, often first manifest in late adolescence or early adulthood,” Ravin writes, “which is precisely the age of the typical college student.”

Ravin notes that the transition of leaving the family home can be an additional stressor, as can increased social, financial and academic pressures. And any of these stressors, she observes, could “trigger or exacerbate mental health problems, especially in those who are genetically vulnerable.”

“Once the safety and structure of home, family and high school are removed,” Ravin notes, “psychiatric problems have more room to blossom.”

And there’s even more bad news waiting for students when they arrive on campus, Ravin says. Just when they’re starting to learn to take care of themselves as young adults, they show up at a place where terrible habits are the norm, not the exception. “Lifestyle factors,” she adds, “such as nutrition, sleep, social support, physical activity, alcohol and drug use, and daily stress have a profound influence on our mental health, for better or for worse.”

We Have the Technology …
The good news is, we no longer live in the harsh, mid-20th-century world of John Nash, when treatments for his mental illness included barbaric rounds of insulin shock therapy, a type of therapy in which large doses of insulin are repeatedly injected to produce daily comas, and first-generation anti-psychotics, which had harsh side effects. Myriad anti-depressants have been developed since then, too.

But the best news, Ravin emphasizes, is how science has enhanced therapy treatments for better outcomes: “[N]ew findings from neuroscience show that our brains have the capacity for resilience … .”

A proponent and practitioner of Cognitive Behavioral Therapy, Ravin notes that CBT and other methods have been scientifically validated, while therapy approaches employed during the last century often relied on speculative theories.

CBT helps the individual understand how their thoughts, behaviors and emotions all affect each other. Practitioners help their clients develop more adaptive behavior patterns, and better ways of coping with distressing thoughts and emotions.

“CBT is an effective treatment for college students with anxiety disorders, depression, insomnia, OCD, body-dysmorphic disorder, bulimia nervosa and binge-eating disorder, among other conditions,” Ravin writes.

“Mental health is influenced by hundreds, if not thousands, of variables,” she adds. “Some of these variables — such as genetic makeup, temperament, and the occurrence of certain life stressors — are outside of our control.”

But, Ravin insists, “ … We all have the capacity to rewire our brains and improve our mental health. We just need help learning how to do it.”

Industry Standards
The International Association of Counseling Services recommends that university campuses provide one counselor for every 1,000-1,500 students.

Statewide, Florida’s public universities are short by 137 counselors, according to the Miami Herald. Using the more conservative ratio, that’s at least 137,000 students who need services but aren’t getting them.

IACS emphasizes that this number is a moving target, and that the more we shortchange our students now, the greater the likelihood that the ratio will have to be reduced during future revisions.

That’s because, as waiting lists grow, and students wait for or give up on mental health care, emotional problems can become more entrenched, and symptoms of psychiatric disorders can worsen. So, when students eventually do see a counselor, they will need more practitioner time to resolve mental health crises that might have otherwise been averted.

Counselor deficits also put students at increased risk for academic failure, according to IACS, and put centers and universities at greater risk for lawsuits. It also strains the university’s mission to assist the community through training and outreach.

The $14.5 Million Proposal
A little more than half of the public safety/mental health bill that Florida’s Board of Governors is proposing would go to fill the state universities’ counseling center deficits.

As the needs get met, waiting lists should decrease or disappear, which would in turn help limit the severity of student crises, support academic success, limit liability for universities, and free up practitioner and educator time to do what they do best: help communities.

For a state that ranks 49th in its mental health expenditures, Florida’s public universities are a good place to start reversing that record.

If we’re going to model resilience for the next generation, while we’re at it, let’s help them find their own.