5 Signs of Suicide Risk in College Students

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

There is nothing more exciting than dropping of your college freshman in late August as the cool nights of Autumn return. But not all students carry with them the same energy and positive outlook for the Fall. Some are carrying some heavy baggage from High School or even younger while others don’t start to develop any major issues until they first get to college (and their first taste of freedom from parents). What parents don’t know is that you likely know your college friends (or at least a side of them) better than their own parents do, and you may be able to tell that something is wrong way before anyone else. This quick list is as much for parents as it is for you students out there. 

The following signs might indicate a student is considering suicide:

  1. A good student who’s behavior suddenly changes – they start ignoring assignments and missing classes which are likely signs of depression or drug and alcohol abuse, which can affect their health and happiness and put them at risk of suicide. And yes, good students and good kids use drugs. Seriously. 
  2. Anyone who doesn’t have friends or who suddenly rejects their friends may be at risk. A friend who suddenly rejects you, claiming, “You just don’t get it,” may be having emotional problems.
  3. College students may be physically or emotionally abused by a member of their family or their girlfriend or boyfriend – or suffering from abuse that occurred long ago but triggered by the new college environment. Abusive relationships can make a college student feel like crap about themselves. Signs that a person may be in an abusive relationship include unexplained bruises or other injuries that he or she refuses to discuss. 
  4. This is a common one – Significant changes in a someone’s weight, eating or sleeping patterns, and/or social interaction style may indicate that something is wrong. Eating disorders are super common at college. Lot’s of perceived competition, anxiety and stress that translates into really unhealthy views of one’s self. 
  5. Coming Out? College students may suffer from depression or have thoughts of suicide if they have a difficult time adjusting to their sexual orientation or gender identity. Gay, lesbian, bisexual, and transgendered students have higher suicide attempt rates than their heterosexual peers.

We understand regret and their could certainly be a real consequence of getting help for someone who seems to be really hurting. They might get pissed at you for not minding your own business. But think of it this way – is the regret of possibly losing a friend better or worse than the potential of knowing you could have saved your friend’s life but did nothing? Tough choice but that’s part of the burden of mental illness. 

Program Review: The Renfrew Center

Renfrew PicMany years ago I had the pleasure of visiting The Renfrew Center just outside of Philadelphia, PA. At first, I wasn’t sure if this was a gigantic private residence with it’s ancient stone farm house, stables, and quintessential barn. Definitely one of the more beautiful suburban locations for a treatment center I’ve seen. I had my tour of the grounds which look more like an upscale farm (in a good way), talked with the Executive Director about mental health under a giant oak tree, and got to know the program schedule as young women shuffled in and out of the various buildings. Below are more details on Renfrew with my Final Thoughts at the end. 

Background

The Renfrew Center is headquartered in has been serving women with eating disorders and behavioral health issues since 1985. As one of the nation’s first residential eating disorder facility, with 16 locations throughout the country, Renfrew claims to have worked with more than 65,000 women since their founding. The Renfrew Center has experienced it’s most significant growth in the last decade and a half have with the additional of programs across the country. 

Services

The Renfrew Center offers a full continuum of care that supports patients well beyond a residential stay. This comprehensive range of services available at most of their locations, includes day treatment, intensive outpatient and outpatient programs. The services are tailored for each patient and with her referring therapist to develop treatment plans and goals based on her unique needs.

Renfrew maintains continuity in philosophy and approach throughout the individual’s treatment, while facilitating timely transitions from one level of care to another in order to maximize treatment and insurance benefits. 

Residential services are only offered in their Philadelphia, Pa and Coconut Creek, Fl locations. 

Clients

Renfrew works with women over the age of 14 suffering from anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified (EDNOS) and related mental health problems.

Locations

Cost
Residential – $8050 per week
They work with most insurers so a significant portion of services may be covered. 

Reviews
Employees on multiple sites give Renfrew some terrible grades for working conditions, diversity of the work force, and work-life balance. Most notably were many comments on Renfew’s seeming focus on profit and not much focus on treatment. They also described poor, untrained supervisors that did little to organize chaotic situations. 

Clients on the other hand often report having a positive experience and feeling somewhat nurtured. There were dozens of reports from clients going back to Renfrew multiple times for support. This could be viewed as good or bad. 
The New York location stood out with many, many negative reviews which highlights an ongoing theme among larger providers like Renfrew – when it comes down to actual effectiveness of a program, everything has to do with the clinicians at specific locations and very little to do with the corporate handlers up above. 

Contact

Here is a link to their online contact form which is probably the best way to get ahold of them. 

Final Thoughts
Oh how I wish programs like Renfrew could just slow down and focus more on quality. I’ve known too many therapists over the years who think poorly of Renfrew’s clinical integrity to feel comfortable referring clients that come to Fonthill. That said, it doesn’t mean women struggling with an ED should avoid Renfrew. I think programs like this have a place in the menu of options, especially if you want treatment close to a major metro area like Philadelphia. Just make sure to make a decision on more than what the admissions folks at Renfrew tell you. Look up reviews, talk with outpatient eating disorder specialists (like Dr. Joanna Marino in Washington, DC) or placement specialists (…like Fonthill ) and do your homework. It’s expensive and takes a huge amount of time to go to Renfrew so don’t rush in. 

Program Review: Veritas Collaborative

In April 2014, Dr. Marino and I visited Veritas Collaborative in Durham, NC, a 2 year old for profit eating disorder treatment program specializing in children and adolescents. Don’t let the age of this program fool you – they clearly know what they’re doing and have some clinical and business heavy-weights in their corner.VC dining pic

 

Below is a write-up of our experiences, thoughts and additional info we gathered together just for you. As always, our perspective as clinicians may be uniquely different from those of perspective clients or their parents. We highly encourage you to do your own research before committing to any program.  

What They Do

Veritas provides Inpatient, Residential Treatment and Partial Hospitalization for adolescents and children with eating disorders. What is key in our description is what is not listed. This means, during a time when other programs do everything for anyone, Veritas has committed to specializing. They have 26 inpatient/acute residential beds and 12 partial hospitalization beds. Below is a description of the three different levels of care (directly from the Veritas Collaborative site).

Inpatient hospitalization is the most intensive level of treatment available. Inpatient treatment is necessary for those who need frequent nursing care or are medically unstable (as determined by vital signs, lab abnormalities, or general physical and psychological condition). Patients who are severely entrenched in their disorders are depressed, suicidal, or are a danger to themselves or others, are also appropriate for this level of care. These patients see a medical doctor daily.

Acute Residential Treatment is a 24-hour monitored, structured treatment program for medically stable patients who still need constant supervision. Nursing care is still provided around the clock, but patients see doctors less frequently. Some individuals are admitted directly to residential treatment while others first go through inpatient treatment and them move to the residential program.VC bdrm pic

The Partial Hospitalization level of care is appropriate for patients who need structured programming but do not need 24-hour supervision. Patients participate in individual and group therapy, structured activities, and programming around meals similar to what is offered in the inpatient and residential programs. Some patients admit directly to this level of care, but many “step down” from the residential or inpatient levels, as partial programming still provides a high amount of structure and support. These patients are medically stable, and can move more readily while maintaining appropriate, non-disordered behaviors without direct supervision.

Another key feature to the Veritas program is the pervasive use of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), both of which are evidence-based treatments for eating disorders and co-occurring mental health issues.

Who They Serve

Veritas serves children and adolescents (both male/female) 10-19 years old from around the country experiencing eating disorders. It’s rare for an eating disorder program to serve younger adolescents and children which is a huge plus. It’s also less common for a program to work with male clients. VC pic

Location

Veritas is located at 615 Douglas St #500, Durham, NC 27705. They sit right next to Duke University. They are 20 minutes from the Raleigh-Durham International Airport (super, super easy airport to travel through) and 2 hours from the Charlotte airport. The parking deck is easily accessed from the road. The building is nondescript but that’s works nicely for those seeking a more discrete treatment experience. 

Fees + Insurance + Financing 

Yes, they accept insurance and will work with you to figure out what is covered.

As with most treatment centers, there are many outside financing agencies that specifically work with mental, behavioral and substance abuse programs.

A quick word about their fees – they wouldn’t say. Not a peep about daily or monthly rates which, in our humble opinion is no bueno. See below in the Reviews section for commentary on this. It’s not unusual for programs to defer questions about cost but they eventually give us an idea (normally as a monthly rate). But not Veritas. 

Reviews

It’s really disappointing and feels a bit awkward when we have a hard time finding negative reviews of a program. Either they’ve done a good job of scrubbing the internet of nasty feedback or…. they actually provide great service. From all around the intertubes we scoured parent blogs, professional review sites as well as the more general review sites. So what’s out there? What’s the overall judgement of this fledgling treatment center? Mostly just really nice praise for the staff, treatment and program as a whole. The thing that kept on coming up over and over was Veritas’s involvement of the whole family – which happens to be another key feature they told us about on our tour. Family work is at the core of how they impact the client’s treatment. 

One negative in our view is discussion of cost. We really, really like programs to be up front about what the estimated costs for service will be. It’s not that we expect a solid dollar amount since we know as well as the next professional that expenses can go up or down depending on loads of variables. But what we do want to see is an effort towards transparency, especially with pricing. When asked for pricing we were told ‘it depends‘ but would not commit to a daily or monthly rate and nothing is listed on their site. 

Other than the cost issue we experienced, there’s not much else for us to complain about. We’ll definitely continue looking for bad reviews and update this post. 

Contact Information

Reach out to Kelly Robinson at krobinson@veritascollaborative.com or 919.698.8574 to learn more or take a tour. You can also schedule a tour directly from their site here: Schedule a Tour.

Final Thoughts

Overall, we encourage perspective clients to take a tour and consider the program. It’s best to higher an educational consultant or case manager to go with you. They will ask detailed questions you may not think to ask or just feel way too uncomfortable to ask. This is a decision you should not make alone. 

The Maudsley Method for Eating Disorder Treatment

imagesThe Maudsley Approach (aka Maudsley Family Therapy) is a family therapy specifically designed for the treatment of anorexia nervosa (but now used for many other eating disorders) devised by Christopher Dare and colleagues at the Maudsley Hospital in London.

The Maudsley approach can mostly be construed as an intensive outpatient treatment where parents play an active and positive role in order to: Help restore their child’s weight to normal levels expected given their adolescent’s age and height; hand the control over eating back to the adolescent, and; encourage normal adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.

More ‘traditional’ treatment of AN suggests that the clinician’s efforts should be individually based. Strict adherents to the perspective ofonly individual treatment will insist that the participation of parents, whatever the format, is at best unnecessary, but worse still interference in the recovery process. In fact, many proponents of this approach would consider ‘family problems’ as part of the etiology of the AN. No doubt, this view might contribute to parents feeling themselves to blame for their child’s illness. The Maudsley Approach opposes the notion that families are pathological or should be blamed for the development of AN. On the contrary, the Maudsley Approach considers the parents as a resource and essential in successful treatment for AN.

Phase I: Weight Restoration

The Maudsley Approach proceeds through three clearly defined phases, and is usually conducted within 15-20 treatment sessions over a period of about 12 months. In Phase I, also referred to as the weight restoration phase, the therapist focuses on the dangers of severe malnutrition associated with AN, such as hypothermia, growth hormone changes, cardiac dysfunction, and cognitive and emotional changes to name but a few, assessing the family’s typical interaction pattern and eating habits, and assisting parents in re-feeding their daughter or son. The therapist will make every effort to help the parents in their joint attempt to restore their adolescent’s weight. At the same time, the therapist will endeavor to align the patient with her/his siblings. A family meal is typically conducted during this phase, which serves at least two functions:

It allows the therapist to observe the family’s typical interaction patterns around eating, and it provides the therapist with an opportunity to assist the parents in their endeavor to encourage their adolescent to eat a little more than she was prepared to.

The way in which the parents go about this difficult but delicate task does not differ much in terms of the key principles and steps that a competent inpatient nursing team would follow. That is, an expression of sympathy and understanding by the parents with their adolescent’s predicament of being ambivalent about this debilitating eating disorder, while at the same time being verbally persistent in their expectation that starvation is not an option. Most of this first phase of treatment is taken up by coaching the parents toward success in the weight restoration of their offspring, expressing support and empathy toward the adolescent given her dire predicament of entanglement with the illness, and realigning her with her siblings and peers. Realignment with one’s siblings or peers means helping the adolescent to form stronger and more age appropriate relationships as opposed to being ‘taken up’ into a parental relationship.

Throughout, the role of the therapist is to model to the parents an uncritical stance toward the adolescent – the Maudsley Approach adheres to the tenet that the adolescent is not to blame for the challenging eating disorder behaviors, but rather that these symptoms are mostly outside of the adolescent’s control (externalizing the illness). At no point should this phase of treatment be interpreted as a ‘green light’ for parents to be critical of their child. Quite the contrary, the therapist will work hard to address any parental criticism or hostility toward the adolescent.

Phase II: Returning Control over Eating to the Teen

The patient’s acceptance of parental demand for increased food intake, steady weight gain, as well as a change in the mood of the family (i.e., relief at having taken charge of the eating disorder), all signal the start of Phase II of treatment.

This phase of treatment focuses on encouraging the parents to help their child to take more control over eating once again. The therapist advises the parents to accept that the main task here is the return of their child to physical health, and that this now happens mostly in a way that is in keeping with their child’s age and their parenting style. Although symptoms remain central in the discussions between the therapist and the family, weight gain with minimum tension is encouraged. In addition, all other general family relationship issues or difficulties in terms of day-to-day adolescent or parenting concerns that the family has had to postpone can now be brought forward for review. This, however, occurs only in relationship to the effect these issues have on the parents in their task of assuring steady weight gain. For example, the patient may want to go out with her friends to have dinner and a movie. However, while the parents are still unsure whether their child would eat entirely on her own accord, she might be required to have dinner with her parents and then be allowed to join friends for a movie.

Phase III: Establishing Healthy Teen Identity

Phase III is initiated when the adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated.

Treatment focus starts to shift to the impact AN has had on the individual establishing a healthy adolescent identity. This entails a review of central issues of adolescence and includes supporting increased personal autonomy for the adolescent, the development of appropriate parental boundaries, as well as the need for the parents to reorganize their life together after their children’s prospective departure.

Maudsley Approach Sites

In addition to the Maudsley Hospital and other centers in London, this family-based approach to treatment is implemented by programs in the United States, including Columbia University and Mt. Sinai School of Medicine, New York, NY, Duke University, Durham, NC, The University of Chicago, Chicago, IL, Stanford University, Stanford, CA, the University of California at San Diego, CA and the Eating and Weight Disorders Center of Seattle (part of the Evidence Based Treatment Centers of Seattle), Seattle, WA. Dissemination of the Maudsley Approach has also been successful in Canada, e.g., Eastern Ontario Children’s Hospital in Ottawa, North York General Hospital and the Hospital for Sick Children in Toronto, and McMaster University in Hamilton, ON. The adolescent eating disorders program at the Westmead Children’s Hospital in Sydney, and the eating disorders program at the Royal Children’s Hospital in Melbourne, Australia, have well established FBT programs. 

Conclusion

In summary, the Maudsley Approach holds great promise for most teens who have been ill for less than 3 years. This family-based treatment can prevent hospitalization and assist the adolescent in her/his recovery, provided that parents are seen as a resource and that they are allowed to play an active role in treatment. For a program or clinician to effictively offer the Maudsley Approach they should be certified through The Training Institute for Child and Adolescent Eating Disorders. Certification training requires workshop participation and 25 hours of supervised training on 3 cases during three treatment phases.