Mental Health Support on College Campuses: What Parents Need to Know

Most larger universities like Indiana University (close to where my office is located) have health programs called CAPS which stands for Counseling and Psychological Service. They are often staffed with licensed therapists/counselors and psychiatrists with a range of experience and expertise. Their primary goal is to act as a stabilizing resource for most mental/behavioral health or substance use issues. Many university CAPS typically offer individual, group and couples counseling along with occassional free workshops. Here’s the list from IU CAPS on what they typical help with:

  • Academic Concerns
  • Relationship Concerns
  • Stress Management
  • Power and Privilege
  • Time Management Help
  • Sleeping Issues
  • Adjusting to College Life
  • Anxiety
  • Depression
  • Substance Use
  • Body Image, Eating, and Exercise Concerns
  • Sexual Assault or Abuse

They have the same confidentiality requirements as counselors like me off campus but are limited in many ways. CAPS limits the number of unpaid sessions (IU CAPS allows for two) and mandates that a student must be working with one of their counselors if they want to meet with a psychiatrist for medication management/evaluation. Here’s a breakdown of IU CAPS fees:

COUNSELING  With IU Health Fee  W/O IU Health Fee
First two sessions (per semester) No charge $55 per session
Additional full sessions $30 per session $55 per session
Additional half sessions $20 per half session $35 per half session
Additional group counseling $15 per 60 min. session

$17 per 90 min. session

$29 per 60 min. session

$35 per 90 min. session

PSYCHIATRY
First visit $55 $105
Follow-up visit $30 per visit $55 per visit

IU CAPS does not accept insurance but does provide a super detailed invoice to be submitted to a student’s insurance company for reimbursement.
Over the last few years, I’ve noticed many CAPS programs around the country have had a huge increase in demand for their services while also having budget cuts or mediocre increases that leave them without the full team of professionals they need for each semester. At IU CAPS, every one counselor is responsible for 2,110 students (yikes!). This is not a new problem at IU and not isolated to IU.

So what can a parent or student do? If CAPS doesn’t seem like a good option, look for a therapist/counselor convenient to campus who specializes in college students. Therapists should be flexible to accommodate busy course loads and social events. In my practice, I have extended evening and weekend hours since many students a slammed with class 9-4pm most days. It’s also important that the therapist be willing to talk with parents and provide updates and suggestions. Parents can sometimes feel like their kids are a million miles away. A good therapist can often act as a bridge and lower the anxiety associated with having kids at school.

Finally, talk with CAPS (or encourage your son or daughter to) the first week of school. It’s easier to cancel an appointment than to stand in line after all the students are back on campus. The intake process should be thorough and your kid shoul feel like the therapist/counselor will really understand their issues and help.

Insider’s Guide: Top 5 Things for Your College Student Transitioning to Fall Semester

Most of the students with whom I work have depression, anxiety and mild substance abuse. One of the easiest, cheapest and most effective tools for combating these struggles in college is detailed planning. Below, I’ve outlined the Top 5 things I tell every student to implement as they are showing up for Fall semester.

  1. Syllabi Dates. Encourage your college student to plug-in all dates into their calendar from the syllabi they receive over the coming days. Once all the test dates are put in, reverse engineer two weeks prior to the test dates and put study dates into the calendar for no longer than 90 minute chunks. If it’s not scheduled, it will get pushed off till the last minute.
  2. Professor Office Hours. Everyone will want to meet with professors the Thursday and Friday before Thanksgiving. Have your above-average college student pull their professor’s office hours from the syllabus (yes, all professors put office hours on there) and plug into the calendar.
  3. Download Your University’s Academic Calendar. In June, I downloaded the Indiana University’s academic calendar for Fall 2016. It is a small file from Indiana University’s Academic page for any student or parent to view or download. Once downloaded, your college student can upload it into their calendar. Now, they’ll know Add/Drop dates, Fall Break, Winter Break, Finals, etc.
  4. Don’t Talk Every Day. Plan to talk 2x/week – (eg. Wednesdays and Saturdays). It’s time to intentionally create more autonomy, build trust, and not feel like you need to hover over them.
  5. Set up Counseling Early. Counselors and mental health providers get slammed since there are so few of us in most college towns. There are even fewer psychiatrists for medication management. Start looking for a counselor/therapist now before the semester gets in full swing. Psychiatrists are often scheduled out 2-3 months.

Good luck and please reach out for more suggestions and strategies to mitigate the challenges your college student is facing with depress, anxiety or substance abuse. Don’t go it alone.

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. 

Virginia Senator Deeds Stabbed by Son (…And How it Could Have Been Avoided)

Virginia Senator Creigh Deeds was Stabbed by his 24 year old son Austin (Gus) Deeds  who then killed himself with a shotgun at their rural home just West of Charlottesville, Va.. Austin Deeds had just been ‘psychologically’ evaluated just hours before at Bath Community Hospital under an Emergency Custody Order (ECO). The ECO is only good for 4 hours with a possible 2 hour extension if ordered by the magistrate.  Hospital staff stated, working within the maximum 4 hour window, they were unable to find a treatment facility to address Austin Deeds’ psychiatric needs despite several hospitals reporting they did in fact have availability.

Here is some analysis/questions from someone (me) that’s been in this profession for years. I also provide some ideas of solutions if you know of someone struggling with a similar situation:

1. Diagnoses: If the hospital was looking for a treatment facility this means that something the evaluator found indicated Austin was either a threat to himself or others or needed a a level of medical intervention not available at the current hospital. I’m also thinking about the type of evaluation that was conducted and why it was even done at BCH, what the evaluator’s credentials are, and how it was reviewed with Austin and his family. 

2. Discharge: If there were no options (which there clearly were), I wonder if and how the hospital communicated their findings from the evaluation as well as their concerns about safety to the parents and authorities. I’m also wondering what kind of discharge meeting took place. When a client is stepping down from a hospital or residential setting, we always facilitate a comprehensive treatment team meeting to talk about discharge so everyone leaves understanding what the next steps are – action steps. When we work with families struggling with similar issues, we don’t wait for the hospital to give updates. But as mental health professionals, we are able to navigate the bureaucracy much easier and get clear answers much faster. 

3. Responsibility: Providers, whether big hospitals or little, ole’ therapists, have an ethical and legal responsibility to communicate to authorities if a patient is in eminent danger. So who is responsible here? If you ask the hospital, they’ll probably point fingers until the next news cycle. If you ask an attorney, they’ll go through the policy and procedures for the hospital regarding intake, evaluations, referrals, discharge, etc. and anyone of making decisions in that chain could be liable.

4. Intervention (Placement Options): The hospital staff at BCH clearly did not consider referring outside of the traditional placement list (psych beds at hospitals). It’s unlikely that it was due to financial constraints and certainly not due to a lack of treatment centers as some have speculated (Yes, there are certainly a lack of medicaid-funded psych units in VA). There are facilities all over the country that are extremely well-equipped to accept, stabilize and work with patients just like Austin. Most hospitals, though, follow a tired, out-dated protocol of calling three near-by psych hospitals to find out if they have a bed avail. If they here no at all three, patient is discharged with a list of therapists to contact to set up an appointment. Sound ridiculous? You’re right. 

5. Solutions: In my humble opinion, Austin would be alive today if earlier intervention had been provided by a treatment team including a psychologist, psychiatrist, therapist, and case manager. The psychologist provides the initial psychological evaluation to identify the issues, what is causing them, and create a specific list of interventions for the rest of the team. The psychiatrist (though in limited supply in Bath Co, VA) performs an initial psychiatric (medical/medication) evaluation and identify what, if any, medication is necessary to compliment any individual counseling being performed. The therapist provides weekly counseling either in-office or in the family’s home to address areas identified within the psychological evaluation. The case manager is the project manager for everyone and is on-call 24/7. This person also facilitates regular treatment team meetings to ensure updates are provided to the family and all professionals. For instance, if the therapist starts seeing signs of bizarre thinking patterns which are historically correlated with dangerous behavior, the case manager can alert the rest of the team and monitor the client more closely while also increasing the frequency of support. If a higher level of care (ie. psychiatric hospitalization) is recommended by any member of the team, the case manager not only identifies a placement but completes all intake paperwork. The case manager also provides psychoeducation to the family to help them understand the client’s diagnoses and what they can do to most effectively support him. 

If you or someone you know is in a similar mess, do not assume your local hospital has the expertise to handle the situation. Contact a mental health professional to find services that can manage the entire project from assessment to placement to discharge and aftercare. 

Treatment 101: Therapeutic Boarding Schools and Residential Treatment Centers

Today we examine some of the basic differences and similarities between therapeutic boarding schools and residential treatment centers (or programs).

 

THERAPEUTIC BOARDING SCHOOLS

Also known as Emotional Growth Boarding School (not used so much any more), is a boarding school based on the therapeutic community model that offers an educational program together with specialized structure and supervision for students with psychological, behavioral, substance abuse, or learning difficulties. Another newer term is Academy which lends some gravitas and impressions of legacy. Basically, it sounds fancier. 

In contrast with Residential Treatment Centers, which are more clinically focused and primarily provide Behavior therapy and treatment for adolescents with serious issues, the focus of a TBS is toward emotional and academic realignment involving clinical and academic oversight for physical, emotional, behavioral, family, social, intellectual and academic development. Therapeutic and educational approaches vary greatly; with the approaches best described as a combination of interventions often based on the founders’ perspective. The typical duration of student enrollment in a TBS range from one to two years with many schools mandating a minimum stay of at least 1 year. Students may receive either high school diplomas or credits for transfer to other secondary schools. Some therapeutic boarding schools hold educational accreditation within their respective states. TBS’s may be for-profit or non-profit entities and might also be owned by a much larger company (eg. Aspen Education Group, Red Cliff Ascent, Universal Health Services to name a few). 

Therapeutic boarding schools are generally middle schools and high schools that have comprehensive therapeutic interventions (medication management, individual/group counseling, life skills) for the students and a program to help them with self-esteem and problem behaviors. Some are more therapeutic than others while some boarding schools are actually therapeutic but will not list themselves in that category to avoid any negative connotation. 

Most of the therapeutic boarding schools do not have a medical plan for bipolar disorder, and do not provide psychiatrists on staff. If you want your child to attend a therapeutic boarding school he or she needs to be stable enough to attend school with therapy support (typically includes individual counseling 1-2x/wk, group counseling 1-2x/wk and 1 weekly phone conference with parents/therapist), while maintaining a relationship with an outside psychiatrist. Additionally, some schools do not wish to administer psychotropic meds. Ask the admissions folks if this is something important for you. 

 

RESIDENTIAL TREATMENT CENTERS

Sometimes the school that best meets the child’s needs just doesn’t exist anywhere near home, or the child may become too unstable to stay at home and attend school. It may become painfully obvious that a change in environment with a twenty-four-hour peer group and non-parental authority figures may help the child grow and mature in a safe environment. Maybe they are a danger to themselves or others and they need to be in a setting that can monitor their illness and behavior, as well as provide them with tools to understand and deal with their illness while not losing ground in school.

Residential Treatment Centers (RTCs) are medical facilities (most of the time). They should have psychiatrists and nurses on staff. They administer medications, make medication adjustments, and provide therapy and schooling. They are required to follow a student’s IEP.

Residential schools can cost anywhere from $56,000 to over $125,00 per year. A school district may pay part or most of the fee of such a placement, but typically only after a due process hearing. This process is not recommended for parents – Definitely bring in professional support for this (yes, a case manager or educational consultant with expertise in IEP/504 process and laws within your state). 

If you have not noticed the theme, here it is – Parents should ask for help from a clinical case manager or educational consultant. While the vetting and application may seem like an easy project for accomplished parents, the timing, financial and clinical complexities can create significant challenges. The case manager should have any professionals working with your child contribute to the discussion on placement strategies and options. Leave this to the professionals. It costs money on the front end but will save you thousands of dollars over months and years and also help you to understand your child, family and the education/psychological process much better. 

Here are some additional resources:

The Affordable Health Care Act (aka Obamacare): How it impacts Mental Health and Substance Abuse Service

The Affordable Health Care Act (aka Obamacare) has been ramping up over the last few months and goes into full-throttle (Health Insurance Marketplace enrollment starts October 1, 2013). Here are some of the important changes the healthcare law impacts. 

Expansion

The Affordable Care Act will expand mental health and substance use disorder benefits  and parity protections for 62 million Americans. Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy, prescription drugs. It also covers services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more. The healthcare act also includes a huge Medicaid/Medicare expansion to provide coverage to millions more Americans currently without insurance. Here are just a few other bullet points of the healthcare act going into effect soon: 

• National goals have been set to identify and reduce mental health care disparities in the U.S.

• More federally-qualified mental health care facilities will be made available and funded.

• There will be an increased focus on telemedicine, which will facilitate mental health services and collaborative efforts from a distance, through the use of telecommunication technologies.

• Additional funding will be allocated to mental health organizations, such as SAMHSA.

• State Health Homes will be made available for individuals recovering from substance abuse and mental health disorders.

• School-based mental health programs will be initiated for child mental health care.

• Grants will be allocated exclusively for training more mental health care professionals.

• No-cost and low-cost preventative screenings will include mental health services.

• Mental health benefits will be included in the Medicaid expansion.

Prevention

Most health plans must now cover preventative services like depression screening for adults and behavioral assessments for children at no cost. All Marketplace plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. This applies only when these services are delivered by a network provider.

Pre-Existing Conditions

Starting in 2014, health insurance plans will not be able to deny clients customers coverage or charge extra for pre-existing health conditions including mental illness. 

Let’s Talk Access

Access through for those un- or under-insured is through Exchanges. Exchanges are set up through state websites designed to make it easy for people to find health coverage. Each state will have one. The District and 16 states, including Maryland, are running their own exchanges. The rest are either partnering with the federal government or, as in Virginia’s case, relying on the federal government to operate their exchanges. To find the correct site, go to www.healthcare.gov.

To learn more about how the Affordable Healthcare Act may impact services with Fonthill Counseling, please contact us with specific questions or concerns. 

 

Time to Start Thinking about Cyberbullying Again

Cyberbullying: The Fist of Technology

By Mary Hannah Ellis

Most of you probably remember your school bully at each level of your education – the tall fifth grader who liked to knock over kindergartners on the playground, or the burly, egotistical jock who made everyone else feel inferior with his brash jokes. However, a student could mostly avoid these school bullies by staying out of their way. Today, technology has enabled a new, ubiquitous form of bullying called “cyberbullying.” Cyberbullying involves a minor’s harassment, tormenting, humiliation, embarrassment, threatening, or otherwise targeting of another minor via technology.

Cyberbullying occurs through a variety of media, including social networking sites, text messages, online chat services, and email messages, to name a few. Facebook and twitter are some of the most active sites for cyberbullying

Do you suspect that your child or teen is a cyberbully or a victim of cyberbullying? Here are some warning signs to consider:

Your child or teen may be engaging in cyberbullying if he/she:

• Constantly uses the computer, even at all hours of the night

• Is secretive about his/her activities on the computer

• Appears nervous when using the computer or cell phone

• Quickly stops using the computer or switches screens when someone approaches

• Becomes excessively angry when cell phone or computer privileges are revoked

• Uses multiple accounts on different websites

Your child or teen may be a victim of cyberbullying if he/she:

• Unexpectedly stops using the computer or cell phone

• Avoids talking about what he/she is doing on the computer or cell phone

• Appears nervous upon receiving a text message, chat message, or email message

• Appears angry, depressed, upset, or frustrated after using the computer or cell phone

• Withdraws from interacting with usual friends

• Seems uneasy about going to school or going out in public

Children and teens who are victims of cyberbullying are more likely to use alcohol and drugs, have lower self-esteem, skip school, experience physical bullying, have poor academic performance, and have more physical health problems. Interestingly enough, cyberbullies themselves are also more likely to be bullied in real life and to have low self-esteem. There is also a significant risk of suicidal ideation associated with cyberbullying. With very little warning, a victimized kid could snap and hurt themselves or others. Without a doubt, cyberbullies and victims of cyberbullying could benefit from counseling or psychological intervention.

Contact us to find out how we can help.

Definition: Education Consultants, Case Managers, and Therapists oh My!

Those of us in mental, behavioral health and substance abuse fields generally know the difference between all the different professionals that support individuals and families. Unfortunately, we don’t always do a great job of helping clients understand the differences (and similarities). So, without further explanation, we present a humble attempt at defining professionals you may come across.

Educational Consultant: Also known as E.C.s, educational consultants started out decades ago helping families get their kids into college, private school and boarding schools. As family needs changed, so did E.C.’s focus. Nowadays, E.C’s serve families looking for academic advice and placement recommendations. In times of crisis, parents are often overwhelmed by a barrage of emotions, options and information. The confusion and desperation associated with having a struggling teenager or child can be extremely difficult. Parents may not be aware of the choices available, or may not be able to decide on their own which alternative best meets their situation and the needs of their child. Among the questions consultants often hear: How do we know when treatment is necessary? What would be best for our child? Is an intervention needed? Should we find a residential program? Would a wilderness therapy program be a good choice, or would an emotional growth boarding school be better? There is no one certification or academic program for educational consultants. Their quality and experience span a huge continuum.

Case Manager: Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Basically they specialize in the organization and treatment planning for families that need finding a treatment program or need help transitioning their child back home. Educational Consulting is often a part of good case management. Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source. Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel, in order to optimize the outcome for all concerned. Not unlike E.C.’s, Case Managers do not require certification or specific academic credentials but are often clinicians with at least a Master’s degree in a disciplin like counseling, psychology, social work or marriage and family therapy.

Therapist: A therapist is a general term for counselors, psychologists, psychiatrists, psychotherapists and psychoanalysts. They are trained professionals that treat mental and behavioral health and substance abuse problems through talk, discussion and interaction. A therapist helps clients you learn about conditions and moods, feelings, thoughts and behaviors. Therapy helps the client learn how to take control of one’s life and respond to challenging situations with healthy coping skills. There are many specific types of therapy, each with its own approach. The type of therapy that’s right for a client depends on their individual situation. Therapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

Check back next time when we talk about Counselors, Psychologists, Psychiatrists, Social Workers and Clinicians. Got a clinical term you’re confused about? Contact us and we’ll post info on it. More than likely, you’re not alone in your confusion.