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While college is often reflected on as a great time in people's lives, that experience was never without stress and anxiety. However, over the past two years, issues that college students normally face have been exacerbated by the uncertainty and grief associated with the COVID-19 pandemic, societal reckonings, and racial and political tensions. So, how are college students doing these days?
Joining us today are two psychiatrists working on college campuses, Dr. Ludmila De Faria and Dr. Meera Menon. They give us insight into college mental health, how the pandemic and other issues have impacted students' experiences and access to services, and provide tips for families and loved ones to better support their students' mental health.
Ludmila De Faria, MD is an Associate Professor at the University of Florida where she also sees patients. Dr. De Faria has been a psychiatrist in Florida for over 15 years and is especially interested in increasing access and decreasing mental health disparities among minorities and providing a culturally sensitive environment for patients. She is a distinguished fellow of the American Psychiatric Association (APA) and an active member of the APA's Council on Children, Adolescents, and Their Families. Dr. De Faria was born in Brazil where she earned her medical degree from the Universidade de Brasilia and moved to the United States in 1991 to complete medical training at Jackson Memorial Hospital/University of Miami.
Meera Menon, MD is a psychiatrist at Ohio State University’s Counseling and Consultation Service. At Ohio State, Dr. Menon is involved in the Eating Concerns Consultation Team, the Transgender Advocacy Team, and the Training Committee. In addition to also being an active member of the APA's Council on Children, Adolescents, and Their Families, she serves as Chair of the APA Caucus on College Mental Health and Secretary of the Association for College Psychiatry. Dr. Menon earned her medical degree from Wright State University where she also completed her psychiatry residency.
Christopher Chun-Seeley: Hello, welcome to Mentally Healthy Nation a podcast of the American Psychiatric Association Foundation. I'm today's host Christopher Chun-Seeley.
Christopher Chun-Seeley: For most families the transition from spring to summer brings celebration for the newest graduate either transitioning out of high school and into college or leaving college for graduate studies or their careers. There's a lot of concern for both of these populations as it relates to their mental health and wellbeing. Campuses should be prepared to handle their incoming student demands, support them holistically, and ensure they leave with the skills to better manage their life experiences.
Christopher Chun-Seeley: We bring with you here today two experts, Dr. Ludmila De Faria and Dr. Meera Menon to share on the state of college mental health, how the pandemic has impacted students' experiences and access to services, and provide tips for families to be better prepared for their roles in supporting our college students' mental health. Thank you both for being here today. Can you share with us the state of mental wellness as it relates to the college experience? Dr. De Faria, we'll start with you.
Dr. Ludmila De Faria: So traditionally, and this is pre pandemic, traditionally there has been a concern about worsening mental health for the transitional age youth, which straddles late high school all the way to the end of college, right? So over the last 25 years that people have been gathering data, there was a trend for worsening of depression and anxiety, sort of like a slight increase in suicide offense and self injury behaviors, and more of the kids were getting to college in need of mental health.
Dr. Ludmila De Faria: Part of it is how successful child psychiatry has been in treating kids and allowing them to actually finish high school and consider college, right? And so the burden kind of shifted from community psychiatrists who are seeing those kids to the community psychiatrist including college psychiatrists who see college students. Now, the pandemic was a total curve ball and Meera and I often talk about that. So I'll pass the ball to her to just talk about it wasn't rosy to begin with, but then the pandemic happened.
Dr. Meera Menon: Yeah. Thank you. So I know in March 2020 a lot of us had to immediately adapt and pivot in response to COVID-19 impacting the United States. So this also included college students and university students as well. So across the United States when students went home for spring break they were also told to not come back afterwards because the ability to provide on campus in person education, we weren't able to do that.
Dr. Meera Menon: So some students had even gone home with a small buff duffle bag or they were overseas on their fun spring break trip, and they needed to figure out and scramble how to get their stuff quickly from their dorm room and return to a safe environment. And safe environment being key for a lot of our students, the university campus setting is a much safer environment because they don't have a robust support system at home. So this also served to be a challenge.
Dr. Meera Menon: When it came to specific mental health treatment, most university counseling centers did not have too many options for telepsychiatry and telemental health services. And so this also was a program that needed to be developed quickly.
Dr. Meera Menon: One barrier obviously was the restriction of practicing across state lines. So this ended up being quite difficult as well because students scattered all throughout the United States, oftentimes outside state lines. And if they were in a state where we did not have a medical license, we had a limited ability to be able to treat them.
Dr. Meera Menon: A lot of states did create temporary licenses to allow for reciprocity if you were licensed and in good standing within your own home state, but these were difficult to navigate and also sometimes costly or kind of impossible to take advantage of. So while somewhat helpful, not as helpful as they could have been.
Dr. Meera Menon: So yeah, quite a big transition. Not to mention the grief that students experience with not being able to experience a traditional college experience, not being able to attend their graduation in person, as well as when the eventual return to campus happened the continued uncertainty about whether or not they'd need to leave campus if there was another peak or spike of coronavirus.
Dr. Ludmila De Faria: And my little niche is minoritized and underrepresented communities within college. And for that segment of students, that was an even sort of worse outcome because several students went home. And then that is the segment of the population that was more affected, especially initially by COVID. And so with their parents and grandparents or guardians actually in the hospital, hospitalized, unable to work, they actually had to step out of college and answer this taking responsibility for the family. So we know there is some data collected that as students actually went back into campus with all the stressors that brought up with them, minoritized and underrepresented students actually did not come back at the same number.
Christopher Chun-Seeley: Let me apologize that I didn't start with this question because you both are very passionate about this population working with college students. And Dr. De Faria, You just touched on your particular focus area. So I am wondering for our listeners who don't know much about you, what brought you to working on college campuses? What really struck you as a psychiatrist about why working with college students is so important?
Dr. Ludmila De Faria: I like to say that they are our future, right? I always think of it as this kid will be the one taking care of the world and doing things in the world when I'm an old woman. So I feel in whichever way I can move that factor into a more positive direction in order to emanate that.
Dr. Ludmila De Faria: They are also a more pliable brain. The brain is still growing. There is a lot of positive impacts that we can do with treatment whether it is psychotherapy or psycho pharmacology treatment for that population. And so I always feel that it's very rewarding to work with college students.
Dr. Ludmila De Faria: And then for me it was a natural gravitation towards working with minoritized population. I am an immigrant. I am a foreign medical graduate. So my experience resonated with them. And then I had kids that were also going into college, my own children, who were first generation college students in the United States because even though I have a college education it was not done in this country. And so I also felt like the stories that I heard from some of the students were the stories that I witnessed in my own house. So I wanted to advocate and make sure that their needs were being looked into.
Christopher Chun-Seeley: Dr. Menon, what brought you to this population?
Dr. Meera Menon: So I attended Wright State University in Dayton, Ohio for my residency in general psychiatry. And so through this program, I had a lot of different opportunities to work with transitional age youth. My residency program has a partial affiliation with the United States Air Force. And even though I'm a civilian, I had the opportunity to work with enlisted military members who are, similar to college and university students, recent high school graduates who are living in community housing and trying to figure out who they are.
Dr. Meera Menon: Also, as a part of this residency program, I had the opportunity to provide a lot of mental healthcare to our different professional schools, like the school of medicine, the school of professional psychology. So I really fell in love with working with this population, partly because of just the quest that all those patients are in terms of developing their own personal identities and figuring out who they are as individuals.
Dr. Meera Menon: Additionally, there's so much stigma that happens when it comes to mental health treatment. And so I like the idea of being able to work with people early on as they're pursuing treatment so that they can kind of learn what to demand for themselves in terms of the type of medical and mental healthcare that they should be receiving.
Christopher Chun-Seeley: And I think both of you have touched on it really beautifully already, but the experiences across college campuses can be very different. During my graduate school studies, I was an intern at our counseling and psychiatric services center and provided services to my fellow undergraduate, some graduate students and some medical students as well. And that experience is just that experience on that campus because of the resources that are available because of the culture that's created on that campus.
Christopher Chun-Seeley: So I'm just wondering what are the differences that we do need to consider when thinking about the different college experiences that students can have from technical to community, private, public, historically Black colleges and universities?
Dr. Ludmila De Faria: This is a wonderful question. Meera and I both have been involved with the American Psychiatric Association college mental health classes. And it's always something that we talk after each meeting every year is the variety. It's definitely, it's not one size fits all. We have some of our members in the caucus are one psychiatrist for 20,000 students and it's a part-time psychiatrist. And then some other universities have a pretty beat up psychiatric clinic and integrated with the counseling center. So it varies a lot.
Dr. Ludmila De Faria: It really depends on resources at the university. So in that sense flagship state universities or Ivy League universities have a lot more resources than let's say community colleges or junior colleges, which is something that I'm trying to work here locally. And I'm trying to bridge that gap by having a community clinic dedicated to seeing college students from junior colleges, as opposed to just the college students at the university where I work, because I feel that there's so much need out there.
Dr. Meera Menon: Yeah, I think you were saying this, but just to reiterate, it is that the closer you are to a larger city and the larger your university or colleges the more access that you'll have to mental health services. For example, Ohio State, where I work, we're located in Columbus, Ohio, which is a large city. And we have the honor of even having an intensive outpatient program that's just for transitional age youth and young adults. Whereas if I was working at a much smaller college and especially one that's rural, I may not have access to those resources.
Dr. Meera Menon: So in terms of psychiatric services, according to the AUCCCD survey data, so this is a survey of counseling center directors, around 36.4% of colleges do not have access to any psychiatry hours. So that is still quite a large percentage.
Dr. Ludmila De Faria: And also even when there is access to psychiatrist, sometimes we find that it's just not enough. So at some of the schools where I have worked there has been a movement toward sort of like a staff care approach where by the time you actually get referred to a psychiatrist the acuity or like the severity of the condition is pretty up there so you need that level of expertise.
Dr. Ludmila De Faria: And I have seen a couple of collaborative care models incorporated with primary care or the medical or health center to take in some of the mild depression or mild anxiety and doing sort of like working in conjunction with the counseling center. One third of the colleges have no access to psychiatrist, but even the two thirds that have access don't have enough access. There's just not enough hours.
Dr. Meera Menon: As an example, some of our colleagues that we meet through the APA might have positions where they're contracting with two or three different universities. And they always express that they wish they could be at least full-time, if not duplicate themselves in order to provide even more services at each of these universities. And getting into another issue that can be a barrier to attracting psychiatrists to college mental health, if they are in a position where they're contracting, they may not be eligible for benefits, which is an unfortunate thing when it comes to recruitment.
Dr. Ludmila De Faria: And the human factor is always a limitation, right? So over the last couple of years, I have wanted to shift my personal focus into looking at policies and system issues that can emanate that and starting as early as possible. So for example, making sure that high schoolers have in school access to some level of mental health.
Dr. Ludmila De Faria: And it's not because we're going to prevent 100% diagnosis to appearing in college, which is like that age where a lot of the diagnosis appear, but I actually want informed consumers. Because I feel if you provide that in high school, by the time that they get to campus they're not going to come and see Meera and I because they're suicidal. They're going to come see Meera and I because they have had a two week period that they don't feel well. And now they understand and they have the knowledge, and they accept it's the stigmatized that maybe the earlier that they get an intervention the better it is.
Dr. Ludmila De Faria: So I've been trying to look at how can we do that pushing for early access through public school or through school in high school. I know some states have passed laws where high schoolers are encouraged to safe mental health aid, which I think is phenomenal. Because it's like we're empowering them to know that, yes, it's important. You should pay attention. You should get help.
Dr. Ludmila De Faria: And even in colleges, what is it in the system that even before COVID and before Meera and I arrived at the scene, what was this in the system that is causing this massive increase? Is it student loan? Because sometimes I'm seeing people in my office that have two jobs plus carry a full load. And of course something's got to give and most of the time it's their mental health. So I am trying to identify people and places where I can help change the focus a little bit, because I know that there's not enough Meeras and Ludmilas in the world and all of our colleagues to take care of the people who are getting sick.
Christopher Chun-Seeley: This is very anecdotal. But for the first few months that I worked at the counseling center, I was doing screenings and I would say around 85% of the students that I screened had had a prior therapeutic relationship before. It went poorly because no one really explained therapeutic relationship, fit of therapist, what it means to navigate your own mental health experience and have the ownership of that. And I think it has to do with a lot of these issues, access and things. But I completely agree with you.
Christopher Chun-Seeley: We have this Notice Talk Act at school program. A training that we have done with juniors and seniors in some high schools has been just that, like how do we take this framework on? Self-screening questions. How does your words and your phrases impact others' mental health?
Christopher Chun-Seeley: But then when it comes to the act part it's, this is your journey. You have access to free services right now. It might be the last time that you have access to free services.
Christopher Chun-Seeley: If you go into a career path, you do this. At least engage, right? You may not like the person and that's, and I'm honest with them, you have four counselors at the school. You don't get to pick, right? It's usually assigned by your last name or whatever. But if you go to that counselor and you say, "Hey, I just don't see that this is a fit for me. Can I talk to one of the other counselors?," I mean, if you're a good mental health professional, it's about what the client needs.
Christopher Chun-Seeley: And though you might be assigned by last names, there's ways that we can step out of these defined boxes to provide the right service and I think give ownership to the mental health in the students, right? Because I think that's the thing that they need. So that to Ludmila your point is when they do experience those two weeks of down, they know that there's a place that they need to go and they need to go now and not wait till that crisis moment to happen.
Dr. Ludmila De Faria: That's right. I am starting to see more of that, which the trend is good, but I'm a little bit afraid of the residual impact of the pandemic. And I don't know if Meera has more to say about that, but we estimate that. And I know for a fact that Meera is working on a wonderful paper on that note, on the impact on the development, just psychological development, that was the pandemic. And we have not seen the full bloom of what is that going to look like? What is that going to look like when they come to college? The middle schoolers and high schoolers that didn't socialize for a full two years. And we anticipate that that's going to be another curve ball that's coming our way.
Dr. Meera Menon: This is anecdotal. But this is the time of year where our students are graduating and moving on to the next step. And one thing that I wonder if it's related to the pandemic is this year more than ever a lot of my graduating seniors are saying, "I just need to take a break. I don't even care about the workforce right now. I just need to finish out the semester and get out of here." Because typically this time of year is the discussion of, "oh, I got this job at such and such place," or, "Oh no, I haven't gotten a call back yet. I'm worried about that. What does that mean?" But right now people are just wanting to get out of the education system and rest. And I think that points to the stress that [inaudible 00:19:47] last two years.
Dr. Ludmila De Faria: I actually think that you're right because I am thinking here that a solid one out of two students that to come to see me is telling me, "I am moving back in with my parents in the next six months. It's going to be just kind of figuring out what my next step is." Everybody is overwhelmed.
Dr. Ludmila De Faria: And then we have to remember that it was not just the pandemic, right? It was coined as the syndemic because there was a systemic justice movement. There was a lot of political unrest, Black Lives Matter movement. So people have been on this intense emotional journey. Much of it totally in isolation or sharing in social media, not necessarily in a healthy way. And I think everybody's a little bit burned out. I see that. The students are definitely a little bit more burned out.
Christopher Chun-Seeley: And you've touched on your focus area, working closely with minority and underrepresented populations. And I think you've touched on kind of the lost information on what it meant for those college students in particular to leave campus, to go back home, to witness the larger impact of COVID in their communities to then switch responsibility, right?
Dr. Ludmila De Faria: Oh, yeah.
Christopher Chun-Seeley: And I think oftentimes we know that representation within the field of mental health professionals is lacking.
Dr. Ludmila De Faria: Oh, yeah.
Christopher Chun-Seeley: And I can only imagine the choice to find support, right? Especially, I mean, we've touched on a couple of these different things that have increased, but to not be able to find the culturally appropriate support that you need.
Dr. Ludmila De Faria: Yeah. And it's not only just race and ethnicity. I happen to be in Florida and Florida along with a couple of other states now have passed legislation that directly impact LGBTQ access to all kind of health. And so we already have experienced a little bit of an increase in the temperature in the students because potentially they're not going to have access to gender affirming therapy because the Department of Health in Florida just passed a guidance that even social transitioning should not be encouraged.
Dr. Ludmila De Faria: And so, I mean, unfortunately for kids that were accessing that through college, because that's the first time that they are in charge of their own care and healthcare and could then work on their identities and look at, that is devastating. So I personally feel that just when I thought everything was going to quiet down and let's see where the chips have fallen and it's this entire new wave, at least in my case, that is coming right behind.
Dr. Ludmila De Faria: And again, I like to work on the system space. I do do my care of my patients. I want everybody to know I care for my patients when they come to see me, but I also feel like it is our responsibility as peers of the community. And so I'm planning on working with my local organization branch to provide education on the gender affirming treatment and therapies because there's a lot of my colleagues in the community that are taking the guidance as a mandate and they literally interrupted treatment.
Dr. Ludmila De Faria: So I feel like I just finished one whole thing with the gender, with the ethnicity and race, and kind of figuring out how I can help those students. And now it's like this other crop that's coming right behind that demands attention.
Christopher Chun-Seeley: Yes, schools have definitely become the political battlegrounds in K through 12 and colleges with all of these social conscious issues. I guess a little bit of information. The APA put together a task force. In September of 1970 a report came out about being a social psychiatrist and the six or seven issues that were outlined in September of 1970 are the same exact issues that we are literally talking about today.
Dr. Ludmila De Faria: I know, hasn't moved an inch.
Dr. Meera Menon: Oh my God.
Christopher Chun-Seeley: I just want to encourage the psychiatrists especially and the other mental health professionals who are listening, there is more for you to do. There's a larger role for you to play, especially on that education side, on that advocacy side, because you do have this information at hand from a developmental standpoint, from an impact from trauma, from retraumatization. And that's really important for you as experts in the field to share with your community members. And though it's not defined like social worker code of ethics, there is an ethical piece for psychiatrists to use your position with your knowledge to educate others.
Christopher Chun-Seeley: Dr. Menon, I want to pass the mic over to you because I know that community members who are trans women or trans men is a special area of concern for you. So I wanted you to jump into this gender conversation as well.
Dr. Meera Menon: Oh, definitely. Before I talk about that, one thing I want to say is I think some colleges and universities are starting to notice the impacts of this sociopolitical of people and the ways in which different races, ethnicities, and other identities seek out mental health treatment differently. So I know I've heard Ludmila use this phrase before like, "No wrong door." So creating across campuses a variety of different ways in which students can engage in mental health treatment.
Dr. Meera Menon: For example, expanding of a service that a lot of universities call Let's Talk, which is more like drop in mental health services where instead of having an appointment you can literally just show up and have 15 minutes to talk about the kind of stuff that can be more or less taken care of in 15 minutes. So there ends up being an avenue for these individuals. As well as expansion of embedded programs, which includes having therapists and psychiatrists specifically located in different majors and buildings across campus, whether that be the school of medicine, whether it be the multicultural center, or anything in between. So this way we can really help the students who may have high levels of mental illness, but have various barriers that might prevent them to actually step foot in the counseling center.
Dr. Ludmila De Faria: That's actually a great way of thinking about that because often is the students that will need mental health are not the typical students that will walk through the door of the counseling center. So sometimes you do have to do this kind of strategic placement of services, right?
Dr. Ludmila De Faria: One of our undergrad STEM educators here at my university, he has this mentoring grant where he places undergrad students in different labs to promote their thinking about a STEM career. And he had noticed a lot of mental health issues. He's not a mental health person. And he reached out to our department and said, "Can you do something about that?"
Dr. Ludmila De Faria: So we developed, built into his grant, process groups that are run by our residents. And in the beginning, our first year, it wasn't mandatory for his students. It was just like, "Hey, we do have this process groups available. We take care of all. It's just one hour. You can come in and you get all the beauty of group therapy, right?
Dr. Ludmila De Faria: He noticed such a difference in the outcome for the ones who have participated in the groups to the ones that didn't that now it's mandatory. And now he told all of his friends on his side of the fence. And now there's three or four other programs for post that for the post docs. All of the people are like, "Oh, we want groups, too. We want to have this."
Dr. Ludmila De Faria: So I think that this is probably the way to go in other campuses is actually establishing this less thought, not a formal. It's not a formal evaluation. There's no diagnosing. But it offers the opportunity for you to maybe get help from your peers, sort of like crowdsourcing, or if there is something that is really clinically significant, then that one person gets referred. So you don't have 20 people coming in for screening and crowding the system, but you have the one or two that really need to see a psychiatrist or be in a little bit more intense therapy. So I hope that kind of initiative happens in more campuses.
Dr. Meera Menon: Yeah. And it's just so powerful to have the opportunity to hear from your peers that you're not alone and that other people are going through the same thing. I had the opportunity to facilitate a group therapy group for trans identified students on campus or students who are exploring their gender identity. So even in that setting, that's been a wonderful opportunity to support students as they explore their gender identity.
Dr. Meera Menon: One thing that we notice is that LGBTQ students, even though they have high rates of suicidality and suicide attempts, they're more likely to seek treatment off campus as opposed to on campus. Unfortunately, they've experienced quite a bit of medical related trauma or discrimination in the medical setting and so it can be scary to seek out any medical or mental health treatment as someone who identifies as LGBTQ. So it's been a nice opportunity for me to get to support these students.
Dr. Meera Menon: Ideally I think a group like that, it would be nice if it was a clinician who identified as gender diverse. I identify as heterosexual cisgender, but it's also an interesting opportunity because I'm an MD. And so there's a little bit of stigma busting that happens when these students in this group get to meet with a physician on a weekly basis and find out that I'm pretty chill. And so, yeah.
Dr. Ludmila De Faria: I actually think that that's probably part of what helps them is that because you identify as heterosexual cisgender, it can create the hope that there are more of you out there.
Dr. Meera Menon: Yeah.
Dr. Ludmila De Faria: So even when they leave you Meera, they will be primed by you to continue to seek care. I actually think that's pretty powerful.
Dr. Meera Menon: Yeah. Oh, I appreciate you saying that.
Christopher Chun-Seeley: It's so important to provide people with other people who have had similar experiences to them. And that's something that we've talked about it already that there's a lack of access to psychiatrists and mental health professionals. Even to the 66% of college campuses that have access to that, right? It's not enough.
Christopher Chun-Seeley: So you have to look for those bridges, those connectors of individuals who can help to create those support systems, so then you bring more people in. And then you find champions within those groups, right? As people continue to move through those support groups, you have the leaders and you have the people who can identify the other people on campus that might need to come into the group. And you can start to grow those groups as well.
Christopher Chun-Seeley: Some of our work is on the justice side of things within the foundation and the same issues across the community happen everywhere. But that's the big thing that we talk about with jails and prisons and reentry programs is you have this group of experts that you have decided aren't experts for some reason, but they have lived experience with mental illness and they've also gone through the criminal justice system.
Christopher Chun-Seeley: And we kind of joke like once you graduate from high school, you are so far removed from high school the day after you graduate because everything changes so quickly. And it's the same with colleges, right? You have this group of individuals who knows your campus culture better than you do as a staff member. You can really pull from their experiences and really understand not only I think your role as a psychiatrist, but I think to Ludmila your point earlier is, what are these other gaps that are happening that I can kind of use my influence and start to address some of these systems that are impacting why they're coming here in the first place?
Christopher Chun-Seeley: And we've touched on COVID-19 and its impacts, loss of experiences, the loss of social interaction and what that will mean long term. And really excited about Dr. Menon's paper and what we might learn from that. But you've also touched a little bit on some lights that have come because of COVID 19, some of the expansions for licensure across state lines. You've touched a little bit on telehealth. And I'm wondering if you've seen the use of telehealth impact the use of support services on college campuses or if there's anything else that has really come out of this pandemic that we can learn from it and really continue to expand on in the future.
Dr. Meera Menon: Yeah, 100%. For example, now I have a greater ability to see students over the summer who are going to be in Ohio because that is where most of the students scatter over breaks is to another city in this same state. So telepsychiatry offers a lot more flexibility with that and that's within my license. Whereas in the past, I would've had more struggle to either try to identify a clinician just for the summer or collaborate with primary care doctors, which can be a challenge when someone may or may not still be seeing their pediatrician.
Dr. Meera Menon: Some of that finagling might still happen across state lines because of licensing restrictions, but telepsychiatry overall has made things more convenient. I also find that it's a lot easier for professional students to attend appointments because instead of having to rush from their clinical rotations or other internships all around the city, they can find a private space and attend their appointment a lot more easily as well.
Dr. Meera Menon: So yeah, it really has been a wonderful expansion, I think. Outside of the traditional one-on-one opportunities, telemental health also includes things like the expansion of apps and other sorts of online services and workshops and that's something that a lot of students across the country are taking advantage of more. For example, downloading apps that are even university sponsored that include wellness activities, and mindfulness techniques, and things along those lines.
Dr. Ludmila De Faria: I'm going to be the Debbie Downer, sorry. I love that you pointed out all of the good highlights. So on the downside privacy access to good internet services-
Dr. Meera Menon: 100%.
Dr. Ludmila De Faria: ... is an issue. Some of the students that went back to crowded places or LGBTQ students that were not out to their parents and now have no private place in the house that they can use. And then, of course, our rural population that have no stable internet. And so these are some of the things that we still need to tweak, right?
Dr. Meera Menon: Yeah.
Dr. Ludmila De Faria: We advocate and I know Meera is with me on this because we have worked on another paper on that. We advocate for repurposing some community spaces. For example, libraries and building soundproof private rooms in libraries that typically have good internet so that somebody can actually go into that room and then be able to telehealth help with Meera and I without having to worry or having rooms available in primary care offices where they can be talking to us. And if there is an emergency or anything that is needed, they are in a medical setting.
Dr. Ludmila De Faria: One of the challenges that I know most of us had at least once during the pandemic was talking to a patient that wouldn't tell us exactly where they were and then became a risk to self-harm. So those things need to be kind of worked out how we're going to handle that. So it worked great for like a great number of students, but there are certain little niches of students that don't necessarily benefit from telehealth or that telehealth needs to be improved.
Dr. Meera Menon: I think, especially what you say about internet access. We're at a point where internet is just as important as utilities like electricity and water. Yet so many people don't have reliable access to broadband internet. So I do hope, and I think this is something APA is advocating for, is the expansion, accessibility of this as a utility.
Dr. Ludmila De Faria: I know it is because in my state where there's so many in terms of legislation, but here there is a bipartisan effort to increasing internet access in rural areas.
Dr. Meera Menon: Oh, nice.
Dr. Ludmila De Faria: It's like, I jump on anything that is common ground. So I'm so happy that's something that everybody on both aisles are like, "Yeah, we need to get this going." And I think in part it was the pandemic. The pandemic created this need to whenever possible don't have to have the patient come in to be seen. But that also shows the have from the have nots right? The people who have access to good internet and stable access and people who don't have that.
Christopher Chun-Seeley: Thank you both. I think when we do get access to new exciting things equity should always be a part of that conversation. And I know that's something that we as a foundation, because we can't necessarily advocate from a legislative process, but when we were talking with the APA and their kind of team, I mean, that was huge for me because if you thought about... I thought about telehealth and how it could change the way that we think about connection to care for people reentering into our communities and across rural under-resourced areas.
Christopher Chun-Seeley: And if we get broadband internet access to every home and it is free or very, very, cheap, that changes the way in which we can provide services and access to care shifts. So I think that's really, really important. And being a Debbie Downer, I think the more that we talk about the problems, the more that we can also focus on solutions. So I think that's completely all right.
Announcer: The first signs and symptoms of mental illness typically show up during our teenage years, but sadly on average it takes about eight to 10 years for those individuals to get connected to care. To address this the APA foundation developed a mental health professional development program called Notice Talk Act at School. Through this program they train school staff to recognize these signs earlier and get students connected to care sooner.To learn more about Notice Talk Act at School visit APAfdn.org/schools.
Announcer: The APA foundation values their work with school communities, but this doesn't just mean for the people within the physical walls of the school. That's why they've created free resources for parents and caregivers on coping skills, reconnecting, distance learning, and more. Check them out today by visiting APAfdn.org.
Christopher Chun-Seeley: And I know both of you are highly engaged in the APAs council on child adolescents and their families, as well as the caucus on college mental health. I would love for you to touch on the role that family plays in mental health in wellbeing of the college students. I know we've talked about some of the differences of experiences of students and whether or not college is a safer place for them because of their family experience. But what is that role that family can play in the mental health and wellbeing? What are some of the pitfalls maybe that parents and caregivers fall into and should avoid?
Dr. Meera Menon: Where do we begin?
Dr. Ludmila De Faria: I was going to say.
Dr. Meera Menon: It is so essential for people to have, regardless of what your age is, especially through this pandemic, I think it's emphasized just how essential it is to have your community and have your support system. That's robust. And for a lot of people that is your family. And for other people it's not necessarily your family, but your chosen family, friends, other support systems.
Dr. Meera Menon: So this balance for parents of encouraging their student to spread their wings while also being a fallback and a safety net, a supportive one at that, when they need the extra assistance. So I guess that's one thing that I would think of with family and other supports is trying their best to strike a balance when it comes to supporting their child as they're going through college.
Dr. Ludmila De Faria: Yeah, we actually have a group of our colleagues in transitional ages, child psychiatrists, that wrote a book about safe transitions to college. And it was basically a book telling both parents and the pediatricians or child psychiatrist what is the best way to ensure care is going to continue in college or if there has been no care, that they at least get acquainted with what's available.
Dr. Ludmila De Faria: And here I'm going to pull out my hat as a college mental health provider and talk about me as the mother of a college student that needed to access services. And this was in the very beginning of my dealings with college mental health. And I made the huge mistake of assuming that all of the resources available where I was practicing were available at the school where my son was. I don't know what I was thinking.
Dr. Ludmila De Faria: And so I told him, "Well, go to the counseling center. Bring your report. That's the way to go. They're going to guide you through." That was done in a way that my son didn't quite understand and I wasn't familiar with the system, but that first semester was a disaster. He had no access to anything, medication or counseling.
Dr. Ludmila De Faria: And at the end they required me actually through friends of friends contacting somebody over there and saying, "Hey, what's going on here? And then service happened. And I was desperately avoiding to be the overbearing mother that was to continue to treat that child as if they're less than 18 and a minor because you do want them to start making their own decisions. But for some kids it's harder than other kids. My kid had a few clinical issues that were happening from before. And so I felt that I should have read that book on safe transition to college before I sent him out to college.
Dr. Ludmila De Faria: So they can be a little bit mad at me, right? I don't know if Meera feels like that sometimes when you're the provider and you have this parent insisting that you sharing information when you're trying to say, "Your child is now an adult and unless your child tells me it's okay for me to share, I really cannot be talking to you on the phone and giving you intimate details," right?
Dr. Meera Menon: Yeah. Mm-hmm.
Dr. Ludmila De Faria: And on the other hand, some of the students that you're like, "Oh, I so wish that family was involved so we could be working hand in hand to make sure that this kid is doing well," but those parents are not available. I have had parents that dropped their very young kids at college with significant clinical needs, significant, without getting into any specifics, and then took off on a month long vacation in Europe. And so when we actually needed parental home consent and communications they were not available. And so it's like you get both sides.
Dr. Meera Menon: Yeah. I think that reminds me of one thing in terms of resources where most colleges and universities require health insurance in order to enroll. However, oftentimes one thing that counts as a health insurance, that may or may not actually cover the student in the actual city where they're attending college.
Dr. Ludmila De Faria: Yeah.
Dr. Meera Menon: And that ends up being a huge barrier, even sometimes in situations where typically the student health center on campus, if a person has the flu, they would go there. But if they have a health insurance that does not cover them on their college and university, they may not be able to get treated for something as routine as the flu or something as emergency as they are having suicidal thoughts and need to be hospitalized. So that would be something that I'd really urge parents and other caregivers to consider is even if your student is the healthiest in the world, do they have medical and mental health coverage that is robust and able to cover them where they're actually going to be attending school?
Dr. Ludmila De Faria: Oh yeah, I don't know how many times a year the year changes, the calendar year, and then suddenly I get this frantic call from the student, "Why do I have to pay $500 for the medication? What have you done, Dr. De Faria?". "Oh, I done nothing, honey. You need to call your parents and talk to them about their deductible because you're not covered for that."
Dr. Ludmila De Faria: And so I know Meera and I often talk about that. We wish there was some sort of United States wide either licensed or insurance coverage so that if you are a college student, then you have access to good healthcare like universal health for college students. And if a provider practices in any counseling center or within a university than that would be automatic reciprocity when that student crosses state lines.
Dr. Ludmila De Faria: Just because I feel like that particular age group, A, it's where a lot of the diagnosis... That's where they have their first break. So it's a huge important age for that matter. And also because you want them to stay engaged in school. You don't necessarily want them to completely withdraw or lose track of what they were doing.
Dr. Meera Menon: I think we calculated that there's around four to five months of the year where the student might be away from campus, whether they're back at home or traveling for a longer break. So, while I want the student to have adequate coverage while they're on campus, that doesn't necessarily help me if then they leave for spring break. And I want them to have a life and travel, but that certainly is a challenge. So I agree with Dr. De Faria. I would love to have some sort of universal healthcare for college students that covers them throughout the United States.
Christopher Chun-Seeley: Well, Dr. De Faria, I'm so sorry that was your son's experience. Thank you so much for sharing that. I think it also highlights that even when you are a psychiatrist and are an expert in mental health, these systems are so different and so complicated.
Christopher Chun-Seeley: The thought that popped into my head is you have an opportunity. Well, most students go on college tours, right? They go on campus visits. And one thing I worked with a high school student and she talked to me about because she has her own mental health experience that she needs to be very concerned about when she's going on. That that was the questions that she asked was, where's your counseling center? How do I access it? How many free sessions do I have? All of those questions are really, really important for you in your vetting decision and choosing where you're going to go.
Dr. Ludmila De Faria: What is the process to see a psychiatrist? That's another one.
Christopher Chun-Seeley: And I think maybe those aren't questions that your students or your child might be comfortable with, but as a parent having that information and asking those questions is really important, too. You don't want to be the overbearing parent, but at the same time having that access to information, then you can feed it to your student once you have it, right?
Christopher Chun-Seeley: I also wanted to touch on the fact that, when we're thinking about students leaving or coming back and all of these different transitions that are happening, is that things can change at a moment's notice, right? And I think that's where from a college perspective or even from a parent perspective being able to recognize when a student has that change in behavior and you notice that change and being able to engage in that conversation with them is really important.
Christopher Chun-Seeley: Dr. De Faria, you said move upstream. Do we have any tips or recommendations to help parents and caregivers build their mental wellbeing to their child or their children before they head off to college? Social/emotional learning curriculums are politically divisive as well right now in the conversation, but in the home what can parents do at the dinner table as a habitual practice that really helps the children develop a better understanding of mental health and wellbeing?
Dr. Ludmila De Faria: I recommend to friends that have kids in high school and middle school, and I practice that because I still have one kid in high school, learn mindfulness meditation and learn a vocabulary to explain what you're feeling. And the vocabulary is not as much as you can talk to other people and say in a very stilted language, "Oh, I am experiencing this boorish mood." That's not about it. It's that, "I am feeling irritable. I feel like anything that you say is irritating me. What is going on?"
Dr. Ludmila De Faria: And it's teaching them, "Well, have you thought that maybe you're burned out? Have you been sleeping well? So I do teach a lot of basic self care to my daughter. I do encourage her to do mindful meditation, which I know she has incorporated. And now that we're like in finals approaching finals and AP exams, she would say things like, "I actually carved out time. On this particular day, I just want to sit down and play some video games and just kind of clear my mind." So even organizing the schedule so that there is some time for mental health.
Dr. Ludmila De Faria: So I think that if a kid can recognize that in high school, then they're a lot better situated when they get to college to know that. I just saw a kid 19 years old who came to me and as I'm taking the history he says, "Well, I've been very anxious and not sleeping well for five days." And in my head it was like, ding, ding, ding, ding, ding, ding, ding. H.
Dr. Ludmila De Faria: He's somebody who knows himself very well. And he's like, "Okay, this is not sustainable. This anxiety is not okay. And I need to kind of get help for this." And he desperately tried to access help. Finally got to me. And so I want all of my students to be like that. To tell me, "I've been having an issue for two or three weeks." Instead of the ones that give you that, "Oh, it's like for the last three years that I've been college, I've been failing every class. I've been feeling terrible. I've been self-harming. I've been using substances." It's a lot harder.
Dr. Meera Menon: Yeah. And that happens so often that we start seeing people after they're already on academic probation or have run into various troubles that are very much related to their mental health symptoms.
Dr. Meera Menon: I mean, and you touched on this, but I guess one thing or two things I'd add or just want to emphasize are developing the basics, like making sure that you know what a good sleep routine is and that you're getting enough sleep, and making sure you're eating. And it doesn't need to be the most pristine foods. All foods are good foods. There are no bad foods. But making sure that you're taking the time to eat. Because that's another common thing that we might end up seeing is a college student who is only sleeping a couple hours per night or having their first meal in the evening when they're done with all their school work, which is also not sustainable and can worsen or even be a main cause of whatever mental health symptom that you might be having.
Dr. Ludmila De Faria: I don't know in how many schools, if this is available. I know at at least one of the schools that I worked at they actually had mandatory for all freshmen. That was a class that was I think one credit. That was the era. It was like, "This is healthy eating. This is how many hours. This is how you do mindful meditation." So it was like, "You can enroll in all of your honor classes, you still have to do this class. We are going to teach everybody that comes through the door." And I've never looked at their results, but I wonder if they actually noticed some improvements.
Dr. Meera Menon: I bet they do. Because even small things, like if you have a class that teaches you how to set up your voicemail or how to do laundry and how often should you wash your sheets, those are some small things that people don't necessarily have the knowledge of before coming to college that are really stressful when you're trying to figure that out for the first time. I remember I was an RA in undergrad and we had these like apartment style living and the amount of people who accidentally put laundry detergent in the dishwasher. That was a disaster.
Dr. Ludmila De Faria: Yes.
Dr. Meera Menon: Stressful all around.
Dr. Ludmila De Faria: Yeah, not only very basic, like eat, pray, be happy, kind of like get your bases covered. I remember a conversation with a patient that I had that was telling me, "Oh, I was at this party and there was a lot of alcohol and a lot of drugs." And I reflectively said because I'm always the mom, right? I said, "Well, I hope you did not drive home. And you called an Uber." And the reply of the patient was, "Oh, De Faria, everybody knows that when you drink too much you do a couple of lines of cocaine and you're good to drive."
Dr. Meera Menon: Oh no.
Dr. Ludmila De Faria: And I'm like, "No, everybody does not know that." So that's when I want a class that actually tells people, "Yes, there are substances out there. And yes, you might be age appropriate to secure some of those substances. But this is the effect that it has on your mental health and on you."
Christopher Chun-Seeley: I had to do discipline meetings with students who would get caught drinking in the residence halls when I was a graduate student and I never approached it from a punishment standpoint. It was, "Here's information for you." Like, "I want you to make an informed decision. So this is the point of diminishing returns for drinking."
Christopher Chun-Seeley: Like, "I don't think you understand drinking as it relates to it as a poison and all these other things. And I'm not going to tell you not to drink. I'm not going to tell you not to use.
Dr. Meera Menon: That's right.
Christopher Chun-Seeley: What I'm going to do is I'm going to provide you with the information to make an informed decision. Because if I tell you not to drink, you're still going to go and drink. But if I give you the information, it's now your choice."
Christopher Chun-Seeley: And I don't think we give kids in general enough credit. When we actually inform them of the consequences and of the pros and the cons of the choices that they do have to engage in. They're 75% of the time going to make that right choice if you give them the right information. But I think to your point, based off of the do two lines of Coke and you can drive fine after drinking, you're also competing against misinformation from their peers as well.
Dr. Meera Menon: Oh yeah. And actually, but I'm all with you on the providing the good information. And I reminded that student that "No, you're making yourself more alert with the cocaine. However, you are still impaired and your reflexes are still not okay because you drank that much. So now you have a co-occurring risky situation that didn't resolve the first one. And you are right. I actually followed that student long enough to see the student making the choice of living a sober life. So yes, they do make the right choices. Once you provide them with enough information and you treat them like, "Well, you're a grown up now."
Christopher Chun-Seeley: Yep. Before we close it out, I do want to give us an opportunity to be future thinking and solution focused here. So what is the next big thing that's happening right now in college mental health that we should all be talking about right now? Or what is the thing in about 10 years that we will be talking about that is kind of emerging?
Dr. Meera Menon: I hope that psychiatrists will have a bigger seat at the table when it comes to large decision making about college mental health. We know that the acuity of mental health symptoms is increasing among college and university students. And we also know that psychiatrists have a lot of experience working with very complex mental health symptoms and diagnoses and working within large systems.
Dr. Meera Menon: Right now, I believe less than 1% of college centered directors are psychiatrists. So I hope that we have more opportunities for psychiatrists to have a seat at the table to be able to support students in this multidisciplinary field.
Dr. Ludmila De Faria: And I mean, I still think it's important to keep looking at the effects of social media, the good, the bad, and the ugly. There's a lot of good things that can come out of social media and how to use that for the greater mental health good. But also understanding the impact of misinformation that is out there and how to reach people when they basically are in their bubble. So I think that we should all be thinking about that, all of those TikTok challenges.
Christopher Chun-Seeley: One of our grant schools, we couldn't get a hold of them for a couple of weeks because the newest TikTok challenge was destroying school property and sending around through it. And it's like, how do we get a good challenge out there around mental health or a positive one?
Dr. Meera Menon: Yeah. Sleep eight hours a night TikTok challenge.
Christopher Chun-Seeley: Right.
Dr. Ludmila De Faria: Yes, that's right. That's your TikTok challenge
Christopher Chun-Seeley: A time lapse of eight hours of sleep. Let's do it.
Christopher Chun-Seeley: But I am just very appreciative of this whole conversation today. We've touched on so much stuff from collaborative care and how that can be impactful especially on college campuses, thinking about educating early. How do we continue to move upstream so that when our students come onto campus that they have the skills to manage stress and anxiety and to come to the professionals when they do need that help and support or to start to address the systems that are also causing this harm for our students when they show up?
Christopher Chun-Seeley: And then especially more access for our minority and underrepresented students. Especially as we think about those who are providing the services, being culturally informed and culturally appropriate. And how does equity impact that, especially when we think about broadband access to telehealth services and some of these other things that have been celebrated, but also need more work to make sure that more have access to it?
Christopher Chun-Seeley: And then just in general, Dr. Menon, you touched on this, more psychiatrists at the table and being more social psychiatrists as well, so that they can feel empowered to address the ways in which decisions that are handed down at the state level are impacting the students and how they show up and how they can be impactful in those areas. But overall, I think, there is a lot that is going to come out of this pandemic that we don't know yet, and that we are going to be waiting for Dr. Menon's paper and then waiting for-
Dr. Meera Menon: Dr. De Faria is on that paper too.
Christopher Chun-Seeley: Oh, so she didn't even give herself-
Dr. Meera Menon: She can't give me all the credit.
Christopher Chun-Seeley: Oh, okay.
Dr. Meera Menon: She can't give me all the credit.
Christopher Chun-Seeley: So both of you will have a paper coming out that we might have to have a follow up podcast conversation on. But in closing, I just wanted to give you both the final words on any takeaway things or anything that you hope our listeners will kind of leave this conversation today with.
Dr. Meera Menon: Oh, well, thank you so much for having me here today. I really appreciate getting the chance to talk to you more about this. Parting words, I guess, I'm thinking about my vision for college mental health. And I'm hopeful for colleges and universities to start to promote more of a wellness and preventative angle in order to create more of a college environment that's supportive and promotes mental wellness as well as availability of mental health services when the need does arise.
Dr. Ludmila De Faria: I would say, everybody that is listening, if you're listening to this podcast, it's because you're probably interested or have skin in the game either as a parent or as a provider or mental health care worker. I encourage you to get involved in advocacy, whether it is spreading the good information, finding out how you can make a difference to this age group, the transitional age group. Just many hands make work light, right? So sometimes a little bit of effort that can put it out there together with a lot of people we can make a lot of change happen.
Christopher Chun-Seeley: Well, thank you so much, Dr. De Faria and Dr. Menon. I really appreciate your time here today, and we look forward to further conversations with both of you.
Dr. Ludmila De Faria: Thank you for having me.
Dr. Meera Menon: Thank you.
Christopher Chun-Seeley: Thank you for joining us for Mentally Healthy Nation. If you liked the conversation today, please consider rating Mentally Healthy Nation five stars on Apple Podcasts and leaving us a review. And remember take care of yourselves and take care of your communities. We are all in this journey of wellness together.
Announcer: The views and opinions expressed in this podcast are those of the individual speakers in their personal capacity only, and do not necessarily represent the views of the American Psychiatric Association Foundation or the views, official policy, or position of the institutions and organizations with which the speakers are affiliated. The content of this podcast is provided for general information purposes only, and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.