College Student Utilization of a Comprehensive Psychiatric Emergency Program

The college years correspond with the peak onset of mental health symptoms in the general population. Half of all people with a diagnosable lifetime mental illness experience symptoms by the age of 14 years and three fourths by the age of 24 years (Kessler et al., 2005). Colleges and universities are ultimately charged with developing strategies for responding to the needs of its primary community members, including "the new diversity" (Nolan, Ford, Kress, Anderson, & Novak, 2005, p. 172), that is, students attending college with significant mental illness or poor coping skills. For the past 2 decades, college counseling center professionals have reported an increase in severe pathology among college students (Benton, Robertson, Tseng, Newton, & Benton, 2003; Cornish, Kominars, Riva, McIntosh, & Henderson, 2000), which has created many challenges for providing adequate services. Severe problems can be defined as "those cases in which the problem significantly disrupts the student's ability to adequately function within the university setting or for cases that require mental health care beyond the capabilities of the average college counseling service" (Sharkin, 2004, p. 314). Many of the studies on this subject reported anecdotal accounts or drew from counselor or college counseling center director surveys, where there may have been considerable inconsistency in how the data were gathered (Barr, Rando, Krylowicz, & Winfield, 2010; Stone & Archer, 1990). Other studies have assessed for broad categories of problems but not the level or degree of problem severity or consisted of data from a single counseling center rather than a national sample (Benton, Benton, Newton, Benton, & Robertson, 2004). In response to these concerns about relying on counselor or director impressions, Erdur-Baker, Aberson, Barrow, and Draper (2006) examined severity and chronicity as measured by students' scores on an empirically validated presenting problem inventory. The severity and chronicity that clients in a national sample reported for depression were greater in the more recent 1997 clinical sample than in the older 1991 clinical sample, providing some evidence that the severity and chronicity of college students' presenting problems are increasing over time. Using random sampling methods with over 80,000 college students as participants, the National College Health Assessment, which is sponsored by the American College Health Association (ACHA; 2008), found that 9% had seriously considered attempting suicide in the past year. In a national sample of over 28,000 college counseling center clients, the Center for the Study of Collegiate Mental Health (2009) found that 8% of these students had made a suicide attempt and 21% had engaged in nonsuicidal self-injury. In a National College Health Assessment survey (ACHA, 2008), approximately 15% of students indicated that they had been diagnosed with depression; this is a 50% increase since 2000 when 10% of students reported depression. In 2008, 36% of depressed students were currently prescribed medications, 24% were in therapy, and 32% had been diagnosed only within the last school year. Unfortunately, not all students with mental health problems will seek help. Eisenberg, Downs, Golberstein, and Zivin (2009) found that students who were male, younger, Asian, international, more religious, or from a poor family reported greater personal stigma surrounding mental health problems. They also found that personal stigma was significantly associated with several measures of lower help seeking, such as perceived need and use of psychotropic medication, therapy, and nonclinical sources of support. Several researchers have shown that psychological distress is correlated with academic problems, poor adaptation to college, and alcohol abuse (ACHA, 2008; DeStefano, Mellott, & Petersen, 2001; LaBrie, Kenney, Lac, Garcia, & Ferraiolo, 2009). Furthermore, student mental health problems can be detrimental not only to the individual student but also to the campus community. …