Margaret Skoch of Cleveland felt a jumble of emotions as the day to leave for college neared. She was thrilled to be attending her dream school, Notre Dame University, her mother’s alma mater. She was anxious about leaving home. And then there was her mental health. Skoch had been diagnosed with obsessive-compulsive disorder, depression and anxiety in high school. Although she was feeling confident and healthy, she worried her symptoms might return.
That worry turned into a full-blown panic attack her first night in her dorm. It was the beginning of a rough few months.
“I was really homesick. I called home every day crying,” recalled Skoch, now a junior. “It was bizarre because I was so happy to be in this place that I loved and at the same time sometimes miserable.”
Due to better mental health care and campus services, more young adults with a mental health diagnosis are attending college than ever. According to the 2013 National Survey of College Counseling Centers, 88 percent of college counseling directors reported a steady increase in students arriving on campus already on psychiatric medication. What parents need to know is that with strategies crafted in advance and monitored from afar, teens with a mental illness can thrive in college and beyond.
Like Skoch, many freshmen with a diagnosis arrive at college without any mental health care in place, said Nance Roy, clinical director of the Jed Foundation, a nonprofit that advocates for the emotional health and suicide prevention of college students. Skoch quickly sought out a therapist, but many students fail to ask for help until their illnesses compromise their academics and/or emotional well-being.
Aaron Chen, 21, of Naperville, Ill., had a depressive relapse his freshman year at the University of Illinois at Urbana-Champaign but didn’t seek out mental health care until his sophomore year.
“When I originally came here, I expected to be independent. I told myself, ‘I don’t need therapy’. But it turned out that I still needed help, and that sort of made my freshman year not so great. I was struggling alone.”
Roy urges parents to be proactive: Once a teen selects a college, contact the counseling office to find a psychologist and a psychiatrist on campus or nearby. Then schedule an introductory appointment for soon after the child’s arrival.
“You don’t want to wait until she’s struggling because there are no services set up,” Roy said. She also suggests having your teen sign a medical release before leaving for college. Otherwise, once he turns 18, you will not be able to access his health information unless there is a crisis.
The academics office also should be informed of a child’s disability, according to Peter Lake, professor of law at Stetson University College of Law in Gulfport, Fla. “(College staff) are anxious to help, and peers are generally very receptive,” he said. “There’s an open acknowledgment of disability on college campuses.”
Student-led mental health advocacy organizations, such as NAMI on Campus (National Alliance for the Mentally Ill) and Active Minds, are sprouting up on college campuses. These groups help reduce stigma and offer students support and education.
As important as it is to build a strong safety net for a teen, academic interests should drive the college search. Also, the student should be encouraged to think carefully about how far he wants to be from home, the size of the school and the setting – city, suburban or rural.
Parents who have been advocates, cheerleaders and anchors in their children’s lives now, in the months leading to college, must nurture independence.
Most college freshmen arrive on campus ill prepared to care for themselves, according to Roy of the Jed Foundation.
“Some of the biggest challenges are basic life skills – doing laundry, going food shopping, managing money, paying the cellphone bill, learning to live with people different than you,” she said. “College has less structure and more independence. There’s time management, organizing your day and handling stressors on your own. If you’re not on top of it and you have an illness, all those things become more challenging.”
Roy recommended gradually increasing responsibilities during the junior and senior years of high school, including the dreaded laundry.
Improving a child’s organizational and study skills should be a priority, said Rick Auger, a professor in the department of counseling and student personnel at Minnesota State University in Mankato, Minn.
“For almost all mental health issues, organization is so critical, especially ADHD, anxiety and autism spectrum disorder,” he said. “Binders, folders, assignment planners – all those things are helpful getting students into the habit of being organized.”
Parents shouldn’t be afraid to let a child fail – modestly, according to Auger. It’s time to be a coach rather than a problem-solver, he explained.
“Ask, ‘How are you going to go about solving this?’ Start with small, low-stakes problems. That’s where kids grow in confidence and self-advocacy.”
If the results of these at-home experiments create doubts about whether a child is ready for college, Auger suggests checking in with high school.
“As a parent, you know so much about your child’s strengths and weaknesses, but teachers have seen thousands of kids at that age level.”
Another readiness indicator, Roy said, is how well a child previously handled separations.
“Did it go smoothly, without a hitch? Did they struggle but manage to get through it, or was it disastrous?”
Ultimately, there is no ironclad timetable for completing college. Counselors say pressure on a teen can be eased by discussing options, like a gap year or starting out at a two-year college.
Eric Haskins, 18, of Orlando, Fla., was diagnosed with bipolar disorder two years ago, but he’s still learning the boundaries he must navigate to stay well.
“I wanted to go to school in England,” said Haskins, who plays bass in a band and hopes to become a music producer. “As my symptoms have gotten worse, we’ve had to take a step back and grasp the reality. I needed to find something local and have a network of people close by so I’m not completely on my own.”
Haskins plans to attend a community college in the fall.
“The goal is to set him up for success,” said his mom, Christine. “His path is not going to look like everyone else’s path.”
Whether a teen attends a community college down the street or travels across the country, a parent is likely to have freshman jitters right along with the child. Staying in regular touch can help both, but the terms of communication should be worked out beforehand, suggested Lauren Freise of San Francisco, a sophomore at Boston College who has battled depression and anxiety.
“While a parent understandably may want to ask their child how they are doing or steer a conversation toward their mental illness, sometimes just sending a text with a picture of where they are and a blurb about what they are doing will really make their kid’s day and lets them know that their mom or dad are thinking about them,” Freise said.
If you’re lucky, you might get a photo back.
Under the Americans with Disabilities Act, almost all colleges and universities must legally provide students with reasonable accommodations (such as being allowed more time to take a test, or to record lectures), as long as your child has a mental illness that meets the legal criteria. To receive academic adjustments, parents likely will be asked to provide written proof of a child’s disability.
Parents of college freshmen quickly will discover that accommodations are less comprehensive than in lower grades.
“Under federal and state laws, all children in K-12 have a right to a basic education, so schools have elaborate (accommodations) in place,” said Peter Lake of Stetson University College of Law. “In higher education, schools are only required to provide opportunity – not to guarantee outcomes or success.”
In higher learning, accommodations are based on individual needs, which could include arranging for early registration, reducing a course load or providing note-takers. Colleges are not required to make substantial modifications. For example, a student may be granted more time to take a test but is not entitled to changes to the content of the test. Accommodations can vary widely from college to college. Parents should research prospective schools until they find those that have the right mix of services for a teen, Lake advised.
The biggest change, perhaps, from K-12, is the college student’s responsibility to disclose a disability.
“Accommodations are generally not available unless you ask,” Lake said. “Too often, students don’t react until their grades plunge.”
▪ “Transition Year”: The Jed Foundation and the American Psychiatric Foundation teamed up to produce this guide to help students and parents prepare for college. jedfoundation.org/students/programs/transition-year
▪ Active Minds: This nonprofit was founded by Alison Malmon after her brother, who had been experiencing depression and psychosis for several years, committed suicide. Active Minds now supports about 400 student-led, campus-based chapters that provide students with programming to educate others about mental health, connect students to resources and reduce stigma toward mental illness. activeminds.org
▪ NAMI on Campus: There are about 90 NAMI on Campus clubs so far. These student-led organizations support fellow students, raise mental health awareness and promote mental health services. nami.org
▪ The American Association of People with Disabilities: The AAPD offers resources for students with disabilities who are planning their college search. aapd.com/what-we-do/education/higher-education/getting-there.html