University Park, Pa. — For any student, going away to college and encountering new academic and social pressures can be a challenging experience. For some, those challenges, as well as pre-existing conditions, can result in issues that need the attention of qualified mental health experts.
Dennis Heitzmann, director of the Center for Counseling and Psychological Services (CAPS) at Penn State's University Park campus and an expert in college student mental health issues, said that the preponderance of students his center sees are dealing with anxiety and depression, but that each client is dealing with a unique situation.
"The circumstances in the lives of these individuals that precipitate the anxiety or depression or exacerbate those conditions are as unique as there are individuals on this campus," he said. "There are different dynamics in their ability to relate to the campus and others on campus — their family dynamics, their academic struggles or failure or success in making connections or building a social network."
Heitzmann noted that for some individuals, initial feelings of depression or anxiety give way as the student becomes acclimated to campus life and academic expectations and develops social networks. For others, though, as the symptoms persist, counseling may be in order.
Mary Anne Knapp, clinical social worker for CAPS, said that young adulthood is frequently a time when issues of depression and anxiety begin to emerge, particularly if there is a biological predisposition to these conditions. And for college students, added pressures can increase the development of these feelings.
"College students sometimes have more choices and pressures and the feeling that they have to be perfect," Knapp explained. "They want to succeed and they want relationships to work. They feel an extra sense of pressure to fit in and 'get it all right.' "
As well as problems with academics and social and romantic relationships, students who seek counseling sometimes are suffering from substance abuse or eating disorders, which can cause or result from anxiety and depression.
"In addition to screening for depression and anxiety disorders when we meet with students in counseling, one of the things we assess for is whether substance abuse is affecting them. Sometimes binge drinking or drug use contributes to academic struggles or is part of a student's mood problem," Knapp said. "Some students slide into a binge drinking lifestyle. They aren't paying attention to how much they drink or the consequences of their drinking. Other students may drink in order to deal with untreated depression or anxiety, including social anxiety."
In 2006-07, about 2,500 students completed a clinical assessment with CAPS. The center reached another 5,000 through outreach activities, and had about 500 calls or walk-ins from students with questions about themselves or friends. With the opening of the new Student Health Center on the University Park campus, CAPS now has more space available to offer more service. But often, those in need of help are also in need of encouragement to seek out assistance.
Heitzmann and Knapp said that family, friends and teachers all have a role to play in identifying when students are having problems, and it is important that they know what to look for, when to speak up and what help is available.
"(Invading privacy) is one of the most common reasons for individuals who are in a position to help for not reaching out and offering that assistance," Heitzmann said. "The truth is, if the individual has been giving signals that they are in trouble and in need of help, they are typically appreciative of someone intervening in a way that can help them find some relief for their pain.
"Without being too aggressive about it, look for the cues and respond with a fairly benign response such as, 'You haven't been your old self,' or 'Is there something you want to talk about?' Give a stimulus like that, and if the person is truly in need and trusts you, they will likely disclose what is going on for them. Then it's important for you to know what's available to help them."
For parents, Knapp said, it is important to be aware of what is going on with a student while not being overbearing.
"Some parents are very tuned in to their students and have a relationship where they can talk about issues and help them get into services," she said. "In those situations, the role parents play is very important. It's tricky because it is at a time in life when students are branching out on their own and often want to be independent. Balancing, offering support and getting students in for needed services, as well as encouraging them to take care of themselves, is important."
When parents recognize a cue, such as when calls home stop or when the student no longer seems happy or responsive, they can already be prepared. While there is no mandate requiring it, nearly every college and university offers some form of counseling. With the wide availability of information about Penn State and other schools available on their official Web sites, parents can become familiar with campus resources before their students even reach campus.
Additionally having an open dialogue with friends and roommates also can help a struggling student to feel better or get the assistance he or she needs.
"Sometimes just talking to a roommate or friend in a meaningful way helps relieve things or even resolve it," Heitzmann said. "There may, however, be some more entrenched circumstances where professional help might be in order. That's the point at which an individual can be aware of the counseling center, or know where to look for what help might be available."
He added that being assertive at the right time is important for friends to help. A friend may consider walking with the student to the center, or accompanying him or her to the appointment.
Faculty, meanwhile, may notice a marked change in performance, behavior or attitude as a sign that something is wrong. Some signs Heitzmann noted are when a student tears up for no apparent reason, becomes avoidant or performs unusually poorly on tests compared to past results. They may suddenly start sleeping in and turning in assignments late.
CAPS has produced an online training program called "Students in Distress: A Guide for Faculty and Staff," and CAPS employees have provided workshops for faculty to show what they can do to help.
The past year has brought more focus on the potential for violence on college campuses in the wake of the shootings at Virginia Tech. Heitzmann, who consulted at Virginia Tech and at Northern Illinois following the shooting tragedies at both schools, said that while students are largely resilient, even when faced with huge tragedies, there has been a heightened sense of vigilance for potential violence among college students.
If faculty have serious concerns about dark themes expressed in a student's paper, they are welcome to consult with CAPS.
"Sometimes a dark-themed paper is just the topic of choice as a creative effort," Heitzmann said. "In certain other cases it is a more obvious statement from an individual who is troubled or potentially at risk. I think if a faculty member has any doubt, they can certainly bring it to the attention of me or my staff, because there are some things we might be able to pick up from the background and information that would suggest the student is at risk. We can consult with a faculty member about determining the nature of the risk and how to address that with the individual."
Knapp said that when a student does agree to get help, counselors try to connect conditions and behaviors such as substance abuse and eating disorders with their consequences.
"Behaviors involving substance abuse and eating disorders are serving a coping function," Knapp said. "There is something the student is getting from the behavior, and that makes it harder for them to want to give it up. On the one hand they know it's not good to be binge drinking or binging and purging, but on the other they think it helps with the anxiety they are feeling. When we see students about other issues we try to connect the condition and behaviors with their consequences to try to increase motivation to work on their problems."
Counselors work with the client to determine what would be the best course of treatment, with choices ranging from short-term counseling to therapy groups to long-term therapy with a private practitioner.
"We review treatment choices and decide with the student what is the best plan," Knapp said.
But to make that plan, students in distress often need a helping hand. In the end, loved ones need to feel comfortable talking about the problems their students may be encountering, especially if suicidal thinking has entered into the picture.
"I think it's important for everyone to feel comfortable asking someone they love if they've thought of suicide," Knapp said. "Sometimes that's the only way you know what a student is thinking and how serious the situation has become. Set the stage and let the student know you want to hear about the problems and not just the successes."
For more information about CAPS, visit http://www.sa.psu.edu/caps/.