Issue 2 | Second Quarter | 2016 by Mary Christie Quarterly

Mary Christie Quarterly A publication of the Mary Christie Foundation

A Difficult Passage: Supporting the Unique Health Needs of Community College Students

p. 15

Q&A with Dr. Charles Cziesler, sleep expert p. 08 College, Interrupted p. 28

Issue 2 | Second Quarter | 2016

Mary Christie Quarterly The Mary Christie Quarterly is a publication of the Mary Christie Foundation, a thought leadership and philanthropic organization dedicated to the health and wellness of young adults.

STAFF Publisher & President Editor & Executive Director Program Manager Communications Coordinator & Staff Writer

Robert Meenan Marjorie Malpiede Dana Baarsvik Ashira Morris

BOARD OF DIRECTORS Chair

John Sexton

Vice Chair

John P. Howe, III

Vice Chair

Michelle Dipp

President

Robert F. Meenan

Secretary

Marjorie Malpiede

Treasurer

Amy Feldman

Member

Frederick Chicos

COUNCIL OF EXPERTS Chair: Susan Windham-Bannister

Terry Fulmer

Lawrence Bacow

Dr. Paula Johnson

Lynne Bannister

Dr. Derri Shtasel

Grace Fey

Ellen Zane

CONTE NTS 03 The Reality Show 08 Q&A: Dr. Charles Czeisler 13 Opinion: A Prescription for Opioid Abuse 15 A Difficult Passage: Supporting the Unique Health Needs of Community College Students 21 Opinion: Mental Health is a Campus-Wide Collaboration 24 Q&A: Cyekeia Lee 28 College, Interrupted 33 Huffington Commencement Advice: Rest 34 Science Summary

Cover art and spot illustrations by Emma Roulette

The Reality Show New York University uses musical theater for and by its students to bring awareness to campus health services

By Ashira Morris ON a Tuesday night in Jan-

uary, incoming New York University transfer students filled the Skirball Center for the Performing Arts for a mandatory part of their orientation: The Reality Show, a 90-minute musical theater performance.

At surface level, The Reality Show is a vehicle to ensure that students know about the hotline, but the subtext is equally important, conveying that there’s no stigma associated with calling the hotline or using any of the campus’s mental health services.

until her death from esophageal cancer earlier this year.

The title may have pop-culture levity, but the content has heft: written, choreographed, and performed by students, the show highlights challenges and pressures new students might face during their years at the school, it sends a strong message that it’s okay to reach out for help if you’re dealing with stress, substance abuse, sexual abuse, or mental health issues.

The show had its first run in 2004, a time of crisis for NYU. The school was reeling from seven suicides in 12 months. As part of the school’s struggle to cope with loss while seeking wellness solutions, the 24-hour hotline was created, as well as the theatrical performance to introduce it.

“It has to be so funny that I’m crying from laughing, or my body has to be moving to the music, or I have to be on the verge of tears at the beauty of your piece,” Martin said. “I’m asking for some really high quality art.”

Throughout the performance, one line is repeated again and again: “Call (212) 443-9999.” By the end, audience members were reciting the number along with the cast like a chorus. That number rings the NYU Wellness Exchange hotline, a 24-hour service that provides counseling and support for students. 03

The school tapped playwright Elizabeth Swados, a four-time Tony Award nominee known for creating socially engaged musical theater, to direct a show created by the students. Swados, who had recently been hired full-time at the NYU Tisch School of the Arts, specialized in working directly with communities to create plays that reflect their realities. She worked on The Reality Show annually

Preston Martin, who took over as director in 2013, is dedicated to maintaining her ethos of the vulnerability and power of a community holding up a mirror to itself.

Martin, who was in the inaugural cast, was drawn to the production’s mission his first year on campus. “Being able to speak directly from my experience going through my freshman year at NYU, using my own experiences to talk to people about what to expect and how they can maybe prevent certain darknesses, seemed like a really exciting opportunity as an artist,” he said.

Photo by Phil Gallo

NYU students perform “The Reality Show” for all incoming freshmen and transfer students. The fall orientation performance in 2014, pictured above, was staged at Madison Square Gardens.

After performing in the production for two years, he became assistant director until 2013, when he took over as director of The Reality Show in New York as well as NYU’s satellite campuses in Abu Dhabi and Shanghai. Every year, the show builds on the bones of the previous year’s production. As a result,

the production continues to access deeper levels as new cast members contribute to concepts previous cast members have put into place. Topics like mental health, depression, and anxiety are mainstays, but each year, the current cast works with Martin and Assistant Vice President for Student Health Zoe Ragouzeos to

create a show that is relevant, entertaining, and accurate. The students spend their summer writing the song lyrics, composing the music, and choreographing the dances. The lyrics feel contemporary, incorporating current events and pop culture shout-outs. The 2016 production included references to the popular in-

door cycling studio SoulCycle intertwined with scenes about sexual assault. “Some people have never heard these words and some people are sitting in the audience suffering with that at that very moment, and it’s very easy to say ‘you don’t know me,’” Martin said. “But if someone is up on stage producing something so virtuosic, you can’t help but listen and watch. It’s about the audience trusting the performers.” Every incoming NYU freshman and transfer student sees The Reality Show. The entire freshman class — usually between 5,000 and 6,000 students — experiences the production in Madison Square Garden or Beacon Theater during fall orientation, partially because those spaces are where you can put 5,000 18-year-olds, but also because it lends the production professional weight.

The students in the cast draw on both their personal experiences and those of the broader NYU community to create the show. Although they are all art students, they ask classmates and professors in other departments about their experiences in order to create a show that’s about the whole campus, not just the drama department. “The actors that do this have something in their hearts about wellness and health,” Ragouzeos said. “They feel passionate about it. They know the impact it can have, so they really work hard on it.” Some topics are easier than others; for a scene about dealing with roommates, Ragouzeos suggested changing the lyrics from repeating “it’s going to be great” to a rotation of more doubtful statements — “will it be great?” “I hope it’s great” — to reflect the uncertainty of living with strangers. The show strives to present

concepts that aren’t singular experiences with only one outcome or solution. “What I want to see is putting the topic out there but not wrapping it up with a red bow,” Ragouzeos said. That goes for the more difficult topics as well. Segments on sexual assault emphasize consent while acknowledging that sometimes, both parties are confused about what happened the night before. A piece on depression shows how a person might withdraw, without offering a simple fix. And every year, Ragouzeos worries about references to suicide. “It’s very hard to send the right messages about suicide,” she said. “It’s very hard to sing and dance about suicide.” The mental health segment was recently updated to weave spoken facts about the human body into the songs about depression, anxiety, and suicide. “The hope is to put that out there in a way that gives com-

fort with what a miracle human existence really is,” Martin said. “It’s strung through the process of, ‘I may be feeling a deep sadness, I may be feeling a really unhealthy amount of anxiety, but once I work my way through this using therapy, using the hotline, using self-awareness, I can also see that I have this incredible miracle here, that I’m walking this planet.’ ” For other campuses looking to emulate The Reality Show, creating an experience that is for and by the community is essential. In New York, musical theater is successful because it engages most of the students in the audience (“even the math students have an appreciation for art,” Ragouzeos said, “otherwise they wouldn’t come to New York”). But on another campus, that might not be the most powerful vehicle. The show succeeds by speaking to the students directly, giving them a familiarity with and a vocabulary for the health challenges that they or their friends may come up against in the next four years. The hope is that this comfort and vocab-

ulary, in turn, will give them the tools to be less reactionary when those health challenges arise. Over the past year, the hotline has received over 110,000

After he saw the production as a freshman, he knew he wanted to be a part of the show. “I’m passionate about mental health and wellness issues,” he said. “And I think there’s a real

“The fact that it’s good theater allows us to communicate these messages in ways that they can hear.” - Zoe Ragouzeos calls. Since its inception, it has helped over 700 students seriously considering suicide make it through the night.

lack of proper education and support for people of all ages. It was exactly what I wanted to do.”

“The fact that it’s good theater allows us to communicate these messages in ways that they can hear because it’s so good,” Ragouzeos said. “It’s written by the students. We don’t write it. I may tell them which angles to go with and which directions we think are important, but they write it. And I think that’s why the students can hear it.”

He had a successful audition and joined the cast knowing that he wanted to expand the mental health section.

That was the case with Tisch junior David Merino.

Specifically, he wanted to write about coping, but not in a necessarily pleasant way: he wanted to present the fact that some people deal with stress through physical actions and bring awareness to better methods.

“I wrote the cutting song,” he said, “which was a reflection on how I handled myself when I was going through a rough time. I chose not to turn to the student health center. I locked myself away and coped with my pain in a way that made sense to me in that moment. Once I came out of that period, I knew I never wanted anyone to feel how I felt in that moment.”

she wanted to make her songs visceral and specific for the students who struggle with similar feelings. “I find that specificity allows for more people to relate to a piece,” she said. “I hope that the song helped people because of its authenticity.”

other people’s experiences and through my own.” The song is now an uplifting segment that describes savoring the little joys in life, like “the brilliance of confetti” and “the taste of spaghetti.” It’s a reminder that mental illness exists, but it doesn’t have to eclipse the small colorful pleasures in life.

“If the show saves one person that year, that semester, that night, I just want that person to know that they’re not alone and that there is a healthy way to cope” - David Merino

Angela Sclafani, a recent graduate of the Tisch School, also worked to expand the mental health suite during her time in the Reality Show cast.

She also wrote “One Tiny Voice,” a song that urges students who have dangerous thoughts to make it through another day, fight through little by little, and ask for help.

Although she wrote lyrics for many segments, working on the anxiety piece hit especially close to home. Because she deals with stress and anxiety,

“It was simultaneously a beautiful and difficult process,” she said. “When I’m writing, I want to dig deep to find that universal humanity through

“If the show saves one person that year, that semester, that night, I just want that person to know that they’re not alone and that there is a healthy way to cope,” Merino said. “That is the whole reason why I’m a part of this cast.”

Q&A: Dr. Charles Czeisler Dr. Charles Czeisler has advised athletes and astronauts about the importance of sleep. Now, he’s turning his focus to college students. Interviewed By Marjorie Malpiede

For 30 years, Dr. Charles Czeisler has been studying the physiology of the human circadian clock which regulates the timing of sleep. As Chief of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, and the Baldino Professor of Sleep Medicine at Harvard Medical School, Dr. Czeisler has conducted volumes of research on sleep’s impact on health and human behavior. His latest work focuses on college students, a cohort that he believes is most at-risk for the short and long-term effects of interrupted sleep patterns and sleep deprivation. This fall, students at a variety of colleges and universities will have the opportunity to take Sleep 101, an online course, developed by the Brigham Sleep Health Institute, in collaboration with Healthy Hours, on the importance of sleep in college. The course, with parallels to alcohol awareness and Title IX curriculum, educates students about the impact of their sleep habits on everything from their physical and mental health

to their grade point averages. His urgency to share his vast knowledge and recent findings underscores his concern that sleep deficit in young people is mistakenly, and dangerously, underappreciated. Mary Christie Quarterly: Why is this a critical time in the realm of sleep research? Charles Czeisler: There is this ironic circumstance occurring right now regarding sleep. As we learn more about the adverse health and safety consequences of sleep deficiency, people are suffering more and more sleep deprivation and circadian disruption than ever before. We really have a public education crisis on our hands. Technology is driving a lot of this: the artificially-lit phones and laptops, the 500 cable channels, the texting all night long. We’re now seeing disorders among students that were only experienced by night shift workers, and we know how detrimental those schedules are on health. For young people this is even worse.

One of the biggest awareness problems is the myth that young people are more resilient to sleep deprivation than older people, when in fact they are much more vulnerable to the adverse effects of sleep loss. And it’s not a small difference. Our research shows that a young person kept up all night will have 5 to 10 times as many lapses in attention as an older person. They really fall apart in terms of performance. MCQ: Why is this the case? CC: In younger people, the system in the brain which detects rising sleep pressure, and mediates the transition from wakefulness to sleep, is working at its best. This means that as sleep pressure rises, the brain can involuntarily initiate sleep. As we get older, this sleep “switch” often deteriorates to the point where it is more difficult for us to transition quickly to sleep. It therefore becomes easier for older people to stay awake – the opposite of what is the common assumption.

“One of the biggest awareness problems is the myth that young people are more resilient to sleep deprivation than older people, when in fact they are much more vulnerable to the adverse effects of sleep loss. ” - Dr. Charles Czeisler

To keep going in the face of sleep pressure, young people, college students in particular, take massive amounts of caffeine that block the receptor in the brain that indicates that you are sleepy. But caffeine does not fulfill any of the functions of sleep such as restoring energy, clearing the toxins from the brain or consolidating memory. MCQ: What has your research shown about sleep deprivation and sleep interruption in college students? CC: College students are a particularly vulnerable population when it comes to sleep deprivation, primarily due to shifts in their circadian rhythms (the physical, mental and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness). But this is little known. We think of college kids as not needing sleep, and they think of themselves this way, so much so that they feel like failures if they can’t function without sleep. The truth is, sleep deprivation and circadian disruption in college students can 09

create a downward spiral that leads to anxiety, depression, weight gain, and greater risk of a variety of health consequences and injury. Sleep is critical for learning and memory. As one of my colleagues likes to say “We’re working on a word document all day long and it is during sleep that we press “save.” It is when we move things from short-term memory to longterm memory so we can retrieve them. Sleep is also when we rehearse things, during the deep slowwave beginning stages of sleep; then we go into rapid eye movement (REM) sleep, which is the sleep stage associated with vivid dreaming. It is during REM sleep that we integrate the new memories we have just learned with everything we previously knew. That’s when we gain insight. Almost half of the REM sleep we will get occurs in the last quarter of the night, so timing of sleep is critical. You need to be able to sleep in a consolidated, undisturbed block. That

doesn’t happen when you’re waking yourself up to study for an exam or if you are interrupted by your roommate’s music. Consistency and timing have more impact than the number of hours. For example, if you get the same uninterrupted sleep every night, even if it’s six hours, your brain will adjust and preserve the REM sleep you need. But not if you’re sleeping till noon on weekends and napping in the afternoon, and then getting up at 4 a.m. on a Tuesday to work on a paper. Yet for many college students, inconsistency is the norm. MCQ: What are the consequences of this inconsistency? CC: That’s what our most recent research is all about. We studied sleep patterns among Harvard and MIT students, taking the 20 percent of students who had the most regular schedules and comparing them to the 20 percent who had the most irregular – people who stayed up all night, three or four times a week. The regular sleepers were mostly sleeping at night, which is good because our brain depends on the timing of the light/ dark cycle. If you have a regular schedule of light and dark exposure, your internal clock is in sync with your environment. If you have an irregular schedule, as many students do, your internal clock is set on average, about two and a half hours lat-

er which means they rarely get the higher quality “end-of-thenight” sleep their brains and bodies need. In addition, a 9 a.m. class will be occurring at the equivalent of 6 a.m. “brain time,” making it difficult for

students to pay attention in or perform well on tests.

What Students Are Saying About Sleep

a.m. Students who make it the whole 12 hours are rewarded with free IHOP.

By Ashira Morris

“It’s supposed to replicate the tech industry,” Waldorf said. “Everyone is bragging about not sleeping, but I felt less efficient.” Even outside the Hackathon, CS50 does not set students up for quality sleep. The office hours for the class run from 9 p.m. - midnight, meaning students often don’t start homework until after the office visit, pushing sleep into the pre-dawn hours.

After spending the semester learning the benefits of ample sleep (and the detriments of too little), the Harvard freshmen in Charles Czeisler’s seminar on the science of sleep weighed in on how the school could make systemic changes to improve their sleep habits. In their final proposals, many of the students suggested shifts in scheduling, whether for exams, office hours or homework deadlines. Others looked inward to adjust attitudes or pace themselves. Genevieve Waldorf, who just completed her first year in computer science, questioned the late night culture of in her major, best exemplified by the annual Hackathon organized around the final project in CS50, a prerequisite class The event runs from 7 p.m. - 7

Our research showed interesting and unfortunate consequences for the irregular sleepers, starting with lower grade

In her proposal, Waldorf’ suggests changing the office hour times to achieve a reverse snowball effect: students who start homework earlier, would get to bed earlier. She’s optimistic that Harvard would actually implement some of the changes the students proposed. “People here actually get things done,” she said. “And these small changes could have

point averages. The irregular schedules were also associated with much poorer scores on indexes related to mental health. We also found that the students who had the irregular schedules had higher rates of anxiety

a large impact.” The class also proposed changes to: Attitudes: “I think we need to increase our willingness to go to sleep without completing all of our work.” The Library: “Dim the lights, reduce the coffee, and paint the walls a less reflective white.” Exam times: “I wish professors would avoid early morning tests that are not in synch with most students’ circadian rhythm.” Work-loads: “We need more frequent deadlines in smaller loads. Why do problem sets have to all be due in one day?” Athletics: “Sleep is a competitive advantage. Teams that have to travel farther have less time for the work/sleep balance.”

Photos by John Gillooly

Dr. Charles Czeisler, a leading national expert on sleep, recently developed Sleep 101. The course will teach students the importance of getting a full nights rest in a similar style as alcohol education modules.

and depression. This was not unexpected, because we know that chronic sleep deficiency increases the risk for these disorders. For example, high school students who do not adhere to a regular bedtime have a higher rate of depression and suicidal ideation, as compared to those who do. MCQ: What about insomnia? CC: It’s all related. We are now seeing a significant percentage increase of young people being treated for depression, anxiety and sleeping disor11

ders. The high prevalence of insomnia in today’s students is absolutely unprecedented, but not that surprising, given what we know. If you have an irregular schedule, this is going to create insomnia. If your circadian rhythm is out of synch, so is the surge time, or “second wind,” associated with that, so that when you try to fall asleep, you can’t. If you’re tossing and turning because you can’t fall asleep and you have an exam in the morning, you are going to be a wreck. And it goes on from

there. To make matters worse, you go to the student health center and get sleeping pills, which can be the start of a dependency, while also doing nothing to reset your circadian rhythm. MCQ: What can colleges and universities do to address this problem? CC: I think everyone needs to acknowledge the dangers of an “all-nighter” culture that glorifies sleeplessness. Most schools have 24/7 food and coffee kiosks that serve energy drinks with 400 to 500 milli-

grams of caffeine. Meanwhile, 25 percent of college students say they regularly use Amphetamines as study aids so they can stay awake. Structural changes can help. One of my students, a college athlete, said he appreciated the need for better sleep, but said his schedule just won’t allow it. His coach schedules off-season gym sessions at 5:15 in the morning so the players have time to work out before class. Another said that the only time the computer lab is regularly available for team projects was between 1:00 and 4:00 a.m. If we don’t address these institutional problems, we are fostering an environment that is harming our students’ health and their academic performance. It’s like providing alcohol at toll booths. Education can be our number one asset when it comes to fighting sleep deprivation on campus, but we aren’t yet seeing enough of it. That’s why we developed Sleep 101 specifically for college students. When we were doing the research on college sleep patterns, I was shocked by how irregular some of these kids’ schedules were. When we began to show the correlation to poor performance and mental health, we said, “We need to

convey this information to the students.” Through a donation by Mary Ann and Stanley Snider, we were able to develop a pre-ma-

MCQ: Are you hopeful that things will change on campus in regards to the sleep culture? CC:

The more information

“Upper class students ask me, “Why didn’t anyone tell us about this when we started college?” - Dr. Charles Czeisler

triculation, interactive education module on the importance of sleep at college. Sleep 101 provides basic information about the benefits of sleep and the real dangers of poor sleep habits both at school and throughout life. We are also including the ability to track sleep and wakefulness patterns and receive feedback.

about the benefits of sleep, the better the chances are that kids will start to reverse these patterns. When upper class students learned how detrimental it was to lose and disrupt sleep, they asked me, “Why didn’t anyone tell us about this when we started college?” In the reverse, I like to tell my students, “Think of sleep as your secret weapon.”

For more information on Sleep 101, email sleep101@partners.org or call 617-732-4800.

Opinion: A Prescription for Opioid Abuse Nation’s most comprehensive opioid addiction bill holds lessons for colleges and universities By Maura Healey and Ellen Zane For college administrators and health directors, this legislation can serve as a blueprint for combatting student addiction.

Massachusetts Attorney General Maura Healey (L) and CEO Emeritus of Tufts Medical Center Ellen Zane (R).

THE opioid addiction ep- all communities must address,

idemic is a public health and public safety crisis of equal opportunity. Across the nation, the impact of addiction to heroin, fentanyl, and prescription opioids has led to devastating health and social consequences for communities and families in Massachusetts and across the country. Addiction is a disease that does not discriminate, and has cut short the promising futures of college students and athletes who did not know the risks associated with painkillers. Opioid addiction is an urgent problem that 13

including our communities of higher learning. To tackle this epidemic, Massachusetts has responded with an “all-hands-on-deck” effort involving legislators, health care professionals, community leaders, families, addiction experts, pain advocates, treatment providers, and policymakers at every level. As a result, the state recently passed a trailblazing law that addresses substance use, treatment, education, and prevention of opioid addiction.

The overprescribing of painkillers, combined with a lack of awareness of their dangers on the part of both prescribers and patients, has led to a national addiction epidemic, and nearly 30,000 opioid overdose-related fatalities in the United States annually. We need to get the word out — especially to young people — about the dangers of drugs and the risks of prescription medication. Too many people aren’t aware of the risks, including the fact that four out of five heroin users started with prescription drugs, and 90 percent of all adults with dependence started using under the age of 18, half under the age of 15. According to a recent survey of college-aged youth (conducted by the Mary Christie Foundation and Hazelden Betty Ford Institute for Recovery Advocacy), 60 percent of

respondents thought prescription pain medicine was less risky than heroin. Almost 16 percent reported having used painkillers not prescribed to them, a number that rose even higher (22.2 percent) among those who are or were in intercollegiate sports. Nearly half (49.5 percent) said painkillers were “easy” to acquire, and could get them within 24 hours. Forty percent of respondents said they would not know where to go for help if they, or someone they know, experienced an overdose. The opioid legislation enacted by Massachusetts does some very important things to get at the problem. It requires prescribers to check the Prescription Monitoring Program (PMP) every time they write a prescription for an opioid. We know, from other states, that mandatory PMP checking reduces opioid prescriptions and doctor shopping. It is time well spent. A similar measure in New York produced a 75 percent drop in patients who were seeing multiple prescribers to obtain the same drugs, which would put them at higher risk of overdose. Prescribers will undergo enhanced training around opioids, and for the first time, they’ll learn how their prescribing rates compare to those of their colleagues, and be notified when they are above average. It also requires doctors and pharmacists to inform

patients about the dangers of opioid addiction when a drug is prescribed. Additionally, the law put a limit on first-time opioid prescriptions, which will cut back on the number of pills in our medicine cabinets and at kid’s parties. And the act includes critical provisions aimed at informing young people, parents, and patients about the risks of prescription painkillers, and requires that education about opioid addiction be incorporated into annual high school sports training and driver education.

prescribe low doses and small quantities. The need for education and enhanced awareness, they say, is also a problem, citing the little-known fact that physical dependence on opioids can happen in a matter of days. According to the University of Maryland’s College Life Study, non-medical prescription drug use does not occur in isolation. In addition to having devastating health consequences, drug use and combined substance abuse undermine academic performance and drive up college drop-out rates. Our role in ensuring the health and

“Opioid addiction is an urgent problem that all communities must address, including our communities of higher learning.” - Maura Healey and Ellen Zane For colleges and universities, education about the dangers of opioids should clearly be a higher priority, given what’s at stake. In the most recent NCAA survey, 23 percent of college athletes reported receiving prescription pain medication. In their article, “Cautious Opioid Prescribing for College Athletes,” Drs. Victor Schwartz and Andrew Kolodny note that athletes who are at high risk for acute pain from injury are also at risk for opioid addiction. Schwartz and Kolodny advise college physicians to avoid opioids whenever possible, or

education of young adults is as essential as the content we provide in the classroom. We must remove barriers so students know the risks associated with painkillers, and have a clear path to addiction treatment and recovery. Maura Healey is the Attorney General of Massachusetts. Ellen Zane is the CEO Emeritus of Tufts Medical Center, Boston, MA and a member of the Council of Experts for the Mary Christie Foundation. 14

A Difficult Passage Supporting the unique health needs of community college students By Derri Shtasel MD, MPH

OF all of the initiatives aimed at closing America’s

opportunity gap, one of the most reliable is — or should be — public higher education. Having established a community college system with an open door admissions policy

and subsidized tuition, our country should be recording high graduation rates and producing the large number of skilled workers our knowledge economy demands. Sadly, we are not.

Only about 39 percent of students who enter the country’s most accessible institutions of higher learning will graduate within six years. At a time when even lower wage jobs require some form of secondary degree, we must explore ways

to help community college students overcome barriers to completion.

neighborhood safety, medical problems, and poverty are significant degree deterrents.

The variables that impact degree completion for the 13 million students for which full-time, four-year college is not a choice or an option are numerous. Many of these factors are the very same that skew the sociodemographic composition of community college students to begin with: those associated with income, social circumstances, and discrimination. In health care, we refer to these as the “social determinants of health.”

While much has been reported about the financial and social challenges of community

The World Health Organization defines the social determinants of health as “the conditions in which people are born, grow, live, work and age.” These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Perhaps not surprisingly, the social determinants of health are largely responsible for health inequities. For many community colleges students, housing, food, child-care,

was foundational to the community health center movement holds valuable lessons for supporting community college students throughout their academic trajectory.

“For many community colleges students, housing, food, child-care, neighborhood safety, medical problems, and poverty are significant degree deterrents.” - Dr. Derri Shtasel college students, there are few rigorous studies that describe the ways in which these health critical/non-medical factors impact their mental and behavioral health — which is to say, how associated health issues impact their degree completion and, ultimately, how better supporting the emotional and behavioral health needs of these students holds enormous promise for all stakeholders. As a psychiatrist and a community health care advocate, I believe a multi-dimensional, socially-informed public health approach that

High Stakes for all Nearly half (46 percent) of all American undergraduates are community college students, an increase that grew, in part, from the great recession of the late 2000s. Of all Hispanic undergraduates, 57 percent are attending community college, as are 52 percent of all Black undergraduates. This degree path is either a stepping stone or an end goal for the majority of all college students of color. For those of us working to turn the tide of racial inequity in this country, access and completion of higher education is the social justice issue of our time. 16

The profiles of community college students range widely, from “not-quite-ready-for-college” teenagers and cost-conscious degree seekers to workers struggling to increase their wages and young adults on their own looking for a ladder up. Community college systems also vary greatly, with some schools, particularly in the Southwest and Southeast, rivaling private, four-year institutions in course offerings and campus settings. Many community college students share profiles with their four-year peers but, in the aggregate, the average community college student is “non-traditional” – older than 24, of lower income, and with other competing priorities such as jobs, children, and/or dependent families. For these students, community college holds the promise of a skilled job, a higher wage, and a better life. For employers, community and vocational colleges are the pipeline for 17

skill-ready workers who can fill the jobs left by the aging baby boomer generation. Greater Need, Fewer Resources According to the American College Health Association, the prevalence (and/or reporting) of mental illness on all colleges campuses in this country has never been higher, prompting administrators and college health professionals to consider new strategies to support students as they navigate the stresses of their journey through to graduation. While there are less data available on the mental health needs specific to community college students, researchers found higher rates of some psychiatric disorders in minority college students in “Mental Health in American Colleges and Universities: Variation Across Student Subgroups and Across Campuses.” The authors of this study also

emphasize the risk factors associated with students of lower income, noting “current and past financial struggles were generally associated with a higher risk for mental health problems including anxiety and depression.” According to the Psychiatric Services study “Factors Affecting Mental Health Service Utilization Among California Public College and University Students,” which was conducted at 39 California colleges and universities (both four-year and two-year schools), “19 percent of students reported current psychological distress in the past 30 days, and 11 percent reported significant mental health-related academic impairment in the past year.” The study also found students on campuses with a formal network of mental health clinics were more likely than students at community colleges to receive mental health services. It also noted that for students who do not receive treatment, mental health problems are likely to persist, resulting in lower academic achievement and graduation rates, higher

substance misuse rates, greater social impairment, and lower post graduate workforce participation and income. In “Too Distressed to Learn? Mental Health Conditions among Community College Students,” Sara Goldrick-Rab makes the case that the stu-

and housing insecurity, are more likely to attend a community college rather than a four-year college or university. Thus, community colleges have fewer resources along with a student population with higher needs, which may contribute to low graduation rates.”

significantly over the last ten years that institutions like his, which had phased our mental health services, are slowly reestablishing them. “It’s the nature of community colleges, because we’re open door institutions, to accept and provide services to a greater

Students who most need mental health services are least likely to utilize them — and, unfortunately, least likely to have them available.

dents who most need mental health services are least likely to utilize them — and, unfortunately, least likely to have them available. In her report, she found that 58 percent of four-year colleges and universities have on-site psychiatric facilities appropriate for treating mental illness, compared to just 8 percent of community colleges. Further, she notes “students with multiple factors for poor mental health, such as food

While additional data could add to the scientific argument, many on the ground wholeheartedly agree with the paradox. Lane Glenn is the President of North Essex Community College in Haverhill and Lawrence, Mass, areas north of Boston known as “gateway cities” for their large number of immigrant populations. He says challenges in the mental health area have grown so

range of students – low-income, veterans, first generation Americans, but also students who are less prepared for the academic experience, students with disabilities, and students facing numerous basic life challenges.” Community Solutions Increasing social service and mental health resources at community colleges is undoubtedly part of the solution to addressing the high demand for these services at two-year 18

schools. But trends in public higher-ed financing overall signal that this can’t be the only approach. Innovative, collaborative efforts to addressing these social determinants of health are emerging on community college campuses throughout the country. Triage-like services such as Single Stop, a program dedicated to helping students navigate

The Psychiatric Services study found that while community college students remained significantly less likely to receive [on-site] mental health services compared to their four-year peers, there was substantial use of off-campus services among this group, possibly because community college students predominantly reside off campus and have easier access to community services or because

“For community college students, the community is their campus and their home. Community health centers are a natural venue for their health and mental health.” - Dr. Derri Shtasel money and housing problems at a community college in New York City, is one example. And community organizations like Health Care for All, a non-profit organization connecting students to affordable health care coverage, are becoming more prevalent. Access and utilization of mental health services remains challenging.

of the absence of a formal system of mental health services on community college campuses. In either case, their findings underscore for colleges and universities the importance of developing solid collaborative relationships with community-based organizations that can help students when they need it. “Having a network of community partners is key,” said Lane

Glenn. “But it needs to be a real partnership. When it’s just a staff member handing a phone number to a student, they rarely do it. But when it’s one of our folks making the connection with someone we know in the community, they are more likely to follow through.” Community health centers (CHCs) may be natural clinical partners for community colleges. Founded in Massachusetts in 1965, the federally funded community health center system provides affordable, accessible, and coordinated care for underserved communities throughout the country. They are responsive to the social needs of their patients, and understand the complexities of improving health in their communities. Their model of care has always been patient-centered. Increasingly, CHC’s have moved forward on integrating primary care and behavioral health care, building on an infrastructure informed by the social, linguistic and cultural needs of their patients. While focused on chronic disease management, they embrace public

health principles, with a goal of disease-prevention and wellness-promotion. “We propose that formal clinical relationships between community colleges and community health centers are an untapped opportunity meriting broad consideration,” says James Hunt, the President and CEO of the Massachusetts League of Community Health Centers. “Health centers nationwide are the key to providing high quality community-based health care in our country. While there have always been relationships between Community Health Centers and Community Colleges around workforce development, the idea of creating formal linkages that are focused on clinical care is intriguing — it could be a win-win. CHCs are the right place for these students, and identifying their medical and behavioral health problems at early stages, and engaging them early in health-promoting behaviors — in the context of their real lives and neighborhoods — has promise.”

Alex Keuroghlian, MD, MSc, a psychiatrist and Fellow at the Kraft Center for Community Health Leadership is keenly aware of the mental health needs of minority populations. He believes that addressing structural risk factors (unstable housing, food insecurity, gender discrimination) is integral to providing comprehensive mental health care.

care, address social need and help students move towards wellness.

“We need partnerships in place to make it easier for people who are struggling on multiple fronts — and we need providers who understand the interplay between social and clinical needs.”

Derri Shtasel, MD, MPH, is the Executive Director of the Kraft Center for Community Health Leadership. She has worked on the academic-community interface for the past 30 years and is deeply committed to providing access and care for underserved populations. Dr. Shtasel is also the Director of the Division of Public and Community Psychiatry at Massachusetts General Hospital and an Associate Professor of Psychiatry at the Harvard Medical School. She is a recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness.

For community college students, the community is their campus and their home. Community health centers are a natural venue for their health and mental health care as well. Now serving 24 million people nationwide, this health delivery infrastructure is likely proximate to many community colleges and equipped to provide clinical

It is time we dedicate thought and resources to support community colleges and local health centers, develop such partnerships, and determine the necessary ingredients for success. Our non-traditional students deserve nothing less.

Opinion: Mental Health is a Campus-Wide Collaboration How better alignment of stakeholders on campus can help students in need By Amelia Arria, PhD

to detect early issues — and to intervene in innovative ways to maximize student potential.

Photo by Amelia Arria

FOR public health professionals, college students have

always presented a paradox. Many students of traditional college age enjoy good health and advantages, which, in theory, make them less deserving of examination. But college is also a time of new-found freedom and exposure to a wide variety of social experiences, 21

making young adulthood the peak developmental period for the onset of mental health and substance use disorders. What happens during college can change the trajectory of a student’s life. Because student health and academic potential are intertwined, college campuses are opportune settings

My goal, as the Director of the Center for Young Adult Health and Development at the University of Maryland School of Public Health, is to use the language of academia – science – to encourage higher education leaders to expand their view of how to help students fulfill their promise. Much of our research focuses on all of the things that can get in the way of that promise, particularly substance use and untreated mental illness. The high rates of self-reported feelings of anxiety and depression among college students are well known. We also know that many students are unaware of the kinds of services available to them, and struggle either because they think they can handle things on their own, or because seeking help is perceived as a weakness. We are now learn-

ing how much these factors act as barriers to academic success and college completion. Our research has focused on the extent to which college-aged depression diagnoses and substance use are associated with academic problems and interruptions in college enrollment. Interestingly, in one study, we found that students entering college with a pre-existing diagnosis of depression weren’t necessarily at any greater risk of enrollment interruptions than individuals without depression. These findings hit home in higher education, where completion rates and GPAs are important differentiators. We also know that most students who drink alcohol excessively, use marijuana, and take prescription drugs nonmedically tend to overestimate the prevalence of these behaviors, and view them as a “rite of passage” of young adulthood. Drugs affect not only learning, memory and attention – all of which are important for academic success — but also motivation. As neuroscientists will attest, drug use hijacks reward pathways in the brain, making academic pursuits take a backseat to immediate gratification. Put

side by side, the instant rewards you get from drugs is more powerful than a scenario where you study hard, do well in your economics class, and eventually end up with a good job. As drug use becomes more severe, academic pursuits become even less valued. Certainly, academic potential is much more than GPA. It encompasses resourcefulness, communication skills, knowledge acquisition, and creativity. It requires that students be cognitively strong and mindful – and have a sharpness of focus which is difficult in today’s world where students are bombarded with competing stimuli. It also requires that students

The college years provide an unprecedented opportunity to address these issues in an environment where every stakeholder is invested in seeing students succeed. Through their settings, resources and focus, colleges can embrace holistic health in a way that can better support the growing number of students who need help. Unfortunately, structural and cultural dynamics within the institutions themselves are preventing this from happening in many schools. Part of the problem has to do with administrative silos. When students struggle academically, they often go to an academic or learning assistance center run by Academ-

“Through their settings, resources and focus, colleges can embrace holistic health in a way that can better support the growing number of students who need help.” - Dr. Amelia Arria have the resilience or “grit” to pick themselves up after failure, and the ability to seek and elicit help from trusted sources. Defining potential in these ways, it is easy to see how substance use and untreated mental health conditions can impede student achievement.

ic Affairs. Students with health or substance abuse issues go to health centers or counseling centers run by Student Affairs. Rarely do these professional teams collaborate, despite the fact that both research and experience tell us that one impacts the other.

Mental health and substance abuse issues are treatable and preventable barriers to academic success, ones that academic professionals can be trained to identify and address. What if students who were struggling academically were screened for substance abuse and/or mental health problems by academic counselors/advisors in a way that was routine, non-judgmental and confidential? While co-locating services would be ideal, at the very least, academic counselors could use simple screening tools and make a referral to an appropriate place on campus for further assessment and intervention. One school I worked with asked questions of students about substance use on a white board that was then wiped clean after the interview.

monly than evidence-based approaches.

What if those counselors were able to help students understand how much more fulfilling their learning experience would be if they weren’t high or hungover — in essence illustrating the discrepancy between what they want out of a college education, and what they’re getting? This strategy has much more promise for changing behavior than “education-only” approaches, where students are educated about the dangers of substance use. Unfortunately, substance-use education is still being used more com-

resources are an issue, the logical answer involves reaching beyond university walls and engaging with professionals that are trained to deal with this age group and their unique needs. It doesn’t add personnel or resources. It simply makes an adjustment in the roadmap students need to get help.

Another reason we might not be seeing widespread screening and coordination is that asking the questions means being prepared to receive the answers. Despite the known need, many schools aren’t equipped to effectively manage and carefully monitor students with substance abuse or mental health problems. In my view, when

Parents can be part of the solution as well by putting pressure on colleges and universities to be more equipped to deal with holistic health issues on campus. They are entrusting their

grown children to these institutions and, in return, they need information about how well the institutions are attending to their health and emotional well-being. And students themselves ought to be more thoughtful and self-aware about the reasons they are in college. This “participant responsibility” can help prevent risk behaviors and lead more students to ask for help. Finally, one of the best ways to help students is creating an environment where the positive rewards of college replace the powerful and immediate ones that come from alcohol and drugs. College presidents should be careful not to “over-vocationalize” the college experience as a means to a job, and instead look for ways to build community. This will reveal to students the built-in joys that exist on campus — service opportunities, research and intellectual discovery — as well as encountering people of different cultures and points of view. Amelia M. Arria, Ph.D. is currently the Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health and an Associate Professor with the Department of Behavioral and Community Health.

Q&A: Cyekeia Lee As the Director of Higher Education Initiatives for NEAHCY, Cyekeia Lee is dedicated to helping homeless students graduate from college Interviewed By Marjorie Malpiede When Cyekeia Lee first learned about the National Association for the Education of Homeless Children and Youth (NAEHCY), it was to gain more knowledge in supporting homeless college students at the university where she worked. At the time, NAEHCY had a volunteer Higher Education Services Committee, but no one staff member dedicated to working with homeless college students. With a Masters in Counseling and a background in financial aid, Lee would later become NAEHCY’s first Director of Higher Education Initiatives. It was a case of “right person/ unprecedented need” when she took on NAEHCY’s effort to build a state-by-state support network for the growing number of homeless students struggling to obtain their college degrees. More than 58,000 college students identified as homeless on the Free Application for Federal Financial Aid in for the 20122013 academic year. And that is only the number that received a homeless status determination from a shelter, school district, liaison, or financial aid administrator. Many others, who sleep

in cars or on friend’s couches, are unofficially and periodically homeless. Lee knows this population well. She’s worked with foster kids and runaways. She knows of their trauma and their resilience. What she would soon learn is how much more is needed to support these kids in their college journey. Lee’s personal and professional mission is to see these students (and many more behind them, given the increase in homeless elementary students) get into college and stick with it, despite their seemingly insurmountable odds. What keeps her focused is their will, despite their circumstances, to better themselves through education. Mary Christie Quarterly: When you think of college students, you don’t think of homelessness. Is that part of the problem? Cyekeia Lee: Yes. People often have a hard time grasping what homelessness looks like and what the new face of homelessness is. If you say the word “homeless,” you instantly

have an image that pops up in your mind — the elderly man or woman on a bench in multiple coats, pushing a grocery cart. I think that’s what a lot of us imagine. It doesn’t trickle down that it’s young people who look just like everyone else. They’re in their yoga pants or jogging suits, they’re clean, they have a book bag. I always tell people to look out the window at their own college campus and you will see there are homeless students out there. It doesn’t go with a certain gender or race or age. MCQ: Why are we seeing an increase in homeless students? CL: There are many ways that students can become homeless. It could be fleeing abuse, neglect, or domestic violence at home. A lot of the students we work with have gone through horror stories. A lot of kids are aging out of foster care. It’s also not just low-income folks. We have some people from middle-income families, 24

but then mom had a drug addiction, and that caused everything to spiral and go downhill from there. The economy also plays a big role. There are 1.3 million children identified as homeless in the K-12 system — that’s a 100 percent increase since the recession. Some of those students who were younger at that time are now crossing into higher education. Families lost homes, people lost jobs, parents got divorced, and kids got caught up in all that. However, some of these families have lived in dire circumstances for generations. The

recession has certainly played into it, but there are so many students whose families never had a home to lose to begin with. MCQ: How does NAEHCY go about supporting homeless college students? CL: My goal is to see these students succeed in getting into school and graduating with their goals met. The process starts well before that. We get an annual report from the department of education, and we look at places that have the states that have the highest number of homeless students. These are students who have

checked the box on their FAFSA or the states that have the highest number of homeless children in secondary school. I start by looking at the K-12 system, the state coordinators for homeless children and youth, and then the school district McKinney-Vento [The McKinney-Vento Education of Homeless Children and Youth Assistance Act] liaisons who work with homeless students. What I really want to do is catch those students before they get on to higher ed, before it’s a little too late, in my opinion. Sometimes you’ll have a college sophomore who never received services on the k-12

Photos by John Gillooly

Cyekeia Lee works to connect state coordinators for youth homelessness and college administrators to provide homeless students with the services they need. 25

ladder because they were never identified or didn’t have the hand-holding they needed. I can’t tell you how many times I talk to students and they’ll say, ‘I never told anybody this,’ they just never had the courage. And I’m thinking, you missed out on free lunch, you missed out on transportation, you missed out on having clothing. You could’ve still been on the basketball team and got transportation to and from practice and the games or for tutoring. They miss out on so much and then they’re really trying to figure it out on their own. So we’re looking at the wide spectrum and trying to think, How do we address this all across the board? So I start there. That’s when I say, ‘Okay, if there’s a state department of education, let’s reach out to them,’ or ‘Let’s go ahead and start looking at the universities and who the state coordinator for homeless children and youth already works with in that state.’ I know we want to work with Wayne State University in Detroit, Michigan, what are the other direct services and supports already on campus? Who is already talking to these students? Who may already be on food assistance or may already be in a shelter? Then we ask: Who is still missing from the table? Do we need to invite others who provide resources and services to children and youth? Do we

need someone from the shelter across the street? Do we need policy makers? The students themselves? We know as adults what we want for these young people, but what do they want? One of the first areas we look at is how to navigate the admissions and financial aid process. Many of these students have

Or it may be a higher education professional calling to say, ‘Hey, I’ve got a homeless student in the office and I really don’t know what to do. Can you tell me how to process a determination of this student’s homeless status, or help me connect the student to a homeless shelter or food bank?’

“It’s young people who look just like everyone else. They’re in their yoga pants or jogging suits, they’re clean, they have a book bag.” - Cyekeia Lee worked hard to graduate high school. They’re being told they need a degree to get a better job. They have the will to go, but they have a lot of barriers in the way starting with paperwork and access, particularly around financial aid. Once they are there, there are supports, but they need to know how to get them. They may have a question about aid or academic advising or their health, and they’re making phone calls all around the place. MCQ: Tell us about your helpline. CL: The helpline was put in place to support students who may have questions like, ‘How do I complete the FAFSA? I don’t have parents, I don’t know what the correct answer is when they ask about taxes.’

With the helpline, people can call, they can email, and now they can even text to get assistance. MCQ: What can colleges and universities do better? CL: A lot of it is about educating the campus so that they can create a culture to be more supportive of these students, and students with food insecurity as well. Colleges need to recognize that these students exist on their campus and know that they’re only going to get more of them. This isn’t a challenge that’s going away. The homeless numbers are not going to go down. I always tell administrators, if you think you only have one student in this situation right now, as the years go by and we continue impressing the need for college upon students, those

numbers are only going to increase. One thing that campuses can do is have a supportive college administrator who is the single point of contact for homeless students. Part of what we’re asking for in legislation is for people to identify that person, and for the government to say that colleges and universities need to have this resource on campus. Schools should also look at what resources are already on their campuses. Some may already have dorms that they can extend to year-round housing or a food bank that they can connect students to. So it’s not only implementing that point of contact. It’s also looking at what you have on your campus and what’s missing. MCQ: What about mental health? CL: This is a really big issue for these students. People do not realize the amount of trauma some of these students have experienced. Some schools are great at it. They get it, down to the tone in their voice, they know about resources. In other places, the people these students interact with have no clue how to deal with mental health issues. So it’s hit or miss. That’s why the point of contact is so important, whether it’s a social 27

worker or someone who has worked at a nonprofit that focused on domestic violence, who knows how to work with these students and connect them to resources. We have a long way to go; some people just don’t understand when students feel guilty that they have a meal plan, but their siblings don’t have anything to eat. Some people just don’t know what to say or what to do. MCQ: What can the government do? CL: I would say that we don’t have the necessary weight on the government that we should have. We’ve been working with [ Wa s h i n g ton] Senator Patty Murray’s staff on the Increase Access to Higher Education for Homeless and Foster Youth legislation. It’s calling on schools to have stronger systems in place to put housing plans together for homeless students. It doesn’t mean paying for it or necessarily keeping the dorms open, but just looking at all possibilities on and off campus. Another part of this legislation, when it passes, would be the government saying that colleges need to have that point person on campus I mentioned to coordinate services for

homeless students. It was recently re-introduced and we’re hopeful, but sometimes things move slowly. MCQ: What do you think keeps these student going? CL: These students are the most resilient group of students I’ve ever worked with. Some of them have slept in their car in the winter in Boston or Detroit. When you can battle that storm, everything else that comes your way becomes a little bit easier. Five students that I’ve mentored have experienced homelessness, and all of them have a master’s degree under 25. All those closed doors really drive them to move forward. It is really important to remember that these are the students that are so responsive to encouragement from teachers. It’s that second-grade teacher who tells them they’re talented or that sixth grade teacher who encourages them to think about college. For assistance with issues related to students experiencing homelessness accessing higher education, you can contact the NAEHCY Higher Education Helpline by calling 1 (855) 446-2673 (toll-free), emailing highered@naehcy.org or texting “NAEHCY” to 335577.

College, Interrupted Dropping out and making it back in with a mental illness

By Ashira Morris RACHEL* was anxious, cried frequently. Every day felt on Young Adult Health and De-

uncomfortably anxious, in the spring of 2008. Her parents and teachers reassured her that it was just nerves about going to college that fall; she was certain that it was something more.

At the time, everything was already in motion for her to leave for school in late August. She asked her parents to take her to a therapist, who said the same thing: her stress was tied to the upcoming milestone of leaving home and going off to college. She’d be fine once she was settled on campus, her mother promised. Once she moved into her freshman dorm, things did not get better. She didn’t feel a sense of belonging at her new school, and her anxiety escalated. By October, she was certain she wanted to transfer out, but her parents encouraged her to stay. Throughout fall semester, she poured her energy into classes, earning straight A’s. Spring semester was worse. She slept all day, missed class,

worse than the one before. In February, she called her parents. “I can’t do this anymore. I’m going to commit suicide up here,” she told them.

Her parents came the next day. They took her home, and she withdrew on medical leave for the semester with no intention of going back. “I didn’t want to die,” she said. “But I didn’t know any other way to express what I was going through. I couldn’t keep living like that, and I didn’t know what to do.” Every year, more than 60 percent of students who leave college campuses do so because of a mental health condition. (The other fraction of the pie is mostly rounded out by students struggling with the financial burden of a university education.) Students who experience depressive symptoms on campus are at risk of taking time away from classes or dropping out, confirms a study by the Center

*Name has been changed to protect the subject’s identity.

velopment. In “Discontinuous College Enrollment: Associations With Substance Use and Mental Health,” researchers also found that students entering college with a diagnosis of a mental health condition fared better than those with untreated difficulties, as they were already comfortable seeking out therapy and had a vocabulary to talk about their depression or anxiety when it reared up. Expressing her depression and anxiety earlier in high school might have helped Rachel with the college transition, but she didn’t understand what was wrong or how to fully express what she was feeling. “My anxiety didn’t get in the way of my school work or my sports,” she said. “But I kept saying ‘There’s something in my head that’s not right.’” For young adults like Rachel, college is often the tipping point. “When you start college, you have all this freedom, all this 28

Photos by Alex Jones

opportunity,” said Darcy Gruttadaro, the director of the National Alliance for Mental Illness’s Child and Adolescent Action Center, (NAMI). “And then you start to experience something new, scary, devastating. It’s true of any chronic condition, but especially mental health because of the myths around it. People feel like, ‘Why me?’ The people who come to college with diagnosis have already grappled with it, accepted it, and received support. But when you’re new to the whole college experience, then you throw in a mental health con-

dition, having to deal with that along with all the other new factors is a lot.” As more people who have mental health conditions are going to college, and still others are experiencing the onset once they arrive, administrations are grappling with the best practices to support these students on campus and, ultimately, through to graduation. In a five-year national study, one-third of students who left college during their first year never returned; of those who

did return, only 17 percent earned a bachelor’s degree. Completion is a near-universal goal. For college administrators, it’s a marker of their school’s success. For students, a diploma is a marker of personal success and, often, the gateway to a better job. There isn’t a clear path to this goal, however. It’s widely acknowledged that providing counseling services on campus is helpful, but there is no guarantee that students will seek out those services. In fact, ac-

cording to a national survey by NAMI, half of the students who leave campus for mental health reasons never access any campus counseling services. For Rachel and students like her, the stigma surrounding mental illness is a barrier to seeking help. “I think college kids are shameful about using those services,” she said. “The assumption is, you’re going to college, you’re going to meet cool people, booze your face off and then graduate. If you’re not having fun, you’re like, ‘What am I doing wrong?’” College enjoys a reputation of being the best years of your life, setting an expectation that doesn’t leave space for coping with depression or anxiety. Even if the national dialogue about mental health has reached a student’s own campus in a useful way, personally admitting that you need to see a counselor can be difficult. Overcoming the stigma around seeking help for mental health issues is one of Gruttadaro’s top priorities at NAMI. But

she’s also aware of the tricky politics of allowing students the autonomy to take care of their health, studies, and social life while ensuring they aren’t at risk of harming themselves or the broader community. Much of the controversy around how to strike this balance plays out in the rules for leaving and reentering school because of mental illness. “It’s fair for schools to say that they want you well enough to return to campus, but they also don’t want to be overly intrusive into people’s lives,” she said. “If schools maintain punitive policies, it really discourages students from coming forward.”

chiatric Services when they decide that they want to take time away from school for mental health reasons. In these cases, the students fill out paperwork to take a semester off campus to reach a better place with their mental health. But not all students who leave do so on their own volition: there are times when campus administrators remove students who they think are at risk of harming themselves or others. In either situation, the conditions for return can become complicated. Some schools completely bar the students from campus during their time away, often with the require-

“I think college kids are shameful about using [mental health] services. . .if you’re not having fun, you’re like, ‘What am I doing wrong?’ ” - Rachel Some students may already be seeing a counselor on campus or have scheduled an appointment with Counseling and Psy-

ment that they prove completion of medical treatment, a certain amount of time without symptoms, or other assess30

ments, before being allowed back on school grounds. Others mandate therapy and counseling with regular check-ins with the campus counseling center. At the University of Georgia, where students who attempt suicide are not allowed on campus for a probationary period, students have spoken out about feeling pushed out by the school. At Columbia University, students have been critical of the school’s drawn-out process for readmitting students who have taken a semester off for mental health reasons.

Even schools that have responded effectively to the mental health needs of their students still struggle with striking the right balance between keeping students safe and allowing them autonomy. In 2004, a straight-A sophomore at George Washington Univer31

sity voluntarily admitted himself to the hospital when he felt that coping alone with his depression after a friend’s suicide wasn’t healthy. While in the hospital, he received notice that he was barred from campus for exhibiting “dangerous behavior.” Instead of jumping through the various administrative hoops to regain his status as a student at GW, he chose to drop out and complete his studies at the University of Maryland. In response, the Bazelon Center, a DC-based organization that advocates for the legal rights of people with mental illnesses, filed a claim on his behalf and won the case. Afterwards, the university rewrote policies and procedures to help students work through mental health issues on campus. A decade later, in the spring of 2014, three students committed suicide on the school’s Mt. Vernon campus. The university reexamined its policies and decided to redesign its mental health supports, consolidating all of the mental health services all into a single building and adding peer support services.

In the absence of national guidelines around services for mental health on campus, the Bazelon Center has created a model policy for colleges. Among the key policies are acknowledging mental health problems without stigmatizing them, allowing flexible amounts of leave time, and permitting students on voluntary leave to visit campus friends and attend school events. “Too often colleges and universities lack a comprehensive plan for addressing such situations, or respond to these students in punitive ways, requiring them to leave or evicting them from university housing,” the guide states in its opening. No path through mental health challenges is identical, and forward-thinking universities are changing their policies to reflect this insight. Some students experience slow but steady improvement, some progress and fall back intermittently, and some worsen further before heading toward wellness. When Rachel returned home from college, her depression deepened. She lost 20 pounds

and passed her days alternately sleeping and crying. “I felt completely out of control,” she said. “I just felt like I was losing my mind and nothing was going to make it better.” Her mom struggled to support her by suggesting activities, but for Rachel, this only made things worse. “My mom didn’t understand that going to the mall wasn’t going to make me feel better,” she said. A few weeks into being home, she was deeply suicidal again. Her parents took her to the psychiatric ward at the hospital. “I knew I didn’t want to kill myself, but I had to be there,” she said. “So again, I felt very trapped.” After five days of group therapy and a blur of other activities, she was able to go home. Rachel found a therapist she connected with and began see-

ing her regularly. Soon, she started applying to colleges and was admitted to a number of schools. She didn’t want to go back to where she had been, but she knew she wanted to be on a campus. She chose a small, liberal arts college not far from home, and started over. “I was scared,” she said. “I had just had the worst three months of my life and now I was in a new place where I didn’t know anyone. I thought, ‘I’ve been in a psych ward. Are people going to think I’m weird?’ ” By the time she arrived on campus, Rachel had been seeing her therapist regularly and felt more prepared to recognize and manage her depression. Her perseverance and optimism, which were forced at first, have become her signature qualities. She made friends with a group of non-judgemental young women who,

Even schools that respond effectively to the mental health needs of their students struggle with striking the right balance between keeping students safe and allowing them autonomy.

eight years later, continue to support one another. “For people my age, friends are huge,” she said. Rachel was one of the small percentage of interrupted students who do make it to graduation. She got her degree in four years, despite missing a semester. She recently earned her Masters in Criminal Justice, a two-year program that she completed in one, and continues to manage her depression. She believes the best thing colleges can do to support students with mental health is to reduce the stigma associated with it, though she is quick to dismiss formal gestures like posters on campus. Instead, she says, we need to normalize mental health by talking about it. “I try to talk about it a lot. I don’t try to hide it. I think this makes it easier for people who have never experienced mental illness to know that it happens. I’m like, ‘Here’s me.’ I have things that are good about me and things that I struggle with. It doesn’t have to be weird or uncomfortable for anyone else.” 32

Huffington Commencement Advice: Rest The media mogul urged Tufts Fletcher School of Law and Diplomacy graduates to take time to recharge By Marjorie Malpiede young people who will become our next generation of leaders. She admonished political figures from Alexander Hamilton to Bill Clinton to Ted Cruz for glorifying the sacrifices they made putting work over sleep.

Photos by Matthew Healey

Arianna Huffington delivered the Tufts Fletcher School’s commencement address. Fletcher Dean James Stavridis presented Huffinton the Dean’s Medal at the May graduation.

ARIANNA Huffington, ed-

itor-in-chief and co-president of the Huffington Post Media Group, had a strong, if unconventional, message to graduates of the Fletcher School of Law and Diplomacy at Tufts University: Take care of your health and wellbeing. In her commencement address, the 2016 recipient of the school’s Dean’s Medal Award spoke of the value of wellness and regeneration as building blocks for wisdom and leadership.

“In this buzzing, blinking and notification soaked world, it is very easy to allow your attention and your essence to be frittered away in a million different ways,” she said. “And when we are exhausted and disconnected that’s when we are more likely to make our biggest mistakes.” Huffington, the author of several books, including “The Sleep Revolution,” spoke on her signature subject: the value of rest, particularly for

“In order to signal their dedication to the institutions or the people they are leading they burn themselves out and proudly proclaim their refusal to sleep – to take time to recharge and renew themselves. As a result, we end up with leaders who are leading with less – often much less -- than full capacity.” Reversing the argument, she cited new science showing the clarity of judgement that can be obtained from sleep. She believes a cultural shift is emerging. “You, Fletcher graduates, can help accelerate that. Please recognize that based on all the latest science you’d be able to fulfill all your dreams and all your obligations much more effectively and with much more creativity and joy if you regularly take time to recharge and refuel.”

Science Summary A recap of research worth noting. By Dana Baarsvik

College graduation rates are increasing, and the job market continues to imDiversity and Educational Outcomes prove for graduates. However, research suggests these societal improvements benefit some groups more than others. As college graduation rates overall have increased in the past decade, graduation rates for black students have not progressed as much as for other student groups. In “Rising Tide II: Do Black Students Benefit as Grad Rates Increase?” the Education Trust presents evidence from a study of 232 institutions, showing that graduation rates for black students improved 4.4 percentage points, compared with 5.6 points for white students. As graduation rates for black students have not shown as much progress, the gap in completion rates between black and white students continues to grow. Furthermore, the study found that one third of the institutions in the study did not improve graduation rates for black students at all, and 39 showed declining graduation rates for black students. The Education Trust argues that institutions with similar demographics have shown divergent results in regards to closing the completion rate gap, proving that the support colleges provide for their students plays a pivotal role in academic success. In their whitepaper, “Bridging the Employment Gap for Students with Disabilities,” the National Organization on Disability (NOD) describes the problem that employers have in successfully identifying and hiring students with disabilities. With employment rates for graduates with disabilities much lower than other graduating students, NOD argues for increased collaboration between college career services and disability services, presenting a case study from the Rochester Institute of Technology that highlights the benefits of such collaboration.

In the Journal of American College Health, researchers investigated the What is Important for the predictors of wellbeing among college Wellbeing of College Students? students, developing a scale for wellbeing that includes physical and mental wellness. While the study found that physical activity, tobacco use, depression, and current or previous use of mental health services, were all associated with wellbeing, the strongest predictor was sleep quality. Many college students experience sleep problems, often going to bed very late and sleeping in noisy environments. The authors suggest interventions to promote sleep quality among college student may make the largest gains towards improving wellbeing and health. Potential strategies include ensuring a quiet nighttime environment at university housing, and teaching sleep hygiene and stress management measures during freshman orientation.

Despite colleges’ efforts to curb high risk drinking on campus over the past High Rates of Heavy Drinking decade, alcohol interventions have not produced significant changes in students’ Continue to Plague Colleges drinking habits. In order to determine the efficacy of interventions to reduce alcohol use and related problems for that members of Greek letter organizations, a recent meta-analysis examined 15 studies that reported on 21 interventions, analyzing a total of 6,026 students. Overall, interventions targeting fraternity or sorority members showed limited efficacy in reducing consumption and related problems. However, participants in some interventions reduced quantity consumed on specific occasions, and the frequency of drinking days. Interventions that addressed “alcohol expectancies,” or the positive and negative expectations students have when they drink alcohol, were the most successful among this group. The authors of the study concluded that more robust interventions are needed for use with student members of Greek letter organizations. In “Drinking Like an Adult? Trajectories of Alcohol Use Patterns Before and After College Graduation,” Dr. Amelia Arria examines the concept of “maturing out” of college drinking patterns after graduation. Through a longitudinal study, the researchers were able to observe that high frequency drinking patterns developed during college are predictive of higher drinking frequency for several years post-graduation and that the concept of “maturing out” of alcohol behaviors applies to decreases in quantity of alcohol consumption, but not frequency.

In recent years, social media has received increased attention for its effect on Social Media and the mental health of young people, espeMental Health cially on young women. In a recent study of 1,787 participants ages 19 to 32, high rates of social media use were found to be significantly associated with increased odds of depression. Another study, “Secret Society 123: Understanding the Language of Self-Harm on Instagram,” explored the exposure to peer non suicidal self-injury (NSSI) images and content through the social media site Instagram. The study authors found NSSI content to be popular on Instagram and often veiled by ambiguous hashtags, making it difficult for users outside the NSSI community to understand, and possible for them to avoid recognition from those outside the subculture. Exposure to peer NSSI images may increase the risks of engaging in these behaviors through normalization or serve as a trigger for NSSI. Furthermore, content advisory warnings on Instagram were not reliable; relying on individual social media sites to screen or generate warnings for harmful content is not sufficient for protecting young people from these images.

As part of an ongoing study of menM ental Health Service Access and tal health prevention and early intervention (PEI) program investment Campus Climate Importance within the California public high education system, the RAND Corporation produced a report on how changing the mental health climate on college campuses improves student outcomes. The robust programming on California public college campuses, which used empirically supported strategies, was “designed to accomplish three main things: help people on campus recognize and support students in need of mental health care, combat the stigma of mental illness, and give students tools for dealing with stress and other personal and emotional problems.” The study found that not only were PEI programs associated with a 13 percent increase use of mental health services and a decrease in dropouts, but also that a campus climate is one of the most important factors in a student’s decision to seek mental health services. The researchers found that on campuses that were perceived to be more supportive of mental health issues and less stigmatizing, students were over 20 percent more likely to seek treatment and 60 percent more likely to receive that treatment on campus. In fact, authors of the study claimed that “If the culture of every California public college campus was supportive of mental wellness, use of services among students with current mental health symptoms or recent mental health–related academic impairment would be expected to rise by an average of 39 percent.” The authors of this paper stressed that the majority of students at public colleges were more likely to seek services off campus, which underscore the importance of developing strong relationships with community-based support organizations and health centers.