Mental Health Care in the College Community
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Mental health concerns are the most serious and prevalent health problems among students in higher education. Increasingly effective psychopharmacological and psychotherapeutic treatments have facilitated matriculation for students with histories of anxiety, mood, personality, eating and substance abuse disorders. This phenomenon has been accompanied by a striking increase in the number of previously undiagnosed students requesting treatment. College and university mental health programs struggle to care for larger numbers of students, necessitating greater interdisciplinary collaboration in treatment, research, outreach, and educational services.

This book fills an important gap in the literature and provides a comprehensive resource for nearly every aspect of college mental health. It includes a strong emphasis on the training and education of graduate and professional students for future work in this field. Chapters are devoted to the significant ethical and legal issues related to treatment and associated administrative and policy challenges. Scholarly chapters on the promise of community mental health and public health approaches are especially innovative. There is also a chapter on international issues in college mental health which will be helpful to those students studying abroad. Mental Health Care in the College Community is written by acknowledged experts from mental health, college and university administration, legal and educational disciplines, all with extensive administrative and clinical experience in higher education settings. This book is clearly written and well illustrated with abundant tables, charts, and figures.

This text will become essential reading for college mental health clinicians, graduate students in the mental health disciplines (psychiatry, psychology, counselling, nursing, and social work), student affairs deans and their staff, and even presidents or provosts of universities and colleges.


Dr. Kay is a Fellow of the American College of Psychiatrists and Distinguished Life Fellow of the American Psychiatric Association and has served as the chair of the APA Committee on Medical Student Education, the Council on Medical Education and Career Development, the Vestermark Award Board, and the Committee on the Practice of Psychotherapy. He chairs the World Psychiatric Association Task Force on Undergraduate and Post Graduate Curriculum as well as the APA Committee on College Mental Health. Dr. Kay is the immediate past chair of the Psychiatry Residency Review Committee of the ACGME and the Founding Editor of the Journal of Psychotherapy Practice and Research and Associate Editor of the American Journal of Psychotherapy. He has published extensively on the topics of medical and psychiatric education, medical ethics, child psychiatry, psychoanalysis, psychotherapy, the neurobiology of psychotherapy, and psychosocial aspects of AIDS and of cardiac transplantation, and has edited numerous books. Dr. Kay serves as the Associate Director of the Comprehensive Neuroscience Center at Wright State University. He received the 2001 APA Seymour Vestermark Award for contributions to psychiatric education. Dr. Kay's current research examines fMRI in borderline personality disordered patients with self-harm behavior.

Dr. Victor Schwartz is currently university dean of students at Yeshiva University and associate professor of clinical psychiatry at Yeshiva's Albert Einstein College of Medicine. He established and was director of the Counseling Center at Yeshiva. Previously Dr. Schwartz was for many years the medical director and chief psychiatrist at the University Counseling Service at New York University. He has also served as assistant director of residency training in psychiatry at NYU School of Medicine. He is a Distinguished Fellow, an original member of the Presidential Task Force on College Mental Health and a member of the Committee on College Mental Health, and co-chair of the working group on law and college mental health all of the American Psychiatric Association. He is also a co-chair of the Committee on the College Student of the Group for the Advancement of Psychiatry. He has written and lectured extensively on college mental health; particularly around the areas of the intersection of law, administration and college mental health, the management of mental health crises in colleges, psychiatric residency training in college mental health services and psychopharmacology practice in college mental health.

Listen to Dr. Victor Schwartz discuss mental health awareness on college campuses.

Listen to Dr Schwartz discussing suicide on campus on the Kids Count radio show



List of Contributors.

1 The Rising Prominence of College and University Mental Health Issues (Jerald Kay).

1.1 Introduction.

1.2 How prevalent are emotional disturbances and mental disorders?

1.3 Study limitations.

1.4 A developmental approach to college mental health.

1.5 Ethical and legal issues.

1.6 Conclusion.

2 History of College Counseling and Mental Health Services and Role of the Community Mental Health Model (Paul Barreira and Malorie Snider).

2.1 Introduction.

2.2 Early development of college and university counseling centers and mental hygiene programs: pre-1945.

2.3 Professionalism and response to increase in student enrolment.

2.4 Formalization of roles and attention to developmental issues and prevention.

2.5 Community Mental Health Movement.

2.6 An example of the early application of community mental health at colleges and universities: Dana Farnsworth.

2.7 Potential modern applications of the CHMmodel to educational settings.

2.8 Conclusion.


3 The Reporting Structure and Relationship of Mental Health Services with Health Services (Gregory T. Eells and Victor Schwartz).

3.1 Introduction.

3.2 Review of literature.

3.3 Administrative integration issues.

3.4 Clinical issues.

3.5 Recommendations.

3.6 Conclusion.

4 Components of an Effective College Mental Health Service (Gregory T. Eells and Robert A. Rando).

4.1 Introduction.

4.2 Leadership philosophy and staff morale.

4.3 Administrative issues.

4.4 Clinical services.

4.5 Working with outside community mental health resources.

4.6 Conclusion.

Appendix A: Triage form (Adapted from Cornell University).

5 Essential Services in College Counseling (Richard J. Eichler and Victor Schwartz).

5.1 Introduction.

5.2 Access to care.

5.3 Clinical consultation, treatment planning and referral.

5.4 Personal counseling and brief psychotherapy.

5.5 Medication services.

5.6 Referring students for consultation.

5.7 Group therapy in college mental health services.

5.7.1 Types of groups.

5.8 Psychological testing and assessment.

5.9 Community outreach.

5.10 Concluding remarks.

Appendix A: The relationship between predictive validity and base rate.

6 The Counseling Center Team (Paul Grayson).

6.1 Introduction.

6.2 The team.

6.3 Challenges to morale and teamwork.

6.4 The director’s responses.

7 Legal and Ethical Issues in College Mental Health (Karen Bower and Victor Schwartz).

7.1 Introduction.

7.2 Conceptual framework.

7.3 Legal framework.

7.4 Application.

7.5 Conclusion.

8 Working with the Campus Community (Lorraine D. Siggins).

8.1 Introduction.

8.2 Some developmental considerations.

8.3 The evolution of the college mental health service mission.

8.4 The college mental health service and the university community.

8.5 Outreach educational and consultative services to students.

8.6 Relationship of college mental health service to the faculty, university administration and deans of student life.

8.7 Confidentiality.

8.8 Conclusion.

8.9 Appendix A: A model “at risk/student support program” in a small residential campus.

9 Crisis and Crisis Intervention on College Campuses (Morton M. Silverman and Rachel Lipson Glick).

9.1 What is a crisis?

9.2 Crisis intervention.

9.3 Common crises and suggested responses.

9.4 When does a crisis become a psychiatric emergency?

9.5 Disasters and other crises that affect multiple students.

9.6 Working with campus leadership to prevent crisis and improve mental health.

9.7 Conclusion.

10 Working with Parents and Families of Young Adults (Kristine A. Girard).

10.1 Introduction.

10.2 Young adult development.

10.3 Generational effects.

10.4 The baby boomers.

10.5 Generation X.

10.6 The millennial generation.

10.7 Privacy standards in higher education.

10.8 Influence of case law on privacy.

10.9 Privacy meets generational attitudes.

10.10 Privacy in the transition from secondary schools to higher education.

10.11 The risk management team.

10.12 Health insurance.

10.13 Family therapy in the university health service.

10.14 Required medical withdrawal.

10.15 Behavioral problems in the residential community.

10.16 Mental health prevention.

10.17 Crisis management.

10.18 Conclusion.

11 Psychiatry Residency Training in College Mental Health Services (Jerald Kay and Victor Schwartz).

11.1 Introduction.

11.2 Benefits to services.

11.3 Benefits to trainees.

11.4 Benefits to training programs.

11.5 Characteristics of a rotation.

11.6 Centrality of supervision.

11.7 Didactic curriculum.

11.8 Developmental psychopathology.

11.9 Psychopharmacology.

11.10 The resident's clinical theoretical framework.

11.11 Increasing visibility of social media.

11.12 Fellowships in CMH.

11.13 Conclusion.

Appendix A: Helpful hints for supervisors.

Appendix B: PGY IV (Post Graduate Year Four) psychiatric resident rotation, student mental health rotations, Wright State University, University of Dayton.

12 Psychology and Social Work Training in University Mental Health (David A. Davar).

12.1 Introduction.

12.2 Administrative matters.

12.3 Ethical and legal considerations.

12.4 Recruitment and selection of trainees.

12.5 Running a successful training program.

12.6 From theory to college counseling practice: CAPS orientation for new trainees.

12.7 From theory to college counseling practice.

12.8 Experiential learning: trainee epistemology.

12.9 Organization of training.

12.10 Teaching the intake interview in the college setting.

12.11 Nurturing competency, addressing deficiency.

12.12 Recognizing and addressing deficiencies.

12.13 Social work and psychology therapists-in-training.

12.14 Conclusion.

Appendix A: Sample syllabus for counseling center trainees.

13 Special Populations (Beverly J. Fauman and Marta J. Hopkinson).

13.1 Introduction.

13.2 Athletes.

13.3 International students.

13.4 Returning students.

13.5 Students with chronic illnesses.

13.6 Graduate students.

13.7 Transfer students.

13.8 Lesbian, gay, bisexual, transgendered and questioning students.

13.9 Veterans.

13.10 Victims of sexual assault.

13.11 Conclusion.

14 Using A Public Health Approach to Address Student Mental Health (Laurie Davidson and Joanna H. Locke).

14.1 Introduction.

14.2 A public health approach to campus mental health.

14.3 Building momentum and infrastructure.

14.4 Thinking and planning strategically.

14.5 Strategies for promoting mental health and preventing suicide among college students.

14.6 Conclusion.

15 Magnitude and Prevention of College Alcohol and Drug Misuse: US College Students Aged 18-24 (Ralph W. Hingson and Aaron M. White).

15.1 Introduction.

15.2 Methods: calculating changes in alcohol-related mortality.

15.3 Study results.

15.4 Discussion: estimates of the magnitude of college drinking problems.

15.5 Implications.

15.6 Interventions to reduce college drinking.

15.7 Conclusions.

16 Conducting Research in College and University Counseling Centers (Chris Brownson).

16.1 Introduction.

16.2 Types of research in university and college counseling centers.

16.3 Practical aspects of conducting research in counseling centers.

16.4 Future directions and conclusion.

17 International Perspectives: College Mental Health in the United Kingdom (Mark Phippen).

17.1 Introduction.

17.2 Setting the scene.

17.3 Support systems in UK universities - Student Services.

17.4 Student mental health - a growing issue.

17.5 The experience of international students in the United Kingdom.

17.6 Conclusion - where does this leave university counselling?




"Mental Health Care in the College Community is a beautifully organized resource that is encyclopedic in its scope and detail. It offers administrators the why and how-to of creating state-of-the-art services that include crisis intervention, triage, psychotherapy, medication consultation, testing, referral, outreach, working with parents, and training psychiatry residents and psychology and social work interns. The authors are attuned to the specific needs of the college environment, among the most pressing of which is timeliness" Read the full review. (Psychiatric Services, American Psychiatric Association, August 2011)

"What makes the volume cohesive is the prominence given to the application of the community mental health and public health models to mental health promotion and care on college campuses." (Journal of the American Academy of Child and Adolescent Psychiatry, March 2012)

"Kay and Schwartz’s text breaks new ground in the attempt to assemble a comprehensive, yet compact resource for college mental health clinicians and health services administrators. I expect that we will hear further from this cohort of clinical innovators" (Journal of Clinical Psychiatry, December 2011)

"This book should be on the shelf of every clinician and administrator working in or with a college or university health clinic. Clinicians and trainees in departments of psychiatry, social work, psychology, and nursing would be well advised to read this book from cover to cover"  (Michelle Riba, Psychiatry: Interpersonal Biological Processes October 2011)

"I would encourage any individual working at the college or university level that comes into contact with students to read Mental Health Care in the College Community" (Synergy, NASPA Newsletter, February 2011)

"I read this text with the same mantra running through my mind: “This book IS good for me, despite my reaction to its psychiatric lens.” Indeed, this book is very, very good. There is a tremendous amount of information culled from a variety of sources (bear in mind that articles in this field are published in many different journals), and this information is seasoned well with the authors’ clinical and administrative experiences ... offers a smorgasbord of pertinent, informed, and thoughtful chapters on working in the college setting." (Journalof College Student Psychotherapy, 2011)

"Mental Health Care in the College Community provides an enormous amount of valuable information on a number of diverse topics pertaining to the campus setting. Working with parents, different model of care, suicide prevention, training programs, and working with special populations are just a few..." (American Journal of Psychiatry, 2011)

"This thorough review and discussion of intervention studies could be helpful to student affairs departments (e.g., residential living, judicial affairs) in making decisions about which approach best fits their campus." (PsycCRITIQUES, November 2010)

"...  Mental Health Care in the College Community is an excellent overview of the key aspects of college mental health services provision. It will be of great help to administrators as they evaluate their existing mental health services or plan for their improvement and expansion ." (, 2010)

"I would like to thank you and Dr. Schwartz for your excellent work on your book "Mental Health Care in the College Community."  I am a psychologist who has held leadership roles in community mental health centers and hospitals for 20 years... Finding your book was a godsend in quickly bringing me up to speed on the issues...I look forward to joining the ranks of college counseling directors and furthering the development of this important field." (Gary Dunn, 2011)

"Mental Health Care in the College Community will be of interest to counselling centre clinicians and also to postgraduate students as they work to understand how students’ mental health impacts the university community" (Early Interventions in Psychiatry, 2011)

"For readers unfamiliar with mental health care at higher education institutions, the book is an effective guide to better understanding how counselling services are provided in these settings. The book may also serve as a textbook in graduate counseling and higher education courses that examine the delivery of counselling services at various colleges and universities" (Community College Review, November 2011)