Managing a Mental Health Condition in College

College means new freedoms and new opportunities. Making the transition to college isn’t easy for anyone. Classes will be more difficult than high school and you have to plan ahead and motivate yourself to study. Plus you may have the new and stressful experience of living with a randomly-assigned roommate. All these things can impact your mental health. To make sure you succeed in college, know where to find support and how to put your best foot forward.

Picking the Right School

If you know that you have a mental illness, you can plan ahead when you're applying to colleges. Here are some things to consider when choosing a college.

  • Location. Some students attend college close to home and commute to classes. This eliminates the disruption of moving and may be the best choice if you're unsure about going far from home.
  • Size. Smaller schools may feel less overwhelming and offer smaller classes and a stronger sense of community. Larger schools generally offer a wider array of health services and housing options.
  • Living situation. On-campus dormitory housing provides a high level of social support but typically places first-year students with roommates. You may be permitted a single if you can provide sufficient medical documentation (see the section below on disability accommodations). Other options are off-campus housing and living at home.
  • School resources. On-campus health clinics and counseling offices offer services for dealing with everyday concerns such as relationship conflicts, adjusting to college and academic issues. They may limit their counseling to a dozen or fewer appointments. On-campus resources are a good place to start when you first develop a mental health problem, but they probably won't be able to provide long-term help. The counselors can help you find a long-term therapist or doctor in the community.
  • Community resources. If you are a seeing a doctor or therapist you may want to find a new one closer to school to provide therapy or monitor medication.

Preparing for College

Going to college means big academic and social changes all at once. If you want to minimize the stress of change, consider gradually transitioning to campus life. This may mean starting off at a local community college to ease into new academic demands. You can then transfer to a four-year college for harder classes and a more social environment. Or if you want to go to a college out of state, you may want to live with a supportive family friend or relative when you first begin classes.

If you have a mental health diagnosis or learning disability and attend a public school, you have been entitled to special education services under the Individuals with Disabilities Education Act (IDEA). On graduation, you'll be leaving your IEP (Individualized Education Program) behind and entering into your college's particular system for accommodating disabilities.

The Americans with Disabilities Act requires colleges to make "reasonable accommodations" to help you succeed, but you and your parents will now bear more responsibility for planning your own "IEP." For instance, to secure "reasonable accommodations," you'll have to show records and medical information and discuss the accommodations that will help you best (see below).

Your high school can help you develop your college plans. If you currently receive special education services under IDEA, you're entitled to transition planning from your high school. This process will help you identify your education goals and prepare to request accommodations from your college. Transition planning should include the following:

  • Learning about your college’s academic requirements and the services that might support your health and academic growth
  • Developing your ability to describe your illness and its impact on your learning
  • Thinking ahead about the accommodations that will be most useful
  • Collecting and organizing documentation to show the college you're entitled to disability accommodations

Before leaving your high school, you should also request a Summary of Performance, which describes your academic achievement and functional performance to date. It should also describe current and past services and supports and include recommendations for future accommodations.

Disclosing Your Mental Health Condition and Requesting Accommodations

If you believe you may need help from the school, you should ask before you face any serious challenges in your classes. Begin the process early. However, you may not know you need help until you've begun classes. If that’s the case, let your school know as soon as possible.

Who You Should Tell

You should only disclose your illness to people who need to know. This means those involved in the accommodation process, such as disability resource center staff, your academic advisor or an admissions officer. You may be discouraged from disclosing to faculty because of student confidentiality issues. Because confidentiality is a complex issue, ask about your college's policies.

If you choose to disclose to others at college, including your peers, it is up to you to decide what information to share. Regardless of how, when or why you talk about your illness, try to remember how much you're achieving and focus the conversation on your abilities, strengths and determination.

How to Ask for Accommodations

To get accommodations you must tell the school that you have a mental health condition. Every college has its own procedures on how to obtain services. It's important to check your college’s policies and procedures first. A typical process for obtaining accommodations looks like this:

Identify what you need. You know best the kinds of accommodations that will help you do well. If you currently receive special education services, your high school's IDEA-mandated transition planning will help you assemble a list of needs.

Register with the disability resource center. To be eligible for accommodations, you will need to register with your school’s disability resource center or disabilities office. Often, the disability resource center will offer a selection of services for you to choose from.

Provide documentation. The college disability resource center will ask you to document that you have a mental health condition. This documentation should provide enough information for you and your school to select appropriate accommodations. Generally, your most recent IEP or 504 plan is not considered adequate documentation. If you have an IEP, your high school transition plan should help you gather the information you need. You will likely want the following:

  • Documentation showing your diagnosis
  • Types of academic accommodations that have worked for you in the past
  • Types of academic accommodations you anticipate needing in college
  • How your illness can contribute to your success in college
  • How your ability to learn and study effectively is impacted

Receive and review accommodations. If you have requested a specific accommodation, the school may approve your request or offer an alternative accommodation if it is more effective. You should expect your school to work with you to identify appropriate supports. If you find an accommodation isn't working for you, contact the disability resource center as soon as possible. They will work with you to resolve the problem.

What Kind of Help Can I Get?

The accommodations you receive will depend on how much help you need and what your school is able to provide. You will be expected to learn from the same curriculum and master the same content as other students. But the following common accommodations can help:

  • Arranging for priority registration
  • Reducing course load
  • Substituting one course for another
  • Providing transportation services
  • Allowing note takers and recording devices
  • Allowing the student to work from home
  • Extending time for testing
  • Extending deadlines for assignments
  • Tutoring
  • Mentoring
  • Study skills training
  • An individual room for taking exams
  • Allowing the student to change rooms or roommates

Taking a Leave of Absence

For some students a break from school is needed to recover and get back on track. Each college has its own policy about granting medical leave, but in general if you're thinking about time off, consider the following issues:

Your college policy. Ask about the policy on medical leave at the disability resource center or the dean of students office. The college policy will tell you the procedure for leave and how long you can take leave before your enrollment lapses and you're required to reapply.

Class credits. You may lose credit or have to take incompletes and finish class requirements later. Or you may want to ask to "retroactively withdraw" from classes if your grades suffered in the weeks leading up to your medical leave. Under the ADA, retroactive withdrawal because of depression or other mental illness is considered a reasonable accommodation.

Documents and procedure for requesting for medical leave. The college or your academic advisor should be able to tell you what documents you need to include with your request. This may include a letter from a psychologist, psychiatrist or counselor stating the reason for a medical leave, diagnosis, the date of initial treatment, the dates of subsequent treatment (if applicable) and the expected timeline for recovery. 

Financial aid for the term. Because college is expensive, a leave of absence raises financial questions. If you take a leave of absence right now, will you need to pay back your loans and scholarships right away? Are you given a grace period? Will any of your tuition or fees be refunded?

Returning to school. Return from a medical leave of absence requires college administrative officials to sign off on your re-entry. Their decision usually takes into consideration factors such as your prior medical history and how responsibly you've managed your academic and medical affairs before your leave. They will also consider application essays, letters of support, and medical documentation from your healthcare provider. To understand the process, it helps to speak to as many college officials as possible. Check with an academic advisor and the dean of students office.

Can a College Require Me to Take Leave?

A college can only put you on involuntary leave of absence under certain, limited circumstances. The law has established that a mental illness crisis by itself is not sufficient reason to ask a student to leave.

If your school asks you to take a leave, they are required to follow "due process." They should conduct an individual assessment and consult with a healthcare professional. They cannot require you to provide them with your complete medical records, though they can ask for information about whether or not you pose a threat to yourself or others. And they must provide you with an explanation of their concerns and allow you and your parents to respond.

A college may be permitted to ask you to leave if they can demonstrate there's a clear risk you might harm yourself or someone else. They should be able to show that their accommodations for you haven't been sufficient to reduce the risk.

If your school is considering asking you to take a leave of absence, try to work with officials to allay their fears and reach a compromise. Consult a mental health professional and take their advice. And if your school insists that you leave, seek legal advice. Your school probably has a process for appealing the decision. You should also consider filing a complaint with the Department of Education's Office for Civil Rights.

University policies are evolving as more students with mental illnesses make their voices heard on campus. The Bazelon Center has information about the most recent Office of Civil Rights decisions about involuntary leave of absence, as well as information on how to file a complaint.

Tips for Succeeding in School

Whether you already know that you have a mental illness, or find yourself experiencing one for the first time in college, you can take some actions on your own to strengthen your health:

Maintain and build support systems. Connections with friends and family at home provide much needed stability and you should keep in touch. But college also provides opportunities to make new friends and create new support systems through clubs and classes. If you're homesick, allow yourself to call home, but also reach out to the people around you. They may be missing home, too, and will welcome a new friend.

Monitor symptoms. A short, daily record of key symptoms such as mood and anxiety levels can help you notice if symptoms are getting worse. College can make it hard to stay on a regular schedule, which in turn makes it hard to notice changes in your eating or sleep patterns. Keeping a record or journal gives you useful information on your mental health. If your symptoms steadily worsen as you make the transition to college, don't wait to consult a doctor or therapist.

Maintain healthy habits. Exercising, eating a balanced diet and getting between 7-9 hours of sleep will give you more energy, help you focus better, and keep you emotionally resilient. Plan ahead for the health challenges of dining hall food and late night study sessions.

Avoid drugs and alcohol. Though the short-term effects may give users a boost, alcohol, marijuana and other drugs are poor ways to cope with stress. If you have a mental illness, you should avoid or at least limit your use of drugs and alcohol. When you plan for the academic work at college, plan for the social life as well. Think about social activities you enjoy that don't involve drugs and alcohol and seek out these activities on campus.

Reduce academic stress. Using academic supports such as study groups, tutors and the campus writing center can make classwork easier and give you encouragement from others. Because the college work load varies considerably from week to week, experiment with time management methods and find the ones that work best for you. Your college may offer first-year students advice on study skills and time management to help with this transition.

Learn more about mental illness. College sometimes offer students support groups for mental illness and stress management. NAMI may have a group on campus or an affiliate in the community. And college is also a great opportunity to learn more about the brain by taking classes in psychology. Knowledge increases your sense of power over your illness.