September 01, 2015

By Luna Greenstein

skills-therapy-pic.jpgThe college lifestyle is not always supportive to those facing mental health struggles, either prior or newly developed. A new environment, social and academic pressures, and easier access to drugs and alcohol are just some of the challenges that students face. Consequently, students often feel alone or do not have the proper supports.

 One of the most devastating outcomes that can result from a lack of support is suicide. More than 1,000 suicides occur on college campuses every year, rendering it the second-leading cause of death among college students. The National Survey of College Counseling Centers conducted by the American College Counseling Association (ACCA) has found that almost every director of college mental health centers has reported an increase in the number of students with serious mental health conditions.

In another report, The American Freshman: National Norms for the Fall of 2014, the Higher Education Research Institute, the nation’s largest and oldest organization for the empirical study of higher education, discovered that students’ self-rated emotional health rating has dropped to 50.7%, its lowest level ever.

Where Schools Are Coming Up Short 

There is a multitude of reasons why it appears schools are not meeting the needs of students. With more students attending college with mental health conditions—in part due to better treatments, and more support at home, resources on campus are being stretched thin. The college-age years are also a time when many mental health conditions first manifest. And at times, some schools are so worried about their reputations that they encourage or force students with mental health conditions to leave.

 “Schools should encourage students to seek treatment. But a lot of policies I see involve excessive use of discipline and involuntary leaves of absence, and they discourage students from asking for the help they need,” said Karen Bower, a private attorney who specializes in disability discrimination cases in higher education, in a Newsweek interview.

This confluence of factors making it hard for students to stay in school means students are not only losing their chance at an education, but also potentially their friends, community, or any type of support system they have at school.

“A depressive episode made it impossible for me to go to classes, and I did not get help until it was too late and I was withdrawn and I could never afford the cost to go back because I lost my scholarship for being withdrawn,” a respondent said in a 2012 survey conducted by NAMI. Statistics from that survey also revealed that 64% of dropouts in college were due to a mental health-related reason.

What Schools Are Doing Well

In order to address the increase in mental health concerns among students, schools have responded by attempting to beef up their mental health services. They have been doing so by providing campus suicide prevention training, increasing the amount of time in training faculty to identify warning signs, providing skills training for clients to help them learn to tolerate and manage emotional discomfort, and increasing essential mental health services such as stress-reduction programs, medical leave policies, education programs, and on-site psychiatric services to prevent suicide.

When counseling centers are equipped, they work. In The National Survey of College Counseling Centers, a majority of students expressed that the counseling center at their school helped them remain enrolled and also helped with their academic performance.

Understandably, providing the support and treatment that students require is far from an easy task. Keeping up with the increasing demand for mental health services is a costly endeavor that requires proper funding and staff to accomplish.

A lot of schools are forming groups and clubs, such as NAMI on Campus, where students are be able to talk with one another and learn new things from each other in a supportive environment. This kind of interaction can help students living with a mental health condition feel less isolated, teach them new methods of coping and help them to build a network of support at school.

Improving the Ability of Students to Cope

There are many ways college students attempt to cope with the new stresses of their new environment. Some may binge drink, have unprotected sex or engage in self-harm. These are destructive coping techniques, however, and will not ultimately help the student. A way to potentially instill better coping methods for students is by teaching aspects of well-researched skills-based therapies. These skills teach students how to deal with stress, handle their emotions more effectively and engage in social relationships more successfully.

Some of these therapies that teach these skill-based skills include cognitive behavioral therapy (CBT), which focuses on teaching people how to better control or change their thoughts and the resulting behavior. Mindfulness-based cognitive therapy (MBCT), another successful type of therapy, focuses on mindfulness and living in the present moment.

One of most well-researched examples of a skills-based therapy is dialectical behavior therapy (DBT). We’ve chosen to explore this therapy in part because Dr. Marsha Linehan is the recipient of the 2015 NAMI Scientific Research Award. 

DBT is most often used to treat borderline personality disorder, but it can also be helpful for people living with other conditions who could benefit from learning positive coping strategies.

“The skills are what people talk about when they talk about DBT. The skills are the active ingredient in DBT,” says Dr. Linehan, the creator of DBT. “Many want these skills in schools, and some want them taught early. They are effective for managing life.”

The four skills of DBT are mindfulness (being present), distress tolerance (how to tolerate pain), interpersonal effectiveness (how to maintain self-respect while engaging in relationships with others) and emotion regulation (how to change or control your emotions).

“Prior to DBT, I didn’t feel like I was living. I was not mindful of what was going on around me, and I was terrified of meeting new people,” says Julia Lesmerises, a 21-year-old student at Southern New Hampshire University. Julia is living with bipolar disorder and has been in a DBT program for the past year. She had tried other treatments before beginning DBT, which were helpful, but she says they have been nowhere near as helpful as DBT has been. “I needed skills that help me cope integrated into my therapy, and regular therapy wasn’t enough,” she says.

There is precedent for using skills-based techniques in school-based settings. An article in the Wall Street Journal this past July featured junior high and high schools that have used skills from DBT to help students handle self-harm. One of those schools was Maple Grove in Battle Ground, Wash. The school is currently testing a class for all students in grades 6 through 8 that uses these skills to create 50-minute lesson plans that can be taught by general-education teachers.

Vanessa Stein, a social work services specialist at the University of Central Florida, is a facilitator for a group that teaches these skills as a part of the school’s counseling center. The group has been running for the past four semesters and has had four to eight clients in each group. “We feel very supported in running a skills based therapy group on our campus and advertise with our student health partners and dean’s office case managers,” says Stein.

Stein has attended trainings, read books and collected resources online about skills-based therapies in order to acquire the necessary knowledge to facilitate the group. “Personally, I love that DBT is skill-based and incorporates mindfulness and homework such as diary cards,” says Stein. “I have seen clients come to understand themselves better and learn when to use skills to help them better regulate their emotions and reduce their impulsiveness.”

Skill-based therapy can be useful to an individual regardless of whether or not there has been a diagnosed mental illness. Getting these skills to a wider audience can help provide people the necessary tools to be able to handle their emotions, live in the present instead of in their heads, handle emotional pain, and not be afraid to engage in social relationships with others.

“We need to get [these skills] to people,” Dr. Linehan declares. “What good is a great treatment if you cannot get access to it? The skills should be everywhere.”

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