College Mental Health as a Specialty

I chose to focus my career on college mental health (CMH), or college counseling, in approximately 1987.  That was my first year in my doctoral program in counseling psychology.  Perhaps it was the time, perhaps the context, but I definitely perceived CMH to be a "field" of study and work.  I recall others being interested in pursuing this same career path then and especially during the early years of my professional life.

If I have learned anything from more than two decades of work in this field it is that CMH is in fact a specialty.  Explaining the nuances in this work could fill more than one volume, much more space than what is offered here.  Starting with an example of definition, the American Psychological Association (APA, 2011) defines a specialty as follows:

"A specialty is a defined area of professional psychology practice characterized by a 
distinctive configuration of competent services for specified problems and populations. 
Practice in a specialty requires advanced knowledge and skills acquired through an 
organized sequence of education and training in addition to the broad and general 
education and core scientific and professional foundations acquired through an APA or 
CPA accredited doctoral program. Specialty training may be acquired either at the doctoral or postdoctoral level as defined by the specialty."

There are professional organizations devoted to this specialty, about some of which I have posted previously.  A short list of American organizations is provided here:

• Association of University and College Counseling Center Directors
• International Association of Counseling Services, Inc.
• American College Counseling Association
• Section on College and University Counseling Centers, Division 17, American Psychological Association
• Commission for Counseling and Psychological Services, American College Personnel Association

But these are just formalities, and not included are the many college counseling centers which provide formal training opportunities including practica and internships.  The essence of the specialty lies in the nature of the work itself.  Some hallmarks of a competent approach to this field include:

• A thorough understanding of the holistic development of late adolescents and young adults as it relates to academic success and personal growth
• A broad range of skills in the area of psychotherapeutic approaches to common issues faced by college students
• An appreciation for the importance of outreach and prevention education programming on a college campus, including the skills of planning, delivery and evaluation of these activities
• A thorough and competent approach to delivering consultation services to members of a college campus community, including faculty, staff, parents, and others
• Where possible, a comprehensive mission of training graduate students in mental health professions in the CMH specialty

Much harder to articulate is what lies at the heart of this type of work.  The nuances mentioned above relate to the skills involved in managing very complex dynamics in multiple and sometimes conflicting work relationships, the urgency involved in responding to the needs of both the individual and the community, and the promotion of the full and genuine identities and life trajectories of students in this context.  If I was forced to explain one view in as few words as possible, which in fact I am in this space, I would offer the following statement:

"CMH is the training for, application, and on-going study of a range of psychologically-oriented human services focused on the academic success and personal growth of college students, with a full understanding of the complete context in which they function, including responsiveness to the needs of all who relate to, work with and serve them, and the successful management of professional boundaries with all involved such that the goals of the individual and community are promoted."

Diagnosis spotlight: seasonal affective disorder

Our environment has a strong influence on our mental health. In fact, an entire disorder is dependent on the time of year: seasonal affective disorder (SAD). Often referred to as the "winter blues," this disorder typically follows an increased depression that begins in the fall and increases as the winter moves on. In some cases, however, the disorder starts up in the spring and peaks in the summer.

Symptoms vary between winter and summer SAD. According to the Mayo Clinic, symptoms of fall and winter SAD include depression, hopelessness, anxiety, loss of energy, a heavy or "leaden" feeling in arms or legs, social withdrawal, oversleeping, loss of interest in activities you once enjoyed, appetite changes (especially a craving for carbohydrates), weight gain and difficulty concentrating. Spring and summer SAD, on the other hand, is demonstrated through anxiety, trouble sleeping, irritability, agitation, weight loss, poor appetite and an increased sex drive.

It's easier to dismiss a problem if it goes away on its own. It can take a long time for someone to be motivated to get help and since SAD dissipates after a few months, some people will never seek treatment. The problem is that this is a cyclical disorder that returns year after year, meaning that it isn't actually going away. 

SAD, though dependent on the seasons, is not any less severe than other forms of depression. It should be taken just as seriously as "regular" depression. This means actively seeking treatment is just as important. The most commonly used treatments are light therapy, medications and psychotherapy.

Light therapy (also known as phototherapy) involves sitting in front of a box that emits specific wavelengths of light. This treatment is based on the idea that a lack of sunlight is partially to blame for the illness, a theory that is supported by increased rates of winter SAD in the north. This is the least invasive treatment and a good first step. Make sure you buy a quality box and consult with your doctor. How long you expose yourself to the light and what time of day you do so is important and should be determined by a professional.

SSRI antidepressants are also used to treat SAD, especially in more severe cases. It can take several weeks for the medication to work, so if you know you know have a yearly problem with SAD, you might want to start a regimen before winter (or summer) hits. Make sure to not go off the medication before your doctor recommends it, even if you feel better. 

Psychotherapy can also be effective in treating SAD. While you can't control the coming and going of the sun, you can control other factors that might be influencing the SAD. A therapist can offer suggestions for managing and reducing your symptom. A therapist can also possibly get at other underlying causes of and contributions to the depression, seeing as it is rarely only one thing that is the root of the problem. 

It's unnecessary to suffer from seasonal depression year after year. If you or someone you know struggles at a particular time of year, don't dismiss it. The temporary nature of the disorder does not reduce its seriousness. Schedule an appointment with a doctor or therapist to further explore what your options are in treating SAD.

Do you get more symptomatic at certain times of the year? What has helped you? Share your thoughts in the comments.

My take on meds

Feel free to ignore this post if you don't want an opinion piece. I just feel that since I will be talking about medication, it's probably best that I explain my stance to provide some context. 

There's so much good that has come from modern medicine. This includes a wide assortment of medications that help treat and even prevent certain conditions. These include entire categories dedicated to mental health issues. Due to the fact that we don't know enough to not be experimental, new discoveries are made by chance. For instance, anti-seizure medication can be used in the treatment of personality disorders. It's a frontier we have yet to conquer.

I have a great level of respect for those who dedicate their lives to finding ways to improve and extend our lives. Unfortunately, the pharmaceutical industry as a whole is not run by philanthropists who throw money at it. It's a business. This means that they have to make money. The competition can be healthy in terms of innovation, but it has to be financed. This is how Prozac got renamed Sarafem and prescribed for PMS. Once the original use for a drug has been tapped into, it's time to find ways to keep making money off of the same formula. Do you have to take four pills a day? We just made a different one that does the same thing, but you only have to take it once! You think anti-psychotics are reserved for schizophrenia? No, they're also used for autism, dementia and even insomnia.

Honestly, it's a really complex system and I'm not here to preach about it. But since medication is a significant aspect of the mental health industry, I can't ignore it. In order to offer a respectful climate for discussion of something so attached to opinion, this is the perspective I am coming from:

• Medication has the potential to significantly improve and even save lives in the mental health field.

• Some people need medication. They have exhausted all their options and cannot find anything else that is sufficiently effective.

• It is not our job to judge whether or not someone needs medication. Don't think your sister needs lithium? It's the job of her and her doctor to figure that out. Think your friend needs some anti-anxiety pills? It's not your call.

• Side effects are a factor that should be taken into consideration when prescribing medication.

• When it comes to children, teenagers and young adults, special precautions need to be taken and other approaches should be more carefully considered. While the body and mind are still developing, a cost-benefit analysis is definitely warranted.

• Are we overprescribing? Probably. I refuse to believe all my classmates who take Ritalin or Aderall actually have attention deficit hyperactivity disorder (ADHD), a childhood disorder that doesn't spontaneously emerge in college.

• Never encourage or support someone in going off their medication without proper medical supervision. Not only may it be inappropriate in terms of treatment, but not regulating the tapering off of a substance can cause withdrawal symptoms and other serious – possibly permanent – complications.

• There are alternative approaches that can be taken, and that's okay, too.

• Ultimately, it's about getting better. Whatever works (and is relatively healthy) is great!

I understand completely if you disagree. I don't claim to be an expert. I'm just being honest about where I'm coming from so that any biases I have are pre-announced. 

I'm back

I apologize for my unannounced and unexpected hiatus from this blog. A lot of things came up very quickly and I had to prioritize other areas of my life for the last several months. I'm starting back up again, though, so look for more posts in the near future.

Thank you for your patience with this bump in the road.