Lynn C. Koch, Ph.d., CRC University of Arkansas-Fayetteville IntegRATED POSTSECONDARY SERVICES AND Supports for students with psychiatric disabilities Lynn C. Koch, Ph.d., CRC University of Arkansas-Fayetteville

Objectives Examine enrollment trends of students with psychiatric disabilities and why growing numbers of students with psychiatric disabilities are attending college. Understand the challenges that students with psychiatric disabilities experience in succeeding in postsecondary education. Summarize research on the academic and social integration, accommodations usage, and postsecondary persistence of students with psychiatric disabilities. Explore several innovative practices to respond to the multifaceted needs of these students. Highlight the role that disability service providers can play to enhance the academic and social integration and persistence of these students.

Dr. Patricia Deegan shares her experiences as a student with a psychiatric disability https://www.youtube.com/watch?v=DVlhfuKDjYE

Postsecondary Enrollment Trends oF Students with Psychiatric Disabilities 1 in 5 students enrolled in postsecondary institutions in the US has a mental health condition (NAMI, 2016). In a survey of postsecondary institutions in the US, 15% of students identified themselves to their institution as having a mental illness/psychological or psychiatric disability during the 12 month 2008-2009 academic year. College counseling center directors have reported in surveys that the number of students with significant psychological problems and their need for a longer duration of treatment is a growing concern for counseling centers that do not have enough staff or resources to adequately serve these students. The high rate of comorbidity of psychiatric disabilities with substance use disorders creates additional challenges.

Highlights from the Center for Collegiate Mental health 2016 annual report On average, counseling centers have been providing 28% more “rapid-access” service hours per client and 7.6% fewer “routine” service hours per client over the last six years Anxiety and depression are the most common presenting concerns for college students. In addition, students’ self-reported distress levels for depression, generalized anxiety, and social anxiety have evidenced slight but persistent increases each year for the past six years. Counseling centers are evaluating and managing increasing numbers of students who may also represent a “threat to self.”

Why Growing numbers of students with psychiatric disabilities are attending college The stronger demand for a postsecondary degree as essential for employment in high-demand occupations Expansion of disability legislation Increase in the number of individuals being diagnosed with a psychiatric disability in the general population Advances in psychopharmacology and recovery-oriented, evidence-based psychiatric rehabilitation practices Changes in public perceptions about mental illness Despite these trends, untreated mental health disorders are highly prevalent in student populations

Postsecondary challenges Psychiatric symptoms that interfere with motivation, concentration, and social interactions Initial onset that may occur while enrolled in postsecondary institutions Lack of awareness of university resources Failure to seek treatment and request classroom accommodations Medication side effects that can interfere with attention, concentration, and stamina Stigma Fears of disclosure Vulnerability to co-occurring substance use disorders

SOCIAL AND Academic Integration Ennals, Fossey, and Howie (2015) conducted a meta-synthesis of 16 qualitative studies with a total 231 participants with psychiatric conditions. Managing the academic pressures and their mental health emerged as key challenges for this group of students. They also reported experiencing social struggles in terms of fitting in, deciding on what aspects of their illness to reveal, making friends, and developing relationships with college personnel. Ennals et al. (2015) discovered that finding the right social network and a place in the social space helped these students alleviate the challenges and stressors associated with academics and their psychiatric symptoms.

Social and Academic Integration Salzer (2012) collected data from 449 former and current students with mental illnesses from over 300 higher education institutions and found that in comparison to students without disabilities, students with psychiatric disabilities reported less engagement in campus facilities, student clubs, and organizations; and Fewer quality relationships with faculty and staff. Significant differences in campus experiences were also found between students who graduated and those who did not. As expected, students with psychiatric disabilities who persisted to degree completion reported more involvement and better relationships than those who did not persist.

Social and Academic integration Koch et al. (2014) found that academic and social integration were positively related to first-to-second-year persistence of students with psychiatric disabilities. Yet, the majority of the 350 students with psychiatric disabilities in the BPS: 04/09 data set used by the researchers never participated in school clubs (73.6%), school sports (81.6%), or fine arts activities (65.0%), never had informal meetings with faculty (60.8%), and never participated in study groups (52.9%) in their first year of college. Findings from these studies suggest that to better support students with psychiatric disabilities, mental health treatment, disability services, and support structures should go beyond assisting students to manage symptoms and balance academic demands and focus on students’ holistic campus experiences.

classroom accommodations For Students with Psychiatric disabilities extended time for tests and quizzes breaks during tests and class quiet or distraction free testing permission to have beverage or food during class preferential seating quiet or distraction free testing/quizzes note takers audio-recording of classes flexible attendance

Use of classroom accommodations among students with psychiatric disabilities Koch et al. (2014) found that less than 10% of a national sample of students with psychiatric disabilities reported using classroom accommodations. Potential reasons for low usage of accommodations include lack of awareness of on-campus programs to assist them with classroom accommodations planning, failure to request and use classroom accommodations because they do not self-identify as persons with disabilities, feeling that they do not need any accommodations, and fears of being stigmatized by faculty and peers if they disclose their need for classroom accommodations.

Postsecondary Persistence Research studies have documented that as many as 80% of students with psychiatric disabilities withdraw before completing their certificates/degrees, and those who withdraw are unlikely to return to complete their certificates/degrees. Koch et al. (2014) studied the persistence rates of students with psychiatric disabilities (N= 350; 2.1% of the total number of students in the data set)enrolled in U.S. postsecondary institutions. They discovered that the first-to-second year persistence rate of these students was 76.6% while the three year cumulative persistence and persistence to degree completion rates were 61% and 54.7%, respectively. In another study using the same data set, Mamiseishvili, Koch, & Wilkins (2016) found that 26.4% of students with psychiatric disabilities and LD/ADD earned bachelor’s degrees within six years compared to 39.3% of students without disabilities.

Innovative practices to promote persistence of Students with disabilities to Degree completion Mental health case management and disability services in one-stop centers Integrated supported education and supported employment Peer run campus advocacy organizations Active Minds http://activeminds.org/about#video NAMI on Campus Students in Recovery Campus wide initiatives to de-stigmatize mental illness, encourage help-seeking at the onset of illness, and create more inclusive campuses KOGNITO https://www.youtube.com/watch?v=ag9aj290nT0 First year experience programs focused on mental health and resiliency

Role of Disability Service Providers: Discussion What trends are you seeing at your institution in the enrollment, academic and social integration, use of accommodations, and persistence to certificate/degree completion of students with psychiatric disabilities? What services and/or strategies have you implemented at your institution to promote their inclusion and academic persistence? What else could you be doing?

References Center for Collegiate Mental Health (2017, January). 2016 Annual Report (Publication No. STA 17-74). Koch, L.C., Mamiseishvili, K., & Wilkins, M. (2017). Integrated postsecondary services and supports for college students with psychiatric disabilities. Journal of Applied Rehabilitation Counseling (48), 1, 16-51.