Triage, Referral and Caring for the Community Richard Kadison M.D. Chief, Mental Health Service Harvard University Health Service

Coordinating Care Resources Restrictions Realities

Resources What are the available staff? How many prescribers? What are the programs:Therapies, Wellness Community Resources Insurance Coverage Medication Coverage

Data 2000 National College Health Assessment students 20 public and 8 private colleges around US 9.4% Seriously considered suicide 93% of students felt overwhelmed 44.5% felt so depressed, hard to function 65% of students report feeling hopeless

Data Antidepressant sales increased 800% since billion dollars 2001 Medication is very expensive 9.3% students seen in counseling 17% students who are seen are on antidepressants nationally

Data Directors report a significant increase in acuity and severity AUCCD 65% of schools have psychiatric services on campus

Suicide Rate 7.5/100,000 in college which is half the rate of age matched population More younger men are successful but equalizes as group gets into early 20’s About 1% of students make attempts Risks increase with age- graduate school

Parallel Problems 40-45% of College Students Binge drink- no change from (Wechsler) 3-5% of students have serious eating disorders (Bulimia and Anorexia) with mortality rates of 5-15%

Restrictions Stigma Health Care information- Parents Managed Care changes University Budgetary Concerns

Restrictions Student Mentality Health Care Costs DNKA (did not keep appointment Disability and Learning problems

Realities Reduce stigma for Care Normalize the problems Outreach Needed Managed Care changes Diminished community resources Confidentiality

Access Structure Triage system- Brief contact with clinicians Philosophy of Care: How much care for whom- development vs. serious mental illness Referrals: to whom Central Schedule Reporting ( visits, new students)

Caring for the community Outsourcing Outreach to students, faculty, and staff Consultation role to University

Coordination After Hours coverage: Who and Where Medical Leave- reentry and policy Identifying Students at Risk Contact with Deans/ residential staff Confidentiality- Handbook notification of medical leave and hospital admission

New Directions and Issues Web- Self screening, alcohol education, health information Web- staff listing, groups, policies, Parents information and orientation Future of in loco parentis Documentation and diagnosis Student involvement in programs and feedback

Summary Triage and rapid intake crucial Outreach and Education Clear philosophy about Resource Utilization Student involvement in programs and development