Mental Disability in Higher Education: A Literature Review

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Statement and Description of Topic

The field of Student Development is ripe with opportunities. Higher education is often wrought with challenges, joys, and new experiences, all of which contribute to a profoundly formative season of life. Erikson (as cited by Evans et al., 2010) noted that as young adults are transitioning from childhood to adulthood, their increased independence leads to a tension between their Identity and Identity Diffusion. They are trying to figure out who they are and how they want to be known. However, some students are arriving at college with not only the same identity development challenges faced by their peers, but with the additional challenges of mental/emotional disabilities. Chickering (as cited by Evans et al., 2010) argued that the educational environment has profound influences on a student’s development. Therefore, caring well for students with mental disabilities is a critical undertaking for every institution. However, this looks differently than caring for other students and there are also legal implications that necessitate familiarity and consideration. This paper reviews the literature surrounding students presenting with mental/emotional disabilities to glean a robust understanding of helpful strategies to care for and support these students.

Background Legal Implications

The discussion would be lacking without an examination of the current rules and regulations surrounding institution’s responsibility to students with disabilities. Research by Aron and Loprest (2012) explained that, prior to 1970, federal law did not protect anyone with a disability. It was not until 1973, when the Rehabilitation Act was passed, that it became illegal to discriminate against someone with a disability. This ruling challenged the common thought that minimal education and unemployment amongst people with disabilities were due to the disability and not to social barriers.

Another crucial piece of legislature was the “Americans with Disabilities Act” (ADA), which was signed into law by President Bush in 1990 and was later amended in 2008 with those changes taking effect in 2009 (“Americans with Disabilities Act of 1990, As Amended,” n.d.). Most applicable to this topic is “Title 42” which defines “disability” and explains rules and regulations for places of education. Disability is defined as “a physical or mental impairment that substantially limits one or more major life activities of such individual” (“Americans with Disabilities Act of 1990, as Amended,” n.d., Sec. 12102, Definition of disability). The following explanation is given regarding the rights of people with disabilities

Any person that offers examinations or courses related to applications, licensing, certification, or credentialing for secondary or postsecondary education, professional, or trade purposes shall offer such examinations or courses in a place and manner accessible to persons with disabilities or offer alternative accessible arrangements for such individuals (“Americans with Disabilities Act of 1990, as Amended,” n.d., Sec. 12189, Examinations and courses).

There are some nuances that apply specifically to postsecondary education, which are helpfully explained by the ADA National Network (Auxiliary Aids and Services for Postsecondary Students with Disabilities, n.d.), namely that postsecondary students are obligated to notify the college of their disability in order to receive auxiliary aid. This is different than elementary/secondary education where support services are provided because, in postsecondary education, the burden of proof rests with the student. If a student asks for auxiliary services, the college has the right to ask the student to provide diagnostic proof of their disability and prescription for aid.

Synthesis of Literature

Mental Disabilities in Higher Education

The preponderance of research pointed to an increased prevalence of college students presenting with mental health disabilities. Much and Swanson (2010) attributed this increase to two factors: students today are dealing with more complicated stressors than in the past and, with increased access to college, college counseling centers are working with more students who are exposed to said stressors. After considering the legal material relating to people with disabilities, Much and Swanson’s (2010) findings reflected that the ADA (and other similar legislation) is paving the way for students with mental disabilities to be accepted into college.

A significant amount of literature recognized stress as a catalyst/obstacle for students battling mental disabilities. College is certainly a stressful time for everyone and Dusselier et al. (2005) examined predictors of stress for all college students. Their findings included some helpful data with implications for caring for students with mental disabilities. The strongest role in contributing to a student’s stress was conflict with a faculty member; additionally, the environment on the residence halls was a prominent factor (Dusselier et al., 2005). This is critical for college administrators to be aware of as this relates to two facets of a college experience over which staff and faculty can be directly involved. These stressors (and others) are important to consider when housing students with mental disabilities and advising them on which classes/professors to take.

Storrie, Ahern, and Tuckett (2009) conducted a review of over 500 scholarly articles which addressed mental or emotional health problems in students. Their review of this literature demonstrated that the impact of mental disabilities on student’s academics was significant. Some of the effects negatively impacted student’s grades, led to social isolation, problems with accommodation, and poor retention (Storrie et al., 2009). Thus, if colleges take retention seriously, an important component of their retention efforts must be helping students with mental disabilities cope and thrive in the midst of a context rife with mental and emotional stress.

Even though research exists that identifies stressors in college student’s lives, there are still some gaps in the literature that could prove helpful to caring for students with mental disabilities. Hunt and Eisenberg (2010) reviewed the literature on mental health amongst college students and found some notable gaps. Pertinent to this discussion was the lack of research examining how mental health is influenced by campus characteristics including the size of enrollment, what course of study is pursued, support systems, etc. Awareness of these factors could be helpful in supporting students with mental disabilities during their time at college.

Caring for Students with Mental Disabilities

With noted increases in students diagnosed with emotional and mental disabilities as well as research indicating the particular difficulties that stress can have on these students, the importance of support systems becomes vividly apparent. There is abundant research, with similar findings, on practical ways for ensuring that students with mental disabilities are well supported.

The recognition of counseling as a valuable asset is acknowledged, as are calls for increasing collaboration between counselors and staff and faculty (Dusselier et al., 2005; Hunt & Eisenberg, 2010; Ryser & Alden, 2005; Taub & Servaty-Seib, 2011). The literature findings point to the often-challenging tension between a holistic approach to caring for students and the legal/ethical standards in place as well. A helpful consolidation of the ethical standards for school counselors was compiled by the American School Counselor Association (Rev. ed., 2010) and thoroughly outlined proper protocol for school counselors and administration. This literature should be common knowledge among staff and students in order to facilitate a healthy and legal atmosphere for counseling to be understood and utilized.

The increase in college students with mental disabilities has also spawned research into the individual and social barriers faced by these students on college campuses. Ryser and Alden (2005) researched advising models for students with learning disabilities and indicated challenges faced by both advisors and advisees. Their research uncovered the pressures that advisors can find themselves in; specifically, advisors often felt overwhelmed by the struggles that students were having and had difficulty knowing what issues they were qualified to talk to students about. Academic and emotional stress are linked to poor mental health (Dusselier et al., 2005) and advisors struggle to balance supporting the student without entering into a therapeutic relationship (Ryser & Alden, 2005).

The literature regarding barriers faced by students with mental disabilities contained common themes, predominantly focusing on the stigma around going to a counselor and the individual traits of the student (Eisenberg, Downs, Golberstein, & Zivin, 2009; Hunt & Eisenberg, 2010; Storrie et al., 2010). Hunt and Eisenberg (2010) also found that Asian American students were significantly infrequent in seeking counseling, even those battling mental disabilities. This supports the national study conducted by Wong, Brownson, and Schwing (2011) that found Asian American students avoiding counseling, in part, due to the model minority myth. Additional research needs to be done addressing how to diminish the negative stigmas surrounding counseling, however, this would be challenging due to the unique environment of each campus.

In addition to these barriers, an exhaustive study of persons with disabilities by Wells, Sandefur, and Hogan (2003) demonstrated that students who receive individualized services (e.g. allowed extra time on tests, oral tests, etc) can often be identified by their peers and subsequently become public knowledge. Thus, the literature indicates that students, who might need this type of support, often avoid it for fear of standing out. School administrators are in a difficult position because they want to know which students are battling mental disabilities but the social pressures felt by students make those students increasingly hesitant to request help.

The importance of training professional staff and paraprofessional staff (e.g. Resident Assistants) was heavily emphasized in the literature, in addition to better communication between staff, faculty, and counselors (Ryser & Alden, 2005; Storrie et al., 2010; Taub & Servaty-Seib, 2011). The research noted the need for staff and faculty to be trained about the counseling process, the ethical boundaries and restrictions surrounding the counseling relationship, and familiarity with the counseling staff at the institution (if available). Taub and Servaty-Seib (2011) focused their research on how to train RAs, and underlined the value of building a relationship with the students in the RA’s sphere of responsibility. Since RAs are often most familiar with the students on their hall, the RAs are an important asset to readily identifying students who are wrestling with mental or emotional struggles. The research denotes that consideration for how RAs will function in a situation with a mental or emotional health crisis should be an integral part to the hiring process.

Summary of what the Literature Reveals

After examining the research for caring for students with mental disabilities in higher education, there are several things which the literature reveals. First, substantial research indicates an increase in college students presenting with mental disabilities. Debate exists over whether or not the mental disabilities students are presenting with are also increasing in severity or just numerically (Much & Swanson 2010). The increase has been attributed to the increasingly complex stressors people are facing today and the impact of the ADA and similar legislation, allowing for students with mental disabilities to be admitted into postsecondary education. Stress acts as an aggravator for students with mental disabilities and can cause mental and emotional health problems. Critical to this understanding of stress was the research by Dusselier et al. (2005). Stress will always be a part of life, especially in college, and the literature pointed to the importance of knowing how to refer students to counseling.

Second, in thinking about how to care for students, it is vital to invest in training for staff and faculty. Research indicated that advisors face difficult situations as they work with students where stress (social and academic) is often manifested. However, the vast majority of them were found to be confused as to the boundaries of their roles. Educating advisors on how to identify at-risk students and how to refer them to counseling is a necessary responsibility for colleges to undertake. Faculty often observe the academic stress that students face but research demonstrated that communication between faculty and counselors is limited at best. It was acknowledged that this is primarily due to the privacy rights of the student but there would be benefits from faculty knowing how the counseling center works so as to alert counselors to students which the faculty observes as at-risk. Caring for students must be understood to be a team effort, an effort which includes paraprofessionals such as RAs. Research stresses the need for staff and faculty to be familiar and knowledgeable about students with mental disabilities and the counseling services that are available for referral.

Finally, the legal implications for how colleges respond to students with mental disabilities are vital to understand. Salient to this discussion is the legislation prohibiting colleges from denying students admittance solely due to a disability, the rights of the student to not disclose his/her disability, and the confidentiality that must be adhered to by counselors and staff. The literature often mentioned familiarity with all applicable laws as an automatic expectation for all staff, faculty, and counselors. Findings pointed to problems in caring well for students with mental disabilities when the law went unobserved or unutilized. Confidentiality restrictions can be tempting to break but the research pointed out that students are often fearful of their problems becoming public knowledge, therefore, it is of the utmost importance to ensure that all confidentiality requirements are being strictly followed in accordance to the law and that students are aware of the colleges adherence to said laws.

Recommendations for Future Research and Conclusion

The literature relating to students with mental disabilities in higher education revealed an impressive amount of research and yielded many informative findings. However, there were some gaps in the literature that further research would do well to fill. The following are recommendations to address aforementioned gaps. The research often argued for the importance of a holistic approach among staff, faculty, and counselors to care for mental and emotionally unhealthy students but there was not research demonstrating effective ways of accomplishing that or, if such a system was in existence, explaining its effectiveness. The literature was optimistic about this approach and the potential for improvement demands further investigation.

In addition to the research for training RAs, more research should be done to examine how best to train advisors and other staff on the complex issues surrounding students with mental disabilities. With a demonstrated increasing presence on campus, it is imperative that research be proactive in pursuing how best to cultivate an environment that is conducive to healthy living for everyone involved. What would it look like for all staff and faculty to have basic training on how to identify and work with students with mental disabilities? Would the investment in such training yield significant enough results to warrant this strategy?

One component of this topic that was sorely in need of research was housing practices for students with mental disabilities. It would be helpful to have research recommending best practices for how to house students with different mental/emotional disabilities (e.g. should they have a room to themselves, one roommate or more, which floor should they be on, etc.). It would also be important to research how best to support and care for the roommate to the student with a mental/emotional health problem. Again, as more students are wrestling with mental disabilities, it becomes imperative to have researched guidelines and recommendations for housing these students.

This is a topic which will continue to evolve and will require continued research for caring and supporting this sector of the student body. Thankfully, much has already been done in this field and awareness of this topic’s salience is growing quickly. The need for further research is widely recognized and this bodes well for professionals and students in this field. The challenge facing future researchers is assessing the unique environments of thousands of college campuses and consolidating the data so that demonstratively helpful practices emerge. There is a plethora of good research to build on and I am confident that good progress will continue to be made for better understanding, supporting, and caring for students with mental disabilities.

Chris SternBy Chris Stern
Read author’s bio here

References

American School Counselor Association (2010). Ethical standards for school counselors. Retrieved from http://www.schoolcounselor.org/files/EthicalStandards2010.pdf

Americans with Disabilities Act of 1990, Pub. L. No. 101-336, § 2, 104 Stat 328 (1991). Retrieved from http://www.ada.gov/pubs/adastatute08.htm

Aron, L. & Loprest, P. (2012). Disability and the education System. The Future of Children 22(1), 97-122. Princeton University.

Dusselier, L., Dunn, B., Wang, Y., Shelley, M. C. II., Whalen, D. F. (2005). Personal, health, academic, and environmental predictors of stress for residence hall students. Journal Of American College Health, 54(1), 15-24.

Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research And Review, 66(5), 522-541.

Evans, N.J., Forney, D.S., Guido, F.M., Patton, L.D., & Renn, K. A. (2010). Student development in college: Theory, research, and practice, 2nd Ed. San Francisco: Jossey-Bass.

Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal Of Adolescent Health, 46(1), 3-10.

Much, K., & Swanson, A. L. (2010). The debate about increasing college student psychopathology: Are college students really getting “sicker?”. Journal Of College Student Psychotherapy, 24(2), 86-97.

Ryser, J., & Alden, P. (2005). Finessing the academic and social-emotional balance: A revised developmental advising model for students with learning disabilities or ADIHD. NACADA Journal, 25(1), 51-63.

Storrie, K., Ahern, K., & Tuckett, A. (2010). A systematic review: Students with mental health problems—A growing problem. International Journal Of Nursing Practice, 16(1), 1-6.

Taub, D. J., & Servaty-Seib, H. L. (2010). Training resident assistants to make effective referrals to counseling. Journal Of College & University Student Housing, 37(2), 10-25.

U.S. Department of Education, Office for Civil Rights. (1998). Auxiliary aids and services for postsecondary students with disabilities: Higher education’s obligations under section 504 and title II of the ADA . Retrieved from http://www2.ed.gov/about/offices/list/ocr/docs/auxaids.html

Wells, T., Sandefur, G. D., & Hogan, D. P. (2003). What happens after the high school years among young persons with disabilities? Social Forces. 82(2), 803-832.

Wong, Y. J., Brownson, C. & Schwing, A.E. (2011). Risk and protective factors associated within asian american students’ suicidal ideation: A multicampus, national study. Journal of College Student Development, 52(4), 396-408.

 

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