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Talia Puzantian, PharmD, BCPP
Professor of Clinical Sciences
Keck Graduate Institute
Claremont, CA

Mental health concerns are common among college students. According to a recent survey, more than 1 out of 3 students reported feeling too depressed to function in the previous 12 months, and 3 out of 5 felt overwhelming anxiety.1 The 2017 National Survey on Drug Use and Health found that 25.4% of full-time college students reported any mental illness, and 7.6% reported serious mental illness, in the past year.2 Alarmingly, 10% had serious thoughts of suicide in the past year, 3.2% planned suicide, and 1.3% made an attempt.2 Graduate students have the highest rates of suicide among students in collegiate programs according to a report from Suicide Prevention Resource Center, and women graduate students are at greatest risk.3 Graduate students may experience more stress than undergraduates, including increased financial burden, concern about time away from careers, being out of the workforce, and uncertainty about the future job market. Specifically, in healthcare professional students, high and continuous levels of stress often result in burnout, which has been shown to negatively affect academic performance, mental health, and quality of life of professional healthcare graduate students.4 Additionally, students of color, international students, lesbian, gay, bisexual, and transgender (LGBT) students, and other minority groups may face increased risk.

To address the mental health and wellness of college students, including student pharmacists, many programs have developed proactive and comprehensive schoolwide initiatives that can help improve mental health, reduce stress, and prevent suicide among students.

Gatekeeper Training

Many student pharmacists are aware of the signs and symptoms of stress, anxiety, or depression that they experience. However, identifying as developing healthcare professionals, they may not acknowledge when they need care and may be reluctant to seek treatment. A “gatekeeper” can be anyone (student, faculty, staff) who is trained to identify, reach out to, and refer a student who may be developing mental health symptoms or who may be in crisis. Ideally, all members of a campus community should be trained as gatekeepers. At the very least, student leaders, resident advisors, faculty advisors, and student affairs staff should be trained. There are many types of gatekeeper trainings available, allowing programs to select a training that best fits their particular setting and needs. Popular trainings include:

  • Question, Persuade, Refer (QPR) – online or in-person, 1-hour, training in which the gatekeeper learns how to directly but gently question someone who may be suicidal
  • Campus Connect – in-person, 2.5-hour, interactive training with role-play to practice skills taught
  • Kognito – online, interactive, 30-minute (students) or 45-minute (faculty) simulations that raise awareness, knowledge, and skills
  • Mental Health First Aid – in-person, 8-hour, skills-based training to help trainees identify, understand and respond

At Keck Graduate Institute (KGI), we have successfully implemented Kognito training for all incoming students and for all faculty/staff, as well as Mental Health First Aid (taught to all 3rd year PharmD students). We also developed a one-page “Care Guide” which helps identify signs of distress, determine what steps to take, and provides key campus resources and contacts as well as crisis lines.

Fostering Connectedness and Belonging

Research has found loneliness and isolation to be significant risk factors for mental health problems, including suicidal thoughts and behavior. Creating a campus culture of connectedness and helping to foster supportive, inclusive social relationships, particularly among traditionally marginalized or higher risk groups, can be protective and preventive. Initiatives to help foster such a campus environment include the development of peer mentoring programs, offering a rich variety of student groups and organizations, defining spaces for student groups to meet, and proactively reaching out to disconnected, isolated or marginalized students (LGBT students, veterans, survivors of violence, students with disabilities, international students, non-traditional students, etc). Often, campus resources may be far from student classrooms creating a barrier or disincentive for engagement. Promoting these resources to students through Brown Bag Lunch programs, drop-in hours, or resource fairs increases connectedness.

Social and Emotional Skills and Resilience

Resilience, grit, and mindset have been described as factors that help students succeed.5 Supporting life skills education, and interpersonal and emotional awareness can help student pharmacists cope with stress, make wise lifestyle choices, and foster resilience. Programming should cover a broad range of topics including communication skills, identifying and regulating emotions, conflict resolution, distress tolerance, relationship skills, managing finances, study skills, test anxiety, stress management, time management, and lifestyle choices for wellness (sleep, exercise, nutrition). In our program, these are covered in a variety of ways – Professional Development Series (PDS) courses, KGI Cares Peer Mentors events, Health Education Outreach peer educators, and “Live Hacks”, a graduate student process-oriented support group provided by our counseling center. This year, we will also be embedding a positive psychology course (Happy Hour, Carleton College https://apps.carleton.edu/healthpromotion/mental-health/happy-hour/) into one of our PDS courses. Other similar programs include the Georgetown Mind Body Program (https://som.georgetown.edu/medicaleducation/mindbody/), the Penn Resilience Training for College Students program (https://ppc.sas.upenn.edu/research/resilience-college-students), and the University of Wisconsin’s At the Heart-Understanding and Managing Emotions (https://wire.wisc.edu/YourSelf/Emotions.aspx).

Reducing Shame and Stigma

Promoting help-seeking behavior is a critical component of a comprehensive student wellbeing program. Often, students experiencing emotional distress are reluctant to seek help due to stigma and prejudices associated with mental illness. Initiatives to eliminate such stigma ideally should be designed and delivered by students, be delivered in a range of methods (fairs, events, activities – goat yoga!, social media campaigns, posters, etc.), normalize mental health problems, and inform students about campus resources. Our KGI-CPNP student chapter has created and widely disseminated public service announcement videos, provided open forum discussions on stress management, planned movie screenings, and invited NAMI In Our Own Voice speakers. Our chapter was also instrumental in mental health fairs such as Fresh Check Day (https://freshcheckday.com/) and Love is Louder (http://loveislouder.com/). Pharmacy programs with CPNP student chapters can make a huge impact on reducing shame and stigma, thereby increasing help-seeking behavior!

Finally, two cornerstones of creating and sustaining a campus culture that promotes student wellbeing must be that:

  1. Student wellbeing is not the sole responsibility of the campus counseling center. It is a campus-wide responsibility and shared value for the entire campus community.
  2. Programs and initiatives for student wellbeing must have support from leaders on campus, not only in the form of financial support, but prioritization and an acknowledgment of the importance of supporting student mental health.

References

  1. American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2018. Silver Spring, MD: American College Health Association; 2018. Retrieved from https://www.acha.org/documents/ncha/NCHA-II_Spring_2018_Reference_Group_Executive_Summary.pdf (accessed September 22, 2019).
  2. Substance Abuse and Mental Health Services Administration. (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf (accessed September 22, 2019).
  3. Suicide Prevention Resource Center. (2004). Promoting mental health and preventing suicide in college and university settings. Newton, MA: Education Development Center, Inc. Retrieved from http://www.sprc.org/sites/sprc.org/files/library/college_sp_whitepaper.pdf (accessed September 22, 2019).
  4. Bullock G, Kraft L, Amsden K, et al. The prevalence and effect of burnout on graduate healthcare students. Can Med Educ J. 2017;8(3):e90-e108.
  5. Stoffel JM, Cain J. Review of Grit and Resilience Literature within Health Professions Education. Am J Pharm Educ. 2018;82(2):124-134.
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