More and more young people are headed to college with an already diagnosed mental health condition. Many of them have been in some sort of therapy, take one or more medications, and receive support services through their high school, from private tutors and/ or other agencies. For these young people, planning ahead for their ongoing mental health needs and academic support needs should be part of the college application process and should begin long before they step onto campus.
If you have a mental health condition you will also need to be ready to manage your mental health care more independently and will need a plan for who will provide you with your ongoing treatment needs. You can be successful with preparation and advanced planning.
Preparing for the transition: middle school and high school years
Starting in middle school and throughout high school, you have many opportunities to gradually develop:
- knowledge of your condition,
- the skills to manage it, and
- the ability to advocate for yourself.
Your parents, school counselors, teachers, and mental health providers should guide you in this process. For example, learning the name of your condition, medications and their side effects, taking increasing responsibility for taking your medication, are all steps in the right direction. Gaining these transition skills should be happening in parallel with you learning more about yourself through academics, social relationships, volunteer experiences, work experiences, extracurricular activities, experiences with faith or religion and your family life.
Preparing for the transition: beginning the college search process
Many high school students begin to think about and learn about college more earnestly and intensely during the summer before 11th grade or during junior year of high school. This is a great time for you to meet with your mental health providers, along with your parents/guardians and other supportive adults, to begin to develop a plan. This should be the start of a series of discussions to frankly review:
- your functioning including your goals, dreams, strengths, vulnerabilities, diagnosis, prognosis
- your level of support (from family, providers, school, friends, tutors, agencies)
- your short and long term treatment goals and service needs ( for ex., how often do you need to meet with a therapist or prescriber? Do you need other kinds of support services to be ok)
- the full range of post-secondary options available to you (gap year, community college, work+school, four-year school, technical school, delayed matriculation, etc.)
Based on these discussions you should create a list of criteria for selecting colleges to visit. These characteristics may include:
- availability of a campus counseling service
- availability of someone who is able to prescribe medication on or near campus
- availability of disabilities resources on campus
- distance from home
- cost of visiting home
- availability of specialty services for those in need (for example, eating disorder or care for those with substance abuse issues)
- campus at-risk team
- emergency services or hospital near campus in case of crisis
- a track record of supporting students with mental health challenges
In addition, it is important at this time to:
- determine if you need to update your psychological/educational testing (most colleges do not accept testing to secure accommodations if it is more than three years old)
- apply for testing accommodations (SAT and ACT) if you are eligible
You should continue to review your plans and discuss your situation with your care team and your family through your junior and senior year. If there are changes in your clinical situation, you may need to reconsider your plans or decisions. But is important to keep the transition to college as part of treatment and planning during this period.
Learning about mental health resources on/near campus
Just as each school has different academic programs, different student populations, and a different “feel”, etc., so too each campus has different mental health and support services available. You can learn about the services offered, requirements to utilize services, their cost and their accessibility in a few ways. Please note, it is best if you know that your service needs can be met at a specific institution and in its surrounding community before you apply and definitely before you matriculate.
- visit the college’s website and search using various terms such as (counseling center, mental health services, disability services, psychiatric services, etc.)
- during college tours pay attention to information provided about mental health and disability services
- contact the school’s counseling center to learn more about the services offered
- once accepted, visit the counseling center and/or disabilities services office during accepted students’ visitation days
- once you select a school, visit or contact the counseling center and/or disabilities services office to discuss your specific concerns and needs
Establishing your treatment team
Similar to many other young people headed to college, you may prefer to remain with your home-based treatment team. You may feel comfortable with your current providers, you do not want to “start over” with new providers, and it just might seem to be the simplest approach to take. However, providers will take into consideration many factors as they discuss treatment plan options with you. The goal is to develop thoughtful, practical, individualized and safe care plans which maximize continuity of care during your transition to adult-level care and to campus.
Some factors taken into consideration by your providers are:
- patient age limit restrictions for some practices
- how stable your condition has been
- how prepared you are to manage your mental health needs independently
- how far away you will be
Some possible treatment plan arrangements are:
- complete transfer of care to providers on or near campus
- treatment shared between home-based and campus-based (on or near campus) providers
- treatment continues with home-based providers
Despite the obvious differences among the above treatment plan scenarios, there are also some important common elements.
- In most cases, providers will recommend that any major medication changes, especially trials off medications, be completed and assessed by late winter/early spring of your senior year in high school. Major medication changes in the few months prior to matriculation put you at risk for problems and it makes sense to plan and make changes with the team that already knows you well.
- You will be asked to commit to a certain frequency of follow-up contacts and/or appointments.
- You will be strongly encouraged to disclose your disability (if applicable) through the campus disabilities office during orientation or as soon as possible after you arrive on campus.
- You will be asked to sign releases of information for new providers to speak with former providers or, in the case of shared treatment, for all providers to communicate.
- You will likely be asked to sign a release for your providers to be able to contact your parents/guardians if you are having difficulties that put you at risk or that they may be able to help address with you. Parents are a good source of historical information and often students turn to their parents in times of distress. Please note that your parents can call your providers with their concerns at any time. The overall goal is open and transparent communication among your support team members with you as an active participant.
- You should establish a plan for when you will reach out for help and whom you will contact first and as a backup if you are not feeling well.
- You will be asked to collaborate on the development of a back-up care plan in the event of a crisis or emergency.
Ideally, your treatment plan should be discussed in detail and put in writing for all key members of your care team. This is especially important in the case of shared treatment. For example, it would make sense to consider your physical location (at school vs at home) to determine who is in charge of your care at any given moment or in the event of an emergency. Of course, everyone wants to be helpful, and should respond and then collaborate in an emergency. Also, if you have medical providers both at home and school, they will need to establish a mutually agreed upon medication refill policy.
Helpful transition tools
Part of self advocacy is being able to tell others about your condition, how your condition impacts your day-to-day functioning, what you need to help you be successful, and what treatments have been tried and been proven helpful or not helpful. Many young people find it helpful to have an easily accessible, electronic copy of a psychiatric medical summary. Such a summary may prove very interesting to you as you evaluate your readiness for college. Ask your mental health providers for their help in preparing this summary. If you will be receiving care at the campus counseling center or if the counseling center may be providing backup treatment, it might be a good idea to have your history on file at their offices. This can also be helpful in case of a medical or mental health emergency.
A psychiatric medical summary typically includes:
- psychiatric diagnosis
- medical conditions
- outpatient treatment history
- other treatments
- allergies to medications, current medications and past medication trials
- diagnostic studies such as lab work, EEGs, brain scans, psychological/neuropsychological testing
In addition to a psychiatric medical summary, it might prove helpful to pull together other important documents into a transition portfolio. A transition portfolio could include:
- psychiatric medical summary
- educational, psychological, neuropsychological testing
- current or most recent 504 Plan or IEP
- list of accommodations and services you may need in college
- psychiatric advanced directive
Obstacles to treatment on campus
Once on campus, you will face many new opportunities and challenges. Some of these experiences may get in the way of your treatment compliance. It is important to talk with your providers ahead of time about these possibilities, that is, anticipate these obstacles or pitfalls, before you head to campus.
Here are some topics to frankly discuss with your provider:
- a desire to shed your old identity and start fresh on campus
- worries about confidentiality
- worries about stigma
- avoiding contact with providers, family and old friends in your new found independence
- your hesitation to see new providers
- a false sense of stability during the easier times of the academic year and stopping treatment
- distinguishing college adjustment issues from more serious mental health problems or setbacks
- how alcohol and drugs may affect your medications and your problems
- how not getting enough sleep may impact you and your problems
Health promotion on campus
Taking care of yourself in ways that promote overall good health and mental wellness is an important part of your transition to campus life. Talk with your support team about and make plans for:
- good nutrition
- regular exercise
- good sleep practices
- smart and safe use of the internet/social media
- tobacco, energy drinks, alcohol and drugs
- safe sex
- stress management
- time management
- dealing with difficult roommates
- wellness programs available on your campus
There are times when even the most well thought out and comprehensive transition treatment plans do not work. It is possible, for example, that a student simply finds that the school is not a good fit and transfers, despite good intentions a student does not comply with the plan, accessibility to the defined services was more difficult than anticipated, a planned new provider moves or becomes ill, etc. These possibilities should not be viewed as failures but as learning experiences for all involved.
For additional helpful information on heading to college with a psychiatric diagnosis, please go the website of the American Academy of Child and Adolescent Psychiatry and review these Facts for Families on college mental health.