Mental Health on College Campuses

Does the Americans with Disabilities Act cover people with mental illnesses? How has COVID-19 impacted people with mental illnesses, particularly those in virtual learning settings? How should college students ask for accommodations on campus? Where can students go for mental health resources? 
This edition of Ask About the ADA features an interview with Brittany Stone, a lecturer in the Department of Psychiatric Rehabilitation and Counseling in the School of Health Profession at Rutgers University, who specializes in mental health and the ADA on campus. For a transcript of today's episode, please visit the Ask About the ADA podcast feed on BuzzSprout.

Learn more with the Northeast ADA's blog about mental health accommodations and the National Association on Mental Illness's guide to college student mental health.

NortheastADA.org

Transcript

[MUSIC PLAYING] 

JOE ZESSKI: Hello, and welcome to Ask about the ADA, a podcast where we answer your questions about the Americans with Disabilities Act. I am Joe Zesski, the program manager at the Northeast ADA Center. Joining me today is our producer and editor, Grace Fairchild. And we have a guest today. We are interviewing Brittany Stone, who is with Rutgers University. She is a lecturer in the School of Health Professions. Brittany, welcome, and thanks for joining us today. 

BRITTANY STONE: Thank you for having me. I'm really glad to be here. 

JOE ZESSKI: We appreciate you coming. And let's begin first by introducing you a little bit more, so that people know more about who you are and what you do. Could you share with us some of your expertise and how you got to where you are now? 

BRITTANY STONE: Sure. So like you said, I'm a lecturer in the School of Health Professions at Rutgers. I'm in the Department of Psychiatric Rehabilitation and Counseling Professions. So my primary role within the department is providing training and technical assistance to agencies and staff seeking to improve education and employment outcomes for people with mental health conditions. And I do this work within New Jersey, but also surrounding states. We do a lot of web-based trainings. We do in-person, as well as in vivo work, where we get to go out into the community and model and demonstrate certain skill sets for counselors. I also get to do a little bit of teaching in our undergraduate psychosocial rehabilitation program. And sometimes, I get to teach in our graduate program, rehabilitation counseling, which is the program that I went through to become a certified rehabilitation counselor. Currently, I'm working on two federally funded grant projects as a co-investigator. They're both funded by the National Institute on Disability, Independent Living, and Rehabilitation Research. One of the projects is designing a manualized supported education intervention for college students with mental health conditions who are in career and technical education programs. And the other grant is a cognitive behavioral intervention for college students with PTSD. And one of the really great things about that intervention is it's going to be a telehealth intervention, which is so needed right now. So as you can see, I really have this passion for working with college students around college student mental health and wellness. I'm also doing my doctoral studies right now in a counselor education and supervision program. And a real area of focus for me is student disclosure decisions, and how to provide intentional support to students thinking to disclose mental health or other non-apparent conditions to faculty or to their peers. My background is in rehabilitation counseling, primarily around mental health and psychiatric rehabilitation. So one of the things that really led me to psychiatric rehabilitation and counseling is that it has a really strengths-focused approach and recovery-oriented approach to mental health services. It's very much on the other side of the medical model of mental health. And it just was so appealing to me because mental health and wellness are--they're health! They're health-related. And often, it kind of gets pulled as something separate or something different than that. 

JOE ZESSKI: And of course, we focus a lot on the Americans with Disabilities Act on this podcast, but that intersects with a lot of different things, including mental health. How do you see the ADA intersecting with some of the work that you do? 

BRITTANY STONE: So the ADA plays a pretty big role in a lot of the work I do. Many college students with mental health conditions, they don't recognize that the ADA can protect them and offer them the same rights. They don't realize that they're covered under the Americans with Disabilities Act. So part of my work is to provide that education and advocacy, and teach them about what their rights are and how to be able to access different types of supports because of it. And those are things like academic or campus-based accommodations. 

GRACE FAIRCHILD: I have to say, I really do appreciate that you are focusing on college students. As a senior at Cornell, that seems very prevalent to me, and really necessary. So what would you say that college students specifically should know about the ADA and their rights at school? 

BRITTANY STONE: Well, first of all, that mental health is covered. So recently, some colleagues and I were doing focus groups of students with PTSD, and so many of the students didn't realize that they could be receiving accommodations because of PTSD. So I wish that more people knew that those services were available to them, and then how to be able to access those services, how to communicate the types of things that they need, and how to be able to have conversations with their professors around those needs. 

JOE ZESSKI: What do you see as the biggest challenges facing students on campus who have mental health conditions? 

BRITTANY STONE: Well, mental health is still a pretty stigmatized health condition. So there are a number of students who are really concerned about accessing supports and services because of the stigma associated with it. Additionally, college-age students, for some of them, it might be the first time that they're needing to access accommodations and utilize the ADA and those protections. So they might not know what they need, and they might not know who to go to have those needs met. They might know that they're having trouble in their coursework, but they don't know what they don't know in terms of what do I ask for, what can be done to best support me. Some students even feel like it's cheating to be able to access accommodations, or that they're getting an unfair advantage. So there's a lot of misconceptions about accommodations and about supporting students with mental health conditions. 
Additionally, because of that level of stigma and the cyclical nature of mental health conditions, students might be fine, they might not be experiencing symptoms for part of the semester, and then something triggers their symptoms or symptoms start to emerge, and then they need support. So that can create uncertainty around how to ask for help. It can create some faculty resistance at points. I've had a number of students say to me, you know, I've had faculty that say to me, well, you don't look like you need an accommodation, because mental health is not apparent condition. Or I've had faculty members say to students, you know, you didn't need an accommodation at the beginning of the semester, why do you need it for the midterm? Or now it's finals, and why do you need an accommodation? So some of that challenge from faculty, who just don't understand the way that mental health conditions can present and can affect student learning. 

JOE ZESSKI: I can say, too, that from working on the technical assistance line at the Northeast ADA Center over the years, I've found that to be true, yes, in college, but even outside, too, in the workforce and in other life circumstances, that mental health conditions have their own sort of set of unique challenges in terms of different accommodations because of those reasons. It's, I think, a type of disability that, for many people, is a little bit harder to grasp how it affects a person because it's not something they can see or touch. I'm not surprised by what you said. 

If I could delve into it a little bit more, just to give people who are listening who may not be familiar a little more background in terms of accommodations and mental health, particularly like what we're talking about with students, can you describes some different types of accommodations that a student with PTSD or depression or another type of mental health condition might need or might seek? 

BRITTANY STONE: Well, and so this is part of the complexity, right? There are a number of different types of mental health conditions, and they don't manifest the same way. It doesn't always read like a textbook. So that becomes a challenge for disability service providers, and for the students themselves to be able to find the right types of accommodations. So the first thing that we do when we're talking to a student is thinking about what do you need. What are the barriers that you're experiencing? What's getting in your way? Sometimes, students don't have the language, especially if this is something new that they're living with. But they might say, I have trouble with. I have trouble with retaining information. I have trouble with getting myself motivated. I have trouble being able to stay focused in a lecture. So we hear those sorts of things. So we're looking at kind of what is this spectrum of need that you have. And again, when we're thinking about college students, it's what are your needs in a lecture, what are your needs in a lab, what are your needs when you're taking exams, what are your needs when you're studying. So it's looking at all of these things, and then balancing that, of course, with the student's strengths. So it really is going to depend on what the condition is and what the barriers are associated with that condition in the specific environment. So for example, one of the most common accommodations that we see-- and I think this is for more than just mental health conditions-- is extended time. 

JOEZESSKI: Yeah, definitely. 

BRITTANY STONE: Now, extended time is really great if you are having difficulty with internal stimuli, so you're hearing voices, or even external stimuli, you get distracted by other things in your environment. And you need a little bit more time to be able to focus on the exam question and be able to pull out the information that you need. Extended time is a wonderful accommodation for those things. However, for students who might experience depression or might have experienced something like obsessive compulsive disorder, giving extended time might not always be the best type of accommodation because more time is more time to kind of put it off or to ruminate, and to go back over that word or that sentence or that paragraph to make it just right. 
So for some students, instead of doing that extended time, doing kind of chunked time might be a better option. So complete the first half of this paper or this assignment. You have this much time to do it. And then the second part of the assignment, you have this much time. So it's these segmented due dates or segmented chunks of time instead of longer and more drawn-out time. For students who might have PTSD, being able to sit close to the door. Often, professors have flexibility in seating, but sometimes, in lab settings, people will have assigned stations. So if a student who is experiencing PTSD might need to step out and take more frequent breaks, or if there's something that's triggering in that environment, be able to step away. So having easy access to an exit might be a great accommodation. There's also really good modifications of different types of assignments. Rather than standing up and providing an in-class presentation, a student might be able to do a recorded presentation. So they still have to demonstrate content knowledge and competence in those specific areas, but for a student who's experiencing anxiety or different types of social phobias, having to stand up and speak in person, that might really affect their performance and their ability to retain and present the information in that presentation format. Now, because we have to keep within the ADA, we need to make sure that the student is meeting the essential functions or the technical standards of that program. So for a public speaking class, a prerecorded assignment might not hit that. However, for most of our other academic courses, being able to provide a recorded presentation rather than an in-class presentation could really fit that need. 

GRACE FAIRCHILD: So within your work, what have you seen with the availability of resources on campus, beyond specifically working within the ADA? Do you think there are enough resources for students on campus, or what would you suggest to improve those resources? 

BRITTANY STONE: Unfortunately, there just aren't enough resources for students with mental health conditions, or to even just meet student mental health needs and wellness-related needs. We have seen a steady increase of the number of students with mental health conditions on campus, which is a wonderful thing, but then we're not able to provide the right types of supports that they need in order to be successful. So there are disability services or accessibility services available on campus for students, which is really wonderful. But if students don't know that they're able to access those types of things, then they're not seeking out those types of supports. 
Additionally, counseling services on campus often has a lot of waitlists and limits on the number of sessions that students can have. So it makes having that consistent mental health support really challenging for students. Students with mental health conditions, research tells us that they underutilize campus-based services and supports, often for fear of stigma or because it's just really hard to access. And when it comes to being able to utilize disability services and receive accommodations, one of the barriers is the documentation of disability that students need to provide in order to get those types of supports and accommodations. 

JOE ZESSKI: And part of that comes from the change in documentation, often, that you see going from high school to college, right? Is that part of the issue, or what contributes to that struggle with getting documentation? 

BRITTANY STONE: Yeah, so there's a few things there. That shift from high school to college is a big one. It's a really large shift in responsibility for what the student is required to do, right? So when you're going from high school to higher education, it's now up to the student to self-identify. They have to provide the documentation that's required by the school. Different schools require different levels of documentation. So that's something unique, too. It's up to them to disclose. And often, students haven't been taught how to do this, this advocacy work in that way. And then they're overwhelmed by the process. They're overwhelmed by fear of stigma. They don't understand what their rights are. They don't understand what it is that they need. So when it comes to the documentation piece, as I said, different schools require different types of paperwork and documentation. Some schools that have campus-based support services might not provide the documentation because they're not providing a diagnosis to students. So they might have a therapist on staff who can do counseling, but they're not providing disability documentation. Other students don't want their parents to know, if they're still on their parents' insurance, that they're going to see a psychiatrist or a therapist or a counselor for mental health supports. And then other times, students are just--when you think of college age, identity development is a really big part of that, figuring out who you are and what your identity is. And for some students, disability identity is part of who they are, and for other students, they don't want to take that identity on because of the stigma associated with mental health conditions. So if they have to get a piece of paper that says they have a mental health diagnosis, it's not always in line with the way that they see themselves or who they are. 

JOE ZESSKI: Definitely. 

GRACE FAIRCHILD: That is a really excellent point. Switching topics a little bit from college students to mental health more generally, how have you seen the pandemic impact mental health? 

BRITTANY STONE: Almost a year and a half now that we've been living in this pandemic universe, and it's really been hard on people's mental health. And people who didn't previously experience mental health issues are now reporting higher rates of anxiety and depression and substance use. And for people who already were living with mental health conditions, for some of them, we've seen an exacerbation in symptoms. People who had really great strategies and wellness plans, those sorts of things were no longer working because of the isolation and because of the shift in the way that our lives have been conducted. So during the Association of Higher Education and Disability annual meeting, we talked to the knowledge and practice group on mental health there, and they were asking, what have you seen within your disability service offices? And the majority of people who attended that meeting were saying we have seen a huge increase in students requesting accommodations for mental health conditions. So we've definitely seen an increase of students seeking counseling supports or seeking ODS supports. 

GRACE FAIRCHILD: Right. And I want to dive into that a little bit more, because what do you think it is about students that might have been more impacted by the pandemic than just the rest of the general population? Is it something to do with remote learning? Is it something else? 

BRITTANY STONE: I think it's a whole combination of things. Remote learning was certainly a big challenge. So while it's provided a wonderful flexibility, it's also provided a bit of an isolation. And for students who have difficulty with certain executive functioning issues, which are also associated with mental health conditions, having to do alot of self-directed learning or learning in an environment that isn't always conducive to learning-- so you might be in a shared space with other people. You might not have the same level of resources. We've seen a lot of students who have food insecurity related to the pandemic or loss of employment related to the pandemic, abuse or neglect within their home life, and then no outlet for that. So we see a whole bunch of these different factors. And then we also, again, with the online learning, if students are having trouble self-directing, that is really required in an online environment, that you have to really be much more rigid in terms of setting your own boundaries, setting your own guidelines. And that type of planning and reasoning and attention control can be very challenging because of the way that mental health impacts those pieces of learning. 

GRACE FAIRCHILD: So as students transition back to in-person classes in the fall, do you look in your crystal ball and see any sort of predictions for what students might struggle with during that transition? 

BRITTANY STONE: Good question. You know, I think anxiety is definitely a big one. We've heard from a lot of people that they have a lot of health anxiety now, and they are fearful about returning to campus and being in those confined spaces and around a lot of people. But then also, adjustment-related issues. So it was a huge shift for many of us to go into more isolation and social distancing, and then we've lived that way for a while. So to now go back into it, it takes time to build up that tolerance of being around so many people and having the stimuli and being out of the house again, and potentially having to get dressed to be in public, to carry on small talk, to kind reintegrate to sitting in a three-hour lecture in a hall, instead of in your room in front of your computer. So I think there will be a lot of those adjustments issues. That might also lead, for some people, to depression or instances with anxiety. I think we will also see a lot of requests for accommodations to remain virtual or to continue to do online classwork or synchronous coursework. And I'm hoping that a lot of universities and a lot of programs are able to maintain that, because I think if you're looking at it from likea universal design approach, offering students that flexibility, whether or not they have a disability, can be really powerful, and it can help get more people engaged and connected if they can't make it to campus, if they have transportation issues. And for a student with a mental health condition, perhaps they can't get out of bed to get to campus, but they can turn their computer on and keep their camera off, and still be able to get the benefit of that lecture. So I think we're going to see a lot of accommodation requests for that continued availability of online learning. 

GRACE FAIRCHILD: Definitely. And just generally, what do you wish that people knew about the ADA? 

BRITTANY STONE: I wish more people knew that collaboration and communication can make it work so much better for them, that it isn't just like this I've gone, I've gotten these accommodations, I'm approved, I'm all set, but that there really is a lot of collaboration that can make it better. If the accommodation doesn't work for you, you want to be able to go back and communicate that with the representative from your school. And you can ask for different types of things. It's not always going to work on that first try, but that there is this built-in collaborative process of, OK, this works really great, this thing doesn't. But you have to be able to stay in communication because it is so self-directed in higher education. And that's, again, a really big shift from going from high school into college. I also wish students were better prepared to have these conversations with faculty. So while they don't have to disclose the nature of their condition to a faculty member, they do have to talk about what the accommodation might look like in the classroom. And how do you do that in an articulate way, in a way that stays true to who you are, in a way that protects your privacy? So I wish there was more around that piece of communication. 

JOE ZESSKI: And that's something for students really to keep in mind, too, that reaching out to places like the Office for Students with Disabilities, which might have a different name on their particular campus, but to reach out to local resources to help them have those conversations with professors, that's an important thing to keep in mind. 

BRITTANY STONE: Yeah, definitely. And the other thing is that it is going to look different from one school to another. So a student who is at community college and then has transferred into a four-year school or a student who's gone from undergrad to grad school in a different location, each school has a slightly different process. You know, what paperwork is required? How do you get an appointment? How long does the process take? So finding out about your school's unique process and making sure that you're working within their policies and procedures is really important. Often, disclosing to a faculty member and requesting an accommodation from a faculty member, that is not the way to get your needs met under the ADA, and to be protected under the ADA. 

JOE ZESSKI: With this conversation and focusing on students, I'd like to circle back a little bit to a broader perspective. And as I mentioned earlier, mental health and related disability needs is something that certainly we hear about and talk with people about at the Northeast ADA Center. In terms of the general public, are there any resources you would recommend, whether someone's a college student or if someone's an adult professional or in some other circumstance in their life, that you would recommend that people go to as possible resources for help or assistance with different mental health-related questions or issues? 

BRITTANY STONE: Yes, definitely. So while I don't think there are enough resources, and I would love to see more done on campuses, there are certainly some really amazing ones. So the first thing that I would do, if you're a person who has a mental health condition and you're a student or thinking about going to school, is to check and see if, within your community, there's a supported education program. Often, supported education programs are run through community mental health centers. And their role is to support people living with mental health conditions in being able to access and complete post-secondary educational goals. So if there's one of those, definitely check. Here in New Jersey, you can find out about those programs through our local division of Mental Health and Addiction Services. So look for those. In other places, those programs might fall under supported employment programs, which are another type of community mental health service or support. Then there's also your community assistive technology centers or campus assistive tech centers. Some of these things can also be used to help people with mental health conditions think about how assistive tech can work for them. The Bazelon Center for Mental Health Law is another good resource. They have a number of publications, including one called Campus Mental Health-- Know Your Rights, that talks to students with mental health conditions about what to expect in being on campus. The Job Accommodation Network, or JAN, while job accommodation is their main thing, they have a number of publications and guides, and they have a support center where you can reach out to them and say, these are some of the things that I have trouble with related to my condition, this is the environment I'm in. So for students who are doing internships or clinical field work, JAM can be really, really helpful. And the Jed Foundation is another great support for college students with mental health conditions and their families, where they can learn about how to prepare, what things to think about, and how might mental health impact learning and academic success. 

JOE ZESSKI: Those are all great resources. And let me just again say thank you, Brittany, for taking the time to be with us, and really for delving into this area that's, I think, under-addressed. I agree with you in that there's a lot of missing or lack of knowledge in this area. And I think Grace and I would both like to say thank you for being on the podcast with us today. 

GRACE FAIRCHILD: Definitely. 

BRITTANY STONE: It's my pleasure to be here. Thank you again for having me. 

JOE ZESSKI: And thank you all for listening to this edition of Ask About the ADA. If you have questions about the Americans with Disabilities Act, about what we talked about today, or anything else related to disability, please feel free to contact us, either by our website, northeastada.org. You can call us at 1-800-949-4232 if you live in New York, New Jersey, Puerto Rico, or the US Virgin Islands. If you call that number outside of those areas, you'll reach your local ADA Center, and they would be glad to assist you, as well. Please follow us on social media. And again, thank you, Grace, for joining me today, and Brittany, as well. And thank you to Peter Quinn of the Yang-Tan Institute media team for assisting with editing today's podcast. We look forward to continuing the conversation with you in the future. 

[MUSIC PLAYING]