Suicide continues to be a leading cause of death among children and young adults, and recently released statistics from the Centers for Disease Control and Prevention (CDC) suggest that it’s on the rise. The CDC reports an overall increase of suicide rates by 24 percent from 1999 to 2014 for all age groups under age 75; perhaps even more alarmingly, the average annual percent increase was greater for the second part of this time period (2006–2014), suggesting that suicide is a persistent and significant public health threat that must be addressed head on.
When we hear such staggering news, it ignites a conversation among families and communities. We read stories in the media and talk with our children, students, and patients. Sadly, these discussions often dissolve and momentum is lost in the fight to stop suicide until it hits again close to home.
Last month we learned of a University of Pennsylvania student who completed suicide by jumping in front of a subway train, marking the 10th suicide at the University in just 3 years. The student, like the ones prior to her, was high achieving and well liked by her peers. She reinforced many people’s misperception that if someone appears happy or successful from the outside, his or her thoughts and feelings must match that within.
These patterns of suicides among college students, combined with the recent statistics, cries out a need to change the culture on how we deal with suicide at universities, including de-stigmatizing the issue and increasing access to mental health services. Dr. Anik Jhonsa, a CHOP psychiatrist, weighs in on some of the challenges and offers his perspective on how we can move forward.
Q: Among college students, what are some of the barriers to accessing mental health services?
A: Some of the barriers in the college mental health community include stigma around seeing a mental health provider from students (including fear that their classmates, parents or teachers will find out), lack of adequate services on some campuses to meet the needs of their patient population, and students being unaware of how to access the services on campus or even that these services exist. Additionally, many colleges do not have their mental health services integrated with their campus health services which creates an extra barrier for primary health care providers from transitioning students they feel are at risk directly into care.
Q: How can we begin to de-stigmatize the issue of mental health concerns on campus?
A: The conversation needs to start early. Major life transitions can be very stressful and students often arrive on campus with expectations of what college and life on their own will be. I think letting students know from the beginning what some common sources of stress college students face and how to get help from them is key, and in particular letting them know it’s okay to seek help if they are struggling. Having opportunities for incoming freshman to hear from their peers who have received treatment for mental health issues in a way they can relate to would be a good start. It lets students know that it is okay to ask for help and to seek it when necessary.
Colleges also need to work to further integrate their mental health services into day-to-day life to reduce the barriers for students. For students that have not had any mental health treatment prior to college, their entire view of health care is through their pediatrician. Having mental health services integrated through college health services would likely reduce some of the stigma and barriers towards mental health care.
Q: What are some recommendations for clinicians who may field calls from concerned parents?
A: There is a lot of stigma out in the community about what can and can't be exchanged between a clinician and a parent of a child who is an adult (18 or older). The fact is that while clinicians have to be mindful of HIPAA, there are ways for parents to express their concerns to providers that are still legal. While it is true that if a clinician does not have a "release of information" they are not able to discuss the specifics of a case with an outside party, including even acknowledging that his or her patient is receiving services there. It is also true that there is nothing that stops parents from leaving a message or giving information to a clinician about their child. Clinicians are able to hear that information and, if applicable or helpful, use it to provide better care for their patient. This provides an opportunity for parents to have their concerns heard by their child's health care provider while still maintaining confidentiality for patients.
I would like to thank Dr. Jhonsa for his perspective and I encourage all to keep up the fight to raise awareness and stop suicide. Click here to read about how CHOP has implemented a universal Behavioral Health Screen that identifies youth at risk for depression, suicidal ideation, trauma, and substance abuse.
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