Introduction

The collection and dissemination of accurate and usable data about health services is an ongoing primary goal of the Health Services Association of California Community Colleges (HSACCC), an organization of college student health professionals. HSACCC demonstrated its leadership in spring 2007 by organizing 13 schools to participate in the American College Health Association - National College Health Assessment (NCHA) survey. This is the first time such a large number of community colleges participated. This spirit of collaboration resulted in the first aggregate data set representing the largest data set of community college students to our knowledge (N=7898). The efforts and results reaffirm the commitment of student health services in making an investment to ensure programs are guided by high quality data.

California Community College Mental Health Data

Assessing the mental health status of students is one of eight components of the NCHA. For community colleges in California and in particular student health services, mental health is increasingly becoming one of the most frequently accessed health issues and sometimes with great complexity. Community colleges provide a safe, caring, and supportive space for students who present with mental health issues and needing professional support to deal with the stressors of school. The NCHA data revealed that 17% of students reported having ever been diagnosed with depression, with 32% being diagnosed in the last school year, presenting a unique opportunity to create prevention and intervention programs.

It is well-documented in this 2007 survey that many aspects of students’ health and well-being can also adversely affect academic performance. Depression, anxiety, and seasonal affective disorder resulted in lower grades on an exam for 6% of respondents, a lower course grade for 4%, while 3% of respondents reported receiving an incomplete or dropped the course. Relationship difficulties also affected academic performance, with nearly one in 10 reported receiving a lower grade on an exam. An even higher proportion of students reported that sleep difficulties and stress affected their academic performance, as illustrated in the Table 1.

Mental Health Services

Mental health services currently provided to California community college (CCC) students range in breadth and depth. In February 2008 the HSACCC conducted a statewide survey to look at the infrastructure of mental health services offered. Sixty-eight colleges of 109 at that time responded. Of these 68 colleges, 87% reported having on-site mental health providers, while the remaining 13% refer to off-site providers only. Of those with on-site providers, 29% employ at least one provider at full time status and 49% provide internship/post doctoral clinical programs. Sixty-six percent employ licensed providers at the masters level (vs. doctoral). Sixty-four percent of the responding campuses stated that oversight is accomplished by Health Services, with student health fee revenue serving as the basis for funding mental health providers.
For students starting their community college experience, it is often their first opportunity to take responsibility for their physical and mental health. Mental health services on California’s community colleges vary as much as services in other departments. Services may include individual personal counseling, group support sessions, campus-wide events such as depression screening day to multidisciplinary teams which address the more serious behavioral issues in the classroom and on campus. As these programs evolve, more standards of practice are developed and ideas are shared among campuses. As shown in the data, mental health issues can directly affect student’s performance resulting in lower grades and academic demise. The goal of these services is to provide students tools to prevent and cope with concerns so they may be more successful in their academic careers and in life.

Personal Counseling

Individual personal counseling is usually limited to 6-10 sessions per semester and address mild to moderate issues such as stress, time management, depression, and relationship problems. These encounters are not meant to take the place of long term therapy or psychiatric services. The availability of mental health services in many communities and counties, however, are slim to none, particularly for those students without insurance, resulting in more complicated issues which pose ongoing challenges for the healthcare/mental health service providers and programs.

Life Coaching Program

A unique program at Ohlone College incorporates a Life Coaching Program within personal counseling services which assists students in exploring their aspirations and helps guide them through the process of making choices about future goals.
Depression Screening Day is held nationally each October in communities and on college campuses and is an effective method of identifying depression, stress, anxiety, post traumatic stress and suicidality. Students voluntarily participate by completing a standardized screening tool administered in a confidential environment. It is then scored by health/mental health professionals. Each student then speaks with a provider and referrals are made to campus services or the community as necessary.
Group support may include multicultural programs addressing situations that are often times verboten by other cultures. Stigma associated with mental health issues is pervasive in many cultures which prevent students from seeking help. Once students are able to access services in a safe and confidential environment, they are more willing to share their problems and accept help in dealing with them.

Behavioral issues in the classroom

Increased behavioral issues in the classroom and on campus have created the need for a multidisciplinary approach to assist instructors in dealing with disruptive students. A multidisciplinary team (MDT) may consist of representatives such as licensed counselors, MFTs, LSWs, PhD’s, health service program directors, including RNs, Nurse Practitioners, MDs and specialty mental health RNs and VPs of student services/development, deans of academic counseling, DSPS and campus security.
With the advent of more sophisticated medications for depression, bipolar disorder and schizophrenia, more students are enrolling in the community colleges on recommendation of their mental health providers as a means of socialization, structure and purpose. Most instructors are not trained to manage these students.

Ohlone’s program “I have a student…” educates faculty on strategies to address behavioral issues presented in the classroom. Concrete ideas are suggested such as including clear information on behavioral expectations in their syllabus. Rules should be reviewed in class, especially for those who may have learning disabilities. Consequences for infractions must be clear. Faculty is encouraged to document in writing any behavioral issues. This forum allows for discussion on faculty responsibilities reassuring them that they have a support system in place. The MDT is also very effective in responding to immediate behavioral crises on campus. Ohlone College received a commendation from the accreditation team in spring 2008 for this program.

In the wake of several violent and tragic incidents, especially that of Virginia Tech in 2007, most CCCs have begun to mobilize limited resources to develop prevention efforts. Many are retooling what has been established and working. A few of many examples of these efforts include Moorpark College “Behavioral Intervention Team,” Santa Rosa Junior College “Crisis Intervention Resource Team,” Foothill College “Community College Mental Health Institute”, West Valley College “Mental Health Services Advisory Committee,” Mission College “Crisis Intervention Team,” and Ventura College “Crisis Intervention Team.”

Future Resource Support

In 2004, California voters demonstrated their support to expand and improve mental health services for underserved populations by passing the ballot initiative Proposition 63, or the Mental Health Services Act (MHSA). One of the five components of the MHSA is Prevention and Early Intervention (PEI), designed to support the earliest possible signs of mental health problems at sites where people go for routine activities including health care facilities and educational institutions. Community college student health service programs are experienced and naturally positioned to contribute to the PEI initiatives by virtue of serving students within the largest higher education system in the nation. Therefore, it is imperative that student health professionals and the campus community at large participate in the county planning process to ensure inclusion of CCCs as one of the priority populations to be considered for funding.

Summary

The mental health indicators as shared above alert us that mental health prevention measures must be deliberately and consistently inserted into the fabric of student lifelong learning and success initiatives. With the delay in access to MHSA funds for the Student Mental Health Initiative (SMHI), designed in spring 2007 and earmarked for release this past July 2008, it behooves the CCCs to leverage resources in two areas that currently exist. First, interdisciplinary efforts must be embraced. Boundaries of campus inclusiveness must be widened and creativity promoted so that all entities contribute. Bridging communication and training gaps within and between all college programs must be a priority as well as revisiting department, program and college goals on all levels.
Secondly, CCC health services must continue to reach out, encourage, and build on collaborations with our county mental health partners. The people our respective public entities serve are our mutual clients. It is important that we recognize each others’ value and expertise, and work diligently toward leveraging collective resources. This can be realized through deliberate collaboration, participatory governance, communication and training. Santa Rosa Junior College and Sonoma County Mental Health is a prime example of such a collaborative partnership.

Table 1: Selected results of NCHA 2007
Within the last school year, the percentage of students who reported:
Feeling overwhelmed by all they had to do (1-10 times within last school year)	66%
Feeling exhausted (not from physical activity) (1-10 times within last school year)	63%
Feeling very sad (1-10 times within last school year)	63%
Feeling things were hopeless (1-10 times within last school year)	53%
Feeling depressed, difficult to function (1-10 times within last school year)	39%
Seriously considered attempting suicide (1-10 times within last school year)	11%
Attempted suicide (1-10 times within last school year)	2%
Have ever been diagnosed with depression	17%
Have ever been diagnosed with depression in last school year	32%
Depression/anxiety/seasonal affective disorder affected academic performance:
Received lower grade on an exam	6%
Received lower course grade	4%
Received incomplete/drop	3%
Relationship difficulties affected academic performance
Received lower grade on an exam	9%
Received lower course grade	4%
Received incomplete/drop
Sleep difficulties affected academic performance
Received lower grade on an exam
Received lower course grade
Received incomplete/drop
Stress affected academic performance
Received lower grade on an exam
Received lower course grade
Received incomplete/drop

 

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About the Authors:

Sally Bratton, RN, FNP, PA-C, Life Coach

Sally has been the Director of the Ohlone Student Health Center since it opened in 1996. Besides her administrative duties, she also provides primary care to Ohlone's 12,000 students. She is a graduate of the UC Davis Nurse Practitioner/Physician Assistant Program, and a certified smoking cessation counselor. She was instrumental in Ohlone becoming a smoke free campus. She is always striving to improve and expand health related programs for the Ohlone campus

Becky Perelli, RN, MS

Becky has served as director of West Valley College Health Services since 1999. Previous experience includes clinical trial research focusing on youth with HIV, coordination of out patient adolescent services at Mount Zion Hospital, SF, adolescent health and counseling work with Palo Alto Unified School District, and behavioral health services with the San Francisco Juvenile Hall. She received her bachelors degree at Boston University School of Nursing and her masters in Mental Health and Community Nursing at UCSF. The WVC Mental Health Services Advisory Committee was established in large part due to her leadership. On the state level she testified on behalf of the CCC System Office and the HSACCC in advocacy for the Student Mental Health Initiative, as developed by Senator Darrell Steinberg. She continues as liaison in this statewide effort and is currently President Elect of the HSACCC.

Sang Leng Trieu, Dr.PH, CHES

Sang has been the health education coordinator at Ohlone College Student Health Center since 1999. She has served in a number of capacities, including working as an HIV test counselor and on a four-year comprehensive tobacco control program that resulted in Ohlone being the first smoke-free campus in the San Francisco Bay Area. Her previous experience includes working for Alameda County and Contra Costa County Public Health Departments, Cal State Hayward Student Health Services (as it was formerly called), and on consulting projects with the Asian & Pacific Islander American Health Forum, California State Office of AIDS, Nike, and Alameda County Medical Center. Sang is also a member of the California Family Health Council’s Board of Directors. She is currently the Los Angeles Health Policy Field Coordinator for the California School Health Centers Association, advocating for school based health centers in K12. Sang received her master and doctor of public health degrees in Health Education from Loma Linda University and a bachelors in Environmental Analysis and Design from UC Irvine.