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Sitting outside the Iowa Memorial Union on the University of Iowa campus, wind whipping her hair, Nora Heaton looked into a camera.
“I took terrifying risks,” she said.
Diagnosed with bipolar disorder as a UI student, Heaton, when depressed, would spend 16 hours a day sleeping.
“I spent the rest of my day fantasizing about dying,” she said. “I would put myself in really dangerous situations. Just the most dangerous situations I could think of.”
As part of a UI Student Government-led campaign in the fall aimed at destigmatizing mental health and raising awareness about its impact across campus, nearly 20 UI students or former students — such as Heaton — spoke on camera about their struggles and triumphs.
“My drinking also got really dangerous,” Heaton, now 27, confessed during her video-recorded segment.
“Not only because of how much I was drinking but because the way I was drinking was really dangerous. I was using alcohol as a weapon to hide from the parts of myself I didn’t like.”
Heaton said she has been sober for six years.
Other students shared how mental illness led to “hard-core drug” use, alcohol abuse, debilitating fear, suicidal thoughts, disordered eating and self-harm. They also shared causes for their mental health concerns, including sexual abuse, trauma, stress and anxiety.
Their stories highlight the many ways mental health intersects with the high-profile campus safety issues facing colleges and universities across the country. From dangerous drinking and drug use to sexual assault or suicide, even the swelling count of active shooters storming American campuses is — in growing frequency — being linked to mental health services, or lack thereof.
In Iowa, the most common way mental health affects student safety is through depression, anxiety, suicide and substance abuse, according to mental health and counseling administrators at the UI, Iowa State University and University of Northern Iowa.
“There is so much pressure and so much stress that comes up when you’re in this setting, and you’re all alone, and you’re faced with all these situations that are unfamiliar to you,” Heaton told The Gazette. “It’s also just a formative time for a lot of students who come when they’re around 18 … for all those factors combined, there are definitely going to be a lot of people struggling with mental health issues.”
When Heaton was a student, she felt alone in her struggles. Abandoned. But mental health stigmatization, leading to seclusion, seems to be shifting, she said. Students today are more willing to share their stories and seek help.
Barry Schreier, director of UI counseling, agrees and said his department has felt that through a surge in demand. Last academic year, University Counseling Service saw more than 2,000 students for direct clinical services — marking the first time it’s passed that 2,000 threshold.
And, according to Schreier, those numbers have continued climbing this year.
“Over half the students that come to the counseling center come for either diagnosable anxiety or diagnosable depression and other mood problems,” he said.
Those who do ask for help often find it at the UI center, according to Schreier.
“The students that come to counseling are benefiting,” Schreier said. “We’re able to work with them at a cognitive level or an emotional level, and they can make changes in their life.”
Occasionally, according to Schreier, students who staff believe could benefit from some type of prescription medication are referred to UI Student Health and Wellness.
“But the far majority of students are in counseling only,” he said.
UI Counseling Services’ success, and what seems like an ever-increasing demand, has prompted the university to innovate with the type of counseling it provides, expand its services and request more resources.
Mental health innovation
Before the Board of Regents in the fall approved its tuition and fee schedule for the next academic year, UI student leaders interjected with a proposal to replace a general $10 health fee with a $12.50 fee specifically for mental health services.
UI Student Government President Rachel Zuckerman said revenue from that fee would allow the university to hire much-needed staff to “narrow the gap between university counseling services capacity and the realistic demand.”
“The University of Iowa is second lowest in the Big Ten for our ratio of number of counseling center staff to number of students, which creates long wait times and pressure on our existing mental health resources,” Zuckerman said at the time.
Thanks to the board’s approval, Schreier said, his office has hired three new full-time staffers, bringing its total to an equivalent of 15 full-time employees. The unit plans to add another six to its roster “as soon as we can,” according to Schreier.
“If we can fill them this spring, that would be ideal,” he said.
Those extra hires will enable the university to embed more counselors in high-risk zones across campus. The university recently stationed a counselor in an east-side residence hall, and Schreier said one of the new hires will join that person — doubling the east-side presence.
“The main counseling service is basically a hop, skip and a jump from the west-side residence halls,” he said. “The east-side residence halls are on the other side of the river, and so we’re trying to staff over to that geographic side of the campus.”
The university also has counselors embedded in the UI Department of Intercollegiate Athletics and the UI College of Dentistry, one of the highest risk populations for suicide locally and nationally. Athletics will get another embedded counselor with the new hires.
UI Counseling Services is stretching those expanding resources by holding more group sessions — where students meet collectively with a counselor. Because many clients are working through relational issues, in addition to their primary symptoms, Schreier said group counseling is actually “the service of choice for a lot of our students.”
“And a positive outcome is it’s much more bang for the buck,” he said, adding the department “has almost tripled the amount of group therapy that we’re doing.”
The university also is seeking to start an alcohol and drug recovery group for those who are making changes but need help sustaining them. Schreier said the number of students looking for that type of help has been going up, and their vices seem to vary.
“It is everything from alcohol to illicit drugs to prescription medications — all of those,” he said.
Mental health resources
At Iowa State University, parallel efforts are underway as it, too, has seen a surge in demand for mental health services. As with the UI, Iowa State in the fall asked and received approval from the Board of Regents for a student fee increase that would specifically address mental health needs.
The Iowa State mental health increase amounts to $24 per academic year, which students not only supported but proposed, said Erin Baldwin, director of the ISU Thielen Student Health Center.
“Spring of last year, we got a request from student government to explore an increased student health fee that would be focused on expanding mental health services,” Baldwin said. “I think that says a lot right there. Because the fact that students reached out to us and said, ‘We’re willing to increase fees so we can have more of these services available to students,’ I mean that’s pretty amazing.”
Iowa State’s student health center for years functioned with just one full-time mental health provider, and now it has two — even as its enrollment has spiked nearly 44 percent, from 25,462 in 2006 to 36,660 this past fall, making it the largest public university in Iowa.
Revenue from the new fee will allow the health center to add one full-time psychiatrist, one full-time mental health nurse practitioner, one registered nurse, one medical assistant and three full-time psychologists at the student counseling center.
“We feel like that will get us to a point where we can more adequately serve 36,000-plus students,” Baldwin said. “For years, we only had one full-time mental health provider — that’s not enough.”
Student health’s primary care providers have, however, been responding well to the mental health demands, according to Baldwin, who noted about 40 percent of what they do is mental-health related.
“They are very adept at dealing with depression, anxiety — the more basic level mental health-kind of conditions,” she said.
Although mental health providers work with Iowa State Athletics and other units across campus, Baldwin said, her office is not seeking to embed counselors as the UI does. Rather, she said, the unit’s long-term dream in enhancing services for students involves more cohesion.
“The enrollment has grown so much over the last years for everyone on campus, but specifically the health and wellness units — we are completely out of space,” she said. “So that’s kind of our big future dream — we’d really love to have a building that would incorporate all health and wellness services on campus so students really could have a one-stop shop for any type of health care need.”
Although Baldwin reported more students coming to campus with significant mental health histories, diagnoses and medications, she also — as with former UI student Heaton — credits part of the increase in demand to destigmatization.
“I think it’s more of an awareness of an expanded definition of mental health,” she said, adding Iowa State’s student government in the fall created a mental health task force. “They wanted to look at the current mental health climate at Iowa State and give feedback and propose solutions to university leadership.”
The increase in demand at the University of Northern Iowa has led to new hires — it now has eight counselors. And Shelley O’Connell, executive director of UNI’s Health and Recreation Services, said she expects the number of students served to keep rising.
“When you have more counselors, you have the ability to see more people,” she said.
Along with group counseling services, O’Connell said, her department is aiming to innovate its mental health services by seeking student feedback. Through public-awareness events and talking posts, she said, students can share their ideas and learn more about what mental health counseling is and isn’t.
That, she said, is helpful for students looking for a little help or a lot.
“When I look at the No. 1 reason that students come to the counseling center, it’s depressive disorders,” she said, noting 295 of the students they served were categorized as such. “The second largest is relationship issues, which is 294.”
Mental health statistics
The American College Health Association’s National College Health Assessment compiles health data for college students nationally and on individual campuses.
The UI spring 2016 report shows stress as the top academic impediment, with 31 percent of respondents identifying it as a barrier to learning. Stress was followed by:
-- Anxiety, with 26 percent
-- Sleep difficulties, 17 percent
-- Depression, 16 percent.
About 12 percent of UI respondents cited alcohol use as an impediment to learning. Nearly 51 percent reported engaging in high-risk drinking — having five or more drinks on one occasion in the past two weeks, according to the health assessment.
Findings from a UI campus-specific climate survey in the fall showed 21 percent of undergraduate female respondents reported being raped since enrolling. The same percentage reported being the victim of attempted rape while at the UI.
Just as at the UI, stress, anxiety and sleep troubles account for the biggest academic distractors at ISU and UNI. Those students also reported issues with depression and relationship challenges.
When looking specifically at the impact on mental health, nearly 18 percent of men and 28 percent of women on the UI campus reported being treated for or diagnosed with at least one mental health condition in the last year.
At ISU, 45 percent of respondents felt “things were hopeless” at some point in the last year, according to the national findings. At UNI, 46 percent reported the same.
Nearly 31 percent of UNI respondents reporting feeling “so depressed that it was difficult to function” at some point in the past year. About 30 percent at ISU and 19 percent at UI reported the same.
Mental health police calls
All that leads to a lot of “mental health calls” — which often come through as welfare checks — for campus police.
“The number of mental health crises that we’re getting called to has grown considerably,” ISU Interim Chief of Police Aaron DeLashmutt said. “We get information that somebody has suicidal thoughts or they’ve made a statement over social media that’s got friends or family concerned, and we need to check on them.”
Calls like that, he said, account for a big chunk of his officers’ time.
“It appears that students are just under a tremendous amount of stress and sometimes struggling with how to cope with all that right now,” DeLashmutt said.
Through his experience, DeLashmutt cited financial stresses and social media as potential contributing factors. And those mental health issues bleed over into other police-involved calls — such as drug and alcohol abuse or violence and sexual assault.
“We’ll see somebody in crisis in a number of different ways,” he said. “We work a lot with the university to — once we start seeing some of those trends or issues — start saying, ‘Hey, this person we really think needs some extra help.’”
When officers aren’t responding to those types of calls for assistance, DeLashmutt said, they’re often focused on fostering — and in some cases restoring — relations with the communities they serve.
“We need to increase the positive community engagement opportunities that are out there,” he said.
Police-civilian tensions have flared across the country in recent years — with a string of white officer-involved shootings of black civilians reverberating and then ricocheting with reverse attacks on officers, including one fatal ambush on Des Moines police officers in November.
DeLashmutt said his office has taken seriously the need to communicate clearly his department’s role in the community and his officers’ charge and humanity. They’ve held meet-and-greets and “coffee with a cop” events.
“We’re engaged with our community in a number of different ways — sometimes it’s somebody getting pulled over because they’re speeding,” he said. “It’s not always the best day for them, so we try to really increase those opportunities to just have a good, ‘Hey, how ya doing? This is who I am.’ ”
New University of Iowa Department of Public Safety Director Scott Beckner echoed those sentiments and said community relations is huge for the officers in his department. They’ve rolled out a number of “innovative ways” to break down barriers — including playing intramural sports against students and using technology and smartphone apps to field anonymous tips.
“Our students come from all over, and they have different interactions with police at their communities,” he said. “So when they come here, we have to give them a positive relationship with the police department — no matter where they came from.”
Through new and improved police-community relations, Beckner said, students have started opening up about problems they’re facing, potential issues they’ve witnessed and even crime-related tips. That’s helped the department respond to mental health-related calls, which Beckner said have come to the forefront for law enforcement locally and nationally.
UI police, specifically, have upped their focus in that area — sending six officers, along with other Johnson County law enforcement, to San Antonio, Texas, recently for crisis intervention training.
“With more open communication, we’re going to get more, ‘Hey, this person is struggling with classes or something. This person is struggling here or there,’ ” Beckner said. “And so, with the six officers we have, we could send a specialist out … and make an assessment.”
The ramped up resources and extra attention on the subject have and will continue making a difference, according to Lily Burns, student safety chair for UI Student Government.
“I believe that if we can start a conversation early enough and give resources to students, the more they will feel comfortable talking about their struggles and know how to deal with various issues,” she said.
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