Sometimes a psychiatric crisis can be triggered by something small. For Alexia Phillips 21, it was a heated argument with a close family member in February 2017. She remembers the fight struck before leaving the house to go to the classes at Queens College in Flushing, New York. At dinner, Phillips, then a sophomore, said she started crying loudly and uncontrollably. "It really triggered me. I got very angry very fast … I cried so much I could not breathe and could not talk. I did not know how to handle it," she said. As she would come to understand later, Phillip's symptoms felt her underlying personality disorder, anxiety and depression, but then she knew she felt too overwhelmed to go home or go to class. She did not want anyone to see her. Finally, she went to her college counseling for the first time, asking for help. Minutes later, Phillips adviser, a security officer of a college publication and a paramedic trained to deal with psychiatric crisis, let her quietly and discreetly follow her to the back of college through a quiet hall door that led to a parked ambulance sent from Zucker Hillside Hospital. She was ferried – without lights or sirens – to be assessed at the hospital's special program for college students. This type of response to a student crisis is unusual. In many colleges, if staff think that the student who has a crisis may be uncertain, they have no choice but to call 911.…
Sometimes a psychiatric crisis can be triggered by something small. For Alexia Phillips 21, it was a heated argument with a close family member in February 2017. She remembers the fight struck before leaving the house to go to the classes at Queens College in Flushing, New York.
At dinner, Phillips, then a sophomore, said she started crying loudly and uncontrollably.
“It really triggered me. I got very angry very fast … I cried so much I could not breathe and could not talk. I did not know how to handle it,” she said.
As she would come to understand later, Phillip’s symptoms felt her underlying personality disorder, anxiety and depression, but then she knew she felt too overwhelmed to go home or go to class. She did not want anyone to see her. Finally, she went to her college counseling for the first time, asking for help.
Minutes later, Phillips adviser, a security officer of a college publication and a paramedic trained to deal with psychiatric crisis, let her quietly and discreetly follow her to the back of college through a quiet hall door that led to a parked ambulance sent from Zucker Hillside Hospital. She was ferried – without lights or sirens – to be assessed at the hospital’s special program for college students.
This type of response to a student crisis is unusual. In many colleges, if staff think that the student who has a crisis may be uncertain, they have no choice but to call 911. Many schools lack resources to deal with serious crises and students are left to navigate in the healthcare on their own .
However, Queens College is part of the Sustainability College’s partnership, an innovative mental health program run by Northwell Health, a healthcare system in New York, in collaboration with more than 77 colleges in the New York City area. The program provides behavioral health care tailored to the life of college students, including emergency evaluations, counseling and treatment of childcare.
Laura Braider, a psychologist and head of the College of Sustainable Higher Education, said she launched the 2009 partnership with Blair Greenwald, a psychiatrist at Northwell Health because she wanted to create a more therapeutic approach to dealing with student crimes.
“We saw a lack of ability to effectively treat students who need care. These students are not adults and not children and need specialized programming to meet their needs,” says Braider.
Their approach begins at the moment of the crisis – the 911 conversation, as Braider says, can be devastating to the students – extends through outpatient care if needed, including support for transition to campus. It is designed to enable students to get treatment and then reintegrate into their academic life with as little disturbance as possible.
“We try to minimize potential secondary trauma for students who are already overwhelmed,” says Braider.
More than 3,200 students have been admitted to the program since it began.
For students who need healthcare, the program has a special unit at Zucker Hospital – a friendly student room environment where students can feel the normality when stabilized.
Dr. Marta J. Hopkinson, a psychiatrist and head of mental health at the University Health Center at the University of Maryland at College Park says that specialized programs such as the School of Economics and Higher Education are an important idle for college students.
The number of college students with mental health problems has increased over the years and counseling centers are struggling with these students’ requirements when they are in crisis, says Hopkinson, who is also chairman of the mental health care section at the American College Health Association.
“Most schools can not expand enough to meet the demands of all students who want and need psychotherapy,” she says. “We all work to prevent these children from falling through the cracks.”
Do it by yourself
College is an exposed time for a student’s mental health. Many serious psychiatric disorders, including major depression, anxiety disorder and substance addiction also present between 14 and 25 years, according to the National Alliance on Mental Health.
One of three college freshmen worldwide reports with a major mental illness the most common depressive disease followed by anxiety or substance abuse, according to a study published in the Journal of Abnormal Psychology in September.
And suicide is the second leading cause of death among college – older people, according to Centers for Disease Control and Prevention.
But colleges often fight to provide effective treatment options, “said Randy P. Auerbach, associate professor of psychiatry at Columbia University College of Physicians and Surgeons, and principal author of the study on the incidence of mental disorders.
“Only a minority of students are looking for treatment, creating a summary on campus,” he says. “Lots of administrators everywhere encrypt to find innovative ways to reach students in need.”
When university students need emergency hospitalization for psychiatric problems, they are usually put into psychiatric services with other adults with serious mental problems. These can be “quite scary places,” says Dr. Victor Schwartz, Chief Health Officer at The Jed Foundation, an ideal company supporting campus efforts to improve psychiatric services and prevent suicide. “They may be particularly upset for a collegiate child with transient problems or in the early stages of a mental illness,” he says.
On the other hand, the School of Sustainability College deals with students in a specialized hospital unit within Zucker Hospital, which is only for young people. It looks and feels like a dormitory. Patients have double rooms where they can settle with their favorite animals and other comforting items. There is a common area with TV, a workout bike, a ping pong table and a piano. Students can pick up snacks and drinks at any time, and eat together in a dining room environment.
Arriving at this environment was a welcome relief for Alexia Phillips after her crisis. She had never been to a psychiatric facility earlier. “Everything I knew was what I learned from movies I saw about it so I was afraid,” she says.
But when Phillips entered the specialized college, she said she liked it. “It was more like being in a college dorm,” she says. “Everyone was very nice and I made friends there. The kids were everyone like me. We could talk openly about how we felt.”
More importantly, Phillips, who had gone to outpatient therapy to be bullied and cut before her psychiatric crisis, was relieved to finally diagnose her problem. She started with dialectic behavioral therapy, which was known to be effective for borderline personality disorders and mood disorders.
“I received good therapy and good medication,” she says.
The transition back to school
] Many colleges will refuse to take back students who have a suicide attempt for accountability. And being out of school to be treated for a mental crisis can bring students back academically; Some will struggle to get back on track to finish their school holiday.
To prevent this, Northwell focuses on mental health care partnerships on family and school involvement, keeping in touch with school advisors and administration throughout the treatment process.
It begins when a student is transported to the hospital. Their college prepares and sends a history of the student, including any abuse, prior psychiatric treatment and other suicidal risk factors.
“Without any security material from school, we do not see the big picture,” says Braider.
Braider believes that “communication for a smooth flow” between the hospital, college, student and their family during hospital care benefits everyone. And colleges respect their assessment of the student’s readiness to return to campus life.
“When the hospital gives us their report when a student is released saying that the student is well and ready to be back in school, we accept it. We are working hard to get the student back to school,” says Dr. Moore, a psychologist and head of the Queens College Counseling, Health and Wellness Center, who has been involved in the mental healthcare partnership since 2011.
When the student is stabilized, a contact contacts all teachers and draws up a protocol for how to get academic.
However, not all students will return. If they missed too many classes, Moore says she can encourage a student to take an incomplete job to compensate for her work without pressure.
“We try the best way to find a transition that works well for them,” she says.
Partnership’s approach worked well for Damian Escobar when he had a serious crisis in November. Escobar, 18, a freshman at Hofstra University in Hempstead, New York, says he became “really stressed” and tried to keep his grades to retain his scholarship.
Escobar, who had already been diagnosed with depression and anxiety before joining college, had failed to hold several meetings at Hofstra’s counseling center.
“I went to classes and just sat there. I did not do anything. I was too depressed to talk about my problems,” he says. He felt he could not talk to his mother about it.
Eventually, Escobar began to have suicidal thoughts and attempted suicide.
Escobar heard about the program and his mother and grandmother drove him to the collegiate unit at Zucker Hospital. He received daily therapy and participated in family meetings and coaching. About 10 days later he felt ready to come back to school.
Before releasing, he worked with the partnership college associate, Danielle Cimafonte, to figure out how to relieve some of his stress. He released one of his five classes without penalty and is back at Hofstra.
“When I got out of hospital, I was like a completely changed person. After my treatment and new medications, my mood became completely different,” said Escobar.
His depression made him shy and protected. After his hospital stay, he returned to school and back to being “tall and open like the guy he used to be.”
It also worked for Alexia Phillips who returned to school after her stay at Zucker Hospital. She said she feared the medications she was prescribed on the device would make her a zombie.
“But I’m just the way I was. It only helps me with my depression, “she says.
It has been a year that she stopped cutting.
Cheryl Platzman Weinstock is a journalist who reports on health and scientific research and its impact on society.