A Primer for Working in Campus Mental Health: A System of Care.

Abstract

This article provides a framework for residents and staff psychiatrists new to student mental health, outlining the issues particular to practicing on a college campus. Treating students on campus often entails more case management than standard community treatment, and it demands that the psychiatrist think beyond the individual patient and diagnosis to understand the context in which patients are living and studying. While some students are adequately treated with psychotherapy and medication, many have issues concerning academic progress, interpersonal relationships, housing, and finances that require institution-specific knowledge and active guidance. To know your patient is to understand the student experience and therefore, the best way to know your patient is to understand your institution. The Substance Abuse and Mental Health Services Administration defines system of care as “a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life” [1]. First described in 1986 as a way to better meet the needs of children with mental health challenges [2], the widely accepted system of care approach is team-oriented and based on principles of shared ownership, with all players working together in the best interest of the patient. The system of care approach has been useful in ensuring that primary and secondary school students’ needs are adequately met to allow successful school completion [3, 4]. The same approach can also help students in higher education. A campus setting naturally exemplifies a system of care by offering a wide array of services of individualized care, with stakeholders including “policy makers, service providers, agency administrators, technical assistance providers, family members, advocates, leaders in cultural competence, researchers, and others” [1]. While team-based collaboration can be challenging in large institutional settings (such as colleges and universities) containing multiple autonomous divisions with competing interests, this approach provides an effective framework in which to manage the complex mental health of our students. Using the system of care framework, we describe components of post-secondary education along the traditional eight overlapping dimensions: education services, health services, mental health services, substance abuse services, social services, vocational services, recreational services, and conduct and justice services (Fig. 1). This framework provides a way of conceptualizing a student’s education, breaking it down into component parts. We begin each section with a brief psychiatric referral scenario, illustrating why that particular dimension may be important, in addition to psychiatric services.