Reported mental health cases rising

The College has found itself part of a nationwide trend of increasing numbers of first-years arriving on campuses already on treatment for a range of psychological disorders. There has also been a rise in the number of students seeking counseling each year, according to Psychological Services. Because diagnoses of depression and anxiety disorders in adolescents have proliferated in recent years, mental health services at Williams and at other small colleges have come under duress as they try to service the increasing demand for psychological treatment.

John Miner, M.D., co-director of Psych Services, said his department has seen a 25 percent increase in students over the past five years, and the number has risen steadily each year. In 2000, 251 students sought counseling from Psych Services, whereas last year, 369 students, or 16 percent of the student body, were seen. To accommodate the increase, the counseling center staff has almost tripled in size, from four part-time therapists on staff six years ago to 11 part-time therapists in 2002.

Additionally, the length of therapy sessions was shortened last year from 50 minutes to 40 minutes so that more students could be seen. While there is currently no waiting list, “we’re getting pretty full,” Miner said, attributing the packed schedule to mid-semester academic stress.

Still, the shortened sessions do not affect the quality of the care students receive, Miner said. Williams’ Psych Services has the advantage over other similar colleges of allowing students to schedule an unlimited number of sessions with a licensed therapist, whereas many colleges and universities limit the number of sessions to six or ten. Most students come in for an average of five sessions, although Miner emphasized that Psych Services is committed to helping students to the best of their abilities and the Counseling Center has never limited the number of sessions a student is allotted. “We do this in part because we like the continuity and because we live in a small, rural area. There are a good number of therapists around, but it’s not like it is in the cities,” he said.

Of the 369 students seen last year, 180 were referred for psychiatric evaluation by Miner, and 80 percent of these were put on medication. Antidepressants were prescribed most commonly, with 60 percent of prescriptions written to treat depression. “We use those quite a lot,” Miner said.

In addition to Miner, nurse practitioner Dale Newman and one clinical nurse have prescription privileges, although Miner handles most of the psychiatric evaluations. In the most recent data on the Health Center’s records from 2000, 98 students carried prescriptions for psychoactive drugs, including selective serotonin re-uptake inhibitors (SSRIs), sedatives, mood stabilizers, anti-anxiety medication and hypnotics. While it is true that more students are on psychoactive medication than ever before, Miner said he does not feel that he is treating students who do not need it. “I don’t think I’m prescribing more readily; it’s just that the numbers [of psychiatric referrals] are higher,” he said.

According to a Sept. 26 article in The Boston Globe, psychologists practicing in New England collegiate circuits have been in discussions regarding the causes and effects of having so many students on psychoactive medication.

Bennington College in Vermont, for example, saw the proportion of the student body on psychoactive drugs soar from 5 percent to 40 percent in the last decade. As a point of comparison, according to the most recent data, approximately 5 percent of Williams students are on medication; of those, 88 percent are on antidepressants and anti-anxiety drugs, with 10 percent on mood stabilizers, such as lithium and Neurontin, and 2 percent on anti-psychotics.

The reason that high numbers of students are on mood stabilizers, which are most commonly used to treat bipolar disorder, is that some students use medication under this classification to treat a variety of other ailments. These can include anxiety and pre-menstrual dysphoric disorder, more commonly known as PMS.

According to the Globe article, the advent of Prozac and other new drugs has made treatment of depression and anxiety disorders more commonly pharmacological, which is a point of conflict among psychotherapists. Antidepressants were prescribed to children between three and five times more often in 1994 than in 1988, claims one study from the University of Maryland. Professional opinion is split as to whether it is beneficial for so many students to be on medical treatment for psychological diagnoses. Many mental health authorities assert that students are medicated simply for common stressors and thus miss out on adolescent experiences and rites of passage.

As to why so many Williams students have started seeking psychological counseling in recent years, Thomas Kohut, dean of the faculty, who holds a Ph.D. in psychology, ventures that many students, accustomed to the home environment and the pressures of succeeding on a level that would get them admitted to Williams, find that once the environment changes and the student enters college, the same “adaptive mechanisms are actually kind of maladaptive and cause you more problems.”

He also views the tendency to diagnose and medicate adolescents so readily as “quite unfortunate.”

“I think we over-medicate. Some pain is not the worst thing in the world,” Kohut said.