On Student Mental Health

The concerns and needs of high school students are cited frequently enough in our culture: the fluctuations in their dependency on their parents; adjustments to significant changes in the family such as divorce, illness, or death; their values and attitudes about academic achievement; their ways of dealing with ‘peer pressure’, troubling moods, use of alcohol and other mind-altering substances. It is a common misperception that college students have left the turbulence of the high school years behind them and are now entering the peak years of their lives. They become part of an academic community to learn, try out new ideas and experiences, and develop a wider, and perhaps wiser, network of friendships. However the college years are far from being so simple.

One reason for the misperception may be our envy that they seem to have so many options and opportunities that we may not have had. With both high school and college students, parents can often find a “bridge” in conversation with their son or daughter by sharing some of their own experiences — right decisions as well as regrets, — in order to provide “the larger picture.” It is very difficult for teens and young adults to “plan for the future” when they don’t yet have enough life experience to help guide them.

Beneath the illusion that students “have the world by the tail” are the real issues with which so many high school and college students must contend:

  • Performance anxiety, including fear of speaking in class or of public speaking; struggles around feeling intimidated by peers, teachers, deans
  • Disturbing and sometimes overwhelming feelings of anxiety, panic attacks, phobias
  • Difficulty expressing or controlling anger, difficulty controlling emotions and behaviors that get them into trouble
  • Difficulty concentrating, inability to change entrenched patterns of procrastination, ambivalence, and “work block”, difficulty writing papers, theses, etc.
  • Prolonged sad or depressed mood that interferes with normal activities and can even become disabling, e.g. complete loss of concentration, loss of appetite,
  • difficulty sleeping, inability to enjoy ‘normal interests’, feeling increasingly isolated and alone, while everyone else goes about their business
  • Confusion and sadness about conflict within the family such as parental divorce, or about an unexpected loss.
  • Obsessional and irrational thoughts about their body and body image, eating disorders, sexuality, preoccupations with illness or death
  • Compulsive or addictive behaviors, such as use of illegal substances and alcohol, internet usage, pornography, various forms of gambling)
  • Struggles to understand patterns in their interpersonal relationships and to disengage from those that are “toxic”
  • Confusion around their sexuality, painful recognition of the impact that past experiences with neglect or abuse have had on them
  • Stresses trying to get their own life together when they have responsibilities as a single parent
  • Emotional conflict around having to straddle two or more different worlds with respect to poverty, race, culture, achievement, family values and expectations

The past two decades have seen an enormous growth in high schools and on college campuses across the country in the development of various student support services, particularly counseling and psychotherapy for personal concerns such as those cited above. It is important to understand that this has become a routine part of student life, especially at the college level. A relationship with a counselor or therapist is a sanctuary the student can turn to in complete confidentiality, for developing greater self-confidence and stability in their lives. Sometimes a consultation alone is all that is needed to clarify the issues and options available. Separate from the student’s benefit from her/his own counseling, the parents may also have concerns and would benefit from a consultation with a clinician who is experienced working with students. This can be particularly helpful when the son or daughter is on a campus at some distance from home.

However there is a caveat that parents should be aware of, having to do with the availability and limits on the counseling services available through the school. At both the high school and college level, counselors are often overwhelmed with the volume of requests for help and can offer only a short term period of therapy.

For a number of reasons, treatment services in the larger community may be very limited, or unsuitable, as well. If a more ‘ongoing’ arrangement for treatment for a student is recommended, it is important for families to determine whether or not their insurance plan* covers the student school/college students for the kind of mental health benefits needed. It is important to note that probably more often than not, they don’t. Also, “in-network” providers are unlikely to have much experience working with high school or college students or in understanding the larger context of the school and its requirements.

In addition to this limitation, many students struggle with “mood swings” that are more severe than the typical “moodiness” of adolescence. Often it is not until the college years that students start to recognize familiar themes in how they react to stress. This would include ‘conflict with authority’ and extreme sensitivity following the ending of a love relationship. Some students turn out to have biochemically-based depressions such as “bipolar disorder”, requiring ongoing, expensive medications for which prescription plans may provide very little, if any, coverage. Overall in both managed care and in the larger context of political “health platforms,” the student population and its real needs for appropriate psychological help are given little or no consideration whatever. This is the same ‘system’ in American culture that reacts dumbfoundedly when there are student suicides and homicides at virtually all levels of education.

The ‘good news’ is that, as troubling as students’ concerns are, they may also have much more flexibility than older people in their capacity to develop an understanding of the many levels of their personalities and moods, and to change what they don’t like about themselves, including how they make choices and decisions. They start to discover, as we all must, that “life is what happens when you’ve made other plans.” Psychotherapy provides a safe and entirely confidential way for the student to share, often for the first time, the confusing, embarrassing, or painful feelings and behavior patterns from which they want to “get unstuck” so that they can progress toward their goals. The special relationship a student develops with a trusted psychotherapist is unlike any other as it explores concerns at an emotional level as well as intellectual. This can be particularly challenging for high-achievers who tend to “live in their heads.” It is common for students who were in great distress at the beginning of treatment to comment a few weeks later that the problem that brought them into counseling has almost been forgotten –

“I don’t even think about it anymore.”


Doris Bertocci, LCSW, BCD