By John M Grohol PsyD

Psychotherapy is full of both extraordinary potential benefits and some possible pitfalls. We’ve discussed some of those things in past entries. But there are some things in psychotherapy that you just shouldn’t spend too much time worrying about. They may seem important or worth worrying about, but it’s just a waste of your time, energy and focus. Here’s a few of them.

1. My therapist is judging me.

A lot of patients spend a lot of time worrying about what their therapist must think of them. That’s because you spend a lot of time sharing deep, emotional and personal stuff in therapy. Some of it may be embarrassing, or some of it may simply be out of the mainstream. Some of it may be things that happened to you as a child, that you had no control of. No matter what it is, you shouldn’t worry that your therapist is judging you. Believe it or not, most psychotherapists have seen and heard a lot of things in their careers. No matter what your story may be, it’s likely they’ve heard or seen worse.

One of the responsibilities and skills of a good therapist is to remain nonjudgmental, no matter their own personal reactions or feelings. Therapists who act or talk in a judgmental manner should be avoided.

2. Sometimes I just don’t know what to say or talk about.

You’re not alone. Virtually anyone who’s tried therapy has experienced a session where they feel hard pressed to come up with a topic to discuss. Some people — and some therapists — try and fill the void with small talk, or socializing. While this is fine if it happens on occasion, it should never be the focus of an entire session (or any significant portion of a session).

Silence is okay. Silence may be awkward at first, but it’s okay. While not every session should be full of many minutes of passing silence, it’s okay to sit quietly while you try and compose your thoughts. It’s also okay to not know what to talk about every session. That’s a normal and natural part of most psychotherapy. A good therapist will help you through this part, and in any case, it’s not something that should cause you much concern.

3. I’m not interesting enough — my therapist must be bored!

You don’t enter psychotherapy to entertain your therapist. While some people may believe they should have “interesting” things to talk about every session, that’s just not a realistic expectation — nor one that your therapist holds. You are there to get help for a specific mental health or relationship problem. Sometimes the conversations you’ll need to engage in to resolve that problem may not be very interesting. But they are all important, and you should recognize that “entertainment value” is not usually high on the list of the reasons psychotherapists enter the profession.

4. Should I know how this works? Should I feel the changes as they take place?

Psychotherapy is not like medications. You take an aspirin for a headache and the headache goes away. You go to a session of psychotherapy and you don’t immediately feel your pain relieved, your depression disappear, or your anxiety take a hike. Psychotherapy takes longer, and sometimes it’s hard to be patient, week after week of sessions.

You won’t know exactly how therapy works or when the changes will take place, as they will take place gradually, often in subtle ways. You may not feel them the same way you feel relief from a headache. You shouldn’t worry too much about this, as the process simply takes time and patience.

5. My therapist watches the clock.

Your therapist wears many hats, and one of those is as a small business person. Their commodity is time, and you’re paying for a portion of that commodity. Your therapist may indeed check the clock once in awhile because it’s in their best interests to do so and end your session on time. But surprisingly, it’s also in your best interests, too. By keeping your sessions on schedule, your therapist is also demonstrating and keeping good boundaries. The ability to keep good therapeutic boundaries is one of the indicators of a good therapist — someone who’s more likely able to help you.

So don’t be too concerned or worried if you catch your therapist glancing at the clock. It may be a little distracting, but it doesn’t mean your therapist cares any less about you. They’re just keeping the relationship professional and focused.

Fortunately the stereotype of talk therapy as a bastion of self-indulgent, unscientific chatter is changing as insurance companies and mental health experts press for more evidence-based treatment. The result, say patients and researchers, is growing proof that all types of talk therapy can be effective, even for patients whose problems are biochemical.

“Drugs and therapy are essential”
Joseph, 55, has been dealing with severe depression for 25 years. In psychotherapy he has learned to predict the chemical shifts in his brain that precipitated his debilitating depressions. Meanwhile, antidepressants have kept him functioning at an even keel between episodes. “For me, drugs and therapy turned out to be essential,” he says.

“No compelling data suggests that everyone with depression must have both drug therapy and talk therapy,” says William C. Sanderson, PhD, a psychology professor at Hofstra University in Hempstead, N.Y.

Drugs work faster, but not better
Medication often works faster than talk therapy. On the other hand, talk therapy promises something pills can’t: the life skills for managing inappropriate emotions, countering negative thought patterns, and forging closer, more productive relationships. These tools can also help prevent subsequent episodes of depression.

“Therapy is a commitment of time and money, and it’s not a quick fix,” says Jayne Bloch, a certified psychoanalyst in private practice in New York City. “It puts you in a position of vulnerability—seeking help and opening yourself up to self-discovery. But the rewards are great. Getting to understand yourself and learning to experience the range of one’s emotions helps to create more options in your life.”

Originally published at: http://www.health.com/health/condition-article/0,,20188156_2,00.html

TUESDAY, May 19 (HealthDay News) — Over the past year, 16.5 million Americans age 18 or older — 1 in 13 adults — experienced at least one bout of major depression, according to a new government survey.

Less than two-thirds (64.5 percent) of those individuals got treated for their depression, the study found.

The report, from the Substance Abuse and Mental Health Services Administration (SAMHSA), drew on data from the agency’s 2007 National Survey on Drug Use and Health, involving approximately 45,000 non-institutionalized adults. A major depressive episode was defined as any period of two weeks or longer characterized by depressed mood, loss of pleasure or interest, and at least four other symptoms, such as loss of appetite, lack of sleep and poor self-image.

Among other findings:

• Rates of major depressive episodes were higher among people aged 18 to 25 (8.9 percent) or 26 to 49 (8.5 percent) compared to Americans aged 50 and older (5.8 percent). About 7.5 percent of all American adults suffered at least one depressive episode.
• 14.2 percent of Americans who described their health as “fair” or “poor” had a depressive episode, compared to 4.3 percent of those in self-described “excellent” health.
• Among people who did seek out help for their depression, many (68.8 percent) saw or talked to a medical doctor or other health professional and got a prescription medication for their illness. A quarter (24 percent) saw a doctor but did not get this type of medication.

Among those with depression who did not receive treatment, more than 43 percent said cost was the reason they did not get help. About 29 percent said they could deal with their depression on their own, 18 percent said they didn’t know where to turn for help, about 17 percent said they didn’t have the time to seek care, 11.3 percent said their health insurance lacked the necessary coverage, and 11.1 percent cited concerns about confidentiality.

Whatever the reason, forgoing care is never a good idea, one expert said. “Depression is a medical condition that should be treated with the same urgency as any other medical condition,” SAMHSA Acting Administrator Dr. Eric Broderick said in an agency news release.

More information

Find out more about depression at the U.S. National Institute of Mental Health.

This article: Copyright © 2009 ScoutNews, LLC. All rights reserved.

Originally published at: http://www.mentalhelp.net/poc/view_doc.php?type=news&id=119181&cn=5

Studies show that people with personality disorders (a classification that covers many of the most common mental health problems) recover seven times faster with the help of therapy than they would without treatment.

When therapy works best
Therapy is particularly effective against anxiety disorders, social phobias, and posttraumatic stress disorder, though medication is critical for treating other mental health conditions, such as panic disorder and schizophrenia.

Research suggests that talk therapy even causes changes in brain function similar to those produced by medication.

Therapy with medication
Certain types of talk therapy, namely cognitive-behavioral therapy and interpersonal psychotherapy, are as effective—but not more effective—than medication for mild or moderate depressions. People with severe depression require medication as well.

“The ideal treatment in most cases is a combination of medication and therapy,” says Kenneth Robbins, MD, clinical professor of psychiatry at the University of Wisconsin–Madison and a Health.com adviser.

In one study of depressed patients taking medication, 70% of the patients who also received intensive interpersonal psychotherapy experienced a significant reduction in symptoms after five weeks, compared to just 51% of the patients who received only 20-minute support sessions.

Twelve months later nearly all of the patients who initially responded to therapy continued to have reduced symptoms, and the disparity between the two groups was even more dramatic. The researchers noted that interpersonal psychotherapy was “significantly more effective in increasing social functioning.”

“Therapy is a gift”
Improvements in “social functioning” may be the dry argot therapists use to describe patient success. Those on the receiving end of treatment use very different language. Many report that a nonjudgmental therapist eases the loneliness of depression, or lights the way to deeper, closer relationships.

Many describe deep healing. “I was amazed at my transformation in therapy,” says Terrie Williams, 53, of New York City, whose weekly psychotherapy sessions allowed her to feel “authentic” rather than “robotic” as she navigated a high-stress job in public relations.

While she was also prescribed Zoloft and Wellbutrin, Williams came to understand that her struggle was more than biochemical. “Therapy is a gift we should all have. We all have deep scars from childhood, which are compounded by everyday slights. [It helps] to have one hour a week to replenish yourself.”

Originally published at: http://www.health.com/health/condition-article/0,,20188165_2,00.html

THURSDAY, Oct. 8 (HealthDay News) — Unemployed Americans are four times more likely than those with jobs to report symptoms of severe mental illness, such as major depression, according to a new national survey that reveals the mental health toll of the recession.

The poll of 1,002 adults aged 18 and older also found that people with jobs who were forced to accept work changes, such as reduced hours or pay cuts, were twice as likely to have symptoms.

The findings were released to coincide with Mental Illness Awareness Week (Oct. 4 to 10) and National Depression Screening Day (Oct. 8). The survey was conducted last month for Mental Health America, the National Alliance on Mental Illness and the Depression Is Real Coalition.

“This survey clearly shows that economic difficulties are placing the public’s mental health at serious risk, and we need affirmative action to address these medical problems,” David L. Shern, president and CEO of Mental Health America, said in a news release. “Individuals confronting these problems should seek help for their problems — talk to their doctor, trusted friend or advisor or mental health professional.”

“Unemployment today stands at almost 10 percent. Nationwide, we face a mental health crisis as well as an economic crisis,” Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness, said in the news release.

Among the other survey findings:

• 13 percent of unemployed people said they’ve had thoughts of harming themselves — a rate four times higher than for those with full-time jobs.
• Unemployed people are about six times more likely to have trouble meeting household expenses. Twenty-two percent said they have great difficulty paying their utilities, and nearly half said it’s difficult for them to obtain health care, which further compounds their situation.
• Respondents without jobs were twice as likely to report being concerned about their mental health or use of alcohol or drugs within the last six months. Among those who hadn’t spoken to a health professional about these concerns, 42 percent said cost or lack of health insurance was the main reason.
• Nearly 20 percent of respondents said they’d had to accept forced changes, such as reduced hours or pay cuts, during the last year. They were five times more likely to report feeling hopeless most or all of the time than people who hadn’t experienced a forced change at work.

“There is no shame in seeking help to overcome unemployment or a medical illness. For the sake of all our loved ones, it’s important to learn to recognize symptoms of depression and other mental illnesses. Screening helps. Talk with a doctor about any concerns,” Fitzpatrick advised.

Major depression affects about 15 million U.S. adults (5 percent to 8 percent of the adult population) each year. Only half of people with major depression seek treatment, regardless of their economic or employment situation, the survey found.

More information

The U.S. Substance Abuse and Mental Health Services Administration offers advice for getting through tough economic times.

This article: Copyright © 2009 ScoutNews, LLC. All rights reserved.

Originally published at: http://www.mentalhelp.net/poc/view_doc.php?type=news&id=122718&cn=5

Difficulty getting your health insurance to cover talk therapy is a common problem. “Insurance companies put patients and psychotherapists in a catch-22 situation,” says Frank H. Goldberg, PhD, chair of the New York State Psychological Association‘s insurance committee and a psychologist practicing in Manhattan and in New Rochelle, N.Y.

Patients in a catch-22
Although most insurance plans make 20 to 30 annual mental health visits available in their contracts with employers, they may deny coverage after approximately eight to 10 visits due to their determination of “medical necessity.” The companies typically ask for an outpatient treatment report, or OTR, after several visits.

“If we state on the OTR that the patient is making progress, the company may deny further payment because the patient is getting better and treatment is no longer a ‘medical necessity.’ On the other hand, if we report that the patient is making little progress, the company often denies additional treatment because it doesn’t seem to be doing any good,” says Goldberg. The concept of “medical necessity” is particularly vexing for patients and therapists because health insurance companies can define it any way they like, and the definition often changes from year to year.

If the insurance company won’t authorize payment for services or therapy sessions that you and your therapist think you need, your therapist is ethically obligated to call the insurance company on your behalf. The first person the therapist speaks with is usually a utilization reviewer or care coordinator. This person typically has no special mental health training and is unlikely to be much help. Your health-care provider should ask to speak to that person’s supervisor who should be a “like professional,” or another psychologist or doctor.

How to appeal for mental health coverage
If the request for services is still denied, you have a right to appeal. But listen carefully: According to the Mental Health Legal Advisors Committee, a state-funded advocacy group based in Boston, Mass., your therapist must tell the insurance company’s utilization reviewer and doctor that he or she will not accept a denial of services or a reduction in services.

If your therapist does not insist on all the terms of the original request, you won’t receive a denial, and you have no basis for appeal. The phone calls to the reviewer and doctor are not part of the appeal process. You must get a denial notice before you can start the appeal.

Once you get the denial notice, you must file an appeal in writing with the insurer. Include your name and policy number, detailed information about the service your therapist requested, the exact dates for which the service is requested, and reasons you think the insurance company should reverse its denial.

Should you pay out of pocket?
If you can afford it, your treatment can continue during this process. If the appeal is denied, you can continue treatment with your therapist, and the two of you negotiate the fee. Goldberg notes that the therapist cannot charge you more than what your insurer was paying if your approved sessions have been used up.

In other words, if the insurance company was paying $50 a visit and you made a $20 co-payment, you will now pay the entire $70. A therapist at a community mental health center may charge from $5 to $50 an hour, depending on your income and other medical expenses if you are not covered by insurance.

Private clinic fees are in the $50 to $100 range, and private therapists typically charge $60 to $125 an hour. Expect to pay a higher hourly rate for a psychiatrist or psychologist than for a social worker, psychiatric nurse, or counselor.

Originally posted at: http://www.health.com/health/condition-article/0,,20188144_2,00.html

FRIDAY, July 31 (HealthDay News) — A growing number of Americans now have a positive opinion on psychiatric medications, a new study contends.

About five out of six people surveyed felt psychiatric medications could help people control psychiatric symptoms, but many also expected the medications could help people deal with day-to-day stresses, help them feel better about themselves and make things easier with family and friends.

“People’s attitudes regarding psychiatric medications became more favorable between 1998 and 2006,” said study author Dr. Ramin Mojtabai, an associate professor in the department of mental health at Johns Hopkins Bloomberg School of Public Health in Baltimore.

Mojtabai expressed concern, however, that people’s attitudes were increasingly positive, even in situations where there might not be a proven benefit to the drugs.

“My hope would be for people to be more discriminating in their views about the effects of these medications. I would hope they’d be more willing to accept them for treating panic and depression, but not for things like stress,” he said.

Results of the study will be published in the August issue of Psychiatric Services.

Mojtabai wanted to assess American’s opinions of psychiatric medications for a number of reasons. One is that the use of such medications has soared in recent years. Between 1990 and 2000, he said, the use of antidepressants increased fivefold. Another reason is that the government has allowed direct-to-consumer advertising for the drugs. And finally, he said that he wanted to learn if the recent FDA black box warnings on some antidepressants and antipsychotics had any effect on people’s opinions of these drugs.

Using data from the U.S. General Social Surveys from 1998 and 2006, Mojtabai compared the two periods to examine people’s attitudes toward psychiatric medications.

The initial sample for 1998 included 1,387 people, while the 2006 survey included 1,437 people. Both groups included slightly more females than males. More than 70 percent of both groups were white, and more than half had more than a high school education.

In 1998, 84 percent of people agreed with the statement, “These medications help people control their symptoms.” In 2006, that number had edged up slightly, to 86 percent.

By 2006, more people believed that psychiatric medications could help people feel better about themselves (68 percent vs. 60 percent), help people deal with stress (83 percent compared to 78 percent), and make things easier with family and friends (76 percent compared to 68 percent).

People were somewhat more willing to take these medications themselves: 29 percent in 2006 vs. 23 percent in 1998. Opinions about the drugs’ potential adverse effects didn’t change over time, according to the study.

Mojtabai said that advertising may have helped increased people’s positive perceptions of these drugs. But, he added, there is also an increasing awareness that many psychiatric disorders have a biological or organic cause that medications may be able to help correct.

Dr. Norman Sussman, interim chairman of the psychiatry department at New York University Langone Medical Center, said that advertising has definitely played a role in people’s perceptions of these drugs, noting that many people now ask him for medications by name. He added that another reason may be word-of-mouth endorsements from people who are taking these medications and have been helped by them.

“These drugs have become a part of our culture,” Sussman said. “Fifty years ago, psychiatric drugs were something you’d take only if psychotherapy failed. Today, psychotherapy often isn’t affordable, and the nature of treating symptoms has shifted toward medications. When these drugs work — for anxiety, insomnia, depression, mania — they can be miraculous for that person. But, none of them work universally.”

More information

Learn more about medications for depression from the American Academy of Family Physicians.

This article: Copyright © 2009 ScoutNews, LLC. All rights reserved.

Originally published at: http://www.mentalhelp.net/poc/view_doc.php?type=news&id=120970&cn=144

The typical talk-therapy session lasts 45 to 50 minutes and involves a conversation, usually with the therapist guiding the patient with skillful, probing questions. Watch what one patient says she gets out of her treatment.

Patients often say they feel worse during the beginning stages of therapy. “This occurs because our natural inclination in dealing with negative feelings is to avoid them,” says William C. Sanderson, PhD, professor of psychology at Hofstra University in Hempstead, N.Y.

“I’ve had patients tell me that they feel worse once they start looking at these personal issues so closely. It’s like focusing on how your stomach feels when you’re hungry. But I’ve had just as many patients tell me that the increased focus on and understanding of their problems makes them feel better right from the beginning.”

Therapy is hard work
A lot of people are surprised to find how much work is expected of them outside of therapy sessions. You may be asked to track thoughts, do assigned reading, and make specific behavior changes. “If you don’t do what I suggest outside of sessions, it’s like joining the gym but never working out. There’s no lasting benefit,” says Sanderson.

Others are uncomfortable with silences and don’t know how to fill them. “There’s a concept in therapy: Talk about whatever you think about, whatever comes to mind. But that’s hard to do,” says Tracey Lipsig Kite, MSW, a licensed therapist in Evanston, Ill. “It doesn’t have a normal frame of reference. We don’t do that with other people. It’s really just weird. People aren’t used to it.”

Projecting is normal
One unexpected byproduct of therapy is intense emotions about the therapist. In other words a patient may have past emotional attachments surface that are projected (transferred) onto the therapist. The desired outcome is to work through the transference. This means the projections are discussed in therapy and not acted out. Acting them out would foster confusion and other problems.

This is normal, says Gary Seeman, PhD, a psychologist in San Francisco. “Primitive, childlike sectors of the mind can be activated during the therapy, and these intense emotions should become grist for the mill,” he says.

However, strict boundaries must be observed. Therapists are prohibited from sexual or even social relationships with a patient.

Originally published at: http://www.health.com/health/condition-article/0,,20188141,00.html

Genetics researchers have yet to pinpoint a specific gene or genes for depression. But researchers do know that people with depression in their family are more vulnerable to the condition. This is most likely due to both genetic factors — and the struggle of having a depressed family member. As scientists work to figure out the genetics of the illness, families and therapists are figuring out ways to cope.

Untreated depression can be “a family calamity,” says Dr. William Beardslee, a professor of psychiatry at Harvard Medical School and longstanding researcher of the effects of severe parental mental illness on children. Nearly 16 million children under the age of 18 are living with an adult who had a bout of major depression in the last year, according to a recent report from the National Academy of Sciences.

Parents may function reasonably well for a time, but when a bout of depression hits, parenting can becomes rocky, says Beardslee. Then the child may experience “a change in parent’s attention, a change in parent’s praise, and a change in parent’s focus,” he says. That can make children angry, sad or wary.

Depression In Families

All scientists can say for sure is that depression in the family increases the risk of any one individual member. According to the National Academy of Sciences report, 2 to 4 percent of young children with a parent who has depression will have depression themselves. As many as four in 10 adolescent children of depressed parents will have depression. And, children of depressed parents are more likely to be substance abusers.

So genes do matter, and having a depressed parent also matters, and that’s why researchers are developing new strategies for families.

Genetics can be an indication of vulnerability, says Beardslee. It may take an environmental problem like a divorce or an experience of violence or poverty to spark depression. And sometimes, parents’ problems can make their children more likely to develop depression.

Getting Support Is Key

Parents with depression can reduce the risk to their children by getting treatment. Families can go in for family therapy, an approach pioneered by Beardslee and supported by the National Academy of Sciences report. If there’s a full awareness of the depression, the family can figure out ways to make sure the child is able to get emotional support from the other parent, a friend or relative when the other parent is going through a bad spell.

“What we’ve found works well is participant support groups,” says Peter Ashenden, head of Depression and Bipolar Support Alliance. “People get to meet other individuals with the same or similar experiences,” he says, and families can see how other families have coped.

Challenges To Healing

Getting the right kind of professional help can be challenging, though money isn’t always the obstacle you might think. Most health insurance policies that cover mental illness include family therapy, says Julie Totten, head of Families for Depression Awareness.

But a problem she does see is that doctors often only treat the patient, not the family.

“It’s not something that medical professionals often talk about as an option,” she says. “That’s how our medical system is set up, to treat the patient and not the family.”

She says it can be a big problem convincing family members with depression to get help.

“Expect them to say ‘no,’ ” she says.”Then keep working at it, get other people involved, because if someone is depressed their first answer is going to be no, they don’t want to do anything because they’re feeling so down.”

Totten’s own brother had depression. She tried to convince him to get help, but he wouldn’t. He eventually committed suicide, which prompted her to found Families for Depression Awareness.

The big stumbling block to getting help is stigma. “People don’t really talk about it enough,” says Totten. “You don’t say to your neighbor, ‘my brother is really depressed.’ “

Groups like Depression and Bipolar Support Alliance guarantee anonymity for people who use their Web site because they understand the importance of this, says Ashenden, the head of the organization.

“We know it from our people that are reaching out to us. There’s a fear in people’s voice when they’re calling us.”

Originally published at: http://www.npr.org/templates/story/story.php?storyId=112339412&ps=rs

Originally published at: http://www.npr.org/templates/story/story.php?storyId=114055588

Arcadio Morales, one of six residence deans at Stanford University, has lived in an apartment in the campus dorms for 15 years, often fielding late-night phone calls from students about everything from Frisbee injuries to mid-term anxiety to alcohol poisoning. He says some arriving freshmen have always packed emotional baggage along with their laptops and books. But the mix of problems he’s called to weigh in on has become more serious in recent years.

“Early on,” he says, “most of the issues that surfaced were roommate issues, compatibility issues.” He still gets that sort of thing, along with the calls from “very involved” parents who want him, for example, to go down the hall and wake up their son or daughter. But these days, Morales is getting more calls about students in need of substantial psychiatric support.

“We’re getting students that wouldn’t have been here 10 years ago,” Morales says, “because they’re on antidepressants or antipsychotic medication, and they’re functioning fairly well.” But it can be a big challenge for colleges when these students have crises, he says.

National epidemiological studies confirm that what Morales is seeing is happening on campuses nationwide, irrespective of the type of college or its size.

“Institutions are faced with several concurrent issues,” says Daphne C. Watkins, a researcher at the University of Michigan School of Social Work who has been studying mental health issues on campus. “First, there are increasing numbers of students with increasingly severe emotional problems. Second, students — and the families of these students — look primarily to colleges and universities to provide mental health and other supportive services for their students. And finally, budgetary cutbacks at these institutions make the growth and advancement of campus mental health services very difficult.”

Who Do You Call?

Some of the sorts of crises that colleges are increasingly called to handle are hard on any school — and any student. Amanda Gelender, now a successful Stanford senior, with many academic and public service awards to her credit, also has bipolar disorder. Her symptoms are mostly evened out with medication. But two years ago, the drug she had been prescribed seemed to stop working for a time, and her depression came roaring back. She remembers the night in the dorm when the bottom fell out, and she called a family member.

“I was in hysterical tears,” she says. “I was making remarks (like), ‘What’s the point?’ You know, things a depressed person would say.”

Gelender says she was very sad, but certainly not suicidal. She just needed to vent. And after that, she hung up the phone and went to sleep. She had no idea that her family was worried enough after talking with her to call 911.

“And about an hour later, there’s banging on my door,” Gelender remembers. “I go to the door, and there’s two armed police who barge in, [saying] ‘Where are your pills? Where are your pills?’” The officers ransacked her room, she says. They searched her shelves and combed through drawers, all the while yelling a steady stream of questions.

“I’m half-naked,” she remembers. “I’m dressed for bed, and you know, they’re like, ‘Are you going to kill yourself? Are you going to kill yourself?’ And I’m just like, ‘No. I’m not going to kill myself.’ And they’re threatening to take me to the psych ward, and they’ve got their handcuffs in their hands. I don’t know what you say to convince someone that you’re not going to kill yourself besides, ‘No. I’m not going to kill myself.’”

The police phoned the psychiatrist on-call, and after some back and forth, they left. But the whole experience left Gelender horribly shaken. She understands that the police were following protocol in dealing with what they thought might be a suicide threat. And she doesn’t blame her family; they just wanted to keep her safe.

“But that’s the option that loved ones have,” Gelender says. “If they fear for someone, they have to call the police, and they have to induce this whole mess.”

Early Intervention

Of course figuring out who is a risk to themselves and who is not isn’t easy for anyone. One of Aracadio Morales’ duties is to help train student resident advisers in the dorm. He says he instructs them to always err on the side of safety. “It’s better to have someone angry and alive,” he says, “than dead and dead.”

Everyone involved agrees that it would be much better to intervene long before that sort of crisis develops. All across the United States, concerned colleges students and parents are trying to do just that. Earlier this year. Amanda Gelender started a theater project to bring mental illness into the light.

And down the street from Stanford, a former Palo Alto mayor and his wife — Vic and Mary Ojakian — became mental health advocates after their youngest son Adam died by suicide during his senior year at the University of California, Davis in 2004.

“We determined that he became very anxious due to a certain situation — what’s called a triggering event,” says Mary Ojakian. “It was ultimately severe depression that caused his death.”

In retrospect, there might have been a few subtle behavioral clues, but none of Adam Ojakian’s friends, family or others close to him recognized the depression before he died, Mary Ojakian says. “He had not been diagnosed with mental illness,” she says. “He did not take drugs. He was a good student. He wasn’t aware he was sick. He wasn’t saying anything.”

After Adam died, his parents interviewed his friends, people in the counseling center, police, professors — even the chancellor. And that’s when they first learned about the shortage of therapists on college campuses. and about how little training most faculty and even first-responders get in how to recognize and handle mentally ill students.

“We realized — and they realized — that there was a lot that could be done to change the situation on campus,” says Mary Ojakian.

The situation at colleges all across the country makes Vic Ojakian angry. “What’s going on right now isn’t acceptable,” he says. “We took a look at our situation and we said to ourselves, “We don’t want another good human being dying. We decided to do something about that — not to sit back, not to do another study. We decided we were going to go out and save lives.” Mary Ojakian is emphatic, too. “Someone’s got to draw the line,” she says. The two have been lobbying colleges up and down the state of California to invest in more and better mental health services for students.

Strengthening Safety Nets

Someone else has drawn the line — or at least tried to. The International Association of Counseling Services (ICACS) sets the standards for mental health services, and it recommends that in order to keep students safe and healthy, a college campus should have a minimum of one therapist for every 1,000 to 1,500 students. When a school falls significantly short of that — and many colleges do — the wait-lists for students seeking help can stretch to a month or more.

In one recent study, students who got stuck on a long wait list were 14 percent more likely to drop out than those who got timely counseling.

When there aren’t enough therapists, students with less severe problems suffer, too, the experts say.

“Students in crisis tend to get the greater share of limited resources, resulting in less assistance to other students who are not so acute but who are dealing with more ‘traditional’ adjustment and developmental disorders,” according to an ICACS position paper. “These students may fall through the cracks.”

By hiring six new therapists last year, Stanford brought its ratio closer to one therapist per thousand students. It also introduced a new system to triage phone calls so that the students who are most needy get in to see a counselor right away. And all callers at least talk by phone with a therapist within a day. Dr. Ron Albucher, a psychiatrist, was hired to head the counseling center, partly in recognition of the increasing number of students in therapy who are also on medication that may need adjustments or monitoring.

“Even with that many counselors, we’re still incredibly busy,” Albucher says. “And one of the consequences of having students with more severe illness on campus is that we recognize we’re not a psychiatric facility. We can’t provide 24-hour coverage for students in the dorms.” Most of those who want or need long-term counseling — beyond a few sessions — are referred to therapists off-campus.

A Critical Time

When Stanford’s endowment took a big hit last year and the school had to cut its budget, it largely spared the counseling center. Stanford did add a new health fee for all students — about $500 a year — with much of that money going to support mental health services.

But not every college has the same resources. Daniel Eisenberg, a mental health researcher at the University of Michigan, says that in these very tight financial times, many universities and colleges — large and small — are feeling forced to make tough choices.

“Part of the tension is that campuses see their central mission as education,” Eisenberg says. “So I think there is sometimes a question about whether mental health really fits into that central mission.”

Vic and Mary Ojakian, whose son died in the midst of a deep depression, think society doesn’t have a choice given the statistics: Half of all cases of mental illness first show up in the early teen years; and 75 percent are present by age 24. College is a prime time to intervene and get these kids on a healthy path, they say.

Some big fixes will indeed cost big money, Vic Ojakian says. But others — such as peer support groups and a basic Web site that at least points students to other telephone and online mental health resources — are cheap enough that even the most financially strapped colleges should have them in place.

“Parents [of high school seniors] need to look at a college not just in terms of its academic credentials,” he says. “Ask what sort of mental health services they have.” The Ojakians were particularly dismayed as they began their work to learn that some schools have no counseling center and no mental health services at all. Ask schools about their therapist-to-student ratio, he says, and about what the institution does for students who have mental health problems after-hours. And although many people think about freshmen as the most vulnerable group on campus, studies show that college seniors and graduate students are at least as much in need of psychological support.

Amanda Gelender, who was so depressed two years ago, says strong support from friends, family and her doctor, along with a change in her medication, were all crucial to helping her get back on track.

“Every day’s a struggle,” she says. “But I have more hope. I’m applying to a lot of post-graduate programs, and I’m actually excited about my future.”