Mandating Mental Health: A Controversial Approach to Combating Mental Illness on Campus

But public discourse on college student mental health isn’t just about the prevalence of mental illness, it’s about the barriers to treatment mentally ill students face. Colleges and universities are typically not equipped, funded, or staffed to identify and treat the needs of students experiencing serious mental health disorders, nor are they able to cope with the growing number of students needing help. As Trip Gabriel of The New York Times writes:

The need to help this troubled population has forced campus mental health centers — whose staffs, on average, have not grown in proportion to student enrollment in 15 years — to take extraordinary measures to make do. Some have hospital-style triage units to rank the acuity of students who cross their thresholds. Others have waiting lists for treatment — sometimes weeks long — and limit the number of therapy sessions.

As a result, many students are not able to find the support they require and are left to struggle alone, sometimes with devastating results. In response to growing demand and public pressure, some colleges are revisiting their mental health policies and expanding mental health services and outreach initiatives. At the University of Central Florida, for example, workshops and therapy groups are now offered daily for students experiencing anxiety, depression, and other types of emotional distress. Next fall, the school will launch a new app-based cognitive behavioral treatment program that students can access through their mobile phones. Other schools are introducing therapy dogs, hiring more clinical staff, and hosting open forums to raise awareness around mental health and encourage those in need to seek treatment.

Like many others, Marney A. White, Associate Professor of Psychiatry and Chronic Disease Epidemiology at Yale University, believes that increasing access to mental health care for college students is critical. The limited resources of many college health systems has created an environment in which care is rationed and only the most critical cases receive immediate attention, leaving students with less severe symptoms without treatment. However, White proposes a solution that goes beyond expanding access to assessment and care – she wants to make assessment and care mandatory. In a recent Washington Post op-ed, White argued that the implementation of mandatory annual mental health screenings would facilitate earlier diagnosis and treatment to contain mental illness before it reaches a point of crisis:

It is critical to point out that if caught early, subclinical mental disorders can respond readily to treatment. From a cost-effectiveness standpoint, it makes more sense to treat conditions in the beginning phases than to wait until a problem has worsened and potentially become chronic.

Realizing that such a proposal will be seen by many as “a violation of students’ privacy and paternalistic medicine,” she pre-emptively defends it, claiming that mandatory health screenings and treatment are already in effect and that mental health should not be treated differently. Rather, she argues that notengaging in mandatory screening and treatment will serve to “perpetuate a cycle of stigma and fear.”

However, critics are quick to argue that colleges, in fact, do not mandate testing and treatment of other illnesses, even commonly communicable illnesses such as STIs, which, unlike mental health disorders, can and do affect the physical health of other students; singling mental illness out suggests that it is actually notlike other illnesses and that people with psychiatric illness do not deserve the same right to privacy and self-determination as those with physical ailments. Some respondents point out that mandatory screening implies that there are consequences for those who do not submit to screening or treatment and ask if people would be barred from accessing higher education if they are not engaging in a particular type of healing. Others believe that mandatory policies would only serve to deepen stigma surrounding mental illness and treatment, scare off students who are experiencing psychological distress, or encourage them to hide their emotional struggles. A response to White’s piece adds:

Therapy is a cooperative process. It cannot be done effectively TO someone against their will. If you mandate treatment for those who are not interested in treatment you immediately set up an oppositional dynamic in treatment. This most of the time will lead to a poor and or non-effective experience with mental health treatment. So, effectively forcing students into treatment won’t help and may create a negative first experience with mental health treatment that leads them to avoid treatment later in life.⁵

In other words, the foundation of mental health treatment is a positive therapeutic alliance between you and your psychiatrist or therapist, and treatment is a collaborative act that requires the engagement of both the clinician and the client, whether that treatment takes the form of individual psychotherapy, pharmacological therapy, or a therapy group. Although being encouraged to seek treatment by family, friends, and healthcare workers can help someone want to participate in treatment, mandatory participation is unlikely to yield positive results.