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7 Signs Your College Student May Be Having a Mental Health Crisis

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Seth J. Gillihan, PhD - Blogs
By Seth J. Gillihan, PhDClinical psychologistDecember 04, 2018
From the WebMD Archives

Starting college is an exciting time, but it’s also a major life stress. For many young people, it’s the first time they’ve been away from home, family, and their childhood friends for an extended period of time. On top of that, they usually face changing sleep schedules, a new social landscape to navigate, and greater academic demands than in high school.

It’s common for mental health issues to emerge during this transition. And since most college students have less contact with their parents, close friends, and instructors than in the past, problems can go undetected for longer.

Often, parents don’t realize how much their child is struggling until their child comes home for winter or summer break. Mental health crises often become apparent around midterm and final exams, as academic demands intensify and students struggle to keep up. Other students may do fine academically but be battling through severe anxiety, depression, disordered eating, or other issues.

What to Look For

Here are some common signs that could indicate a mental health crisis. None of these necessarily signal a crisis per se; think of them instead as cues to seek more information.

Struggling to Meet Academic Expectations - You might discover that your child is missing a lot of class, doing poorly on exams, or not turning in papers. Students often have reasonable explanations for missing a class or two, or turning in a paper late. Consider the overall pattern you’re seeing, and follow your instincts if you sense there’s something bigger behind your child’s difficulties.

Withdrawal - It’s typical for students to spend many hours sleeping when they come home for break, especially for the first few days when they’re probably more sleep deprived than usual from long hours of work at the end of the term. However, pay attention if you notice that your child is withdrawing from their normal activities, like:

  • Not going out with friends
  • Not answering texts
  • Staying in their room
  • Avoiding family meals and other gatherings

These types of withdrawal could reflect the low energy and motivation that are common with depression, or the fear and avoidance that come with high anxiety. They could also reflect other struggles that make your child want to hide.

Changes in Alcohol and Other Substance Use - Chemical substances are often used to ease the pain of depression or trauma, or to blunt feelings of anxiety. Be especially vigilant if your family has a history of substance use problems. Changes in your child’s consumption of alcohol, marijuana, or other substances can be a sign of an underlying mental health issue. Look for changes like:

  • More frequent use, such as drinking most nights
  • Greater volume when using, like binge drinking to the point of blacking out
  • Using substances alone, like smoking marijuana alone in their room

Lack of Self-Care - Basic self-care is often one of the first things to go when a person is having major life difficulties. They might stop brushing their teeth or bathing regularly, to the extent that they look disheveled or have noticeable body odor. And whereas they previously took care in how they dressed, now they wear the same dirty sweat pants every day.

You might also notice poorer food choices, like surviving on fast food or unhealthy snacks, as well as not exercising. Unfortunately, these behaviors can worsen the person’s condition, since poor diet and lack of exercise are linked to worse well-being.

Major Life Stress - Although experiencing stress is not a sign of a crisis in and of itself, stressful life events are one of the most reliable predictors of mental health struggles. Life stress comes in many forms for college students, including:

  • Failing a class
  • Having health difficulties
  • Being in a car accident
  • Being assaulted
  • A romantic breakup
  • Being bullied
  • Death of a friend or family member

For many students, simply moving far from home and from one’s high school friends is a major stressor. Stresses that continue for a long time, like chronic health problems or ongoing academic struggles, often have a cumulative effect. For this reason, your child may seem to be doing surprisingly well as they face enormous challenges. However, our bodies and minds will start to struggle as the stress drags on and our nervous systems stay on high alert. Plan to check in regularly to see how your child is doing.

Change in Perspective – One of the more subtle changes you might notice is in the way your child sees the world. Perhaps they’ve become more pessimistic or cynical, and are quick to see the worst in others. It may seem that they’re looking at the world through mud-colored glasses. You might notice a difference in tone in your interactions with them, and a shift in how they see themselves.

Hopelessness - Pay special attention if your child expresses a lack of hope that things will get better. It’s hard to overstate the value of hope, and it can be crushing to lose it. Listen for statements like:

  • “I feel like giving up.”
  • “I don’t see things ever improving.”
  • “It’s pointless—I don’t know why I even try.”
  • “Things are never going to get better.”
  • “Nothing ever works out.”
  • And of course, “I feel so hopeless.”

Loss of hope can lower our willingness to seek help and to invest our energy in activities and relationships that help us feel better. Hopelessness is also an almost universal experience for those who attempt suicide. That’s not to say that most people who feel hopeless try to end their lives, but the risk goes up greatly when hopelessness is high.

How to Help Your Child

So what can you do for your college-aged student if you suspect they’re in a crisis?

Be Aware of Your Own Anxiety - It’s normal to be anxious about your child’s well-being. However, excessive worry about someone’s welfare can inject an unhelpful energy into our conversations with them. For example, we might become angry if the person isn’t immediately forthcoming, making them even less likely to share openly. It’s unrealistic to expect yourself to be perfectly calm, of course, but simply recognizing our own anxiety about a situation can help us to manage it more effectively.

Start a Collaborative Dialogue - Discuss your concerns with your child at a time that’s mutually convenient (unless they keep putting you off). Describe what you’ve seen honestly, directly, and in as non-judgmental terms as possible, and then invite them to respond. Strive to let them know that you’re there to help, and to work together as a team.

For example, you might say, “I’ve noticed that you haven’t gone out at all with your friends in the week you’ve been home, which you always used to do on break. I’m a bit concerned about you. How are you doing?” This lead-in is more likely to invite a positive and collaborative response than something like, “You can’t just lie around the house all the time—what’s gotten into you?”

Expect that the conversation won’t be easy, and be prepared for a range of responses. For example, your child might:

  • Express genuine confusion if they think they’ve been doing fine
  • Get irritated, perhaps because they don’t think your concerns are justified, or because they know they are
  • Validate your concerns and tell you more about how they’re doing
  • Get defensive, often from feeling shame

Expect Your Child to Feel Ashamed – The issue of shame is very important, because it so often comes with psychological struggles and can prevent a person from opening up about how they’re doing. Shame might be especially pronounced if your child is failing in school and is already feeling guilty about their poor performance and about wasting your money; drawing attention to their failure can amplify that sense of guilt and shame.

They may also feel ashamed if they’re doing things they’re not proud of, like skipping classes or drinking too much, and may interpret your concern as condemnation. Express as clearly as you can that you love and support them, regardless of what the struggles might be.

Discuss How You Can Help - If it turns out there is a crisis, discuss with your child how they would like you to help. Options can include:

  • Providing a listening ear whenever they want to talk
  • Helping them come up with a self-directed plan to address the crisis, if professional assistance isn’t required
  • Brainstorming other resources that might be helpful, like using on-campus resource centers
  • Providing practical assistance, like taking over some of their responsibilities to free up time for them to pursue treatment
  • Researching psychotherapists or other professionals who could be helpful
  • Accompanying them to appointments if they want

Take care not bring up psychotherapy too quickly, which can shut down the conversation before a person has really felt understood. If your child is reluctant to see a therapist, asking if they “need to see someone” can make them less inclined to let you know that they’re struggling, for fear they’ll be forced into treatment. It may be an important thing to think about with your child, but it doesn’t have to be a part of the initial conversation.

What If They Don’t Want Help? Unfortunately many people in the midst of a crisis aren’t ready to receive help. Keep the following guidelines in mind if your child refuses to seek help:

  • Stay as calm as possible. Adding your anger to theirs or getting locked into a battle of wills lowers the chances that your child will get the help they need.
  • Take the long view. Just because your child isn’t ready to seek help now doesn’t mean they’ll never be. This principle assumes there isn’t an emergency, like the risk of imminent self-harm.
  • Stay supportive. Make sure your child knows that your love and care aren’t dependent on whether they get the help you think they need.
  • Remember that ultimately the decision is theirs. It’s agonizing to watch our children suffer and not get the help that may be available. Watch out for thoughts like, “They have to get help,” or, “I have to convince them to start therapy.” The best you can do is to encourage them to take care of themselves (including appropriate incentives). It’s important to communicate to them a sense of their own agency as young adults, assuming they’re not so compromised that they can’t make a sensible choice.
  • Take care of yourself. You will certainly need extra support during your child’s crisis. Seek out the company of those you’re closest to, and don’t hesitate to get therapy if you feel you need it. A therapist who knows you well can probably offer guidance for how to manage your child’s crisis.

Note: If you believe your child is a serious threat to themselves or someone else, take them to the nearest emergency room or call 911.

Planning for Success at School

As you consider whether your child is well enough return to school or needs to take a break, keep the following ideas in mind.

Set Clear Expectations - When your college student is dealing with a mental health condition it can be difficult to know how to balance your love and support with the requirement that they be well enough to attend (or return to) school. For example, if your child has taken a leave of absence and continues to have the same kinds of struggles as they had while at school, you would understandably be reluctant to approve their returning to campus. You want your child to be safe and to have a high probability of doing well in school, not to mention wanting to avoid paying thousands of dollars for classes they might have to drop at the last minute.

On the other hand, you might be concerned about your child’s friends graduating well ahead of them, and about their being away from their support for an extended period of time. You also may not want to seem like you don’t believe your child can succeed in school if they’re determined to return to campus as soon as possible.

It’s generally best to set clear expectations of the conditions under which you would approve (and pay for) their return to school. For example, you might require that your child successfully (however defined) complete two courses at a local college or university, and show consistent ability to keep appointments and fulfill their responsibilities. You might also expect that your child keep regular appointments with a mental health professional, if needed, and to arrange for continuation of care once they’re back on campus.

Know the Policies - If your child needs to take a medical leave of absence because of a mental health crisis, educate yourself about the relevant policies. For example, when can a student return after a medical leave? What are the requirements for return? Will the classes they take at another school while on a medical leave count toward their degree requirements? How can a student minimize the fallout for their GPA if the crisis is leading to failing grades?

Seek Appropriate Accommodations - Colleges are required by law to provide reasonable accommodations for students with a documented disability. Keep in mind that your student must disclose the disability to the appropriate center (such as the Office of Student Disability Services) to be eligible for accommodations. Depending on the student’s condition and needs, accommodations might include extended time for testing, the services of a note taker, permission to write essay exams on a computer rather than by hand, and so forth. The American Psychological Association provides an online guide to academic accommodations.

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About the Author
Seth J. Gillihan, PhD

Seth J. Gillihan, PhD, is a licensed psychologist and host of the weekly Think Act Be podcast. He is author of The CBT Deck, Retrain Your Brain, and Cognitive Behavioral Therapy Made Simple, and co-author with Dr. Aria Campbell-Danesh of A Mindful Year: 365 Ways to Find Connection and the Sacred in Everyday Life. Dr. Gillihan provides resources for managing stress, anxiety, and other conditions on the Think Act Be website.

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