Planning Ahead for Your Mental Health Care as You Transition to College
If you are heading to college with a diagnosed mental health condition, you are in good company. More and more young people arrive on campus with a diagnosis these days. Many of them are in therapy, take one or more medications, or receive other support services through their high school, private tutors or other agencies. Planning ahead for your mental health and academic support needs will make your transition to college healthier, smoother, and more comfortable. And it can begin well before you step onto campus.
Preparing for the transition
Middle and high school years
Starting in middle school and throughout high school, you will have many opportunities to gradually develop:
- Knowledge of your condition.
- The skills to manage it.
- An ability to advocate for yourself.
Your parents, school counselors, teachers, and mental health providers should guide you in this process. For example, learning the name of your condition, medications and their side effects, taking increasing responsibility for taking your medication, are all steps in the right direction. Gaining these transition skills is a similarly important process to growing in other areas, such as academics, social relationships, volunteer experiences, work experiences, and extracurricular activities.
Beginning the college search process
Many high school students begin to think and learn about college more intensely during the summer before 11th grade or during junior year. This is a great time for you to meet with your mental health providers, along with your parents/guardians and other supportive adults, to begin to develop a plan and talk about:
- Your functioning including your goals, dreams, strengths, vulnerabilities, diagnosis, prognosis.
- Your level of support (from family, providers, school, friends, tutors, agencies).
- Your short- and long-term treatment goals and service needs (for ex. how often do you need to meet with a therapist or prescriber? Do you need other kinds of support services?).
- The full range of post-secondary options available to you (gap year, community college, work and school, four-year school, technical school, delayed matriculation, etc.).
These discussions can help you create a list of criteria for selecting colleges to visit, which might include:
- The availability of a campus counseling service.
- Someone who is able to prescribe medication on or near campus.
- Disabilities resources on campus.
- The distance from your home and/or the cost of visiting home.
- Services for specific conditions, such as eating disorders or substance misuse.
- A campus at-risk team.
- Emergency services or hospitals near campus in case of crisis.
- A track record of supporting students with mental health challenges.
It’s also a good time to:
- Determine if you need to update your psychological/educational testing. Most colleges do not accept testing to secure accommodations if it is more than three years old.
- Apply for testing accommodations (SAT and ACT) if you are eligible.
You should continue to review your plans and discuss your situation with your care team and family through your junior and senior year. If there are changes in your clinical situation, you may need to reconsider your plans or decisions. But, it is important to keep the transition to college part of your treatment planning.
Learning about mental health resources on/near campus
Just as each school has different academic programs, different student populations, and a different “vibe”, etc., each campus also has different mental health and support services available. It’s important to know that your care and services needs can be met at a specific institution and in its surrounding community before you apply and matriculate.
You can learn about the services offered, any requirements to utilize them, their cost and accessibility in a few ways:
- Visit the college’s website and search for: counseling center, mental health services, disability services, psychiatric services, etc.
- During college tours, pay attention to information provided about mental health and disability services and ask questions.
- Contact the school’s counseling center to learn more about the services offered.
- Once accepted, visit the counseling center and/or disabilities services office during accepted students’ visitation days.
- Once you select a school, visit or contact the counseling center and/or disabilities services office to discuss your specific concerns and needs.
Establishing your treatment team
Similar to many other young people headed to college, you may prefer to remain with your home-based treatment team. You may feel comfortable with your current providers, not want to “start over” with new providers, or it just might seem to be the simplest approach to take. However, providers will take into consideration many factors as they discuss treatment plan options with you. The goal is to develop thoughtful, practical, individualized and safe care plans which maximize your continuity of care during your transition to campus and adulthood.
Some factors taken into consideration by your providers are:
- Patient age limit restrictions for some practices.
- How stable your condition has been.
- How prepared you are to manage your mental health needs independently.
- The distance you will be from home providers.
Some possible treatment plan arrangements are:
- Complete transfer of care to providers on or near campus.
- Shared treatment between home-based and campus-based (on or near campus) providers.
- Continued treatment with home-based providers.
Despite the obvious differences among the above treatment plan scenarios, there are also some important common elements. In most cases, providers will recommend that any major medication changes—especially trials to go off medications—be completed and assessed by late winter/early spring of your senior year in high school. That way, if you need further adjustments, you will be working with a team that knows you and your history well.
You may also be asked to:
- Commit to a certain frequency of follow-up contacts and/or appointments.
- Share your disability (if applicable) through the campus disabilities office during orientation or as soon as possible after you arrive on campus.
- Sign releases of information for new providers to speak with former providers or, in the case of shared treatment, for all providers to communicate.
- Sign a release for your providers to be able to contact your parents/guardians if you are having difficulties that put you at risk or for which they can be a support. Parents are a good source of historical information and often students turn to their parents in times of distress. Please note that your parents can call your providers with their concerns at any time. The overall goal is open and transparent communication among your support team members with you as an active participant.
- Establish a plan for when you will reach out for help and whom you will contact first and as a backup if you are not feeling well.
- Collaborate on the development of a back-up care plan in the event of a crisis or emergency.
Ideally, your treatment plan should be discussed in detail and put in writing for all key members of your care team. This is especially important in the case of shared treatment. For example, it would make sense to consider your physical location (at school vs at home) to determine who is in charge of your care at any given moment or in the event of an emergency. Of course, everyone wants to be helpful, and should respond and collaborate in an emergency. Also, if you have medical providers both at home and school, they will need to establish a mutually agreed upon medication refill policy.
Helpful transition tools
Part of self advocacy is being able to tell others about your condition, how your condition impacts your day-to-day functioning, what you need to help you be successful, and what treatments have been tried and proven helpful or not. Many young people find it helpful to have an easily accessible, electronic copy of a psychiatric medical summary. Ask your mental health providers for their help in preparing this summary. If you will be receiving care at the campus counseling center or if the counseling center may be providing backup treatment, it might be a good idea to have your history on file at their offices. This can also be helpful in case of a medical or mental health emergency.
A psychiatric medical summary typically includes:
- Psychiatric diagnosis
- Medical conditions
- Outpatient treatment history
- Other treatments
- Allergies to medications, current medications and past medication trials
- Diagnostic studies such as lab work, EEGs, brain scans, psychological/neuropsychological testing
In addition to a psychiatric medical summary, it can be helpful to pull together other important documents into a transition portfolio. A transition portfolio could include:
- Psychiatric medical summary
- Educational, psychological, neuropsychological testing
- Current or most recent 504 Plan or IEP
- List of accommodations and services you may need in college
- Psychiatric advanced directive
Obstacles to treatment on campus
Once on campus, you will face many new opportunities and challenges. Some of these experiences could get in the way of your treatment compliance. It is important to talk with your providers ahead of time about these possibilities, so you have a plan to manage or avoid them.
Here are some topics to discuss frankly with your provider:
- A desire to shed your old identity and start fresh on campus
- Worries about confidentiality
- Concerns about stigma
- Avoiding contact with providers, family and old friends in your new found independence
- Any hesitation to see new providers
- A false sense of stability during the easier times of the academic year and stopping treatment
- Distinguishing college adjustment issues from more serious mental health problems or setbacks
- How alcohol and drugs may affect your medications and your mental health
- How not getting enough sleep may impact you and your mental health
Health promotion on campus
Taking care of yourself is an important part of your transition to campus life. Talk with your support team about and make plans for:
- Good nutrition
- Regular exercise
- Good sleep practices
- Smart and safe use of the internet/social media
- Tobacco, energy drinks, alcohol and drugs
- Safe sex
- Stress management
- Time management
- Dealing with difficult roommates
- Wellness programs available on your campus
Outcomes
There are times when even the most well thought out and comprehensive transition treatment plans do not work. It is possible, for example, that students find that a school is not a good fit and transfers or, despite good intentions, they don’t comply with the plan, maybe accessibility to the defined services was more difficult than anticipated or a planned new provider moves or becomes ill, etc. If any of these happen to you, treat them as learning experiences for you and your team and an opportunity to make changes that will help you return to prioritizing your mental well-being.
For additional helpful information on heading to college with a psychiatric diagnosis, please visit the American Academy of Child and Adolescent Psychiatry and review these Facts for Families on college mental health: