“The time to begin preparing for college life is a year prior to attending.”
It may be no coincidence that one of the most common ages for mental illness to emerge is nineteen. This is when a teen is on their own for the first time. The stress of being away from home, the adjustment to a new environment, and the change in routine can all add up to depression, anxiety, or, for the person with a history of such an illness, relapse.
Teens with a history of mental illness have a disadvantage but also a distinct advantage. It’s a disadvantage because you know they are vulnerable and the illness could recur. But your teen also knows which medicines work for them. They’ve had therapy and gained insight into what triggers the illness. They can capitalize upon these strengths while mitigating the risk. The first step is finding the most suitable environment.
Choosing the Best College Location
Many students decide to study within a short driving distance from home. This makes it easy for them to come home for a weekend if the noise and lack of privacy of dorm life become too stressful. If your teen wants an out-of-state college, take a look at flights and calculate how long it will take to reach your teen if they need you. Some out-of-state colleges with a major airport nearby are quicker to reach than some in-state colleges that are nowhere near an airport.
Choosing the Right Size College
Every college has its own style. Some teens who have experienced depression or another mental illness prefer a small environment where they will not feel lost in the shuffle. Small colleges usually offer smaller classes and more personal attention and hence a less stressful environment. However, some teens prefer the anonymity of a large school and they may want a college with major sporting events. Beyond size, students usually know whether they want a religious school or a liberal school. An outstanding website that lets students search for college names based on criteria that they specify is College Confidential’s College Search. This website lets you specify the student’s grade point average, test scores, desired location, major, school size, religious affiliation, and more. I’ve tried them all, and this is my favorite.
Visiting Colleges
It is best to visit colleges when class is in session so that your teen can get an idea of what a typical day feels like. Avoid going during the college’s exam week when students are stressed and appear grim. Plan to visit one or two colleges per day, checking out tour times on the school’s website. While the tour guide shows you around, he or she will give you important details regarding the special opportunities or traditions that the school offers.
Pay attention to your teen’s reaction. You may think a college is perfect, but if they hate it during the tour, they will hate it if they attend. As frustrating as it may feel to drive 200 miles for nothing, at least now you know what your teen doesn’t want.
The Junior College Advantage
Also known as a community college or a two-year college, this low-pressure alternative to the traditional four-year college offers several advantages. Class sizes are small, the student can remain at home or close to home, the transition feels less severe than at a four-year college, and the financial cost is low. Junior colleges usually do not require SAT scores and admission is easier than at a four-year college. It is often easier to transfer into a favored four-year college as a successful junior than it is to get accepted as a freshman. This gives your teen more time to continue recovering while still adjusting to college.
Evaluating Support Services
Once you have identified some colleges that might be appropriate, check each college’s website for information on counseling and disability assistance. Many colleges offer priority registration (this is considered to be especially important for students with ADHD who may need to schedule their classes carefully), note-taking, and extra test time.
Preparing for Life on Campus
The time to begin preparing for college life is a year prior to attending. If your teen’s symptoms are stable, I recommend putting them in charge of their own medicine. Let them dispense it to themselves, and show them how to handle refills. If you are refilling prescriptions for your teen, keep track of them on your calendar so that you can provide them in time. You may also want to use a mail order pharmacy if your doctor will write a prescription for a 90-day supply (you can sometimes even request automatic refills).Have your teen do their own laundry so that college is less of an adjustment.
Roommates can make for instant friendship or for added stress. Remind your teen that everybody has a couple of unusual habits and that a little courtesy goes a long way. If, however, the situation is intolerable, don’t force your teen to suffer. Most college housing staff members are willing to move students around and help them change roommates.
The more personal connections your teen has on campus, the healthier they will be mentally. Move-in day is the time to begin letting people get to know them. Urge them to be friendly to everyone they meet. It is not necessary to bond with each and every person, of course, but the first week on campus is when everybody notices who is friendly and who seems to want to be left alone. On move-in day or during your first visit, offer to take your teen and his roommate (or any other friend) out for dinner. This simple, time-tested strategy works better than anything I know for helping your teen bond with new friends.
If your teen has a favorite professor, encourage them to stop by during office hours and to take additional courses with the professor. This person may become a mentor and eventually, may be needed for a letter of recommendation. If your teen is eager to form a social life but wants to avoid drugs and alcohol, encourage them to try university-sponsored clubs and events. If they are invited to a party not hosted by the university, it is likely to have a lot of alcohol and no food. Warn your teen that alcohol on an empty stomach has three times the effect it has on a full stomach. Make sure they understand the likelihood of an interaction between their medicine and alcohol.
If your teen finds that they cannot fit in anywhere socially and is lonely, suggest that they find a part-time job on campus. This will make them feel involved and less isolated. It is a good way to find friends too. While they are looking for a job, they may want to ask the secretary of the department in which they plan to major. This person usually is well-informed about job opportunities within the department.
Working with the Disability Office
After your teen sends in their admissions deposit, they should contact the disability department. They will need documentation from the therapist or psychiatrist; often the school provides a form. After the school receives the documentation, they will set up an appointment and discuss the services they think are appropriate, including extended test time. Keep in mind that the disability office works differently from high school. Unlike K-12 schools, they are not required by law to provide specific services. You will not be able to use an IEP as proof of disability, although the college may use it to help determine accommodations. Check the school’s website for details. Keep in mind that, unless your teen chooses, there is no reason to disclose a mental illness to the disability office until they are accepted and have decided to attend.
Therapy in College
First the good news: almost every college has a counseling center. Now for the bad news: they often limit counseling sessions, sometimes to as few as six per year. Sometimes the therapists in the counseling center are interns, meaning college students who are supervised on-site but are not yet licensed to practice. If your teen has a history of a serious mental illness that has required hospitalization in the past, you may want to hire your own therapist near the campus, someone who has enough clinical experience to recognize the subtle, early signs of a relapse. You can also hire a psychiatrist if the college is far from home. The counseling office can recommend therapists and psychiatrists in the area.
If possible, have your teen meet with the new therapist before school starts. Then schedule weekly appointments for the first month of school, keeping in mind that your teen will be undergoing a tremendous adjustment and may need the support. Some students start out fine and then develop problems around mid-October. Remember that the first therapist may not work out; the same is true if you hire a psychiatrist. But the time you spend upfront will pay off later. Do be wary of a psychiatrist who wants to make a medicine change right before school starts, especially if the current regime is working well.
If you hire your own therapist, have your teen register at the counseling center anyway so that somebody knows them if they need to go there in a pinch. After all, their therapist may be unavailable during an emergency. Let them know your teen’s history so that if something comes up, they already have the facts. Keep in mind that a residential adviser (RA), faculty member, or another student can refer your teen to the counseling center if they suspect a problem, so it is helpful for the counseling center to know the history and diagnosis. It is hard to put a price on peace of mind.
Your son or daughter may surprise you, as my son did, by deciding not to register with the counseling department or hiring a therapist. It is fairly common for teens to want to start with a blank slate, hoping for the best that nothing will go wrong. You can negotiate. I asked my son to reconsider. He finally agreed to register with the counseling center and met once with one of the therapists there before school started. That was all I could persuade him to do, but it was something. (Incidentally, everything went just fine all four years, so I guess he knew what he was doing.)
Colleges will require you to purchase health insurance from them. If you have your own insurance, you can waive their insurance fee, provided you show them proof of coverage. Before purchasing the university’s insurance plan, compare their mental health benefits to your own insurance plan. If you choose to use your own insurance, make sure it covers therapists, psychiatrists, and a behavioral health hospital near the college.
The Academic Load
I suggest that your teen take a somewhat lighter load the first semester, tackling twelve units rather than the usual fifteen. It’s not a bad idea to let them register for fifteen units and then drop the course that seems like it will cause them the most trouble. Just make sure they don’t wait too long to drop the course or they may have an F on their transcript at the end of the semester. Keep deadline dates on hand. Encourage them to balance their course load each semester with a mix of hard and easy courses.
It may seem to you that your teen should be able to handle these details now that they are in college, but in reality, most students need someone backing them up and showing them the way for the first couple of years. Several of my professor friends have told me that they wish parents wouldn’t just drop their child into college and then depart. You are not a helicopter parent if you watch out for your teen and explain things like registration policies and professor expectations. If you did not attend college yourself and your teen is a first-generation college attendee, you may not know the “ropes” yourself. Read the college website, ask your friends for advice, and don’t be afraid to call the college if you still can’t find an answer. Guiding your teen through the college process will enable them to mature and intellectually flourish without unnecessary stress or painful repercussions.
Time Management
Time management can be the greatest challenge for new college students. In high school, your teen’s time was structured for them. They awoke at the same time each day, walked to school, attended classes all day, then did homework in the evening. This steady schedule reduces stress because the brain knows what to expect. One of the best things a person can do for their mental health is to rise at the same time each day and go for a twenty-minute walk. The daylight lets the brain know that it is morning and that alone is a tremendous sleep regulator. Unfortunately, in college, students often sleep late, dash off to class without eating breakfast, and then return to their room for a nap. They may be up all night studying or partying. The following day may be completely different. This kind of non-scheduled lifestyle can wreak havoc on the brain. Urge your teen to set up a schedule that is similar from day to day, even if they rise late and go to bed late. The key is regularity.
Preventing Relapse
The best way to avoid relapse in college is to have a therapist and psychiatrist available to your teen. Make sure that your teen does not run out of medicine. Every year, college health centers and counseling centers experience a huge wave of freshmen who have run out of medicine and become symptomatic. If you leave your teen on campus with only a 30-day supply of medicine, make sure you send a refill or remind your teen to go to the pharmacy for a refill. In time, your teen can handle this on their own, but in these early days when they are adjusting to so many new responsibilities, they are likely to need help in keeping their medicine stocked.
Sometimes, despite everyone’s best efforsts, your teen will waver. It is a vulnerable time for students with a mood disorder. The sooner you know about it, the sooner you can take steps to minimize the effect on their studies.
If they want to tough it out after seeing their psychiatrist and/or therapist, ask them to check in with you daily. They may be able to get through the semester, but if they can’t, all is not lost. You have three options. The first is to let them drop one or more classes to lighten the stress load. Be aware of the deadline, usually three weeks into the semester, to drop classes without a record of enrollment. The second option, if they are further into their semester, is to withdraw from one or more courses. By withdrawing, they do not get a grade, but a W will show up on their transcript. The third option, If they are past the drop or withdraw date, is to see if they can take an incomplete in their classes. In this case, the college will give them a specific period of time to make up the work. After the work is made up, the incomplete is removed from their transcript. If they do not make up the work, they get an F on their transcript. Arm yourself with information beforehand about the school’s policies. The deadlines for dropping and withdrawing from courses is listed on the college’s academic calendar. Call the registrar’s office before you make any assumptions. They will tell you what your options are.
It can be difficult for a teen to decide whether to try and finish out the semester or whether to leave. Dropping a couple of courses so that the workload–and stress load–is minimal may be a good strategy. But they must decide how severe their symptoms are. If a hard relapse is in full swing or is showing signs of rapidly progressing, it is best to let them quit, especially if their medicine requires adjusting. The goal is to get them back to a recovered state as quickly as possible. Tell them not to be discouraged. As soon as they are feeling well, they can resume their studies. Many students do not return to college following a relapse, which is unfortunate. If your teen has bad memories of the college, see if they can enroll in another college close to home.
“Mental illness can be so subtle at times. We find ourselves getting impatient or confused by our teen’s behavior, not realizing that it is a remnant of the illness.”