THE INCLUSIVE UNIVERSITY: PSYCHIATRIC DISABILITIES 

This section includes resources specific to what is typically classified in college service systems as “psychiatric” disabilities. Also included is information related to mental health, mental illness, mental disabilities, self-esteem, cognitive disabilities, and many other interrelated topics.

Belch, H. A., & Marshak, L. E. (2006). Critical incidents involving students with psychiatric disabilities: The gap between state of the art and campus practice. NASPA Journal, 43(3), 464-483.

The proliferation of students with psychiatric disabilities and the severity of the issues they present pose significant challenges to campus personnel and specifically to student affairs staff. This study identified the specific types of critical incidents related to students with psychiatric disorders that senior student affairs officers found particularly problematic. In addition, the study examined the implications of these incidents on policy, resources, training, and communication. Our findings suggest that specific institutional issues and the complexity of these incidents are exacerbated, in part, by the limitations of current policies, a lack of appropriate campus and community resources, privacy issues, and relationships with and expectations of parents. We explore the implications of these findings on practice and policy development.

Brockelman, K. F. (2011, Winter). Faculty members’ ratings of the effectiveness of academic strategies for university students with psychiatric disabilities. Journal of Postsecondary Education and Disability, 24(1), 43-52.

University faculty members were surveyed regarding which academic strategies they used to accommodate students living with psychiatric disabilities and the effectiveness of these strategies. Differences were found between Engineering and faculty in fields other than science, technology, engineering, and math (non-STEM) with regard to the academic strategies they use to accommodate students living with psychiatric disabilities; five of the strategies were used more frequently by Engineering faculty than non-STEM faculty and four of the strategies were used more frequently by non-STEM faculty. One strategy, providing extra time on an exam, was rated as significantly more effective by Engineering faculty than non-STEM faculty.

Collins, M. E., & Mowbray, C. T. (2005, April). Higher education and psychiatric disabilities: National survey of campus disability services. American Journal of Orthopsychiatry, 75(2), 304-315.

Students with psychiatric disabilities are an increasing presence on college and university campuses. However, there is little factual information about the services available to these students in campus disability services offices or the extent to which they use these services. This article reports the results of a survey of disability services offices at colleges and universities in 10 states. Data from 275 schools revealed the number of students with psychiatric disabilities seeking assistance from disability services offices, characteristics of these offices, and the types of services they provide. Survey data also identified barriers to full participation of these students in academic settings. Implications of the study are discussed to inform policy and postsecondary institutional practices with the goal of better serving psychiatrically disabled students to maximize their talents and potential.

Collins, M. E., & Mowbray, C. T. (2005, August). Understanding the policy context for supporting students with psychiatric disabilities in higher education. Community Mental Health Journal, 41(4), 431-450.

Interest in postsecondary education for persons with psychiatric disabilities is high among consumers and advocates. However, the existence of program supports for higher educational goals is very uneven across U.S. states. This study was designed to examine the policy context in which states and educational institutions address needs of individuals with psychiatric disabilities to attend and succeed in postsecondary education. In 10 selected states, telephone interviews were conducted with key informants in state agencies of mental health, vocational rehabilitation, and higher education, as well as representatives of state-level advocacy organizations. Additionally, a search of websites relevant to state policy was conducted. The findings identify factors that facilitate and inhibit the development of policy and programs supportive of students with psychiatric disabilities. Facilitating factors include a strong community college system, progressive philosophy of the state mental health agency, and interest of consumers and the advocacy community. Inhibiting factors include political and budgetary uncertainty, competing priorities in the mental health system, emphasis on a medical rather than rehabilitative model, regulations of the VR system, and lukewarm enthusiasm of the advocacy community. Implications for community mental health services are included, particularly related to further policy development in support of students with psychiatric disabilities.

Demery, R., Thirlaway, K., & Mercer, J. (2012, June). The experiences of university students with a mood disorder. Disability & Society, 27(4), 519-533.

Mood disorders typically materialise in young adulthood, a life-stage when many enter university. However, Padron notes that few studies have examined the experiences of students with a mood disorder. The current study offers a thematic analysis of semi-structured interviews with five university students who had personal experience of such a disorder. Participants described how symptoms affected their academic and social experiences of university based around the themes of: Social and family support, Powerful symptoms, Stigma and labelling, and Inter-professional dynamic. It was concluded that stigma and lack of information prevented students from obtaining sufficient support, whilst the addition of key staff such as a university-wide mental health trainer is identified as a potential way forward to help such students negotiate the higher education environment.

Duckworth, K. M., & Kitchen, S. G. (2007). Accommodation and compliance series: Students with psychiatric impairments. Morgantown, WV: Job Accommodation Network. Retrieved from: http://www.jan.wvu.edu/media/HiEdStudentsPsych.pdf.

This document is one of a series produced by the Job Accommodation Network (JAN) that addresses psychiatric impairments, including information on accommodations and ideas on how to support students with psychiatric impairments in postsecondary education.

Francis, P. C., & Abbassi, A. (2010). Ethical issues and considerations for working with community college students with severe and persistent mental disorders. Community College Journal of Research and Practice, 34(5), 423-437.

Students with severe and persistent mental illnesses (e.g., schizophrenia or other psychotic disorders; moderate to severe mood, anxiety, dissociative, eating, or personality disorders) are attending community colleges in increasing numbers. Their need for counseling services presents counseling centers with unique ethical issues to consider. This article presents those issues and discusses possible actions that counselors can take to protect the rights of their clients, the institution, and themselves.

Jago, B. J. (2002, December). Chronicling an academic depression. Journal of Contemporary Ethnography, 31(6), 729-757.

This autoethnographic story chronicles the author’s recent struggle with major depression. Grounded in narrative theory, utilizing the methodology of emotional introspection, and written as a layered account, this personal narrative explores mental illness within the context of the academy. The story considers a variety of issues including identity and the social construction of self, medical discourse and the canonical story of depression, academic research and the tenure process, and the interrelationships between personal and professional experience.

Kiuhara, S. A., & Huefner, D. S. (2008). Students with psychiatric disabilities in higher education settings: The Americans with Disabilities Act and beyond. Journal of Disability Policy Studies, 19(2), 103-113.

College students with psychiatric disabilities face multiple challenges. Judicial rulings under the Americans with Disabilities Act (ADA) of 1990 have generated outcomes that are sometimes more harmful than helpful. To reduce discrimination against persons with disabilities requires, among other things, a cultural shift in how psychiatric disabilities are viewed. This article examines (a) challenges that students with psychiatric disabilities face on higher education campuses; (b) the definition of disability under the ADA, with a focus on major life activities that may be substantially limited for people with psychiatric disabilities; (c) the implications of judicial rulings under the ADA for students with psychiatric disabilities; and (d) recommendations for accommodating students with psychiatric disabilities in higher education settings.

Martin, J. M. (2010). Stigma and student mental health in higher education. Higher Education Research & Development, 29(3), 259-274.

Stigma is a powerful force in preventing university students with mental health difficulties from gaining access to appropriate support. This paper reports on an exploratory study of university students with mental health difficulties that found most students did not disclose their mental health problems to staff at university. This was primarily due to fear of discrimination during their studies and in professional employment. Many students went to considerable efforts to hide their mental health condition and in doing so struggled to meet university requirements. Of the minority who did disclose, most received helpful assistance with both their studies and management of their mental health condition. The university was the main source of support services including counselling, disability, student union and housing. A range of measures are required to address the impact of stigma and mental health to empower students so that they can disclose in the confidence that they will be treated fairly.

McKinney, K. A., & Greenfield, B. G. (2010, August). Self-compliance at ‘Prozac campus.’ In K. Applbaum & M. Oldani (Eds.), Towards an Era of Bureaucratically Controlled Medical Compliance? [Special Issue]. Anthropology & Medicine, 17(2), 173-185.

This paper focuses on psychiatric medication experiences among a sample of North American university students to explore a new cultural and social landscape of medication ‘compliance.’ In this landscape, patients assume significant personal decision-making power in terms of dosages, when to discontinue use and even what medications to take. Patients carefully monitor and regulate their moods, and actively gather and circulate newly legitimated blends of expert and experiential knowledge about psychiatric medications among peers, family members and their physicians. The medications too, take a vital role in shaping this landscape, and help to create the spaces for meaning-making and interpretation described and explored in this article. In concluding the article, the authors claim that two popular academic discourses in medical anthropology, one of patient empowerment and shared decision-making and the other of technologies of self and governmentality, may fail to account for other orders of reality that this paper describes – orders shaped and influenced by unconscious, unexpressed and symbolic motivations.

Megivern, D. (2002). Disability services and college students with psychiatric disabilities. Journal of Social Work in Disability & Rehabilitation, 1(3), 25-41.

Weiner (1999) has suggested that the process of accepting a disability and its associated limitations is often protracted for students with psychiatric disabilities, thus leaving many students unable to fully participate in services or in the design of academic accommodations. This research examines the relationship between psychiatric disability identity and use of academic accommodation services for 57 undergraduates with psychiatric impairments who are experiencing problems in their academic functioning. Willingness to utilize services was related to students’ identification as having a psychiatric disability. Social work interventions are needed to support students in accepting psychiatric disabilities while concurrently crafting necessary accommodations.

Megivern, D., Pellerito, S., & Mowbray, C. (2003, Winter). Barriers to higher education for individuals with psychiatric disabilities. Psychiatric Rehabilitation Journal, 26(3), 217-231.

To study barriers to higher education, this qualitative study explored the college experiences of 35 people with psychiatric disabilities. Academic performance was related to psychiatric symptoms which subsequently led to college attrition. However, many research participants showed remarkable persistence in pursuit of academic goals. Campus-based support services were rarely utilized. Implications for psychiatric rehabilitation practice are discussed.

Morrison, I., Clift, S. M., & Stosz, L. M. (2010, March). Supported further education provision for people with long-term mental health needs: Findings from a survey of further education colleges and primary care trusts across the south east of England. Perspectives in Public Health, 130, 78-85.

Aim: Government policy has highlighted the need for inclusive education for people with long-term mental health needs. As a starting point, the aim of this study was to assess the extent to which further education (FE) colleges in the south east of England provide supported education for people with mental health needs, and the extent to which these organizations collaborate with local NHS primary care trusts (PCTs). Also, to assess the potential numbers of people who might benefit from fully inclusive educational provision needs assessment, together with the potential healthcare cost savings.

Method: A survey was conducted of 33 multi-faculty FE colleges and 49 PCTs via structured telephone interviews with nominated representatives, in order to collect quantitative and qualitative data of the provision of supported education provision for people with mental health needs. The FE survey enquired whether they had provision for people with mental health needs, and if so, the details. The PCT survey gathered data on their caseload of standard and enhanced clients for the population covered, and the extent to which they were aware of the benefits of learning on mental health.

Results: Only 15 FE colleges (45%) had some form of provision for students with long-term mental health needs, and only six PCTs (12%) provided an educational link co-ordinator. FE colleges with existing provision averaged 70 students per college, against an attainable potential target of 130 students per college. Encouragingly, cohorts of students with mental health needs were reported to have levels of retention’, achievement’ and success’ rates that were comparable with students from the general population on mainstream courses — e.g. expected rates of around 85% retention, 75% achievement (of those retained), 65% success (overall from enrolled to achieving), with some 5% progressing to university and 12% into employment. On present levels of FE recruitment, there is a potential net saving to the taxpayer of {pound}13 million in mental healthcare costs (around 50%) and if recruitment increased to projected levels, then the potential net saving to the taxpayer would be {pound}26 million. The substantial estimated savings to the health budget not only shows that supported education provision in FE is effective in promoting mental health, it also indicates the high level of its cost-effectiveness.

Conclusion: This research has implications for budget holders, health promotion staff and mental health teams working within a social model of health, and the collaborative use of resources to assist people recovering from or managing mental health difficulties in moving forward in their lives.

Mowbray, C. T., Mandiberg, J. M., Stein, C. H., Kopels, S., Curlin, C., Megivern, D., Strauss, S., Collins, K., & Lett. R. (2006, April). Campus mental health services: Recommendations for change. American Journal of Orthopsychiatry, 76(2), 226-237.

College officials indicate that the number of students with serious mental illnesses has risen significantly. Recent media attention surrounding several high profile suicides has opened discussion of mental illness on campus. The authors summarize literature on college students and mental illness, including barriers to service receipt. Recommendations to improve campus‐based responses to serious mental illness are presented on the basis of well‐accepted service principles.

O’Donovan, M. M. (2010, September). Cognitive diversity in the global academy: Why the voices of persons with cognitive disabilities are vital to intellectual diversity. Journal of Academic Ethics, 8(3), 171-185.

In asking scholars to reflect on the “structures and practices of academic knowledge that render alternative knowledge traditions irrelevant and invisible,” as well as on the ways these must change for the academy to cease “functioning as an instrument of westernization rather than as an authentically global and diverse intellectual commons,” the editor of this special issue of the Journal of Academic Ethics is envisaging a world much needed and much resisted. A great deal of the conversation about diversity in higher education emphasizes, rightly, the need for an international and ethnically diverse population of scholars and students. Less attention is paid to the value of cognitive diversity–the diversity of cognition generated by cognitive disabilities. As one aspect of intellectual diversity, cognitive diversity promises novel ways of thinking and new understandings of what knowledge is, who makes it, and how it is made. The unique value of cognitive diversity is its insistence on a radical shift in our conception of who can know and who can produce knowledge. Insisting on the inclusion, as scholars, of persons with minds labelled disabled, an epistemology of disability pushes us to reform the much criticized but still dominant notion of the expert and scholar as able-bodied and hyper-rational.

Padron, J. M. (2006, Fall). Experience with post-secondary education for individuals with severe mental illness. Psychiatric Rehabilitation Journal, 30(2), 147-149.

There is a need for increased understanding and support of students with severe and persistent psychiatric disabilities in post-secondary education. Advancements in the pharmacological treatment of psychiatric disabilities are permitting a broader range of mental health consumers to reach a level of recovery allowing these consumers to begin or restart college careers (Eudaly, 2002). A post-secondary education is now considered a mandatory investment in the future (“Higher Education,” 2003). There are a growing number of people pursuing higher education including those with serious mental illness. I am working on a Master’s degree in a Rehabilitation Counselor Education program and face many obstacles due to my psychiatric disability, Bipolar Disorder.

Price, M. (2010). Mad at school: Rhetorics of mental disability and academic life. Ann
Arbor, MI: University of Michigan Press.

Mad at School is the first book to use a disability-studies perspective to focus specifically on the ways that mental disabilities impact academic culture at institutions of higher education. Focusing on situations such as classroom discussions, academic conferences, and job searches, scholar and disabilities activist Margaret Price challenges readers to reconsider long-held values of academic life. Individual chapters examine the language used to denote mental disability; the role of “participation” and “presence” in student learning; the role of “collegiality” in faculty work; the controversy over “security” and free speech that has arisen in the wake of recent school shootings; and the marginalized status of independent scholars with mental disabilities. Ultimately, Mad at School argues that academic discourse both produces and is produced by a tacitly privileged “able mind” and that U.S. higher education would benefit from practices that create a more accessible academic world.

Rickerson, N., Souma, A., & Burgstahler, S. (2004, March). Psychiatric disabilities in postsecondary education: Universal design, accommodations and supported education. Paper presented at the National Capacity Building Institute Issues of Transition and Postsecondary Participation for Individuals with Hidden Disabilities, March 31-April 1, 2004, Honolulu, Hawaii. Retrieved from http://www.ncset.hawaii.edu/institutes/mar2004/papers/pdf/Souma_revised.pdf.

This article provides a call for increased awareness and academic support for students with psychiatric disabilities in postsecondary education. The limited literature in this area is reviewed. The authors correct misunderstandings about these types of disabilities and provide information to increase faculty, administrator, and staff awareness regarding the rights and needs of postsecondary students with psychiatric disabilities. Three areas of focus are highlighted: typical academic accommodations, application of principles of universal design of instruction; and supported education through advising, counseling, and postsecondary preparation courses. Further research is encouraged.

Rothstein, L. (2008, Spring). Law students and lawyers with mental health and substance abuse problems: Protecting the public and the individual. In A. Bernstein (Ed.), Lawyers with Disabilities [Symposium]. University of Pittsburgh Law Review, 69(3), 531-566. Retrieved from: http://lawreview.law.pitt.edu/issues/69/69.3/06Rothstein.pdf.

“This Article evaluates whether mental illness and substance abuse policies, practices, and procedures appropriately balance the concerns of the individual lawyer with the interests of the public. This Article concludes by offering recommendations to improve the handling of these issues and suggestions about areas where additional study is needed” (p. 533).

Saks, E. R. (2008). The center cannot hold: My journey through madness. New York, NY: Hyperion.

Elyn Saks is a success by any measure: she’s an endowed professor at the prestigious University of Southern California Gould School of Law. She has managed to achieve this in spite of being diagnosed as schizophrenic and given a “grave” prognosis — and suffering the effects of her illness throughout her life.

Saks was only eight, and living an otherwise idyllic childhood in sunny 1960s Miami, when her first symptoms appeared in the form of obsessions and night terrors. But it was not until she reached Oxford University as a Marshall Scholar that her first full-blown episode, complete with voices in her head and terrifying suicidal fantasies, forced her into a psychiatric hospital.

Saks would later attend Yale Law School where one night, during her first term, she had a breakdown that left her singing on the roof of the law school library at midnight. She was taken to the emergency room, force-fed antipsychotic medication, and tied hand-and-foot to the cold metal of a hospital bed. She spent the next five months in a psychiatric ward.

So began Saks’s long war with her own internal demons and the equally powerful forces of stigma. Today she is a chaired professor of law who researches and writes about the rights of the mentally ill. She is married to a wonderful man.

In The Center Cannot Hold, Elyn Saks discusses frankly and movingly the paranoia, the inability to tell imaginary fears from real ones, and the voices in her head insisting she do terrible things, as well as the many obstacles she overcame to become the woman she is today. It is destined to become a classic in the genre.

Saks, E. R. (2008, April). Commentary: The importance of accommodations in higher education. Psychiatric Services, 59(4), 376.

“Another question is how accommodations are invoked by and benefit different groups of students, such as students with learning disabilities and those with psychiatric illnesses. […] it will be also be important to examine whether ADA requirements decrease stigma because persons with mental illnesses are experienced by fellow students as successful peers or whether stigma increases because the nondisabled student body resents their being given accommodations. Yet I have a very active and satisfying professional life as a chaired mental health law professor” (p. 376).

Salzer, M. S., Wick, L. C., & Rogers, J. A. (2008, April). Familiarity with and use of accommodations and supports among postsecondary students with mental illnesses. Psychiatric Services, 59(4), 370-375.

OBJECTIVE: Many persons with serious mental illnesses are interested in pursuing postsecondary education and are doing so in increasing numbers. Accommodations can be essential, but limited research suggests that few formally seek accommodations, although increased efforts to heighten awareness may be changing this. The purpose of this study was to examine whether students with mental illnesses are increasingly aware of, and utilize, accommodations and academic supports and to identify the supports that are most used and perceived to be most helpful.

METHODS: A national Internet survey was conducted from July 2005 to July 2006, resulting in responses from 190 current and 318 former students with mental illnesses.

RESULTS: The study found modest but significant negative correlations between how long ago students left college and their familiarity with accommodations, their request for or receipt of accommodations, and their use of the Office for Students With Disabilities. These results were particularly noticeable when comparing current and former students. Moderate positive correlations that were significant were found between familiarity with accommodations, use of campus disability offices, and request for or receipt of accommodations.

CONCLUSIONS: There is increased awareness and use of accommodations among students with mental illnesses, but it is also clear that most receive supports directly from instructors without going through the formal accommodations process. Encouraging students to utilize disability offices and greater attention to accommodation barriers may further increase support seeking. Supports that are most used and viewed as most helpful provide direction for service providers and campus personnel in their efforts to facilitate students’ educational goals.

Stansbury, K. L., Wimsatt, M., Simpson, G. M., Martin, F., & Nelson, N. (2011, July/August). African American college students: Literacy of depression and help seeking. Journal of College Student Development, 52(4), 497-502.

“…the purpose of this research was to examine African American college students’ mental health literacy regarding depression. Previous studies using this approach have found that individuals who are mental health literate are likely to seek help for themselves, and/or recommend professional assistance to family and friends experiencing symptoms of depression” (p. 497).

Storrie, K., Ahern, K., & Tuckett, A. (2012). Crying in the halls: Supervising students with symptoms of emotional problems in the clinical practicum. Teaching in Higher Education, 17(2), 89-103.

There is evidence that the number of university students with mental health problems has increased over the past few years. The literature also suggests that the number and effect of troubled health science students create significant problems in the clinical practicum. However, there are gaps in the literature as to how clinical teachers actually feel about and deal with these students. For this paper, we interviewed 16 clinical teachers from various health science disciplines to identify components of the dilemma faced by them when encountered with a student with challenging behaviour, and to then explore the strategies they applied. We found that the teachers’ emotions played a significant role in the identification of troubled students, and that successful strategies employed by participants entailed both professional demeanour and infrastructure components.

Taylor, M. J., Baskett, M., Duffy, S., & Wren, C. (2008). Teaching HE students with emotional and behavioural difficulties. Education + Training, 50(3), 231-243.

Purpose – The purpose of this paper is to examine the nature of the types of adjustments appropriate to university teaching practices for students with emotional and behavioural difficulties in the UK higher education (HE) sector.

Design/methodology/approach – A case study in a UK university was undertaken over a two-year period.

Findings – A variety of types of adjustments may be necessary for UK university students with emotional and behavioural difficulties including adjustments to pastoral care, teaching and assessment.

Research limitations/implications – The case study focussed on only three students with emotional and behavioural difficulties. However, given that the number of students entering UK universities with such difficulties is increasing, the results of this research can hopefully inform the teaching of future students.

Practical implications – This paper addresses what UK university teaching staff may need to do to support students with emotional and behavioural difficulties.

Originality/value – Although research has been conducted into the teaching of individuals with emotional and behavioural difficulties in schools, little if any research has been undertaken regarding teaching such students at university level.

Unger, K. V., Pardee, R., & Shafer, M. S. (2000). Outcomes of postsecondary supported education programs for people with psychiatric disabilities. Journal of Vocational Rehabilitation, 14(3), 195-199.

Supported education programs provide support and services so people with a major mental illness can begin or continue postsecondary education. 124 students from three supported education sites were surveyed for five semesters to assess demographic and service utilization information, education and employment outcomes, predictors of school completion and job/education fit. The study showed that students completed 90% of their college course work and achieved an average grade point of 3.14. Increases were noted in the number of students living independently. Type of psychiatric diagnosis was not a predictor of school completion but having one’s own car and number of psychiatric hospitalizations prior to program participation were predictors. The school retention rate was comparable to the general population of part-time students; employment rates (42%) during the study were lower than the population of other part-time students but higher than the population of people with mental illness generally. There were no significant changes in either quality of life or self-esteem. Students reported a job/education fit of 50%.

Weiner, E. (1999, Spring). The meaning of education for university students with a psychiatric disability: A grounded theory analysis. Psychiatric Rehabilitation Journal, 22(4), 403-410.

In this qualitative study, eight university students with mental illness, who were attending a large campus, were interviewed, indepth, in order to explore the purpose and goals of their academic program. Three groupings emerged: students who saw university as a means to an end, part of larger life goal; students who saw university as an end in itself, their primary life goal; and those students who, because of the precariousness of their illness at the time of the study, were situated in between these two groupings.