RESEARCH WEEKLY: College Students and Severe Mental Illness
By Meara Kane, Tasha Paul, Preethika Ratnam, Megan Miller and Atasha Merced
Editor's note: In honor of May being Mental Health Awareness Month, we are featuring guest Research Weekly blogs written by members of Active Minds, a non-profit organization focused on young adult mental health with more than 550 chapters at high schools and colleges/universities throughout the United States.
College can be a stressful time for all students, especially for those with severe mental illness. College students with severe mental illness face stigma from teachers and faculty members and require greater coordination between the health and education systems all while experiencing the educational and social stressors of college. Therefore, specialized education programs are essential to ensuring students with mental illness can thrive in a college setting and develop the skills needed to succeed post-graduation.
A landmark study on supporting young adults in education and employment was published in 1993 by Judith A. Cook and Mardi L. Solomon from the University of Illinois. The study suggests that supported education programs can improve outcomes for young individuals with mental illness enrolled in post-secondary education or seeking employment.
The study observed the outcomes of the Thresholds Community Scholars program at Thresholds, a psychological rehabilitation agency in Illinois. This program incorporated mobile education support, individual counseling, support groups, networking with school faculty and preparatory curricula to help clients succeed in post-secondary school settings. Mobile education support was provided on or nearby the campus and involved actions such as negotiating with faculty on behalf of students, providing mental health services in natural settings, debunking myths about being a student to promote self-esteem, validating students’ goals and apprehensions, and helping students honestly evaluate their strengths and weaknesses.
The study ran over a 36-month period, and data was collected on the number of classes completed, average hours worked, and self-reported levels of anxiety, self-esteem, and mastery of coping skills. By the end of the program:
- 42% of program participants had taken at least one class at a post-secondary institution,
- 78% of participants held at least one job,
- the proportion of participants who held their own, fully independent jobs rather than jobs in sheltered workshops or group placements, rose from 25% to 35%,
- mean number of hours participants worked every week increased, and
- self-reported levels of self-esteem and coping mastery increased, while self-reported levels of anxiety did not change significantly.
Based on these results, it was concluded that the program increased academic and job performance, as well as self-esteem and mastery of coping skills without also increasing participants’ anxiety levels. The authors suggest that career counseling, preparatory classes, tutoring, mobile education support, and support groups are all recommended for psychological rehabilitation services interested in improving their education support programs. Cooperation of school faculty was crucial to the success of the program, as students required support services to help them access campus resources and navigate class registration and financial aid. Therefore, the results of this study support the idea that psychological rehabilitation patients can be successful in attempting post-secondary education if they are given proper support.
Supported education and employment after first episode of psychosis
In a more recent study published in 2020 in Psychological Medicine by Keith Nuechterlein et al. from the University of California and Dartmouth College, researchers examined the effects of supported education and employment programs for individuals who have experienced their first episode of psychosis.
The researchers conducted an 18-month randomized controlled trial on the effectiveness of enhanced vocational interventions for helping individuals with a recent first schizophrenia episode return to and remain in competitive work as well as regular schooling. The enhanced vocational intervention combined Individual Competitive Employment (IPS) with a Workplace Fundamentals Module (WFM). IPS involves the rapid search for a competitive job, integration of vocational services into mental health treatment, consideration of client job preferences, community outreach, and continuous job support. WFM is a group skills training approach focused on general skills that increase work and school performance such as how work or school changes one’s life, learning about one’s place of work or school, identifying stressors, solving problems, managing symptoms, medication, socializing with peers or coworkers, and finding motivation.
Patients were randomly assigned to either the combined IPS-WFM program or a conventional vocational rehabilitation program (BVR), which involved referrals to services at separate agencies without a specific focus on vocational skills.
After the first six months, 83% of patients in the IPS-WFM group were participating in competitive work or school compared to only 41% in the BVR group. This suggests a substantial improvement in competitive employment and school participation for those taking part in IPS-WFM. During the following year, 92% of IPS-WFM patients were in school or competitive employment during at least part of the time period compared to 60% of BVR patients. Higher medication adherence during the first six months of the study was associated with being in work or school during that time period, and the severity of psychotic symptoms was not significantly impacted by group assignment.
This study concluded that IPS-WFM treatment had significant benefits for helping first-episode psychosis patients return to competitive work or school and extend their participation in work or school over a longer period of time. IPS programs can be successfully implemented in community clinics in the United States, and the results of this study support the application of supported education and employment at early stages of psychotic illness.
Both studies found that with the proper support, individuals with severe mental illness can succeed at school and in the workplace. With supported education and employment programs such as the Thresholds Community Scholars Program and the IPS-WFM model, individuals with severe mental illness were able to successfully return to school and work and reported signs of higher wellbeing. These programs are highly effective, particularly for young adults pursuing post-secondary education, and further research and funding could allow them to reach more people.
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