“Going to college is exciting, but students need to know that this experience, though positive, may also be stressful,” said REACH faculty member Elena Man, MD. Dr. Man recommends resources  (see below) and strategies that pediatric primary care clinicians can use to prepare patients for this significant transition to a new environment for learning, living, and friendships.

First, talk with patients about ways to stay healthy. Address the need for sleep, nutrition, exercise, stress management, and social connections.

Next, review the 5 Ws to help you clarify the steps patients need to take to obtain support and be prepared for college.

Who?

This point is critical for patients who need extra support. Encourage patients and families to explore who will provide any needed mental health and academic support at school. If students will not be home often enough for you to follow them, they will need a local prescriber at college. If they learn that campus health and counseling services can’t offer enough support, families should look for in-network providers that are near campus.

What?

Advise parents to encourage their young adult children to take responsibility for their needs. Suggest that students organize a list of campus phone numbers, including, if possible, a relative or family friend in that state. Parents and students can become familiar with the topics listed below.

Responsibility and privacy

Once children turn 18, their privacy is protected to an extent that often surprises parents. If parents and students agree, students can sign an authorization form to give parents access to their college information, including grades and  campus health records, and a separate authorization for their medical information.

Therapy

• Patients who are currently in therapy should either identify a new therapist near school or figure out how and how often they will stay in touch with their current therapist. Encourage them to set up a first appointment.
• Encourage patients to explore apps that can help them monitor their mental health and provide coping tools.
• Suggest that patients look for clubs and activities that can provide on-campus support.

Medications

• Parents can review what students need to know about insurance coverage and the need to plan in advance for follow-up visits and prescription refills. Phone alarms are good appointment and medicine reminders.
• Emphasize that students need a secure place to store their medications and that sharing prescription medications is illegal and dangerous.
• For patients with ADHD, erratic sleep and study schedules at college can be challenging. You may want to consider a stimulant patch or a short-acting stimulant for patients needing more flexible coverage. If you pursue this option, have patients try the new medication in the summer before college. Caution them about stimulant abuse, and track the frequency of their refill requests.

Accommodations

• IEPs and 504 plans do not directly carry over into college. However, disabilities —  which include any physical, mental, or learning condition that “limits a major life activity” — do remain protected under ADA, which guarantees equal access and protection from discrimination.
• Students requesting academic or living accommodations need to register with their campus disability service. The process varies from college to college but always requires documentation.

Gender and sexual orientation

College is a time when identities may emerge more openly. Explain to parents the importance of accepting their young adult regardless of how they identify. The biggest predictor of long-term well-being in the LGBTQIA community is family support, which reduces otherwise increased rates of depression, anxiety disorders, and suicide.

Safe behaviors

Use patient education resources to counsel students about:

• Sex. Discuss consent, safe sex, and safe relationships.
• Substance awareness. For patients who take medications, talk about drug interactions. Knowing that some students will experiment, educate all patients about drug and alcohol abuse.

When?

Now! Students should identify and contact campus and local resources.

Where?

Families should identify clinicians and pharmacies that are covered by their insurance and figure out how students will travel to an off-campus provider.

Why?

College can be overwhelming! Even patients who are well-regulated at home may have to adjust their approach to mental health in response to the demands of college life. Meanwhile, students who have not experienced anxiety or depression symptoms are still at risk; 75% of mental illness begins by age 24.

In a fall 2018 survey, three out of five college students said that they had experienced overwhelming anxiety in the last 12 months; two out of five students said they were too depressed to function. Although many students experienced new or worsening symptoms of a mental health condition, only 10-15% sought professional help.

Finally, Dr. Man offered this suggestion:  “Emphasize that college is exciting and fun, but that it is not unusual for students to experience difficult feelings or to find at some point that they need more support to get back on track. If you normalize that experience for upcoming freshmen, perhaps they will take steps to get help if they need it.”

RESOURCES

Dr. Man offered education resources you can suggest to help patients and families plan for college transition.

For all patients:

• Crisis lines, available 24/7: National Suicide Prevention Lifeline at 800-273-TALK (8255) and the Text Crisis Line at 741741 (text “STEVE” to reach a crisis counselor of color)
• Sexuality, relationships, and LGBTQ resources: Planned Parenthood, loveisrespect, and the Trevor Project, which includes a hotline for LGBTQ youth at 866-488-7386
• College Student’s Guide to Avoiding Drug and Alcohol Abuse
• Apps: CBT-i Coach for sleep challenges; CBT Tools, Mindshift, and Calm for coping techniques

For parents:

• Starting the Conversation about mental health in college
• Preparing for College Emotionally, Not Just Academically

For patients with an existing mental health condition:

• What’s Your Plan? College with a Mental Health Disorder, a website for students
• Suggestions for families on helping students manage mental health independently

For patients with disabilities (including mental health diagnoses):

• Exploring Accommodations for your Student 
• Transition of Students with Disabilities
• Family Resources to support students with intellectual disabilities