Running head: CAMPUS MENTAL HEALTH SERVICES

Actual and Perceived Academic Performance: Do Campus Mental Health Services Make a

Difference for Students with a Mental Illness Diagnosis?

Devan Grigg Lalas

Western Carolina University

CAMPUS MENTAL HEALTH SERVICES 2

Actual and Perceived Academic Performance: Do Campus Mental Health Services Make a

Difference for Students with a Mental Illness Diagnosis?

Abstract

An increasingly large number of students who have been diagnosed with a mental illness

have been enrolling in higher education programs, and as a result, campus mental health service

caseloads are increasing. Campus mental health professionals are sensitive to the service needs

of this group as they struggle to accommodate the growing need for the student body as a whole.

Effective mental health services can mean the difference between student retention and degree

completion. Therefore, it is important to know if students who have been diagnosed with mental

illnesses have lower academic performance and, if so, whether campus mental health service use

makes a difference. In this study, we examine whether diagnosed students have lower academic

performance compared to students who have not been diagnosed with a mental illness. Given the

well-documented association between student mental health service use and academic success,

we tested the impact of campus service use on the relationship between diagnosis status and

academic performance. While controlling for mental health, service related, campus integration,

and demographic variables, we would expect to have an impact on this relationship. Our case

study of 598 undergraduate and graduate students at Western Carolina University during the

academic year 2014 found that, T-test results comparing mean GPA for students who have

(GPA=3.35) and have not (GPA=3.38) been diagnosed with a mental illness were not significant

and, in fact, were almost identical. We also found that the majority (60.7%) of respondents who

had been diagnosed with a mental illness reported that their mental illness had negatively

affected their school performance. And, for these students (i.e., those who have been diagnosed
CAMPUS MENTAL HEALTH SERVICES 3

with a mental illness), CAPS use is significantly related to the perception that their mental illness

negatively affects their academic performance (Chi-Square=5.232, p<.05 and Phi=.176, p<.05).

Introduction

In recent years, the severity of mental illness among college students has increased. More

students than ever before with mental illnesses are coming to college (Gallagher, 2008;

Guthman, Iocin, & Konstas, 2010; Gruttadaro, & Crudo, 2012). Although there is documented

evidence of this trend in the literature, still less than 11% of American college students currently

engage in campus counseling services (Reetz, Barr, & Krylowicz, 2014). More specifically, at

Western Carolina University, only 8% of students enrolled in campus-based academic programs

used campus Counseling and Psychological Services during the course of the 2014-2015

academic year, according to the Director of CAPS (K. Gorman, personal communication, August

2015). Given the well-documented association between student mental health service use and

academic success (Locke, Bieschke, Castonguay, & Hayes, 2012; Gruttadaro, & Crudo, 2012;

O'Keeffe, 2013), and this study's findings that stigmas and stigma associated with disclosure are

the major contributing factor hindering students from help-seeking behaviors and help-seeking

behavior reporting. This case study demonstrates that it is the university's best interests to

provide quality mental health services, attempt to reduce the stigma surrounding mental illness,

and encourage students to use mental health services.

Review of the Literature

As an extensive review of the literature, we first demonstrate the rapid increase in student

psychopathy, then discuss how mental health issues negatively affect academic performance.

Transitioning, we explain the on-going debate over the role of campus counseling and

psychological services (CAPS), and then examine the adverse effect CAPS can have on student
CAMPUS MENTAL HEALTH SERVICES 4

academic performance. We highlight current practices for addressing the rising mental health

concerns on college campuses.

Mental Health Issues Increasingly Common on College Campuses

Current literature indicates a clear increase in psychopathology among students in recent

years (Barr, Rando, Krylowicz, & Winfield, 2010; Gallagher, 2008, 2012; Twenge, Gentile,

DeWall, Ma, Lacefield, & Schurtz, 2010). The number of cases of mental health illness on

college campuses is more prevalent currently than in the past, and some researchers report that

the rate of students dealing with mental health issues is up-to or equal with their noncollege-

going counterparts (Hunt & Eisenberg, 2010). Additionally, beyond the well-documented cases

of elevated psychopathy, the severity of mental illnesses among college students has also

increased. A recent study by Brunner, Wallace, Reymann, Sellers, and McCabe (2014) reported

increases in the severity and complexity of the mental health concerns of college students in the

recent years. Thus, with more students with mental illnesses in college than before and with

raised severity of mental health illnesses among those students ...college and university

counseling centers have also been experiencing a sharp increase in the demand for counseling

services (Kitzrow, 2003, p. 170).

Mental Health Issues Negative Effects on Academic Success

A review of the literature identified that mental health issues can have a negative impact

on students academic performance, retention, and graduation rates. (Anderson, 1985; Tinto,

1985; Gerdes & Mallinckrodt, 1994; Brackney & Karabenick, 1995; Kessler et al., 1995;

Savanum & Zody, 2001; Kitzrow, 2003). In a 2005 study that examined mental health effects on

students academic performance, Hysebegasi, Hass, and Rowland reported that depression was
CAMPUS MENTAL HEALTH SERVICES 5

negatively associated with students' academic performance, observing a decrease in students

GPA by approximately half a letter grade. Furthermore, they concluded that "depressed students

reported missing a significantly greater number of classes, exams, and assignments" (p. 148);

events that consequently negatively affect students overall academic performance. DeRoma,

Leach, and Leverett (2009) found in their study of 164 undergraduate and graduate students that

participants' Beck Depression Inventory-II score (a self-reported rating inventory that measures

characteristic attitudes and symptoms of depression) had a significant negative correlation with

self-reported GPA. Eisenberg, Golberstein, and Hunts (2009) survey of 2,800 undergraduate

and graduate students from a large, academically competitive, public university found that

depression was a significant predictor of lower GPA, even after controlling for covariates such as

anxiety, eating disorders, and prior academic performance. They additionally reported that

depression is a significant predictor of both lower GPA and the likelihood of leaving the

university.

The Role of Campus Counseling and Psychological Services

According to a study about college counseling centers and student retention, "the primary

function of college counseling centers continues to be the provision of direct counseling

interventions to students whose personal problems interfere with their ability to function in the

academic environment" (Sharkin, 2004, p. 99). However, one of the fore-facing challenges

counseling and psychological service units consistently encounter is the continued demand to

demonstrate their effectiveness in retaining students to graduation (Sharkin, 2004). A major gap

in the literature appears in the inconsistency among the ultimate function of these units. It is

unclear whether counseling services function to promote student well-being or retain students to

degree?
CAMPUS MENTAL HEALTH SERVICES 6

Empirical evidence of the positive impact of counseling and psychological services on

student retention (Garni, 1980; Bishop & Brenneman, 1986; Bishop & Walker 1990; Mattox,

2000) could make a compelling argument for administrators interested in their campuses

retention efforts, to view counseling and psychological services direct value as retention

purposes (Astin, 1975). Though, some researchers argue that the goal of counseling is not (and

should not be) to keep students in school (Sharkin, 2004, p. 105). Sharkin argues that using

student retention as measures of counseling and psychological services success is inadequate

(2004). Other researchers, like Kitzrow (2003), support the claims of Sharkin, postulating that

not all retention is good. [F]or example, mental health problems can significantly interfere with

or otherwise impair the ability of students to function in the academic environment (Sharkin,

2004, p. 105), and in which case a students early leave or dismissal from the college may be

best in the overall well-being of the student (Sharkin, 2004). Using retention measures to

evaluate counseling and psychological services effectiveness may negatively reflect the work of

these units. When in reality, in such situations, college counselors may be most helpful to

students by evaluating the advantages and disadvantages of remaining in school versus

withdrawing temporarily or permanently (Sharkin, 2004, p. 105). Relying on retention data

alone or standard measures of academic success (i.e., GPA, credit hours completed/attempted) to

evaluate the effectiveness of counseling and psychological services is unjust.

Counseling and Psychological Services Positive Effects on Academic Performance

Hysenbegasi and colleagues at Western Michigan University found that treatment was

associated with a protective effect of approximately 0.44 [grade] points in students with

diagnosed depression (2005, p. 145). Some researchers have found that self-perception of ones

own mental health can have a significant impact on their perceived academic performance.
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Turner and Berry (2000) revealed that 70% of their 2,300 student participant sample disclosed

that their perception of their personal issues negatively affected their academic performance.

However, their own perception of help-seeking positively influenced their perception of their

own academic performance. Nearly sixty-one percent (60.7%) of Turner and Berrys study

participants perceived that their use of counseling services improved or maintained their

academic performance (2000).

Counseling and Psychological Services Negative Effects on Academic Performance

Many researchers dispute the positive effects counseling and psychological services have

on students academic performance. A frequently cited study by Illovsky (1997) found that

college counseling services were not related to improved academic performance among students.

Lee, Olson, Locke, Michelson, and Odesanalysis (2009) study of college freshman and transfer

students who used counseling services at a northeastern, large, public university between the

academic years of 2004 and 2006, showed that the relationship between counseling experience

and cumulative GPA was statistically significant. Yet more specifically, the cumulative GPA of

the Non-counseling Group was .07 [grade point] units higher than the Counseling Group

(p.311). Additionally, Hunt and Eisenberg (2010) explain that the lack of empirical evidence and

shared acceptance of counseling and psychological services best practices has resulted in the

inconsistent effects of these services.

the variation across campuses in resources, programs, and policies does not appear to

be based on systematic evidence about what works best in different types of campus

settings. This situation undoubtedly stems in large part from the limitation in the [current]

research; if there are few campus-level programs and policies that have shown
CAMPUS MENTAL HEALTH SERVICES 8

definitively to work, then it is not surprising that each campus functions differently

(Hunt & Eisenberg, 2010, p.7).

As noted in the literature, there is no consistent claim of the effectiveness or

ineffectiveness of counseling and psychological services on students academic performance. A

dichotomy of results is still overwhelmingly present as researchers continue to craft arguments to

support both sides of the debate.

Addressing Mental Health on College Campuses

The literature calls for broad culture shifts among institutions of higher education in

terms of addressing campus mental health. "[I]nstitutions need to adopt the attitude that student

mental health is an important and legitimate concern and responsibility of everyone involved in

higher education (including administrators, faculty, and staff), rather than being the sole

responsibility of counseling centers" (Kitzrow, 2003, p. 175). Hunt and Eisenberg (2010) assert

that the institution of higher education is the premier place to do this culture shifting work. As

the ability of those in higher education to gather evidence, conduct research, and effectively

disseminate best practices is commonplace. "Campuses by their scholarly nature [are] well

positioned to develop, evaluate, and disseminate best practices colleges offer a unique

opportunity to address one of the most significant public health problems among late adolescents

and young adults" (Hunt & Eisenberg, 2010, p. 3). A stark absence of literature that addresses

the recent shift in the prevalence of students with mental illnesses, the severity of their illnesses

and institutional responses to the overwhelming demands for campus counseling and

psychological services prevails.

CAMPUS MENTAL HEALTH SERVICES 9

References

Anderson, E. (1985). Forces influencing student persistence and achievement. In L. Noel, R.

Levits, & D. Saluri (Eds.) Increasing student retention (p. 44-61). San Francisco: Jossey-

Bass.

Astin, A. W. (1975). Preventing students from dropping out. San Francisco: Jossey-Bass.

Bishop, J. B., & Brenneman, K. A. (1986). An initial assessment of a counseling center's role in

retention. Journal of College Student Personnel, 27(5), 461-462.

Bishop, J. B., & Walker, S. K. (1990). What role does counseling play in decisions relating to

retention?. Journal of College Student Development, 31(1) 88-89.

Brackney, B. E., & Karabenick, S. A. (1995). Psychopathology and academic performance: The

role of motivation and learning strategies. Journal of Counseling Psychology, 42(4), 456-

465.

Brunner, J. L., Wallace, D. L., Reymann, L. S., Sellers, J. J., & McCabe, A. G. (2014). College

counseling today: Contemporary students and how counseling centers meet their needs.

Journal of College Student Psychotherapy, 28(4), 257-324.

Eisenberg, D., Golberstein, E., & Hunt, J. B. (2009). Mental health and academic success in

college. The BE Journal of Economic Analysis & Policy, 9(1), 1-35.

Gallagher, R. P. (2008). National survey for counseling center directors. Arlington, VA:

International Association of Counseling Services.

Garni, K. F. (1980). Counseling centers and student retention: Why the failures? Where the

successes?. Journal of College Student Personnel, 21(3), 223-228.

CAMPUS MENTAL HEALTH SERVICES 10

Gerdes, H., & Mallinckrodt, B. (1994). Emotional, social, and academic adjustment of college

students: A longitudinal study of retention. Journal of Counseling and Development,

72(3), 281.

Gruttadaro, D., & Crudo, D. (2012). College students speak: A survey report on mental health.

(Survey Report). Arlington, VA: National Alliance on Mental Illness.

Guthman, J. C., Iocin, L., & Konstas, D. D. (2010). Increase in severity of mental illness among

clinical college students: A 12-year comparison. American Psychological Association

118th Annual Convention: San Diego, California.

Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among

college students. Journal of Adolescent Health, 46(1), 3-10.

Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the

academic productivity of university students. Journal of Mental Health Policy and

Economics, 8(3), 145.

Illovsky, M. E. (1997). Effects of counseling on grades and retention. Journal of College Student

Psychotherapy, 12(1), 29-44.

Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of

psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152(7),

1026-1032.

Kitzrow, M.A. (2003). The mental health needs of todays college students: Challenges and

recommendations. Journal of Student Affairs Research and Practice, 41(1), 167-181.

CAMPUS MENTAL HEALTH SERVICES 11

Lee, D., Olson, E. A., Locke, B., Michelson, S. T., & Odes, E. (2009). The effects of college

counseling services on academic performance and retention. Journal of College Student

Development, 50(3), 305-319.

Locke, B. D., Bieschke, K. J., Castonguay, L. G., & Hayes, J. A. (2012). The center for

collegiate mental health: Studying college student mental health through an innovative

research infrastructure that brings science and practice together. Harvard Review of

Psychiatry, 20(4), 233-245.

Mattox, R. (2000). Building effective campus relationships. In D.C. Davis, K.M. Humphrey

(Eds.), College counseling: Issues and strategies for a new millennium (p. 221-237).

Alexandria, VA: American Counseling Assocaition.

O'Keeffe, P. (2013). A sense of belonging: Improving Student Retention. College Student

Journal, 47(4), 605-613.

Reetz, D. R., Barr, V., & Krylowicz, B. (2014). The association for university and college

counseling center directors annual survey. Aurora, IL: American Publish.

Sharkin, B. S. (2004). College counseling and student retention: Research findings and

implications for counseling centers. Journal of College Counseling, 7(2), 99.

Svanum, S., & Zody, Z. B. (2001). Psychopathology and college grades. Journal of Counseling

Psychology, 48(1), 72.

Tinto, V. (1985). Increasing student retention: New challenges and potential. In L. Noel, R.

Levitz, & D. Saluri (Eds.), Increasing student retention (p. 28-43). San Francisco: Jossey

Bass.
CAMPUS MENTAL HEALTH SERVICES 12

Turner, A. L., & Berry, T. R. (2000). Counseling center contributions to student retention and

graduation: A longitudinal assessment. Journal of College Student Development, 41(6),

627-636.

Twenge, J. M., Gentile, B., DeWall, C. N., Ma, D., Lacefield, K., & Schurtz, D. R. (2010). Birth

cohort increases in psychopathology among young Americans, 19382007: A cross-

temporal meta-analysis of the MMPI. Clinical Psychology Review, 30(2), 145-154.