Action Research Project

Mental Health Support Services in Higher Education

Alisa Sweet, Leslie Jackson, Sydney Donaldson
AHE 555
June 2, 2016

Abstract
Mental health support is a topic that continues to be stigmatized and considered taboo. It is often left

out of conversations on diversity in higher education, and students with mental illnesses continue to

struggle silently against stigma and discrimination. In this paper, we study the current reality of

mental health support in higher education both for the general American public and for, specifically,

the Native American population. Through research and interviews with service providers on the

campuses of Western Washington University and Northwest Indian College, we found that while

support is available at both campuses, the major struggle is in getting past the stigma that surround

mental illness. To effectively help students in need, it is recommended for these schools to expand

outreach to students and raise awareness of the services available. It is crucial that we be able to

discuss mental health openly in order to decrease the stigma associated with the topic, so that the

topic garners the attention that it desperately needs.

Introduction
As the number of college students with mental health issues continue to increase, we find that mental

health continues to be critically overlooked in the discussion of diversity in higher education. The

conversation and research surrounding mental health is nowhere nearly as extensive as those

surrounding other diverse populations in higher education. Although student services continue to

evolve as needed, the reality is that students with mental health concerns continue to fight against

stigma and bias. When intersecting identities are involved, this struggle can be further exacerbated by

factors such as politics and historical trauma. In this paper, we delve deeper into the realities

surrounding students in higher education with mental health issues; the discrimination they face, the

resources that are available to these students (in terms of policies and legislation), and the reality of


available resources at two specific institutions: Western Washington University (a public four-year

university), and Northwest Indian College (a tribal higher education institution). The goal of our

research is to understand the current environment for students with mental health issues faced by two

populations, Native Americans and a predominantly white population, and make recommendations

based off of our research as to best policies that can be used to support students with mental health

issues.

Research Discussion
Current Policies in Higher Education
In order to understand the current state of mental health support offered by universities, we first

looked into policies and programs that are set in place to ensure equitable access to students who

suffer from mental health issues. Research shows that psychiatric disabilities is also covered by

federal policies such as the Rehabilitation Act of 1973 or the Americans with Disabilities Act.

(Collins & Mowbray, 2005). While these federal programs create a solid foundation for supporting

students with mental health issues, most initiative taken to support these students happen at an

institutional level (2005). In their survey, Collins and Mowbray found that none of their respondents

were able to identify any formal state policies to support students with psychiatric disabilities. Most

programs that they mentioned were local programs, which tended to be pilot programs. This is

mainly due to the lack of funding for mental health support in higher education institutions.

Resources are dispersed among various programs, and schools struggle to agree on the importance of

mental health support. Additionally, a lack of funding creates an environment where staff cannot

comfortably discuss new ideas or initiatives. Even mental health advocacy organizations tend to have

a broader agenda then supporting people with mental illnesses attend postsecondary education.

Collins and Mowbray wrote of a number of advocacy organizations who did not participate in their

interview since mental health was not a priority for them. In their conclusion, Collins and Mowbray

called for a combined effort from various state agencies (education, mental health, vocational


rehabilitation), levels of government (federal, state, local), and advocacy organizations. Without

collaboration and prioritization, the current situation will not change.

In terms of policies providing mental health support for the Native American population

specifically, there is the Indian Health Care Improvement Act (IHCIA) and the American Recovery

and Reinvestment Act (McLeigh, 2010). The former provides congress the legal authority to provide

funds for the health care of Native Americans, the Indian Health Service (IHS). This system is facing

critical budgetary constraints and personnel issues, which causes limitations in services. For example,

in 2004 the IHS was limited to basic psychiatric emergency care. This created further reasons for

many Native Americans to distrust the government (2010). In an attempt to change this, President

Obama hosted an unprecedented summit with leaders representing 386 tribes in 2009. At this summit

he signed a memorandum requiring cabinet agencies to report every 90 days about their progress in

improving the relationship between the federal government and tribal communities (2010, p.179).

The American Recovery and Reinvestment Act included provisions designed to prevent economic

deterioration and promote economic development in Indian Country (2010, p.179). It had a goal to

create new funds for IHS, which would be used to build new facilities, increase health information

technology, and promote housing, education, and public safety. From this, further initiatives such as

the Indian Health Care Reauthorization and Extension Act, the Seventh Generation Promise Youth

Suicide Prevention Act, and the Childrens Health Insurance Program were created and passed. In

order to make these programs effective for the Native American communities, initiatives must be

developed and evaluated. McLeigh Stresses the need for development of economic assets,

strengthening of democratic institutions, and a culturally grounded reform of a (currently) externally

managed health and social services. A partnership must be formed for these initiatives to truly take

effect.

Comparative Data


We found a study which compared survey results by two separate populations of Native Americans

(Southwest tribe and a Northern Plains tribe) to the results of the National Comorbidity Survey

(NCS) conducted in 1990 -1992 (predominantly white participants, substantial number of African

American and Hispanic participants, American Indian/Alaska Natives were about 1% of the NCS

sample (Beals et al. 2005, p.1726). In their study, Beals et al. found that the most common lifetime

diagnoses in the American Indian populations were alcohol dependence, posttraumatic stress disorder

(PTSD), and major depressive episode. Compared to the NCS sample, both tribes had higher risk for

PTSD and alcohol dependence, but lower risk for major depressive episode. Among men, both

American Indian samples had higher rates of alcohol dependence and PTSD compared to others in

the United States. Among women, both American Indian samples were at higher risk for PTSD

compared to the women in the NCS sample (2005). Beals et al. found that their findings were both

similar and different from reports about other ethnic and racial minorities in the United States. For

example, African Americans, Hispanics, and Asian Americans often have lower rates of depressive

disorders compared to whites. However, opposed to the results for American Indians, African

Americans tend to have lower rates of substance use disorders compared to whites. While help-

seeking for substance use disorders were relatively high in the American Indian samples, American

Indian women were less likely to seek help for depressive/anxiety disorders (2005). Beals et al. also

found that American Indians relied heavily on traditional resources (especially in the Southwest

tribes), which underscores the need to better understand the importance of such healing in the

service ecology of American Indians (p.1731).

Stigma
While there are policies and legislation surrounding mental health, students who battle these issues in

higher education continue to face stigma and discrimination that often discourages them from

disclosing their illness. This in turn prevents them from accessing the support available to them. In

her study done at a university in Melbourne, Australia, Jennifer Martin describes stigma as


something which creates powerful barriers to students seeking and receiving assistance (Martin,

2010, p.260). She found that slightly under 2/3 of the students she spoke with had not disclosed their

mental health conditions to staff, even though they had experienced difficulty in their studies. Under

1/3 of the students interviewed expressed concern that they would be seen as telling lies and/or

wanting privileges (p.265). Students fear their peers discovering their illness, and being

stigmatized because of that. There was also some concern over privacy issues, with one student

disclosing his/her illness to a staff member at their Disability Liaison Service. A staff member from

this service addressed this student before an exam in front of the entire class, saying if you dont

feel well at any time, you can just leave if you need to! (p.266). This resulted in the student never

attending that class again, and failing the course as a result. Privacy in cases like these is crucial, as

stigma can lead to further problems including physical, psychological, and social conflicts. Students

affected by the stigma of mental illness often lose motivation, struggles to maintain motivation and

focus, and appears unhappy. Martin explains that most students who disclosed their illness had

positive outcomes from the experience. However, it is necessary and crucial to address the stigma of

mental illness in order to help students overcome their fears and concerns of disclosing to university

staff and gaining access to the support they require to succeed in their studies (p.271). Martin also

concludes that it is necessary for academic and administrative staff to receive training on how to

recognize signs and symptoms of mental illness and respond appropriately. Educating the staff to

appropriately care and support for students can reduce the impact of the stigma of mental illness.

Methodology & Research Questions

For our project we decided on a mixed methods approach. Because a large part of our project was

focusing on specific areas of mental health services for students that could be improved, we needed

to start with some research. We focused on finding research that focused on the stigma and bias that

often comes with mental illnesses as well as the influence these stigmas had on the students. We

decided that we wanted to focus on two separate institutions to get a better idea of how student


services varied. Leslie had a connection with Northwest Indian College that she could speak with,

and Alisa had a great connection for Sydney to interview a counselor at Western. After deciding that

we wanted to focus on two different types of institutions, we continued our research to find

traditional differences between predominately white college students and Native American college

students. Finding comparative research allowed us to create some specific focus points for our

research, this lead to our research questions. For our research questions we wanted to focus on 1) The

different stigmas that were associated with mental illnesses, as well as the difference in stigmas

between the two different study bodies. 2) What the student services looked like at each institution

and how they varied 3) How the services could be improved to help battle the stigmas and discomfort

surrounding the subject of mental illnesses.

After we decided on our research questions and what we wanted to accomplish through our

interviews the next step was actually scheduling them. Due to the small amount of time we had to

gather our research, we found that e-mail interviews were going to best our best method. Using this

method allowed us to get our questions to our interviewees quickly and receive our data back quickly

as well. Gay et al. discuss some of the pros and cons of e-mail interviewing one advantage of the e-

mail interview is that you dont have to transcribe a taped interview- the transcription of the

interview has already been done for you (Gay et. al, 2009, p.372). This was a great advantage for us

and really sped up our information-gathering process. We felt that our mixed methodology of

gathering research, creating research questions then electronic interviewing was a perfect fit for our

project as well as our timeline. The list of questions we sent to each interview subject is attached in

the Appendix.

Findings
Northwest Indian College
Students at Northwest Indian College (NWIC) come from several different tribes from the lower 48

states as well as Alaska and Canada. These students come with a variety of issues unlike any other

student attending college. However, Native Americans have a different set of issues that are


generational and can be traced back to historical trauma. Maria Yellow Horse Braveheart, a Lakota

woman on the faculty of Columbia University, has argued that historical trauma captures the

collective emotional and psychological injury (both over the lifespan and across generations) that is

the product of a cataclysmic history of genocide. Its effects include substantially heightened risk of

depression, traumatic stress, alcohol abuse, child maltreatment, and domestic violence (McLeigh,

2010 p.77-78). With that being said, there were no real surprises when Victoria Retasket, Dean of

Student Services at NWIC, answered the questions provided to her on mental health issues at the

college.

With special attention to the mental health issues at the college, Victoria described the

majority of the issues are linked to alcohol and substance abuse. She cited these issues may be

related to learning disabilities these students encounter as a result. Her response was, most often we

work with students who have had and are recovering from substance abuse issues and with a variety

of learning disabilities that translate into a number of other challenges our students face (Retasket,

2016). One of the most difficult issues trying to help these students is the stigma attached to mental

health issues. In her experience, students have a difficult time disclosing health issues, therefore they

are undocumented and undiagnosed. The problem lies in that without documentation, because of

funding and policy, they cannot provide help. Since funding is very limited the documentation is

required for assisting in accommodation.

Although services are free for students at NWIC, they also have access to Lummi Vocational
Rehabilitation and do work closely with them for referring students with bigger needs. Victoria
explained,
If students come to disclose a disability that is yet undiagnosed, I have developed a great
relationship with the staff at the Lummi VR program who can help demystify some of those
stigmas they might feel and really help build a bridge between their services and ours at the
college. Also, we get referrals often from the substance abuse recovery programs and it can
be challenging for those students to share their struggles in order to receive help
(Retasket,2016).


She also agreed there were common stereotypes associated with mental illness and as a result, she

felt many students even without mental disabilities do not ask for help. This perception can deter a

student with mental illness from completing their associate's or bachelor's degree. She added a

hopeful adage, saying

I find that our students who overcome the hurdles of having an illness diagnosed, disclosing
that challenge, enrolling for classes, then put themselves within the ability of only completing
a workforce education program or an associates degree and need lots of reassurance that
with our support, they could indeed complete a bachelors degree or beyond (Retasket, 2016).

The college is making a huge effort to try and reach out and engage all the students so they may

provide a safe and open learning environment. The college has recently updated their website, and

have disseminated a lot of information on the site in the hopes the students and potential new

students will see what the college has to offer for students outside of the academic part. Victoria

explained that since the government does not financially support this area and they are not able to

provide an on-campus mental health counsellor for the students, which is particularly difficult when a

student is a vulnerable stop and needs help. However, she said that with Obama Care many of the

students have been able to sign up for Apple Health. She said just these past winter and spring

quarters 5-6 students were helped by Apple Health that would have otherwise had to drop out of

school for financial reasons.

One change Victoria hopes the Lummi Tribe to uphold and honor the Jay Treaty Rights of

First Nations students who are considered students of North American, and either Canadian or US

and provide healthcare (2016). She figures this would cost quite a bit to change due to policy and

procedure between the two countries and the tribes involved. The college itself tries to help by not

charging out of state tuition to those who can show proof of membership to First Nations or enrolled

tribal members.

It is obvious to see the challenges that face students at NWIC, especially those in need of

mental health services. Since the college is small and not funded as heavily as state institutions, their


resources are limited. However, the tribe does try and take care of their own and through resources

like Lummi Vocational Rehabilitation, as well as other services such as Apple Health, the students at

NWIC do have some sort of outlet to go to for support. The problem though is asking for help and

following through with it.

Western Washington University

Addressing the stigma of mental illness is a first and crucial step in getting students to

overcome their fears and concerns of disclosing to university staff and gaining access to

the support they require to succeed in their studies (Martin, 2010, p.271). It is too often and too

common that students feel ashamed to disclose a mental illness. Whether it be to a friend, family

member or counselor, students generally do not feel comfortable disclosing their personal struggles.

Martins study, conducted in 2010 at an Australian university, revealed that the average college

student will deal with some sort of anxiety and or depression during their college career. When asked

the reasoning behind students hesitation some of the answers included the following, I feel very

uncomfortable telling them (staff) because I am worried that they will think Im lying or that my

conditions not bad enough and I just want privileges (p.265). Other students spoke on the lack of

comfortability they felt when experiencing a particularly vulnerable episode, if I experience a lack

of understanding of my circumstances or feel that I will be judged or considered an inappropriate

candidate for my chosen course/career (p.265). Another student discussed that if they did seek help,

that the staff at their school would not be able to help I dont think many staff would understand if I

told them I was having anxiety or a depressive episode (p.265). Yes, this may just be one study, but

it does speak to how students are feeling about dealing with mental illnesses.

We took a look at the resources for students on Westerns campus and spoke with David

Herzrog, a clinical psychologist for Western as well as the outreach coordinator for the universitys

Counseling Center. When we asked David what specific services are provided to WWU students we

replied with the following



We offer group counseling, short-term individual or couples counseling, and psycho-

educational workshops and classes to help students address their concerns and gain the skills
to be successful at WWU. We also assist students by referring them to other services on
campus and to community resources that can offer more specialized or longer-term help with
problems and concerns (Herzog, 2016).
With such an extensive list of services, we were curious to what students most often came to the

counseling center for. A majority of our research indicated that students most often dealt with issues

surrounding anxiety and depression and wanted to see if that rang true at Western. Because David

also does work in outreach, he has a broader experience in dealing with a variety of student issues

students come to the Counseling Center with a variety of concerns. Many are personal concerns

about relationship problems, stress, assertiveness, low self-esteem, anxiety, depression, body image,

or eating disorder (Herzog, 2016). It was hard to get into further detail of student issues due to

HIPPA regulations, however it was very interesting to see that there was a large variety of issues

students came to the counseling center with.

When asked on how students felt about disclosing their mental health illnesses and if he felt

that there was a stigma attached David was fairly vague in his answer some students are concerned

about possible stigmas associated with mental health issues as well as with seeking counseling

(Herzog, 2016). However, what we found very helpful was the background David had in outreach

and how they specifically deal with battling these stigmas. As part of the counseling center, specific

outreach and education is provided for students and staff surrounding mental health issues. He

explained that a recent change that counseling services has provided is the addition of group

counseling. Through outreach services and consultations, the counseling center has found that more

students had a desire for group counseling sessions. The increase of outreach to students is a main

part of Davids job and something he particularly enjoys being able to hear directly from the

students who have used the counseling center, and those who have not, is a great way to gain a new

perspective on what we can do to improve access and comfortability for students. Our main goal is to


help students feel comfortable and through our increase outreach we are working more closely with

that goal (Herzog, 2016).

Recommendations
When it comes to making recommendations to a program and to professionals that have done so

much work in their field, it is hard to do. After speaking with both David Herzog and Victoria

Retasket, it is safe to say that our group is humbled by the work that they do. In particular, after

speaking with Victoria we find it outside of our cultural power to recommend to another culture what

they should or should not do to better their situation. However, from where our group stands and

having Leslie who has worked with the people of NWIC for the past eight years, she has developed a

better understanding than many people could in regards to the cultural issues that these people face.

Our hopes are for NWIC to gain more funding, perhaps through a grant, to fund a full time mental

health counsellor on staff, this would be a first crucial step to improve on-site help. When Leslie

worked for the college, she heard multiple times from students about the limited access to a mental

health counselor. Another possible suggestion for NWIC would be for the federal government to

offer Obama Care free of charge to all enrolled tribal members and have enrollment accessible on all

tribal college campuses.

As far as suggestions and recommendations for Westerns campus goes, we believe one of

the biggest steps would be to continue to build off the increased outreach that the counseling center

has begun. When we asked David what he felt was one of the biggest changes the university could

make he spoke on the ongoing effort to make the services more accessible and well-known to the

study body, by offering educational workshops at the Student Health Center and other venues on

campus. Something we think could greatly improve these outreach efforts would be to have a

mandatory online workshop for students at Western. Currently there is a health awareness program

regarding drugs, alcohol and sexual violence that all students must complete by a certain date, we

suggest a similar setup for mental health awareness. Both research and our discussions showed that


the stigma associated with mental illnesses is one of the largest factors that inhibit students from

seeking help. It is important to constantly work toward riding of the stigma and making the

discussions about mental illnesses a normal thing. It should not be uncomfortable for students to

talk about and by spreading information and lessening the stigma surrounding the topic, we think

students would be more open to discusses these issues.

Last week on Westerns campus a student attempted to end his life. President Shepard sent

out an email explaining and emphasizing the point that this subject needs to be discussed and the

stigma needs to end. In his email it read why should a president clutter your inbox with a message

about a subject that many would prefer not to talk about? Precisely because it is a subject we too

often avoid talking about (Shepard, 2016). He continued to discuss that no matter how

uncomfortable the topic may be, it is important that we continue to have these types of discussions so

that the subject no longer becomes taboo, because of the stigma surrounding such topics, people do

not bring the manifestations of a usually VERY treatable problem to the attention of others I

encourage you to consider joining me in that vow: break the stigma surrounding these topics by

being willing to discuss them just as you would any other ailment (Shepard, 2016). It is with much

regret that this happened, but the event itself speaks to the importance of this topic and the relevance

of our work. We echo President Shepards words in that our main recommendation is to break the

stigma and have those uncomfortable conversations, and utilize the tools around you.

Conclusion
When we began brainstorming ideas for our action research project we all agreed on one thing,

mental health support services are not given the attention they needed. Research shows the

significant impact that the stigma surround mental health illnesses has and it is an issue that needs to

continue to be discussed and properly addressed. Having the opportunity to learn from two different

institutions provided our group insight to the realities that students face today. Whether it be at

NWIC, Western or any other institution, the issues lie in the comfortability of students, and it is part


of our job as students and ambassadors of higher education to help battle these issues. Through our

project we have taken a small step toward finding out more information and beginning more

discussions on mental illnesses, but the real work lies ahead of us. Being able to start the

uncomfortable conversations and relaying information about mental health services are just a few

steps we can continue to take toward solving this epidemic.

Appendix

Mental Health Support Services in Higher Education

E-Mail Interview Questions

- What services are provided for (WWU or NWIC) students?

- Are these services free?
- What are some of the most common mental health issues and/or disorders
you see in WWU students?
- Would you say that students feel a stigma attached to any mental health
issues they discuss; i.e. do you find that students feel ashamed or afraid to
disclose what they struggle with?
- There is often stereotypes associated with mental illness, would you say this
is a common issue among students, being conscious or afraid of these
stereotypes?
o If so, what are some ways you try and combat the stereotypes for the
students you work with?
- How does policy of both government and the university affect the mental
health services for students?
- How would you say aid to students has changed recently?
- What services outside of the university do you recommend for students to
pursue?
- What would you say is the biggest change needed in regards to mental health
services and aid to students?


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Collins, M. E., & Mowbray, C. T. (2005). Understanding the Policy Context for Supporting

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Herzog, D., Psy.D. (2016, May 23). Mental Health Support Services at Western Washington

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Martin, J. M. (2010). Stigma and student mental health in higher education. Higher Education

Research & Development, 29(3), 259-274. doi:10.1080/07294360903470969

McLeigh, J. D. (2010). What Are the Policy Issues Related to the Mental Health of Native

Americans? American Journal Of Orthopsychiatry, 80(2), 177182.

Retasket, V. (2016, May 21). Mental Health Support Services at Northwest Indian College

[Interview].

Shepard, B. (2016, May 25). Western Cares: Campus message from Bruce Shepard. Retrieved


May 31, 2016, from https://westerntoday.wwu.edu/news/western-cares-campus-message-

from-bruce-shepard