56 The Journal of College Orientation and Transition College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It By Richard Kadison, M.D. and Theresa Foy DiGeronimo Published by Jossey-Bass 2004, 304 pages Reviewed by Denise L. Rode (drode@niu.edu), Director of Orientation, Northern Illinois University Orientation professionals often are the first interpreters of the college experience for parents and other family members as their students enter higher education. For this reason, it is essential that we understand and be able to communicate the current mental health climate on our campuses. Kadison and DiGeronimo’s The Campus Mental Health Crisis and What To Do About It assists us in that task by providing an accurate overview of normal developmental issues for traditional-aged student populations and the conditions under which these issues may become more serious psychological problems. This resource, combined with data from our own campuses, will serve us well in discussing what Kadison and DiGernomino term the growing mental health crisis among students. The authors divide the book into two main parts. Part I elucidates “The Problems: Why Are Some Kids So Unhappy at College?” while Part II presents “The Solution: For Colleges, Parents, and Students.” Although the primary audience for this book is parents and family members, college and university administrators, high school counselors, and even students will benefit from this readable, well-balanced look at the mental health of college students. While some readers may be alarmed by statistics such as “…since 1988, the likelihood of a college student’s suffering depression has doubled, suicidal ideation has tripled, and sexual assaults have quadrupled” (p. 1), the tone of the book never becomes alarmist. Rather, readers should come away from this book empowered to assess potential warning signals and to proactively address emerging mental health concerns before they become debilitating. Chapter 1 traces the normal developmental issues facing young adults as they begin college—identity development, relationships and sexuality, interpersonal issues, and how gender influences the ways in which females and males cope with college life. Speaking directly to parents, the authors state: Before the college years, you were able to organize your children’s lives and supervise their activities. Now they are on their own and face the developmental task of learning how to balance their lives so they can feel confident in who they are, become fully engaged socially, learn what they are able to do and what they can’t or shouldn’t do, and be academically successful. These tasks are all normal developmental issues that cause crisis only when they get out of balance. (p. 33) Chapter 2 outlines the stresses and competition of college life, pinpointing the pressures to succeed academically and live up to parental expectations, and discusses 57Spring 2006 • Volume 13, Number 2 additional issues which may be faced by minority, immigrant, and international students. Throughout this chapter, the questions “Who am I?” and “How do I fit in?” are paramount, as traditional-aged students experience a loss of identity from their previous environment and establish a new identity in college. Financial worries and social fears are treated in Chapter 3, with parental concerns about campus safety—especially the fear of sexual assault—dealt with in some depth. This is one of the weaker chapters in the book but is followed by a thorough treatment in Chapter 4 (“Crisis on Campus: Feeling Hopeless and Helpless”) of more serious mental health problems that students may bring to campus or that may arise during a student’s enrollment. In order of frequency, destructive consequences of dysfunctional coping mechanisms that exacerbate the resolution of normal developmental issues include depression, sleep disorders, substance abuse, anxiety disorders, impulsive behaviors such as sexual promiscuity and self-mutilation, and suicide. This chapter benefited me both as a university administrator and as one who has teenagers beginning the college search/selection process in the near future. The authors offer a description of each potential problem with symptoms and warning indicators of each condition. Just enough information is provided in terms of risk factors, frequency of occurrence in college populations, and Web sites and other resources for further reference. The authors counsel parents to walk a fine line between interfering with the normal developmental experiences students need for maturation (so-called “helicopter parenting”) and being attuned to subtle signs of psychological and emotional difficulty. Because the number of students who seek mental health help on campuses across the nation is relatively small, parents are encouraged to pay attention to “red flags” and provide guidance and wisdom to recognize and address problems. Parents are told that “You are the first and best judge of your child’s mental health. . . .They need someone who has known them all their life, who can see the differences in their behavior, and with whom they have had regular contact to ask, notice, and know what the symptoms mean” (pp. 90-91). Parents with students who have previously diagnosed mental health concerns are often reluctant to mention this history as the student begins college, thinking that college will offer “a fresh start” for the student. Kadison and DiGeronimo advise students and families to be open about past conditions and aware of resources in the new environment that are available to help. Part II (“The Solution”), which is intended for parents, students, and higher education professionals, begins by acknowledging the gray area of institutional responsibility and liability for students’ mental needs and subsequent behaviors such as sexual assault, battery, suicide, or murder. Also acknowledged is the ever-increasing need for more mental health services and funds to support these resources. The entire student body benefits from strong mental health services, in Kadison’s perspective. His recommendations for creating strong mental health service centers include providing student education to promote prevention, funding adequate staffing (the average ratio of full-time mental health professionals to students is 1 per 1,574, 58 The Journal of College Orientation and Transition according to the authors), emphasizing community outreach, giving follow-up care, and ensuring off-campus resources and coordination of care. Chapter 6 focuses on the complicated but crucial role parents play in their students’ mental health. According to Kadison and DiGeronimo, “the parental factor that most directly affects the mental health of a college student is communication” (p. 185), which comes as no surprise to orientation professionals who are accustomed to promoting student-family communication in their programs. Specifically, parents are urged to model strong communication skills (including listening skills); discuss important issues with students without lecturing, dictating, judging, or criticizing; know the warning signs of distress; encourage problem-solving skills; and be proactive with the college. For families in which the student has a previously diagnosed mental health concern, the authors recommend full disclosure and honesty with the institution’s counseling center, explaining to readers the confidentiality policies to which these units are bound. Final words of advice to parents in Chapter 6 are to develop a “crisis action plan” in the event of a mental health emergency, and to understand the limits of what a parent can do for students from a distance. The final chapter (7) is “for students only.” It succinctly summarizes the advice given in previous chapters in a readable, personal, and nonthreatening fashion. In an upbeat way, it encourages students to recognize the pressures of college and cope with them positively—by exercising regularly, eating nutritiously, getting adequate sleep, staying connected with family and friends, organizing and evaluating use of time, being informed about mental health concerns, tackling problems proactively, and reaching out when necessary. Personal essays by current and former students throughout the book help readers understand the often complicated symptoms of depression, sleep disorders, substance abuse, anxiety disorders, eating disorders, and cutting (self-mutilation). In my opinion, this chapter would be most useful if the pages were perforated so that it could be pulled out as a “pull-out” piece for students to read and save. Even though a student might not personally experience anxiety, depression, alcohol abuse, sexual assault, or other potentially debilitating psychological problems, he or she undoubtedly will encounter others struggling with these issues during the college years. A variety of appendices add value to College of the Overwhelmed, including “Everything You Need to Know About Medications,” “Checklists for Colleges and Counseling Centers,” and a compendium of resources on mental health conditions discussed in the book, complete with Web site addresses. How might an orientation professional use College of the Overwhelmed? First and foremost, it is a “wake-up call” for anyone who may not be current with what has been called “the extraordinary increase in serious mental illness on college campuses today” (p. 1). The book provides a window into the world of the most common psychological problems students face. After reading the book, orientation directors and their staffs may want to meet with counseling professionals on their campuses for a discussion of issues and resources specific to the campus and its surrounding area. As professionals who are charged with representing our college or university, we are 59Spring 2006 • Volume 13, Number 2 often reluctant to approach the negative aspects and sensitive issues of college life. This book convinces us of the need to address mental health concerns and existing resources with new students and their families at Orientation. It has compelled me to include these important topics this coming summer in my remarks to students and family members, and it will be listed in my university’s student and family handbooks as a resource. This book opens us to conversations with our new students, staff members, parents, and colleagues about critical but rarely discussed problems. If these conversations lead to increased use of enhanced mental health services on our campuses, the book will have accomplished its mission.