Andrea Maldonado was diagnosed with Graves’ disease during her sophomore year of high school, which stopped her from swimming competitively and began impacting her mental health.
The immune system disorder regularly bumps Maldonado’s heart rate to nearly double what it’s supposed to be. That not only makes athletic activities difficult, but it also has led to her having trouble falling asleep and struggling with anxiety and depression.
“It was just a lot of life changes and lifestyle changes for me, which can get discouraging at times,” she said. “It’s just like a ripple effect of all of these other symptoms that come with it.”
Maldonado didn’t know who to turn to, and her parents often did not understand her struggles. When she started classes at Paul Quinn College in 2019, counselors and school staff constantly encouraged her to visit its mental health clinic.
“Mental health overall is a very taboo thing within people of color and under-resourced communities,” said Maldonado, now a junior majoring in business administration. “Coming to a place where it was super, super emphasized and pushed … I have been able to get through some of the hardest things I’ve gone through.”
Paul Quinn, a historically Black college in southern Dallas, has interwoven mental health awareness into its foundation as the small school aims to recruit students from areas often overlooked by other colleges. Many of its 680 students come from historically underserved communities, some of which are plagued with gun violence or high poverty rates.
Too often, school leaders would see students delay or derail their graduation even after maintaining good grades. Class disagreements would sometimes turn into fights. Paul Quinn administrators realized addressing students’ mental welfare — such as helping them manage trauma, stress, guilt and depression — was the missing link to their success.
“I failed to realize the level of post-traumatic stress that people would experience once you lifted them out of those environments,” Paul Quinn President Michael Sorrell said, “the depression that people go through once you’re in a place where you can begin to unpack these experiences.”
Paul Quinn developed an exhaustive program that begins supporting its undergraduates as they commit to the school. All students start their academic journey at the college by sitting with counselors who assess their mental health needs. The school has an on-campus clinic where students can receive therapy and join support groups — all free of charge.
The cornerstone of the college’s mental health initiative is interceding and introducing students to services early as well as approaching students directly instead of hoping they reach out themselves.
Such proactive efforts help keep more students on track as they learn how to manage challenges in a positive way, officials said.
Before the clinic opened, students struggled with graduating on time or at all. At one point the college had one of the country’s lowest graduation rates at barely 1%. Now that rate is about 36%, school officials said.
Experts say college students — particularly students of color — have added stresses and pressures that can impact their mental health even as they are going through biological brain changes.
So robust resources — including screening, counseling, support groups and medication management — should be available widely on campuses, said Greg Hansch, executive director of the Texas affiliate of the National Alliance on Mental Illness (NAMI-Texas).
“We see colleges and universities as being a critical leverage point for facilitating access to mental health care,” Hansch said. “If there are no mental health resources on campus, then we’re just throwing caution to the wind.”
It’s not as simple as just being there for students. Once students arrive on campus, staff must jumpstart the process of breaking down barriers to mental health and pointing them toward available support.
“I tell the students all the time, ‘Everyone has a season. Everyone has a season where they struggle,” Sorrell said. “And the difference between a season and being trapped in that place your whole life is your ability to get the help you need.’”
Getting students to ask for help
Paul Quinn pushes a campus-wide approach where there’s no wrong door to walk through. Professors, coaches or academic advisers can offer support or direct students to on-campus resources, said Stacia Alexander, Paul Quinn’s mental health and wellness clinic director.
While trying to normalize asking for help, the college — and other schools — are still challenged by the stigma and shame often associated with mental health among communities of color.
Black “college students are less likely to access services around mental health than their white peers,” noted Nance Roy, the chief clinical officer at The Jed Foundation, a nonprofit that promotes emotional health and aims to prevent suicide among teens and young adults.
Black students are more likely to reach out to family, friends or spiritual leaders than a mental health professional, Roy said. That’s often due to costs and the lack of insurance, not believing therapy will help or the dearth of counselors of color, Roy noted.
During orientation, incoming Paul Quinn students learn about the clinic, campus services and the mental health assessment they can opt out of if they choose. Students can then schedule an appointment with a counselor who will help them navigate the resources and identify their personal challenges.
During the initial evaluations, students are asked if they’ve ever had a traumatic experience, to which most say no. Many don’t understand what trauma is, explained Alexander.
So counselors ask more specific questions. Have you experienced neglect, physical or sexual abuse? Ever been homeless? Do you have support from your family? Lost someone to violence?
It isn’t always easy to get students to open up. Having a counselor who looked like her was invaluable to sophomore Ericka Drinker, who is Black.
“I was a lot more comfortable to speak about things such as microaggressions and racism in the workplace with (them) than I would have been with somebody who didn’t look like me,” Drinker said.
Campuses across the country struggle with staffing counseling centers that reflect the diversity of their student bodies. About 83% of psychologists in the United States are white, according to the U.S. Census Bureau. Hispanic psychologists make up the second-largest group at 7%, while only 3% are Black.
“They’re not seeing a lot of therapists that look like them and perhaps don’t think they will be able to understand their circumstances,” Roy said.
Paul Quinn’s clinic boasts a staff mainly composed of three women of color.
When researching how to help students, the school reached out to experts and the University of Texas Southwestern Medical Center, which helped develop the clinic’s programming.
Now UT Southwestern provides the campus clinic a full-time psychiatrist, who often pulls in two more residents to assist students.
Drinker, 19, heard about the college’s mental health clinic before she even started classes. Monthly visits are a requirement for all honor students. Now Drinker frequently visits multiple times a month, often simply to talk.
It’s “an outlet that’s not my friends or my parents to talk to about what’s really going on … somebody that’s kind of a neutral person in my life that can just give me either advice or just hear me vent about what’s going on,” Drinker said.
Identifying need early on
Mental health screenings are essential for early identification and intervention, said Hansch, of NAMI-Texas.
“It is all too common for mental illness to go unnoticed,” he said. “There’s often a significant delay in between when mental health symptoms arise and when a person gets access to mental health care.”
On average, that’s up to a 10-year delay across all age groups to when a person accesses the mental health services they need, he added. However, about 50% of all mental health conditions begin before age 14 and 75% by age 24.
A challenge with such screenings is that they essentially rely on self reporting of your mental health status and counselors “can only hope that people are going to answer those questions honestly,” Hansch said.
Although it’s an imperfect tool, experts say it remains one of the most efficient ways of identifying those in need of services and resources.
From 2003 and 2017, researchers found that suicide rates rose among Black youth of all ages — with the biggest increase seen among the 15- to 17-year-olds, according to an article published in the Journal of the American Academy of Child & Adolescent Psychiatry.
The numbers don’t reflect the impact the pandemic and social justice movements over police killings have had on Black youth.
A study done by the Centers for Disease Control and Prevention in 2020 found that the percentage of people who reported having seriously considered suicide in the 30 days before completing the survey was significantly higher among young adults and Black respondents.
The early screenings help integrate the on-campus resources into students’ everyday routine “as opposed to an afterthought,” Alexander said. That gets the young adults using services regularly instead of when there is a crisis, she added.
The pandemic’s hindrance
Before COVID-19 rolled in, the Paul Quinn clinic was coaxing more and more students toward its mental health services. Alexander would go to campus club meetings, basketball games and other events to encourage students to use the resources.
Counselors saw a drop in students using its services as the pandemic upended lives and moved courses — and the clinic — online. Although many expressed their need for support, the amount of students reaching out dwindled significantly the longer remote learning went on.
Many students also went back to their hometowns, which set back the strides they’d taken on campus.
“Once you start getting people to heal, then you put them back in the environment which damaged them without the ability to escape from that, it makes it tough,” Sorrell said.
Although staff constantly reached out to students through emails and direct phone calls, mental health counselors relied mainly on the faculty to alert them if they noticed a student was struggling.
Paul Quinn returned to in-person learning in the fall of 2020. Clinic staff showed up at student events, reintroducing them to the clinic’s resources and reminding them of the support systems on campus.
Attendance at the clinic isn’t up to what they experienced before the pandemic. But school officials are hopeful that, with each incoming class, more students will reach out as they’ve done in the past.
“We’re serving a purpose in a big puzzle,” Alexander said. “We have one piece of that puzzle that we need to execute proficiently so that these students can have what they need emotionally and cognitively … so that they can have this fabulous picture when they come out of college.”
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