Examining Current Challenges in Secondary Education and Transition
September 2004 • Vol. 3, Issue 1
The Emergence of Psychiatric Disabilities in Postsecondary Education
By Michael N. Sharpe, Brett D. Bruininks, Barbara A. Blacklock, Betty
Benson, and Donna M. Johnson
Issue: An unprecedented and growing number
of postsecondary students report psychiatric disabilities. How can postsecondary
personnel support the success of these students?
Defining the Issue
A significant development in the field of postsecondary disability supports
in the last decade has been the proliferation of individuals with psychiatric
disabilities. This phenomenon has emerged at a pace that one observer characterized
as a “rising tide” (Eudaly, 2002). Measel (1998) found that within
one year, five institutions in the Big Ten Conference encountered an increase
from 30% to 100% in the number of students served with psychiatric disabilities.
At one institution, the University of Minnesota, the number of students reporting
a psychiatric disability as their primary disability (285) was more than the
combination of students reporting learning disabilities and attention deficit
disorders (269). Although there is little systematically collected data to provide
a reliable estimate of the emergence of psychiatric disabilities in postsecondary
education, information from current sources provides evidence that this issue
is likely to come into sharper focus as data from more studies become available.
Despite recent recognition in the postsecondary setting, the growth in the
number of individuals declaring a psychiatric disability is consistent with
national statistics. Each year about one in five Americans experience a diagnosable
psychiatric disability, which includes major depressive disorders, schizophrenia,
eating disorders, and anxiety disorders (National Institute of Mental Health,
2002). Some psychiatric disabilities remain dormant, manifested only at critical
stages of human psychosocial development or by physiological events.
Unger (1992) noted that the onset of major mental illness often occurs between
ages 18-25—a time when many young adults are seeking postsecondary education,
preparing for future careers, and developing social relationships.
Perhaps the most influential factor resulting in more individuals declaring
a psychiatric disorder in the postsecondary setting is how such disabilities
are identified and treated. Today diagnostic criteria have expanded so that
the term “psychiatric disability” represents a much broader range
of disorders and syndromes than before. While once attention was largely focused
on the diagnosis and treatment for the “major” psychopathologies
(e.g., schizophrenia), the field has broadened to encompass disorders generally
requiring less intensive treatment interventions. For example, there is a dramatic
increase in the identification and treatment of a number of anxiety disorders
within the last decade, particularly those related to social anxiety, post-traumatic
stress, and various types of phobic disorders (Swinson, 1997). As diagnostic
criteria continue to improve in identifying other types of mental health disorders,
it is likely the population of students with psychiatric disabilities in postsecondary
education settings will continue to grow.
Current Research and Practice
Some early efforts to address the needs of individuals with psychiatric disabilities
within the postsecondary setting occurred as a result of the emergence of supported-education
programs. Based on the definition of “supported employment” in the
Rehabilitation Act Amendments of 1986, supported-education programs began in
the 1980s as a way of providing supports to individuals with psychiatric disabilities
in the postsecondary setting (Unger, 1998).
According to Unger (1998), supported-education programs involve three prototypes:
(a) a self-contained setting, where students are reintegrated into the postsecondary
setting; (b) on-site support, where ongoing support is provided by the institution’s
disabilities support staff or a mental health professional; and (c) mobile support,
where support is largely provided by community mental health service providers.
It is estimated that about 30 supported-education programs currently exist in
the United States to serve individuals with psychiatric disabilities in postsecondary
While supported education is a model for serving the needs of students with
psychiatric disabilities, the more typical case is that they are served by disability
support services (DSS) staff at the postsecondary level, or by community agencies
not necessarily affiliated with DSS or the postsecondary institution.
Many DSS staff have traditionally received training in a disability area related
to learning and instruction (e.g., learning disabilities) and do not feel adequately
trained to address the needs of individuals with psychiatric disabilities. Indeed,
some DSS staff report that they are often challenged in meeting the needs of
students with psychiatric disabilities. They indicate efforts to provide accommodations
are not as clear as in other disability areas (Sharpe & Bruininks, 2003)
or that working with students with psychiatric disabilities might require addressing
multiple, complex problems such as social isolation, withdrawal, and academic
failure (Blacklock, Benson, & Johnson, 2003). In addition, many DSS providers
are not fully informed about services available in the community. The resulting
lack of collaboration prevents some students from accessing needed services
(Whelley, Hart, & Zaft, 2004). Clearly, serving students with psychiatric
disabilities in the postsecondary setting represents new challenges to many
While there is only limited research on this issue to guide practice, information
has recently become available that helps identify some barriers faced by students
with psychiatric disabilities and service providers alike (Blacklock, Benson,
& Johnson, 2003). Based on the results of 39 focus groups conducted with
postsecondary DSS staff, faculty, administrators, and students with psychiatric
disabilities, Blacklock et al. (2003) identified five primary barriers that
impact the educational experiences of students and service-delivery issues for
providers. These include:
Stereotypes and Stigma—All of the focus groups
stated that students with psychiatric disabilities often face incorrect, stereotyped
views about their disability and endure the stigma and negative consequences
that frequently accompanies disclosure of such a disability.
Complex Nature of Psychiatric Disabilities—Students
feel challenged to simultaneously manage their disability and maintain academic
performance that reflects their abilities. Service providers and faculty share
students’ concern about this complex issue.
Access to Resources—All focus groups indicated
that students with psychiatric disabilities face additional barriers because
of their need to seek out services within bureaucracies (educational or governmental)
that are unclear and uncoordinated. These extra efforts are necessary to maintain
their health insurance, student status, and access to mental health and disability
Access to Information and Services—Many students
in the focus groups expressed frustration with the lack of information about
psychiatric disabilities and limited access to services that would allow them
to effectively manage their disability.
Organizational and Institutional—Focus group
participants identified a lack of coordination and communication between service
providers on and off campus as additional barriers students with psychiatric
disabilities face at the postsecondary level.
The identification of these barriers appears to be consistent with other observations
(Collins, 2001; Eudaly, 2002; Loewen, 1993; Angle, 1999; Unger, 1992). To address
these barriers, Blacklock, Benson, and Johnson (2003) advocate four strategies:
(a) implementing universal instructional design strategies to improve the learning
experiences for all students, including those with psychiatric disabilities,
(b) creating sub-communities to foster social connections for students with
psychiatric disabilities, (c) improving clarity, coordination, and communication
with all key stakeholders, including inter-organizational and community-based
service providers, and (d) promoting access to resources for all key stakeholders
through information sharing and training efforts.
A common theme in the literature relating to the support of students with
psychiatric disabilities is how such services should be configured at the postsecondary
level. This issue not only involves the “mission” or “values”
of the program (Unger, 1998), but also the need to articulate the parameters
in which students will be served. Efforts to outline overall program mission
and values will establish a scope of services relative to the institutional
and community resources available. This activity can also be helpful in clearly
defining how support services will be accessed and maintained by students with
psychiatric disabilities. Through a series of interviews conducted with DSS
staff in Big Ten universities and colleges, Sharpe and Bruininks (2003) identified
several basic requirements common to these institutions:
Documentation—Students with psychiatric disabilities
must provide current documentation by a qualified medical or mental health professional
to qualify for DSS services.
Diagnostic Criteria—Generally, a diagnosis
must reflect criteria established by the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) or the International
Classification of Diseases Manual, Tenth Edition (ICD-10). Moreover, the diagnosis
must meet disability criteria established by the Americans with Disabilities
Accommodations—Although clinical input regarding
functional limitations and instructional accommodations are considered, DSS
staff generally make the final determination regarding what specific accommodations
will be provided.
Accountability—In nearly all cases, the declaration
of a psychiatric disability does not exempt one from a code of conduct and similar
policies established by the institution.
The processes used to notify postsecondary instructional staff about the need
for accommodations are not always consistent. In some cases, the student is
obligated to discuss the need for accommodations directly with the instructor.
In others, a letter or memo was sent to the instructor by DSS staff regarding
accommodation needs for a student (Sharpe & Bruininks, 2003).
While this provides a basic overview of current research and practice in serving
students with psychiatric disabilities within postsecondary settings, much more
work needs to be done. At this point, only a small glimpse has been captured
about this growing population of students. Much needs to be learned about the
overall nature of students with psychiatric disabilities entering postsecondary
education settings. Currently little accurate information exists regarding the
overall prevalence and variability of students with psychiatric disabilities.
For example, little is known about how many students exhibit severe and persistent
mental illness in relation to those whose illness is considered “mild.”
This evidence would do much to illuminate the extent to which the students with
psychiatric disabilities need psychological treatment concurrent with their
Strategies for Practice
Despite little empirical evidence regarding strategies leading to increased
positive academic, social, and employment outcomes for students with psychiatric
disabilities, a range of instructional accommodations has been collected and
disseminated through various studies, professional networks, and training activities.
The accommodations shown in Table 1 are most common and can be implemented with
cost-efficiency and relative ease.
The accommodations are universal in the sense that they are equally applicable
to most types of disabilities. This is good news for students with psychiatric
disabilities in the postsecondary setting—accommodations differ little
from those typically provided to all students with disabilities (Sharpe, Johnson,
& Murray, 2003). What remains unknown, of course, is how effective these
types of accommodations are for students with psychiatric disabilities.
Table 1. Accommodations for Students with
Modified deadlines for assignments
Preferential classroom seating
Early availability of syllabus and/or textbooks
- Reflect upon broader, programmatic issues—specifically, the mission
of the DSS provider and the policies that may—or may not—be in
place to address the needs of students with psychiatric disabilities in the
postsecondary setting. When a clear direction (e.g., a “mission”)
has been defined for the DSS program, it is possible to identify opportunities
for improving or enhancing services to students with psychiatric disabilities.
For example, developing collaborative relationships with community-based health
professionals might be an option to begin building a support network for students
with psychiatric disabilities. DSS staff also may opt to communicate with
institutional counseling services to serve as adjunct support system for students.
- Realize that, unless trained and licensed, the role of postsecondary support
personnel is not that of mental health professional. Nor should they feel
compelled to expand their role beyond the scope of their primary responsibility—to
facilitate instructional supports for students with disabilities. Because
many DSS staff are already consumed with excessive caseloads, it is even more
imperative to collaborate with all types of partners to develop, implement,
and maintain innovative strategies for addressing the needs of students with
- Review Unger’s (1998) description of philosophy, mission, values,
and program policies for programs focused on students with psychiatric disabilities.
For DSS staff who want to pursue a comprehensive approach to providing services
to students with psychiatric disabilities in postsecondary settings, supported
education provides a model and template of services that can be fully or partially
- Design and implement policies to reflect clearly defined roles and responsibilities
for postsecondary support staff. Several of these polices were presented in
the previous section (i.e., documentation, diagnostic criteria, accommodations,
accountability). Further information is available from Web sites of two- and
four-year postsecondary institutions.
Muckenhoupt (2000) has suggested that the impact of untreated psychiatric
disabilities is “staggering.” Only recently has this population
been recognized within the postsecondary setting, presenting a challenge to
service systems and providers alike. While research on best practice in this
area is clearly lacking, efforts continue on behalf of many disability support
service providers to develop and implement models of service to meet this challenge.
To support these efforts, a “rising tide” of research, information
sharing, and training will also be necessary to match the growth that in all
likelihood will continue.
Michael Sharpe, Brett Bruininks, and Donna Johnson are with the Institute
on Community Integration at the University of Minnesota; Barbara Blacklock and
Betty Benson are with Disability Services at the University of Minnesota.
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