Meera Menon, MD

is a Senior Staff Psychiatrist at The Ohio State University and Co-Chair of the American Psychiatric Association Caucus on College Mental Health.

Videos

Meera Menon, MD, talks how best to care for your college student patients when they are a long way from home. 

Psychiatric Services for College Students Across State Lines

State medical boards restrict the practice of medicine across state lines. This paper reports on challenges faced by college psychiatrists working with college students who are temporarily out of state. The conclusions highlight the negative outcomes experienced by students from this disruption of care and lend support to a federal bill that would grant college psychiatrists a waiver to treat students in all fifty states. Such a bill would decrease treatment barriers, ensure continuity of care, and reduce poor outcomes.

There is a health crisis on university campuses across the United States. The need for mental health services for college students is staggering. The proportion of students with mental health conditions and the utilization of mental health services on campuses has continuously increased over the past decade.

of college students in the United States in the 2018 to 2019 academic year reported that 36% of students experienced depression, 31% experienced anxiety, 24% reported engaging in self-injury behavior, and 14% had suicidal thoughts.

 This translates to nearly 7 million students nationwide with mental health needs.

Many colleges and universities provide mental health services for their students on campus. However, college students are mobile, and college psychiatrists have long faced difficulties in ensuring continuity of care when students are away from school during summer and holiday breaks. This issue was amplified by the COVID-19 pandemic when students were abruptly sent home in the middle of the Spring 2020 semester. Due to federal and state regulations that mandate physicians to obtain licensure in the state where their patients are located, it has proven exceedingly difficult for college psychiatrists to meet the mental health needs of students who travel to other states. During the pandemic, licensure restrictions in most states were 

temporarily, and a law is being introduced to make licensing accommodations uniform across states.

 However,after the expiration of the temporary easing of regulations due to COVID-19, the longstanding issue of helping the mobile college population will still not be addressed. 

insurance also varies in coverage for the practice of medicine across state lines, adding to the barrier of providing treatment for out-of-state students.

To better understand the specific challenges of treating out-of-state students, an anonymous national survey of college psychiatrists was conducted. We hypothesized that college psychiatrists would face common challenges in ensuring continuity of care, and the survey results would lend support to a federal bill granting college psychiatrists a licensure waiver to treat students across state lines on a permanent basis.

A survey of 11 questions (Q) was initially developed to provide data concerning the introduction of a federal bill to address licensure regulations for college psychiatrists (scroll down for 

). Of the 11 questions, 9 were multiple choice and 2 (#10 and #11) requested respondents to provide a narrative response. Two of the multiple choice questions (#7 and #9) allowed respondents to select more than 1 choice. The survey was created using the free online version of Survey Planet (

). After review of the survey results, the authors decided to publish the results in the hope that they may garner more interest and support for advocacy efforts.

The survey was emailed to a listserv of 467 members of the 

 (APA) Caucus on College Mental Health. Members on the listserv included medical students, residents, fellows, attending-level psychiatrists, nurse practitioners, and physician’s assistants. Only attending-level psychiatrists were asked to respond to the survey. The survey was encouraged to be shared with other attending-level college psychiatrists who may not be members of the Caucus. The authors are attending-level college psychiatrists and completed the survey as well. The survey was sent on May 14th, 2020, and participants were asked to respond by May 20th, 2020. Several respondents completed the survey through May 29th, 2020, and their results were included. No identifying information of the respondents were collected.

The survey was self-determined to be eligible for Institutional Review Board exemption for existing data according to 

 Exemption status was documented and confirmed with completion of the Exempt Self-Determination Tool provided by the 

Results of the multiple choice questions were analyzed by the Survey Planet program. The qualitative data of the 2 narrative responses (#10 and #11) was analyzed by identifying unique negative outcomes or challenges noted by each respondent, and each outcome or challenge was tabulated in a frequency table. Responses that were related to 1 theme were grouped together by consensus of the authors.

A total of 85 responses were received: 82 attending psychiatrists and 3 non-attending psychiatrists. Only the results of the 82 attending psychiatrists are reported.

The majority of psychiatrists reported employment within a counseling center (n = 33, 40.2%). The rest worked with college students at a student health center (n = 24, 29.3%), the university department of psychiatry (n = 10, 12.2%), in group or private practice (n = 8, 9.8%) or other settings (n = 7, 8.5%).

Q 3: Number of states students were dispersed

Once the COVID-19 health emergency was declared, the majority of psychiatrists reported that students were dispersed to between 1 to10 states (n = 44, 53.7%). A smaller number reported that students were dispersed to 11 to 20 states (n = 18, 22%); 21 to 30 states (n = 10, 12.2 %); or more than 30 states (n = 7, 8.5%). Fewer than 4% of psychiatrists reported students were either not dispersed (n = 1) or unknown (n = 2).

In order to comply with current state regulations, the majority of psychiatrists would need to apply for 1 to 10 waivers (n = 46, 56.1%). A smaller number would need to apply for 11 to 20 waivers (n = 12, 14.6%); 21 to 30 waivers (n=6, 7.3%); and 30+ waivers (n = 2, 2.4%). Approximately 2.4% (n = 2) did not know how many waivers they would need, and 17.1% (n = 14) did not need a waiver or did not apply for a waiver because they only worked with students in state, provided limited referral services, or for other reasons.

Q 5: Delay in processing time for waivers

For psychiatrists who did apply for state waivers (n = 25), 28% (n = 7) stated that treatment was delayed due to processing time and 72% (n = 18) reported there was no delay.

During the COVID-19 pandemic, a large majority of psychiatrists (n = 72, 87.8%) reported facing the dilemma of choosing between providing psychiatric care to students across state lines without a waiver versus abandoning students. Approximately 12.2% (n = 10) reported not facing the dilemma.

Q 7: Services provided out of state during the COVID-19 pandemic

Respondents were able to select more than 1 response to this question; therefore, the total n is greater than 82. Only 3 psychiatrists stopped all communications with the students. The rest provided a range of services, and the range of services provided included referrals only (n = 14), referrals plus bridge care (n = 48), full comprehensive psychiatric care via telephone (n = 48) and/or video conferencing (n = 49). A small number (n = 2) provided other services depending on availability of state waivers.

Q 8: Students without psychiatric coverage

Approximately 18.3% (n = 15) of psychiatrists reported that over 51% of their students went without care when students were out of state. Additionally, 19.5% (n = 16) of psychiatrists reported that 26% to 50% of their students went without care, and 50% (n = 41) of psychiatrists reported that 1% to 25% of their students went without care. Approximately 12.2% (n = 10) reported no students went without care.

Q 9: Primary reason students have not received care

Respondents were able to select more than one response to this question; therefore, the total n is greater than 82. The primary reasons given for students going without care when out of state included (in order of decreasing frequency) include lack of availability of care (n = 61); financial and insurance reasons (n = 56); frequent travel preventing establishment of care (n = 41); family/community opposition (n = 38); stigma with receiving care (n = 22); and other reasons (n = 13), including the student being out of the country, lack of initiative or confusion on the part of the student, or the student deciding to stop treatment.

Q 10: Negative outcome as results of interruption of care

Negative outcomes as a result of interruption of care that were commonly cited are summarized in 

. No negative outcome was reported by 13% (n = 11), and in 18% (n = 15), responses were not applicable or unrelated.

Q 11: Challenges in providing care to students during the COVID-19 pandemic

Despite the availability of state waivers, there were many challenges in providing care to students (

). Concerns that were most frequently mentioned were related to licensing and waivers, including difficulties navigating the ever-changing, variable, and complex state requirements. Student-related factors included lack of motivation to engage in treatment, non-adherence or dropping out of treatment, students traveling state to state or out of the country, students not being aware of available resources, unsupportive family environments, and lack of insurance or financial support. 

Concerns less frequently mentioned (by less than 10% of psychiatrists) are summarized in 

 and elaborated here. Access to care issues include lack of resources and limited psychiatrists in certain locations. Barriers in prescribing out of state include difficulty with prescription of controlled substances in other states and COVID-19-related delays in pharmacy services. Obstacles in caring for complex cases out of state include concerns about hospitalizations, delay of referrals to subspecialty services, access to higher levels of care for severely ill patients, and taking care of severely depressed patients. Problems related to telehealth include connecting students to telehealth, privacy issues, and internet connectivity. Approximately 14.6% (n = 12) reported no challenges and in 12.2% (n = 10), responses were not applicable or unrelated.

The results indicate the difficulties faced by college psychiatrists in providing care to students across state lines during the pandemic. Although many states offered waivers for licensing requirements, this did not alleviate the problem. Navigating the complexity of licensing requirements from state to state was one of the most difficult challenges for psychiatrists. Nearly 90% of psychiatrists faced an ethical dilemma: risking their license and practicing without malpractice insurance coverage or abandoning their students. Our survey showed that the vast majority of psychiatrists continued to provide care via phone or video. Many also worked to connect their students to local care.

Of major concern is that 37.8% of psychiatrists reported that 

of their students went without psychiatric care and 18.3% reported that more than 51% of their students went without psychiatric care when not in school pre-COVID-19. This result indicated that continuity of care is not a new issue in college mental health. There are many barriers for students receiving care during breaks when away from school. Reasons endorsed by psychiatrists included lack of availability of care, financial and insurance reasons, frequent travel preventing establishment of care, family and community opposition, and stigma with receiving care. Although not part of the survey questions, gaps in psychiatric care are also an issue when services on campus are closed for the summer months or when campuses face staffing shortages and cannot meet the demand in service. The survey demonstrates that the inconsistency in a student’s treatment throughout college years can result in a myriad of negative consequences, including students dropping out of treatment, worsening of symptoms/relapsing, hospitalization, and experiencing suicidality. Less commonly reported negative outcomes include persistence of symptoms; needing a higher level of care; and negative financial, academic, or work consequences.

"Even though more research can be done, the need for legislative action now is clear. College students deserve continuity of psychiatric care. We need to adjust licensing and malpractice regulations so they can receive that care in the long term, not just during emergency situations."

These poor outcomes should prompt a change of licensing and malpractice regulations for college psychiatrists now that telemedicine is an available and reliable treatment modality. Congress, universities, and governmental agencies need to collaborate to provide a standardized license across state lines for college psychiatrists. There exists a precedent of the federal government intervening to ease regulations on interstate medical care. With the 

 sports medicine providers are allowed to care for their student athletes in states where the provider is not licensed as long as they maintain a license in 1 state. The Clarity Act can serve as a blueprint for future developments in the regulation of interstate treatment for college psychiatrists. Telepsychiatry has shown efficacy in general psychiatry settings and university settings.

 If state licensure restrictions were to be lifted, telepsychiatry has the potential to solve continuity of care challenges.

One limitation of the present study is the pool from which respondents were drawn. It is possible that the responses cannot be generalized to all college psychiatrists. Not all college psychiatrists are on the APA College Mental Health 

listserv. Most respondents were APA members given that this listserv was used. A review of the 3 respondents whose responses were excluded because they were not attending psychiatrists revealed that their concerns were consistent with the other responses. There may also be a selection bias in those who chose to participate in the survey.

Even though more research can be done, the need for legislative action now is clear. College students deserve continuity of psychiatric care. We need to adjust licensing and 

regulations so they can receive that care in the long term, not just during emergency situations.

The survey results highlight the challenges college psychiatrists face in the United States in ensuring continuity of care for students who are away from school. The main challenges reported during the COVID-19 pandemic include the time-consuming process of securing waivers and state licensures, complexities related to state licensure requirements, and ever-changing state laws. College psychiatrists also reported that continuity of care was an issue before the pandemic and led to significant negative outcomes. These concerns will continue to affect the treatment of mental health disorders in college students after the pandemic has abated, just as they did before the pandemic. The challenges and negative outcomes highlighted in this study lend support to a legislative solution which would grant college psychiatrists a permanent waiver to work with college students in the United States when they travel within the country.

is staff psychiatrist, Student Health Center, University of California, Irvine. 

 is chief, Psychiatric Services, Harrison Health Center, St John's College, Annapolis, MD. 

 is staff psychiatrist, Counseling and Psychological Services, and Feinberg School of Medicine, Northwestern University, Evanston, IL. 

 is senior staff psychiatrist the Ohio State University Counseling and Consultation Service, Columbus, OH. The authors report no conflicts of interest concerning the subject matter of this article.

1. Lipson SK, Lattie EG, Eisenberg D. Increased rates of mental health service utilization by U.S. college Students: 10-year population-level trends (2007-2017). 

2. Eisenberg D, Lipson SK. The Healthy Minds Study 2018-2019. 

https://healthymindsnetwork.org/wp-content/uploads/2019/09/HMS_national-2018-19.pdf

3. Federation of State Medical Boards. US States and Territories Modifying Requirements for Telehealth in Response to COVID-19. Accessed October 5, 2020. 

https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf

4. Wein EH, Goodman RB, Ferrante TB. COVID-19: States waive in-state licensing, requirements for health care providers. 

https://www.natlawreview.com/article/covid-19-states-waive-state-licensing-requirements-health-care-providers

5. Equal Access to Care Act. October 5, 2020. 

https://www.cruz.senate.gov/files/documents/Bills/2020.06.17%20-%20Equal%20Access%20to%20Care%20Act.pdf

https://www.cchpca.org/telehealth-policy/malpractice

7. Office for Human Research Protections. 

Human subjects regulations decision chart.

 U.S. Department of Health and Human Services.Accessed October 5, 2020. 

https://www.hhs.gov/ohrp/regulations-and-policy/decision-charts/index.html#c5

Sports Medicine Licensure Clarity Act of 2017

https://www.congress.gov/bill/115th-congress/senate-bill/808

9. Hubley S, Lynch SB, Schneck C, et al. Review of key telepsychiatry outcomes. 

10. Khasanshina EV, Wolfe WL, Emerson EN, Stachura ME. Counseling Center-based Tele-mental for Students at a Rural University. 

APPENDIX. Survey of College Psychiatrists

1. What is your discipline?
a)	Attending psychiatrist (MD/DO)
b)	Resident or fellow physician in training
c)	Nurse practitioner
d)	Physician’s assistant
e)	Psychologist
f)	Other mental health professional

2. In what setting do you see college students?
a)	I am employed within a University or College Counseling Center
b)	I am employed within a University or College Student Health Center
c)	I am employed in a University setting but under the Dept of Psychiatry
d)	I am in a group or private practice seeing college students
e)	I see students as a contracted consultant to a University campus
f)	Other work settings

3. Once COVID-19 health emergency was declared, the students you treated were dispersed to how many states (please approximate)?
a)	All students stayed in state
b)	Between 1-10
c)	Between 11-20
d)	Between 21-30
e)	More than 30
f)	Unknown

4. How many out-of-state temporary licenses or waivers would you need to apply for to be in compliance with current regulations?
a)	None - did not need waiver (only treated students in state)
b)	None - did not apply but provided limited referral services
c)	Would need to apply for 1-10 state waivers
d)	Would need to apply for 11-20 state waivers
e)	Would need to apply for 21-30 state waivers
f)	Would need to apply for 30+ waivers
g)	Other

5. If you applied for a state waiver, was treatment delayed due to processing time?
a)	Yes
b)	No
c)	Not applicable

6. Did you face the dilemma of choosing between providing psychiatric care to students across state lines without a waiver versus abandoning them?
a)	Yes
b)	No

7. What types of services are you providing to students across state lines? (Select all that apply)
a)	No service at all (stop all communication once students leave state)
b)	Limited service - provide referrals
c)	Limited service - provide referrals and bridge care until students connected with local providers
d)	Provide psychiatric services via telephone
e)	Provide telepsychiatry service via video conferencing
f)	Other

8. Prior to COVID-19, what percentage of your students go without psychiatric coverage during the summer months and on breaks while they are not on campus and out of state?
a)	0%
b)	1-25%
c)	26-50%
d)	51-75%
e)	76-100%

9. Prior to COVID-19, what are the primary reasons that your students have not gotten care while in another state? (Select all that apply)
a)	Lack of availability of care
b)	Stigma with receiving care
c)	Financial and insurance reasons
d)	Family/community opposition
e)	Frequent travel preventing establishment of care
f)	Other

10. If there were negative outcomes during those breaks due to lack of care (eg, safety/medical/hospitalization, worsening of symptoms) please describe below the negative outcomes and number of cases you recall. Please do not include any identifying information. [Essay]

11. Did you experience any specific challenges in following-up with students’ care during COVID-19 pandemic despite availability of state waivers? Please do not include any identifying information. [Essay]


Articles

The pandemic has brought into focus treatment barriers, disruption in care, and possibly negative outcomes in the mental health of university students. To better understand the specific challenges of out-of-state students, the authors conducted an anonymous national survey of college psychiatrists.

Treatment Challenges for College Psychiatrists and Their Patients

Public health emergencies may present a range of unanticipated potential stressors to vulnerable patients and communities. Psychiatric patients can be disproportionately affected by these conditions due to pre-existing health disparities, lack of resources, or limited executive functioning under stress, all of which may impede effective responses during an emergency. As college students comprise a demographic with a growing burden of mental illness, public health emergencies pose special challenges to this population.

 are uniquely vulnerable to both everyday stressors and severe mental illness, and psychiatric symptoms among college students appear to be on the rise. Stress, anxiety, depression, suicidal ideation, and self-harm all appear to be increasing among this population.

 Suicide is currently the second most common cause of death in this age range, and the rate of suicide continues to climb.

These psychiatric symptoms can have a widespread effect on the overall health of students as mental health conditions and viral diseases remain linked by a range of biological and behavioral pathways, with mechanisms varying by viral illness.

 While depression and stress may increase vulnerability to 

, depressive symptoms may also lead to a delay in help-seeking or reduced likelihood of detection of health conditions including communicable diseases.

 Studies show that people with severe mental illness (SMI), including schizophrenia, bipolar disorder, schizoaffective disorder, and major depressive disorder, have an excess mortality that is two- or three-fold higher that in the general population, shortening life expectancy by 13 to 30 years.

The current public health emergency in response to 

 has disrupted life on many university campuses, and increased anxiety and distress in many college students. There are a litany of reasons that college students may encounter unique challenges, stressors, and barriers to mental health treatment.

Many universities have extended spring breaks to delay the return of students to campus so campus leadership can have more time to prepare for a potential health care crisis and implement infection precautions. Other universities have cancelled all events, shifted to online classes, or ended their semester early. Many students have been mandated to vacate their dormitories with only a few days’ notice.

Dormitory evacuation is a stressful scenario for college students. International students may not be able to return home. Students from families with financial stressors, marginal housing, or other challenges that limit their capacity for support may have disproportionate difficulty arranging last-minute transportation and housing. Food insecurity, a significant problem affecting students with limited financial resources, may worsen if college cafeterias close or financial aid for the academic year is cut off.

 As local businesses close, it will be more difficult for students to find low-wage jobs to earn income. At home, some students do not have the technological infrastructure to be able to keep up with online classes and engage with their now-virtual social communities, leading to academic stress and further social isolation. The few students who are granted exceptions to the evacuation mandate will be isolated in otherwise vacant campus dormitories with significantly limited services.

Other students may be quarantined due to perceived risk of spreading the virus. These students may lose opportunities critical to their scholarly or professional advancement. The social isolation and decreased activity during quarantine may exacerbate rumination and feelings of hopelessness. The circumstances could understandably perpetuate stress, anxiety, and low mood.

Even students not under quarantine and from well-resourced families are stressed about the rapidly changing and uncertain climate of relocations, academic deadline changes, shifts to online teaching modalities, and cancellation of anticipated events such as graduation ceremonies. In a population that is already vulnerable to mental health problems (eg, anxiety, depression) and is simultaneously experiencing a potentially traumatic public health crisis, these stressors may lead to clinically significant psychiatric symptoms and illness. This is compounded by the social isolation intrinsic to many of the containment efforts as well as the potential stigma and limitations of accessing psychiatric care at home and having to switch from typical sources of on-campus support.

College mental health services must swiftly respond to this changing landscape to support their students during this stressful and potentially isolating experience. Many are attempting to rapidly shift to virtual visits and other forms of 

. However, building technological infrastructure and negotiating reimbursement takes time. While a range of legislative and regulatory hurdles had previously restricted the use of telemental health, state governors and regulatory agencies are taking action to eliminate barriers and expand use of telehealth to both protect clinicians and improve access for patients.

 authorized the New York Licensed Office of Mental Health Programs to waive sections of regulatory requirements pertaining to telehealth to reduce barriers and increase access to mental health treatment across the state (Ann Marie Sullivan, MD, personal communication, March 11, 2020). This aims to streamline the approval process governing telehealth in order to increase the number of providers who can utilize telehealth to treat patients.

Ohio Department of Mental Health and Addiction Services

 announced expansion of telehealth for the treatment of mental health and substance use concerns during the COVID-19 pandemic (Lori Criss, personal communication, March 14, 2020). This measure will permit telephone encounters, eliminate the requirement that new patients must be seen in-person for their initial encounter, and increase flexibility of monitoring medication-assisted treatment of opioid use disorders. This will allow patients to establish and continue mental health and substance use treatments during the pandemic.

 has mandated that health insurers must cover telehealth services, reimburse these services at the same rates as in-person encounters, and cannot require prior authorizations on these services.

 Furthermore, an additional executive order mandated that providers in Massachusetts can provide care to patients in other states who were enrolled in college in Massachusetts during this academic year.

Requirements that clinicians have a license to practice in the state where the patient physically resides is a significant barrier for college students continuing mental health treatment after their campus evacuation. Many students may stay with family members in a state different from their university and be left unable to receive services from on-campus mental health providers.

Some universities who had implemented a telemental health platform in a limited capacity prior to the pandemic were often able to more rapidly roll out online resources with relative ease. For example, 

 was able to provide their entire student body access to a secure online cognitive behavioral therapy program within one week because of a prior trial based on a grant from the Substance Abuse and Mental Health Services Administration (Holly Wilcox, MA, PhD, personal communication, March 12, 2020).

Less conventional communication modalities may create access for students who are juggling logistical challenges and find it difficult to regularly attend in-person appointments during a relocation or quarantine. Many clinicians have expanded their use of telephone appointments as hurdles related to both privacy and billing have been gradually addressed (Melissa Eshelman, MD, personal communication, March 16, 2020).

Some universities are inviting students within driving distance to attend in-person appointments although students are encouraged to reschedule or use telehealth if they are medically symptomatic. A few psychiatrists, who are seeing patients in-person, have relocated to larger offices to maintain social distancing during sessions (Melissa Eshelman, MD, personal communication, March 16, 2020). However, as the pandemic expands, many such as The Ohio State University are transitioning to solely telehealth appointments and encouraging staff to work from home as much as possible.

As mental health clinicians provide services with more flexibility, psychiatrists are reducing barriers as well. Programs that had previously enforced policies regarding providing medication refills only during in-person appointments have liberalized their stance to include prescribing refills based on a phone encounter, allocating more refills, or providing 90-day rather than 30-day prescriptions. Many college mental health clinics are implementing practices typically utilized at the end of the semester in preparation for potential coverage gaps during summer break.

Some Intensive Outpatient Programs (IOPs) and Partial Hospitalization Programs (PHPs) are transitioning to telemental health delivery while others have stopped accepting new patients. IOPs and PHP are important levels of care for our system to both limit psychiatric hospitalizations and facilitate safer discharges from psychiatric hospitals. As these programs care for the highest-risk patients outside of psychiatric hospitalizations, it is crucial to develop innovative ways to deliver these services.

Anticipated clinician shortages across the entire health care system may affect university mental health clinics as well as clinicians, as family members are quarantined and schools and childcare centers close. While many programs hope to facilitate telehealth appointments that can be utilized from clinicians’ homes, if resource scarcity and clinician shortages become severe, it may be necessary to triage urgent appointments while minimizing routine follow-up.

College students are psychiatrically vulnerable, psychiatric patients are physically vulnerable, and the current circumstances on college campuses are exceedingly stressful and potentially socially isolating. Given these factors, college students are likely at an elevated psychiatric risk right now, and college mental health services must adapt to support their students during these circumstances. Continued enactment of legislation and regulatory changes that facilitates telemental health and allow treatment across state lines is critical to ensuring adequate mental health treatment access for college students during this pandemic.

 is an MD Candidate at the University of Michigan Medical School; 

 is a Senior Staff Psychiatrist at The Ohio State University and Co-Chair of the American Psychiatric Association Caucus on College Mental Health; 

 is an MD Candidate, Harvard Medical School. The authors report no conflicts of interest concerning the subject matter of this article.

Technology and college student mental health: challenges and opportunities

Increased rates of mental health service utilization by US college students: 10-year population-level trends (2007-2017)

Are we in crisis? National mental health and treatment trends in college counseling centers

4. Centers for Disease Control and Prevention National Center for Health Statistics. 2019.

Anxiety and depression: linkages with viral diseases

7. De Hert M, Correll CU, Bobes J, et al. 

Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

A systematic review of food insecurity among US students in higher education

Better Information Could Help Eligible College Students Access Federal Food Assistance Benefits

. GAO Publication No. 19-95. Washington, DC: US Government Accountability Office; 2016.

Actions Needed to Improve Access to Federal Financial Assistance for Homeless and Foster Youth

. GAO Publication No. 16-343. Washington, DC: US Government Accountability Office; 2018.

11. Commonwealth of Massachusetts Office of the Governor.

 Order Expanding Access to Telehealth Services and To Protect Healthcare Providers

12. Commonwealth of Massachusetts Office of the Governor.

 Order Extending the Registrations of Certain Licensed Healthcare Professionals

College students are uniquely vulnerable to both everyday stressors and severe mental illness, and psychiatric symptoms among college students appear to be on the rise.

Meera Menon, MD

Articles

Psychiatric Services for College Students Across State Lines

Treatment Challenges for College Psychiatrists and Their Patients

Universities’ Response to Supporting Mental Health of College Students During the COVID-19 Pandemic