If you want to know how to best support your college student through potential mental health or anxiety issues, who better to ask than a psychiatrist? That’s exactly what Vicki and Elizabeth did in this episode. We were joined by Dr. Bianca Busch, founder of The College Psychiatrist, a medical practice that works with college students and their families. Dr. Busch emphasized that each individual is on a unique journey at a potentially stressful time in their life. We learned so much from Dr. Busch about helping students overcome challenges, navigating school and career stressors, relationship issues and identity exploration. Some students may never need counseling or mental health services, others come to college knowing they want to connect with someone for support, and others may be taken by surprise when they find they now need support. Parents will find this episode helpful no matter what lies ahead. This conversation will help you be prepared to give appropriate parental support and also guide your student who may want to seek professional help.
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Dr. Bianca Busch, MD joined Elizabeth and Vicki in this episode to talk about college students and their mental health. Dr. Busch, known as The College Psychiatrist, is not just a psychiatrist, she is a psychiatrist focused on college students and their families.
We know that the number of high school and college students who face mental health challenges, including depression and anxiety, has continued to rise in recent years, so understanding the causes and treatments is essential.
Dr. Busch identified three main areas that can cause difficulty for students making the transition to college – managing newfound freedom and independence, potential breakups of relationships in high school, and changes in expected grades for those who have always earned great grades. She also discussed substance use as another potential area to watch for.
As we discussed the anxiety that many students feel, Dr. Busch stressed the importance of parents caring for themselves as they make their own transition. Often, our own parental anxieties are passed down to our students. If you want to explore this topic further, check out our episode # 088 – How Parents’ Fear of Failure Can Influence Students.
We also covered several other vital topics – whether or not to ask your student to sign a FERPA waiver, the importance of setting up a communication schedule with your student why extracurricular activities in college are so important – and difficult for students to manage, and the importance of sleep for students. You can follow up on some of these topics with these CPA articles and podcast episodes.
What FERPA Means for You and Your College Student
#005 – Communicating with Your College Student
Are College Extracurricular Activities Really ”Extra”? Why Your Student Should Participate
Sweet Dreams! Is Your College Student Getting Enough of Them?
#073 – Sleep Matters: Why Don’t College Students Get Enough – and Why They Should
Review: The Sleep-Deprived Teen by Lisa L. Lewis
Dr. Busch also discussed this issue of substance use and the importance of discussing this with your student. She shared several important resources if you have concerns about your student.
National Alliance on Mental Illness (NAMI)
We also recommend Jessica Lahey’s essential book on the topic. Listen to our interview with her as well.
The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence
#038 – The Addiction Inoculation: An Interview with Author Jessica Lahey
We’re grateful to Dr. Busch for sharing so much information with all of us. If you’d like to learn more or reach out you can find her at the following places.
Her website: https://www.thecollegepsychiatrist.com/
On Facebook, TikTok, Instragram – @collegepsychiatrist
On LinkedIn at either Dr. Bianca Busch or The College Psychiatrist.
You can also check out her College Coping Kit on Etsy.
Don’t forget that you can listen to all of our previous podcast episodes here or subscribe wherever you listen to podcasts. You can also go to followthepodcast.com/collegeparentcentral to add our podcast so that you’ll receive each new episode as we release it.
Let us know what you’d like to hear about on future podcasts! Leave a comment here or email us at podcast@collegeparentcentral.com.
Note: Some links in our post are for affiliate products. If you use our links, College Parent Central receives a small percentage of your purchase price. This does not change the cost to you. We think it’s only fair to let you know that.
Transcript:
Announcer
00:10
Welcome to the College Parent Central podcast. Whether your child is just beginning the college admission process or is already in college, this podcast is for you. You’ll find food for thought and information about college and about navigating that delicate balance of guidance, involvement and knowing when to get out of the way. Join your hosts as they share support and a celebration of the amazing experience of having a child in college.
Elizabeth Hamblet
00:52
Welcome everybody. We are here on Facebook and also recording for the College Parent Central Podcast. If you have not subscribed already, what are you waiting for? I’m a subscriber as well as a co-host and a fan. We are here today to talk to Dr. Bianca Bush, who is the College Psychiatrist, and I am so excited to have her here. We are doing this in July, which is a really good time to start talking about mental health for our students who are headed to college for the first time, perhaps in the fall, or for those who are returning. So I’m hoping you will get a lot out of this conversation and have a lot of steps that you can take when we are all done. Again, if you want to re-listen to this podcast, make sure that you subscribe. It will hit your podcast feed sometime July, end of July, Vicki?
Vicki Nelson
01:44
I am checking the date. I should have that at the tip of my tongue. It will be released October, early October, right when college students may be looking for some help and support.
Elizabeth Hamblet
02:05
But in the meantime, if you are watching this and want to share it with your friends, it will live here on my Facebook page under LD Advisory, and it will also be on my YouTube channel so your friends can watch it there. But if, like me, you have a dog to walk and that’s when you listen to your podcasts, you’ll have to wait until October to see that. So, Dr Bush, I have come across you on social media and loved what you’re putting out. But before we get started, tell us a little bit about yourself. How did you get into psychiatry? How did you get interested in college students, sort of as a specialty?
Dr. Bianca Busch
02:43
Yeah, so I for a long time knew that I wanted to be a medical doctor and, you know, entered in medical school thinking I would do pediatrics, because I’ve worked with families and children for a long time. I had seven years between college and medical school and so, you know, got there. Pediatrics was interesting, but then I had my psychiatry rotation and it was fascinating. You’re really taking everything about a person, taking that into consideration, about how that’s impacting their entire body, and I was hooked. So in child and adolescent psychiatry, I’m an adult child and adolescent psychiatrist. You can really serve all ages and you’re working with families, which was really my desire in pursuing pediatrics. So that’s how it came to be and I am still so excited and thrilled by the choice.
03:31
I love my work and, as I had started my private practice in 2020 doing the work, I had licenses in multiple states and just sort of found that I was helpful for college students, as they would go away to school. Oftentimes they’ll lose access to their therapist or their psychiatrist, but having the multiple state licenses really did help me stay connected to students and so, yeah, I just found that I had fun with them and then, as a child and adolescent psychiatrist, we are really trained to work with families, and I found that that’s something that’s so needed. Even when a student is 18 or 19 or 20, they’re still transitioning away from the home most often, and their parents are in transition. They’re going through their own transition and sometimes need some help. So that is really how the college psychiatrist came to be. Is that I found, hey, I really like this work and I found that there was also a need.
Elizabeth Hamblet
04:30
And so for those who have not heard of the College Psychiatrist sort of as an entity, what does that mean for families?
Dr. Bianca Busch
04:37
So the College Psychiatrist we’re a group of psychiatrists who prescribe medicines, provide therapy for college students, and then we also do have some ancillary supports for parents and that really looks like maybe having a session or two providing psychoeducation or helping you understand what your student is going through obviously only with their written permission. And then you know we’ve got a few other things. We have a coping kit, which is fun. It’s kind of like a care package, a mental health-focused care package, and we’ll have some other offerings coming up around, testing with confidence, and then some group therapy offerings later on this fall. So we’re really trying to think holistically about how to support students and families.
Elizabeth Hamblet
05:21
Wow. That’s great. So for those of you watching us here on Facebook, you can put your questions for Dr Busch in the chat and we will try to get to them.
Vicki NelsonCo-host
05:30
And with that let’s go. And in the meantime we have a collection of questions that we’re going to ask and you know I said this is coming out in October and it may be, and I think that is a very good time, as I see students, it’s about when they need things. I was just looking at the schedule and I’m not sure we might be able to do August too. So just thinking August, October, whatever, it’s always a good time to talk about it. It’s always a good time. It’s always a good time to talk about it. It’s always a good time.
06:05
It’s always a good time to talk about mental health, because there are all kinds of reasons all the way through, especially the freshman year, that we see them falling apart. But often, as parents are getting ready to send their kids off and as kids are going, mental health may or may not be top of mind of what they’re thinking about. They’re thinking about what comforter to get for the dorm and they’re thinking about whether they’re going to make friends and they’re thinking about new academics. They have other things going on. So I wonder if you could talk a little bit about what aren’t freshmen and their parents really thinking about when it comes to mental health at college and is there anything they could or should be doing proactively before they go or at that very important first six weeks of college?
Dr. Bianca Busch
06:58
Oh, that’s a great question. Yeah, you’re right. All of these things can be so consuming, all the other sort of tasks to get through the summer before the school starts, and even registering for classes that can take up a lot of time. So I think that things that sometimes surprise students and parents dealing with if someone has a romantic relationship at home and they break up when they go there, sometimes parents can be looking out for that, but it may take students by surprise if those relationships don’t work out.
07:30
So, that’s one topic. I think another one can be the use of substances. That really can be shocking. You have a whole new level of freedom as you enter college and some parents, teens may have had exposure to substances during high school and some not at all, and this is the time that they’re really going to be experimenting. So that is something with respect to mental health that maybe families aren’t anticipating but is going to come up when they come to college and then just sort of the vicissitudes that will take you grades may take you through.
08:04
For a lot of students, this is going to be the first time that they’re really challenged.
08:10
It depends on where they’re coming from and where they’re going, but you know, this could also be a time where they’re really challenged and they haven’t faced this before.
08:21
They’ve never been the student to get the lowest grade in their class. Maybe they’ve been the student to always get the highest grade in their class. So those three things are the topics that I find come up and surprise parents and so, like you know, what do you do about it? Because that’s a variety of topics and one thing that I advise the parents to do is to just be open and to be ready for your young person to come and say I’m having a hard time and to be with them through that. And then, as you’re getting to the campus, really making sure they know where to get supports, you educate yourself as a parent about what’s available on campus, and that’s mental health supports, that’s academic supports, accommodations if they’ve had accommodations in high school and throughout their other schooling and then also physical health knowing where the student health center is, so that if your student is like I can’t remember, you might be able to guide them or direct them to the right place.
Vicki Nelson
09:23
I think that’s really helpful in having students think about what can they do proactively and to be prepared, because those times when mental health is shaky can I want to say almost inevitable at some level as I watch these students go through that freshman year. So just to follow up on that a little bit once the student goes to school and hopefully knows where the supports are and thinks ahead and there have been some conversations with students and parents before they left, what can parents do from a distance to support their student as they’re not there?
Dr. Bianca Busch
10:13
Yeah, and there can be so much anxiety for parents being away, right, I think let’s acknowledge that first. You know, one of the trainings I’ve had is for it’s called SPACE Support for Parents of Anxious Children, and one of the things that we know is that your child might be anxious. These things are hereditary, okay, and so parents might be anxious too. But the thing that we can do to help our young people is to deal with our own anxieties, whether that’s getting our own support in therapy, having a support group of other parents to talk to. And so when you say something that you can do from a distance, obviously you’re thinking about caring for your student from a distance, but I want to encourage parents to think about caring for themselves and managing their own anxieties, because sometimes we can exacerbate our children’s anxieties with our own, and we also can communicate that we might not think they can do it if we’re so anxious. And so it’s really important that you sort of work internally, even if you don’t think your student can do it, that you project that you know they can do it. So that’s one thing. And again, being available, you know it’s not helpful I hear from my students it’s not helpful when their parents are calling them, often expecting to text them, to text them back every day, all day, and so you know that may have been the standard in high school, but this is a very important transition for your young person, right? You want them again to know that they can do it, they can exist on their own, and so you know.
11:50
A check-in every once in a while and this is something you should negotiate with your student about how frequently you’ll check in Is it going to be a phone call? Is it going to be a text? But having that communication they need to know that you’re there, right? That’s still really important, but you don’t want to hammer them with phone calls and texts. So that’s one thing. How to care for them from afar is negotiating what that communication is going to look like. And then I’ll be curious to hear what you guys think about tracking. I think it’s a no and that might be controversial, but I say turn off the tracker, turn off the tracker. This is again about your young person experiencing independence. They’re going to run into trouble, period. It’s going to happen.
Elizabeth Hamblet
12:33
Yeah and yeah, go ahead. No, please go ahead.
Dr. Bianca Busch
12:36
And so you know. What’s most important is that they know that you’re there when they run into trouble and that they can reach out to you for some help or they know where to reach out for some help. So I would encourage parents to turn those trackers off and let their young person experience life, experience some difficult times and it’s going to decrease your anxiety as a parent. You’re not going to be checking that tracker all the time right.
13:06
This is a transition for parents, and so I’m sympathetic to that right. This is a transition for parents too.
13:13
I’m a mom and oh my gosh I have. My son is only three and I can’t even imagine when he gets to be called a date, oh my gosh. So you know I’m sympathetic. I’m not saying this as a single person. You know I have a little child and I can imagine the anxieties I will feel as he grows older and wants more independence. So it’s like it’s kind of a fine. You know you will navigate this with your young person. You ask what do you do from afar? You want to be supportive, but not invasive, if that makes sense.
Vicki Nelson
13:50
I think that’s. Two things jump out at me from what you’ve just said. I mean it’s all spot on. But one is that counterintuitive thing that it feels as though if you’re the way to be supportive is to call all the time and to check and all. And it feels counterintuitive to say I can support my student best by stepping back, not stepping out, but stepping back and not calling as much, so not raising my anxiety in that way. That really jumped out. And then I’m with you 100% on the tracker and it relates.
14:24
I often talk to parents about even FERPA waivers because the message that it sends to the student I don’t trust you, I need to track you, or I don’t trust you, I need you to sign a FERPA waiver because I don’t believe you’re going to tell me the truth, to sign a FERPA waiver because I don’t believe you’re going to tell me the truth. So taking that chance, turning off the tracker, not asking for a waiver for FERPA, but saying let’s keep the communication open, and then if things change, things change. So thank you for that. I know, Elizabeth, you’re trying to say something.
Elizabeth Hamblet
15:02
Well, I just want to jump in for those who are new to this, what FERPA is. So FERPA is just part of the alphabet soup at college Family Educational Rights Privacy Act. So if you’ve never sent a student off to college once they turn 18, and even if they are not 18 when they start college and this is not to do with dual enrollment programs where they’re still in high school, that’s a whole different ball of wax but if they are enrolled at college, they are considered adults and the only thing that the college is willing to send you without their permission is the bill. So you can expect to see that. But other than that, FERPA means that you, for instance and this is my area can’t get your student registered for disability services. If your student has registered with us or with the counseling center, those people can’t talk to you without your student’s permission.
15:55
And so I have a colleague who runs a disability services office who says that after he has an intake meeting with students, that after he has an intake meeting with students and if they sign you know when they sign, excuse me, the FERPA waiver if they’re, especially if their parent is there they say to them I just want to let you know that at any time, you can, you know, retract this or take it back, and so your students do have those rights. I also wanted to mention that my friend Vicki and her colleague and co-host Lynn Abrahams have a lot to say about a communication schedule, as Dr Busch has also recommended. Vicki, is that a blog post or is just something you always talk about? That I’m trying to think of
Vicki Nelson
16:37
Both.
Elizabeth Hamblet
16:54
Okay, well, let’s get those for the show notes.
Vicki Nelson
For the show notes, I will link to the blog posts, and I believe we also have a podcast episode. They’re blurring a little bit in my mind, but yes, it’s something that we talk about a lot. So, yeah, but making a plan.
Elizabeth Hamblet
I saw, Dr Busch, your very recent video on getting your students ready to go and normalizing all of this stuff that we are talking about, that it is going to be a challenge and that that’s to be expected, but the importance of communicating to them that you think that they’re capable, yeah, there’s a lot being said about parent anxiety and it’s it’s all perfectly understandable, but it’s really important what messages you’re sending.
Dr. Bianca Busch
17:24
Absolutely. I just wanted to comment on the FERPA Two things. So I am on the National Network of Depression Centers Task Force for College Mental Health. It’s a very long title, but basically it’s a collection of very smart psychiatrists across the country at different college mental health centers. And this is one of the things that we talk about is FERPA and HIPAA, because these are two things that prevent communication for what’s going on with your student, which is helpful.
17:50
Right Again, they’re in this transition. We want to respect that. They’re 18, but it can also sometimes make it difficult to provide care. So these are things that we talk about and navigate with students and I just I love that idea of, yeah, let’s keep it, let’s trust our students with their grades until maybe we see otherwise. Let’s trust them with their mental health until maybe we see otherwise. So I just wanted to highlight that from the provider perspective, it’s protective for the students, but sometimes it can provide challenges for us to communicate when a student really is in trouble and I just like that. Let’s trust them until maybe they are showing some signs that they need some help.
Elizabeth Hamblet
18:29
Yeah, Dr Busch. So while we’re talking about trackers, one of the things that struck me because I see this in my professional community is parents asking their student for the login for the learning management system so they can check their grades, which parents may be accustomed to doing from their high school days. Any advice on that?
Dr. Bianca Busch
18:48
I like to just let’s see how they do and then maybe give them access later, right?
And so this is I say to my students hey, this is a big opportunity
You can show your parents that you can do it and that if you’re having a hard time, you communicate that to them so they’re not needing to log into the system, right?
19:10
So I try to present it as as an opportunity for growth for both the student and the parents that, hey, this is, this is big, this is an opportunity for them to show that they can do it or that they can be responsible enough to manage themselves if they are having a hard time. So, yeah, I say let’s not release that login, with the exception, I do have some families that I work with where the students have had very serious academic failure and we didn’t know until the end of the semester. And so then I say, okay, for this next semester, let’s have some more transparency, are you okay that? And then you know, let’s change your password in the middle of the semester, when things are going well, or you know, and and we’re all having a conversation about this. So, yeah, that’s a good point, it’s. It’s so different, probably for you guys, when I was in college, the grades came in the mail.
Vicki Nelson
20:01
So yeah, yep, a different time, you had to run out to the mailbox every day and make sure you got them first.
Elizabeth Hamblet
20:10
I don’t think college students check their campus mailboxes. I mean, yeah, you have to tell them that you sent them something that they want to get them to go get the mail.
Vicki Nelson
20:18
There’s money in that card you might want to go.
Elizabeth Hamblet
20:24
And just a reminder for those who are watching us on Facebook. We are recording this podcast, but you can also put your questions in the comments here. I am monitoring that, if you want to ask Dr Busch your own question.
Vicki Nelson
20:37
And I just wanted to go back a little bit and, Dr Busch, maybe you can help us clarify, because we’re talking about FERPA and we’re talking about HIPAA. So FERPA had, you know, grades and all of those, but if a student is working with a counselor, either privately or through the college health center, is that covered by FERPA or is that only covered by HIPAA? Where’s the crossover between the two?
Elizabeth Hamblet
That’s a great question.
Dr. Bianca Busch
21:11
Yeah, it’s covered by HIPAA. Where’s the crossover between the two? It’s a great question. Yeah, it’s covered by HIPAA.
Vicki Nelson
21:14
Okay.
Dr. Bianca Busch
21:14
So the grades are covered by FERPA, but all of the mental health care and medical care will be covered by.
Vicki Nelson
21:21
HIPAA Okay.
Dr. Bianca Busch
21:22
Health Insurance Portability and Accountability Act, which just basically says that there has to be written permission to share any of your health information with it if you are the age of 18.
Vicki Nelson
21:34
So students and parents can agree to one and not necessarily the other. It’s not. It doesn’t have to be all together.
Dr. Bianca Busch
21:47
And just as someone can revoke the FERPA waiver at any time. You can revoke a waiver for HIPAA at any time as well. So if you’re coming to the student counseling center we were just talking about this on our call last week what are the practices across the country? Some counseling centers will have students sign a waiver or ask them to sign a waiver for a close friend or family right up front. Some will just ask for an emergency contact and that is not leaving HIPAA. That’s just saying, in the case of an extreme emergency, can we contact someone, and so, yes, you can sign that and then your parent can have access to information. An important thing to know for parents is that you can always provide information to student counseling, to the student health center. You can always provide information, but you may not be able to get information about your student’s health unless they have signed that release of information or HIPAA waiver.
Elizabeth Hamblet
22:46
I was going to say can a parent say to counseling hey, my student’s telling me he’s depressed, but he won’t come and see you. You know, will you reach out? Will they do that in your experience?
Dr. Bianca Busch
22:55
There’s no guarantee that they will reach out or that they can reach out, but absolutely and this gets so tough this is a really nuanced population because, yes, we can receive that information is a really nuanced population because, yes, we can receive that information. You know, um, I think different counseling centers will handle it in a different way, but the student, it’s really on the student to come and seek the help themselves. It’s just so hard.
Elizabeth Hamblet
23:23
So there’s a really good question that that just dovetails onto that. So a parent has asked um what’s the best way to establish mental health services at the university, and in this situation the student actually wants the parent to help do it, but what are the limits or abilities of parents there?
Dr. Bianca Busch
23:44
Yeah, sometimes students need help Again. This is why, as a developmental psychiatrist, I welcome parent participation at certain points in a developmentally appropriate way, because sometimes the student just needs help reaching out. And so what you can do as a parent is you will have to ask your student to sign a release of information and then you can help them coordinate care. So they will have to go to the student counseling center themselves, either send an email, phone call or physically walk over and say I’d like to get an appointment for an intake and then in that intake information they will sign a release of information for their parents so that their parent can sort of help them coordinate. You know, as an RA, in the dorms we don’t know students. People are coming to us with a fresh start and they may have a very long mental health history that we don’t know anything about, and that is their right.
24:42
That is their right. However, it can be very helpful to get some context. So you know, sometimes it is helpful for parents to give a little bit of information. So that’s what you do. You will have to assist your students. You know, maybe you make that phone call together to student counseling, maybe you help them email. If they’re in town with you, maybe you walk with them to the student counseling center. They might be able to ask their resident head or resident assistant to do that with them. So if you’re not physically with your student, those are some resources that you can call on to get help. And then they’ll need to sign a release of information so that you can then help coordinate. Hey, my child had a depressive episode when they were 16. They had to be hospitalized. Here are some medicines that they took. They stopped taking them. You know, there’s probably a lot of information that you might be able to provide that the counselor or the psychiatrist that they see at student counseling.
Elizabeth Hamblet
25:35
In your experience, are counseling centers very busy at the beginning of the semester or is it like is that a really good time for a student to just have an initial you know meeting and just say I don’t know if I’m going to need? Can they go and say I don’t know if I’m even going to need anything, but I just wanted to come?
Dr. Bianca Busch
25:55
That’s great. I think that’s a great time because the busiest times are going to be like midterms and finals right, you know that’s when it’s everybody is having a hard time.
26:01
Um, and even you know, be on. Uh, college students just children and adolescents are E. Eds are the busiest. Once the school year gets going, summer is a ghost town, but in the fall is when things get really busy, and so I think that’s a fantastic idea. During orientation week, stop by. They undoubtedly have free stuff that you can take home. They got some freebies you can take with you and just you know. So you know where it is, you know how to get there.
26:29
That’s a fantastic idea, but it’s never too late to reach out for help. So you know, middle of the semester, end of the semester, definitely do it then, but it is nice to sort of go and just at least know where the place is in the beginning. Another thing that I will mention is that there can sometimes be group therapy available, depending on the counselor, and so you know sometimes that group therapy is arranged around playing video games. Do you know what I mean? It’s not even around a very specific diagnosis. So that’s a great way to plug into your student counseling center as well, so that you’re creating community and you just sort of have a built-in support system or group of people.
Vicki Nelson
27:08
And how might a student go about thinking about with whether individually working with someone or group might what might be best?
Dr. Bianca Busch
27:19
yeah, that’s a good question. Um, you know, on that initial intake, your counselor that you’re working with may make some recommendations for you. For some people it depends on the person’s sort of makeup. If you’re socially anxious, an individual is going to be better. If you’re perhaps a little bit more outgoing and worried about the one-on-one that feels too intense, then a group may be better. So it just depends. Or if you feel like, oh, I don’t know how to really talk about my issues, a group might be better because that’s going to come out amongst the group and you’re going to say, hey, that actually applies to me, or I felt that way too, or that thing happened to me too. So I think it depends on comfort level.
28:03
I would say, if you’re not sure, you feel like you need some help, but you’re not sure what you would talk about on an individual level, groups can be good. But if you’re very anxious and you don’t want to reveal a lot about yourself amongst a group, then an individual might be better. And then there are considerations for your specific diagnoses as well. But when you do your intake session, you complete your intake session with student counseling. They’ll be able to help guide you and direct you, and it may be helpful to have both, so I would say that too. It may not be either, or. But it may be helpful to have both, so I would say that too. It may not be either, or but it may be helpful to have both.
Elizabeth Hamblet
28:32
So what are? You know? We’ve been talking about the campus mental health center and I mean we’re assuming every college has one. You know parents, as soon as they’re done watching this, can get on the website for the school their student’s going to be attending in the fall and double check and if they can’t find one, they can, you know, try the directory. You know, call the main number. But what are some other resources that students and their parents might not be thinking about that can support mental health and nurture it that aren’t as obvious as the counseling center?
Dr. Bianca Busch
29:09
Well, that’s a great question. So at first I thought you were thinking about more mental health specific resources, which I have some recommendations for those that are not on campus. Yeah, well, we can do those too I think are important and sometimes I feel like don’t get enough attention. It’s extracurricular activities. It could be the set of patients that I see that are sort of more on the anxious side tend to have been historically academically successful. They’re going in there and thinking got to get good grades, got to get good grades, got to get good grades, so I can do this internship, so then I can go to this graduate school. Right, they are totally academically focused and the thing that I find is, if you are that student who’s been previously academically successful, all you’re focusing on is academics.
29:55
You get to college you get your first C or D, you don’t know what to do with yourself. And so the thing that I like to say to my students is something that can buoy you is, if you have something going on outside of class, you have something that’s taking your attention and time that you enjoy, that you find pleasurable. So if you have that happen to have that low grade, okay, we’re going to work on that, but you’ve got something else that is making you feel fulfilled, satisfied and accomplished. So that is something that I really, you know for a lot of high school students, their parents do all the programming. Ok, you’re going to go to this, this sport, this, I’m picking you up, right? So college students aren’t accustomed to making that programming schedule for themselves. So I think this is like one of the biggest things that I see in that transition that falls by the wayside is figuring out how to involve yourself in extracurricular activities. I don’t know, do you what do you guys see and again, it could be the sample?
Vicki Nelson
30:56
I really I’m really glad to hear you say that, because I do hear a lot from students when I say, what are you going to do beyond the classroom? And they say, well, no, I’m not going to join anything this first semester because I just want to focus on my studies. So the student that you’re talking about that’s just totally focused on that. It absolutely is a lot of students.
31:25
And the other thing that I hear from some students is a lot you talk about parent programming, but also they’re doing extracurricular activities in high school so often because they know that’s going to look good on their college application and so they see it as serving that purpose. And then they get to college and they say, well, oh good, I don’t have to do extracurriculars anymore. So, thinking in a new way about it, as this is going to provide me with a group of people, particularly some kinds of activities that don’t require you to audition or try out or make the grade, but just something that you can walk in the door and be part of yeah, I would really encourage that. I agree.
Dr. Bianca Busch
32:17
And you’re right. So some of my students that I work with in therapy we’re figuring out well, what does give you joy and pleasure?
Elizabeth Hamblet
32:48
Oh, wow.
Bianca Busch
Yes, yeah, because they haven’t really been afforded the opportunity to. Because, again, they’re doing these things because it will look good on a college application. But what do they actually like? What do they actually enjoy? And so we’re working together to say, okay, what’s available on campus, let’s try it out. Maybe you’ll like it, maybe you won’t, that’s okay.
Elizabeth Hamblet
Yeah, and our friend Harlan Cohen, who we interviewed very recently, you know, talks about finding the places where you’re going to sweat, finding your people, finding you know and especially activities, as Vicki said, where you don’t need to audition, you don’t have to pass it, you know some kind of test to get in, so to speak.
33:06
You just get to participate. Now I think it’s really important to make sure that they are thinking beyond the grades and, again, for you to communicate that right, as you were talking earlier about their parents communicating their belief that students can do it. Also, the importance of having you know that full life that’s why they’re at college right to impart is to develop that. So we did have a really good question, you know, here we are talking about parents trying to establish an appropriate amount of communication from them to their student. We had a question about what? How do you help parents when it’s their student constantly reaching out to them from college? Maybe they’re anxious, whatever, whatever the reason is, they’re calling multiple times a day. In this situation, you know, how can a parent help?
Dr. Bianca Busch
33:59
That’s good. That’s a really good question, yeah, so it’s going to be similar. Again, the whole goal is to communicate that they can do it, and so you might say okay, I know that you’re really concerned and you’re really nervous, right? So, again, the space approach. We want to acknowledge what’s happening for them and then we want to say we know that this is happening, we know that you’re worried or anxious, but we know that you can do it.
34:22
And so what I would encourage them is say okay, if you’re calling me four times a day, let’s take it down to three, then let’s take it down to two. I’m not going to pick up the phone for you, but know that I am here and we’ll talk at the end of the day, right? So you’re going to have to create some sort of plan where there is regular communication. Your young person knows that you’re there, but you are sort of weaning them down and saying okay, you normally call me, like I said, three times a day. Let’s take it down to two. Call me in the morning, call me at night and whatever it is that you would want to talk to me about in the middle of the day. Take a note, write it down and we can talk about it at the end of the day. But you’re going to have to hold up your end of the bargain as a parent and not pick up the phone end of the bargain as a parent and not pick up the phone.
Elizabeth Hamblet
35:13
And so how do parents cope for themselves on their own while they’re watching the phone calls and texts come in. Any recommendation? Do they take a yoga class? Do they binge a TV show?
Dr. Bianca Busch
35:20
Yes, so this is the parent transition, right? I mean, depending on what your parent is doing. If you’re a stay-at-home parent, for some of my parents who this has been the case, this is what they would do. This was such a big part of their identity is taking care of their children, right? So you’ve got to build in some activities.
35:38
I’ve heard a great advice, actually, from a neighbor. She’s got four young adults and she was a stay-at-home mom and she said what she did was, two years before her final child was going to college, she started to pick up more activities for herself, and so she was already starting that transition. And so, yes, this guy, pick up a yoga class, a new hobby, new volunteering, or if you are a working parent but your afterschool hours are really occupied with taking folks to practice and doing that, that you pick up something for yourself. You undoubtedly had a hobby or a passion that you put to the side for the last 20 years while you were raising this young person and so encouraging them to go back to that and having someone that you can rely on when you’re feeling anxious like, oh my gosh, I’ve got to respond to this text because my young person might be really spiraling out, someone that you can rely on, whether it’s your partner or a friend, so they can help you through those tough times for yourself, when you’re not responding to these messages.
Vicki Nelson
36:44
It’s really taking your own advice and we’re talking about encouraging students to find extracurriculars and do something that they love, and parents need to do the same thing. You know, the students focused on academics, the parent is focused on parenting and we all need to broaden just a little bit.
Dr. Bianca Busch
37:06
It’s a transition for everyone. It’s a transition for everyone.
Elizabeth Hamblet
37:09
It’s a transition for everyone. It’s a transition for everyone. Any way for parents to and I realize this is a really tough question to differentiate between sort of typical expected stress and anxiety in their student and when they might really need to get on that phone and say, look, I’m really worried about you, you need to go to counseling. Are there any like kind of obvious red flags for parents?
Dr. Bianca Busch
37:34
Yeah, I think any big changes in the calling patterns that you guys haven’t talked about and established. So if your young person is starting to call you a lot more frequently, then you might wonder what’s going on. And then the calls have just dropped off completely. And again you guys haven’t talked about decreasing your communication, have just dropped off completely. And again, you guys haven’t talked about decreasing your communication. Those may be some red flags.
37:54
If you’re FaceTiming, you know sometimes parents can notice that their student has lost a lot of weight or gained a lot of weight though this is a little bit nuanced, but you know those can be signs. If you notice your young person is sleeping a lot, and this is hard right. This is why you would be anxious as a parent, because you’re not there with them so you’re not going to be able to eat all of these things. But if you can observe amounts that they’re not eating as regularly I said that was sort of the weight loss, sleeping more, sleeping less you may not be able to tell from afar if they’re using more substances or not, but if you do happen to notice that sometimes students’ friends will reach out to their parents with concerns. I’ve had that happen before, so that’s a time where you might want to intervene. I’m trying to think of any others. Those are kind of the big ones and obviously, if someone is talking about ending their own life, that is, you know, obviously a time where we need to reach out right away.
Elizabeth Hamblet
39:03
So, speaking of age, go ahead, Vicki
Vicki Nelson
39:06
Well, before we shift. You know we talked earlier about FERPA and if the student has not signed a FERPA release or HIPAA, sometimes I remind parents that that means that the college can’t share any information with you, but it doesn’t mean that someone from the college can’t listen to you. So if you have concerns to call a dean, to call someone and say I know you can’t tell me anything, but here are my concerns. Would you check on my student? And they can do that.
Elizabeth Hamblet
39:43
They have teams. I think it’s some schools that that respond in that way, and so the only thing I was going to say cause it. You mentioned sometimes students’ friends call. So I was going to say, because you mentioned sometimes students’ friends call, so I’m so old that there was a phone in the room and if my parents were concerned they could have at least called my roommate. Everybody’s got their own phones now. So I mean, when students go off to college they may not know anybody. Is it awkward, is it appropriate for parents to ask for their kids’ roommates’ phone number? I mean, like I’m just sort of thinking to myself like how do you do this?
Dr. Bianca Busch
40:19
now I wouldn’t recommend that. I mean, when I was talking about the kids’ friends reaching out, it’s often that they will get the phone number for their friend’s parent and they will. The friend will contact the parent., yeah, it’s often that the friend will contact the parent more. So the reverse, yeah, I probably wouldn’t recommend that the parent would get the contact information, the student necessarily yeah, I’m not sure.
Vicki Nelson
40:45
I think I I sometimes would recommend that, but early on, like move-in day as just part of that, I’m not going to use this. I don’t intend to use this, but if there’s an emergency and I need to reach you and for some reason you’re not answering your phone, I need to be able to reach out to someone. So that it’s making it clear, I’m not asking for this because I’m going to call your roommate and check up on you all the time, but it’s just emergency contact. Might be a way that you have it and you tuck it away and you hope you’re never going to use it, but it’s a way you could going to use it, but it’s a way you could, yeah.
Elizabeth Hamblet
41:36
So what is the range of experiences you’ve seen your patients have transitioning to college? You know, are there any lessons in there for families? I assume some of them go off and everything’s pretty cool, right, Like we need that. That happens too right.
Dr. Bianca Busch
41:51
It absolutely does. And again, I have the I have a skewed sample right I’m only seeing folks who are having a hard time. So, but yeah, many go off and everything is just fine. Many go off and have a hard time and recover. You know, I’m sure students have these experiences that they’re like oh my gosh, if my mom or my dad knew what really happened, they would be horrified and they’ll tell them in their forties, if they ever tell them at all. So people are going out and they’re being successful and they’re doing just fine.
42:26
I think a message that I would like to communicate to parents is that if your student goes out and has a hard time, it’s not the end of the world. If they go out and they have a hard time, they need to stop for a little bit, they need to take a semester off, they need to drop a class. It’s not the end of the world. There are so many paths to success.
42:50
I think that’s the thing that I like to communicate to parents, because sometimes we can, and even our students can, think that there’s only one way to be successful. There’s only one way to be a pre-med student, there’s only one way to be a pre-law student. There’s only one way and there are so many paths, and so I think that is the thing I try to hit home is, like you know, every student is on their own journey, their own path. What’s important is that they keep progressing forward, that they’re remaining healthy. If they need to take some time away to be healthy, that’s really important and it is possible for them to get back on track. So, yeah, that’s probably one of the biggest takeaways I would say.
Vicki Nelson
43:37
So if I could follow up a little bit about you know the different paths and the different tracks. There are a couple of things that I’m thinking about, and it’s some students who have never been in treatment in high school and this would be a totally new experience for them. There are some who have all along and they need to decide whether they’re going to continue with someone they’ve been seeing before or start to see someone new. And then I’m loading. See, I managed to load one question with about four things here, but they’re all related. The other is, as a medical doctor, you sometimes prescribe medication, so I’m thinking about students who may have never had medication before, students who have had medication and have stopped taking it, students who are starting. How does all of that work in terms of students starting or stopping medication treatment? Yeah, All of the above.
Dr. Bianca Busch
44:41
Yeah, okay, so a couple of important things to think about here. We, as medical doctors, are licensed at the state level, and so when a student goes to college, if they’re going to college out of state, unless their doctor has a license in that state, they will not be able to continue to care for them. Now, if their regimen is stable and nothing is changing, it is likely that the doctor can prescribe to a local pharmacy and the patient can pick up the medicine, With the exception of controlled substances for which you have to have a state license, and those are things like stimulants for ADHD. Those are the most common things that college students are going to be taking. So this is one of the reasons why I founded the College Psychiatrist, because this becomes a real challenge for families.
45:31
If you’ve got someone taking care of you at home, you go out of state like sorry, I can’t prescribe there. Often you can get some help from College Mental Health. They will have someone who can prescribe medicines, but they are not always willing to prescribe stimulants. and so this can be pretty tricky. So what you want to do is check ahead of time to see if your counseling center or the student health center is willing to prescribe your stimulants and, if not, that you’re identifying a local psychiatrist or mental health provider or family medicine doctor someone with an MD, nurse practitioners can also prescribe who can do that for you on your local campus. So that’s something to that’s one of the biggest things to keep in mind.
46:11
Now, in terms of starting and stopping medications, I think it depends on the condition. I am the kind of prescriber that I never say that someone is committed to lifelong medications with the exception of a few diagnoses, and that’s probably schizophrenia and maybe even bipolar disorder, depending on your illness. Other than that things like anxiety and depression it is possible for you to start medications, get better, get some great skills and stop the medication. So this is a long answer.
Vicki Nelson
It’s a long question.
Dr. Bianca Busch
46:48
It’s a long question. And so you know. It is possible that they have been on a medication in high school, but they will not continue in college. It is possible that they never had medication in high school and they really do now need it in college, and so you know. For these reasons, I think again the parents working with the students say okay, you saw a therapist in high school and that was enough for your anxiety or depression. If things get worse, let’s make sure you get back into therapy or counseling, and then there might be a need for medication. And again, the student health centers are good about having all of those resources available and saying okay, now is the time for you, we’ve done all that we can do with therapy, or therapy is maybe just not enough right now and we should consider medication. So it’s kind of a case by case thing, but, just as you stated, either can be true that you have not started medication in high school and you do find that you need it, and vice versa.
47:48
Another thing that I find to be true, outside of depression and anxiety, is that someone may have been diagnosed with ADHD as a young child and, depending on the parent preference, they may have said no, we’re not going to do medication. Let’s just get you executive function coaching, let’s just really make sure we have these systems in place and let’s forego medicine. Well, oftentimes what will happen when students get to high school or even to professional school, is that the academic load is such that all of the systems that they put in place are overwhelmed by the volume of the information, by the complexities of the information, that they’re required and they may actually need medication. So I have a fair number of students that they may start stimulants for the first time with me once they’re in college or in professional school, even though they have a longstanding diagnosis of ADHD.
48:35
And sometimes they don’t even have the diagnosis of ADHD yet and they’re just getting it as a young adult or an adult. So that’s a long answer. I hope I answered your question.
Vicki Nelson
48:46
Yeah, I mean they need to be flexible and not say I’ve never needed this before, I’m not going to need it now, or I’ve always needed this. Things change a lot in college. It’s very different.
Dr. Bianca Busch
49:03
One other thing that I would add. That’s interesting because now the student is 18. So you don’t actually need your parents’ consent to start the medication. However, your parent is still a part of your life, and so sometimes that can influence a student’s decision to start or stop medication. If their parent is like, no, you don’t need medication, but they kind of want to try it, it can maybe prevent them from getting the help that they need. So, again, as we’re inspiring independence, I would say, because everyone has different attitudes about medications, understandably so. None of the medications that we prescribe are without side effects, so I can understand the caution, but the thing that I encourage families to do is make sure you’re educated about what the medicines are and then really encouraging your young person to make a good decision for themselves. So that’s another complexity that we talk about as psychiatrists. Like we really want to start this, but the parent isn’t on board, even though they don’t have to be on board, and so that’s preventing the treatment from going forward.
Elizabeth Hamblet
50:07
I was thinking as you were talking about, you know, students and I’ve seen this working at the college level going off their meds because they’ve decided they don’t need it. And, just, you know, thinking about what I would then generalize is resistance to treatment, let’s just say so. One of your videos you talked about how anxiety affects not just you know, female, cisgender female students, but cisgender male students. And so do you have any advice for parents, especially because for some you know individual groups of kinds of students, there’s a resistance to saying I need help. You know, maybe it affects their self-esteem to think that, or it is, you know, a cultural thing for them to. You know, their family is discouraged seeking that kind of help. Any kind of suggestions?
Dr. Bianca Busch
50:58
That’s a good question. Yeah, you know, when I have this family is before me in my clinic space, I normally am exploring why they might be resistant, and so many different things come up. A family member had a bad experience with the treatment system or medication. So you know, some of that work people can certainly do on their own. But to ask themselves, why is it that you don’t think that this could be helpful? Is it because of a previous experience? Is that experience likely to be the case here at this institution or with this provider or this treater?
51:37
And then to also ask about the cost and the benefit, the thing that I highlight to people is that, um, the suffering that they have, they don’t have to have, um, and that’s. You know, if there’s a resistance to medication, I find much more buy-in with behavioral approaches or even natural supplements, and so that’s more thinking about how to get buy-in as a provider. But I just highlight like, hey, this doesn’t have to be the case, and I even will use other patients that I’ve had as examples and say you know, when they did this treatment or when they started this medication, they were surprised to realize how much anxiety they were actually experiencing, and they didn’t even know because they just had been living with it for so long they didn’t even really know that they could live a different way, and so sometimes I’ll use that as an example. So yeah, that’s. I think trying to find positive examples of people who have gotten treatment can be helpful, and I do try to really be respectful of culture, um, experiences, um, when I am trying to bring someone on board for treatment.
Elizabeth Hamblet
52:53
And I want to add, for those who are listening um, one of the concerns you know, working in disability services at the college level that I hear about why students don’t want to come and get their accommodations, is they are concerned that that will somehow be noted on their transcript from college that they used accommodations, yeah I mean, and whether they’re looking for a job afterward or graduate school. So let’s be really clear that college transcripts do not say anything about any supports that students have accessed. and our office and the campus counseling office are not going to be sending. If a student’s applying to grad school and wants their transcripts sent, the college is not going to send a record from our office or from counseling or for any other resources. Yeah right, but I understand why people A they just don’t know and are worried about that, but that this treatment is completely confidential. Professors don’t know about it. Nobody needs to know that these students are seeking help. It’s private.
Dr. Bianca Busch
53:59
That’s a good point yeah.
Vicki Nelson
54:02
So I think we could go on and on, because this is really important and a big topic, but unfortunately we probably do need to begin to wind up. So I’m wondering, you produce videos and all on so many topics.. What have we not asked you about that you wish you had had an opportunity to talk about? Is there anything, wrapping up, that you’d like to make clear, make a statement about?
Dr. Bianca Busch
54:50
The only other thing that I didn’t get to mention before. It’s just about substance use, and this is, I guess, maybe my own personal soapbox. Is that I really want families to be honest with themselves and your young person about the family history of addiction.
54:54
It’s a very hard topic, but I think your young person needs to know, before they’re going into college and they’re exposed to so many different things, whether or not they have a genetic tendency towards addiction. Because I see young people who just don’t know and they’re wondering why it is so hard for them to stop vaping, smoking marijuana, drinking alcohol. And you know, they’re just genetically predisposed. So that is something that I think I always will want to say is that if you’re having a hard time thinking about it or not sure how to approach it with your young person gosh, my mom is just blunt, right.
55:42
So many people have family history of addiction, certainly on both sides of my family, and so my mom was just like, hey, you have to be careful because this is on both sides Right, and so you come into your experience with a different mentality than like, oh, this isn’t going to affect me, I can just have however many drinks and set it down Right. So that is one thing I want to hit home. Please talk to your young people about this. If you’re having a hard time, you can always go to organizations like NAMI for more information, or even AA or Al-Anon. These are all sort of addiction-focused or mental health-focused resources to figure out how to talk about it. You can really, I think, save your young person from a tough path if you can be honest with them, even if you yourself have a history of addiction that they don’t know about. It can be a good time for you to talk about that.
Elizabeth Hamblet
56:42
Vicki, as a fan of Dr Bush’s, I know she’s also talked about sleep, which we haven’t touched on.
Dr. Bianca Busch
56:48
Oh, goodness. Sleep is really important. Tough for college students because their schedules are so, so varied. But sleep, oh my goodness, it’s so important for mood, it’s so important for anxiety, for concentration, for the consolidation of memories. All that studying that you’re doing, your brain has to have time to put it all together. So, of course, all-nighters are not the best way to get things done, even though it seems like a good idea. So, trying to plan if you can and get the best sleep that you can You’re not going to get eight hours every night, that’s unreasonable. But as many nights as you can, getting, you know, seven, seven to nine hours of sleep. And then, when you get home for breaks, parents let them sleep for a little bit. They’re okay, I promise they’re most likely okay.
Vicki Nelson
57:35
They need to sleep for a little bit, so yeah, I’m for parents and students to hear that about sleep from any direction that it can come. When I mentioned to my students you know, are you getting sleep I? They usually laugh at me. So you know they don’t understand what happens when you’re sleeping. So, but yes, we need to wrap up. Um do, would you? Can you just share with us? If parents would like to find out more about you, contact you. What should they know?
Dr. Bianca Busch
58:15
Absolutely, absolutely so. You can find us at www.collegepsychiatrist.com that’s website. We’re on all social channels Facebook, tiktok, instagram. @ college psychiatrist. You can also follow me, Dr Bianca Bush or The College Psychiatrist on LinkedIn. We’ll have information there, but through any of those channels you’ll hear about what’s upcoming, the things that we have to offer and just general information, and we always love to hear back from people. So if there’s something you want to know about, like comment, um, you know, in any of the posts or things like, hey, what about this, and we’ll make a video about it, we’ll address it and let’s see what else to say.
58:54
We have our coping kit was available on Etsy that is a platform I didn’t mention but it’s a great care package. You can get that in, get it in rotation now, order it, send it to your student. It’s got over 10 items that promote good mental health. It’s a lot of fun. It’s got some fun stickers that they can put on their water bottles or laptops, and then we’re going to have some great stuff coming up about testing with confidence.
59:19
I find that anxiety can really get in the way of students showing exactly what they know on their exams, and so we have a book coming out about test anxiety with some tips that students can really use. We also have a one on one that we can do like therapy wise. That is fantastic. Incorporates CBT for anxiety and then some integrative psychiatry, and then we’re going to be rolling that into a course when I find all the time to do these things, but the ebook is really in motion, so just look out for those things. And then some group therapy in the fall as well. So many exciting things coming from us.
Vicki Nelson
59:55
Wow, so much going on. Well, I know we both want to thank you for the people who were able to join us today on Elizabeth’s Facebook, and this episode will be forthcoming maybe in August. It may not be till October. We’re going to see how this schedule pans out, but we will be sure to let everybody know when that’s going to happen, and there’s never a bad time to learn more about student mental health. It’s so important. So thank you so much for joining us.
Dr. Biance Busch
Thank you for having me.
Elizabeth Hamblet
01:00:31
Thanks everybody.
