Wheelchair ramps, automatic doors, and close-captioning units in classrooms daily remind us of the many barriers we have removed in our efforts to provide equal access to higher education. Educators have made great strides towards meeting the needs of students with physical disabilities, and yet we have still not made higher education accessible to all students. There is one disability frontier for educators and administrators left to explore: students with psychiatric disabilities. Although protected by the Americans with Disabilities Act (ADA, 1990), the needs and challenges facing the vast numbers of students carrying the invisible burden of mental illness remain largely unaddressed. These students face incredible personal, interpersonal, and institutional barriers throughout their educational career. Until mental illness on campus is fully understood and new methods of educational practice are implemented, students with psychiatric disabilities will continue to remain anonymous and underserved. The current discussion examines the prevalence and nature of mental illness, the critical issues facing college students with psychiatric disabilities, current approaches, and implications for future approaches to this population within higher education.

Chris has it all. Four outstanding undergraduate years on the pre-med track propelled her into one of the nation’s top medical schools. Her medical school achievements have been laudable, and residency programs are actively recruiting her application. Her academic and professional life is one to admire, yet very few people would trade her outward success for the life which she lives in secret. Chris has a debilitating disability, one that threatens the stability of every day in her life and that constantly pulls her away from her role as a student and professional. However, few people will ever realize the extent of her daily obstacles, for her disability is among the class of invisible diseases that plague the lives of students on every campus across this nation: mental illness.

While contemporary higher education has made great strides to meet the needs of students with physical disabilities, the last disability frontier for educators and administrators to explore is the array of needs and challenges facing the vast number of students carrying the invisible burden of a psychiatric disability. These students experience incredible personal, interpersonal, and institutional barriers throughout their educational careers. Until mental illness on campus is fully understood and new methods of educational practice are implemented, students with psychiatric disabilities will continue to remain anonymous and underserved. This paper examines the prevalence and nature of mental illness, the critical issues facing college students with psychiatric disabilities, and current approaches to this population within higher education.

Chris is definitely not alone. In fact, every professor and student affairs professional could probably tell a host of similar stories of troubled and impaired students. The National Institute of Mental Health reports that one in five Americans is diagnosed with a mental illness in any given six months (Unger, 1992), and many have hypothesized that this number is even greater on college campuses across this nation. This hypothesis has proven to be true--the number of college students with psychiatric disabilities has dramatically increased over the last thirty years. A comprehensive study of nearly 100 counseling centers reported that over 85% of counseling center directors were observing an increase in the overall psychopathology in their clinics, and that 56%reported spending more time on severe cases (O’Malley, Wheeler, Murphey, O’Connell & Waldo, 1990). Offer and Spiro (1987) found that 20% of students entering college were sufficiently disturbed to need mental health treatment (as reported in Hoffman & Mastrianni, 1989). Other student health researchers have reported statistics that indicate between 30 – 50% of college students suffer from a diagnosable mental disorder at some point during their college career (Rimmer, Haliikas & Shuckitt, 1982; Valentino, 1995).

The statistics on suicide are important to note as well, as suicide represents one of the leading causes of death among college-aged people. Silverman (1998) found that an average of 7.5 per 100,000 college students committed suicide. However, Bernard and Bernard (1980) reported that nearly 20% of college students threatened or attempted suicide during their college careers (as reported in Hoffman & Mastrianni, 1998). Whether students are suicidal or simply depressed, it is clear that more students are coming to college with, or are developing in college, complex psychiatric, emotional, psychological, cognitive and behavioral problems. It is self-evident to student affairs professionals that these problems pose significant threats to achievement in a college or university setting and that higher education will need to become more attuned to this population of students on campus.

There are several reasons for the reported increases in psychopathology on college campuses. Some of the increases in counseling center use may be accounted for by a greater acceptance of counseling and psychotherapy in recent generations. The studies are clear that a growing social awareness and acceptance of the benefits of counseling cannot fully account for the dramatic increase of psychotherapy needs among college students. The objective, measurable population of students either arriving on campus with, or developing during college, a diagnosable mental illness has increased beyond dispute. There are some significant factors for this increase. First, the federal government has dramatically reduced the funding for psychiatric institutions, resulting in more individuals receiving only outpatient care and being “mainstreamed” into society (Valentino, 1995). With greater scientific understanding of cognitive development and dysfunction, more individuals are able to live productive, safe lives outside the walls of in-patient treatment centers. Individuals with severe disorders are now provided with opportunities to secure employment and to live independently. Second, and more importantly, the advanced technology of psychotropic medications has made it possible for people with diagnosable mental illness to reduce or control the symptoms associated with their disability (Unger, 1992; Zimmerman, 1997). These medications provide unlimited opportunities for individuals who suffer from moderate or intermittent mental disorders and allow for a substantively normal lifestyle that was formerly unattainable.

Critical legislation has served to offer significantly more support for individuals with psychiatric disabilities within the public domain. One direct result of disability legislation is that institutional barriers were removed and legal rights for the mentally ill were established, both of which provide greater access to higher education for those with psychiatric disabilities. The Rehabilitation Act of 1973 (§ 504) established that public institutions that receive federal funding cannot discriminate against individuals with handicaps (Unger, 1998; Zimmerman, 1997). While this original act was meant to address discrimination against both physical and mental disabilities, institutions have been less responsive to the latter. In the last ten years, however, more legal and political attention has been given to psychiatric disability issues. For example, the Americans with Disabilities Act (ADA) in 1990 extended the rights of individuals with physical and mental disabilities to include both public and private institutions. Furthermore, the ADA was also much more explicit in regards to mental impairment. Mental impairment is specifically cited as a disability in the ADA and includes any mental or psychological disorder, such as emotional or mental illness, that limits one or more major life activities, including caring for one’s self, performing manual tasks, learning, and working, among others (Unger, 1998). As a result of this legislation, institutions of higher education, whether public or private, are subject to the law and must not discriminate against students with diagnosable mental illness (Unger, 1998). This has opened the door for many students who have formerly been denied access to higher education and has substantially contributed to the influx of students with psychiatric disabilities.

The DSM IV, the clinical guide to psychiatry, defines a mental disorder as, “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychiatric Association, 1994, pp. xxi-xxii). Chris, the successful medical student mentioned previously, has been diagnosed with obsessive-compulsive disorder (OCD), which leads her to perform repetitive, compulsive, intentional acts (such as excessive hand-washing, repeatedly turning lights on and off, etc.) all day long to relieve persistent mental and emotional distress. Other diagnosable mental illnesses that qualify under the ADA as psychiatric disabilities include, but are not limited to: panic disorders, anxiety disorders, extreme phobias, antisocial or borderline personality disorder, post-traumatic stress disorder, major depression, manic-depression (bi-polar disorder), dysthymia, seasonal affective disorder, anorexia nervosa, bulimia, attention deficit hyperactivity disorder (ADHD), and schizophrenia (American Psychiatric Association, 1994).

The most common presentations of mental illness among college student populations are mood disorders (including manic- and major depression), anxiety disorders and adjustment disorders (Rosecan, Goldberg & Wise, 1992). In one study, 39% of an observed cohort presented signs of mental disorders at some point in their college career, 90% of which were related to depression (Rimmer et al., 1982). However, Perlmutter, Shwartz and Reifler (1985), who studied students that had been admitted to a psychiatric emergency department, found that psychiatric diagnoses were equally divided among psychoses such as schizophrenia, neuroses such as anxiety or depression, personality disorders, and substance-abuse induced episodes. Few studies have determined if there are substantial differences between males and females, and there are currently no studies on the differences of mental illness across ethnicity and race. Another gap in the body of research is that most of the studies of clinical mental disorders have failed to specifically report on the extent of anorexia nervosa and bulimia.

Cultural Stigma
Despite modern technology, a greater acceptance of psychotherapy and counseling, and the widespread use of psychotropic medications, the burden of a psychiatric disability is exacerbated by a cultural stigma around mental illness (Zimmerman, 1997). Mental illness is often described as “the last bastion of ‘unmentionable’ diseases” and patients who have had first-hand experience of mental illness have described their experience as socially “tortuous…humiliating…frightening…frustrating…confusing…shameful” (Graff, 1996, p. 35). Strong cultural stereotypes of the mentally ill are evident in the language and slang used to describe those around us, such as “paranoid,” “schizo,” “crazy,” and “psycho,” among others. Such phrases reinforce the assumptions that all mentally ill individuals are permanently institutionalized, unable to function in mainstream society, and exist in a perpetually psychotic state (Unger, 1992). As a college student who suffers from ADHD explained, “As long as the public is willing to believe in the old ideas that all of the psychiatrically disabled are violent, mindless beings, or that all of us are helpless, there will be no new forms of therapy to help give back the dignity that was lost through the stigma of being mentally ill” (Strickland, 1993, p. 53).

The stigma of mental illness has been documented in primary research as well. Sibicky and Dovidio (1984) created a research scenario in which participants were introduced to new people. They found when the participants were introduced as clients of mental health services, they were perceived as defensive, awkward, and unsociable (descriptors consistent with stereotypes of the psychiatrically disabled). In addition, they found that participants playing the role of a mental health client also experienced the effects of the “self-fulfilling prophesy” and began to behave in ways that confirmed the stereotypes placed upon them. This study confirmed that merely seeking therapy can be stigmatizing in our society, and that those with mental disorders who depend on therapy to manage daily life must fight even harder against the impact of stigmatization. Unfortunately, our cultural assumptions about the nature and abilities of individuals with a mental illness have perpetuated an educational system which has historically denied these individuals the opportunities they need to overcome the stigmas.

Age of Onset
A major factor related to how psychiatric disorders manifest themselves in a college-aged population is in regard to the age-of-onset of the illness. Most people initially develop the first symptoms of their disorder between the ages of 15 and 25 (Cooper, 1993; Unger, 1992; Unger, 1998; Zuckerman, 1993). The onset of mental illness, therefore, often coincides with their college career and/or times when they are making critical life decisions as well as during a time when they are learning to live in a community as adults (Housel & Hickey, 1993). The unpredictable and often dramatic onset of psychiatric dysfunction disrupts this process (Unger, 1992) and threatens the academic success of those trying to complete a degree.

Another characteristic of mental illness is that it takes on an episodic nature. Hoffman and Mastrianni (1989) explain that the view of abnormal mental functioning as all-encompassing is a misconception. For example, some students with diagnosable mental disorders may find that they can function successfully in one area of their life but struggle in other areas. A student might be able to handle their academic obligations but be incapable of managing interpersonal relationships, or vice versa. The episodic symptoms of psychiatric disorders are also exacerbated by extreme stress or change, such as midterms or finals, romantic relationships, holidays, or leaving/returning from home. Meanwhile, students whose illness develops during college, or those who are not diagnosed until college, will likely experience several episodic crises and/or visits to a therapist before their mental disorder can be diagnosed and treated (Zimmerman, 1997).

Drugs and Alcohol
Another critical factor in psychiatric disabilities among college students is the high rate of comorbidity with drugs and alcohol (Chisholm, 1998). Comorbidity refers to the high rate of association between two diagnoses; in this case, many college students who are diagnosed with mental disorders also abuse drugs and/or alcohol. This is a salient concern for mental health professionals, as the college social scene tends to foster an environment of substance abuse. In a study of undergraduates who were hospitalized for psychiatric problems, Rosecan et al. (1992) found that 33 percent of admitted students had a current or past history of alcohol abuse and 35 percent had a current or past history of drug abuse. While alcohol and drugs may provide temporary escape for students who are suffering from acute mental disorders, such abuse is extremely dangerous for students with mental disorders and will often push students into a psychiatric emergency or crisis situation.

Stress
The stressors associated with the college experience can also serve to exacerbate mental illnesses, whether a student is clinically diagnosed prior to attending college or experiences their first symptoms while in school. The academic cycle with its accompanying stress can negatively affect students with mental disorders. There are typically more admissions to psychiatric treatment facilities during certain times of the year, such as the beginning of an academic term or graduation (Rosecan et al., 1992). Exams, academic difficulties, and pressure to succeed also contribute to the onslaught of stress for students who are particularly sensitive to such stress. Family discord and the changes associated with moving home and returning to school can also impact a student’s mental stability. The episodic nature of psychiatric problems are also affected by other external factors such as loneliness, relationships and roommate problems (Lore, 1997). Sexual identity issues and the “coming out” process are also predictors of severe psychological distress (Rosecan et al., 1992).

Effects of Medication
For students whose psychiatric disorders are being successfully managed by medication, there are still variables which can severely impede academic and interpersonal stability. Often medication dosages are difficult to regiment, and students may have to experience trial periods monitored by their treatment provider, who may or may not be sensitive to the fluctuations of the academic term (Zimmerman, 1997). Psychotropic medications are also prone to causing side effects such as inability to concentrate, fatigue, slow or confused cognitive processing, extreme emotions, and other physical complaints (Unger, 1998). All of these side effects are likely to disrupt the educational process.

There are currently few systems in place on college and university campuses to acknowledge and understand the needs of students who suffer from mental disorders. Despite the ADA mandates, psychiatric disability services are limited, if not obsolete, on many campuses. A major precursor to the lack of services is the lack of sensitivity to the nature and needs of the psychiatrically disabled student. Two very serious problems arise from this lack of sensitivity. First, most educators and administrators are unfamiliar with, and therefore not always capable of recognizing, the indicators of serious mental illness among their student population. The common assumption is that our students who exhibit unhealthy behaviors are “simply having trouble adjusting to college life” (Chisholm, 1998). The contrary, unspoken, assumption is that anyone with a diagnosable psychiatric disorder could not, would not, and should not be in a college or university setting in the first place. As one disability specialist explained, “Part and parcel of these beliefs is the notion that cognitive deficits, which are the hallmark of mental disorders, automatically eliminate the possibility of any academic success” (Lieberman & Goldberg, 1993, p. 99).

Another critical problem is that many young adults with psychiatric disabilities are hesitant to self-disclose their illness because of the fear of discrimination and the pervasive stigma and stereotypes of mental illness (Unger, 1992). Students may not see any visible indications that a campus will be sensitive to their needs, such as disability or academic services departments which advertise supports for the psychiatrically disabled. Students may also experience a cultural silence in their institution, which discourages them from seeking help or academic accommodations. Consequently, those who need the most help are frequently overlooked in institutions of higher education because they are often able to hide their “invisible” disability. In the best of cases, these students suffer in isolated silence; in the worst, they either drop out, take a voluntary or involuntary withdrawal, or, out of total desperation, commit suicide.

Additionally, the effects of mental disorders on an individual’s ability to function in an educational environment result from a complex interaction of the disorder itself, the environment, interpersonal functioning, and academic stress. Some of the most common symptoms include mental dullness, difficulty blocking out environmental stimuli in order to concentrate, low stamina, difficulty adapting to change or responding to negative feedback, inability to handle multiple competing time pressures and tasks, as well as strained interpersonal relationships (Mancuso, 1990). Of course, all of these challenges must be successfully managed in order for students to navigate a college experience. It is critical that educators and student affairs professionals, although not formally trained in medical issues, are aware of the prevalence and nature of mental illness among their students. They must be able to initially recognize both moderate and severe presentations of mental disorders and be sensitive to the fact that the educational environment is often the place in which these disorders are manifest.

Until the passage of the ADA in 1990, little attention was directed towards meeting the needs of the psychiatrically disabled student. Students in crisis are often disruptive, and institutions formerly handled such disruptions by eliminating the source of the problem: the mentally ill students themselves. A 1981 study found that 81% of institutions surveyed required mandatory withdrawal of students who displayed psychiatric problems (as cited in Hoffman & Mastrianni, 1989). Such practices are now considered illegal discrimination, yet many institutions have found ways to perpetuate similar practices. Gary Pavela (1990) has researched the intersection of campus disciplinary protocol and students with mental illnesses. His research has established that mentally ill students are accountable for their behavior when it leads to breaches in conduct, but that disruptive conduct that does not extend into judicial territory cannot be grounds for withdrawal or dismissal (as cited in Unger, 1992). In short, “removal of the mentally ill student from the campus for any other than academic or behavioral reasons is, then, potentially illegal” (Hoffman & Mastrianni, 1989, p. 18).

Most colleges and universities are now aware of their legal limitations, yet many have not taken the additional steps necessary to provide a supportive environment in which their mentally ill students can succeed and complete their education successfully. If institutions are indeed committed to diversity and to providing access to higher education for those who have been historically excluded from such opportunities, they have an obligation to respond to those students who suffer from mental illness but who are still highly capable and functional.

The model which has gained the most acclaim in the last decade is the supported education model. The supported education model was created by educational practitioners at Boston University who founded the Center for Psychiatric Rehabilitation. Their model begins with the mandates established by § 504 of the Rehabilitation Act of 1973 and the ADA of 1990, and extends into guidelines for institutional practice which foster rehabilitation of students with mental illness in order to achieve their educational goals.

Supported education can be defined as ‘education in an integrated setting for people with psychiatric disabilities for whom postsecondary education has not traditionally occurred or for whom postsecondary education has been interrupted or intermittent as a result of severe disability and who, because of their disability, need ongoing support services to be successful in the education environment. (adapted from the Rehabilitation Act Amendments of 1986 as cited in Unger, 1992, and Zimmerman, 1997)

The premise of the supported education model is to provide environmental and institutional supports for students with diagnosable psychiatric disabilities. This can happen in several ways. First, a supported education model acknowledges the legal rights of students with documented mental disabilities. By acknowledging these rights, this model ensures that students are guaranteed the educational accommodations mandated by legislation. Accommodations must be deemed “reasonable” and generally include academic adjustments such as changing test formats or locations, allowing students to bring food or drink into class, allowing students to use textbooks on tape, etc. In order to be granted academic adjustments, students must provide medical documentation of their mental illness and must self-disclose to the individuals who are to grant them the adjustments. Accommodations are not changes to course and degree requirements in any way, but are meant to level the playing field and to minimize the discriminatory effects of the psychiatric disability (Center for Psychosocial Rehabilition, 1999).

The supported education model goes beyond simply providing academic adjustments. The model hopes to also provide integration of services between the medical or psychiatric treatment providers within an institution and the student disability services professionals. This collaboration also extends into the community agencies which may provide support for students with psychiatric disabilities (Unger, 1993). In addition, supported education advocates for special services and supports which benefit mentally ill students. Some of these services could include academic coaches, increased counseling services (especially at stressful academic times to handle psychiatric emergencies), peer support groups, time- and stress-management seminars, training for faculty and administrators on mental health issues, and greater dissemination on the rights of students and the disability services offered by an institution (Cooper, 1993).

While many campuses across the nation may be providing services for students with psychiatric disabilities, it is clear that there are few progressive models to follow. The supported education model is, after all, only one program and has only been implemented at a handful of institutions. Supported education is also a model that has been primarily implemented at community colleges; very few four-year institutions have followed a similar course. Moreover, psychiatric disabilities remain very misunderstood, and there is a disturbing lack of discussion of the issues among educators and student affairs professionals in particular. Young adults are the fastest growing group of individuals with mental illness (Zimmerman, 1997), and yet colleges and universities continue to push the issue to the fringes of academic and educational concerns. The burden of responsibility is consequently directed toward overburdened counseling centers or local psychiatric treatment centers. Ultimately, the psychiatrically disabled student remains isolated, underserved, and often discriminated against in the educational environment.

Mental health concerns on college campuses have moved into the spotlight, and it is critical that student affairs professionals join in the dialogue early on. With media coverage of events such as the Harvard University murder-suicide and the Columbine shootings, conversations are emerging about how we can meet the needs of mentally ill students before tragedy results. As the country begins to recognize the fragile status of mental health, colleges and universities should be the first to take the necessary action to provide healthy environments and opportunities for people who suffer from psychiatric illness--diseases as real as cancer or diabetes.

Taking substantive action on campus is the only viable option. Educating your campus community on the myths and stereotypes of mental illness is a good place to start. When faculty, students, and administrators begin to understand the prevalence of mental illness on campus, they will be more willing to learn and become sensitive to the particular needs of this population. This will create a “safe space” for students with mental illness in which they will be more apt to self-disclose and seek accommodations, as well as share their campus experiences with others.

Clinical counseling and medical resources should be drastically enhanced on campus. Access to psychologists and psychiatrists remains difficult because most counseling centers are already underfunded and understaffed, and not all student insurance plans cover mental health services. With more students on medication, more medical professionals need to be available to them in order to effectively manage the side effects of medication and provide sufficient counseling. In addition, faculty, residence life staff, and advisors need to be trained to recognize the symptoms and manifestations of psychiatric disorders, as they are often on the “front lines” when students experience their first psychiatric crisis away from the support of their families.

Many campus policies and procedures have not been modified in consideration of psychiatric illness. Student behavioral codes and academic regulations must clearly outline the rights and responsibilities of students with a diagnosable mental illness, including policies for medical withdrawals, personal files, leaves of absences or extensions, and conduct violations. Students with mental illnesses should also be informed about their legal rights to accommodations and about all available campus resources. Collaboration between deans, disability service providers, mental health professionals, and judicial and legal affairs is essential to meeting students’ needs across these different spheres.

We each work with students every day who struggle through their college experience carrying the baggage of a psychiatric disorder, and yet may never realize it. Nevertheless, the implications of our behavior and attitudes, our policies and our practices, are monumental in their success. Until recently, there has been little evidence that educators and student affairs professionals considered the implications of mental illness on the campus experience. Now, however, the discussion cannot be avoided. The questions that remain are painful to consider: Will we continue to neglect these students’ disabilities by our institutional silence while they suffer? Will we simply push them out our doors by withdrawal policies or deny them reasonable accommodations so that they fail academically? Or, are we willing to begin to re-evaluate our current practices in order to meet their unique needs? New practices, of course, will take time, energy, and money—assets which most institutions already struggle to find within their current resources. The alternatives, however, are much more expensive: the cost will be the lives of our students for whom we exist to serve.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th Edition. Washington, DC.

Chisholm, M. S. (1998, May 15). Colleges need to provide early treatment of students’ mental illnesses. The Chronicle of Higher Education, B6.

Cooper, L. (1993). Serving adults with psychiatric disabilities on campus: A mobile support approach. Psychosocial Rehabilitation Journal, 17 (1), 25 - 39.

Graff, N. P. (1996, Spring). To the outer banks of the soul. Dartmouth Medicine, 35 - 43.

Hoffman, F. L., & Mastrianni, X. (1989). The mentally ill student on campus: Theory and practice. Journal of American College Health, 38, 15 - 20.

Housel, D. P., & Hickey, J. S. (1993). Supported education in a community college for students with psychiatric disabilities. Psychosocial Rehabilitation Journal, 17 (1), 41 - 51.

Liberman, H. J., & Goldberg, F. R. (1993). Helping seriously mental ill patients to become students. Psychosocial Rehabilitation Journal, 17 (1), 99 - 108.

Lore, C. J. (1997). Student mental health and funding constraints: A delicate balance. Journal of American College Health, 46, 43 - 47.

Mancuso, L. L. (1990). Reasonable accommodations for workers with psychiatric disabilities. Psychosocial Rehabilitation Journal, 14 (2), 3 - 19.

O’Malley, K., Wheeler, I., Murphey, J., O’Connell, J., & Waldo, M. (1990). Changes in levels of psychopathology being treated at college and university counseling centers. Journal of College Student Development, 31, 464 - 465.

Perlmutter, R. A., Schwartz, A. J., & Reifler, C. B. (1985). The college student psychiatric emergency II: Diagnosis and disposition. Journal of American College Health, 33, 152 - 158.

Rimmer, J., Haliikas, J. A., & Shuckit, M. A. (1982). Prevalence and incidence of psychiatric illness in college students: A four-year prospective study. Journal of American College Health, 30, 207 - 210.

Rosecan, A. S., Goldberg, R. L., & Wise, T. N. (1992). Psychiatrically hospitalized college students: A pilot study. Journal of American College Health, 41, 11 - 15.

Sibicky, M. & Dovidio, J. F. (1984). The stigma of counseling: Stereotypes, interpersonal reaction, and the self-fulfilling prophecy. Paper presented at the Eastern Psychological Association Annual Meeting. ERIC Document 246 357.

Silverman, M. M. (1998, June 19). Treating mental illness on college campus (Letter to the editor). The Chronicle of Higher Education, B10.

Strickland, H. R. (1993). I only look normal. Psychosocial Rehabilitation Journal, 17 (1), 51 - 53.

Soyden, A. S. (1997). Frequently asked questions by educators about students with psychiatric disabilities. Trustees of Boston University. ERIC Document 429 358.

Unger, K. (1992) Adults with psychiatric disabilities on campus. Health Resource Center Publication, American Council on Education. ERIC Document 349 739.

Unger, K. (1993). Creating supported education programs utilizing existing community resources. Psychosocial Rehabilitation Journal, 17 (1), 11 - 24.

Unger, K. (1998). Handbook on supported education: Providing services for students with psychiatric disabilities. Baltimore: Brooks Publishing Company.

Valentino, M. J. (1995). Responding when life depends on it: What to write in the margins when students self-disclose. Paper presented at the Conference on College Composition and Communication. ERIC Document 385 852.

Zimmerman, G. M. (1997). Advising students with psychiatric disabilities. NACADA Journal, Monograph Series Number 5, 57 - 60.

Zuckerman, D., Debenhem, K., & Moore, K. (1993). The ADA and people with mental illness: A resource manual for employers. National Mental Health Association publication.

Websites:
The Center for Psychosocial Rehabiltation at Boston Univeristy http://www.bu.edu.sarpsych/reasaccom.html.

Corynn M. Gilbert is the Academic Counselor for Student-Athletes in the Academic Skills Center at Dartmouth College and a second year HESA student. She is a 1995 graduate of the University of Puget Sound, where she majored in communication studies and psychology.