In addition to these barriers encountered by many college students, people with psychiatric disabilities face a number of unique challenges. Perhaps the most obvious challenge is the mental illness itself. The case of Paul, explored in Chapter 1, clearly illustrates how acute psychiatric symptoms such as hallucinations and delusions can interfere with one's ability to focus on course material or sometimes even get to class. However, even when major symptoms are in remission, many people continue to struggle with residual symptoms such as reduced ability to concentrate or process information. Functional deficits can also interfere with ability to perform well in academic settings. For example, a student who lacks appropriate social skills may monopolize class discussions or repeatedly ask the professor irrelevant questions and then be unaware that his behavior is disrupting the flow of the class. (As university professors, however, we can attest that this deficit is not unique to persons with psychiatric illnesses.) In addition, side effects of psychotropic medications can cause difficulties such as slowed movements and inability to stay alert in class due to sleepiness (Cooper, 1993; Dougherty et al., 1996; Frankie et al., 1996; Megivern et al., 2003; Mowbray, Moxley, & Brown, 1993).
The stress associated with final exams or major class projects is a challenge for most students. For those with a severe mental illness, stress may contribute to the recurrence or exacerbation of symptoms (see the discussion of the stress-vulnerability-coping-competence model in Chapter 2). At times, either because of stress-induced relapse or simply due to the episodic nature of a severe mental illness, hospitalizations occur that can interrupt a student's course of study. Not surprisingly, many students who have psychiatric disabilities become discouraged by the effects that even a brief hospital stay can have on missed work, poor grades, and incomplete semesters. For some people, it is not so much the psychiatric symptoms themselves, but the fear of recurring symptoms or hospitalizations that creates a barrier to the completion of educational goals.
Another challenge faced by people with psychiatric disabilities who are trying to return to school is systems management. Many people have already been frustrated by the mental health system, the vocational rehabilitation system, and the Social Security Administra tion. Taking on yet another bureaucracy such as a large university with its own complicated systems of admission, financial aid, and registration may be overwhelming. Some students give up before they start because the application process alone is so complex. Managing these systems often requires tenacity, creativity, flexibility, and support (Cooper, 1993; Dougherty et al., 1996, Frankie et al., 1996). Many schools fail to provide adequate services for students with disabilities, and are particularly ill equipped to serve students with psychiatric disabilities. Lack of coordination between campus-based student support services and community-based mental health services is yet another systems management failure (Megivern & Pellerito, 2002; Mowbray, Megivern, & Holter, 2003b).
As if the above-mentioned challenges were not enough, many people with psychiatric disabilities also must face negative attitudes and stigma while attempting to pursue an education (Mowbray, 1999; Unger, 1994). Sometimes, these come from otherwise well-meaning family members and friends who firmly believe that their loved one is too fragile to cope with the pressures of being in school. Unfortunately, many people are also discouraged by mental health and rehabilitation professionals who hold antiquated beliefs about the capabilities of persons who have severe mental illnesses, and are thus reluctant to support them in achieving their educational goals or to refer them to supported education programs (Cook & Solomon, 1993; Frankie et al., 1996; Mowbray et al., 1993). Although many current practitioners do embrace the concepts of recovery and empowerment, too many others still convey disheartening messages such as "College and competitive employment are not in your future. If you want to stay out of the hospital you should participate in less stressful activities."
Negative attitudes and misconceptions about people with psychiatric disabilities are also commonly held by the faculty, administrators, and staff of many postsecondary educational institutions (Becker, Martin, Wajeeh, Ward, & Shern, 2002; Mowbray, 1999; Unger, 1994). Most know very little about severe mental illnesses and how these illnesses may affect students in the classroom and in other areas of college life. Many academic personnel express concern that students who experience psychiatric symptoms will be disruptive, violent, dangerous, or unable to meet academic standards (Frankie et al., 1996; Housel & Hickey, 1993; Jasper, 2002; Unger, 1998). In fact, until the passage of the Americans with Disabilities Act in 1990, some colleges and universities had dismissal polices for those who were diagnosed with a severe mental illness, even if there was no evidence of poor academic performance or dangerous behaviors (Mowbray, 1999). Despite the fact that there is now evidence that many people with psychiatric disabilities can successfully complete degree requirements and that laws are in place that protect their right to do so, attitudes on many campuses have been slow to change. Mowbray (1999) reported that in her experience academic administrators were often reluctant to spend time discussing SEd strategies and were sometimes more interested in talking about keeping people with psychiatric disabilities out of the classroom.
As you will see later in this chapter, there are many supports and resources that can help students with psychiatric disabilities overcome what may seem like insurmountable barriers to education. However, sometimes the biggest challenge is the student's own belief that he or she will be unable to manage both a mental illness and a postsecondary education. Many people with a psychiatric disability have expressed fears of failure, discrimination, and isolation in academic settings (Cooper, 1993; Dougherty et al., 1996; Mowbray et al., 1993). In addition, being labeled with a psychiatric diagnosis, failing at attempts to achieve personal goals, and experiencing the stigmatizing attitudes of others can all contribute to the low self-esteem experienced by many people with psychiatric disabilities. This type of low self-esteem has been labeled "self-stigma" and may be the most daunting barrier to overcome.
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