The New Face of College Counseling Services
AN INTERVIEW WITH PHIL MEILMAN
BY NANCY GRUND
Phil Meilman, director of counseling and psychiatric services and professor of psychiatry at Georgetown
University, is co-editor along with Paul Grayson, New York University’s director of counseling and
behavioral health services, of College Mental Health Practice (Brunner Routledge, 2006). He has
also served on the board of directors of the American College Health Association and on the Health Services
Advisory Board of Princeton University. Leadership Exchange spoke to Meilman about trends in identifying
and treating students with mental illness.
How has pressure increased on college campuses to
identify students in need of mental health services?
“There is a significantly greater level of concern about the
dangerousness of certain students. Colleges and universities
are putting in place student-of-concern committees. Here at
Georgetown we are using case management, which typically
consists of representatives from many offices, including counseling, residential life, chaplains-in-residence, off-campus life,
judicial affairs, associate deans, and advising for student services. The team meets weekly as an early warning or radar
detection system for students who are at risk or have the
potential for causing difficulty on campus.
Actual crises and mental disturbances have become more
commonplace. There is a movement in the direction of what
might be called forceful interventions: Therapists acting both
in loco parentis and in protection of the institutions they serve.
College clinicians, higher education institutions, and recent
court decisions have swung back to a more directive stance,
assuming a greater sense of responsibility for the individual’s
behavior and campus welfare.”
What is the bottom line for universities?
“Students who make risky and dangerous choices warrant
strong responses. That raises many questions for counseling
center staff and their respective institutions. At what point do
clinicians violate students’ right to confidentiality in the name
of protecting them? At what point do clinicians take steps that
their patients might oppose to protect the larger student
community? How does a clinician balance his or her therapeutic role with an administrative role?”
How have students changed?
“We are dealing with a more diverse student population.
Students today differ in race, ethnicity, country of origin,
sexual orientation, socioeconomic class, and age. People work
in jobs that are constantly changing, live in different types of
families, choose from lots of different media. Computers, cell
phones, and other devices, such as personal digital assistants,
are dominant in students’ lives. College careers no longer
mean four consecutive years at the same institution. Students
now increasingly use and abuse prescribed medications. All of
these things affect students’ adjustments in college and find
their way into therapy sessions.”
How has the actual counseling practice changed?
“I came into the field 31 years ago. My first job was as a staff
psychologist at William and Mary. In 1977, we had a steady
diet of developmental cases—homesickness, test anxieties,
boyfriend/girlfriend problems. I can’t tell you the last time
someone came in with normal developmental problems.
Today clinicians must brace themselves for suicidal and self-cutting students, substance abusers, and those with eating
disorders, psychotic breaks, and chronic mental illness.
The trend today is toward more targeted treatments based
less in theory and designed to produce demonstrated results.
There is a lot more interest in creating a safety net on campus
with training for faculty and staff to learn to assess and refer
troubled students. The threat assessment teams that campuses
are putting together take it to a higher level and bring in legal,
public affairs, and the campus police.”
What factors contribute to this shift in the severity
of cases?
“Since the 1970s there has been an explosion in the pharma-
ceutical industry with more and better drugs. In the ’70s,
there was basically haldol and thorazine for psychoses and
valium and librium for anxiety. Now there is a full menu of
drugs, and pharmaceutical companies market directly to the
public, which reduces the stigma of taking these drugs. Kids
are medicated in middle and high school, with prescriptions
