Moderator: Maureen Madison
June 6, 2012
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session.

Today's conference call is being recorded. If anyone has any objections you may disconnect at this time.

And now I'll turn the call over to Maureen Madison. Thank you. You may begin.

Maureen Madison: Hello and welcome to Ensuring Access and Inclusion in Higher Education: Rights, Rules, and Responsibilities.

Today's webinar is sponsored by the Substance Abuse and Mental Health Services Administration Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health also known as the ADS Center.

SAMHSA is the lead Federal agency on mental health and substance abuse and is located in the U.S. Department of Health and Human Services.

Please join the ADS Center listserv to learn more about social inclusion including upcoming webinars, new resources, and events.

This webinar will be recorded. The presentation, audio recording, and a written transcript will be posted to SAMHSA’s ADS Center Web site at http://www.promoteacceptance.samhsa.gov in late June.

The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session.

During that time, please press Star 1 on your telephone to ask a question. You will enter a queue and you will be invited to ask your question in the order in which it is received.

Upon hearing the conference operator announce your first name please proceed with your question.

Due to limited time we may not get to all questions. If your question is not answered or you want further information, the presenters’ contact information is provided at the end of this presentation so you can contact them directly.

Access to and inclusion in higher education is a central issue in achieving social inclusion. There is a significant disparity in education and literacy levels for people with mental and substance abuse disorders compared to the general population. And this is a matter of serious concern.

Access to education impacts the individual in terms of personal satisfaction, health and wellness, financial stability, and other factors essential to having opportunities for social inclusion.

All of us benefit when people with mental health and substance abuse problems have access to support to pursue an education and secure rewarding work that contributes to their becoming full participants in the life of their community.

Ensuring proper access for students calls for a proactive approach from the entire higher education community.

Administration, faculty, student services, and mental health service providers need a proactive person-directed approach that focuses on how to keep students in school and fosters a system of outreach and support.

Our speakers today will share information and resources that can be used to support people to pursue their education goals as well as inform policy, legal right and accommodation issues, and enhance our education and social practices as we move forward towards a more inclusive society.

Our first presenter is Julia Graff, an attorney at the Judge David L. Bazelon Center for Mental Health Law where she develops and litigates groundbreaking cases to advance rights and reform public systems.

Ms. Graff also represents and advises college students to help them remain in school with access to services that they need to succeed.

Prior to joining the Bazelon Center, she worked for several civil rights and advocacy organizations including the American Civil Liberties Union and the Public Citizen Litigation Group.

Julia will be speaking about each student's right to access in higher education and the importance of creating and sustaining a student-centered approach to campus mental health. Thank you for joining us Julia.

Julia Graff: Hi there everyone. Thank you for the introduction. Can everyone hear me okay?

I'm going to be talking about why and how we should pay attention to campus mental health and some of the challenges we see out there in our practice here at the Bazelon Center. And then at the end we'll go over some self-advocacy tools.

I want to start out by going over some disability rights principles for the higher education context.

On this slide, you see some of the values we would hope to see embraced on every campus. If the university's leadership espouses these principles then we are likely to see success rates rise for students with psychiatric disabilities.

So let's talk about why this is so important. Overall about 4 1/2 percent of the U.S. population experiences serious mental illness. This includes anxiety disorders or mood disorders like depression and bipolar disorder.

In the demographic though of 18- to 25-year-olds that percentage jumps up to about 7 1/2 percent. So a fairly big number when multiplied over an entire university community often of several thousand students.

So it makes sense that a fair amount of college students who largely fall within that 18-to-25 demographic struggle with their mental health.

And it also makes sense to make college education more accessible to the students so they can contribute their best selves to the campus community, earn their degrees, and then can contribute their full potential to our larger society.

Another reason it's important to rethink our approach to campus mental health is that many students entering college are just not aware that what they're experiencing is or might be a mental illness, often because it’s just emerging as they enter their late teens and early twenties.

This presents a real challenge because disability law as many of you probably know requires that college students self-identify as having a disability when they request accommodations, which is a big change from the way the law treats elementary and high school students.

But often the student hasn't yet discovered a name for their illness or even realized that they're ill or doesn't quite realize that they're experiencing certain things differently than others.

And so often a student doesn't know it until they’re simultaneously experiencing a mental health crisis and facing either suspension or failing grades or sometimes even are banned from campus.

Along similar lines, college students being relatively young, although they are the experts on how their illness impacts them and as importantly how it does not impact them, they may not yet be experts on what kinds of accommodations could help them succeed in school and participate fully in campus life, often because no one has asked them or they haven't realized that there are options available.

So we'll come back to this point in a bit because there's a lot of room here to be creative and flexible.

One more challenge I wanted to point out is that some disability services, support services personnel sometimes perceive their mission as fairly narrow or restricted, which can really limit their utility, specifically for students with mental illness.

So one thing I’d really like to see is that more disability support offices expand their focus to be not just on learning disabilities or physical disabilities, which I think is a familiar focus, but also to increase their familiarity with mental illness and the accommodations that could be appropriate in that context.

I think that too often the first context students with mental illness have with the university administration is through the disciplinary process or through the academic, how do you call it, academic probation process rather than through the accommodations process.

So this leaves us with the question: how should colleges respond to help students achieve success? And I think the answer needs to be a student- centered approach.

The main idea I want folks to take away from my presentation today is that we need to redefine the possibilities for people with mental illness rather than continually excluding them from our communities.

What I see from many universities is a knee-jerk response to exclude rather than to bring in and support.

And the biggest targets for this knee-jerk response tend to be students who exhibit self-injurious behaviors, either cutting or eating disorders or suicide attempts.

Students whose habits or their talk of suicide or self-harm either annoys or disrupts others in the community.

And students whose substance abuse becomes public in ways that are unacceptable to the university, usually by landing in the hospital for alcohol poisoning or getting arrested.

Sometimes students facing a mental health crisis will want to take a leave of absence to focus on their health.

And colleges in that circumstance should consult with the student and meet with their mental health provider about how long the student thinks he or she will need to recover and how to make that process, both the process of leaving and the process of returning, as easy and smooth as possible.

But just as often a student will want to remain in school and will have the support of his or her mental health provider yet the college will insist that it's in the student's best interest to take a leave of absence.

I would really like to see universities get away from imposing exclusion from the campus community over a student’s expressed wishes.

This kind of exclusion can have really detrimental impacts on someone's mental health. It isolates them from their natural supports such as friends and professors and their mentors. And it cuts them off from their intellectual pursuits and other activities of interest.

I chose this Viktor Frankl quote because I think it nicely captures the rationale for a more person-centered or in this case student-centered approach.

All of us and particularly people in recovery need the ability to design meaningful lives. And for some students that includes remaining engaged with their studies and with their community.

This just illustrates that there is not—there is no one-size-fits-all solution to a mental health crisis. And because each student is unique I would encourage universities to adopt a more student-centered approach to campus mental health and to adopt clear policies to facilitate this approach.

A few years ago the Bazelon Center put together a model policy to help universities address campus mental health in a more student-centered and pro-wellness way.

You can find this model policy on our Web site. I provided the URL, the link in the Resources section of this presentation.

The policy’s pretty detailed so I'll just cover some of the basics here. And actually this first slide has points that I'll cover elsewhere so I will speed ahead.

With reasonable accommodations because the idea in student-centered planning is that the strategy should emanate from the student; they don't need to conform to a list of predetermined reasonable accommodations.

The Disability Support Services Office can be flexible and dynamic here. And there's a lot of opportunities to do creative things that will serve the student that aren't necessarily going to be expensive.

Now colleges aren't required to make any modifications that would fundamentally alter their program or that would constitute an undue burden in terms of difficulty or expense.

But often as I said the solution’s really easy and inexpensive and it just takes a little bit of creativity and the political will on campus.

And I think the main question to ask in each situation is, can ideas for support that emanate from the student through guided conversations with trained staff be worked into a reasonable accommodation?

Sometimes these things are fairly standard like allowing an excused absence from class for treatment including hospitalization.

This is especially important in classes where there's a component of the grade for class participation or for attendance.

Allowing the student to drop a course after the drop date if that's when their—if that's when the crisis emerges. Also, providing retroactive withdrawals from courses if academic difficulties were due to depression or another mental health condition.

And in one of my cases, this is just an example of something that can be really easy, one of my cases my client had posttraumatic stress disorder and severe and debilitating panic attacks.

And she had a psychiatric service dog that she had trained to alert her when he sensed the physiological precursors to her panic attacks.

He was a small dog and he was trained to stand up out of his bag and lick her fingers or paw at her when he sensed increased perspiration or heart palpitation.

The requested accommodation was just to leave her be and to not have security guards escort her off campus for supposedly violating the animal control policy of the university.

Very simple, free to the university, required fewer resources than having guards remove her each time she came to class with her service dog or attending to her during panic attacks when she did not bring him.

And this is an example of a student who knew what she needed, and what she needed was easy and free to the college.

Eventually this case settled on terms very favorable to the student, and she was allowed to be on campus with her service dog.

On this note about suicide prevention I want to mention another pair of cases we had several years ago. I'll start with one called Doe versus Hunter College.

Our client was a student who took an overdose of OTC drugs and then went to the hospital. By the time she got back to her dorm room the college had changed the locks on her dorm room and said that she couldn’t return to the dorms for the next two semesters and that thereafter she could reapply.

They had a written policy at Hunter College that any student who quote, attempts suicide or in one way attempts to harm him- or herself will be asked to take a leave of absence for at least one semester from a residence hall. As a result of our settlement the college changed the policy.

And the other case I want to mention quickly Nott versus George Washington University, we represented a student who began to experience depression after his friend took his own life right as our client was trying to break into his dorm room to save him.

So after this incident he sought treatment and began taking antidepressants. One night afraid the meds that he was taking might be making him suicidal he asked a couple of friends to go with him to the hospital where he checked himself in.

And that same day the university evicted him from his dorm room and then in short order suspended him, banned him from campus, and initiated disciplinary proceedings against him for engaging in quote endangering behavior.

These kinds of approaches do a lot of harm. If students know that they will lose the roof over their heads if they go to the hospital or that they risk getting kicked out of school they will not seek help and this is not a good outcome for anyone.

Along those same lines this next point is very important and we see a theme here. Students will not seek help if they have reason to believe that the things they tell their counselor at a student health center will be used against them to remove them from school.

On to the next slide, we've already talked about the first of these. And as for conditions of reenrollment I would say that a good rule of thumb is that the policy for students with psychiatric disabilities shouldn't be any different from the policy for students with physical disabilities or who are recovering from physical illness or injury.

If they're not required to provide medical documentation when they apply for reenrollment then it really can't be required of students with psychiatric disabilities.

Okay, this next slide just lays out the primary laws that prohibit discrimination on the basis of disability in institutions of higher education.

Many people haven’t heard of Section 504 of the Rehab Act but it is essentially the same as the better-known ADA.

The ADA applies to public institutions. And Section 504 applies to both public and private institutions that accept Federal dollars which is if not everyone then nearly everyone.

I should also mention that the Fair Housing Act applies when students have issues about access to their residence halls. And it has similar principles as these other two.

Okay so here are some general take-aways from some of the cases that I’ve discussed earlier as well as some guidance issued by the Department of Education's Office of Civil Rights which is also referred to as OCR.

OCR investigates complaints of discrimination in higher ed. And when they do that they issue what's called a resolution letter to the college that is the subject of the student's complaint summing up their findings and conclusions about what does and doesn't violate Federal antidiscrimination law.

So some of the main points that can be taken both from the resolution letters that have come out as well as from Federal disability case law are—and I'll just go over some of these.

You can't take adverse action against someone because of their diagnosis and assumptions about what most people with that diagnosis experience or how most people with that diagnosis might behave.

So that is before taking an adverse action there has to be an individualized assessment that is grounded in evidence unique to that student’s experience.

This often will come up when a college believes that a student may pose a threat to him- or herself or to others. And it's really come up a lot since Virginia Tech.

One important development here is that since new regulations took effect in March 2011 OCR has issued a resolution letter suggesting that colleges can no longer take adverse action against a student who poses a threat to self but not a threat to others.

That was the Spring Arbor University case in case you want to Google it.

Just going to move on now to the next slide. This is a list of the three cases that I mentioned earlier that the Bazelon Center has brought in Federal court.

You can find more information about these and other cases on our Web site but I wanted to make sure that you knew how to spell them.

Okay let's see now what can you do if the university is not espousing the disability rights principles that I discussed earlier as a student or a student’s advocate?

First I think it's really important for college students to know what their rights are. So I encourage everyone on the call who is a college student with a mental health disability or who knows one to check out our Know Your Rights! guide which is again the URL is listed in the Resources section of this presentation.

This should help you navigate the college's internal processes about how to resolve situations that may arise.

And I'm also always happy to field questions and you'll get my contact info at the end here.

If your college or university is unresponsive you can file a complaint with OCR. And information about how to do this is also in the Resources section.

The big advantage of an OCR complaint is that the complaints do not become public. It’s intended to be a very complainant-friendly process meaning that you don't have to have a lawyer. And I know OCR tries to resolve complaints within 180 days.

Another option is to hire a lawyer to navigate conversations and negotiations with the university if they’re still unresponsive, after that to take legal action.

Bringing a lawsuit can sometimes be done under a pseudonym to maintain privacy but it's not a fast process and can sometimes take years.

So I think that's it for my part. Here are the resources that I discussed. I know it's a lot of information so I'll be happy to take any questions in the Q&A portion of the presentation.

Maureen Madison: Julia thank you for giving us insight into how to reduce marginalization and increase self-determination for students and as well as the legal aspects of ensuring inclusion and access into higher education. That was very helpful to anyone in the higher education world.

Now we’re going to hear from Lisa St. George. Lisa is the Director of Recovery Practices at Recovery Innovations and has been planning and developing a wide range of peer-run programs since September of 2000.

She shared her knowledge worldwide and worked with systems in the United Kingdom and New Zealand.

Lisa believes in the inherent courage, wisdom, and strength of people served by mental health systems.

Her lived experience in education has had a positive impact on those people as well as systems of care.

For Lisa education was instrumental in her path to wellness. Lisa will be sharing her story of overcoming barriers both internal and external and in turn helping others to overcome their obstacles to accessing education and meaningful work. Thank you for joining us Lisa.

Lisa, are you there? Lisa un-mute—un-mute—if you've muted your phone.

Lisa St. George: Can you hear me?

Maureen Madison: Yes. Thank you Lisa.

Lisa St. George: Okay sorry. Hi everyone. My story’s not unique but it's evidence to me that education and work are really powerful tools for wellness.

To reach my goals in life I had to overcome a lot of obstacles. Some of the obstacles were inside of me and some of them were outside of me. Some I had to work through and some I simply had to endure.

For me, I think that the fear and the shame that I felt around my mental health challenges were some of the hardest things that I had to overcome.

Shery Mead helped me put my shame in perspective in 2001 around my sexual abuse history when she said why is the perpetrator of my abuse walking around free and I'm labeled with a mental illness? They are the one with the problem.

That was a huge “aha” moment for me. It help me put in perspective that the shame that I felt was not mine to carry.

The other thing that was challenging was medication side effects. And some of those I had to endure until we just found a combination that help me the best.

In high school, I felt as I'm sure that many kids do like a square trying to fit in with circles. There wasn't a lot of support in those days; I don’t think that there was an awareness, very much, at that time about mental health challenges or especially childhood sexual abuse like there is now.

I was a child who was obedient and quiet. I was never any problem in school. So I think it's important for educational systems to be aware of . . .

Coordinator: Lisa has disconnected from the call. Please wait while she rejoins.

Maureen Madison: Okay. Please bear with us while we reconnect Lisa.

Coordinator: Lisa rejoins.

Maureen Madison: Lisa are you there? Lisa, un-mute.

Coordinator: Lisa please go ahead.

Lisa St. George: I'm sorry. I don't know what my phone did.

Maureen Madison: That's all right. Thanks for rejoining. Go ahead.

Lisa St. George: Thank you. So I just think that schools need to be aware of children who are too quiet, too good.

And I was really good at looking like everything was fine because I was a model from the time I was 7 years old so that was all about looking fine on the outside but on the inside everything was a mess.

It took me 11 years to find confidence after I was given a diagnosis at the age of 17 by a doctor in the early 1970s to return to school—11 years.

At that time I don't think that doctor had a lot of trauma-informed care. I don't think he was used to working with transition-age youth. And so his distance from me confused me and frightened me.

During high school I had to struggle to get through each day so I didn't think that I could do well in college because I didn't do well in high school.

I started in community college. And part of the reason I did that is because it felt safer; there were small classes and I would have access to an instructor. I could begin with the basics. And I remember that my first college math class actually started with one plus one.

I took one class at a time. And then as my confidence grew I was able to take more and more classes each semester.

And pretty soon I was ready to transfer to the university and it didn't take nearly as long as I thought.

Some barriers remained in college but I hung in there and persevered. I white-knuckled it a lot, pushing on.

At that time my oldest child was battling cancer so I had a lot of big feelings about that. And university personnel were really happy to support me when it had to do with my child's life-threatening illness.

It doesn't feel like mental health and addiction challenges are held with compassion as other illnesses, challenges, or disabilities are. So I kept quiet about my mental health issues as we heard Julia talk about.

And the application process and all the bureaucracy that goes with applying for college was really daunting. But I think that my goal was stronger for me so I persevered.

It wasn't always easy. I was still managing symptoms, taking meds, and I was enduring life's challenges as we all do.

At one point I had a series of overwhelming life events. So I had a divorce, my child's cancer left her blind, and my grandmother who’d been like a mom to me passed away.

And without thinking about it or planning it I took an overdose. I ended up in the hospital for about a month.

I was given incompletes in school and I had to make them up before the end of the next semester or they would turn into failing grades.

It was hard to take my next set of classes staying with my cohort of classmates who were now my community and complete the courses from the previous semester at the same time.

Even though the school knew I had ended up in a psychiatric hospital I wasn't given extra support and no one met with me, no one checked to see how I was doing.

But because I was used to existing with great sorrow and under overwhelming conditions I just drew upon that part of my soul to continue.

I realized my strength at that time. I began to understand very clearly that I was not weak and disabled but rather immensely strong and unique.

My graduation was a huge day for me. It was also great that I was hired at my internship before I even graduated. And I began to see myself in a different light as I took charge of my life.

The things that would have helped me in that situation were to have some peer support or some other kind of buddy to meet with who'd come through similar challenges so I didn't have to feel embarrassed about it.

And it would have also helped me to have access to support on campus. Not so much someone to weep to but rather someone to continuously remind me of my abilities.

It would have also helped if my professors would have related to me in our common humanity.

As I go through my life—I'm pretty old now—it becomes clear to me that every person has had an experience or many that they have to overcome or recover from.

And so if we can all come from that part of ourselves, that humanity and that compassion, it would be really helpful to students.

Eight years after I began my career as a social worker I was in the wrong place at the wrong time and experienced a violent attack.

This triggered a huge trauma response, and I lost 3 months of time and memory and I lost my job.

I endured these events with optimism and hope as is typical in my way of being. However, when I came into the public mental health system at that time because of my significant challenges, my doctor, who felt she was coming from a place of caring, she truly did said these words: You can never work again; you can't take the stress. Those words, more than anything in my life, caused me to lose hope.

I came into a place of despair. I felt useless. I lost my meaning and purpose. Because I lost my meaning and purpose I had constant thoughts of suicide. I felt like I was just taking up space.

But the part of me that was a mom and that was wise stayed determined and kept on trying. It still took me 6 years to move past those 10 words.

In those 6 years I experienced poverty, I went on SSDI and had I not been remarried I would have lost everything and probably my children too.

Unfortunately, I still have people tell me that they've been told by their providers that they can't work. During those 6 years I was truly helped by the public mental health system.

However I did not get many positive hopeful messages. No one seemed to believe that there was any possibility of change or recovery for any of us at that time.

All that I had done in my life was forgotten. I took care of my children; I laid on the couch, and stared at the ceiling for 6 years.

Mental health systems have to hold the hope for people. New science tells us that people recover. And it's important to help people hear about recovery at the diagnosis at the very first moment of their very worst moment.

In about the end of the sixth year of staring at the ceiling Charlotte became my case manager in the public mental health system.

Let me tell you we need more Charlottes. She reminded me of everything I’d been able to do my life. She validated my strengths and she helped me sneak and go back to work.

The reason I say sneak is because I was afraid the doctor would hospitalize me again against my will or that I would get in trouble for being noncompliant, as they say.

As a person who has always done as I was told it was really hard for me not to do exactly what I was told.

It was worrisome to me when a person is too compliant because people who experience trauma as I have are all too willing to do what they're told without question.

We all have to have the right to question in order to reach our goals. It's healthy to be able to disagree.

Charlotte never stopped encouraging me. She gave me hope. She helped me see my capabilities again. It was as if I was in a dark and scary hallway and she turned on the lights.

She told me again and again I could work. I interviewed with Gene Johnson, the CEO of Recovery Innovations, in August of 2000 and the interview was an amazing experience.

He saw my strengths, my wisdom, and my intelligence. He reflected back to me in a way I'd never experienced before—the amazing determinant—determination and courage that I had.

The fact that I had book smarts was important to him but so was the fact that I was a survivor, that I was my hopeful self. That I did not give up.

He hired me. And I started work on September 5, 2000. I came to work as a Muslim in my beautiful scarves, with my education as a social worker and a leader, and with the gift of my lived experience of recovery.

All of me was valued. I didn't have to hide any part of myself for the very first time ever.

Along with peer employment training one of the first things I was asked to do was make a Wellness Recovery Action Plan, a WRAP.

I thought when I first saw it, how can this help me? I have been in therapy and seen doctors for 30 years so I just really wondered if anything could help me.

However I was excited about my job and I wanted to do well so I worked hard making my WRAP. I got help from the team who were all trained facilitators.

WRAP changed my life completely, completely. I understood that one reason I struggled so much was triggers.

I have three pages of legal-sized paper, each line with a different trigger on the back and the front of each page, sometimes in two columns. This was a big discovery.

So I started using my action plan every time I became aware of a trigger. And as I was mindful of my triggers I understood them more and I used my tools to work through them.

Now I have three triggers left and they’re things that I’m aware of. And when they occur I work through them and I really feel strong and unstoppable.

After I began working at Recovering Innovations I returned to graduate school in 2000.

And then in 2003 while working full-time, while my oldest daughter had five major surgeries, my husband was recovering from a broken neck, and my youngest daughter was in elementary school, I graduated with an almost perfect GPA with my master’s degree.

So stress is not something I can’t take. When I went to show my doctor my degree she was really proud of me.

My thesis was on the outcomes of Recovery Innovations peer employment training. And it's been placed on the Web site of the International Initiative of Mental Health Leadership.

Since for 12 years and I'm currently in an executive position as the Director of Recovery Practices. I support our organization's attention to recovery, no force first, and recovery coaching, and a lot of other things.

In these 12 years I started our first Peer Support Services Peer Recovery Team. I helped develop the first peer employment training manual and learned to facilitate it.

I facilitated WRAP classes and saw the glorious results of that. I've written books, articles, spoken at lots of conferences, and develop many tools that help keep people in the driver’s seat of their own recovery.

I started Peer Advocacy Services in 2003. These services are in the county psychiatric hospital where we have two peer support specialists on each unit every day for 8 hours.

The outcomes in the hospital that first year that peer support was present was a 47 percent reduction in restraints and a 36 percent reduction in seclusion, which means a lot less trauma for so many people.

And additionally there was a 56 percent reduction in recidivism, which means millions of dollars were saved.

Peer support works. These statistics were all tracked by the hospital. I also assisted with the startup of our Recovery Education Center.

Then I went to San Diego and started our first services outside Phoenix. I supported San Diego County in their tremendous work to develop a recovery-focused system that’s making significant use of peer support and whole-person wellness and brought the treasure that is WRAP to many people using a wonderful team of Peer Support Specialists.

Then I opened our offices in Ventura County whose visionary leaders brought peer support workers from our team right into their clinical teams as well as supported us to provide WRAP and other classes in the community.

Then Recovery Innovations was contracted for services in New Zealand, which I had the honor of starting up.

We see the same kinds of challenges in New Zealand but we also see a commitment to peer support recovery and whole-person wellness as well as a commitment to family and community support.

In some places like San Diego where we provide peer employment training we are able to provide college credit for that class.

Peer employment training has been used in many places in the United States and other countries. And it helps create a powerful well-trained recovery-focused team. We've trained about 3,000 Peer Support Specialists worldwide.

And it's been such a joy in my life to engage in this wonderful work every day. I want you to know that even on the darkest days I always held a glimmer of hope. Hope is energy that can keep us going.

Remember that words are powerful. Hopeful words create hope and hopeless messages take away hope and it can do great harm when we use hopeless words.

Lori Ashcraft said during a training we did together in New Zealand that our job is to inspire hope in the people that we serve, to constantly connect with what is strong in them, not what is wrong.

They will begin to remember how strong they are, the treasure that they are, and how much they can do even when they are faced with significant challenges.

The world is a richer place because people like me who experience diversity of mood, thought, and emotion are here.

We contribute to the wonderful rich vibrancy of the world. Education and work can help people’s wellness. It helped mine.

My brother of choice Mike gave me a book after I had heart surgery called My Grandfather's Blessing by Naomi Remen.

And it gives me a lot of peace and hope, and it is one wellness tool I carry almost all the time because I live my WRAP every day.

As Mary Ellen Copeland says, we should all be who we want to be. And I became who I am because my education gave me knowledge and my life experience gave me wisdom. Thanks.

Maureen Madison: Lisa, thank you so much for your powerful story of resilience and hope. The lived experience that you shared with us and your work in peer recovery continues to motivate people and helps not only higher institutions of higher education but also the systems of care that you work with. Thank you so much.

Our final speaker is Dr. Dori Hutchinson, Director of Services for the Center for Psychiatric Rehabilitation at Boston University, a center funded by SAMHSA and the National Institute on Disability and Rehabilitation Research.

Dr. Hutchinson oversees a supported education program that helps students successfully navigate college life, graduate, and live their lives fully.

She's also Associate Clinical Professor at Sargent College of Health and Rehabilitation Sciences at Boston University and the Principal Investigator for SAMHSA’s Garrett Lee Smith Campus Suicide Prevention Grant also at Boston University.

Dr. Hutchinson will share how Boston University has built a supportive system of education for students with psychiatric challenges.

The ideas she shares can be implemented in other colleges and universities so that all students will have what they need to succeed and to reach their educational and career goals. Dr. Hutchinson, thank you so much for joining us.

Dr. Dori Hutchinson: Thank you and good afternoon everyone. It's really a pleasure to be on this call. And I want to thank my co-presenters for their very knowledgeable and very inspirational presentations.

It's because of folks like you that I also am inspired to try and help young adults who are challenged by any kind of psychiatric illness to be successful on campus.

As you know college has always been a significant life process and a time of great transition and growth beyond academics. It covers all of our domains in life.

And this experience is really magnified for students who are living with or beginning to develop mental illness and mental health challenges.

So I'm going to be sharing with you today what we've been doing at Boston University.

And I wanted to start with what I feel are really important principles and serve as a foundation for our program and really guide our program development and how we go about trying to create a culture on our campus so that all students have a right to an education.

We have a series of values that we really feel are non-negotiable around supported education. And these are the values of hope that we heard Lisa talk about so eloquently.

Choice: that all students should have the same choices irregardless of the challenges they face.

Self-determination: that students, students with disabilities and students with mental health illnesses, should be able to self-determine their path through college so they can get that important credential and growth.

That because this time of life when students go away to college or go to community college is such an important time of transition and growth that students with disabilities have that same right and that same capacity to grow into adults who will contribute rightfully to their communities.

So these principles really help us strive to foster the actualization of these values not just to the students who are living with disabilities but to our administration and faculty as well.

Another important foundation for us is resiliency. We focus on building skills that will help students to roll with and deal with adversity and the hassles in college life and life beyond.

We also focus a lot on health promotion and prevention. Cross-functional health is the health that you have that allows you to push off from and deal with all of the challenges and transitions that college brings.

And then finally another really important foundation in—in supported education is psychiatric rehabilitation.

We focus with our students on identifying what are their critical skills that they need and the critical supports that they need to be successful and satisfied in the valued role of being a student so they can achieve that important credential.

We know from the research that all students struggle in college. And they struggle due to sources, very sort of key sources of stress—academics, finances, relationships, family, and jobs.

And but why is this an important issue? Well what's been happening in the last couple of decades is there's been significant growth in the number of students on campus who are living with serious psychiatric challenges.

We know that 15 percent of students in a large campus study indicated that they were taking psychiatric medications and had serious psychiatric challenges.

We also know very importantly that when students are struggling and trying to learn to live well with these challenges that this can impair their academic performance and have a direct impact on retention rates.

We also know on the flip side of this equation is that education level is a key predictor for departure from Supplemental Security Income and Social Security Disability Insurance.

And so the quest to help students with psychiatric challenges achieve this very important credential of a college degree is extremely important if we are going to help people and prevent people from becoming disabled by the system and remain on Social Security.

So what are some of the barriers that students face with psychiatric challenges?

What we've learned here through our programs at Boston University is that one of the key barriers is the implementation of reasonable accommodations that are often granted by offices of disability services.

And as Julie mentioned the limits or the degree to which office of disability services helps students, they often have a very limited focus.

And so they may grant a reasonable accommodation but then having that accommodation implemented often falls short because students feel ashamed.

They are often asked to bring that reasonable accommodation to a professor themselves. And the prejudice and discrimination they may receive around that is much more than they are willing to bear.

And so those reasonable accommodations will often go unimplemented and students will struggle or fail.

Loneliness is a huge issue for students with psychiatric challenges. And college can be a time where students are surrounded by hundreds and hundreds of other students and feel very isolated.

Social media, which is how students are living their lives, can also lead to further isolation. They may have 700 friends that is listed on their Facebook but may not have any face-to-face interactions.

Various issues relating to people's wellness and self-care skills: this is a time when college students do a lot of experimenting.

They also when they’re developing any kind of mental health issue trying to navigate wellness around a mental health issue and staying well in college can be very challenging and then just the regular social and academic demands balancing that for many students is challenging. And then you add the layer of a psychiatric challenge on top of it, it can be a real mountain to climb as Lisa talked about.

So in Boston University we began a program in 2008 with some foundation funding that came from a foundation that was set up by a person who was actually separated from his university because he had a mental illness.

And he left money so that it would never happen to another person who was living with a mental health challenge.

Since 2008 we've served about 100 students through this program and it’s provided at no cost to these students.

We've been delivering supported education at BU since 1984 and have served we believe close to 2,500 people in our Supportive Education Services, but our program at BU began in 2008.

So what is it that we do for our BU students? We have some operating principles that are really important.

We are providing a coaching service that really surrounds students who are referred to us from a variety of sources including community professionals but Student Health Services and Office of Disability Services who are struggling with a serious mental health issue.

And we surround them and provide basically whatever it takes to help these students function well in all their domains.

So we help them access academic resources. We help them with wellness issues. We help them with roommate issues. We help them with their—their fitness and their nutrition.

We teach them coping strategies. We really provide whatever it takes and they determine what it is that they need to succeed in school.

What has happened as a result is that we’ve seen a de-siloing of services on our campus between Student Health and Office of Disability Services.

We are communicating comprehensively with one another because we’re all working from different angles to ensure that these students are successful on campus.

And our aim is really to create a caring academic community for anyone, for any student, who is struggling.

So our college coaches, we build relationships with students that are mutual, supportive, very person-centered.

We support students in developing a wide range of skills, relationship skills, stress hardiness, resiliency skills.

We provide and build supports. We text, we email, we call, we go to classes with students. We wait outside of classes with students.

We'll go with them to pick up a reasonable accommodation and then help them negotiate that accommodation with a professor.

We meet them all over on campus—Starbucks, the gym, we take walks on campus.

We have as a result created a large circle of collaborative relationships that really have become a safety network for students with other providers on campus, with their roommates, with their coaches, with faculty, and sometimes with the student’s family.

I can tell you a story of one student who—to give you an example of this. We had a student at our university who was a student in the School of Engineering and began to develop psychotic thoughts that led him to do things on campus that brought him to the attention of the campus police as well as the upper administration.

And there was some investigation done and they determined that this person was really not a risk for anyone on campus and they asked us to work with him.

So one of our college coaches met with this student and they talked about the symptom that was really interfering with his ability to be a successful student here.

And she taught him mindfulness skills, some walking meditations that he could use to resist the voices that were telling him to take action that—and these actions were getting him into trouble.

So she would walk up and down with him on Com Ave. helping him practice this walking meditation to resist his voices.

He was able to do this successfully. He graduated from the university with a degree in engineering and he’s now working out in his community living a full life. So it's that kind of wraparound support that we provide.

Some of the outcomes that we are witnessing in our program we—these are preliminary outcomes of a NIDRR research study that we are currently doing on this program.

As we've seen that students’ coping skills are increasing, that their satisfaction here at the university increases, that they're—both their physical and their mental wellness and I might even add their spiritual wellness is nurtured and increased and students are earning their degrees.

We've been able to increase retention and academic performance. We've been able to help shift housing policies that allow students to maintain housing with less than a full academic load.

Students used to have to have a full academic load to remain in housing. We have been able to negotiate that so they—it's a win-win for everyone.

The university is able to maintain housing dollars and the student is able to remain fully on campus and engage in their courses and be more successful.

Tuition dollars are retained this way. Grade point averages increase. And what we tell the university is that we’re cultivating future alumni donors when you have a caring community that surrounds a student who’s struggling.

As I mentioned earlier we are—this program is provided at no cost for Boston University students. And we are in the process of developing a sustainable plan for this program. And we’re looking at a variety of sources to do this.

One thing that we’re investigating is the idea of utilizing Student Health Services dollars so cost-sharing with the Student Health Service, this program so that students pay a fee, a flat fee for student health insurance when they come in and utilizing some of that money for these students to help pay for the program.

We’re also considering the idea and the university is actually considering this, as many universities are around the country, of seeking reimbursements from students’ personal health insurance and using the term “medically necessary” in order to get some of our services reimbursed.

Another option is to create a fee-for-service program with a menu of services for students with disabilities to purchase in terms of these coaching and support services.

And then we’re also in conversation with our university to seek operational costs from them to support the program.

The idea being that all students are benefiting in all colleges and in all departments at our university from this service. And having the university fund this service benefits the entire university.

Well I'm going to stop there because we’re at right at 4 o'clock.

Maureen Madison: Thank you. Thank you, Dr. Hutchinson, and thanks for keeping an eye on the time. We really appreciate that.

Your important work at Boston University really is an inspirational model for creating caring and empowering campus communities. So thank you so much for sharing that with us.

Before we open up the lines for questions we want to ask each of our speakers to share their vision for access and inclusion in higher education, so we'll start with Julia. Julia?

Julia Graff: I envision a world in which people with psychiatric disabilities can access the services they need to pursue meaningful lives of their own design without pity, paternalism, or fear.

Maureen Madison: Thank you Julia. Lisa, we’ll go with you next. What is your vision?

Lisa St. George: I envision an educational system where diversities of all kinds are welcome and where people with diversity of thought, mood, and feeling experiences are treasured for their wisdom, strength, creativity, humor, and courage as they pursue the life of their choosing.

Thank you very much. Thank you, Lisa. Dr. Hutchinson?

Dr. Dori Hutchinson: I envision the development of campus mental health services that assist students with serious psychiatric challenges in all domains of their life on campus so they may succeed and graduate with a college degree, which holds the power to prevent disability.

Maureen Madison: Thank you. Thanks to all of our speakers. They provided some great resources at the end of their presentations.

And on Slides 48 through 52 there are some additional resources so that you can learn more about the topics that they've discussed here today.

We will now take questions from our callers. To ask a question, please dial Star 1 on your telephone to be placed in the queue.

Be sure to tell the operator your name. If you do not wish your full name to be announced then please only state your first name.

Because time is limited please limit yourself to only one question. After the conference operator announces your name please ask your question.

Once you've asked your question your line will be muted so that presenters may respond.

Before we ask the operator to go to their first question we do have a question that came through on our chat.

Kelly asks, “I live in a rural region and transportation and being able to find affordable housing are big stressors and barriers to remaining enrolled in school. What models if any are addressing these or what ideas do the presenters have about addressing this issue?” We thought we might start with Dori, Dr. Hutchinson on this one?

Dr. Dori Hutchinson: Hi. So it sounds like the caller is asking is there a way a way for students like herself to access campus housing so that she can remain in school?

And certainly, depending upon the type of school in your rural area, if there's campus housing, looking at the policies that the colleges have around the number of courses and how many courses one needs to have to access housing, it would be an important first step.

Many colleges are moving towards the model of allowing students to access housing without having a full load of courses, which then makes it more affordable for students to be on campus and have housing so they can finish their degree on all domains sort of emotionally and fiscally.

Maureen Madison: Thank you. Julia or Lisa, do you have anything else that you might want to add to that?

Julia Graff: I don't.

Maureen Madison: Okay. Any thoughts?

Lisa St. George: And I guess I would say also to explore the college on Internet even though that keeps us alone and away from people. It also is a way—and I took some of my classes over the Internet and it worked well. You have to have a lot of self-discipline but you can do that too.

Maureen Madison: Thank you. Thank you for that. Operator, I think we'll go with our first question.

Coordinator: Thank you. Dr. Osborne, you may ask your question.

Dr. Osborne:Yes, thank you. We are testing supported education services for student veterans with psychiatric disabilities and other mental health challenges.

And my question is, is SAMHSA working with the VHA and the VDA to possibly secure waivers to the full-time course load requirement under the post 9-11 GI bill in order to obtain the full VAH for student veterans who do qualify as having service-connected disabilities or non-service connected psychiatric disabilities?

Maureen Madison: Okay that’s—some of that information may have to be answered by the ADS Center off-line. But we thought we might take that to Dr. Hutchinson and/or Julia.

Do you have any experience with dealing with issues related to veterans on campus?

Dr. Dori Hutchinson: This is Dr. Hutchinson in response. It's a great question you're asking. I work closely with the VA here in Massachusetts and that question has come up as well.

We do serve veterans on our campus but we—they are coming—we have a very active ROTC program. And the veterans are coming back through that door so they have somewhat of a unique situation with our university.

In terms of whether or not SAMHSA is helping to advocate for the change in that policy I am not the person to answer that question.

Maureen Madison: And for the caller you can certainly send that question to the ADS Center and we will do some more research on that for you regarding what SAMHSA may or may not be doing regarding that.

The next question operator.

Coordinator: I'm not showing any more questions.

Maureen Madison: Okay. One moment please.

Coordinator: Okay again it is Star 1 and record your name please.

Maureen Madison: Okay while we’re waiting for questions I thought I would open it up to the speakers again to perhaps—I know that you had just a prescribed amount of time.

Is there anything that—and I'll go through you each one by one. Is anything else that you wanted to add about your resources, about what you're doing that can help the people that are listening in? I'll start with Julia.

Julia Graff: Well gosh; I just cut a bunch of material so that I could make time. You know the main thing I want to say is just that, you know, a lot of the advice for self-advocacy and whatnot at the end of my presentation was geared toward students and students’ advocates.

But, you know, we created the model policy with the university administration audience in mind.

And we would be delighted to work with folks in disability support services offices or in other offices at colleges and universities to help them redesign their policies and practices to be more pro-wellness in orientation.

And I would be just as happy to receive a call from someone in the university administration as I would be to receive a call from a student.

So I hope that people would take us up on that offer. We do have a lot of experience working collaboratively with folks that might under different circumstances be kind of on the other side of the table from us. And those relationships have been really fruitful I think on both ends so.

Maureen Madison: Thank you. I think we do have a question that came in on our chat line. It's a bit of a comment but it's also a good question. And I think Dr. Hutchinson may have some experience with this.

Full-time status is a big sticking point for international students. In order to maintain their visa status they need to have a full-time load.

And I'm just wondering do you have or is—and also this the person on the chat is wondering is there anything that you’d—that you've worked with to help international students who may be in crisis?

Dr. Dori Hutchinson: This is a wonderful, wonderful comment and question because we at Boston University have a huge number of international students who come here and bring their wonderful diversity to our community.

And when they begin to develop serious mental health issues the sort of the cultural perspective obviously becomes very important as well.

At Boston University we have a large, large number of students from the Asian Pacific rim of the world where for many of them mental illnesses are—bring great shame to the family.

And so it brings into issue for us when students really struggle and we have to hospitalize them and, you know, trying to gain family support for them and the privacy issues at hand as well.

Many students don't want their family to know but then we’re caught in the quandary that family’s going to be receiving a bill from a hospital for services provided perhaps.

So it has been a very big part of our dialogue of how to be responsive and supportive of students from international countries who are struggling with serious mental health issues on campus.

We try to be very responsive and culturally respectful when it comes to these issues.

In terms of the visa issue, that's a huge consideration. And what we've tried to do is work closely with university to help students spread out their work over time in a way that we maintain that full-time status.

At the—our university is three courses so students may be able to drop down to three courses and extend assignments over time so that they're enrolled but they may be getting more additional time to complete assignments that they might need in order to complete those courses and maintain their student immigration status.

Maureen Madison: Thank you Dr. Hutchinson. Lisa, I know that you've done some work internationally. Has anything like that ever come up with you?

Lisa St. George: Well not so much in the work that I've done internationally but I would say in my own community I—we have a huge number of students who come over here to go to school.

And it is as Dori says something that's very challenging to bring up to families from many cultures.

And I think it's the responsibility of each and every person, not just educators but all of us and doctors and us as a community of human beings to see that mental health challenges are like any other illness.

And the more that we talk about them, bring them out the open as Dori talked about, create a healing community not just for people with mental health challenges but for everyone it will become more and more safe, and I don't want to use this word but normalized, for people to seek help when they're having these feelings and not necessarily go right to the mental health challenge or the diagnosis but let's see how we can get through the hard times and maybe not have to go down the whole road of a mental illness. Thanks.

Maureen Madison: Thank you. Julia, have you had any experience with international students or international student issues at . . .

Julia Graff: I have not.

Maureen Madison: Okay. All right, we have another online question. Megan asks, “I'm an education specialist working in a mental health service. I struggle with working with my clients because they're in a rural area and funding has been hard to find to support my clients just due to the fact that they’re nontraditional students. We have a regional campus here in town but other than that the only other option is driving at least 45 minutes. Most of my clients don't have transportation or cannot drive. I'm trying to provide as many educational opportunities as possible. Are there any resources that you know of that would be beneficial to helping my clients; any financial resources that you know of would help as well?”

And I know that Lisa did talk about online options. A lot of universities do have some online options. Is there anything else that the speakers can think of that could help this question?

Dr. Dori Hutchinson: One thing that we've done in the past and I know that Lisa probably recalls that Recovery Innovations has done this as well is approaching the local community college about building a collaboration for students with diverse needs and developing programming that, that’s a win-win for both the university and for the students.

So we've gone to local community colleges about our particular student population that is seeking to be engaged in higher learning but lack the resources to do so and tried to build and have at times successfully built programs where students can get credit for some of their life experiences which means they're paying for less credit as they go along.

We also have worked closely with those community colleges around financial aid information and navigation for our students.

Maureen Madison: Thank you very much. Does anyone—did any of our other speakers have anything to add?

Lisa St. George: I would just like to add that a lot of times what we've done with Recovery Innovations is we go out into the community and we might start providing wellness courses and things like that to people where they live, in different kinds of settings like churches or libraries.

And then often we’re called in to provide our peer employment training classes. So some of the people that we train go back to work and then they get the means to be able to go to get their education.

So the work might be coming before the education. And also we see that a lot of people, you know, they start that way then they continue on with their education or a lot of people go back maybe to work that they were doing before that they thought was lost to them when they were hit with their mental health challenge.

Maureen Madison: Thank you. Operator, are there any callers with questions?

Coordinator: We have a question from Laura.

Laura: Hi. I have a daughter in high school with serious mental health issues. And I'm wondering if any of you have suggestions on how to evaluate colleges—she's hoping to go to a 4-year college—on how supportive they would be when we’re looking at where she should apply? Thanks.

Dr. Dori Hutchinson: Great question and I'm delighted that you're thinking so proactively ahead of time because we often find that parents haven't done that kind of homework and kids end up, you know, sort of having losing time because we’re trying to catch up once they get here.

I think one of the things that—well there are—certainly there are colleges out there that are known for providing a very close-knit community to students with disabilities.

For example, Landmark College in Vermont is such a place; Curry College in Massachusetts is such a place where they have particular programs that provide sort of an extra layer of support for students with any kind of challenge.

I also would recommend taking a really close look at office of disability services in the colleges that she might be interested in to see what they do beyond granting reasonable accommodations and if, you know, and interviewing them about the types of work they do with students who might have mental health challenges.

And then once she decides on a college I would recommend collaborating with the Student Health Services folks and the Office of Disability Services so that they're fully informed about—with your daughter about what she needs to be successful in school.

We invite our students as they enter our university to share with us what they need to be successful on campus.

And for those students who do, it's really helpful information because we can help them hit the ground running that way.

Maureen Madison: Thank you. Julia, Lisa do you have any other things to add to that, any other helpful hints?

Julia Graff: Yes this is Julia. I just wanted to, I was going to mention what Dori did about interviewing the staff at the office of disability support services as part of, you know, I don't know if you're visiting any campuses.

But if you make a college visit I would schedule an appointment with the Disability Support Services staff, talk to them about your daughter's strengths and needs and kind of feel them out about how they usually respond and what they recommend.

And you might also even meet with someone from the housing staff just to see, you know, I mentioned some really terrible housing policies in the presentation and you would kind of want to make sure depending on what your daughter's needs are or may be what you anticipate. You might just want to talk with him about how supportive they are.

For example depending on your daughter's condition if she needs a single, is that available? If she would ever need a support person to stay with her would that be an option?

Some dorms have policies against overnight guests so you might want to look into that.

You might want to—and again this is just very condition-dependent, but you might want to know what it's like to move off campus in the middle of the semester or, you know, basically maybe brainstorm and jot down some needs that you think might arise and then interview the colleges that she's most interested in.

Maureen Madison: Thank you. Lisa?

Lisa St. George: No I think those were really wonderful answers.

Maureen Madison: Okay great. Thank you. Operator, do we have another question?

Coordinator: Yes. We have a question from Donna.

Donna: Yes hello?

Maureen Madison: Go ahead Donna.

Donna: Okay. Yes I happened—you guys are going—my question is in regards to what you guys have been talking about.

I also have some mental health challenges. And it just so happens I started my recovery at Recovery Innovations which was META back in 2002 and worked for them and then worked for the clinics in Arriba area of Arizona or Maricopa County and now have started working for Recovery Innovations again at our recovery response center.

And I have signed up with our community colleges to start in the fall to get my associate’s degree in applied science in behavioral health science.

And when I went in to enroll I went to see about prior learning experience or life experience and my CEU credits if that would kind of transfer over because I have over 9 years’ experience.

And my professor who is, also teaches a lot of the VHS classes said that unfortunately her director wouldn't transfer over any of those credits.

And I'm 53 years old and I want to go far as getting a bachelor’s degree because I'm already doing associate’s work and have been.

Are you guys checking into this because I was having trouble getting on at the beginning of the meeting?

Maureen Madison: Thank you. Do any of our speakers have any knowledge or information about that?

Dr. Dori Hutchinson: I—I'll just—this is Dori Hutchinson. I'll just respond. I don't know whether you heard me mention that we have had some luck here on the East Coast with some of the community colleges who are willing to give certain amount of credits to life experience.

We've been able to help people do that but it sounds like it's school by school or department by department even.

I would, you know, predict that all of your great work experience and life experience will probably be great, you know, foundation for you to do quite well in school and achieve your goal of getting your bachelor's degree.

Maureen Madison: Okay thank you. I'm going to try to get to a few more questions here so I'll move along to one that came through on the chat.

Sarah asks, “How can we know the difference between supporting or caring and enabling or handholding? What might be some of the limitations? How do we balance our educational purposes with being a treatment center?”

Dr. Dori Hutchinson: Could you repeat that question again?

Maureen Madison: Certainly. How can we know the difference between supporting or caring and enabling or handholding? What might be some limitations?

How do we balance our educational purposes with being a treatment center? What are some of the balance issues that come with that?

Dr. Dori Hutchinson: Okay I—this is Dori. Can I respond to that please?

Maureen Madison: Certainly.

Dr. Dori Hutchinson: I'll take a first stab at it. First I feel quite strongly that, you know, we talk a lot in psychiatric rehabilitation that dependence is not a dirty word and that people with psychiatric challenges need supports to be successful often. And often people with psychiatric challenges need people to be supportive.

And we don't say to a student in a wheelchair okay you've used the wheelchair too long and we want you to start walking now. It's time to get up out of that wheelchair and walk.

But we do that with people with mental illnesses. We say, you know, enough is enough, pull yourself up by your bootstraps. We've given you that kind of support.

And I say that based on our experiences here in our, you know, our university there is that sort of prevailing attitude that we, you know, we’re not a mental health center, we’re a university.

I contend that every person with a mental illness has a right to the education if they can get accepted on their credentials to come into the school. And if they need people supports to be successful then so be it.

And they determine how much they need and how little they need and when—and our goal is—our responsibility really as people who are supporting students at our universities is to empower students to really take charge of their education and their life during this time of their life when they’re being educated.

So it's really our responsibility to develop, you know, empowering programs and practices that give students the skills and the supports that they need so they can succeed and graduate.

So, you know, it is a—it's your question is right on. It's a balance. But it's also about the values and principles that we use while we’re doing that balance and also our attitudes around. For some folks they might need handholding to get to that exam and to get out of that exam.

But if it allows them to do well in school and get the degree and then they mature and develop and they get out there and work then that has served its purpose.

Maureen Madison: Thank you very much. I know that there are some more questions that have come in and unfortunately we don't have much time for that.

So if you do have questions that have not been answered we encourage you to connect with the speakers directly with those questions.

And I'm sure they'll work on a very interesting dialogue between you and give you some individual attention on that.

We just want to share one more kudo. Barbara says kudos to all the presenters. Lisa you are an amazing inspiration; bless you. You have given me more hope and encouragement in obtaining my master’s degree. I've procrastinated over 5 years now. From a grateful peer, thank you.

And for Kerry who talked about the Jed Foundation who has great resources for parents and students including their transition to your Web site, we'd like to say that the Jed Foundation is on our resource list so please check that out at the end of the presentation.

Again thank you so much for the thoughtful questions and answers. It really picked up speed there towards the end so we really appreciate that.

And I know that we didn't get to everybody and I do apologize for that but we really encourage you to either talk to the ADS Center or to the speakers directly.

You can reach out to the ADS Center at promoteacceptance@esi-dc.com. Contact for each speaker is available on Slide 54 and you can read more about each speaker on Slides 55, 56, and 57.

In addition we really value your feedback. Within the next 24 hours you will receive an email request to participate in a short anonymous online survey about today's training.

It will take about 5 minutes to complete. Please take the survey and share your feedback with us. Survey information will be used to help determine what resources and topic areas need to be addressed by future training events.

This conference has been recorded and the audio recording and transcript will be available in late June on the SAMHSA ADS Center Web site.

If you enjoyed this training teleconference we encourage you to join the ADS Center listserv to receive further information on recovery and social inclusion activities and resources including information about future teleconferences.

To learn more about SAMHSA’s wellness efforts, go to http://www.samhsa.gov/wellness.

We’ve come to the end of our time today. Again if you have more questions or would like followup please contact the SAMHSA ADS Center.

The Web site is http://www.promoteacceptance.samhsa.gov. For future reference the ADS Center contact information is on Slide 61.

On behalf of all of us at SAMHSA’s ADS Center we want to extend our sincere appreciation to Julia, Lisa, and Dr. Hutchinson who donated their time and expertise to help all of us learn more about access to higher education and a student-centered approach to campus mental health as well as lived experience in gaining an education and a career.

And thanks to you all of our listeners for taking time out of your afternoon to join us and thanks in advance for completing our survey. Goodbye.