STARTING THE

CONVERSATION
College and
Your Mental Health
Copyright August 2016, the National Alliance on Mental Illness (NAMI) and The Jed Foundation

ABOUT NAMI
NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organiza-
tion dedicated to building better lives for the millions of Americans affected by mental illness.

What started as a small group of families gathered around a kitchen table in 1979 has blossomed into the
nation’s leading voice on mental health. Today, we are an association of thousands of state organizations,
local affiliates and volunteers who raise awareness and provide advocacy, education and support in com-
munities across the United States.

ABOUT THE JED FOUNDATION

JED is a national nonprofit that exists to protect emotional health and prevent suicide for our nation’s
teens and young adults. We’re partnering with high schools and colleges to strengthen their mental
health, substance abuse and suicide prevention programming and systems. We’re equipping teens and
young adults with the skills and knowledge to help themselves, and each other. We’re encouraging com-
munity awareness, understanding and action for young adult mental health.

Facebook: NAMI Facebook: jedfoundation

Twitter: NAMICommunicate Twitter: jedfoundation
Instagram: NAMICommunicate Instagram: jedfoundation
Tumblr: notalone.nami.org n ok2talk.org YouTube: jedfoundation
WHY START A
NAVIGATING
CONVERSATION
COLLEGE
ABOUT MENTAL
page 4
HEALTH? page 3

STARTING YOUR
CONVERSATION
page 6
MENTAL HEALTH CONDITIONS ARE
COMMON page 7

COMMON SIGNS OF A MENTAL HEALTH

CONDITION page 8

MENTAL HEALTH CARE ON CAMPUS page 13

HEALTH INFORMATION PRIVACY LAWS

AND RULES page 15

KEY TAKEAWAYS AUTHORIZATION

page 22 FOR RELEASE
OF HEALTH
INFORMATION RESOURCES
page 25
page 23

S TA R T I N G T H E C O N V E R S AT I O N 1 C O L L E G E A N D YO U R M E N TA L H E A LT H
A NOTE TO READERS...

TO STUDENTS: This guide is written to provide you with important information about mental
health during the college years. We encourage you to read this guide, learn from it and use it to

start and continue a conversation about mental health.

TO PARENTS: This guide is for you, too. It’s important to know more about mental health
1

during the college years and proactive steps that can help you support your student if needed.

The term “parents” is used throughout the guide to include caregivers, family members and other important and trusted adults involved in
1

the lives of college students.

ACKNOWLEDGMENTS
This guide was made possible by support from the National Technical Assistance Network for Children’s
Behavioral Health at the University of Maryland, a center funded by the Center for Mental Health Services,
Child, Adolescent & Family Branch of the Substance Abuse and Mental Health Services Administration
(SAMHSA). NAMI and JED greatly appreciate the support for the guide.

NAMI and JED thank the college students and parents who contributed their ideas and expertise to this
guide. Their input helped us to effectively communicate the importance of college students and families
learning more about mental health, holding conversations and better understanding health information
privacy laws and rules. NAMI would especially like to thank Elizabeth Bryan and Robert Marko-Franks,
college students and summer interns, for their valuable contributions to the report. NAMI appreciates the
legal expertise and guidance on HIPAA and FERPA shared by Adam H. Greene, a partner with the law
firm of Davis Wright Tremaine, and Anna Watterson a lawyer formerly with the firm. We also appreciate
the contributions of Nancy: Wolf and Margaret Go, parents who shared their personal experience and
expertise on this topic.

This guide was prepared by the staff at NAMI and JED. NAMI staff included Darcy Gruttadaro and Angela
Kimball. NAMI thanks Caren Clark, Happy Carlock, Valerie Hunter, Lauren Gleason and others for providing
helpful review and comments during the preparation of the report. This report is made possible by the
leadership of Mary Giliberti, Chief Executive Officer of NAMI. JED staff included John MacPhee, Gussie
Foshay-Rothfeld and Victor Schwartz.

S TA R T I N G T H E C O N V E R S AT I O N 2 C O L L E G E A N D YO U R M E N TA L H E A LT H
WHY START A CONVERSATION
ABOUT MENTAL HEALTH?

Attending college is an important achievement and exciting time in life. You will gain
greater independence, meet new people and have new and memorable experiences. It
is a time of significant transition, which can be both positive and challenging. For some,
the stress of college may impact mental health, making it difficult to manage the daily
demands of school. In fact, did you know as many as one in five students experiences a
mental health condition while in college?

To help put a thoughtful plan into place should a mental health condition arise, NAMI (the
National Alliance on Mental Illness) and JED have created this guide to help start the
conversation. It offers both parents and students the opportunity to learn more about
mental health, including what the privacy laws are and how mental health information can
be shared.

Conversations allow you to plan for the unexpected; to know what to do if you develop emo-
tional distress, a mental health condition or if an existing condition worsens. Talking about
mental health is important even if you don’t experience a mental health condition because a
friend may need help. Students often prefer to confide in a friend before confiding in anyone
else—or you may notice that a peer is struggling and you may be able to assist. By learning
more, you’ll be better equipped to know what to do if you or a friend is in distress.

S TA R T I N G T H E C O N V E R S AT I O N 3 C O L L E G E A N D YO U R M E N TA L H E A LT H
 S T R E S S O R S T H AT M AY
A F F E C T M E N TA L H E A LT H

77 Relationship breakups
77 Academic pressures
77 Poor grades
77 Financial stress
77 Social status pressures
77 Feeling alone or homesick
NAVIGATING 77 Feeling marginalized, misunderstood

COLLEGE or like you don’t fit in

77 Concern or worry about your family
members at home

College life is full of opportunities for per- 77 Loss of day-to-day family or

community support
sonal growth, greater independence and
77 Drug and alcohol use
exploration of new social and academic
77 Inadequate sleep
experiences. New experiences make col-
77 Feeling overwhelmed
lege an exciting time, but one that may 77 Grief
also be stressful. Stress may come from 77 Gender and sexuality questioning
keeping up with academic demands, 77 Friendship challenges
forging new relationships and managing 77 Sports team losses

greater independence. Changes in stress 77 Unmet expectations

levels, along with new sleep patterns and

eating habits, can have a big impact on
your health.

S TA R T I N G T H E C O N V E R S AT I O N 4 C O L L E G E A N D YO U R M E N TA L H E A LT H
 BUILDING
CONNECTIONS

Also, many students face insecurity, Connections with others, including

loneliness or disappointment during involvement with campus and community

college. Others may experience bouts activities, can help you protect your mental
health. Explore opportunities through your
of depression, anxiety or the start of
campus student activities center and get
other mental health conditions. While
involved in one or more of the following:
strong feelings are common, we want
you to know what to do if you feel too 77 Campus events
77 Campus clubs
overwhelmed, if you begin to experience
77 Campus interest groups
mental distress or if an existing condi-
77 Sports
tion worsens.
77 Student organizations
77 Volunteer activities

MANAGING
STRESS

77 Create to-do lists and tackle items one 77 Practice mindful meditation or prayer
by one 77 Eat healthy foods
77 Exercise 77 Avoid alcohol, drugs, smoking and caffeine
77 Get enough sleep 77 Seek support from family, friends or peers
77 Explore time-management strategies 77 Talk with your resident advisor, a trusted
77 Ask friends how they manage stress adult or the campus counseling or
77 Listen to relaxing music guidance center

77 Set aside time for self-care

S TA R T I N G T H E C O N V E R S AT I O N 5 C O L L E G E A N D YO U R M E N TA L H E A LT H
 WHO TO INCLUDE IN
YO U R C O N V E R S AT I O N

STARTING YOUR We recommend starting a conversation with

your parents about mental health. If your
CONVERSATION support network includes trusted adults
who are not family members, that’s OK;
have your conversation with trusted adults
The following four topics are important
who will provide support if you need it.
to discuss as part of your family conver-
sation about mental health. We encour-
age you to review the information in this
guide about each of these topics and
share it within your family as part of your
conversation.

1. Mental health conditions are

common

2. Common signs of a mental

health condition

3. Mental health care on campus

4. Health information privacy laws

and rules

S TA R T I N G T H E C O N V E R S AT I O N 6 C O L L E G E A N D YO U R M E N TA L H E A LT H
MENTAL HEALTH C O N V E R S AT I O N
S TA R T E R S
CONDITIONS ARE
COMMON Conversation starters for students:

77 My school shared this guide about

77 1 in 5 youth and young adults
mental health. Can we sit down and
experiences a mental health condition 2

talk about it?

77 75% of all lifetime mental health
77 This guide has helpful information
conditions begin by age 24 3

about handling stress and

77 30% of college students reported information schools can and cannot
feeling so down at some point during share with families. I’d like us to
the previous year that they found it review it together.
difficult to function 4

Conversation starters for parents:

Experiencing emotional distress or devel-
77 I know you’re excited about starting
oping a mental health condition while in
school next month, and I’m excited
college can be lonely and frightening, but
for you too. Before school starts,
it doesn’t have to be. Feelings of anxiety,
I’d like to talk with you about some
depression and mental health conditions are
common struggles that might arise.
common, and recovery is possible. Building
This guide has helpful information.
connections to others and having a strong
77 (If relevant) We have a family history
network of support can help—and so can
of mental illness or substance
talking. The more you talk about mental
abuse, so I’d like to talk with you
health, the easier taking care of your health about mental health. This guide has
and well-being will be. information that can help you be
proactive about your overall physical
National Institute of Mental Health. Accessed on the web at http://
2

www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness- and mental health.

ami-among-us-adults.shtml
National Institute of Mental Health. Mental Illness Exacts Heavy Toll,
3

Beginning in Youth. June 6, 2005. Accessed on the web at http://

TIP: Don’t let the conversation stop there.
www.nimh.nih.gov/news/science-news/2005/mental-illness-exacts-
heavy-toll-beginning-in-youth.shtml. Keep it going and check in periodically
American College Health Association. American College Health Asso-
4

ciation National College Health Assessment II. Spring 2014. Linthicum, throughout the school year.
MD: American College Health Association; 2014.

S TA R T I N G T H E C O N V E R S AT I O N 7 C O L L E G E A N D YO U R M E N TA L H E A LT H
COMMON SIGNS OF A MENTAL HEALTH CONDITION
Mental health conditions have 10 common warning signs that should be taken
seriously. If you or someone you know experiences one or more of these signs, you
should talk with trusted family, peers or mentors and seek assistance.

1. Feeling very sad or withdrawn for more than two weeks

2. Severe, out-of-control risk-taking behaviors

3. Sudden overwhelming fear for no reason

4. Not eating, throwing up or using laxatives to lose weight

5. Seeing, hearing or believing things that are not real

6. Repeatedly and excessively using drugs or alcohol

7. Drastic changes in mood, behavior, personality or sleeping habits

8. Extreme difficulty in concentrating or staying still

9. Intense worries or fears that get in the way of daily activities

10. Trying to harm oneself or planning to do so

It can be difficult to know whether what you are experiencing is an early sign of an emerg-
ing mental health condition or part of adjusting to college. You don’t have to know the
answer to this question. Listen to your mind and body. If you are not feeling right and are
having trouble shaking that feeling, then talk with someone who can help you sort things
out and help you decide what kind of support or care you need.

S TA R T I N G T H E C O N V E R S AT I O N 8 C O L L E G E A N D YO U R M E N TA L H E A LT H
 CAMPUS RESOURCES
F O R M E N TA L H E A LT H

Talk with your parents or a trusted adult 77 Call the campus counseling or health

about what to do if you are worried center

about your mental health—ideally, before 77 Request a confidential conversation

with your resident advisor if you are
you leave for college. Here are some
in a campus residence hall
issues to consider:
77 Talk with the dean of student affairs,
77 Whom will you talk to? peer support specialist or campus
chaplain
77 How can your parents or other
77 Request a confidential conversation
trusted adults be most supportive?
with your academic advisor or a
77 How much and what information faculty member
would you want shared with your 77 Contact the leader of a campus
parents or trusted adults about your mental health organization, such as
situation? NAMI on Campus or Active Minds

77 What works best for you in sharing

TIP: Not all conversations can be kept
and conveying information?
confidential, especially if you share
information about self-harm or harming
Think through your preferences and create
others. In general, the most confidential
a simple plan if you begin to experience
place on campus is the counseling or
emotional distress or if you suspect you mental health center. They can share
might have a mental health condition. information about you only with your
agreement—unless they feel you might be
Be sure to discuss any family history of
an immediate danger to yourself or others.
mental illness; mental health conditions Other offices might discuss your situation
often run in families. If a family history and concerns with other professionals on
is present, know the warning signs, pay campus or perhaps your parents—but only

close attention to your mental health and if they are directly concerned about your
safety or risk to others.

S TA R T I N G T H E C O N V E R S AT I O N 9 C O L L E G E A N D YO U R M E N TA L H E A LT H
ALCOHOL AND
DRUG USE

Avoid alcohol and drug use to cope with seek help when needed. And if you cur-
stress and if you are experiencing the rently use mental health services, talk about
warning signs of a mental health condition. how you’ll continue your mental health care
Alcohol and drug use can worsen an on campus, how you and your family will
underlying mental health condition.
recognize new or increased symptoms and
Drug use, especially marijuana and
what you will do if such a situation arises.
hallucinogens, may increase the likelihood
of psychosis in people who are at risk of Also discuss strategies for managing stress
developing a serious mental illness.
during college because high levels of stress
increase the risk of developing a mental
health condition. Talk about what you will
do and who you will reach out to if you
experience a high level of stress or find it
difficult to manage stress.

Keep the conversation going throughout

the school year because your mental health
and stress levels can change. Some students
report not confiding in parents about declin-
ing mental health to avoid worrying their
family, especially when they are far from
home. However, communicating with your
parents or a trusted adult can help you get
needed support.

S TA R T I N G T H E C O N V E R S AT I O N 10 C O L L E G E A N D YO U R M E N TA L H E A LT H
 SUICIDE HELP AND
RESOURCES

If you find yourself struggling, seek help. If you or someone you know is experiencing

The sooner you get help, the better. Don’t suicidal thoughts and feels like life is not

take on the burden of what you are expe- worth living, seek help immediately by
calling the National Suicide Prevention
riencing alone; reach out so others can
Lifeline at 800-273-TALK (8255), by texting
support you. Reaching out is a sign of
Crisis Text Line at 741741 or by calling
strength. We all have challenging times
911. Involve others; connect with family,
in life when we need to lean on family,
a resident advisor, a counselor, a trusted
friends and professionals for support. You friend or another trusted adult.
are not alone.

Suicidal behavior is also a risk for college

students, especially when mental health
conditions are undetected and untreated.
Suicide—although rare—is the second
leading cause of death among youth
and young adults ages 15 to 25. Suicide
can be a difficult topic, but talking more
about mental health and seeking care
and support when needed can help keep
you safe.

S TA R T I N G T H E C O N V E R S AT I O N 11 C O L L E G E A N D YO U R M E N TA L H E A LT H
 I F YO U A R E A PA R E N T
O R T R U S T E D A D U LT
WHO SUSPECTS A
STUDENT IS STRUGGLING

Even if you are not experiencing diffi- REACH OUT. Let him or her know you are

culty, you could be in a position to help concerned.

a friend or peer who experiences emo-

CONTACT COLLEGE STAFF. If your student
tional distress or develops a mental health
is unresponsive or you think the issue
condition during college. Know the signs could be serious, contact a campus mental
and the mental health resources on your health professional, the dean of students or
campus. Don’t be afraid to say something. another staff member.

You do not increase the risk of suicide

SHARE INFORMATION. A campus mental
by talking about it with a friend you are
health professional may not be able to
worried about. By speaking up and letting
provide health care information, but they
someone know you care, you may help can listen to your concerns or health
him or her get the help they need. information about your student.

KEEP TALKING. Help start—and continue—a

dialogue about mental health.

S TA R T I N G T H E C O N V E R S AT I O N 12 C O L L E G E A N D YO U R M E N TA L H E A LT H
MENTAL HEALTH CARE ON CAMPUS
Whether you currently use mental health services, begin to
experience distress or develop a mental health condition
or never need mental health care, you should know how to
access mental health care on campus.

Many people with mental health conditions attend and are

finding success in college and many colleges are working
to accommodate and support students with mental health
needs. Most—but not all—colleges have a counseling center
or health clinic on campus. A counseling center or health
clinic can help by talking with you or by linking you to other
campus or community-based resources.

Here are things to check out online or in-person before or

soon after you arrive on campus:

:: Where are mental health services provided?

:: How do you make an appointment for mental health care?

:: Are drop-in services available?

:: How do you access mental health services after hours or

in an emergency?

:: What mental health services and programs are available?

:: Are there any fees for mental health services and

supports?

:: Are there limits on the type or amount of services

available and if so, will your school link you with care in
the community?

S TA R T I N G T H E C O N V E R S AT I O N 13 C O L L E G E A N D YO U R M E N TA L H E A LT H
 OFFICE FOR STUDENTS
WITH DISABILITIES

If you do not find information about men- If you have an existing mental health
tal health care on campus or your college condition or develop a condition, learn

does not offer mental health services, more about your college’s office for
students with disabilities. Talk with the
contact your school’s health center if one
office about possible accommodations
exists or the disability services office for
for your condition, if needed.
assistance. Your school may partner with
a community mental health center where
they will refer you. You may also seek
guidance on resources from your academic
advisor.

Once you have explored mental health ser-

vices that are available, put mental health
center and emergency service contacts
into your phone.

In addition to mental health services, your

college may have additional resources,
such as trained peer support specialists or
peer education services, clubs focused on
mental health (such as NAMI on Campus
and Active Minds) and spaces for open
dialogue about mental health.

S TA R T I N G T H E C O N V E R S AT I O N 14 C O L L E G E A N D YO U R M E N TA L H E A LT H
HEALTH INFORMATION
PRIVACY LAWS AND
RULES
If you experience distress or a mental
health condition and seek help at college,
you should know how your health infor-
mation is protected and what your options
are for sharing health information with
your parents or trusted adults.

Health privacy and confidentiality laws

protect your health records, including
mental health records, because if you are
over age 18, you are legally entitled to this
protection. These laws safeguard your
information, but they can also prevent
colleges from contacting your parents if PA R E N TS C A N S H A R E
you are facing significant challenges or a I N F O R M AT I O N
serious mental health condition. Yet, par-
ents or a trusted adult may be important Parents are legally permitted to share
sources of support if you experience chal- information about you with the school or

lenges, especially at the onset of a mental mental health professionals. This one-way

health condition or if an existing condition communication can help if your parents or a

trusted adult are worried about you or have
worsens or results in hospitalization.
important information about your mental
health, including medications, successful
treatment approaches, co-occurring
medical conditions or special needs.

S TA R T I N G T H E C O N V E R S AT I O N 15 C O L L E G E A N D YO U R M E N TA L H E A LT H
Health privacy and confidentiality laws require an emergency or an imminent threat of
harm to self or to other people before parents may be contacted and health information
shared. While many people believe that parents would be contacted in a serious situation,
this is not always the case. The interpretation of “emergency” or “imminent threat of harm
to self or other people” can vary, and identifying when you or someone you know is expe-
riencing a mental health crisis is not always easy. Further, a mental health provider may
believe that the family is a major source of conflict or distress and could worsen the situa-
tion. In assessing difficult situations, providers often choose to protect health information.

If you are over age 18, you can decide whether or not to authorize the sharing of health
information with your parents or a trusted adult and, if so, what information you are willing
to share. Consider completing an authorization form before you leave for school so that
your parents or a trusted adult can help you if you experience a mental health challenge.
If you have an existing mental health condition and value your parents’ or another trusted
adult’s support, it is especially important to consider completing an authorization form.
And remember, you retain the right to revoke your authorization at any time.

Two federal laws regulate when information included in your student education records
and health information may be shared with your family or others. The Family Educational
Rights and Privacy Act (FERPA) protects information in your student education records.
The Health Insurance Portability and Accountability Act (HIPAA) protects your health
information.

S TA R T I N G T H E C O N V E R S AT I O N 16 C O L L E G E A N D YO U R M E N TA L H E A LT H
L AW S A N D R U L E S O N
H E A LT H P R I VAC Y 5

Family Educational Rights and Privacy Act (FERPA)

What does FERPA FERPA applies to student education records including records kept
apply to? in college counseling and health clinics

What protection does FERPA prohibits colleges from sharing information in student
FERPA provide? records with parents, with narrow exceptions such as:
77 In a health or safety emergency
77 If parents document that the student is claimed as a tax
dependent
77 With written authorization from the student

Can I sign a FERPA Yes, FERPA authorization forms are offered by most colleges online
authorization form or through the office of the Academic Dean.
allowing my parents
Note: FERPA authorization forms do not permit clinicians to share
or others to access my protected health information. That requires you to complete an
authorization form, such as the one included with this guide.
education records?

Are there state laws Yes, mental health providers working in campus counseling centers
and other rules that may also be subject to state laws and professional licensing rules
protect my records that are more restrictive than FERPA.
kept in the campus
Note: These laws and rules may restrict mental health professionals from
counseling center? communicating with parents. Your written authorization is important if you
want your mental health provider to share information with your parent,
such as if you experience a serious situation or a mental health crisis.

Mental Health Care in the College Community. Edited by Jerald Kay and Victor Schwartz © 2010 John Wiley & Sons, Ltd.
5

(Book Chapter 7: Karen Bower, J.D., and Victor Schwartz, M.D. Legal-Ethical Issues in College Mental Health).

S TA R T I N G T H E C O N V E R S AT I O N 17 C O L L E G E A N D YO U R M E N TA L H E A LT H
Health Insurance Portability and Accountability Act (HIPAA)

What does HIPAA HIPAA applies to health information kept by health care providers
apply to? outside of the campus community, such as:
77 community psychiatrists
77 therapists and counselors
77 campus-based university hospitals

What protection does HIPAA prohibits the sharing of your health information with your
HIPAA provide? parents except:
77 In a health or safety emergency
77 When an individual presents a threat of harm to self or others
77 With verbal or written authorization from the student

Can I sign a HIPAA Yes, this guide includes an authorization form for you to use to
authorization form disclose information to others. You also have the right to access
allowing my parents your health information, although psychotherapy notes are
or others to access my generally not disclosed.
health information?
Note: HIPAA does not allow psychotherapy notes to be shared unless
an authorization form specifically authorizes the disclosure. Even then,
therapists may refuse to disclose therapy notes.

Are there state laws Maybe; some states have laws that are more restrictive than
that cover my health HIPAA. However, a signed authorization should permit disclosure.
information? Unlike FERPA and student education records, parents are not
permitted to access health information by showing that they claim
you as a tax dependent.

S TA R T I N G T H E C O N V E R S AT I O N 18 C O L L E G E A N D YO U R M E N TA L H E A LT H
By discussing these issues with your TYPICAL SCENARIOS
parents or a trusted adult and planning I N V O LV I N G H E A LT H
ahead, you can make thoughtful and P R I VAC Y
informed decisions about sharing mental
health information instead of having to 77 Parents call a college counselor

decide when a mental health condition who is working with their son to say
that, on his last phone call home, he
develops or worsens and the stakes may
sounded down and has not returned
be considerably higher. With an under-
texts or calls for three days. They are
standing of health privacy laws and rules
worried. HIPAA and FERPA do not
and the circumstances in which colleges
limit the ability of families to reach
can communicate with your parents, you out to treating providers. Families
are better equipped to have an informed may also send documents to the
conversation about information-sharing. counselor or college administrators
with their concerns. They may also
As you consider whether you want to ask for the college to check in with
authorize your parents or a trusted adult the student. The counselor is likely
to have access to protected health infor- to tell the student that the parents
mation, keep in mind the following: called and that they are worried
about the student. However, without
77 Your school must have verbal authorization, the counselor may
or written authorization before not respond with specific or detailed
disclosing health information to your information, but they may listen to the

parents or others unless there is a family and often do. The counselor
may, however, discuss certain topics
serious or imminent threat of harm to
or information with the family if the
self or others and under other narrow
student has authorized the counselor
exceptions.
to do so. (MORE ON NEXT PAGE)

S TA R T I N G T H E C O N V E R S AT I O N 19 C O L L E G E A N D YO U R M E N TA L H E A LT H
77 A mother receives a call from her child’s roommate, who says she
is worried about the student; she is not going to class, rarely leaves
the dorm room and is not doing well. The parent calls the dean of
students and leaves a message, then calls the counseling center to
find out if her daughter is receiving services and to get help. Without
authorization, the dean and counseling center will likely not share
any details about the student with the family but may talk with the
family with general information. School staff and administrators are
likely to look into the welfare of the student. However, if they do not
believe that the situation involves an emergency or an imminent
threat of harm to self or others, they will likely not share information
about the student with the family without approval from the student.

77 A student is talking with a therapist in the counseling center and shares that he is
having suicidal thoughts. The therapist expresses concern and asks for permission to
contact his family. The student agrees, and they call his mother together to tell her
about what is happening. If the student had not agreed, then the counselor would have
had to decide whether the circumstances allowed her to contact the student’s family.
If the counselor decides to contact family, the student should be informed that this is
going to happen unless the counselor believes that this step would be dangerous.

77 A student stops coming to class, and her grades are slipping

fast. Several people on campus know about these circumstances,
including friends and college faculty. However, the family may not
know, and schools are not obligated to tell the family despite the
fact that this behavior may be a warning sign that the student is
experiencing a mental health challenge. Privacy laws also prevent
schools from sharing information about a student’s academic
performance without a student’s consent.

S TA R T I N G T H E C O N V E R S AT I O N 20 C O L L E G E A N D YO U R M E N TA L H E A LT H
77 Your school may offer an authorization form for releasing health information on its
website. If it does, use the school’s form. If not, use the form included with this guide.

77 You may specify what types of health or mental health information you authorize for
disclosure (and to whom) on an authorization form. You can authorize sharing of very
limited information or more mental health information.

77 A new authorization form must be completed each year. If you like, you may authorize
sharing for a time period of less than one year.

77 Complete an authorization form before you leave for school and submit your form to
the student counseling or health center so they have it on file. You and your parents or
trusted adult should also keep copies.

77 If you receive treatment from a community mental health clinic, hospital or off-campus
mental health provider, you must sign a new authorization form for providers to be
permitted to talk with your parents or other trusted adult.

77 Because failing grades or academic probation can be a warning sign of distress,

substance use or a mental health condition, you should also discuss completing an
authorization form for releasing academic information. However, a FERPA release related
to academic information does not authorize the sharing of your health information.

S TA R T I N G T H E C O N V E R S AT I O N 21 C O L L E G E A N D YO U R M E N TA L H E A LT H
KEY TAKEAWAYS

Starting a family conversation about mental health is

beneficial for everyone. Conversations allow you to plan
for what to do if you or someone you know experiences
distress or a mental health condition—or if an existing
condition gets worse. Remember these key points:

77 College is an exciting time in life and an important

time to maintain self-care and find ways to
manage stress.

77 Mental health conditions are common among

college students.

77 Know the common warning signs and what to do

if you experience one or more.

77 If you need help, reach out. You are not alone, and
help is available on campus and in the community.

77 Decide what information you want shared with

family and trusted friends and be proactive about
letting your school know.

S TA R T I N G T H E C O N V E R S AT I O N 22 C O L L E G E A N D YO U R M E N TA L H E A LT H
AUTHORIZATION FOR RELEASE OF
HEALTH INFORMATION

Information about you and your health is personal, private and protected. This information
may be released only with your written authorization and may be disclosed only for the
purposes described below unless there is a serious or imminent threat to the health and
safety of you or others. This form provides that authorization and helps make sure that you
are properly informed of how this information will be used or disclosed.

PLEASE READ THE INFORMATION BELOW CAREFULLY BEFORE SIGNING THIS FORM.

I, or my authorized representative, request that health information regarding my care and

treatment at _______________________ be released to the party(ies) named below.
(college or university)

All seven sections must be fully completed

1. Name of person whose information will be released: __________________________

Date of Birth: ___ /___ /___
Address: _____________________________________________________________
_____________________________________________________________________

2. Requested information to release (initial all that you authorize release of):
__ Attendance (appointments scheduled and met; date of service)
__ Treatment (diagnosis and recommended treatment)
__ Safety concerns (level of danger to self and others)
__ Alcohol and other drug use
__ Written mental health records
__ Treatment summary
__ Academic-related issues
__ Billing records
__ Other: _____________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. Name(s) and Address(es) of person(s) who will be receiving this information:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

4. Expiration date: This authorization automatically expires 365 days from today’s date,
unless an earlier date or event is specified: __________________________________
_____________________________________________________________________

5. I understand:
• What this release says and means. I had a chance to have my questions
answered, and I voluntarily agree to this release.
• Information shared based on this release may be further shared by the person
receiving the information and will no longer be protected by state or federal
confidentiality laws.
• I have a right to a copy of this release.
• I may view or get a copy of any health information or education records subject
to this release.
• I may refuse to sign this release. My refusal will not affect my ability to obtain
present or future treatment, payment, enrollment or eligibility for benefits or
educational services from the disclosing entity.
• The authorization provided through this form means that the organization,
entity or person authorized can disclose my protected health information to the
organization, entity or person identified on this form, including through the use
of any electronic means.

Signature: _____________________________________________ Date: ____________

Witness: ______________________________________________ Date: ____________

RESOURCES

NAMI U.S. Department of Health and

77 www.nami.org Human Services (HHS): health
information privacy and HIPAA
77 www.hhs.gov/hipaa/index.html
NAMI on Campus Clubs
77 http://www.nami.org/Get-
U.S. Department of Education and
Involved/NAMI-on-Campus/
HHS: Joint Guidance on FERPA and
NAMI-on-Campus-Clubs
HIPAA and student health records
77 http://www2.ed.gov/policy/gen/guid/
The Jed Foundation (JED) fpco/doc/ferpa-hipaa-guidance.pdf
77 www.jedfoundation.org

Other JED Programs National Institute of Mental

Health (NIMH)
▪▪ JED Campus: www.jedcampus.org/
77 www.nimh.nih.gov/health/
▪▪ Ulifeline: www.ulifeline.org/
publications/depression-and-college-
▪▪ Half of Us: www.halfofus.com/ students-new/index.shtml
▪▪ Love is Louder: www.loveislouder.
com/
More Information about HIPAA
▪▪ Set to Go: settogo.org/ and FERPA
77 Student Mental Health and the Law:
Active Minds www.jedfoundation.org/assets/
77 www.activeminds.org Programs/Program_downloads/
StudentMentalHealth_Law_2008.pdf
77 Supporting Students: A Model Policy
Substance Abuse Mental Health for Colleges and Universities: www.
Services Administration (SAMHSA) bazelon.org/Where-We-Stand/
77 www.samhsa.gov/ Community-Integration/Campus-
school-campus-health Mental-Health.aspx

S TA R T I N G T H E C O N V E R S AT I O N 25 C O L L E G E A N D YO U R M E N TA L H E A LT H
www.nami.org www.jedfoundation.org

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