The Impact of Accommodations for College Students with Mental Illnesses
A literature review for my Mental Health and Social Services course that accompanied a research poster presented at the Georgia Southern GS4 Students Scholars Symposium
The Americans with Disabilities Act (1990) federally protects the right to accommodations in public spaces, workplaces, as well as in educational institutions. Educational accommodations serve to provide equitable access and opportunities for students with a variety of disabilities. However, patterns in research show that many disabled students do not utilize accommodations, especially in higher education settings. Various barriers contribute to this, despite federal protections. Disparities in accommodation registration are noted between disability subgroups. Accommodations can vary widely in application, with blind students receiving braille or students with ADHD receiving extended time on tests.
This literature review will cover neurodevelopmental conditions as well as mental illnesses. According to the American Psychiatric Association (2013), neurodevelopmental conditions include but are not limited to learning disorders as well as conditions like ADHD and Autism. These are also comorbid with mental illnesses such as Major Depressive Disorder, Generalized Anxiety Disorder, etc.
Regarding these conditions, awareness of rights to accommodations can be lacking. This literature review will assess barriers, concerns, and impacts of educational accommodations.
Educational accommodations have positive impacts on college students with neurodevelopmental conditions, and by creating an environment of social support there are benefits both academically and socially.
The prevalence of learning disabilities and mental illnesses is significant. The National Center for Learning Disabilities (2017) found that 1 in 5 children have a learning disability but only 1 in 50 children receive educational accommodations. Alongside this, recent studies have found that more than 60% of college students meet the criteria for one or more mental illnesses (Lipson et al, 2022). These numbers show that significant numbers of students qualify and could benefit from educational accommodations and learning more about the options available to them.
For students with neurodevelopmental conditions, there are a variety of ways to give them support. Zee & Bolger (2019) highlights the importance of social support, through both visible and invisible methods. Visible social support is direct support from one's social network and is interpreted as help by the recipient. Invisible social support is more indirect and may not be recognized as being helpful by the recipient. Visible and invisible supports have benefits biologically, psychologically, behaviorally, and relationally but have different benefits in different scenarios.
Within the context of this literature review, visible social support can be seen in disabled populations through transition-age mentorship programs and Centers for Independent Living (CIL). CILs were developed and normalized following the Independent Living Movement in the 1960s and 70s. The Independent Living Movement aimed to prioritize accessibility and independence for those with disabilities, especially those in the transition age range (Plotner & Walters, 2022). The movement and advocacy efforts of the time have brought us to where the disability community is today, with accommodations being federally protected and seeing continuing advocacy in modern day. A variety of studies have indicated the benefits of programs like this, whether they be CIL or programs aimed to improve wellbeing through mental healthcare, employment first opportunities, etc.Davis et al. (2022) found that patients of transition age (between ages 14 and 24) with serious mental illness had more positive outcomes when they were assured of access to mental healthcare alongside adequate Vocational Rehabilitation services. This knowledge coupled with Sanchez et al. (2021), which implicates higher efficacy of resilience and coping capabilities when serious mental illness patients are integrated into their communities, establishes thorough benefit from support in these forms.
Invisible social support could be argued to include educational, workplace, and other forms of accommodations and accessibility efforts.
Both forms of social support alike have understood anecdotal confidence within disability justice communities. This indicates that barriers to accommodations must be significant to maintain such large gaps in coverage.
For example, nearly half of students with disabilities do not register with their university’s disability services offices. There is also a reported 1 in 3 students who did not have positive experiences with these offices when trying to access accommodations (Gierdowski, Brooks, & Galanek, 2020). Empirical studies such as Smith et al. (2018) have identified common factors of negative university disability resource offices as being linked with negative peer interactions along with discomfort and anxiety around disclosing their disability.
Even prior to interactions with disability resource offices, many students encounter barriers due to the medical model of disability. Due to medicalization attached to neurodevelopmental conditions, students must have access to healthcare to be able to receive physician letters necessary for obtaining educational accommodations. With 1 in 5 disabled adults having unmet healthcare needs due to cost, this is a legitimate consideration (Centers for Disease Control and Prevention, 2022).
Common barriers specifically for students with mental illnesses in higher education have also been identified, such as the unpredictable nature of their mental illnesses and coping with that, interpersonal struggles, as well as complications when accessing accommodations (Sabella, 2021). With these notable barriers in consideration, core needs have been identified for aiding students and addressing accommodation gaps. The core needs are as follows: access to disability services and professionals, integrated support networks to address the various needs of these students, and community connections (Biebel, Mizrahi, & Ringeison, 2018).
When core needs are met, especially by way of access to accommodations and services, benefits are comprehensive. Both anecdotal and empirical evidence points to positive relationships between social support and the well-being of disabled students in higher education (Yeager, Gandara, & Martinez, 2022). Community programs built on foundations of self-advocacy and community connectedness helped students to self-advocate and integrate within their universities.
Alongside positive impacts on well-being, positive outcomes were observed when it comes to academic achievement. When students were able to utilize accommodations, increases in grade point averages (GPA) were observed. Findings also indicated that students with cognitive and psychological disabilities were less likely to be approved for accommodations. Similarly, students with physical disabilities were twice as likely to graduate compared to students with cognitive disabilities and 30% more likely to graduate than students with psychological disabilities. This study also acknowledged the possibility that these differences could be due to the nature of these disabilities but that accommodations were able to aid disabled students across the board (Chiu et al, 2019).
Several recommendations have been made to address the aforementioned issues and gaps in accommodations.
By building community spaces for these students and utilizing lived experiences and conversations around accommodations, professionals can work towards closing these gaps.
Specific recommendations have been laid out by Gierdowski, Brooks, and Galenek (2020). The first recommendation refers to Universal Design for Learning (UDL), which is an educational philosophy and practice that works to create equity in the classroom outside of formal accommodations. In application, this may look like a variety of assignment formats, feedback, and flexibility of workspaces (CAST, n.d.).
The other two recommendations from the study include professional development on disability for university staff and expanding access to mental health services for students (Gierdowski, Brooks, & Galanek, 2020). Professional development for university staff could assist in easing the anxiety and discomfort many students feel when disclosing their disability as well as facilitate smoother interactions around accommodations. Expanding access to mental health services for these students would not only aid those with mental illnesses but provide support for otherwise disabled students as they transition into college.
Despite progress in the treatment of disabled individuals following the passing of the Americans with Disabilities Act (1990), many issues concerning proper accommodations persist. These gaps are especially prevalent in post-secondary education, with disproportionate impacts on those with neurodevelopmental conditions. By fostering community spaces in various formats and expanding access to essential services, positive changes can be made to close the accommodation gaps seen.
References
Biebel, K., Mizrahi, R., & Ringeisen, H. (2018). Postsecondary students with psychiatric disabilities identify core services and key ingredients to supporting education goals. Psychiatric Rehabilitation Journal, 41(4), 299–301. https://doi.org/10.1037/prj0000280
CAST Understood Founding Partner. (n.d.) 5 Examples of universal design for learning in the classroom. Understood. https://www.understood.org/en/articles/5-examples-of-universal-design-for-learning-in-the-classroom
Centers for Disease Control and Prevention. (2022). Disability impacts all of us. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html
Chiu, Y. J., Chang, H. V., Johnston, A., Nascimento, M., Herbert, J. T., & Niu, X. M. (2019). Impact of Disability Services on Academic Achievement Among College Students with Disabilities. Journal of Postsecondary Education and Disability, 32(3), 227-245. https://files.eric.ed.gov/fulltext/EJ1236854.pdf
Davis, M., Koroloff, N., Mizrahi, R., & Morrison, E. (2022). Collaboration between mental health and vocational rehabilitation programs for transition-age youth vocational outcomes. Psychiatric Rehabilitation Journal, 45(4), 303–313. https://doi.org/10.1037/prj0000539
Gierdowski, D. C, Brooks, D. C., & Galanek, J. (2020). Student Technology Report: Supporting the Whole Student. Educause, Section 6. https://www.educause.edu/ecar/research-publications/student-technology-report-supporting-the-whole-student/2020/accessibility-and-accommodations
Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M., Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013–2021. Journal of Affective Disorders, 306, 138-147. https://doi.org/10.1016/j.jad.2022.03.038
National Center for Learning Disabilities. (2017). The State of Learning Disabilities: Understanding the 1 in 5 Snapshot of Learning and Attention Issues in the U.S. https://www.ncld.org/wp-content/uploads/2017/03/1-in-5-Snapshot.Fin_.03142017.pdf
Plotner, A. J., & Walters, C. B. (2022). The importance of centers for independent living supporting youth with disabilities: a critical contribution to maximize transition service delivery. Career development and transition for exceptional individuals, 1-10. https://doi.org/10.1177/21651434221116310
Sabella, K. (2021). Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions. Psychiatric Rehabilitation Journal, 44(4), 373–380. https://doi.org/10.1037/prj0000470
Sánchez, J., Estrada-Hernández, N., Booth, J., & Pan, D. (2021). Factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS): A study on persons with serious mental illness living in the community. Psychology and Psychotherapy, 94(3), 620–645. https://doi.org/10.1111/papt.12336
Smith, S. A., Woodhead, E., & Chin-Newman, C. (2019). Disclosing Accommodation Needs: exploring experiences of higher education students with disabilities. International Journal of Inclusive Education, 25(12), 1358-1374. https://doi.org/10.1080/13603116.2019.1610087
Yeager, K. H., Gandara, G. A., & Martinez, C. (2022). “It’s Bigger Than Me:” Influence of Social Support on the Development of Self-Advocacy for College Students with Disabilities. Journal of Postsecondary Education and Disability, 2022, 35(2); 145-159. https://www.slu.edu/life-at-slu/student-success-center/accessibility-and-disability-resources/pdfs/its-bigger-than-me-influence-of-social-support-on-the-development-of-self-advocacy-for-college-students-with-disabilities.pdf
Zee, K. S, & Bolger, N. (2019). Visible and Invisible Social Support: How, Why, and When. Association for Psychological Science, 28(3). https://doi.org/10.1177/0963721419835214