Paul Grayson

Can We Talk about Prescribing Practices, Please?

College counseling centers are not all alike. Given huge campus differences in mission, size, location, resources and student makeup, how could they be? Still, certain basic expectations do hold. The influential International Association of Counseling Services (IACS), our field’s foremost accrediting organization, devotes 15 tightly packed pages to college counseling service guidelines. Standards are set forth for a service’s relationship to the campus community, the recommended ratio of counselors to students, individual and group counseling, outreach, research, training programs, confidentiality, staff qualifications and lots more (IACS, 2010). So while individual variations are allowed, we have a blueprint for how counseling centers fundamentally operate. Why, then, are prescribing practices all but ignored? Surely the use of psychotropic medications is not a marginal concern. Yet all we learn from IACS’s directives, literally the only references to medication practices in the entire document, is that counseling staff and trainees should have access to psychopharmacology consultation resources, and specialists in psychiatry are important resource professionals. Pretty loose, those statements. “Access” could mean almost anything: within the center, elsewhere on campus, offcampus providers. Same thing with characterizing psychiatrists as “important resource professionals.” What does that tell us? In practice, of course, campuses’ prescribing arrangements are widely divergent. To say there is no consensus is putting it mildly. Thus the 2012 counseling center directors’ survey reports roughly 37% of centers have psychiatrists in the counseling center only, 14% in the student health center only and 8% in both services, leaving 11% with other sorts of arrangements and 29% with no access to psychiatrists except through private referrals (Association for University and College Counseling Center Directors, 2012). So depending on a student’s college, getting a prescription may be easy or hard, included among counseling center services or separate from them. Depending on the school, college counselors and therapists may have psychiatrists as colleagues or as consultants, or not.

Eat Your Veggies

The MIND diet has 15 components, including 10 “brain-healthy food groups” that include green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine. The other five groups make up the unhealthy categories that include red meats, butter, sweets, and fried or fast food. Participants who increased their vegetables and whole grains to 3 servings a day while reducing their butter, cheese, and fast food intake, saw the greatest gains.