Health

Colleges Say They Don’t Have Money for Mental Health. Here’s What They Should Do​

The model, called stepped care, is kind of like triage.

by Mark Hay
May 8 2019, 1:40pm

Image: COD Newsroom/Flickr

More college students than ever are reporting mental health issues—a spike that is overloading existing campus resources, leading to long wait times for care, and in some worst-case scenarios, leaving some to drop out of school or suffer serious physical or mental harm. In 2017, STAT News found that wait times for an initial appointment hovered between two and three weeks at many schools; earlier this year, the New York Times reported examples of some schools where the wait climbed up to two months.

At first glance, the solution to this resource crisis would seem to be as simple as expanding services, hiring more mental health experts, and building out the mental health center infrastructure. Unsurprisingly, the answer is not that simple.

For starters, many schools have been expanding their mental health services for over a decade, and those efforts haven’t been cheap. Even well-resourced schools have found that they can’t keep up with rising demand, notes Laura Horne of the DC-based college mental health advocacy group Active Minds. Nor is merely staffing up a sufficient step, as students may need more diverse resources and types of support than counselors alone.

Many schools with smaller endowments or income streams—especially community colleges, which often serve communities with some of the greatest mental health needs—don’t have the resources to staff up any further. Some community colleges don’t have a health center or a mental health center at all, says Nance Roy, a psychologist at the Jed Foundation, a college mental health advocacy and support organization. And it seems unlikely that new funds will materialize for these low-resource schools anytime in the near future, especially from the government.

Even well-resourced schools have found that they can’t keep up with rising demand

Fortunately, experts have developed a few techniques over the years to help schools with limited resources provide more robust mental health services. These approaches are hardly hard and fast. As Horne points out, every campus has slightly different resources and needs, so there are no universal solutions. But they are useful guiding principles.

In an effort to maximize existing resources, many schools appear to be shifting to a “stepped care” model of mental health services. This means that they no longer send everyone who walks into a mental health center to a counselor, explains Shane Owens, a psychologist in private practice, assistant director of campus mental health services at Farmingdale State College in New York, and a college mental health expert.

Instead, everyone who seeks or is referred to mental health services gets screened by a certified therapist or psychologist for serious mental health issues. Those who are dealing with common life stresses—like roommate troubles—get funneled out to other resources on campus. There, they can learn coping tools, like meditation, to manage low-grade stress before it may blossom into a more acute or chronic mental health concern.

This strategy allows those students to receive quick and adequate services while freeing up mental health experts to focus on students with serious mental health needs. It may also incentivize more qualified experts to take college mental health services posts. Owens points out that many experts avoid these positions because they assume they will be bogged down with talks about low-grade interpersonal troubles, rather than serving those in serious need.

Calvin College in 2017, for example, introduced a solid model of both stepped and community of care, in which an initial counseling screening, scheduled within two days of a student’s first contact with their mental health center, results in an action plan that can move them through nine additional steps of potential care, from engagement with career counseling to help mitigate life stresses, for example, all the way up to a referral to an outside mental healthcare specialist. This model has, according to their statistics, decreased student wait times by 56 percent already.

Stepped care goes hand-in-hand with developing a “community of care,” wherein an entire campus becomes a general support structure for student mental health, rather than relegating mental health concerns to an overwhelmed office. Mental health staff, or outside advocacy groups, can train staff, faculty, and students to recognize both general stress and serious mental health issues. Select staff and faculty can learn to offer basic resilience and coping tools, and students can learn to offer peer-to-peer support.

The University of California, Irvine, for instance has a well-respected set of programs, like their “Managing Distress in the University Community” workshops, in which counseling center pros train other staff and faculty how to recognize and respond as initial points of contact to students who may be having issues. One set of their workshops focuses specifically on suicide prevention.

Such a culture of widespread awareness can also increase awareness of all stages of stepped mental health services, and funnel more students in serious need to expert care before they reach a crisis point than would have, perhaps, on their own. Faculty, after all, “are often the ones confronting students in distress,” says Dana Tasson, a counselor affiliated with the American College Health Association, and so can be great frontlines for student mental health—with some training.

These actions, which one might call “para-mental health” services, took a great deal of pressure off of students

Building this sort of ubiquitous knowledge and culture of caring, Roy argues, doesn’t really require resources insomuch as it just leverages existing officials’ our outside groups’ expertise. A number of schools, Horne says, have achieved a great deal of success with simple, low-cost initiatives that may at first blush not look like they’re related to mental health services at all. She points to Jefferson Community College in Watertown, New York, which has helped more students access childcare, transportation services, housing assistance, food pantries, and disability testing—all established programs at the school or in the surrounding community.

These actions, which one might call “para-mental health” services, took a great deal of pressure off of students, setting them up for less stress and pain, and more success. Simple efforts at other schools to make sure that students understand various elements of the university experience and know how to navigate institutions also seem to help with lifting anxiety off of students, and thus pressures off of student mental health services.

There is no set playlist for the wider tweaks schools can make to serve mental health ends, Horne says. This tactic involves less in the way of checklists, and more in the way of listening and fact-finding efforts by existing administrators to understand the roots of student stress, test out potential solutions, monitor their impact, and run with what works.

Still, some schools don’t even have the resources to hire so much as one mental health expert to handle serious cases. That’s why many institutions have started to reach out to mental health resources in their surrounding communities, Roy says, developing agreements and understandings about the process of funneling students towards them, how to prioritize students in their own care loads, and what costs a student might incur by seeking them out. Ideally, institutions can find low-cost, or even pro bono, mental health services for students in their areas.

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The University of Florida student health care center is one example of a school looking for more resources for mental health. Image: University of Florida

With these agreements in place, Roy explains, “I know that if I have a student who really needs to get seen, I can call and set up an appointment for them within the week.”

For low-resource campuses in rural areas, however, agreements with local resource providers might not be an option because there are no local resource providers. Both for the sake of these schools and their communities, Owens argues, our country and its healthcare system need to find incentives to get more experts to work in these communities, and make them accessible to scattered populations. But that is a very long-term solution. For now, Roy says, many rural schools seem to be turning to “tele-health” services, online portals that help to screen students for the severity and nature of their conditions and connect some to self-guided programs to build coping and resiliency strategies, or connect others to human resources via text or video chat.

Roy adds that tele-health services are not ideal, as many people still react better to in-person care, especially when it comes to diagnoses. Tasson also notes that the jury is still out on their long-term efficacy. Yet they are popular—and not just at low-resource and rural schools, but also at larger institutions and in more urban centers. Tele-health is useful for students who might want to fit self-guided coping exercises into their own idiosyncratic schedules, Roy says.

Figuring out what approaches to pursue takes time and careful consideration. It requires building task forces, ideally with ample student input, to evaluate the status of a campus’s mental healthcare services and needs, the experts I spoke to agree. Then you need to figure out what ideas are floating around in the community to address them, and come up with feasible ways to communicate those fixes out to the entire school. Thankfully, this just requires engagement, awareness, and persistence, rather than an influx of cash. It’s all about being strategic with existing resources, Horne says.

Low-resource schools, of course, can’t always get away with shuffling around funding or accessing free knowledge. Sometimes they do need to bring in a small but vital amount of new cash to, say, hire an expert to manage agreements with outside services and help to coordinate training for a community of care and the operations of a community of care system. Or they might need funding to pay for tele-health services, which may be affordable but are often far from free.

Money may also be required to conduct outreach programs and fact-finding operations to figure out how to leverage resources. “People are fond of saying we can’t staff our way out [of mental health conundrums], Tasson says, “but that doesn’t mean that [additional] resources don’t help a lot.”

Most schools are capable of cobbling together a few resources by getting the highest-ups at an institution on board with reallocating or fundraising explicitly for this purpose. While in years past mental health services often went on the chopping block in a funding crunch, the experts I spoke with largely believe that today many officials are willing to prioritize support for them—especially when you start talking about issues of liability and responsibility, Owens says. Mental health services also lead to lower dropout rates, better student experiences—and therefore more tuition and hopefully later-life support for an alma mater, Tasson says.

Even with a few new resources, a plan for stepped care, and other appropriate solutions, however, students may still run into some problems finding the help they need. No system will ever run perfectly or be able to cater to every experience. But at the very least, it’s clear that students at even the smallest, most remote, and poorly-funded schools can still receive adequate mental health services if their institutions follow best practices and attend properly to their students’ needs.

That could reduce untold amounts of pain and suffering.