By: Emily Kist, DNP - Director of the Health Center at Adrian College
The traditional college student today is balancing a million things, including school, work, sports, family, friends, global pandemics, social injustice - the list goes on. With this seemingly impossible balance to maintain throughout their academic career, something's got to give. The American College Health Association indicates that 33% of college students reported stress had negatively affected their academic performance. (1) Indeed, it has been shown time and again that college students with proper mental health support do better. (2-4) While there is increased utilization rates for mental health professionals by college students today (5), the demand for services vastly exceeds the ability for many college campuses to keep up.
As the sole provider in the student medical clinic on campus, I quickly realized that students at Adrian College required more support. I found that approximately 30% of my visits were strictly related to a mental health condition or emotional support. Given the lack of a licensed counselor to collaborate on care, I referred students to community resources, and while the city of Adrian, Michigan is home to excellent clinicians, students found immense difficulty in leaving campus to receive care due to over-booked schedules and insurance coverage barriers. With 80% of college leaders making mental health more of a priority on their campus (6), I began building my case for increased mental health resources on our campus - a significant task given the widespread budget cuts across the nation.
With some innovation, patience, and collaboration, expanding mental health services on campus can be a reality for many institutions. Here are some steps I took to help me make the case for the mental health budget at Adrian College:
Step 1: Cultivate alliance with the Vice President for Student Affairs (VPSA)
The Vice President for Student Affairs is a vital collaborator in the mission to improve mental
health resources on campus. As a first step, align yourself with your VPSA, an ally of the student population, by engaging in open and honest discussion about the overall health needs of students. I have weekly scheduled meetings with our VPSA and we used this time to prioritize the topic of improving mental health services and to brainstorm feasible solutions, with a main goal of creating a shared vision to present to senior staff at Adrian. Every new initiative needs to identify a strategic champion that will spearhead needed change in current processes, and at Adrian our VPSA continues to fill this role and is an irreplaceable collaborator in expanding our mental health services.
Step 2: Conduct a needs assessment
Before going to your senior staff, it can help to collect the hard facts first. We began by assessing our unique needs through a survey that went out to all students who attended visits at the Student Health Center. The survey aimed to understand the student health experience by asking questions related to the quality of services provided and whether students felt it was meeting their needs. Under the comments section, the vast majority of students wrote that the counseling services were insufficient on campus. These survey results gave us the foundational knowledge we needed to establish our need on campus, and as the sole clinician in the clinic, I was also able to add anecdotal experience based on just how many students I was seeing for mental health care in comparison to acute or medical visits.
Step 3: Gaining organizational buy-in
As with any new project idea, gaining organizational support is key. The process begins with a clear need and proposed solutions, which is why presenting factual data and student feedback on current service needs was an essential initial step. In addition, it’s important to discuss your plans for the following points:
- How your solution complements the school’s overall mission
- The evidence that this solution will help achieve desired outcomes (patient access to care, improved clinical outcomes and student retention rates, etc)
- A clear plan for project roll-out: Who at the school will be involved? What different services are we going to offer to address the problem? What strengths or challenges can we anticipate in implementation?
By gaining organizational support by senior staff, I could work alongside the VPSA to expand mental health services through collaborative partnership with Mantra Health, a telemental health software company focused on higher education populations. Despite budget remaining a factor, we were able to allocate funds for a 12 week test pilot for psychiatry and therapy, offering students necessary services in the spring semester while collecting information on how these services ultimately work in our setting.
Step 4: Assess pilot success in improving access to mental health care
When starting any new initiative, close monitoring of target outcomes helps identify whether the pilot is meeting its goals (decided upon in Step 3 above) and is important to regularly communicate back to the senior staff that facilitated this decision. Fortunately, the success of our pilot program with Mantra Health only further solidified the importance of utilizing telemental health on campus. While there is no true replacement for face-to-face counseling, technology gave us the tools to augment mental health care and fill gaps in care in an effective way. Students reported that they appreciated the privacy, ease, and cost of telepsychiatry services, which during the pilot was mainly supported by the Health Center at Adrian. Most importantly, the software seamlessly integrated into our established clinic workflows and promoted continuity of care with the Mantra-affiliated provider. With the 12 weeks of pilot data on utilization rates and feedback from students, we now had an effective model that helped decide the best way to provide services in the future.
Step 5: Scaling and sustaining a new model of care
Adrian College is not alone in its quest to improve mental health care on campus, nor is it alone in its tight budget. So how do you go from offering a successful pilot service to a larger proportion of students in need, with minimal funding? After the telemental health pilot period with Mantra Health, our VPSA and I proposed a minimal yearly Student Health Fee that would allocate funds for improved student health and wellness resources. To add to the base institutional support, we began applying for grants specific to implementing innovative mental health care strategies on our campus. Fortunately, Adrian leadership highly values innovation and understands the importance of adapting with our students and approved this new model of improving mental health care on campus. The key takeaway, though, is the foundational steps we took beforehand and the case we made to allocate funding that promoted this initiative to begin with.
The use of technology for increasing mental health support will only become more robust in the coming years and it has been exciting to be a part of how it improves the lives of our students. As institutions go forth and expand mental health services, it is important to remember the “why.” Students desire mental health care, and they are empowered to take control of their own health and wellbeing. We as health care providers have the responsibility to provide them with the necessary tools.
- American College Health Association. National College Health Assessment Spring 2018. Accessed at: https://www.acha.org/documents/ncha/NCHA-II_Spring_2018_Reference_Group_Executive_Summary.pdf
- The Healthy Minds Study. 2018 - 2019 Data Report. Accessed at: https://healthymindsnetwork.org/wp-content/uploads/2019/09/HMS_national-2018-19.pdf
- Eisenberg, Daniel, Ezra Golberstein, and Justin B. Hunt. Mental Health and Academic Success in College. B.E. Journal of Economic Analysis and Policy; 2009, 9(1).
- Arria, Amelia M., Kimberly M. Caldeira, Kathryn B. Vincent, Emily R. Winick, Rebecca A. Baron, and Kevin E. O’Grady. Discontinuous College Enrollment: Associations with Substance Use and Mental Health. Psychiatric Services 64 (2): 165–172.
- Center for Collegiate Mental Health. 2015 Annual Report. Published January 2016. Accessed at: https://sites.psu.edu/ccmh/files/2017/10/2015_CCMH_Report_1-18-2015-yq3vik.pdf
American Counsel on Education. College Student Mental Health and Well-Being: A Survey of Presidents. Published on August 12, 2019. Accessed at: https://www.higheredtoday.org/2019/08/12/college-student-mental-health-well-survey-college-presidents/