In my twenty-five year career as a college psychiatrist, this period has proven to be one of the most stressful for students and staff. Fortunately, prior to the Covid pandemic, I received some training in trauma-informed care. I find myself turning to the principles of trauma-informed care, which is uniquely suited to help college students and staff cope with the adverse events connected to the Covid pandemic.
Trauma-informed care involves understanding how the different traumas our patients and we have experienced can increase risk for depression, anxiety, and substance use disorders. Treatment empowers individuals to find the tools that will work for their recovery. According to SAMHSA’s Guidance for a Trauma-informed Approach, trauma results from an event or series of events that is experienced as emotionally or physically harmful or life threatening, causing lasting adverse effects on mental and physical well-being.
The numerous adverse events brought on by Covid can certainly qualify as traumatic to many in the campus community. In fact, students are already experiencing impacts on mental well-being. From the fall of 2019 to the spring of 2020, the number of students who screened positive for depression increased from 36% to 41%. In June, one of four 18-24 year-olds reported having seriously considered suicide in the last month.
Adverse Events in the Time of Covid
The Covid pandemic has bombarded students with negative experiences that are out out of their control. They lack contact with friends and often describe feeling lonely. They live with the uncertainty of whether in person classes will go online and they will have to vacate their dorms. They worry about finances if they or their parents have lost jobs. They fear getting Covid from roommates or giving Covid to parents when they see them.
College mental health staff are facing parallel challenges. They miss seeing friends or loved ones. They may not know day to day if their children will be learning at home or in school. Furloughs due to budgetary shortfalls could be on the horizon. If they are working in their buildings, they worry about getting Covid.
Loss may be the biggest stressor we all face. Anecdotally, several college mental health professionals have described losing an older friend or relative to Covid, and we may see students experiencing the death of a loved one. Students describe feeling they have lost unique experiences such as making new friends in freshman year or of celebrating graduation with family during senior year. We live with a sense of loss and the potential for loss.
How College Mental Health Services Can Incorporate Trauma-Informed Care
1. Validation of trauma
Clinical: Ask your patient how they are impacted by Covid - are they lonely, struggling financially, worried about illness in themselves or others? Validate that many students are struggling with similar issues. Encourage them to meet with other students outdoors or by video. Direct them to grants for financial setbacks and the student health care center for medical concerns. Identify racial trauma; Black and Latinx populations have been disproportionately affected by Covid and subject to distressing incidences of violence. Group therapy by telehealth can be a good way to connect students who are experiencing similar traumas.
Organizational: Check in with staff at team meetings regarding the impact of Covid on their lives. Team leaders can talk individually with someone who might be struggling. Acknowledge that this is a difficult time for the organization and educate employees about mental health resources.
Clinical: Most college mental health centers have transitioned to telehealth as the safest way to provide care, with exceptions for some circumstances, such as emergency evaluations. Student surveys can assess patient satisfaction and best ways to deliver care for telehealth. In my experience, most students are happy with telepsychiatry services. However, it is critical to develop a protocol for delivering services when an emergency arises during telehealth.
Organizational: While most university mental health providers use telehealth, some are working from home, others from offices, and still others in a hybrid model. Campus organizations should evaluate their ventilation systems and cleaning procedures to maximally reduce the risk of Covid spread. Staff should feel comfortable reminding colleagues to follow mask protocols. If a student is seen in person, it should be in a large well-ventilated room with masks worn.
Clinical: Students should be equal collaborators in treatment and empowered to share in clinical decision making. After an initial mental health evaluation, students can be offered an array of tools for their problems, often depression or anxiety. These could include wellness activities such as meditation, exercise, or yoga; avoidance of substance misuse; individual and/or group therapy; and psychiatric treatment.
Since trauma increases risk for depression, anxiety, substance use disorder, and PTSD, therapy approaches should be tailored accordingly. Specific approaches for PTSD include CBT, EMDR, and prolonged exposure therapy. A trauma-informed approach to psychiatric treatment includes a thorough discussion of the diagnosis and evidence-based medication treatments including risks and benefits. Often, I will mention a few different medications and we will decide together which might work best.
Organizational: As we develop protocols for delivery of care to students, it is essential to include providers, case managers, and support staff in the discussion. Leadership should be transparent about the reasons for their decisions. Information should be shared in a respectful, collaborative manner. Staff who feel it is in their best interests to work from home but are being asked to return to the office should be made aware of the path to apply for an alternate work location.
For at the least the near future, we will feel the shadow of Covid hanging over us, potentially impacting our mental and physical well-being. By taking a trauma-informed care approach that focuses in validation, safety, and collaboration, we can provide excellent care for college students and support each other in the process.
Dr. Marcia Morris is an Associate Professor of Psychiatry and Associate Program Director for Student Health Care Center Psychiatry at the University of Florida, and author of The Campus Cure: A Parent's Guide to Mental Health and Wellness for College Students.