Articles and research from our team on the future of mental healthcare for young adults.

Last year, Mantra published an inaugural provider burnout White Paper, which revealed a worrisome status quo: in college counseling centers, 9 in 10 clinicians reported experiencing burnout. This is 12% higher than the average burnout levels reported in a large-scale survey of North American psychiatrists.   

The COVID-19 pandemic marked a paradigm shift for mental health care needs. COVID-related challenges and anxieties across the population have contributed to severity of mental health issues. Beyond a taxing workload, the burnout clinicians experience is often compounded by the emotional strain that mental health providers are navigating themselves. 

Building on our 2020 provider burnout survey, we collected insights from college counseling center staff. In what follows, we review 2021 findings about the state of burnout amongst college mental health clinicians and directors. We then offer key takeaways to inform counseling center priorities in the coming year. 

The state of provider burnout in college counseling centers in 2021

Colleges and universities are preparing for an onslaught of public health emergencies, including new strains of COVID-19, Monkeypox, the seasonal flu, even polio – all of which will, inevitably, affect the mental health of college students, many of whom are away from home for the first time, immunocompromised, at high risk, or dealing with ongoing stress, anxiety, or trauma related to COVID-19. 

It’s been a challenging few years for academia, but Ellen Larson, MD, Director of Student Health Services at Colgate University in Madison County, New York, is optimistic that the lessons of the COVID-19 pandemic have prepared her and the university community to weather the challenges that are bound to rise amidst the impending public health emergencies. 

“It’s all about the balance of providing education and information without creating stigma,” said Dr. Larson. 

Like many of her peers, Dr. Larson is focusing heavily on fact-based information. It’s important to explain to students how these viruses are transmitted, what a Monkeypox rash really looks like, and what to do when you suspect you’ve been infected, she said. In addition, Dr. Larson is considering more self-care guidelines on how to treat a fever, how to take care of yourself when you’re sick, when to stay home and wear a mask, and when to visit the health center.  

Prevention is arguably the best medicine – and colleges and universities all around the counter are bracing for what’s next. Northwestern University, for example, has assembled a team of infectious disease specialists to advise on its response to the virus. Their work will include guiding awareness campaigns, creating diagnosis plans, organizing contact tracing tools, and writing isolation protocols. University of California of Irvine and Bucknell University have each created websites that function as a hub offering for students and staff ongoing access to the university’s monkeypox response, prevention, and management plans, and providing them with contact information about on-campus testing, vaccines, and other health resources.

Regardless of your size, all colleges and universities should be focused on producing educational resources, encouraging frank discussions around health and mental health, as well providing health and counseling services, and building networks to support students who get infected and must isolate in place. 

Combating Fears – and Building a Path of Recovery

“I'm hopeful that this is the year that we recover,” Dr. Larson said. Now that we have a better understanding of public health concerns and have built the right tools, resources, and protocols, Dr. Larson thinks “we're in a place where we can be proactive.”

So many students in their developmental years have been negatively impacted by the COVID-19 pandemic. Many students’ ability to connect with their peers has changed, said Dr. Larson, and as a community we need to be prepared to support these students as they try and rebuild their social skills. Something as simple as asking another student for their contact information can feel awkward to this generation which has been isolated on and off for more than two years, Dr. Larson explained.

The hope is that these public health concerns will encourage students to visit their health and counseling centers, get vaccinated, talk about their fears, and take precautionary measures to stay safe and healthy. By focusing more heavily on health and mental health, we can better prepare students and the college community at large to prevent, mitigate, and manage these crises more effectively. 

For more resources and guidance on curbing infectious diseases in college communities, we encourage you to check out best practices offered by the Biden Administration:

Reducing Monkeypox Transmission in Congregate Living Settings

Reducing Stigma in Monkeypox Communication

Disinfecting Home and Other Non-Healthcare Settings

We can’t predict what will happen this year, but we do know that public health concerns have a direct effect on mental health, which is why we’re encouraging all colleges and universities to think critically about their mental health offerings. You may have a fully staffed counseling center, but do you have long waitlists? Do you have students with high acuity cases that need psychiatric care? Make sure you’re focusing on all aspects of health beyond just the physical.

For more information on Mantra and our telehealth solutions for colleges and universities, visit us here.

COVID-19, Monkeypox, and the Seasonal Flu – Is Your Campus Prepared? 

Students can play a critical role in mental health crisis management and suicide prevention. Students are much more likely to reach out to peers for support before exploring other resources, like campus counseling. In fact, according to the 2021 Healthy Minds Study, 58% of students report going to a friend or roommate when experiencing serious emotional distress. 

Although this informal social support can be beneficial, most students aren’t well-equipped or trained to handle a mental health crisis and don’t know who to notify or how to respond.  How can we ensure that they know the right protocols, have access to the right resources, and are empowered to take action to protect their peers?

"By providing education and training, promoting open dialogue, and making help resources easily accessible, institutions can engage students in creating a culture of care on campus. Peer support and social connectedness are crucial parts of building this,” says Emily Grady, LPCC-S, Clinical Solutions Consultant at Mantra Health.

Educating Students on Crisis and Suicide Prevention

Crisis and suicide prevention starts with awareness. Students need to know what a crisis is, who’s at risk for suicide, how to identify a crisis in real time, and what to do when a peer comes to them for support. Here are some ways campus leaders can help educate students:

Conduct suicide awareness campaigns. Contrary to popular belief, speaking publicly about suicide does not make people suicidal. In fact, research shows that suicide awareness campaigns can increase public knowledge and acceptance of depression and other mental illnesses. Suicide awareness campaigns on campus can help debunk information, give students a better understanding of mental health issues, and remind students that they’re not alone and help is available.

Encourage open conversations. Mental illness thrives on shame and secrecy. By encouraging campus-wide conversations about mental health and suicide, you can reduce mental health stigma on your campus and make it easier for students to ask for help. Campaigns and resources like Seize the Awkward from The Jed Foundation can help facilitate these conversations and help students feel more comfortable talking about their mental health.

Train students on the signs and symptoms of a crisis. Students might not know what a mental health crisis looks like. Depression and other mental health conditions can also present differently for different people (for instance, some people with depression may exhibit irritability and anger, rather than sadness). Provide free workshops and training sessions so students can identify when a peer is in crisis.

Provide effective intervention training. Students may be able to recognize when a peer is experiencing mental health issues, but they might not know what to do or say. Give them step-by-step guidance on what questions to ask, how to provide support, and how to notify the right people. “A student has an amazing ability to be a bridge and empower their peers to connect with support systems. The right training can help them build the confidence to know how to make these connections,” says Grady. 

Ensure that all students know campus protocols. Every campus should have policies or guidelines around mental health crises and emergencies. Instead of limiting these protocols to faculty and staff, make them known to students so they are prepared. “This information, along with resources, can be incorporated into orientations or first-year seminars. If you can, host additional conversations or trainings throughout the year with student organizations and leadership groups,” says Grady.

Make resources accessible. Crisis management and suicide prevention resources help students and other members of the campus community respond effectively. Put these resources on your campus website, on social media platforms, and in public spaces on campus so students can easily access them. Every student should know how to reach a mental health professional should they need to.  

Host peer support groups. Peer support groups should be offered to students as they provide an added layer of support to students. Often these are led or hosted by students who have lived experiences with mental illness or suicidality. Students may not want to visit a therapist or call the crisis line, but they may feel comfortable talking to someone their age who understands what they’re going through

Provide crisis services. Students might be hesitant to call 911 when someone is in crisis, especially if they’re concerned about punishment for drug use or underaged drinking.  Encourage students to use the Suicide & Crisis Lifeline (988) or your own campus crisis line. Remind students that they can also call the line on behalf of a peer.

Everyone has an important role to play when it comes to ensuring the health and safety of the campus community. By educating students on crisis and suicide provention, you can equip students with the tools they need to support their peers when a crisis occurs.

Want to learn how Mantra supports crisis and suicide prevention efforts. Contact us at outreach@mantrahealth.com. 

How to Educate Students on Crisis and Suicide Prevention

NEW YORK, April 1, 2021 /PRNewswire/ -- Mantra Health, a digital mental health clinic that partners with higher education institutions, today announced an extension of $2 million bringing its total funding to $5.2 million. The round includes new institutional investors Canaan Partners, City Light Capital, and Baleon Capital, as well as strategic angels, including Dr. Nitin Nanda, the founder of Aligned Telehealth, acquired by Amwell. Mantra will use the extension to continue to expand its network of psychiatric and therapy providers to all 50 states. Additionally, the company will continue to sign and support contracts with health insurance carriers across the country to increase access to evidence-based mental healthcare for the 20 million post-secondary students in America. This move will help increase payment options for colleges and universities, and increase continuity of care for students during seasonal breaks and after graduation. 

While a recent survey indicates 72% of college and university presidents have reallocated or identified additional funding to address mental health, more than half (58%) said if they had unlimited resources they would hire additional staff—mostly in the counseling center. Mantra Health uses telehealth technology to deliver evidence-based mental health treatment by integrating directly with on-campus counseling and health centers to help them expand their services and make seamless off-campus referrals that meet the specific needs of their student populations. This improves student outcomes by making it easier for schools to access high quality mental health providers that can work across traditional daytime hours, as well as evenings and weekends, aided by the flexibility of telehealth.

Mantra Health's program is currently deployed across 26 college campuses with more than 180,000 students enrolled. Historically, counseling centers have said only 40-50% of students make it to their first appointment when referred to a community provider, with an even lower percentage among rural schools. Through a mix of software and care navigation, Mantra has seen that referral success rate spike to 97% when referring students to a Mantra-affiliated provider. 

"Mantra Health has seen a dramatic increase in demand from colleges and universities for their telemental health services since the beginning of the public health and civil rights crises last year, which caused a surge in students experiencing depression and anxiety," said Byron Ling, Partner at Canaan. "We seek to invest in category-defining teams with ambitious visions and believe that Mantra Health is building the preeminent digital mental health solution for universities and colleges. Their collaborative, evidence-based approach to telemental health leverages technology to improve access and outcomes, while deeply integrating with university counseling teams for comprehensive care."  

With the increased demand and associated costs among school counseling centers, Mantra Health started accepting in-network insurance from UnitedHealthcare, Aetna and Cigna in January 2021. The latest capital infusion will help the company bring on additional health insurance carriers. By doing so, Mantra eases the financial burden that schools have been facing when providing behavioral health services to their students. Students also benefit by having the opportunity to remain in the same ecosystem of care whenever they leave campus for seasonal breaks or graduate and transition to post-college life, which can often be a vulnerable time for patients.  

"We're thrilled to welcome these new investors as we look to become the leading digital mental health player focused on Higher Education," said Ed Gaussen, co-founder & CEO of Mantra Health. "Covid has exacerbated the prevalence of mental health issues on college campuses, yet students aren't getting the care they need due to various structural issues. By launching our insurance partnership capabilities, we're taking a major step in our mission to democratize access to care for students across the country."

After bringing on Dr. Nora Feldpausch as Mantra Health's new Medical Director last month, the company is in the process of expanding services and obtaining licensure in all 50 states and Washington, D.C. in time for the Fall 2021 semester. 

According to Mantra Health's co-founder & COO, Matt Kennedy, "Offering 50 state coverage to our university partners through our collaborative clinical model will fundamentally change mental health delivery for university and college students. Our ability to deliver care across the country will improve access and enable continuity of care for the 20 million university students in America over summer and after they graduate. Furthermore, we are doing it entirely through our provider group under Dr. Feldpausch's leadership, keeping a tight control on clinical quality and continuing to build on our reputation as the most clinically-informed partner in our space."

Mantra Health Announces Multi-State Insurance Network Contracts and Fifty State Expansion; Brings Total Funding to $5.2M

College Students Need Quality Mental Health Care Now More Than Ever

On campuses across the country, the need for accessible, high-quality mental health services is rising. Grace Wickerson (Rice University Student Body President, 2019-2020) told Mantra, “A national study done by RISE found that 75% of college students have had increased anxiety, depression, or stress due to disruptions to their education. On my own campus I’ve seen this first hand, with mass calls from students for increased mental health support especially since their University is their main mental health provider.” 

Heightened demand for mental health services should be met with increased access to services. Yet, according to a recent Healthy Minds Network Study, 60% of students indicate that the coronavirus pandemic has made access to mental health care more challenging. Although demand for mental health services is rising, many college students are not visiting counseling centers to have their needs met. The Center for Collegiate Mental Health (CCMH) reports that the average number of students seeking treatment from college counseling centers declined significantly during the pandemic.  

Emergency Relief Funding for Mental Health Care

One of the greatest obstacles to improving mental health services on campus is budgetary constraints. Thankfully, the latest COVID-19 relief bill allocating $40 billion in funding for colleges and universities includes funds targeted for mental health care. 

The federal government’s Coronavirus Aid, Relief, and Economic Security (CARES) Act established the Higher Education Emergency Relief Fund (HEERF) model in March of 2020: at least 50% of funds must be allocated to student grants, while the remaining 50% can be spent on institutional costs arising due to the coronavirus pandemic. The American Rescue Plan (ARP), signed into law on March 11, 2021, builds upon the initiatives in the CARES Act by further funding the HEERF. 

The Department of Education has not yet released information about whether institutions that received CARES Act funding must take additional steps to secure ARP funds. The National Association of Student Financial Aid Administrators will update their reference page as more information becomes available.

One of the “emergency costs” that the institutional portion of HEERF can be allocated towards is mental health care. Colleges and universities that received funding through the CARES Act and are waiting on ARP funding have resources to bolster mental health services on campus. Institutions of higher education now face the challenge of allocating funds to optimize student wellness. 

Higher Education Needs to Meet Growing Demand for Mental Health Services

Prioritizing quality mental health care poises colleges and universities for success. Students utilizing college counseling services report being more satisfied with their quality of life and academic performance. 

Not only do colleges with thriving wellness cultures and quality counseling have happier students, they also have higher retention rates. Struggling with mental health is the most common reason students drop out of college.  A Healthy Minds Network  study estimates that treating 100 depressed students in a school year can prevent 6 dropouts, saving colleges and universities an average of $240,000 in tuition costs. 

Unfortunately, colleges and universities lack the infrastructure to meet the diverse and extensive mental health care needs of their student bodies. In an Inside Higher Ed article, Kelly Davis, Director of Peer Advocacy Supports and Services for Mental Health America (MHA), characterizes the present challenges facing mental health care in higher education as “a larger version of the same problem we’ve seen on campus–people are struggling, we tell them to reach out for help, but we didn’t build the help.” 

A common challenge for college counseling centers is being under-staffed with resultant long appointment wait times. Luckily, necessity breeds invention: Shifting to telepsychiatry has convinced Dr. Davis that telehealth is “an effective way to provide the treatment that students need to thrive, without compromising outcomes.”

A substantial body of evidence finds telehealth to be equally as effective as in-person therapy in both levels of patient satisfaction and treatment efficacy. Dr. David Mohr, Director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, who researches telepsychology and digital mental health, told the American Psychological Association, “What we’ve seen is that telehealth is essentially just as effective as face-to-face psychotherapy—and retention rates are higher.” 

Telehealth also has unique benefits for colleges, universities, and their students when incorporated into existing campus structures. According to Larry Moneta, Ed.D., former Vice President of Student Affairs at Duke University and longtime advocate for telehealth in higher education, “Even prior to the coronavirus crisis, the contemporary lives of college students–perpetually on the go, highly stressed and with little time to spare–showcased the need for telehealth as augmentation to the excellent health care provided through student health and counseling centers on our campuses.”

Here are three of the most impactful ways telehealth improves mental health care for college students: 

1. Higher conversion on long-term care referrals.

A major challenge for mental health care on campus is appointment attendance within the community after a referral from the counseling center. Especially for students already struggling with their mental health, the directive to seek care off campus can be daunting. Telehealth is advantageous in that it lends itself to collaboration between the university and external providers, augmenting counseling center services instead of trying to replace them.  

Increased appointment availability and ease of scheduling translate to better follow-through for students referred to telehealth. Mantra’s internal research indicates that more than 95% of referred students attend their first telepsychiatry appointment when effective telehealth services are in place. 

On-campus counseling offices that take advantage of a digital portal have the added benefit of supporting students in pursuing self-care on their own time. Dr. Nora Feldpausch, Staff Psychiatrist at Michigan State University, explains that one of many benefits of telehealth is that it “support[s] patient self management by offering modules or links to resources such as psychoeducational handouts, empirically supported self-help apps, and crisis intervention services.” 

2. More inclusive care for BIPOC and LGBTQ+ students.

Utilizing a telehealth service designed by medical experts with college students in mind can enable more patient centric care. With access to more specialists, diverse therapists, and customizable self-care resources, students can feel supported by therapy tailored to their needs. 

Telehealth also promotes culturally competent care by connecting students with therapists who “look like them,” or therapists who understand unique challenges they may be facing. Especially for students of color and LGBTQ+ students, the ability to transcend geographical boundaries and gain access to therapists they feel comfortable with can be a game-changer. 

3. Appointment availability on nights and weekends.

Telehealth allows more students to receive quality mental health care by enabling scheduling of exponentially more appointments. While high-risk students are understandably prioritized by counseling centers with limited services, with telehealth, preventative care can be offered to any student who wants to proactively manage their mental health through telehealth.

Many students are unable to take advantage of traditional counseling center services, which operate during the same hours as classes. By providing access to nighttime and weekend appointments, telehealth accommodates students with busy schedules. Not only does this support individual students’ wellbeing, but it minimizes stigma by normalizing therapy for everyone. Effective telehealth can transform campus cultures into emotionally enriching environments in which mental health care is celebrated. 

Optimize Relief Funding for a Mentally Healthy Student Body

Funding alone does not ensure quality mental health care on campus. Transforming mental health services to be easily accessible and widely utilized by college students requires thoughtful new infrastructure that complements and strengthens the existing campus structures, processes, and goals. 

To learn more about how Mantra can expand telehealth services on your campus through your CARES Act funding, get in touch to speak with our partnerships team.

The CARES Act and University Mental Health

Our story and inspiration behind the scholarship.

Since our founding in 2018, Mantra Health has been committed to serving and supporting diverse patient populations through the unique mental health challenges they face. Research demonstrates the inequities that BIPOC and LGBTQIA+ communities face in finding, accessing and maintaining quality identity-affirming care and support. According to the American Psychological Association, 84% of psychologists identify as White, making the mental health workforce less diverse than the American population (APA, 2018). With the dearth of diverse providers across our country, particularly in rural areas where many campuses tend to be located, colleges and universities face challenges in meeting the needs of historically-marginalized students. We believe that it's paramount to connect college students to mental health providers who can reflect their identities and experiences, and/or integrate them into the core of care with cultural humility.

Mantra’s affiliated provider group, Wellround Provider Group which is led by Medical Director and psychiatrist Dr. Kristel Carrington, recognizes the need for more diverse providers in the field of mental health. As telehealth now enables us to recruit and train providers from all locations in the country (so long as they are duly licensed), Wellround aims to fill this gap in care on campuses and maintain at least 50% representation of providers from diverse identities to better meet the needs of students.

Being in the higher education space, we understand that it is difficult for many students to get the support they need to achieve their academic and career goals. The mission of this scholarship is to support individuals from diverse backgrounds who are interested in becoming mental health providers. Our aim is to reduce barriers for BIPOC to enter the field, not only to provide equal opportunity and support for aspiring providers, but also to address disparities in mental health care at large.

Eligibility​: Graduate and postdoctoral students of color in the US who are actively pursuing a degree related to mental health (e.g. social work, counseling, psychiatry, occupational therapy) and are currently completing (or will complete) fieldwork/practicum/rotation in a university or college counseling center. Candidates for the scholarship are graduate students with historically marginalized identities (e.g. Black, Hispanic and Latinx, Native American, Asian and Pacific Islander). Graduate programs can be at the Master, Doctoral, or Professional/Medical level.

Application requirements​: Applicants must provide the name of the university counseling or health center of their current or upcoming placement, the dates of their placement, and the contact information for their supervisor at the university.

Our aim is to reduce barriers for BIPOC to enter the field, not only to provide equal opportunity and support for aspiring providers, but also to address disparities in mental health care at large.

If you know of a qualifying student or university representative who would like to learn more, visit our scholarship application page and share here.

Introducing the Mantra College Mental Health Provider Diversity Scholarship

Before partnering with Mantra Health, Alfred State College had a dedicated counseling center, but few psychiatric services. A SUNY college located in the rural town of Alfred, New York, Alfred State needed more offerings to reduce waitlists and improve the quality of care offered to students. 

Since adding on Mantra, the college has helped fill gaps in care by offering assessments and treatment plans for conditions such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), generalized anxiety disorder, and other mental health conditions.

"Patients love the services. We have not had one bad or negative review,” said Libby Tsibulsky, MSEd, LMHC, Alfred State Counselor.

Since launching the program, 90% of students felt their Mantra provider was a good match for their mental health treatment and 100% felt their Mantra provider helped them accomplish their goals in therapy and psychiatry.

Improving Student Mental Health at Alfred State College with Psychiatry Services

There’s no question that athletic departments around the country are starting to address mental health on a larger scale, but what does this look like in practice? How can we train coaches, athletic directors, and other athletics leaders to better understand mental health, while ensuring that athletes are receiving individualized care?

In order to improve the mental health of student-athletes, we must look beyond the athletes themselves to consider the greater role of coaches, athletic directors, staff, and other members of the community. This is something we discussed in our latest webinar Strengthening the Player-Coach Relationship to Improve Mental Health. 

“Coaches don’t have to be clinical psychologists, but they have to be aware,” says Joe Valerio, Former NFL Athlete; Senior Director and Regional Client Service Operations Officer at Willis Towers Watson, who says he, himself, had a coach who knew that every player was motivated differently. “He spent as much time coaching us on the field and off the field.” 

Mental health literacy is a key component, says Stephen Hebard, PhD, Chief Innovation Officer at Prevention Strategies. “What is anxiety, depression, substance abuse? What are the implications of trauma?” He asks. “You don’t need to know the criteria in the DSM (a standard classification of mental disorders), but having a sense of how depression shows up in athletes is really powerful information.” 

Deborah Wardlaw, Director of Athletics at Columbia College, says that coaches should be “mindful, patient, and proactive” to figure out what’s going on with a student. As an athletic director and administrator of the college, she believes it’s just as important to support coaches with education and professional development so they can understand and practice mental health best practices, she explains. If you can have a mental health counselor in the building, that can be extremely powerful, but even if you can’t, she suggests building a unique partnership between athletics and the counseling center. 

There’s no one-size-fits-all approach to mental health at the university level, because every campus is unique and has its own set of systems and processes, but there are best practices which can be implemented into every athletic program.

Dr. Hebard suggests the four mental health best practices established by the NCAA Sports Science Institute:

Providing access to licensed mental health professionals 

Establishing emergency and non-emergency action plans 

Implementing confidential mental health screenings 

Creating a culture that supports mental well-being and resilience 

We also expanded on these best practices in our new white paper Taking a Team Approach to Mental Health: Best Practices for Collegiate Athletic Departments, which includes contributions from industry experts including Dr. Hebard, Deborah Wardlaw, Director of Athletics at Columbia College, and Erin J. Reifsteck, PhD, Associate Professor in the Department of Kinesiology at the University of North Carolina-Greensboro, among others.

While there are many different leaders, organizations, and associations leading the way on student-athlete mental health, it’s important to seek out evidence-based education, training, and resources, which aims to provide the most effective care available.

Here are some evidence-based resources to check out:

Coaches Assist – you’ll find three different handbooks (including Managing Student-Athlete Mental Health and Coaches Handbook - Managing the Female Athlete Triad), along with training for coaches

Hilinski’s Hope Foundation – this includes the Hilinski’s Hope Game Plan, created in partnership with NCAA Sports Science Institute and Prevention Strategies

NCAA Sports Science Institute – we recommend checking out Mind, Body, and Sport and Mental Health Best Practices. 

In his article The State of College Athletics, Alex Auerbach, PhD, MBA, Director of Wellness and Development for the Toronto Raptors, argues that resources aren’t enough. In order to create a supportive culture of mental wellness, we must work together to change the system. He provides specific recommendations, including making coaching healthier and redistributing the power within athletics. 

For more information, download the white paper here or watch the latest webinar recording here. 

Webinar Recap: Strengthening the Player-Coach Relationship to Improve Mental Health

“You have to take action and tell the story about what and why you are changing”: Learnings from a Mental Health Roundtable Discussion with Diversity and Cultural Center Directors

It’s widely acknowledged that minoritized students seek support within the communities that feel safe to them. Craving a reflection of their own lived experiences, students often look for support from the staff at campus diversity and cultural centers (e.g., LGBTQIA+ centers, African American Cultural Centers, Latinx Cultural Centers).  While some cultural center staff may possess counseling training, many  are cornered into a position of becoming adjunct therapists without the adequate training, resources, or compensation to address students’ mental health needs. This dynamic highlights another instance in which a lack of institutional investment and commitment to holistic well-being disproportionately impacts BIPOC and LGBTQIA+ students, faculty and staff. 

This month, I had the unique opportunity to host two roundtable discussions with various higher education stakeholders from diversity and cultural centers nationwide. The roundtables aimed to carve out space for necessary discussions about not only the intersection of equity, identity, and mental health, but also opportunities to better support the well-being of historically-marginalized students on campus. Often, the conversation surrounding mental health services on campus, and the burden of providing them, gets limited to counseling centers. With the abundance of on-the-ground expertise within their communities, we hoped to elevate these voices to better understand how campus mental health services can better meet the needs of all students, not just those already accessing care. 

Key learnings from the diversity roundtable discussions:

Minoritized students may have a (warranted) lack of trust in the institution’s intent and ability to support them, and may believe that the traditional mental health services at their campus counseling center will not be helpful. 

Students who do overcome cultural barriers to help-seeking are often met with waitlists for limited, short-term care during working hours provided by therapists who do not reflect their identities. In the words of one of our participants, “students don’t want to give the racism 101 or sexism 101 talk. By the time they’re at session 4-5, their time is up and they’re outsourced to a therapist in the community.” 

Negative perceptions of the counseling center become strengthened by confirmation bias, which may dissuade other first generation, BIPOC, and LGBTQIA+ students from seeking counseling services. 

When minoritized students don’t utilize the counseling center, they may turn to cultural centers for support (or not seek support at all). 

If students turn to cultural centers, the already overburdened and under-resourced staff are put in the uncomfortable position of doubling as therapist, care navigator, case manager, and mental health educator.  

Cultural centers are rooted in community and trust. When referring students to services outside of campus, staff want to feel confident that their referral will provide a supportive environment. 

The current model of mental health pathologizes natural, communal experiences, such as racial trauma and grief. One of our participants noted, “students have reservations using certain resources due to a fear of being pathologized.”  

Ask minoritized students what they need— listen to them and implement real sustainable policy changes with wide-reaching impact. 

Hire therapists to represent a wider range and intersection of identities and lived experiences. If recruitment is a challenge, explore why it’s so difficult to recruit and retain therapists of color— is compensation high enough? Is the culture inclusive? Also, consider alternative options such as telehealth partners to increase access to culturally-responsive care during extended hours.  

Anticipate the impact of current events instead of waiting for students to demand timely responses and increased resources. 

Acknowledge the ongoing impact of racism/racialized trauma, homophobia, transphobia, and indigenous erasure. Carve out spaces for students to address the impact on their mental health and well-being. * Words matter: call things what they are (e.g. white supremacy, communal trauma). 

Expand the paradigm of mental health care to be more inclusive of community-based practices and approaches. 

Extend resources to families and/or incorporate families into care

Create a deliberate counter-narrative to address the negative perceptions of the counseling center on campus. The counter narrative may be action (hiring more diverse therapists) or knowledge-building (“we do have therapists of color on campus and you can get an appointment within 2 weeks”). In the words of one of our roundtable participants, “You have to take action and tell the story about what and why you are changing.”

These two roundtable discussions provided actionable insight on the experiences of Diversity and Cultural Center staff and their observations of the mental health care needs of minoritized students. We view this conversation as the first of many as institutions work toward systemic change, and are confident in our own ability as a company to continue prioritizing the voices of historically marginalized students, faculty and staff. 

A summary of roundtable discussions on diversity in college mental health

The importance of quality mental health care on campus comes into focus when we turn our attention to the experiences of students in crisis. One of our team members shared a personal story about his nephew that offers valuable framing for this discussion:

"He began college in September 2020 but withdrew four months later due to mental health challenges that went untreated. He was experiencing depression and anxiety and didn’t get the kind of help he needed. Despite his track record as a happy high-achiever in high school, after his brief college stint he was left with unfinished courses, substantial debt, a relationship breakup, and an overwhelming sense of defeat. At the heart of his crisis was mismanaged medication. Now, he’s back home with parents getting help he didn’t know how to find on campus but with greater uncertainty about how to succeed in college going forward. He has a tarnished relationship with the college experience, in general, and his university, in particular."

Stories like these are too common—and perhaps what is most devastating about them is their preventability: 83% of students believing their academic performance has been hampered by poor mental health. Depression and anxiety are manageable with quality mental health services. It is widely accepted among mental health providers that combining medication management and psychotherapy drives the most effective outcomes for common disorders including anxiety, depression, and bipolar disorder. However, most centers only staff psychologists with patient session caps, and less than two thirds of centers offer psychiatric services at all. 

With telehealth emerging as a strong candidate to help fill these resource gaps, universities are faced with the choice of how to invest in mental health services that are indispensable to student success. 

University Leadership Is Advocating for Students

There is a new wave of empowered students and parents who recognize that mental health services are essential to student success. As stigma around psychiatric illness dissipates, student affairs and counseling leadership can usher in new technologies and approaches onto campus to meet student demand and propagate meaningful change.

A simple Cost-Benefit Analysis by the American Council on Education illustrates the ROI of investing in mental health services:

Consider a university onboarding clinicians to care for 500 additional depressed students. The investment to provide these services costs $500,000 at most ($1000 per student is a generous estimate of treatment cost). By averting student dropout rates, this program would yield $1,000,000 in tuition revenue for the institution. Lifetime economic returns for students are predicted to be over $2 million. 

Mental health services yield economic returns for universities far exceeding their cost. The ROI suggests a huge potential to deliver a better academic experience to students while also realizing important incremental revenue. This analysis does not even account for less tangible, yet still meaningful, benefits of quality mental health care to student wellbeing and institutional reputation.

Investing in psychiatry drives quality care.

Psychotherapists, or talk-therapists, are often more accessible to college students than psychiatric providers. But high quality care requires access to both psychotherapy and psychiatry. A meta-analysis of 101 studies on treating moderate depression found that combined treatment was more effective than both psychotherapy alone and pharmacotherapy alone. 

According to a recent large-scale study, while the proportion of college students taking psychiatric medications has risen in the last decade, the proportion of students receiving medication management via psychiatric providers has been stagnant. There is also a trend towards polypharmacy, with 40.8% of college students using multiple categories of psychiatric medication in the last year. As college students seek care for complex conditions, the imperative to connect them with psychiatric providers is heightened. 

Despite the fact that psychiatrists provide the most informed mental health care, primary care doctors are prescribing the majority of psychiatric medications in use—prescribing 58.8% of psychiatric medications versus psychiatrists prescribing 36.1%. While it can be challenging for colleges to afford in-house psychiatric providers, telepsychiatry offers a compelling solution to the need for highly qualified practitioners who can manage complex treatments for college students.  In light of extensive evidence that general outcomes do not differ between in-person treatment and telepsychiatric treatment, telepsychiatry has the potential to fill in gaps in care.  

Telehealth solutions make quality care scalable. 

Telehealth in general is well-suited for college students with busy schedules, enabling greater appointment availability and remote therapy sessions. According to a review of recent literature, “College students find Telemental Health to be convenient, accessible, easy to use, and helpful. Telemental health also helps to overcome the barrier of stigma, which may help ethnic minority students in particular to seek care.”  

While the efficacy of telehealth in treating moderate to severe psychiatric illnesses has been met with skepticism, treatment results are proving that virtual therapy is an effective complement to face-to-face treatment. Supporting ease of collaboration and oversight, telehealth enables universities to employ non-M.D. licensed clinicians like Psychiatric Nurse Practitioners who deliver high quality care with the supervision of a psychiatrist.  Without telehealth, schools often lack the resources to provide that supervision. Colleges often lack access to Psychiatric Nurse Practitioners—particularly in rural areas—so telehealth connects universities with qualified, affordable clinicians, removing barriers of geography and scheduling. 

Empowering Students through Telemental Health Services

Students care about having access to quality mental health care. In a 2020-2021 American Council on Education survey series, college and university presidents consistently designate student mental health as the most pressing issue on campus. 

Students’ enthusiasm for improved mental health services suggests that treatment is likely to be highly effective. One of the most powerful predictors for treatment efficacy is internal motivation of patients. As stigma around mental health treatment lessens and students are empowered to gain control over their mental wellness, institutions have a responsibility to offer robust and flexible care.  

At Mantra we believe that high quality mental health care is a right of every student. Practitioners have long waged the battle to increase awareness and support for the treatments that help students thrive. Now is the time to augment face-to-face services with affordable, effective and critical telepsychiatry care and teletherapy services, so that each semester leaves students more empowered, capable, and motivated than before. 

The Cost of Crisis: Making the Budget Case for Telepsychiatry on Campus

Sitting here in my new home “office” (read corner of my bedroom - the only vaguely quiet spot in a house with four kids doing online school) and gazing out at the wind swept Colorado prairie, rather than the ivy-clad university arts quad I had grown used to seeing through my office window, it’s hard to grasp just how much has changed in the past two semesters. Even my colleagues who are still on campus are sitting alone in socially distanced offices with little of the usual hum of learning, energy, and growth that drew so many of us to go into college mental health in the first place. Yet in spite of the students staying off campus or heading home early for the winter break, there remains a lot of work to be done.

Before the pandemic began, universities were already struggling to keep up with demand for mental health care. According to the 2019 Healthy Minds Study, which surveyed over 62,000 college and university students across the United States, 36% of students reported moderate to major depression, more than one third demonstrated scores consistent with an anxiety disorder as measured by the Generalized Anxiety Disorder-7 (GAD-7) and 14% reported having experienced suicidal ideation in the past year (1). Having spent the last ten plus years working in college mental health, I’ve seen firsthand the struggle to staff psychiatric providers in adequate numbers to address the need. To put it bluntly, most counseling centers in higher ed just don’t have the space or the resources to hire their way out of this, and, nationwide, there is a shortage of psychiatric providers (2) overall. Locating and recruiting specialists, especially those from diverse backgrounds, is particularly problematic in rural areas, which is where many colleges and universities are located. Given we know that students of color and those that identify as LGBTQ, two groups particularly unlikely to seek treatment for mental illness (3), access services more often when they are able to meet with providers who look like them or have similar identities (4), it’s crucial that we find better solutions.

For more straightforward mental health concerns on campus, primary care providers (PCPs) can certainly play a vital role. With their broad background in treating most other general health conditions, PCPs are uniquely positioned to decrease the so-called “silo-ing” of mental health care and can often build on their existing rapport with patients. Although I am grateful for the many PCP’s I work with who help increase access to mental health care, non-psychiatric providers, along with everything else they are required to know and do, may not have the training or the time in their schedules to diagnose and treat significant mental illness adequately (5). In fact, nationwide, only 13% of patients treated for mental health by PCPs are receiving “minimally adequate” care that aligns with evidence-based guidelines (6). Furthermore, a higher rate of patients are referred to mental health providers after being diagnosed with a mental health condition than when given other primary (physical health) diagnoses (7), suggesting that PCPs recognise the need for access to specialists with more extensive training in the art of both diagnosing and treating mental illnesses. 

With as many as 24% of college students arriving on campus already having been prescribed psychiatric medication (8), colleges and universities are needing to think outside of the box to find the resources they need to keep students well and performing their best in school. For this, telehealth is a promising and economic approach to increasing access to a diverse group of mental health practitioners specifically experienced in helping transitional aged youth. If using telehealth, regardless of the location of the school itself, campus health centers can recruit highly trained candidates from essentially anywhere nationwide, since providers can practice from any state as long as they are licensed in the state in which the student is located at the time of the appointment. This also makes it possible to offer continuous ongoing care even as students move on and off campus, or home for holidays or summers, which are times that have historically led to disruptions in traditional campus-based services. With the onset of COVID-19, many, if not all, universities with college counseling centers have had to  switch over to virtual care at least temporarily, using whatever providers were previously on-site. For those who need help maintaining or growing these services moving forward, there are now telepsychiatry companies focused on making specially trained college health providers available to colleges and universities.

Telemental health, which includes various modalities of communicating and receiving mental health care virtually, also has the ability to support patient self management by offering modules or links to resources such as psychoeducational handouts, empirically supported self-help apps, and crisis intervention services, in addition to real-time video appointments. This may be especially useful for colleges and universities that have switched to a stepped care model in order to maximize the limited resources available on campus. Telepsychiatry can be part of platforms that offer the option of incorporating secure messaging to address side effect questions and treatment goal check ins. As providers, we know that when patients can easily access us with questions or concerns, compliance increases, and the therapeutic relationship, an essential component of the success of mental health treatment, is strengthened. 

Although telehealth has been shown to be convenient and affordable, it must be proven effective if it is to become a permanent part of college mental healthcare after the pandemic. Fortunately, even before telehealth was widely implemented on college campuses, data strongly supported virtual care as providing equal or, at times, better treatment than could have been available in person (9). According to the APA online telepsychiatry toolkit “telepsychiatry is equivalent to in-person care in diagnostic accuracy, treatment effectiveness, and patient satisfaction” (10). Indeed, some of the most common mental health diagnoses in college aged youth have been successfully and safely treated via telehealth, including anxiety disorders, PTSD, Major Depressive Disorder, eating disorders, and substance use disorders (11, 12, 13). Outside of medication management, which, of course, is only one piece of treating mental illness, both video-based cognitive behavioral therapy and group therapy as well as other online modalities have demonstrated similar success as face-to-face care (14).

As college and university counseling centers consider continuing online care, it is important to remember that telehealth is not just doing the same thing as when we were talking with patients face-to-face. Special attention must be given to asking about and observing the things that are less apparent when interviewing patients virtually. The smell of alcohol or poor hygiene, physical exam findings such as tremor, involuntary movements, even tears may be harder to notice when the patient and provider aren’t sitting in the same room. Clear protocols for high risk or crisis situations, which may develop quickly and without much warning, need to be in place as do plans to help students access in-person or higher levels of care when appropriate. Finally, the development of rapport can take extra care, skill and attention, although seeing into a patient’s actual home or meeting their favorite pet during a session, can sometimes actually make it easier to find a personal connection (I’ve seen more cute dogs than I ever did when working on campus).

Back in my improvised office, despite having to adjust to working from home, I’m becoming more and more convinced that continuing telehealth services on campus may just be the best way to fill the ongoing gap in care. It is an effective way to provide the treatment that students need to thrive, without compromising outcomes, and gives more students access to providers who look like them or who can be available at times that suit their schedule. I hope online care remains a permanent option for students long after the pandemic is over.

(1) Eisenberg D., Lipson S.K. The Healthy Minds Study. 2019. Accessed from: https://healthymindsnetwork.org/wp-content/uploads/2019/09/HMS_national-2018-19.pdf

(2) National Council Medical Director Institute. The Psychiatric Shortage: Causes and Solutions. Published March 28, 2017. Accessed on April 20, 2020 at: https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Shortage_National-Council-.pdf?daf=375ateTbd56

(3) Chen, J. A., Stevens, C., Wong, S. H., & Liu, C. H. (2019). Psychiatric symptoms and diagnoses among US college students: A comparison by race and ethnicity. Psychiatric services, 70(6), 442-449

(4) Cabral, R. R., & Smith, T. B. Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology. 2011; 58(4), 537

(5) Fraser, K., Oyama, O. Knowledge of Psychotropics and Prescribing Preferences of Family Physicians: A Preliminary Study. Acad Psychiatry. 2013; 37, 325–328. https://doi.org/10.1176/appi.ap.12090160

(6) Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-Month Use of Mental Health Services in the United States: Results From the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):629–640. doi:10.1001/archpsyc.62.6.629

(7) Geissler K.H., Zeber J.E. Primary Care Physician Referral Patterns for Behavioral Health Diagnoses. Psychiatric Services 2020 71:4, 389-392

(8) Eisenberg D., Lipson S.K. The Healthy Minds Study. 2019. Accessed from: https://healthymindsnetwork.org/wp-content/uploads/2019/09/HMS_national-2018-19.pdf

(9) Carleton KE, Patel UB, Stein D, Mou D, Mallow A, Blackmore MA. Enhancing the scalability of the collaborative care model for depression using mobile technology. Translational Behavioral Medicine. 2020; 10(3): 573–579. doi:10.1093/tbm/ibz146

(10) American Psychiatric Association. Telepsychiatry Toolkit. Accessed from: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit

(11) King S.C., Richner K.A., Tuliao, A.P., et al. A comparison between telehealth and face-to-face delivery of a brief alcohol intervention for college students. Substance Abuse. 2019. DOI: 10.1080/08897077.2019.1675116

(12) Eisenberg D., Lipson S.K. The Healthy Minds Study. 2019. Accessed from: https://healthymindsnetwork.org/wp-content/uploads/2019/09/HMS_national-2018-19.pdf

(13) American Psychiatric Association. Telepsychiatry Toolkit. Accessed from: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit

(14) Hilty, D.M., Maheu, M.M., Drude, K.P. et al. The Need to Implement and Evaluate Telehealth Competency Frameworks to Ensure Quality Care across Behavioral Health Professions. Acad Psychiatry 42, 818–824 (2018). https://doi.org/10.1007/s40596-018-0992-5

Telepsychiatry as an effective and affordable long-term solution to specialized mental healthcare on campus

This post is written by Kelly Carleton, MA, Clinical Operations Director at Mantra Health. She has a background in managing over $6 million in grant funded programs (e.g., federal, private, etc) to support behavioral health integration and telemental health initiatives at a large medical center. If you have questions related to the grant application process or want guidance on where to start, please contact Kelly directly to set up a free consultation call, or you can book an appointment here. 

Grant funding can be an excellent way for higher education institutions to lift pilot projects off the ground or enhance existing programs or services. College and university health and mental health care departments may especially benefit from obtaining additional grant funding to support innovations in health care delivery, particularly in light of the recent Coronavirus-19 (COVID-19) public health emergency which has made telehealth services much more ubiquitous. 

In response to its rising popularity, grants supporting telehealth programs have increasingly become a priority topic due to the ability for telehealth to address major gaps in our healthcare system including care access, quality, and patient/provider satisfaction. The COVID-19 crisis has filtered even more funds to support telehealth and has led to deadline extensions from existing funding announcements. For example, to address health care needs during COVID-19, the Health Resources and Service Administration (HRSA) Telehealth Network and Telehealth Resource Centers Grant Programs authorized $29 million per year through 2025 and has relaxed the criteria for who qualifies as an eligible applicant. (1)

With adequate resources and support from someone experienced in the grant application process, colleges and universities can use grant funds to embark on projects that create opportunities for cutting edge and high quality care for their students.

Grant-Seeking Process: High Level Considerations

Though starting the grant application process takes substantial effort to research and plan, there is a methodological way to approach the process that helps save time and increase one’s chances of being successfully awarded funding. Below are some example questions and suggestions to consider while reviewing various funding opportunities. For more information, please contact Kelly Carleton (contact information above) or book a consultation call here, which will include a thorough review of how to prepare for grant applications.

Understand the various types of grants (e.g., federal agencies, regional and national foundations, etc) and determine what funding type best fits the aims of your project.

Does your organization fit within the eligibility criteria listed in the RFP/FOA?

When are awards announced and funds dispersed, and does this align with your budget needs for the project and fiscal year?

Are there any restrictions on how the funds can be used that are going to prevent me from carrying out project activities as desired?

The Rural Health Information Hub is a reputable go-to resource for researching telehealth-related grants with filtering options by topic, geography/state, and active/inactive funding. An exhaustive list of grants, including opportunities from NIH/NIMH, SAMHSA, HHS, and NSF, can also be found at grants.gov, with ability to add parameters such as open/close date, applicant eligibility, funding agency, and keyword search.

To facilitate the grant seeking process, we compiled a list of programs and funding sources whose priority areas align with supporting telehealth related programs at your college or university. Of note, the list below ranges from low to high intensity in respect to how much time and effort is required in the submission process. Interested applicants can book a call with our Clinical Operations Director to help analyze the available funding opportunities and what is the right fit for your project idea.

The priority areas, status, and due dates for the programs listed below are subject to change. We strongly recommend periodically checking program websites for active status grants and/or signing up for email notifications for each respective source.

If you don’t see your state below, email me (kelly@mantrahealth.com). I will research relevant grants available in your state and send it to you directly by email.

Health Resources and Service Administration (HRSA)

Telehealth Network Grant Program ($300,000 per year)

Evidence-Based Tele-Behavioral Health Network Program ($350,000 per year)

Rural Health Care Coordination Program ($250,000 per year)

Telehealth Focused Rural Health Research Center Program ($950,000 per year)

United States Department of Agriculture (USDA)

Distance Learning & Telemedicine Grants ($1,000,000 total)

Patient-Centered Outcomes Research Institute (PCORI) (award varies per FOA)

Agency for Healthcare Research and Quality (AHRQ) (award varies per FOA)

William T Grant Foundation ($600,000 total)

Aetna Foundation (~$50,000 - $100,000 total)

United Health Foundation (award amount negotiable)

Food for Thought

Articles and research from our team on the future of mental healthcare for young adults.

The state of provider burnout in college counseling centers in 2021

COVID-19, Monkeypox, and the Seasonal Flu – Is Your Campus Prepared?

How to Educate Students on Crisis and Suicide Prevention

Mantra Health Announces Multi-State Insurance Network Contracts and Fifty State Expansion; Brings Total Funding to $5.2M

The CARES Act and University Mental Health

Introducing the Mantra College Mental Health Provider Diversity Scholarship

Improving Student Mental Health at Alfred State College with Psychiatry Services

Webinar Recap: Strengthening the Player-Coach Relationship to Improve Mental Health

A summary of roundtable discussions on diversity in college mental health

The Cost of Crisis: Making the Budget Case for Telepsychiatry on Campus

Telepsychiatry as an effective and affordable long-term solution to specialized mental healthcare on campus

Telehealth Grant Opportunities for Higher Education Institutions (UPDATED)

Why I Joined Mantra Health as a Medical Director

The importance of culturally competent care

What societal unrest means for mental health on campus

Mantra Health’s Spring Telepsychiatry Program

2022 Update: The CARES Act and University Mental Health

Mantra Goes to the DMV: Webinar Series with Consortium and Expansion in DC-Area Schools

The Rising Need for Telepsychiatry on College Campuses

Advocating for the Mental Health of Student-Athletes at the NAIA National Convention

Mantra Health and Didi Hirsch to Bring Quality Virtual Counseling and Crisis Care to Struggling College Students