Attention-grabbing articles, backed by research.

Across the country and indeed the globe, the coronavirus pandemic has upended people’s lives. Over 150 million Americans have been ordered to stay home, and the vast majority of them are not physically ill right now. This news still feels like a shock to the system, but as these radical changes shift from days to weeks and even months, the combination of widespread anxiety and social isolation will be a major strain on our mental health. Here’s what I’m doing (and what you can do) to maintain sanity during this insane time.

Coronavirus news is everywhere, and it is true that the facts are changing by the day. Naturally, I want to know about the latest number of cases, emerging science about the virus itself, and government plans to address the illness as well as the effects on the economy. However, being trapped at home makes the world feel small, and constantly reading about the coronavirus adds worry with little solace. A supervisor once told me that reading fiction is the best training for a psychiatrist. As we move from our own mind to another person’s point of view, we literally practice empathy. I have also come to realize that reading fiction transports me to another time and space (without exposing me to any viruses). This week, I finally read Tara Westover’s Educated. Reading about the Idaho mountains added a breath of fresh air to my small New York City apartment. 

Remember the mind and body are connected. Just because you can’t go to the gym doesn’t mean you can’t work out. I strongly prefer gyms or playing a sport, but these are not options right now. I’m focusing on what I can do from home: 5-minute yoga sequences in the morning to stay limber, and bodyweight workouts that do not require much space. The American Heart Association guidelines suggest we aim for at least 30 minutes of moderate activity 5 times per week or 75 minutes of intense physical activity per week. If you need people to help motivate you, many fitness studios and yoga classes are offering online streaming so that you can continue your group fitness class from the comfort and safety of your home. 

Do that project you’ve been putting off

Let’s face it: with the lack of commute to work and social events, most of us have more time on our hands than we’re used to. Especially for people who are feeling well and suffering from “cabin fever,” try to think of this time as an opportunity. We all have things we’ve been meaning to do when we get more time: clean out our closet, make a scrapbook, learn a language. Now is the time to work on these items. 2020 will be forever remembered as the year of coronavirus in history, but in your personal story it can also be the year you began something new. In my case, I’m working on improving my Gujarati skills to pass on the language of my parents to my newborn child.

Language and communication are the essence of what makes us different from every other animal species. While social distancing is the best public health strategy right now, social isolation runs counter to human nature. Perhaps that is why isolation is a risk factor for depression, anxiety, poor cognition, physical illness, and even premature death. I have family in 4 different states, and we’ve implemented a FamilyFaceTime on Saturdays at 12pm. It really is different (and better) to get dressed and look at one another in real-time. For many younger people reading this, a video-chat may feel intrusive in today’s text message-oriented culture, but remember, if they are a human on this planet, your friends and family are likely at home with more time on their hands too. While you’re at it, consider reaching out to people you care for but have lost touch with. Reconsider strained and estranged relationships in favor of burying the hatchet. Calamities like this one risk isolation and despair, but they are also an opportunity for mutual understanding and coming together.  

Extra time can make anyone stir crazy, but it is also an opportunity to consider what you want out of life. Introspection requires us to pause and think about who we are, what we believe in, and what we want out of life. Mindfulness and meditation using apps like Headspace and Calm can help with focusing our minds in the present moment. For people who find such exercises challenging, this reflection could take the form of journaling about where you are in your life and where you want to go. Finally, for people who have been considering it, now is an excellent time to start therapy - just be sure to find a provider using telehealth. 

College is a time of exploration, growth, and development. It has its own ups and downs. In that context, freshmen who were just getting their feet wet and seniors wrapping up their final semester (and everyone in between) have all been asked to halt everything, return home, and try to take their courses online. Naturally, much of the magic of college occurs in conversations, group meetings, clubs and extracurriculars, and class discussion. Feeling sad, disappointed, and even angry are all normal emotions to have during this time. If you are feeling particularly out of sorts, reach out to your college counseling center. They are likely still functioning (albeit online), and they can help you figure out the best way to get through this situation. 

Wherever you are, I hope these tips help you as we prepare for weeks and maybe even months of social distancing, lockdowns, and more time at home. Take care of yourself. Look after others. And above all, stay safe. 

Ravi N. Shah (@RaviShahMD) is assistant professor of psychiatry at Columbia University Irving Medical Center and Co-Founder of Mantra Health. 

Tips from a Psychiatrist on Coping at Home During Coronavirus

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.

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

Trauma-informed principles of validation of trauma, safety, and collaboration can be applied clinically and organizationally to help campuses cope with Covid. 

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. 

I spent the majority of my career in the college mental health space as the Director of Counseling and Psychological Health at UMass Amherst in Massachusetts. As with most counseling centers in higher education settings, UMass Amherst struggled with the flow of getting each student the mental health care they need. Each year, utilization rates would rise and outstrip on-campus resources. Like many other campuses, we were additionally bound to providing care only during the active academic calendar, which means students who seek care were often confronted with a several month disruption in treatment as they move off campus to their respective homes for breaks. 

Knowing that it is incumbent upon us as campus leaders to use clinically based decision making, I searched for any and all efficiencies that will not compromise our clinical standards. For example, referrals to the community are an integral component of any comprehensive stepped care plan, however, when coordination or communication with the campus based center is clinically indicated such community referrals can fall short in the context of busy schedules or privacy laws. Operational barriers aside, referrals to psychiatric services pose particular challenges given the sparsity of psychiatric providers in so many areas of the country. 

As I approached retirement, I often reflected on these systemic problems and knew I still wanted to make an impact on this continued problem in the field. I had intended to slow down, develop a part-time consulting practice, and engage in a small clinical practice focusing on college and university students, all of which I’ve been fortunately and gratefully able to achieve. Joining an entrepreneurial start-up was completely out of my radar for my “lower key” retirement plan, despite being regularly approached throughout my career by telemental health vendors wanting to offer a variation of some solution that addresses the challenges inherent to providing mental health services in large residential communities. I was not interested in working with a technology group, especially when there are so many that exist in the market today opting to solve the same problems - how does one truly distinguish one company from another? It felt risky at this point in my career.

When I was approached by the co-founders of Mantra Health, I was quickly intrigued by their unique system - knowing that this was a niche product unlike what I’ve seen before. I was immediately taken by the way in which this team understood it’s clients’ challenges and capitalized on their ability to address them. This was a team that truly understood the power of using technology to promote care quality, without neglecting the interpersonal importance of connecting patients and providers, and instead, finding ways to augment this care interaction. Despite this being a new chapter in my professional life with various other plans for how I was going to spend it, I knew that I had to somehow collaborate with this visionary team.

Mantra’s team is made up of a unique blend of individuals with clinical expertise to understand the challenges and potential solutions in the mental health care space, but also with impressive technology operators who have contributed to building market defining solutions. The end result of this structure offers a fresh take on using technology to increase access to needed long term therapy or psychiatric care by focusing on the importance of interdisciplinary team communication and collaboration, which as mentioned above, is one of the biggest challenges in the field. Understanding the importance of close collaboration with the counseling center is the foundation of Mantra’s software, an intuitive tool that allows counseling centers to have real-time, bidirectional input into the care of the student. Mantra also expertly finds a way to identify and address each clients’ pain points and propose a flexible solution that helps higher education institutions achieve their overall academic and student success goals, including ensuring that patients are never left without mental care options, regardless of which academic calendar their school’s services are bound.

Currently as a Clinical Advisor for Mantra, I am able to take the decades of experience working in a higher education counseling center setting and modernize that knowledge to address the needs of students today. This role gives me an opportunity to weigh in on these important issues in a substantive manner throughout each stage of Mantra’s development and expansion as a start-up company. I am grateful for the opportunity to contribute to this new wave of care delivery, especially in this dire time prompted by COVID-19. Mantra’s solution not only solves a need with the pandemic today, but offers a solution for challenges faced in the field for decades making it both timely and timeless.

Why I joined Mantra Health as a Clinical Advisor

Mantra Health reached out to a coalition of student body presidents (SBP) to get a better understanding of how mental health care on campus is viewed from the students’ perspective. The SBP’s recently published an open letter to state licensing boards gathering signatures from more than 150 universities across the country. We asked questions about why mental health support is a crucial part of a student’s journey in higher education, particularly now with the widespread impact of COVID-19.


Mantra: From the student experience, what do you think is the major barrier in accessing mental health resources and services on college and university campuses?

William Zhou (Brown University Student Body President 2019-2020): “As mentioned in our letter, one barrier to accessing mental health resources are licensing laws that bar mental health practitioners from providing out-of-state care. As a result, many students are now left to cope with severe stress without the assistance of essential mental healthcare practitioners. Counselors at universities across the country have transitioned their work to an online format, but are not able to offer their assistance to students living outside of their state due to licensing regulations. We have seen a similar issue arise when students return to their homes for university breaks, which are shorter and less anxiety-inducing than the state of affairs with which we are presently faced. 

To adapt to licensing laws during these breaks, state governments have recommended that mental health practitioners apply for temporary licenses in their patients' home states. However, the unforeseeable nature of COVID-19 has left mental healthcare practitioners with little to no time to apply for such licences to ensure that they can continue seeing their patients. This then poses an additional barrier and threat to students' wellbeing, which should be of top priority to ensure that they can remain focused and in good mental health.” 

Mantra: In your opinion, what is the impact of students not receiving needed mental health services?

Grace Wickerson (Rice University Student Body President, 2019-2020):  “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.”

Mantra: How do you envision the path towards improving mental health resources across college and university campuses, and what exactly are the student needs at this time?

WZ: “We believe that the path forward involves state medical boards mandating the suspension of interstate regulations on counseling services so that those who are licensed and in good standing in any state can practice without civil or criminal penalty. We also believe that the telemental health practitioner definition should include any professional, paraprofessional, or licensed behavioral health staff who deliver qualified services via telemental health. Fortunately, many state boards now offer temporary licenses to help support the increased mental health need and we hope to see more follow suit.” 

Mantra: How do you see telemental health services playing a role in helping address barriers around getting help?

Ranen Miao (Washington University in St. Louis, Student Body President 2020-2021): “Amidst social distancing measures, financial and academic stressors, and anxiety induced by COVID-19, we need to support students while they adjust to online classes and transition home.”

WZ: “As mentioned in the letter, the expansion of telehealth can play a role in supporting students in getting help. Its expansion across state lines is necessary when considering the influx of mental illnesses due to the social isolation mandated by many state governments. While this practice is necessary to flatten the curve, it has also imposed severe health consequences for people who are now cut off from their social circles and support systems.” 

Mantra: If you could relay one message to the Vice President of Student Affairs at your school related to improving mental health services on campus, what would that be?

WZ: “COVID has had a significant impact on student life. For students unaccustomed to living at home, returning to their families may elicit stress in many forms, including complex family dynamics, financial strains and food and housing insecurity among others. And for a number of obvious reasons, some students may be placed in a position or situation where they must take care of themselves or loved ones who cannot care for themselves (like younger siblings). It’s incredibly important that students continue to have access to support systems remotely as without them, these challenges can be exacerbated.” 

How would you rate the importance of mental health support for students in this new normal as opposed to prior to Covid, from much less important - much more important?

Student body presidents on why mental health care needs to be supported now more than ever

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.

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.

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/

5 steps a Student Health Center Director took to make the case for mental health budget

The stay-at-home restrictions and social distancing necessitated by COVID-19 have had sudden ripple effects on mental health services for everyone who counts on these supports and treatments. 

College students have faced their own unique effects, as campuses have emptied requiring students to relocate to their respective homes. Although psychological treatment is included amongst essential services, social-distancing has created a widespread prohibition on in-person therapy. An added wrinkle for out-of-state students who’ve been mandated to leave college housing is that their therapist is most likely not licensed in the students’ home states (not to mention the situation faced by international students returning to their home countries).

Dealing with uncertainty is the core underlying theme of stress and anxiety. Hence, the quick switch to all online classes, its effects on graded assignments, and trying to figure out where and when to study without distraction in the home that now serves as a makeshift, all-in-one school and workplace all produce a state of flux. Not the least of these issues is questions about how to reconnect with or find a therapist for remote treatment – or if this is even possible.

A first proactive coping step is to identify the specific questions you are facing and take stock of your automatic thoughts about them – “What am I going to do about therapy?” Such rhetorical questions are usually veiled negative thoughts – “I’m not going to be able to have therapy sessions.” For a different approach, the next step is to consider actual information – what you know and what you do not know (yet) – and decide on a course of action. In the case of this sort of rhetorical question – “What am I going to do about [fill-in-the-blank]” – the task is constructing a literal answer to it and a realistic, attainable action plan. 

So, let’s focus on what we know about how to access therapy services during the COVID restrictions.

1) First and foremost, remember that psychological emergencies, such as suicidal thoughts, plans, and intentions warrant a trip to or at least contact with a hospital emergency department, urgent care center, or crisis response center, which are still open and accessible. Calling 911 for emergency response is also still the correct response to an imminent risk to one’s life due to suicidal thoughts and actions. Other resources include: 1-800-273-TALK (8255) / https://suicidepreventionlifeline.org (online chat available) / via Twitter @800273TALK

2) Don’t assume that your college counseling services are not available, as many institutions have transferred all of their services to telehealth. Reach out to your therapist and the college counseling center for information about how they are handling established (or new) clients, including out-of-state students.

3) Even before COVID-19, increasing numbers of therapists were using remote video platforms that allow for secure video-therapy sessions. With remote sessions now mandated, even therapists who might have been skeptical are utilizing such options. There has also been a loosening of privacy regulations to allow the use of some popular video platforms for remote sessions, such as Skype and Facetime, to meet the current need for accessibility to services during the emergency.

4) With the stay-at-home mandate, though, you will not have the same privacy of your therapist’s office, as household members are ever-present. The video-therapy platforms mentioned above are accessible by computer, tablet, and smartphone, which allow for portability. If you are open about your sessions with family, you can coordinate sufficient privacy for sessions; otherwise, it will require creativity, such as going outside for a walk, or driving your car and parking somewhere for a session on your phone, or other ideas for safeguarding your privacy that adhere to social distancing standards.

5) Many students live in different home states from where they attend college. Thus, a remote session would be with a now-out-of-state college therapist, which typically violates state licensing laws for the practice of psychology. However, many states have modified these licensing restrictions to address the need for continued, remote psychological services with established clients during the COVID-19 emergency. Although your therapist will be kept abreast of any new changes, you can check The Association of State and Provincial Psychology Boards for daily updates of states’ interjurisdictional remote practice status for COVID-19. See updates at:  https://www.asppb.net/page/covid19

6) Difficulties refilling psychiatric medication prescriptions is another issue that runs up against cross-state practice issues. As with therapy, reach out to your prescriber to collaboratively work out a solution. A complicating factor is that some classes of medications have specific restrictions in being prescribed through telehealth, most notably stimulants for ADHD. In some cases, out-of-state physicians have remotely consulted with students’ home-state primary care physicians to take over specific prescriptions until a return to treatment-as-usual.

7) Money is a common stressor that will span pre- and post-COVID life. Most insurance companies will reimburse for remote sessions during COVID-19 restrictions, even if they had not previously done so. Some are even waiving co-pays during this time and permitting coverage for a 90-day supply of medications. However, you cannot talk about insurance coverage without the time-worn but necessary caveat – contact your carrier as to how it is handling services and reimbursement during COVID.

One of the goals of psychological treatment itself is to better manage the ups-and-downs of life. Current circumstances will put these skills to the test as you reconnect with your therapist, not to mention all the sudden changes thrown at you and other students. Facing the discomfort is what advances not just resilience but anti-fragility, the newfound strength and skills gained by muddling through and getting to the other side of difficult times. 

My therapy in college was interrupted by COVID-19 and I still need it – now what?

Dr Rockland-Miller is a Clinical Advisor at Mantra Health and Director Emeritus of the Counseling Center at UMass Amherst. 

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All of us are experiencing uncertainty and worry in the face of the Coronavirus pandemic.   Social distancing, while necessary at this juncture, comes at a cost. Connection is always critical to our emotional health. Now, more than ever, it is critically important to find ways to maintain deep interpersonal connection.  As therapists, many of us are accustomed to using phone visits when patients are away or sick.   During this current public health crisis, I have learned that several of my colleagues have decided to use phone calls and messaging over conducting face-to-face, video sessions.  In this article, I outline the reasons I overcame my own internal hurdle to try telehealth, and the reason I feel video sessions are preferable to phone visits.

As clinicians, we have a responsibility to our clients to be clear in our communications, to use the clinical relationship as a vehicle for change and growth, and to never abandon our clients. In the past, when faced with a disruption in care, I always turned to phone calls. Although I am generally proficient with technology, telehealth is something that I previously resisted.   Somehow being with a client on a screen just didn’t seem right, and I feared it would not facilitate a genuine connection. In addition, until recently there were many obstacles to the use of video platforms for mental health treatment.   

Now, everything has changed. Most of these roadblocks have been, or are in the process of being, removed. High speed internet and sophisticated video platforms allow for smooth communications. Barriers to third party reimbursement are rapidly fading, and state licensure issues are being addressed. Most patients are expecting to be able to connect via video, and it’s unclear just how long in-person care will be impossible. 

So, in the context of the public health crisis we are all confronting, and wanting to safeguard the health of myself and others, I moved my clinical practice to a video platform.  To start my journey, I rapidly educated myself on the mechanics and ethics of telehealth practice. I quickly took one of the many on-line courses available around telehealth, read several guides, studied the many posts about telehealth on my primary listserv, and subscribed to a HIPAA-compliant video platform (Simple Practice).

For my clients, the transition to video seemed seamless, and I was amazed at the positive feedback I received.  Having a practice that focuses on college/university students, they are all already comfortable with video technology—using Facetime, Skype or Zoom with regularity.  Indeed, they are “digital natives.” That is, they grew up using technology as an essential component of their social and educational worlds. All report that they are finding the video sessions to be helpful, allowing an opportunity to maintain treatment and an important connection, without a loss to the clinical relationship.  They are relieved that their insurance plans have included payment for this service, so that they can continue in therapy even from afar.  Many are happy to not be going into the community where they might risk spreading or contracting the virus.

All of us have had occasion to speak with our clients by phone.  While an important resource, the video connection is so much deeper than that allowed by phone. It seems to offer real capacity to experience the presence of the other. In addition, seeing my patients in their home environment gives me a new glimpse into their lives. I can see their room, whether disheveled or neat, the way they interact with pets, and much, much more.  In this way, I now feel that telehealth offers a unique opportunity to observe and understand my patients deeply. I will be delighted to return to in-person visits, but this experience with telehealth has changed my practice forever. 

For those of you who are finally ready to make the switch (whether by choice or by necessity), here are a few key tips that helped me in my conversion to telehealth: 

Technology—get comfortable with the video platform prior to your first clinical session, perhaps doing a trial run with a friend.

Insurance - Confirm insurance eligibility, and be aware of correct coding modifiers.

Geography – If operating with a client outside of your state of licensure, confirm that your license is valid in another state.  Things are rapidly changing in this domain.

Privacy: While the government has suspended HIPAA requirements during the national emergency, I recommend you use a HIPAA compliant platform so that you can continue to use the same platform in the future. .

Be professional—even with a video call, be sure to dress professionally,  be aware of background and lighting in the room, turn off phones, etc. Some platforms like Zoom have a feature called “virtual background” that allows you to change the background to a blank screen so that clients cannot see your home. 

Confirm that your client is in a private space. If that is not possible, encourage them to use headphones so that your comments are not heard by others. 

Plan Ahead - Have a backup plan in the event that there are technical glitches.

Informed Consent - Obtain and document informed consent for telehealth.

Communicate - You must proactively tell clients about the availability of this modality.

Have fun! Just as we ask our clients to play with new concepts, try to have fun as you learn a new skill. 

Remember - This is about meeting the needs of our clients during this challenging time. For some, you may be the only helpful person that your client sees at all

A technophobe shares why you should use video visits during Coronavirus

Parked Thoughts