Attention-grabbing articles, backed by research.

When I began working as a clinical advisor to Mantra Health in early 2019, I have to admit I was reticent, even cautious. 

I had spent my entire career embedded in university mental health centers, and telepsychiatry was a relatively new modality for me. I had my reservations about whether a private, digitally-focused company could match the quality of in-person appointments that I felt students deserved. Like most university mental health center clinicians, however, I was witnessing first hand the growing surge of mental healthcare needs on our college campus, which was quickly outpacing the ability for existing care to meet the demand.  

We simply could not hire our way out of the problem and, in the meantime, as suicide rates in our young people skyrocketed nationally and wait times for local mental health care options continued to grow, it was clear that more and more students were being left behind.  I tried to search for options with an  open mind, talking with colleagues about what their centers were doing, wishing for a better way to bring together excellent clinicians and patients in need. 

I first heard of Mantra when a colleague sent me a link, noting how Mantra was trying to build something different: a personalized, evidence-based group of clinicians and a system that integrates with existing university services, designed to be a complement to the providers who already have their boots on the ground.  I have to admit, I was intrigued.  

I had plenty of fundamental questions during my first meeting with Mantra’s founders.  What were their protocols for ensuring clinical excellence, how were they recruiting their providers, how did they decide which students were appropriate for telehealth care, what were they doing to ensure the cultural competence of their provider group, did they understand the importance of the provider-patient relationship in mental health treatment, were they prioritizing student health or head-counts?  

Surprisingly, Mantra had plenty of questions for me.  What did university health centers need, what did the student populations look like, what priorities and characteristics of a third party telehealth platform should Mantra have to provide excellent care?  There seemed to be a genuine enthusiasm for not only increasing accessibility for patients, but also a commitment to making sure that the care provided was strongly evidence based, built on establishing clinical relationships and including students as working partners in their own health.  

And it was not just lip service. Over the coming months, I was invited to join a group of highly respected, experienced professionals, like Dr. Harry Rockland-Miller, Director Emeritus of Counseling Services at UMASS Amherst, to work on developing the protocols and the priorities of Mantra as it began to envision a different approach to telehealth in the university setting, an approach that valued the role of existing services on campus and specifically built on the strengths and priorities of university-based care.  

As a data-driven clinician, while Mantra’s  approach took shape, I began to dig through the research on telehealth itself in transitional-aged youth.  I was surprised to discover that The American Telemedicine Association, the American Psychiatric Association Telepsychiatry Practice Guidelines, and many other reputable sources presented ample evidence showing that telehealth is as effective as in person care for many, if not all, of the most common mental health challenges facing students, including ADHD, Depression, Anxiety, Eating Disorders, and even suicidality.  Further, telehealth offers students access to a diverse, specialized group of mental health providers nationwide, unconstrained by an individual colleges’ ability to recruit and employ a large number of local staff. 

 As I continued to gain enthusiasm for telehealth as a modality, and Mantra as a company, I began to wonder: if we worked together to build a unique platform that allowed collaboration between counselors, prescribers, and patients and that linked other available resources such as crisis support, evidence-based mental health apps, and on-campus programs and clinicians, could our outcomes and our accessibility even outperform standard face-to-face care? Especially for marginalized cohorts, students of color, and those identifying as LGBTQ+ (all groups with a high need for services and greater barriers to treatment), I came to the conclusion that a telehealth program like Mantra could be an excellent answer to filling the gap between available campus resources and student demand.

Now, in 2021, looking over the effective partnerships with universities that Mantra has already created and feeling optimistic about what is yet to come,  I am delighted to have the opportunity to transition from a clinical advisor to becoming the Medical Director of Wellround, Mantra’s provider group. Over the past several years, I have seen first hand the good that this company can do in college mental health and I am eager to help build on that success. 

In this new role, I remain deeply committed to continuing Mantra’s mission to recruit diverse and culturally competent providers, ensure clinical excellence and build holistic and person-centered treatment approaches. If the last ten-years are any indication, mental health care needs on campus will continue to far outpace available local resources and I firmly believe that working with an innovative telehealth solution like Mantra is the best approach to ensuring students have the care that they need. Keeping an eye on where we have come from and never losing sight of the students we do this work for, I look forward to growing together in our dedication to bringing the best technology, the best evidence-based treatments and the best mental healthcare options to college and university students nationwide.  

Why I Joined Mantra Health as a Medical Director

Colleges are in the middle of a mental health crisis. The pandemic has increased rates of depression, anxiety, substance use, and suicidal thoughts in the general public – and emerging studies from college campuses show a similar and alarming pattern. 

Studies show that students of color tend to seek mental health services less as compared to their White peers, but are more likely to endorse feelings of hopelessness, anger, and thoughts of suicide; this was before COVID and the horrific events that inspired the racial justice movement of 2020. Students of all races have stepped forward to demand that college administrators do more to speak out against racism and implement diversity, equity and inclusion initiatives, including increasing access to mental health providers who can understand the nuances of how race impacts identity and mental stress. College leadership must be cognizant and proactive in understanding the challenges students of color experience when seeking mental health treatment. 

These challenges are rooted in historical, social, cultural, political, economic, and religious contexts. High levels of distrust toward medicine and mental health stigma result in students relying on family, community, and spiritual support, but foregoing medical or psychiatric treatment. On campus, experiences of racial hostility leave students feeling invalidated and unsupported by their institutions. 

Students are discouraged by the lack of diversity at counseling centers. Since the pandemic, they are facing financial challenges and therapy may seem like a luxury they cannot afford. Many are grieving the loss of loved ones, or stepped in to be the emotional support system for their own family members.

COVID has highlighted disparities between communities of color and the rest of the population. The internalization of this trauma, the murders of people of color, the repetitive implicit and explicit messages of “you don’t matter and you don’t belong here” are important factors for why students of color want a provider of the same race or cultural background.  This might present the biggest challenge for increasing access to a diverse mental health pool – the numbers of mental health providers of color are significantly fewer than White providers. 

Example: In 2015, the American Psychological Association completed a survey finding that 86% of psychologists practicing in the US were White, 5% were Asian, 5% were Hispanic, 4% were African-American, and 1% were multiracial or from other racial/ethnic groups. This reality is visible and presents an added layer of complexity for students seeking treatment. Colleges will not be able to meet the increasing mental health needs for their students unless they expand access to a diverse pool of mental health professionals.

Students across campuses nationwide have organized and emphasized the critical need for comprehensive interventions that can bolster support and increase access.  Telemedicine presents a practical, efficient, and effective solution for increasing access. Colleges that are implementing telemedicine have the opportunity to connect with skilled mental health providers from diverse backgrounds. 

Understanding that students of color may be hesitant to seek help, it is important for colleges to be proactive and engage their student body by fostering a positive attitude toward addressing health and wellness. Soliciting student feedback is crucial in facilitating this goal; student groups have called for interventions that include mental health training for faculty, staff and students, suicide prevention programs, peer-run student mental health organizations, mental health information during campus tours, orientation, health classes and other campus-wide events, walk-in student health centers, 24-hour crisis hotlines, ongoing individual counseling services, screening and evaluation services and comprehensive referrals to off-campus services and supports.

Recognizing that it might be especially difficult during this time to connect with a provider of color, we still must encourage all students to seek the help they need wherever it is available. Mental health professionals are trained to work with everyone and students of color need care now. 

My hope is that as more students of color seek care, then more stigma will be reduced. Perhaps that might lead to more minorities choosing careers in mental health, thereby increasing the pool of providers of color, which over time, might reduce some of these disparities.

1 Wang X, Hegde S, Son C, Keller B, Smith A, Sasangohar F. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study. J Med Internet Res. 2020;22(9):e22817. Published 2020 Sep 17. doi:10.2196/22817

2 Chen JA, Stevens C, Wong SHM, Liu CH. Psychiatric Symptoms and Diagnoses Among U.S. College Students: A Comparison by Race and Ethnicity. Psychiatr Serv. 2019;70(6):442-449. doi:10.1176/appi.ps.201800388

3 Lipson, Kern, Eisenberg, Breland-Noble. Mental Health Disparities Among College Students of Color. J Adolescent Health. 2018 Sept; 63:348-356. https://www.jahonline.org/article/S1054-139X(18)30191-5/abstract

4 Lin, Stamm, Christidis. How diverse is the psychology workforce? News from APA’s center for Workforce Studies. 2018 Feb; Vol 49; No.2

The importance of culturally competent care

Whether your school is a statewide system across multiple campuses or a rural liberal arts college, staffing psychiatry providers at campus counseling centers has proven to be an enormous challenge.

Nearly 25% of freshmen arrive on campus having already been prescribed psychiatric medication, and primary care practitioners are only a partial solution to manage complicated psychiatric cases.

Working with urgency to meet this student demand, Mantra Health is now offering a limited-time discount on our telepsychiatry Managed Care Program for this upcoming spring. When your university adopts Mantra Health from January 18th through the end of February, your counseling center immediately benefits from quality, evidence-based mental healthcare that works as an extension of your current resources.

Let's discuss telepsychiatry options for your school – click here to get in touch with at partner@mantrahealth.com.

How does Mantra’s telepsychiatry Managed Care program expand upon your counseling center’s existing operations?

Unparalleled student engagement. More than 95% of referred students make it to their first telepsychiatry appointment, and remain engaged throughout the course of care through ongoing video appointments, messaging, progress tracking and psychoeducational content. All of our psychiatric providers are passionate about treating young adults, and collaborate with on-campus counselors to reach higher clinical outcomes – and increased student retention.

Close the care loop. Colleges often lose track of students once they’re referred to community providers. Our Collaboration Portal facilitates direct messaging communication between our provider group and your school’s care team – so there’s no medical information falling through the cracks. 

An answer to recruitment limitations. We hire top providers from across the country, with 50% of our providers identifying as people of color (primarily Hispanic and Black) or specialize in treating LGBTQ+ populations. Our flexible staffing model makes it easy to dedicate providers who expand your care hours to nights, weekends, and over breaks.

"Mantra has become the go-to resource for psychiatry needs in our students, and we do so with confidence knowing that Mantra providers offer a holistic approach to their care, including both medication management as well as wellness coaching and lifestyle changes." Dr. Keith Kokseng, Associate Director, Counseling & Wellness Center, New College of Florida 

Launch Mantra’s Telepsychiatry Program at your school this spring. Email partner@mantrahealth.com to get in touch about telepsychiatry at your counseling center.

Mantra Health’s Spring Telepsychiatry Program

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)

Alabama Power Foundation (award varies per proposal)

Vitalyst Health Foundation ($175,000 total)

Northern Arizona Healthcare Foundation ($100,000)

California Health Care Foundation ($250,000 total)

The Ahmanson Foundation ($5,000 - $1 million)

Ben B. Cheney Foundation ($20,000 - $40,000)

Telligen Community Initiative Grants ($50,000 total)

Caring for Colorado Foundation ($575,000 total)

The Colorado Health Foundation (award varies per proposal)

New Canaan Community Foundation ($20,000)

Community Foundation of Greater New Britian ($25,000)

Florida Blue Foundation ($100,000 per year)

Healthcare Georgia Foundation (~$75,000 total)

Community Foundation for Greater Atlanta ($10,000 - $25,000)

The Blowitz-Ridgeway Foundation ($30,000 total)

McElroy Trust (award varies per proposal)

Fort Dodge Community Foundation (award varies per proposal)

Baton Rouge Area Foundation (award varies per proposal)

Blue Cross Blue Shield Foundation of Louisiana ($25,000)

New Hampshire Charitable Foundation (award varies per proposal)

Maine Health Access Foundation (award varies per proposal)

Maryand Department of Health (award varies per FOA, up to ~$6,000,000)

The Leonard and Helen R. Stulman Charitable Foundation ($150,000)

The Blue Cross Blue Shield of Massachusetts Foundation ($200,000 total)

Peter and Elizabeth Tower Foundation (~$50-100,000)

Michigan Health Endowment Fund ($500,000 total)

The Superior Health Foundation ($25,000 per year)

Foundation for the Mid South (award varies per proposal)

Bower Foundation (award varies per proposal)

Minnesota Dept of Human Services (award varies per proposal)

Health Forward Foundation (award varies per proposal)

Missouri Foundation for Health (award varies per proposal)

Minnesota Department of Human Services (~$2,000,000)

Saint Louis MHB (award varies per proposal)

Telehealth Grant Opportunities for Higher Education Institutions (UPDATED)

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. 