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

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

College students are facing unprecedented levels of stress, as they endure heavy workloads, crippling student loan debt, environmental crises, academic pressures, social barriers, and other serious concerns, so it comes as no surprise that 34% percent have anxiety and 41% suffer from depression. 

Campus counseling centers know the rising concerns and are working overtime to support students, but are, far too often, short-staffed, under-resourced, underfunded, and unable to meet the growing demand. They also have limited networks and few psychiatrists on staff, if any, who have the expertise and credentials needed to address more complex psychiatric issues.

While the majority of college presidents have recognized mental health as the most pressing issue on their campus, few employ psychiatrists – or invest in comprehensive psychiatric care, which is often needed to address severe mental illnesses like severe depression, psychotic disorders, and schizophrenia, among others. This gap has a crippling effect on students’ health, well-being, and success on campus – and could be a contributing factor to the 43-86% dropout rate among students with mental illness.

Nora Feldpausch, M.D., Medical Director of the Wellround Provider Network at Mantra Health, believes that every college campus should take a holistic approach to address student mental health and include telepsychiatry in their service offerings. Doing so is no longer simply a benefit, but a necessity. 

The importance of psychiatry in college mental health care

Long before the COVID-19 pandemic, students were facing high levels of severe mental health conditions. According to a Healthy Minds Study, which included 10 years of population-level data, lifetime mental health diagnoses among students rose from 22% to 36% – and 88% of counseling centers reported an increase in treatment seeking behaviors over a five-year period.

There’s no question that mental health services are needed, but college leaders need to think beyond this to account for students’ complex mental health concerns. By adding psychiatric services to a counseling center’s offerings, colleges can actually work across departments and specialties to meet the personalized needs of students, many of whom are arriving on campus with pre-existing conditions, severe disorders, and comprehensive treatment plans. 

Psychiatrists are highly trained in complex mental health disorders and can work closely with on-campus providers and clinicians to co-manage mental health disorders and provide a holistic, cognitive behavioral approach to care, Dr. Feldpausch says. Psychiatrists should not replace current clinicians, but act as consultants, so on-campus providers and clinicians are supported rather than overburdened with issues they can’t solve on their own. 

Adding telepsychiatry to on-campus offerings and supporting continuity of care

With college students living off campus, in remote locations, without transportation access, and with significant personal obligations, college leaders need to consider alternative options to care. Not every student has the time, ability, or desire to visit their on-campus counseling center, especially when wait-lines are preventing them from accessing services quickly. This is where teletherapy and telepsychiatry come in – and offer a more sustainable, long-term solution.

In addition to providing virtual therapy sessions, colleges can work with psychiatrists to offer medication management support to students battling severe mental health disorders. Adding on teletherapy and telepsychiatry to current offerings allows students to access mental health care outside of counseling center hours, connect with more diverse providers who have unique specialties, and engage in sessions from anywhere, including their home or workplace. 

“We’ve had students join sessions at private locations from their workplace,” says Dr. Feldpausch – and she says more and more students are now requesting teletherapy and telepsychiatry services as they live in remote areas, can’t access transportation, or wish to continue their care virtually over the summer months or on breaks. 

Reaching more students with Mantra Health

Every student is unique. When colleges and universities limit their mental health options to in-person care, they miss an opportunity to address personal preferences and more severe mental health conditions. Not every student wants to visit a mental health professional and many feel their needs aren’t being met by the limited on-campus staff members whose specialities or backgrounds don’t align with their concerns. 

While working with Colgate University in Madison County, New York, we have found that telepsychiatry services could drive a major shift in the college’s quality of mental health care. When providers work together on a consistent basis, they can leverage each other’s skills, expertise, and training to provide the best, most holistic care to their student patients. This includes reviewing student medical records, conducting symptom severity screenings to monitor improvement in treatment, and recognizing physical symptoms to identify and treat existing and developing conditions. 

Our psychiatric services at Moravian College in Bethlehem, Pennsylvania, also resulted in significant mental health improvements. Among the students requesting services in 2021, 95% attended their scheduled intake appointment and 89% attended a follow-up appointment. In addition, 66% saw improvements in anxiety symptoms and 45% saw improvements in depression symptoms.

At Mantra Health, we have developed our own provider network to accommodate the comprehensive, personalized needs of students and we work closely with counseling centers to connect them to diverse providers who are trained in specialty areas. For many students, this is a non-negotiable. If a provider doesn’t understand or can’t speak to their racial, gender, identity, or socioeconomic concern, then mental health conditions can worsen – and students may be discouraged from seeking services in the future.

We have the fastest-growing, clinically-backed digital mental health solution for college students and we’re on a mission to increase access and improve the quality of care for college students, while relieving the strains put on health centers. 

If you want to learn more about our offerings and how we’re changing youth mental health care for the better, please get in touch with us today! 

The Rising Need for Telepsychiatry on College Campuses

Student engagement has drastically changed since the start of the COVID-19 pandemic, and colleges and universities are now in the difficult position of having to find new ways to reach students, make them aware of counseling services, and support their mental health needs.

A 2021 Student Voice survey showed that a startling 65% of students report having fair or poor mental health and 47% said they would have liked more support from their college during the pandemic. Yet, only 15% of students said they used campus counseling services. 

Up until the pandemic, events were the most prominent avenue for student engagement, but with COVID-19, Monkeypox, and other health concerns rising, many students no longer feel comfortable attending in-person events and many are fatigued by virtual ones. So what can counseling centers do to counteract this problem?

Most college counseling centers are under-resourced and understaffed, making it difficult to allocate time to student engagement and find new ways to conduct outreach. While events can still be utilized, college counseling centers should look to new ways to approach students and remind them of available resources and counseling services.

How to Engage Students with Mental Health on Campus

With new technology and new ways of engaging, there are ever-increasing ways for students to engage with counseling services, and vice versa. We’ve compiled ten recommendations that can help college counseling centers better connect with students.

Build events around mental health: Offer free meditation classes for students during stressful times in the academic calendar. Set up a booth on campus during Mental Health Awareness Week, which includes free giveaways, food-to-go, and pamphlets on self-care strategies. Bring guest speakers to campus to talk about specific mental health issues. Host free mental health workshops. Dartmouth College Health Service, for example, has previously hosted an "Anxiety Toolbox Workshop" and an "Attention Please! Workshop” for students with ADHD.

Collaborate with students and key partners: Work with student-run organizations and groups, including diversity, equity, and inclusion organizations and LGBTQ+-friendly groups, to build strategic partnerships. Students running these groups can help inform outreach efforts and promote events, resources, and services to their members. 

Go beyond email to keep students informed: Many colleges and universities use text messaging to communicate with students. You can use this outreach method to remind students of counseling services, to encourage mental health breaks, or simply to invite them to attend campus-sponsored events, such as a free dinner, a Pride parade, or another event that fosters connection. You can also utilize apps to support students. Northwestern University, for example, created “Thought Challenger” and “Daily Feats” to support behavioral health. 

Post mental health resources and service offerings on Blackboard and other learning systems: Students are frequently engaging in these learning platforms. Posting or pinning an announcement across the platform is a great way to remind students of the counseling center and mental health resources available to them. 

Contribute to the student newspaper: While professional newspapers may be struggling to find readers, student-run publications are still highly read. Best of all, they are free and widely available on campus, both online and in print. If you want to connect with students directly, you can place an ad or contribute a piece addressing student mental health issues, providing coping strategies, or highlighting the importance of mental health care. 

Advertise in campus buildings and popular hangout spots: Put information in classrooms and buildings where students regularly pass through. In addition to advertising services in communal spaces, head to the local hot spots. Post information in public or private spaces not affiliated with the college where students are known to go, such as coffee shops or local libraries. If you’re not sure where to advertise your services, connect with student organizations and see what they recommend.

Add referral information to your website: Referrals should be easy to make and even easier to fulfill. Colleges and universities should have this information on the school’s website. Ideally it would go on the home page, but if not, it should at least be accessible on the counseling services page.

Develop strategic partnerships: If you’re not already working closely with faculty, staff, and other members of campus, now is the time to start. Establish mental health committees. Bring in student-run organizations, campus police, and others, to discuss mental health on a macro and micro level. These relationships are vital to maintaining campus mental wellness and preventing or managing mental health crises. You can also partner with other departments and outside organizations to address specific issues. Seattle Pacific University, for instance, 

Incorporate on-campus resources into class materials: Encourage professors to share campus mental health resources as part of their syllabus and remind students of the services that are available to them, especially during high-stress times like midterms and finals. See if professors will bring you in as a guest speaker. This can be especially valuable in graduate classes, as many graduate students are balancing work obligations or parenting responsibilities. 

Utilize social media: Not every student is on every platform, but many college students are online. Building social media platforms for your counseling center is a great way to connect with students. Check out Texas A&M University’s Counseling & Psychological Services (CAPS)’s Instagram and Twitter accounts. You can share campus resources, highlight events, recommend mental health tools, and encourage students to engage with your staff in a fun, innovative way. Host online giveaways or share student success stories, when possible. Students should also be encouraged to reach out directly if they’re feeling stressed or overwhelmed. 

Use focus groups or surveys to find out what students need: The best way to engage with college students is to ask what they want. If possible, send a survey to all students. You can also ask current patients what resources they’d like, what ways they prefer to engage.

Diversify your offerings: Keep students front of mind. If students are requesting telehealth services or weekend availability, you may want to consider working with a telehealth provider. You can also consider adding psychiatry services, crisis care, or wellness workshops. 

Students’ needs and preferences are constantly evolving, which is why it’s so important to be creative in your approach. College counseling centers are vital to the health of a campus, but students can’t access the care they need if they don’t know what services are available or how to access them. 

At Mantra Health, we work closely with college counseling centers to expand students’ access to mental health care. We provide teletherapy, telepsychiatry, and 24/7 crisis care services to colleges and universities, tailoring our care to the individual needs of the campus. Learn about our solutions here.

Strategies to Increase Student Engagement and Improve Student Mental Health

Alecia Sundsmo, PsyD, hadn’t planned to take her passion for psychology into the field of higher education, but she knows this is where she belongs. 

“I really fell in love with higher education. It gives you a chance to really think about population health and public health and really wrap your arms around the entirety of it,” Dr. Sundsmo says. “College students are a discrete set of people that you have the ability to influence. They live together, they eat together, they go to school together.” 

Dr. Sundsmo discovered her passion for mental health in an introductory psychology class. For years, Dr. Sundsmo had been asking the question: why do people in the same place experience life in so many different ways? 

“I learned how much the brain influences how we uniquely see the world and how different that is from person to person,” says Dr. Sundsmo. Taking this path, Dr. Sundsmo believed she could really help people to learn how to flourish in their lives by helping them understand what's going on in their brain.

Addressing the Needs of Underserved Populations

Dr. Sundsmo knew early on that she wanted to provide mental health services to underserved populations. She trained at a Native American boarding school, where institutions with a long history of trauma were being rehabbed, and this is when she began to understand the importance of relationship building, identifying the interpersonal dynamics that exist in cross-cultural conversations, and the need for culturally-informed care. 

Though she applied for numerous diversity-focused internships, Dr Sundsmo was never matched. That’s when a supervisor suggested higher ed. Dr. Sundsmo didn’t expect to fall in love with the work, but after completing a practicum at Portland State University, then pre-doctoral internship at Grand Valley State University, she knew this is where she wanted to be. 

Students are not only the next generation of leaders, but they are a population facing unique barriers to care and Dr. Sundsmo saw this career path as an opportunity to make direct systemic changes to influence health equity and accessibility to mental health care across a diverse student body. 

“You're not just influencing this one students’ treatment and care,” she explains. “You're showing that mental illness can be treated. You're de-stigmatizing help-seeking. And in doing so, you are putting somebody out there who then has influence in their work, their family, and their community to really help encourage people to access care.”

In her 15+ years in higher ed, Dr. Sundsmo has seen students leave campus to get care, put their studies on hold, or abandon school altogether, when, perhaps if the system was more supportive, they could have completed their degree and found the right treatment for their mental health needs.

“Schools are doing a better job of recruiting a diverse student body, but they don’t necessarily catch up to meet the needs of who they are recruiting,” she says. “They expect everybody to sort of pave their own way.”

Funding for mental health services are behind the curve, Dr. Sundsmo explains. While education is the top priority for many institutions, she believes student health can make or break the ability to learn. Many institutions have wrongly asked, Given the amount of money I have, what’s the best I can do? But Dr. Sundsmo would like to see institutions asking the questions: What do students really need? How do we resource that? 

“Nobody has met the need. Nobody in higher education has had enough resources to actually tackle this,” says Dr. Sundsmo. “I think influencers like Mantra can really come in and look at this problem from the outside and say, ‘How can we do this in a different way?’”

Influencing the Future of Collegiate Mental Health Care

Even though Dr. Sundsmo no longer works in higher education, she is continuing to serve college students – and aims to make an even greater impact on their mental health care as Mantra’s Executive Director of Therapy. 

“My mission at Mantra Health is the same, just expanded,” Dr. Sundsmo explains. “How do I not only influence my population of students but how do I affect the national conversation about student health and well-being? How do I make a difference and make sure that we are giving students the care that they need and deserve?” 

We have a cultural gap in this country around our knowledge about mental health and mental illness, Dr. Sundsmo says. “What does it mean to not be doing well versus having an actual mental illness? How do we help you flourish regardless of whether you have an illness? She believes we need to put the interventions in place to actually address the problem, and that includes therapy, medication, but also includes other self-care tools and community-based interventions. Rather than approaching mental health from a one-size-fits-all approach, she said we need to make treatment available for mental illness, but also promote mental health and well-being. 

“Good quality care helps people engage in meaningful lives,” Dr. Sundsmo says. “It helps them have good relationships with people, helps them be civically engaged, helps them to be a functioning part of the society.”

Learn more about Dr. Alecia’s new role as Executive Director of Therapy and follow along for more insights here. 

Removing Barriers to Mental Health Care with Alecia Sundsmo, PsyD 

Karen Singleton, PhD, Associate Medical Director and Chief of Student Mental Health and Counseling at MIT, recently joined Nora Feldpausch, MD, Medical Director at Mantra Health, and Alecia Sundsmo, PsyD, Executive Director of Therapy at Mantra Health, former Director of Counseling and Psychological Services (CAPS) at Cornell University, for an important conversation on provider quality, in which they discussed the value of diverse care, what quality entails, how to assess telehealth vendors, and why higher ed institutions benefit from working with Mantra.

How to Assess Telehealth Providers for Diversity and Quality of Care

Faced with a dramatic rise in utilization, numerous staff resignations, and a demand for more diverse care, MIT’s counseling center turned to telehealth services to help backfill their staff, expand their mental health offerings, and give on-campus counselors more support. 

“We were all seeing students. We were all doing more intakes,” says Dr. Singleton, who directed student health services at Columbia University before joining MIT. “Part of what I really appreciated and the clinicians appreciated about the [Mantra] partnership was the ability to do other things, things that these clinicians came to the profession to do,” like seeing students more regularly, conducting more preventative work, doing more outreach, and running groups.

While assessing prospective telehealth providers, Dr. Singleton wanted to ensure that Mantra’s telehealth provider group not only represented the racial, ethnic, and gender diversity of students on campus, but that they had an understanding of religious backgrounds, LGBTQ+ issues, as well as the expertise to work with students of diverse clinical needs.

If you’re looking for the best quality care for your campus, Dr. Feldpausch, who previously worked in the counseling centers at Michigan State University and Colorado State University, and Dr. Sundsmo, who previously directed Cornell’s CAPS program and led clinical services for UW-Madison, Dickinson College, and Grinnell College, recommend taking the following into consideration:

Clinical leadership – Telehealth providers are working day-in-and-day-out with your students, which is why it’s so important to ensure they’re providing the highest quality care possible. Pay attention to a company’s clinical expertise at the leadership level and the systems they are putting in place to ensure quality. Are they using evidence-based care? Are they providing ongoing training to their staff? Are they staying on top of new, innovative treatments for young adults? Find a telehealth provider that can help problem-solve with you when the tough cases arise.

Transparency – Even if students are being treated by a telehealth provider, the on-campus counseling staff should be able to communicate with the telehealth providers in real time, access on-demand documentation, and work collaboratively to resolve mental health crises or emergencies. 

Diversity – Does the provider group meet the level of training you’d prefer? Do they have the right clinical expertise? In addition to offering diverse providers in terms of identity, you should also consider clinical specializations that match or broaden the range you have on staff in your own clinic.   

Different models of care – Not every counseling center works within the same models of care. Many large schools are working within a stepped care system, for instance, which can change the way you triage student requests for care. To maximize your resources and ensure care is consistent, make sure the telehealth provider you choose has the ability to integrate with your current service delivery model.

Emergency protocols – Mental health crises and emergencies happen, and you want to ensure that any company you work with is prepared. When providing telehealth care, you need to know what protocols are in place to ensure the safety of your students. Are there clinical protocols in place to guide risk decision-making? How are telehealth providers trained on these and who is supervising their work? Do telehealth providers have immediate access to clinical consultation in an emergency if they need a second pair of eyes? What happens if the assigned telehealth provider is not available? 

Other questions to ask: Does the provider group understand your student populations? Do they offer in-house care or are they outsourcing to community services? Are they doing this work responsibly? Are they carving out time for their providers to do administrative tasks? Does the care match your counseling center’s quality measures?             

Why MIT Chose Mantra for Telehealth Services

Developing a staffing model that can withstand today’s counseling center climate, while also effectively increasing mental health care access is a challenge that many colleges and universities are unprepared for, but Mantra makes it easy.

“What I have loved most about partnering with [the] Mantra [team] is their respect for the colleagues within counseling services,” says Dr. Singleton. 

Even after working with a competitor, MIT found that Mantra was the best choice for its campus. Not only does Mantra act as an extension to on-campus counseling services, but the company builds a custom framework of evidence-based psychiatry services, including risk management, that best serves each institution’s unique student body.   

“I really wanted to make sure that what we were investing in, what we're building here [at Mantra] was collaborative,” says Dr. Feldpausch.

While many counselors fear outsourced services will replace them or their work, forcing them to take on more acute cases, or deal with more crisis situations, that doesn’t need to be the case, Dr. Sundsmo explains. If you’re hiring a company with a diverse provider network, which includes psychiatric providers, MDs, and other clinical experts, then it’s possible to build an integrative, collaborative model that supports rather than burdens on-campus staff.

“We all have the same goal: excellent, supportive mental health care for college students,” says Dr. Feldpausch. 

Learn more about Mantra’s approach to student mental health care and how we provide campus-tailored care by requesting a demo here. You can also watch this webinar recording here. 

Assessing Telehealth Providers: Why MIT and Other Higher Ed Institutions Choose Mantra

In this new edition of our expert interviews, we are welcoming Dr. John Russell Ramsay, PhD, associate professor of clinical psychology at the Perelman School of Medicine at the University of Pennsylvania, Co-director and Co-founder of Penn’s Adult ADHD Treatment and Research Program, and an advisor to Mantra Health.

I am with Dr. Russell Ramsay,. Dr. Ramsay, you wrote a book on non-medication treatments for Adult ADHD. How do you conceptualize ADHD as a disorder?

It is often not thought of this way, but ADHD itself is not a knowledge problem but rather a performance or implementation problem – recurring difficulties organizing and following through on tasks and goals despite knowing what needs to be done.

It’s my understanding that medications are highly effective for treating the symptoms of ADHD, including for adults. Don’t these medications usually treat these problems? 

Yes. Medications are very effective with symptom reduction, and for many adults these improvements set the stage for improved functioning. However, symptom reduction alone does not necessarily translate into improved time management, organization, or being less prone to procrastination. ADHD coping skills are not in the pills, as the saying goes.

So then, what are the new developments that may address these coping issues?

The psychosocial treatment of adult ADHD, specifically cognitive-behavior therapy or CBT, is well-established as an evidence-based treatment. CBT adapted to adult ADHD is designed to foster the development of coping strategies for managing ADHD that will most definitely improve functioning. There are no trade secrets about what works, but the central focus is on the implementation of these skills.

A recent study examined a course of group-administered CBT that was provided to two groups of adults with ADHD: one group was on a stable regimen of ADHD medications; the other group was not medicated. At the end of the 12-week group treatment, the CBT plus medication group improved at a significantly higher rate than the unmedicated group - no surprise there. But, during the 6-month follow up phase after treatment ended, the CBT + coaching group continued to improve and caught up to the CBT plus medication group in terms of improvements.

What do these results mean for adults with ADHD in their daily lives?

First, medications + CBT from the outset can provide improvements at a faster rate, but the skill-focused CBT for adult ADHD can also lead to improvements over time, which extend beyond treatment, which is important because ADHD requires ongoing efforts to manage. The take home message is that improving concentration with daily medications is great, but making changes to your time management or organizational system can improve your executive functioning over the long-term. 

Second, a unique feature of this particular CBT approach was that weekly group meetings were augmented with twice weekly, between-session phone contacts with a “coach” for about 10-15 minutes each to review any coping difficulties and help participants stay on track with their goals. This coaching feature was rated by participants as very helpful. If adopted elsewhere, this added step may improve outcomes for adults with ADHD. This is also consistent with the Mantra approach for integrating care and fostering follow through on patients’ behavioral health and overall wellness goals in daily life.

Dr. Ramsay, thank you for sharing this useful update. 

The Latest on ADHD coaching from Mantra Expert John Russell Ramsay, PhD

Today, we have the distinct pleasure of sitting down with Maria Oquendo, MD, PhD. Dr. Oquendo is currently the Chair of the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and a Past President of the American Psychiatric Association. She also serves as a Clinical Advisor to Mantra. In this post, we explore the ways in which psychiatry as a field is changing and what this means for patients in America. 

What is your perspective on collaborative care and how it relates to the future of psychiatry? What makes this model so important?

Collaborative care is the future of mental health (MH) care delivery. There simply will never be enough psychiatrists to provide MH care for everyone who needs it, so we need to be practical.  The system can be set up to be nimble and leverage psychiatrists to oversee care for a greater number of patients. 

How are you employing the principles of collaborative care at Penn? Why?

Here at Penn, we have been devising novel strategies to implement collaborative care.  We call it Penn Integrates Care. Piloting the program in 8 primary care clinics covering 100,000 patients is the first step towards a broader implementation. Not only does collaborative care provide a valuable service to our patients, it also has been embraced by providers including primary care doctors, therapists, and psychiatrists.

How can pre-screening help save time and money for patients without compromising the quality of the experience? How are you using this process? 

Using evidence-based tools and decision support software, we can devise clever ways to triage patients. Most will be well-served by a collaborative care model, and only a minority will need in-person specialty psychiatric care. 

What is the role of a coach (sometimes named care manger or patient navigator)? How are you thinking about this in your department? 

The conditions that we treat affect motivation and volition, so even the most willing patient may have difficulty following directions or adhering to medication regimens and keeping appointments. Coaches can help overcome these problems. As psychiatrists, we’re used to giving medications, but we’re not used to how scary it is for patients to take them. That’s another reason why coaches are so helpful.

Why do we need measurement-based care? Isn’t it enough to ask someone if they feel better or not? Why or why not? 

Measurement-based care is essential because patients will often feel so relieved if they are 30% or 50% better, that they might accept that as a reasonable end-point.  When you track symptoms using validated scales, you ensure that you know exactly how much better the patient is and how far they are from remission or recovery.

Can mental health care really be delivered via technology? 

We are learning more every day about how to leverage technology to deliver MH care. This will be especially true as younger generations who grew up with texting, Instagram and other social media come for MH care.

How can a patient know he or she is getting the best care, especially when using a technology platform? What advice do you have for patients considering getting their mental health treatment from a telehealth-based service?

Patients should use common sense in this decision.  How much support does the person need?  Is there a method for tracking symptom improvement?  Are side-effects taken into account?  Are things explained in a way that is easy to understand?  I would also advise people to trust their “gut feelings.”  If there is discomfort about how things are going, it is crucial to speak up.

The Evolution Of Mental Health Care with Maria Oquendo, MD, PhD

Looking for a telemental health partner for Fall 2020 that is specialized in Higher Ed? Book a call with our Partnerships team here or email us at partner@mantrealth.com

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This blog is co-authored by Mantra Health, a telemental health and software platform company focused on serving the needs of higher education, and Epstein Becker Green, a national law firm with an expertise in the provision of health care services in higher education environments.   

In early March 2020, the federal government officially declared the novel coronavirus (“COVID-19”) outbreak a national emergency (1), and the U.S. Department of Health and Human Services (“HHS”) declared the COVID-19 crisis a public health emergency under Section 319 of the Public Health Service Act. (2) These events resulted in a myriad of changes to federal laws related to telehealth, as well as many related changes at the state level. These changes have prompted an influx of questions from mental health care providers who are pivoting to telehealth as their sole modality for providing care. This is particularly true in the higher education setting where university and college students and staff have been evacuated to their homes or other safe environments and education continues on a remote access basis.

This blog series, published by Mantra Health and Epstein Becker Green, was initiated in response to questions from the field of higher education mental health providers who are incorporating telehealth into their settings while concurrently adjusting to support a remote campus. Mantra Health and Epstein Becker Green will be publishing a series of three posts that will cover a range of changes in federal and state laws related to the use of telehealth, including:

Blog 1: Professional licensure, state-specific definitions of telehealth, and acceptable telehealth modalities and platforms

Blog 2: Privacy and security regulations pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)

Blog 3: Remote prescribing and managing high risk patients

As mentioned in our first blog post, the Centers for Medicare & Medicaid Services (“CMS”) has made significant changes to its telehealth coverage and reimbursement rules in response to COVID-19, including but not limited to:

Waiver of the requirement that providers have a valid license for the state in which they provide care (3); and

Expansion of the list of acceptable platforms upon which telehealth services may be provided. (4)

Similarly, the Office for Civil Rights (“OCR”) within the U.S. Department of Health and Human Services (“HHS”) has issued guidance related to the application of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) rules during the COVID-19 national public health emergency time period. (5-6) Per OCR’s guidance, these changes include, but are not limited to:

Expansion of the list of acceptable platforms upon which telehealth services may be provided;

Statements that penalties for HIPAA non-compliance will not be enforced, and that audits will not be conducted;  and

Suggestions regarding the locations from which providers can conduct telehealth visits, and related guidance regarding ways to maintain the privacy during such sessions.


FAQs from Higher Education Providers: Telemental Health Regulatory Considerations

Some elements of HIPAA are relaxed, but do I still need to maintain some level of privacy and protection of PHI?

As college and university mental health care providers transition to virtual communications with students who utilize their services, the basic practices of privacy and security of the records (whether under HIPAA or the Family Educational Rights and Privacy Act (“FERPA”), including unauthorized access, sharing and de-identification of patient information, and data security should continue to be followed. The mitigating circumstances of the COVID-19 national public health emergency should not impact or modify those practices. Providers should continue to incorporate the basic rules of confidentiality into practice in order to avoid a potential breach of privacy. (6-7) Such rules include:

Using unique passwords for each employee accessing the telehealth platform;

Maintaining privacy during interactive audio-video and interactive audio sessions, not only in the space where the provider is located but in the space where the student is located (by reminding and encouraging students to take such precautions prior to starting sessions); 

Using lowered voices and avoiding the use of speakerphones, or recommending that students move to a reasonable distance from others when discussing PHI;

Documenting and maintaining records concerning all telehealth encounters in the electronic health record (“EHR") system;

Restricting access to student medical records to authorized members of the treatment team. 

Communication with Out-of-network Providers

In light of COVID-19, the widespread movement of students from college and university campuses to their respective remote locations may require transfers of care to local providers for certain students, especially if risk levels increase as discussed in our first post. At a minimum, continuity of care should be preserved to the extent possible under all applicable regulations, which may include sharing medical records, existing prescriptions, or other important treatment information with a local referral. As a standard practice, providers always should obtain a student’s consent to disclose information to an external, referral provider. (8) Written consent, which is standard practice, often is not feasible in a remote environment. During the COVID-19 national public health emergency, documentation of verbal consent may be sufficient, particularly as it relates to an emergent situation,9 but providers are encouraged to check applicable state consent laws to confirm how different states have shifted these requirements in light of the current situation.

Although HIPAA non-compliance penalties for using telehealth technology in good faith are not expected to be enforced during the COVID-19 national public health emergency period, (5) we can assume that HIPAA rules and requirements will resume in full force once this period is over. For example, a business associate agreement (“BAA”) is not required in light of the COVID-19 emergency for a provider’s telehealth technology of choice; yet, in anticipation of a “return to normal” with respect to HIPAA requirements, we recommend that colleges and universities consider entering into a BAA with the chosen telehealth vendor, if not already signed, to avoid operational disruption following the conclusion of the current national emergency period by ensuring a HIPAA compliant telemedicine platform for students is in place when the waiver is lifted. 

A majority of states require providers to obtain informed consent prior to starting a telemental health visit. While a number of states permit providers to maintain documentation of verbal consent, some states (for example, Idaho (10) and Delaware (11)) do require that providers obtain written consent.

On a practical level, providers should have students electronically sign consent forms prior to receiving treatment, or should establish documentation in their EHR that a conversation about informed consent took place verbally. Consider including the following elements when documenting informed consent (12) to ensure the student understands the risks and benefits of telehealth:

What are the expected benefits and risks associated with receiving care through telehealth?

What security and privacy measures will be taken during the telehealth visit?

Our next and final blog post in this series will focus on changes made in the wake of the COVID-19 national public health emergency to regulations and other requirements related to remote prescribing and managing high risk patients.

The above information has been reported to the best of our knowledge, and with the understanding that both federal and state guidance continues to evolve rapidly. We recommend referring to relevant federal and state government websites frequently (e.g., HHS, CMS, DEA, OCR, SAMHSA) for the most current guidance. To stay up to date with the latest regulatory changes, reference Epstein Becker Green’s Coronavirus Resource Center. 

The White House. Published on March 13, 2020. Accessed at: https://www.whitehouse.gov/presidential-actions/proclamation-declaring-national-emergency-concerning-novel-coronavirus-disease-covid-19-outbreak/

U.S. Department of Helath and Human Services. Published January 31, 2020. Accessed at: https://www.hhs.gov/about/news/2020/01/31/secretary-azar-declares-public-health-emergency-us-2019-novel-coronavirus.html

U.S. Department of Helath and Human Services. Published March 13, 2020. Accessed at: https://www.phe.gov/emergency/news/healthactions/section1135/Pages/covid19-13March20.aspx

The Centers for Medicare and Medicaid Services. Published on: XXX. Accessed at: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

The Office for Civil Rights, Department of Health and Human Services. Accessed at: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

The Office for Civil Rights, Department of Health and Human Services. Published on March 20, 2020. Accessed at: https://www.hhs.gov/about/news/2020/03/20/ocr-issues-guidance-on-telehealth-remote-communications-following-its-notification-of-enforcement-discretion.html

The Office for Civil Rights, Department of Health and Human Services. Accessed at: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf

The Office of the National Coordinator for Health Information Technology. Last updated September 19, 2018. Accessed at: https://www.healthit.gov/topic/health-information-privacy-law-and-policy

The Office for Civil Rights, Department of Health and Human Services. Published February 2020. Accessed at: https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf

State of Idaho, Division of Occupational and Professional Licenses. Published on May 6, 2016. Accessed at: https://ibol.idaho.gov/ibol/cou/documents/Telehealth%20Guidelines.pdf

State of Delaware: The Official Website of the First State, Division of Professional Regulation. 9.0 Code of Ethics. Accessed at: https://regulations.delaware.gov/AdminCode/title24/3900.shtml

Center for Connected Health Policy. Accessed at: https://www.cchpca.org/telehealth-policy/informed-consent

Telehealth Regulation (Covid Updates): Privacy, Security & HIPAA

Blog #1: Professional licensure, state-specific definitions of telehealth, and acceptable telehealth modalities and platforms

Blog #2: Privacy and security regulations pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)

Blog #3: Remote prescribing and managing high risk patients 

The Centers for Medicare & Medicaid Services (“CMS”) has made significant changes to its telehealth coverage and reimbursement rules in response to COVID-19, including but not limited to:

 However, the guidance that has come from CMS is only applicable to federal health care programs. Such guidance may not apply to a large segment of the higher education student population, given the relatively small numbers of students receiving coverage under a federal health care program. It nevertheless is important to understand the federal-level guidance to the extent it can provide a roadmap for similar changes that may be occurring not only at the state level but also by private insurers. 

Of note, the relaxation of federal and state laws stems from the COVID-19 national public health emergency and, as specifically stated by many authorities, is temporary in its nature. We cannot predict when the national public health emergency period will end or the extent to which these emergency actions will change the prior regulatory and legal framework more permanently. However, in the absence of evidence to the contrary, higher education providers should anticipate that most, if not all, regulatory and legal changes will revert back to the status quo as it existed prior to the COVID-19 emergency. 

How have professional licensure requirements changed? As a provider serving a higher education institution’s student community, and/or providing telemental health services to college and university students, does this mean I can practice across state lines?

With college and university campuses shut down and curriculum moved online, most higher education students have been forced to relocate elsewhere, often to a different state than where the college or university is physically located. Yet, the students are still considered to be under the care of the institution’s student health program and the specific health care providers who are providing treatment to students. These providers remain responsible for maintaining proper clinical care, including a continuity of care, within the scope of their professional licenses. Therefore, understanding states’ professional licensure rules and requirements, and the limits that may apply to providers needing to shift to cross-state practice of their student populations, is critical. 

In the face of COVID-19, a number of states, such as Maryland (5), Mississippi (6), and Massachusetts (7), are temporarily modifying professional licensure requirements (3), allowing out-of-state licensed mental health practitioners to provide services within their states, either by temporarily waiving professional licensure requirements or by modifying such requirements so providers may expeditiously obtain temporary licenses to practice. 

On March 24, 2020, the Secretary of HHS issued a letter to all state Governors, urging all states to offer licensure modifications or waivers in response to the national public health fight against COVID-19. (8) Many states already have taken action and more are expected to follow and take similar actions.

Depending on the breadth and nature of each state’s changes, we recommend tracking not only the licensure requirements in your primary state of practice but also the state(s) in which your student patient populations are located, either permanently or temporarily, during the period of the current national public health emergency. We also recommend that certain cautionary measures be taken by providers, including:

Food for Thought