Mental Health, Substance Use, and Wellbeing in Higher Education Supporting the Whole Student (2021) / Chapter Skim
Currently Skimming:
5 Moving Forward
5 Moving Forward
Pages 111-142
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From page 111... ...
The increased prevalence of mental health and substance use problems has many academic leaders and policymakers describing the situation in near-crisis terms and looking for solutions. This chapter aims to provide those leaders, as well as agencies that fund efforts to improve student mental health, with evidence-based approaches for addressing the major issues confronting institutions as they try to meet the growing demand for mental health and substance use services among their students, building on the already proven effectiveness of campus counseling centers (McAleavey et al., 2017)
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From page 112... ...
In the committee's judgment, based on its information gathering activities, there are multiple proven approaches for intervening around mental health and substance use issues and promoting student wellbeing in ways that will positively affect student success. For that reason, the committee is not advocating a single "ideal" that all institutions of higher education should adopt or strive for.
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From page 113... ...
It is in the spirit of this moment that the committee believes that academic leaders have an important role to play in bringing together the different communities on campus to address those aspects of institutional culture that do not support the mental health and wellbeing of all students, particularly students who are BIPOC or who come from other underrepresented groups.
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From page 114... ...
Additionally, community colleges and other colleges and universities that have a higher percentage of adjunct faculty, part-time faculty, lecturers, or other instructors may not have received the same kind of professional development and support as their full-time, tenure-track peers.
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From page 115... ...
This includes providing services for students who return to campus as older adults, as well as those with dependents and those who have served in the military. As noted later in this chapter, the Equity in Mental Health Framework, developed by the Jed Foundation, the Steve Fund, and McLean Hospital's College Mental Health Program, is an accessible resource for schools seeking to promote mental health and wellbeing among students of color and other underrepresented student populations (Steve Fund and Jed Foundation, 2017)
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From page 116... ...
. In developing the framework, the Steve Fund, Jed Foundation, and McLean Hospital's College Mental Health Program carried out a nationwide survey of campus programs intended to support mental health and wellbeing among students of color in an effort to identify promising practices.
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From page 117... ...
Nevertheless, the committee endorses the use of the Mental Health Equity Framework as a foundation for practice and encourages each individual campus to set additional priorities, strategies, and actions to ensure an equitable and inclusive culture. CHANGING INSTITUTIONAL POLICIES Policies for Medical Leave and Re-enrollment Institutional medical leave and reenrollment policies, when they exist, can serve as barriers for students whose mental health or substance use problems are
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From page 118... ...
• Institutions should implement methods to reduce and/or alleviate the financial burden on students related to medical leave and other issues related to course completion. • Academic affairs and student affairs units should develop collaborations to share information appropriately, while also respecting a student's right to private/confidential treatment, in order to support students at the inter section of mental health and academic concerns.
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From page 119... ...
The following guidance may also be helpful for incoming students to review before arriving on campus. The following suggestions have been adapted from the National Association of State Mental Health Program Directors guide, Back to School: Toolkits to Support the Full Inclusion of Students with Early Psychosis in Higher Education: • Continuation of care: For students who have received medical treatment and health services at a separate location, devising a plan for continued support through remote support or planned appointments during breaks to ensure continuity is important.
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From page 120... ...
In addition, the report notes that the cost of student services and student facilities, such as campus counseling centers, represent a major concern to university presidents. Tuition revenues have plateaued in recent years, with Moody's Investor Services reporting that flat enrollment, rising tuition discount rates, and an emphasis on affordability contributed to limited growth in net tuition revenues (McCabe and Fitzgerald, 2019)
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From page 121... ...
• To ensure that mental health and emotional wellness services are priori tized, institutions should consider reallocating existing institutional funds to support counseling centers, support the increased use of online mental health services (when appropriate) , and support data collection on the need for and use of mental health services by students.
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From page 122... ...
. There are many reasons that counseling centers do not bill insurance, including: • concerns about student confidentiality when students are on their parents' insurance plan • the cost involved in setting up billing infrastructure and credentialing providers • the fact that many counseling centers have robust training programs that would have difficulty billing insurance • concern about adding another barrier (cost)
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From page 123... ...
• Insurance companies should keep up with market rates for reimbursement to incentivize more providers to accept insurance carried by students, sup port providers from institutions of higher education in becoming paneled quickly, and communicate and improve the confidentiality measures in place to dependent subscribers between the ages of 18-26 to ensure that they can seek services using their parents' insurance and be afforded the confidentiality they are entitled to receive. • States should modify insurance laws or regulations, or provide administra tive guidance, to enable institutions to use general funds and/or designated health fees for expenses that are not covered by students' personal insur ance for charges incurred at student health and counseling services.
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From page 124... ...
State insurance regulations or university fee plans could also be changed to include additional privacy protections for adult dependents on their parents' health plans and to require insurance companies to empanel providers at colleges and universities that are delivering health services to their students. UNDERSTANDING THE STATE OF STUDENT MENTAL HEALTH AND WELLBEING ON EACH CAMPUS While colleges and universities share a similar set of challenges in supporting student mental health, the issues, priority areas, and available resources on campus vary substantially across institutions.
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From page 125... ...
at Penn State University, is a frequently used measure for assessing mental health functioning of students seeking treatment through counseling centers (Locke et al., 2010)
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From page 126... ...
Colleges and university budgets will constrain the scope of services available on campus, so each institution should evaluate the mixture of services available on campus, in the local community, and online -- to support student wellbeing and provide care for those students in need. Institutions may decide to pay particular attention and allocate funding for specific types of treatment in the event there are no services available in the surrounding community.
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From page 127... ...
. This survey, which does not include community colleges and is not representative of the entire scope of this report, does reflect the reality that even in a global pandemic, 63 percent of the leaders surveyed recognized the need for resources; however, they did not necessarily have the means to increase clinical support.
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From page 128... ...
. In 2018, some 43 percent of the 571 college and university counseling centers surveyed by the AUCCCD increased the number of staff positions in counseling centers, while less than 9 percent lost staff positions (LeViness et al., 2018)
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From page 129... ...
. A survey of community colleges and four-year institutions in California found that community college students had more severe mental health concerns and fewer on-campus mental health resources than four-year college students (Katz and Davison, 2014)
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From page 130... ...
. Additionally, the American Psychiatric Association has developed best practice recommendations and identified special considerations for college students around the use of telehealth during the pandemic (American Psychiatric Association, APA Committee on Telepsychiatry & APA College Mental Health Caucus, 2020)
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From page 131... ...
On the other hand, expanding the use of internet-based therapeutic programs could provide an option that many students, including students of color and those from underrepresented populations, may prefer over face-to-face counseling. Tele-mental health approaches may also be particularly useful for rural or small colleges or for community colleges, where students may lack transportation to reach off-campus sites or where the distance to the nearest provider might be too far to travel.
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From page 132... ...
Therefore, when considering the implementation of programs such as these, institutions should be prepared for subsequently addressing a growth in demand for services. Making appropriate mental health services more available in primary care settings can also facilitate students' access to mental health care and improve coordination between mental health and primary care providers, both on campus and in telehealth services.
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From page 133... ...
• Institutions of higher education should create collaborative relationships in the community that will increase clinician diversity to better serve diverse student populations. • If counseling centers rely on community-based resources to meet the mental health needs of their students, they should consider investing in case managers/resource navigators to help students connect with these community-based resources.
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From page 134... ...
. Faculty Can Help Address Student Mental Health Issues There are several ways in which faculty can help students deal with mental health and substance use issues without directly providing counseling or other treatment services themselves.
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From page 135... ...
In addition to identifying students in need and referring them to campus resources, faculty can support student mental health by taking steps to design learning environments that prioritize student learning and wellbeing (see Box 5-6 for an example of a program promoting student wellbeing at the University of Texas at Austin)
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From page 136... ...
." In response to this issue, the university developed its Well-being in Learning Environments program, which offers faculty a guidebook with a variety of strategies -- based in research and the experiences of fellow UT Austin faculty -- to use in the classroom to support student wellbeing. The guidebook advises faculty to "pick and choose" approaches that best fit with their interpersonal and teaching style and offers the following advice on how to promote general wellbeing: • On the first day of class, use a survey to get to know students.
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From page 137... ...
how to identify, initiate conversations with, and refer to treatment those students who may be having problems with mental health or substance use 2. how to make learning environments inclusive and supportive of student wellbeing 3.
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From page 138... ...
Ideally, such a plan is embedded in policies throughout the college that are part of a larger plan to support student wellbeing. Numerous organizations have developed guides to help colleges and universities develop suicide prevention programs (JED Foundation and EDC, 2011; SPRC, 2004)
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From page 139... ...
. Account for the Importance of Communities in Shaping Student Wellbeing Research has shown that communities, not solely individuals, shape health, and college and university communities are no exception (Slusser et al., 2018; Sontag-Padilla et al., 2018b; Weil, 2014)
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From page 140... ...
and community colleges (Cuseo, 1997) , that offer such courses have found they help promote a healthy transition to the institution (Choate and Smith, 2003; Ellis, 2017; Lockwood and Wohl, 2012)
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From page 141... ...
• Each institution should also periodically offer refresher or "booster" train ing on these issues. • Institutions should regularly and widely provide guidance to students and faculty on mental health resources available on campus and in the community.
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From page 142... ...
142 MENTAL HEALTH, SUBSTANCE USE, AND WELLBEING IN HIGHER EDUCATION RECOMMENDATION 5-10 Institutions of higher education should recognize that there is no single approach to promoting wellbeing and dealing with mental health and substance use problems that will be appropriate to all student populations. • Support services should be tailored to the unique histories, circumstances, and needs of individual student populations.
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