Many higher education institutions have made substantial investments into student life facilities over the last 20 years. New student housing facilities, recreation centers, student unions and dining halls have been built across the country. Strategic reasons for those investments include, primarily, recruitment and retention of students in the competitive landscape of higher education. Recently, two additional factors have become extremely relevant: student mental health concerns and COVID-19.
Historically, mental health was not discussed very openly due to a stigma attached to it. In the last few years, however, attitudes have been changing and the acceptance of mental health counseling has grown to the point where many students actually expect it on a college campus. High-quality counseling is also expected by parents. Not providing the right level of mental care may even create a liability for the institution.
COVID-19 has wreaked havoc on virtually every industry, education in particular. While the problem may be solved with a vaccine or therapeutics, hopefully in the not too distant future, the pandemic underscores the importance of appropriate health care on campus. Parents and students will likely expect it and, to some degree, factor it into their college selection decision.
Facing these challenges, many institutions are contemplating new health and wellness center (HWCs). The days of a campus nurse are long gone. The new facilities provide a wide variety of services and programs targeting student well-being in a comprehensive manner.
Seven dimensions of wellness are often used as a point of departure in the programming process. Health services are typically the largest component both in terms of the required amount of physical space and operating budget allocation. Offerings include services such as primary care for non-urgent issues, minor injury treatment, college health, psychiatric care or chronic disease management. Additional services considered may incorporate EKG, lab work, immunizations, weight and eating disorder management, or even X-rays.
Counseling includes individual mental health consultations, therapeutic assessments or group therapy. In addition, the counseling component may integrate well with the academic side of the university by offering internship or training programs for graduate students in areas related to mental health.
One question that always comes up in programmatic conversations is whether health services and counseling belong together under one roof. There are meaningful synergies in co-location. One of them is a more holistic approach to student health and well-being by addressing both the physical and emotional side. Staff interaction and referrals can also be positive—a student may need rest and mind/body-type of activity rather than a strictly medical treatment. Making that determination may be easier if all these options are available in one place. The downside of co-location is a potential compromise of patient privacy. While some spaces in a HWC can be shared for synergies, a thoughtful layout of the facility, the clinical service areas in particular, becomes critical.
HWCs can be very inclusive programmatically. Health and counseling can be complemented by other services. Student wellness is typically offered in many locations on campus including a recreation center, health center or even student union or housing. Bringing all these programs to a single place and co-locating them with health and counseling makes much sense. It helps with the promotion of wellness services, which are often underutilized due to poor awareness within the student body. The wellness service may include nutrition consultations, health risk assessments, cooking workshops, sleep consultations and many more. When combined with health and counseling, those services will assure a proactive and holistic approach to one’s health as opposed to a strictly medical one.
In addition, depending on the campus’s needs and the local market context, HWCs may include pharmacy, dental care, alternative medicine, physical therapy or even optometry.
Location on campus
The chosen location of a HWC is very important to maximizing the student usage of the facility. The center must be conveniently located, although as a destination, it does not necessarily have to be in a high traffic area. Locations on the outskirts of campus, however, will discourage utilization.
It also important to find programmatic synergies between the center and other student life assets. The campus recreation center is a natural choice. By co-locating a HWC with recreation facilities, the physical and mental health services can be easily supplemented by exercise programs or mind and body offerings such as yoga or meditation.
While student unions are often considered as possible locations, it is not ideal. Although these buildings are typically in convenient areas, they may not be able to offer the desired privacy. In addition, the pedestrian traffic in the student union may not be only generated by the campus community as unions host a variety of meetings and conferences. Isolation of health/wellness services from the commercial uses may pose a problem.
HWCs draw their revenues from a variety of sources. Those include student health fees, health insurance reimbursements, payments for services and university support. Typically, student fees are flat, per-term or per-credit-hour, very similar to charges for campus recreation or student activities. In addition, the HWCs seek insurance reimbursements for a variety of procedures they offer to students. A small portion of services may not be covered by insurance, in which case students must pay of pocket.
If those three income sources were sufficient to cover all operating expenses and, potentially, debt service, a HWC would function as a pure auxiliary operation. However, many of these facilities also receive some institutional support in the form of utility and/or maintenance cost coverages. It is ultimately up to the institution to determine the right balance of revenue sources and define the appropriate business model for the operation.
Also important to note: Some HWCs may compete with off-campus medical service providers either at local medical centers or small commercial clinics. The competitive situation should be evaluated to make sure that the quantity and quality of services match the market demand. In addition, appropriate marketing of health, wellness, and counseling services must be done as the HWC’s are not as visible as other student life facilities.
When it comes to implementation of these centers, generally the traditional on-balance sheet model has been utilized. However, it is possible to look at risk transfer opportunities from the financing, design/construction, operations and maintenance perspectives. It may be advantageous to a university to engage in a public-private partnership if the facility is needed but does not fall directly within the institutional mission or core competencies.
The COVID-19 pandemic and the growing demand for mental health counseling on campus are driving demand for robust on-campus health and wellness centers. Universities administrators should take a strategic approach to this issue by defining the right programmatic and operational models. If implemented thoughtfully, HWCs will function as important assets within the broader portfolio of student life offerings.
Greg Wachalski, AIA, is a founder and principal of Wachalski Advisory, a real-estate consulting practice providing a wide range of capital planning and project implementation services to higher education institutions across the United States. He can be reached at [email protected].