Even before COVID-19, the traditional model of college campus counseling was failing the growing mental health needs of our students and burning out our staff. A model that requires staff therapists to wear a plethora of stressful clinical hats, that over-relies on short-term individual counseling, and that can only meet demand by hiring more therapists is simply not working.
Soon students will return to campus with mental health challenges that have only been worsened by COVID-19 and recent social unrest. I’m more convinced than ever that the structures and traditions of college counseling are outdated.
First, we can no longer avoid serving students with high mental health needs.
The Association of University and College Counseling Center Directors reports that almost every symptom area has risen since 2007, and these are only going to increase. For example, according to the Substance Abuse and Mental Health Service Administration (SAMSHA), trauma includes an event that is physically/emotionally harmful or life-threatening, has lasting adverse effects and causes significant impairment in functioning. By this criteria, many were traumatized by the fear and isolation of the virus. In addition, many students of color feel traumatized by the killings of George Floyd, Breonna Taylor and Ahmaud Arbery, and many Asian Americans are traumatized by daily bigotry.
However, counseling centers tend to offer limited counseling sessions per student, often requiring a waiting list. This will not meet the significant mental health needs of our students. Indeed, colleges are not treatment facilities and campus centers cannot provide the level of care that a community behavioral center can provide. That’s why we should partner with them!
At Texas Christian University, our partnership with local treatment centers allows us to host an intensive outpatient program and a dialectical behavioral therapy program on campus. These programs didn’t cost the university any money (though a gracious donor covered the initial student fees for the DBT program) and they literally saved lives.
We can also no longer assume that clinical therapy is the best response for every mental health need.
When I became director at TCU, we noticed that many of our current clients were former clients who have returned to counseling, indicating that the center needed to do a better job at providing after-care or follow-up services. We developed “peer support communities,” which aren’t therapy or psychoeducational groups, but that foster social support with like-minded individuals.
Surprisingly, we found that many students elected to join a peer support community instead of counseling. Even more surprisingly, many students reported that these support communities met their needs. Every campus counseling center needs to have a peer support initiative, or some alternative to the perception that every student who contacts the counseling center should be a client.
Lastly, we must no longer accept high levels of burn-out amongst our staff. The traditional model asks college counselors to wear so many hats: an individual therapist, an intake coordinator, a crisis counselor, a clinical supervisor, a mental health educator, a consultant, a group coordinator, etc. Not only does that multi-tasking limit individual time with students, it taxes our staff members and makes them less effective. Centers should instead compartmentalize certain responsibilities.
Creating a dedicated triage and crisis response team, as our office did, can create a sense of purpose for staff who lead the team, while freeing up the schedules of other staff therapists to see more clients.
As colleges and universities resume in-person classes, our campus counseling centers—already overwhelmed by increasing demand—will face the pandemic’s and society’s psychological fallout. We will likely see higher demand for services while still needing to be nimble in ways that allow us to maintain contact with high-risk students and engage students with video and remote services. While many of my colleagues will struggle with these issues within their traditional model of service, we’ve seen that a Comprehensive Collaborative Care Model can be adaptable and resilient. Our specialized services for students with high needs allows us to stay engaged with students of concern, our peer support communities serve students across state lines, and the morale of our staff is better protected.
The COVID-19 crisis and recent social events has caused many in higher education to rethink their way of doing things. Our campus counseling centers should be no different. We should embrace this opportunity to reconsider the underlying structure of our treatment model. The old way of doing things wasn’t working then and it won’t work now.
Eric Wood is the director of counseling and mental health at Texas Christian University in Fort Worth.
