Has your college had a conversation on telepsychiatry and student care?
If the words “mental health” don’t grab your attention as a college administrator, maybe these statistics will.
More than a third of all students are suffering from moderate depression, and 21% have screened positive for major depression. Of those, 13% have thought of suicide and 6% have a plan to follow through.
Dr. Nora Feldpausch, the medical director at mental health provider Mantra Health, says the need to get help to students has reached a crisis stage at institutions of higher education.
“So, 1% of students every year attempt suicide. If you’re looking at a Big Ten school, that’s almost 500 students a year attempting suicide,” she says. “There’s an astronomical number of students dying every year. Every campus ends up dealing with suicides. A third of students say that at least two days out of the week, they’re affected by their mental health to the point that they can’t complete their studies. If we have students dropping out, that’s a huge economic burden on universities. But we’re also talking about how to keep students alive.”
Mantra Health, which is continually expanding its partnerships with colleges and universities, just launched Telepsychiatry: Transforming Campus Mental Health, a resource that looks at those staggering numbers based on data from the Healthy Minds studies and others. It offers an in-depth look at how their scalable solutions can have a positive impact on students and institutions. The report outlines the costs and outcomes of having flexible, vetted providers available via telehealth to free up overwhelmed campus counseling centers. And it outlines what happens when those services are not in place.
Dr. Feldpausch, a former staff psychiatrist at Michigan State University’s Olin Health Center and at Colorado State University, likened a typical counseling center’s position now to one of a triage unit.
“College counseling centers have a huge job on their hands,” she says. “They’re finding that they cannot keep up in terms of hiring the number of providers necessary. Even if there was enough funding to be able to pay for the kind of care that college students are needing, just to be able to recruit that many providers locally is essentially impossible for most universities. Since many universities are in rural areas, it becomes even harder.”
That has resulted in a large portion of students who need care not being able to access it 24 hours a day. Some who were surveyed simply gave up. Sadly, 30% of those said they either self-medicated or self-harmed. Colleges are clamoring to do what they can to address it, with more than 70% allocating more funds toward mental health.
Providers are important to students
Primary care physicians (PCP) are often thought of as the first and best source of treatment for individuals in health care. But that traditional option is not necessarily the best for students who have mental health concerns or issues. In Dr. Feldpausch’s work and noted in the study, students need psychiatric providers, but a third of institutions don’t have them. Half of those who sought care on campuses in the survey instead saw PCPs. The vast majority of students said they would prefer to see a psychiatric physician, and many of them would like to do that through telehealth.
Dr. Feldpausch highlights in the report that only 13% of mental health patients receive “minimally adequate care” from PCPs. “[Primary care providers] have such a depth of information that they need to learn in a relatively short period of time that many of them are not able to get specialized training to do it,” she says. “There’s a reason why we have psychiatrists. There’s a reason why we have psychiatric nurse practitioners. Those folks have spent several years or more training on how to handle these types of illnesses. Many primary care providers refer out when they start to get folks with mental illness.”
And increasingly, those patients—and new ones—are ending up in remote care for mental health, particularly ones who suffer from depression and anxiety. Other, more complex issues such as bipolar disorder, schizophrenia or substance use would need in-person evaluation. Colleges and universities, understanding telehealth’s value both in terms of flexibility and ability to provide a vast network of options, are increasing pairing up those services with ones they have on the ground.
“Once you get a taste of telehealth, it’s very hard to convince people to go backward,” Dr. Feldpausch says. “You’re talking about being able to offer appointments in the evenings or on the weekends and being able to say to a student, ‘You don’t have to schlep across a freezing cold campus to come in and see me. You can just join from your dorm or wherever you are.’ I think college counseling centers are still incredibly important and need to be preserved. But to incorporate that telehealth piece is going to increasingly become the standard of care going forward. You’re going to have a hard time convincing students that this isn’t an option for them.”
The availability, level of care and sheer number of providers, especially during the pandemic, have boosted telehealth’s image.
“Can you actually do good care via telehealth? The answer is yes. If you look at the outcomes, they are comparable or better doing video conferencing vs. in-person care for many of the illnesses that we treat,” she says. “We offer a group of providers who are well vetted, who are high-quality, who are specialized in this population.”
And, she says, the array of providers is far wider than what a typical institution could offer.
“Say we have a provider that’s working 40 hours. We can have them do five hours of their time at multiple different universities,” she says. “Let’s say they’re an LGBTQ provider of color. That might be a relatively niche person who really saves lives and help retain students. Maybe a university couldn’t hire someone full-time in that position. We can say, ‘We’ve got that provider for you, and we can embed them within your counseling system.’ We can also bring in folks that maybe don’t want to live in rural Pennsylvania or southern Florida. We can open up this realm of providers that you can’t recruit locally.”
Assistance for colleges and universities
Once on board, Mantra Health effectively creates a system for institutions that includes a dashboard, allowing colleges and universities to see how many students are accessing care and how many students are high-risk. Some of the colleges that have executed it well—Penn State University, Moravian University and Hamilton College—have put plans in place that get students assistance and position them for success in the future. Because they can access services when they’re away from campus, they also get whole coverage during high-risk periods.
“There’s always this fear on campus that we’re going to come in and somehow suck the students away or give them subpar care and the campus is going to lose track of them,” Dr. Feldpausch says. “That’s not us. We are a complement to the on-the-ground care.”
For institutions, telepsychiatry is not without cost, but Mantra Health says it’s worth it. “It’s hard to convince the administration that investing is incredibly important. It takes upfront money to prevent loss of students,” she says. “But for a relatively small amount upfront, you will gain back in tuition two to three times what your initial investment is.”
Mantra Health’s report, in fact, outlines how spending $1,500 each on 100 students can result in a huge return on investment. Take that $750,000 and put it up against the cost of 95 students who are likely to stop out or drop out. If tuition is just shy of $25,000, that’s $2.3 million.
Beyond the report, another great resource is Healthy Minds, which has a calculator that can help leaders can punch in their own stats and get ROI. Institutions also can continue to lean on the Association for College Psychiatry and the Association for University and College Counseling Center Directors for guidance. Mantra Health, meanwhile, also hosts open forums each month that center around different topics related to mental health.
Dr. Feldpausch recommends that institutions “be in the conversation with [national organizations and leaders] to see what other university centers are doing. There’s a ton of collaborative spirit I found among higher ed folks. Even the smaller schools, the more you can get connected with some of those national forums, the more you’ll learn and be able to rely on your colleagues to help you put together a program together.”