When Mantra Health conducted a survey of 94 college and university counseling center directors this fall, nearly 90% expressed worry about student wellbeing. More than half were concerned with their ability to handle short staffing, high caseload numbers and crisis management.
Tragic mental health outcomes have been well documented, from the rise in anxiety and depression among young adults to the reports of suicide that have pushed at least two universities this year—Saint Louis University and the University of North Carolina at Chapel Hill— to cancel classes and allow communities to heal.
Overburdened, overwhelmed and still coping with the impacts of COVID-19, college wellness centers are being counted on to be that backbone of support and services for students. But they can’t do it alone. Increasingly, institutions are turning to telehealth and forging alliances with partners like Mantra, which can help increase the network of providers. Along with their own services, that three-pronged approach is giving students 24/7, 365-day access to care if needed, both on- and off-campus.
Hamilton College in upstate New York is one that has successfully adopted the hybrid approach. Its counseling center has undergone a complete transformation—including a sparkling new home in 2018—since its three-person staff tried to handle all matters of mental health and wellbeing just six years ago.
“It was very much a kind of private practice setting,” says Dr. David Walden, Director of Hamilton’s Johnson Center for Health and Wellness. “Now, if you count all of our part-time and multidisciplinary folks, we’re at about 16 or 17 people. We’ve shifted from just providing individual therapy and frontline treatment to providing a comprehensive array of integrated services to students.”
The Center has exponentially boosted the number of its resources, caring for students with wide-ranging services that include group psychotherapy, peer counseling, psychiatric and dietitian services, and even acupuncture.
The need has been there. Since Dr. Walden’s arrival, the percentage of the student body now utilizing the Center has risen from 12% to 41%.
“There’s been an increase in the overall presentation of students who are struggling with anxiety and depression,” he says. “You see a lot more students presenting with acute issues like suicidal ideation, self-injurious behavior, things that lend themselves to more complex problems to deal with, or that need more supports that activate a system in different ways.”
Though signs of fatigue, stress and depression existed long before COVID-19’s arrival, the pandemic has heightened those factors in a different way.
“Anecdotally, we’re all pretty stressed,” Dr. Walden says. “As human beings, we tend to not deal too well with uncertain and ambiguous situations. We like to know where things are going and what’s going to happen. One of the features of this time is that literally everything is new. As a society, we have not had to face these challenges. That lends itself to a lot of uncertainty and therefore a lot of anxiety.”
Dr. Walden, also a psychology lecturer, provided further insight in a conversation with University Business on the mental health crisis and how Hamilton is managing it through its resources and team of counselors.
Coming into the fall, what were some of the strategies the Center wanted to employ to help students in need?
We wanted to provide three things. One was the direct clinical services that allow us to provide good treatment for students. The second is we wanted to continue to provide some wellness support that was helping students connect with one another, plus offer services that would help them take care of themselves—pace themselves. Third, we wanted to make sure that we were still providing good crisis services, making sure that the students at 2 p.m. or 2 a.m. who were in pretty severe distress or crisis had resources available to them.
You’re still operating completely virtually at the moment. Why is that?
We made that decision for a couple of reasons. We’re required to wear masks and it’s harder to do therapy with a mask. It’s harder to read facial expressions. If a student is very emotional, that’s a difficult thing to manage with a mask. We also wanted to preserve the emotional availability of our therapists. We have therapists who are in risk groups and we have therapists who have small children. If our therapists are anxious, they’re not going to be providing as good a service.
What has been the overall approach to wellness and care for students at Hamilton?
If you come into the work with a holistic vision, you can provide different levels of services for different aspects of who people are. Think about that as a wellness wheel. You want to provide more than just clinical services. You want to provide some wellness. We have a lot more language now around our psychological-emotional wellbeing, and I think our services ought to match that. We ought to be providing a comprehensive array of services because people are much more aware of who they are as holistic beings.
You have quite a robust staff for the size of your institution (1,900 undergraduate students), with some partnered through Mantra Health. How great is it to have access to that extra network of providers?
It’s helpful to have the sheer bandwidth and number of hours. It’s also helpful if you have a diversity of providers because every student wants a different thing in a therapist. Therapist-client matching is really important to getting people in the office. It actually doesn’t impact outcome all that much. But it does impact whether or not people are willing to come into the office. If somebody perceives that you understand them, then there’s more trust. We don’t have everything covered, but we have providers that operate from different approaches or have different demographic identities, and that helps reach more of the population.
How beneficial has the addition of telehealth been to Hamilton?
Telehealth is critical for us, and in my view, it’s here to stay. When we surveyed our students last spring, half of them said, I can’t wait to see you in person, and half of them said, please keep virtual visits because it’s easier, or it’s more convenient, or the screen helps me feel safer because I don’t feel as intimidated.
How have the options for care and the wellness center been received by students?
Receptiveness has been really positive. They’re wanting to use that space, whether it’s frontline clinical treatment or wellness-based services. A great example is our community pantry. We give boxes of ingredients to students for a meal for free. We subsidize that, and then there’s a Zoom cook-together. The original intent during the first parts of COVID was to allow folks in different residence halls to have some mode of interacting. That has shifted a little bit into wanting to offer some broader-based life skills for students, get them cooking and used to using the kitchen. At the height of our services, we were giving 90 boxes and ingredients a week that would sell out in two minutes on our campus. We’re putting stuff out there that folks are using. They’re saying this is going to be valuable to me, whether it’s helping me modulate my stress or learn new skills or just distract me for a while.
One of the most serious topics around mental health is suicide. How vital is it to have that wellness component to further protect students?
When thinking through the lens of suicide, I think of it as breathing room. We all have a certain amount of breathing room at different points and places in our lives. That breathing room is increased when we have more resources—meaning friends, a system that will support us. Some students have less breathing room. What we’re trying to do is increase breathing room. Wellness service, whether it’s just a distraction for the moment, a little respite from the stress of daily life, or whether it’s teaching them a valuable skill, all of that is increasing breathing room. When we’re thinking about something like suicidal ideation, we’re simply trying to increase the resources that are available to that student. You also want to make sure that you’re increasing some very real structural resources for students, not just wellness services. You’re really trying to help folks lessen their distress, so they don’t need the most time-intensive resource, which is a clinician.
How is your counseling center getting the word out on resources and supports that are available to students?
Obviously, we send out emails to everybody. Depending on the resource, we tend to go old school a little bit with flyers on tables and in residence halls. We use social media, both for our counseling center and for our peer counselors. Because of our small student population, we tend to benefit from a really high level of awareness of resources (92% from Healthy Minds Network). We have this beautiful building smack-dab in the center of campus. There’s no missing it. I also do presentations for the community, whether that’s to student government or particular clubs. Our career counselors do that as well. If there’s a through-line on what helps, it’s relationships. If you build a relationship with a particular sector of your college or university, they’re going to be more aware of your services. They’re also going to trust you more.
Do you and other colleagues across the country share thoughts and ideas about wellness and mental health?
That’s one of the things that’s really special about college mental health. It’s a real community. There are places (state listservs and the Association for University and College Counseling Center Directors) that you can reach out to, ask any question and get dozens of responses within hours about your particular need. Whenever you talk to another colleague in a different counseling center, they’re always very quick to be supportive.
What is something that should be a strong consideration for the future of counseling in higher education?
We focus a lot on the sustainability of the services we’re providing students, and that’s paramount. But we also need to be focusing on sustainability for our staff. How do we make this higher ed mental health space sustainable for the people who want to work in it? How do we make it attractive, because we’re going through a moment where the pools are smaller and not as high quality. A lot of people are leaving for private practice and other ventures. There’s something very special about college mental health and very special about college counseling centers. We need to make the work nourishing for our staff so that they want to work here.