A number of key trends shaping the future of student mental health services have been present for some time, but their salience has been magnified by the COVID-19 pandemic and its impacts on higher education. Taken together these trends strongly suggest that colleges and universities should take bold steps to address the quality, availability and costs of their student mental health services. Outsourcing various aspects of the function is an increasingly relevant option.
Every recent survey shows a sharp spike in the prevalence of student anxiety and depression related to the COVID-19 pandemic and its disruption of all aspects of student life. Prevalence will continue to grow over the duration of the pandemic and will remain at high levels for many years to come.
Recent surveys also document an increasing severity of mental health problems among college students. Wellness programs aimed at promoting student resilience and preventing more serious mental health issues will not meaningfully blunt this trend.
Parent and student expectations will continue to drive up the demand for mental health services, and colleges will be expected to provide a range of high-quality options to their students. As rising prevalence, increasing severity and higher expectations interact with changing social norms about receiving mental health care, more and more students will be demanding individual counseling.
Social distancing, a direct impact of COVID-19, will be a relevant factor for some time to come. Social distancing will continue to affect student location and scheduling, and it will continue to be a barrier to in-person counseling. Both impacts will require greater use of tele-counseling.
Prompt access to mental health services has been an issue for students and parents for some time, and access will be an ongoing challenge for colleges as prevalence, severity and expectations continue to stoke demand. Schools will be challenged to build enough on-campus capacity to enable prompt access.
These trends comprise a complex and challenging scenario in which colleges and universities must deliver and pay for mental health services that contribute to student recruitment, retention and academic success, yet are not in fact part of their core mission.
The costs of mental health services will be an increasingly important consideration for all parties as students, families and schools deal with major financial impacts from the pandemic. Fortunately, the Healthy Minds Study shows that investments in better mental health services can generate returns in the form of tuition and fees from retained students.
Equity will be a substantial concern in light of the commitment to social justice that is mutually supported by colleges and their students. Mental health services will need to be delivered in ways that promote equity in access for students from a range of demographic and identity groups and students with limited financial resources.
These trends comprise a complex and challenging scenario in which colleges and universities must deliver and pay for mental health services that contribute to student recruitment, retention and academic success, yet are not in fact part of their core mission. The size and synergy of these trends also mean that expanding the classic model of campus-based mental health services by hiring more counselors is not a suitable, scalable or sustainable option.
The main elements of a new approach to delivering mental health services should include student-centered options that are easily transferrable to outside partnerships and typically involve new technologies. These include: 24/7 support lines, remote counseling via teletherapy, enhanced care management and access to local clinical networks. Schools should look for approaches that leverage students’ existing care arrangements and insurance coverage so as to promote continuity of care and lower costs. ACA coverage and telehealth expansion enable these approaches, and care management personnel facilitate their application.
In the COVID-19 era, college presidents consistently cite student mental health services as a top concern. In addressing that concern administrators who oversee their school’s counseling efforts must understand that the times call for new approaches rather than an expansion of business as usual. In recent years higher education has sought scale, service and price advantages by partially or fully outsourcing services that are not directly related to core academic functions. The time has come to actively pursue outsourcing as a path to improving the quality, cost, and access of student behavioral health services.
Robert Meenan, MD, is president of Christie Campus Health.