TeleHELP in higher ed
Today’s college students face stress everywhere they turn, from friend and roommate tensions to financial strains and fear of becoming a victim of school violence. Consider these stats:
- Nationwide, more than 8 in 10 college students report feeling overwhelmed, and the average student waits two weeks for a college counseling center appointment, according to a National Alliance on Mental Illness (NAMI) study.
- Universities report an increase in the prevalence and severity of students’ mental health issues and an increase in the number of students taking psychotropic medications, according to another NAMI report. Overall, 40 percent of students with diagnosable mental health conditions did not seek help, citing stigma as the top reason.
Since most higher ed institutions aren’t able to hire enough staff to meet their students’ mental health needs, some have added teletherapy services, according to a new Higher Education Mental Health Alliance guide. Such services can be delivered through videoconferencing, phone or online messaging.
Teletherapy options are often effective in helping students find their way to counseling assistance—which may continue as teletherapy or transition to in-person help.
Online exclusive: Telemedicine providers on campus services realities
Here’s what campus administrators need to know about virtual behavioral health services and how to implement them.
Potential service quandary solution
4 common hurdles in finding conventional therapy
1. Access At a rural institution or one near rural areas, students may not be able to find a local therapist because there are few in the vicinity, says Raquel Contreras, a licensed psychologist and director of counseling and psychological services at Clemson University in South Carolina.
2. Affordability Mental health providers often may be out-of-network or may not accept insurance at all. In communities with few therapists to begin with, it’s even harder to find one who offers sliding-scale fees, says Contreras.
Say a student who is depressed faces a four-week waiting list for treatment. “That’s the difference between surviving a semester and flunking out and floundering,” says Sherry Benton, former director of the University of Florida’s student counseling center. “You can affect the entire trajectory of someone’s life.
“For me, this was intolerable. We needed to find a way to get more services to more students,” adds Benton, who is founder of TAO Connect Inc., which delivers remote behavioral health therapy via college counseling centers.
Options for teletherapy vary widely, but all methods direct students to seek immediate care if they’re in crisis or are considering harming themselves or others.
The general practice is to offer teletherapy for more mild conditions that respond well to cognitive behavioral therapy. But it can help get students who are in distress immediate in-person therapy because those who avoid their college counseling center may initially only reach out for teletherapy.
Teletherapists may be psychiatrists, psychologists or licensed clinical social workers.
Institutions most likely to seek teletherapy services for students are those with few behavioral health clinicians in their communities and schools without on-campus counseling—such as satellite campuses and some community colleges, says Sharon Mitchell, head of the Association of University and College Counseling Center Directors (AUCCCD).
The onset of severe mental illness, such as bipolar disorder or schizophrenia, often strikes when people are in their late teens and early 20s—and it’s common for people with these conditions to escalate to the point of crisis before seeking treatment.
Sidebar: Teletherapy at a glance
In emergency rooms, they may well languish while waiting to see a psychiatrist. As an ER physician, Dr. Dorsha James, co-founder and CEO of telemedicine services provider CampusRx, is passionate about keeping those students out of the ER.
Teletherapy provides an additional level of screening and support to students who may fall through the cracks, James says. When these professionals recognize the signs of a more serious issue, they can refer the student to local resources for greater support.
The face of teletherapy
4 common hurdles in finding conventional therapy (cont.)
3. Appointment availability Nationwide, most psychiatrists’ schedules are overbooked. Patients who are stable with their medications can have brief checks via Skype or Facetime with these same professionals, says Dr. Herbert Harman, regional director of the psychiatric practice for telemedicine provider Vituity.
4. Aptitude Not all students have the time or organizational skills to get to the college counseling center during business hours. More than 45 percent of young adults who stopped attending college for mental health-related reasons did not request accommodations; and half of them did not access mental health services and supports, according to a National Alliance on Mental Illness study.
Campus clinicians generally start with a needs assessment by phone or in person, and then connect students to virtual counseling delivered by staff or an outside provider.
On its own, teletherapy is most effective for students who are highly motivated and have less intense behavioral health needs, such as family, roommate and relationship trouble, anxiety and stress, grief, LGBTQ issues, or mild depression.
Counseling models and costs differ. Students using TAO, for example, first complete online lessons delivered via videos covering their condition, such as anxiety, depression and substance abuse. Then they participate in a 15-minute phone or video check-in session with the institution’s staff therapist.
TAO charges universities a flat, annual fee based on enrollment so all students can access online tutorials addressing the full range of behavior health issues.
Some staff therapists incorporate the tutorials within group and individual therapy. CampusRx institutions also pay based on overall student enrollment, but monthly instead. That works out to about $6 to $8 per student, per month, at a college with 5,000 students, says James.
Some companies, such as BetterMynd, bill the students’ insurance directly on a fee-for-service basis for each session. It was started by a graduate of Colgate University in New York, which became BetterMynd’s first client.
Dawn LaFrance, Colgate’s director of counseling and psychological services, says that because of the university’s upstate New York location, teletherapy could be the only way students of color find a therapist who looks like them. Also, the counseling center lacks the resources to offer weekly sessions all year—which is a non-issue with teletherapy.
Testing and rolling out teletherapy
When researching teletherapy providers, check with peer institutions to help make an apples-to-apples comparison. Starting small, with two or three highly motivated clinicians who can work out the program’s policies and guidelines, is how teletherapy expert Marlene Maheu recommends launching a teletherapy service on campus.
“There’s no need to jump in with both feet. See how student groups respond to this,” says Maheu, founder and executive director of Telebehavioral Health Institute, a 20-year-old firm that trains teletherapists. “It’s not all or nothing.” Clinicians, not administrators, should set the pace for what teletherapy will look like on campus, she recommends.
Institutions could run a pilot study with faculty volunteers to sample different teletherapy delivery methods.
A TAO feature that allows staff to track how many students are using the service and which modules they’re viewing “will help us get a pulse for what’s happening with students,” says Mitchell of AUCCCD, who is also senior director for counseling, health and wellness at the University of Buffalo.
Universities can advertise the service through announcements to faculty and staff; through student affairs, residential life and the school newspaper; on posters around campus; on the center’s web pages; and at freshman orientation.
Managing clinician and institutional concerns
Counseling center directors say some clinicians are skeptical or uncomfortable with the notion of counseling via videoconferencing.
Some issues, like social anxiety, are better addressed in a group setting, says Kathryn Kominars, associate director for Counseling and Psychological Services at Florida International University.
Sitting face-to-face with a therapist and discussing the discomfort of an eating disorder or depression may produce better outcomes, says Greg Ellis, director of counseling and psychological services at Cornell University in New York, which uses telephone calls with clients as the first step toward providing counseling, a practice the university has followed for 16 years.
Privacy is another concern. Online therapy is more susceptible to breaches than are therapy notes from an in-person session, says Ellis, who is a member of the American College Health Association’s Mental Health Section.
Maintaining privacy can involve simple rules about where the student is during a session—such as that a session must be canceled if the student doesn’t connect from a location with privacy.
Clinicians must also be careful to practice only in the state where they are licensed. So, for example, counselors can’t provide teletherapy via Skype or Facetime to a student studying abroad.
Institutional leaders may be concerned about liability risk in an instance where the therapist doesn’t detect that the student may hurt themselves or others. Yet remote counseling doesn’t increase that risk, says Kominars. “In every situation, if we don’t get the information, we can be at risk for not knowing.”
Counseling staff concerned about the efficacy of virtual counseling can be assured of this: Multiple peer-reviewed studies have shown teletherapy is, in fact, just as effective as in-person therapy in treating conditions for which it’s recommended.
In one study of patients with moderate depression, 53 percent of those who had online therapy and 50 percent of those who had face-to-face therapy could no longer be diagnosed as depressed after completing treatment.
Three months later, 57 percent of the online therapy group had no detectable depression, compared to 42 percent of those in the conventional therapy group. Satisfaction with treatment and therapists was about equally high among the two groups.
“Across the board, in numerous studies including several meta-analyses, telepractice is on par with in-person practice in terms of efficacy,” says Maheu. “The outcomes are the same, in some cases better.”
Theresa Sullivan Barger is a Connecticut-based writer.