An Exploration of College And University Student Mental Health Services and Supports

1. An Exploration of College And University Student Mental Health Services and Supports Jay Feldman, RTI International Deborah Tull, VentionWorks, LLC

2. Sponsored by The National Council on Disability A Research Project Benefiting Students with Disabilities

3. Need for Research and Improved Mental Health Services • The percentage of students seeking support for mental health disabilities, including those of a severe degree, attending colleges is increasing. • More students are seeking support for mental health disabilities, including those of greater severity. • This growth in the number of students needing mental health services highlights weaknesses in current supports offered by colleges. • Students with mental health disabilities who do not receive assistance are not as academically successful as their peers, with lower GPAs and higher dropout rates. • Given increased demand and limited funding for mental health services, some have argued that the country has reached a “campus mental health crisis.” • Colleges must ensure that mental health services are available to students and provide a campus culture that supports the mental and emotional well-being of students.

4. Benefits of increased mental health support • Improved Academic Performance • Increased Resilience and Reduced Stress • Reduced Substance Abuse • Reduced Suicide Rates • Economic Benefits for Colleges

5. Research Goals • To examine and assess the status of college mental health services and policies • Provide recommendations for colleges to improve college mental health services and support academic success for students with mental health disabilities

6. Research Methods • Data collection • Literature Review • NAMI and Active Minds Participation • Interviews with 37 key informants • Interviews with 48 college students • Open-ended questionnaire responses: • 101 responses from practitioners • 148 responses from students

7. Focus of Research Questions • Policy: This includes gaps, weaknesses, and discriminatory aspects of current federal and college policy and recommendations for policy and system reforms at the postsecondary level. • Access: This includes availability of mental health services on campuses, policy and physical barriers to students accessing services, as well as programmatic barriers, and whether students receive the appropriate reasonable modifications and accommodations to help them remain and succeed in school. • Practice: This includes the services that colleges provide to students with mental health disabilities, best and/or promising practices and emerging trends in the field in providing support to students, as well as best practices in training mental health professionals and college faculty and staff to effectively provide services.

8. NAMI: A Great Partner Contributions • NAMI On Campus Clubs • Resources and Referral Services • Advocacy at State and Local Level • Education Programs and Support Groups • College Guide Material • Research: College Students Speak

9. NAMI Research: College Students Speak Statistical Highlights: • 64% of students who stopped attending college are no longer attending because of mental health related reasons. The primary diagnoses were depression, bipolar disorder and posttraumatic stress disorder. • 72% of students experienced a mental health crisis on campus. Yet 34% did not report it to their college. • 57% of students didn’t access accommodations through college disability resource centers and 40% didn’t access college mental health services. • 36% of students cited stigma as a barrier to accessing their college’s mental health services and supports, making it the number one reason students don’t access treatment.

10. NAMI Research: College Students Speak Students emphasized the critical need for the following services and supports to be available on campus: • Mental health training for faculty, staff and students. • Suicide prevention programs. • Peer-run, student mental health organizations. • Mental health information during campus tours, orientation, health classes and other campus-wide events. • Walk-in student health centers, 24-hour crisis hotlines, ongoing individual counseling services, screening and evaluation services and comprehensive referrals to off-campus services and supports.

11. National Response to Critical Needs Are college and university mental health services and supports meeting the needs of students?

12. State of Mental Health Supports in Higher Education Hours of Service: • Only 12 percent of campus mental health centers offered services outside the normal 8 a.m. to 5 p.m. hours, seven days a week. Forty-six percent did not offer any services outside of these hours. Afterhours Access to Counseling and Helplines • Almost 90 percent of respondents indicated that there is an active crisis hotline available in the community that students can use, while 42 percent said there is an active crisis hotline provided by the campus that students can use.

13. State of Mental Health Supports in Higher Education Fees at Counseling Services • 16% of university and college counseling centers charge a fee for initial medication evaluation, 17% for ongoing medication follow-up, and 10% for formal psychological assessment which provides a diagnosis and establishes functional limitations. 5% of college counseling centers charge fees for counseling (no community college centers charge a fee); the average fee is $20. Websites • 96% of campus counseling centers had websites: 100% of websites provided information about center services, and 70% provided educational information on psychological issues.

14. State of Mental Health Supports in Higher Education • Waitlists for Counseling Services • Limited Sessions at Counseling Services • Limited availability of Counseling Staff with Mental Health Licensure • Limited availability of a Diverse Mental Health Counseling Staff • Very limited availability of Psychiatric Medication Services • Access issues for Reasonable Accommodations

15. State of Mental Health Supports in Higher Education Student engagement practices • 56% of counseling directors reported that their campuses had a student mental health organization. • 57% of counseling directors reported that students are provided gatekeeper training (designed to increase the knowledge and skills to identify those at risk of mental health disorders and make referrals when necessary). • 20% of respondents reported that students are directly involved in their counseling centers’ strategic planning. • 73% of survey respondents reported that their counseling centers included students in outreach strategies. • 34% reported that campuses had trained peer counselors.

16. Promising Best Practices Training and Other Anti-Stigma Activities • Student groups • Integrated support services throughout campus to promote general inclusivity • Campus-wide wellness initiatives • Framing disability as a diversity issue • Co-location of mental and physical health services • Outreach at orientation • Transparent discussion of services on college website • Campus-Wide Conversations • Universal design

17. Promising Best Practices Student Engagement • Peer-to-Peer Support Services • Student representation on campus mental health committees • Gatekeeper training • Student-led organizations • Expand nonprofessional support, such as informal networking groups of students, staff, and faculty. Increasing the number of informal networks around campus increases student connections, which is particularly helpful for students of color and other non-majority groups. • Greek Life

18. Promising Best Practices Faculty and Staff Training • Provide mandatory mental health sensitivity and awareness training for faculty, staff, and administrators, including streamlined identification and referral protocols and reasonable accommodation suggestions for students who have mental health disabilities. • Provide mandatory faculty training on ADA and 504 regulations so that colleges comply with federal law and faculty understand their obligations. Encourage faculty to team with college disabled student’s programs.

19. Promising Best Practices Faculty and Staff Training • To encourage more mental health practitioners of color, forgive student loans of professionals committed to working with students with mental health disabilities in college. • Ensure that all counselors have cultural competency. Provide professional development in understanding the cultural considerations of students of color and other vulnerable student groups if necessary. It is important to have mental health counseling staff that is as diverse as the student body they serve.

20. Promising Best Practices Communication • Faculty talking openly about mental health issues. • Discussions of mental health challenges and resolutions can be incorporated into curricula to reduce stigma and normalize the process of embracing mental health wellness. • Requirement of all course syllabi to have a standard section that includes statements for students with physical or mental health disabilities, including why and where to seek support.

21. Promising Best Practices • Coordinated support • Case management, BIT teams, etc. • Collaboration • Community Non-Profits • County Mental Health Entities • Department of Rehabilitation • Law Enforcement • Other colleges • Suicide prevention planning • Violence prevention plan with postvention services • Individualized services for special populations

22. Stop Out and Start Up Procedures Withdrawal/Leave and readmission

23. College Collaboration and Policy Recommendations • As an African proverb states, “If you want to walk fast, walk alone. If you want to walk far, walk together.” • There is a critical need for colleges to collaborate internally with on campus student services and academic affairs programs to create a web of support as well as externally with community-based organizations, county organizations, and other colleges to work together toward common mental health support goals. Successful teamwork is essential if colleges are to fully meet the mental health needs of their students.

24. College Collaboration and Policy Recommendations • One example of successful collaboration is the California Community College (CCC) Student Mental Health Program. The statewide program is funded by CalMHSA, developed when the state’s voters approved Proposition 63, which levied a one percent tax on millionaires to support mental health efforts in the state. A percentage of the CalMHSA funds supported college-based mental health programs in California. • The CCC Student Mental Health Program works with colleges throughout the state to build strong collaborations within colleges, between colleges, and between community mental health departments. The program developed a collaboration toolkit available at: http://www.cccstudentmentalhealth.org/

25. College Collaboration and Policy Recommendations • One collaboration within the CCC Student Mental Health Program is the Building Healthy Communities Initiative in Los Angeles, California, in which college and Department of Mental Health partners agreedon multiple strategies to support students (website: www.lahc.edu/studentmentalhealth) • Strategies ranged from cross-participation on committees in each organization, population-specific mental health services for different populations, strategies for increased accessto services, faculty and staff training, inclusion of student voice, and parity between physical and mental health budgets.

26. College Practice Considerations • Embrace diversity when providing mental health services. Individualize offerings for special populations (Veterans, various ethnic groups, Foster Youth, Homeless, and LGTBQ). • Ensure appropriate in-reach and out-reach is done to embrace at-risk individuals needing help. • Provide services in an integrated setting. • Ensure that all faculty, staff and students receive training on mental health sensitivity and awareness with appropriate referral networks fully in place. • Partner successfully with campus law enforcement through provision of mental health sensitivity and awareness training and collegial policy development.

27. College Practice Considerations • Integrate Masters and Doctoral level Psychology Internship Program on campuses to increase college capacity to meet mental health needs in a cost effective manner. • Ensure that violence prevention training and BIT team activities are conducted with full respect for those living with mental illness. Ensure that we debunk the myth that individuals with mental health disorders are violent. • Cultivate campus climates which normalize mental health and optimize wellness.

28. Our questions for you • How do you feel we are doing as a nation with student mental health? • What recommendations do you have to improve mental health services and supports? • Do you have any personal experiences which we can learn from.

29. Any Questions? Jay Feldman, RTI International • jayfeldman@rti.org Deborah Tull, VentionWorks, LLC • drdebtull@gmail.com