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Crisis on Campus: Navigating Mental Health Needs in Colleges and Universities

By Casey Tallent, PhD

Are college campuses able to adequately meet the needs of their students in this surging mental health crisis? Like so many others around the world, college students in the U.S. are struggling with stress and mental health issues. Therefore, mental health advocates are calling on campus leaders to improve access to quality mental health treatment resources.

There are some viable solutions to this problem. But first, let’s look at the current levels of distress among college students today.

Ideally, all college students will be able to access the mental health services they need. And, while barriers to care do exist, innovative strategies also exist to support students and staff members during this challenging time.

It’s time to reevaluate the way we provide care on college campuses. We outline some ways to approach that here.

Solutions to the Mental Health Crisis on College Campuses

These are unprecedented times. More people are turning to therapy to find relief from mood and anxiety disorders, eating disorders, and other challenges, often worsened by the COVID-19 pandemic. As a result, therapists around the nation are taking on larger caseloads. Many of these providers are suffering from burnout or are choosing to change careers or places of employment. More concerning, many mental health providers are experiencing a decline in their own physical or mental health.

To support both the students who are struggling and the people that work with them, we’ve identified several interventions that colleges can consider as they work to expand the services they can provide students.

Group Therapy

Group therapy is a great option for colleges as it offers the chance to provide services to multiple students at one time, increasing the numbers of students that can get access to care at once. Many students will see benefits from participating in group therapy, similar to the benefits they might receive from individual therapy. Colleges are wise to start or expand group therapy programs so that more students can participate.

Peer Support

Many students, particularly those who are Black, indigenous, or others of color, can benefit from peer counseling and peer support options on campus. Investing in a program like this requires a generous time investment up front, but fewer students might feel the need to seek individual therapy at the college counseling center if they feel adequately supported through peer-to-peer programs.

Campus Outreach

Many campuses have well-established campus life and wellness offices staffed by compassionate professionals. College counseling centers can partner even more with these important groups to educate students on mental health and stress, focus on prevention, and identify students who might be at risk. Workshops, events, and other resources can help all students learn how to identify symptoms and warning signs and identify new solutions to manage their mental health.

Insurance & Financial Advocacy

If you are a professional who refers students to outside mental health treatment providers, we encourage you to help students identify their most affordable treatment options. If the student is uninsured, help them consider all their options. Can they join a family member’s health insurance plan or find an affordable plan on the exchange? Can they work with certain providers who offer sliding scale fees? It’s important to consider affordable options so that financial concerns do not increase students’ stress levels further.

Online Support Groups

College-age individuals can connect with others in our free support groups led by trained facilitators. Check out our Eating Disorder Support Groups and Mental Health Support Groups for college students and young adults.

Higher Levels of Care

For students at high risk for severe health risks or consequences related to mental health concerns, we encourage colleges to consider whether those students might benefit from higher levels of care, which we explore in greater detail below.

Higher Levels of Mental Health Treatment for College Students

If the majority of college students need help for their mental health concerns, we must review the way that these young people are accessing care. Right now, we can identify at least three problems hindering colleges’ abilities to provide access to quality care for all students.

  • There is a higher need for services due to the current mental health crisis.
  • There are longer waits for services due to staff shortages and the increased need.
  • Outpatient therapy with external providers is costly and not always a viable option.

Even when students can get in with a therapist for help, they tend to get fewer sessions throughout the school year because the demand for services is so high on many campuses. Thankfully, colleges do have other options to consider, including referring students out to higher levels of care.

Consider the following factors when determining if a college student should be referred out to a treatment center for a higher level of care.

  • Risk of harm to self or others (suicidality, self-harm, homicidal or aggressive thoughts or behaviors, impulsivity)
  • Functional status (ability to take care of self, social interactions)
  • Co-occurring issues (substance use, medical or psychiatric conditions)
  • Level of support (emotional support or therapeutic options)
  • Treatment and recovery history

How do you know which level to refer the student to? Here is a rundown of the different levels of care for mood and anxiety treatment and eating disorder treatment.

Levels of Care for Mood & Anxiety Treatment & Eating Disorder Treatment

Inpatient

This level is ideal for individuals that need immediate stabilization and ongoing psychiatric care. However, some students feel as though they don’t necessarily fit into these programs because they believe that their issues are not as severe as other patients’, and consequently their issues may be overlooked. Inpatient care is essential for students who need both medical and psychiatric interventions (particularly important for students with eating disorders).

Residential

For students that are experiencing persistent suicidal ideation and safety concerns, residential programs are often the best fit. At this level of care, students receive 24-hour monitoring and supervision. Medical doctors can address psychiatric stabilization while managing and observing reactions to medications. Typical stays in residential care range from 4 to 6 weeks.

Partial Hospitalization

Once a student can manage their lives well at night, they can step down to a partial hospitalization program (PHP). PHP takes place usually 6 days a week, for most of the day. This level of care is helpful for students struggling with intrusive thoughts related to anxiety, depression, or PTSD. Or perhaps a student needs help managing persistent OCD symptoms. Clinical support throughout the day includes care from psychiatrists and therapists. There are ample opportunities to practice new skills learned in treatment while being able to return home at night. Students that are struggling to make it to class or are self-harming may benefit from the structure provided in PHP or a residential program.

Intensive Outpatient

When students are able to get up and attend classes but still struggle with their mental health, an intensive outpatient program (IOP) may be the right fit. IOP offers a structured treatment day (often a few hours a day) along with groups. This is more intensive than outpatient therapy sessions but the student will be able to stay active in their life outside of treatment. IOP offers support while the student learns and practices new skills. Many treatment centers now offer Virtual IOP, which can be a great fit for students.

We’ve seen students come back from treatment recognizing the benefits of higher levels of care. We’ve seen their gratitude.

How to Tell If a College Student Is in Crisis

We must do everything we can to ensure the safety of each student on campus. If you are unsure if a student needs a higher level of care, or if they are truly in crisis, consider the following questions:

  • Are you seeing any improvement in their symptoms day after day?
  • Are their symptoms worsening?
  • Do you find yourself worrying about the student in the evening or at night? (Do you think they are safe?)
  • Are you so concerned about the student that you don’t want to take a day off because you’re unsure who will cover for you?
  • Is the student consistently using crisis appointments between sessions?
  • Would the student benefit from more care than you can provide or more care than they are currently receiving?
  • How many hours do you spend on this student per week (phone calls, sessions, etc.)?

Along with ensuring your students’ safety, we encourage you to make sure that you are taking care of yourself too.

Support for Mental Health Treatment Providers

As mental health professionals ourselves, we know exactly how much our fellow therapists are struggling. This is emotionally draining work. Here are some ways to take some of the weight off your shoulders if you are feeling overwhelmed.

  1. Talk about it! Even if you tend to keep things bottled up, open up to a trusted member of your team. If you don’t have a group of fellow peer therapists, consider making one. Joining together with a group of peers to create a supportive partnership or group can help you discuss your struggles and frustrations openly. This allows you to feel heard and validated. You can also provide help to others.
  2. Know your boundaries. If you are personally working on a challenging case and feeling overwhelmed, seek supervision or consultation. No one is too experienced to need help on occasion. Likewise, know your limits. If your caseload is too large, find ways to manage it that work for you.
  3. Look for support online. There are various groups on social media and on other sites that can help you find in-person and virtual support for therapists.
  4. Take time off. Really. paid time off is there for a reason, and it can help you manage burnout and let go of all that stress you are carrying.
  5. Make time regularly for self-care. Make this nonnegotiable by scheduling it into your calendar along with your other daily commitments. Remember: you can’t pour from an empty pitcher. Fill your bucket!

By developing new partnerships and accessing community resources, we hope you can identify a new world of solutions that offer you the support you need. We also look forward to seeing how campuses rise to meet the needs of these vulnerable students in this important developmental stage.

This blog was based on our continuing education course, Navigating the Mental Health Crisis on Campus, presented by Casey Tallent, PhD and Jennifer Moran, PsyD.

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[1] Hamza, C. A., Ewing, L., Heath, N. L., & Goldstein, A. L. (2021). When social isolation is nothing new: A longitudinal study on psychological distress during COVID-19 among university students with and without preexisting mental health concerns. Canadian Psychology/Psychologie canadienne, 62(1), 20–30. https://doi.org/10.1037/cap0000255 

Written by

Casey Tallent, PhD

Casey N. Tallent, PhD is the Director of Collegiate & Telebehavioral Health Initiatives for ERC and Pathlight Mood and Anxiety Center. Dr. Tallent co-founded ERC and Pathlight’s virtual IOP…