Delivering Student Behavioral Health in the COVID-19 Era

Delivering Student Behavioral Health in the COVID-19 Era

Robert Meenan, MD, MPH, MBA
President, Christie Campus Health

The delivery of student behavioral health services, like many aspects of higher education, will undergo substantial change in the COVID19 era.  Just as colleges have had to rapidly shift instruction from the classroom to the online environment, the new realities of the COVID-19 era will require them to shift student behavioral health to new models of service delivery. 

While there are major unknowns in any prediction about the impacts of COVID-19, a number of key factors relevant to the redesign of student behavioral health services are already apparent. Most of these factors have been highlighted recently in the 2019 ACHA student survey results, in a college president survey conducted by Inside Higher Ed, and in a report issued by the Chronicle of Higher Education.

College students will be more distressed than ever before 

The steadily rising rates of anxiety, depression, and other behavioral health issues among college students have been well-documented in recent studies.  This ongoing trend will be exacerbated by COVID-19 and the many disruptions and uncertainties it has introduced into the current and future lives of college students.

Student behavioral health is now the #1 short term priority for a large majority of college presidents  

In the IHE survey, 92% of college presidents indicate that they are very or somewhat concerned about student mental health, moving it to the top of their list of short-term concerns. Coming in fourth on that list at 85% is the related concern of increased student attrition. There is little doubt that behavioral health services have also risen on the list of concerns for college students and their parents. So improving behavioral health services may be a very effective way for colleges to retain accepted and returning students for the 2020-21 academic year.

Money will be tighter 

Despite higher levels of student anxiety and depression, additional funding for counseling centers is unlikely given the serious financial impacts COVID-19 is having on higher education.  More likely will be calls for budget reductions focused on staff salaries and other fixed costs. Center directors may be able to retain or even increase their budgets if they make a convincing case that they will implement fundamentally new approaches for both delivering and financing student behavioral health services. They may also need to seriously consider raising center revenue through behavioral health fees and counseling visit co-pays.

Students will have less access to parental health insurance 

The US unemployment rate has spiked from 2.5% to at least 15% due to COVID-19 induced shutdowns, and it may rise higher as those shutdowns ripple through the economy. Many of the newly unemployed have also lost their health insurance, and so have their college-aged students. Students who retain parental health insurance will have less coverage as employers offer plans with narrower networks and higher out-of-pocket payments. Schools will need to craft a mix of insurance and non-insurance approaches so they can ensure that students will receive the care they need. 

Telehealth and other technologies for delivering behavioral health services are here to stay

The use of telemedicine has exploded in response to social distancing and the higher infection risk of health care facilities. Tele-counseling will quickly become mainstream for both providers and consumers, especially for college students who are both technologically savvy and transportation challenged.  Tele-counseling represents a distinct outsourcing opportunity for colleges looking to deliver more care with a stable or somewhat reduced professional staff.

Better wellness programming is necessary but not sufficient

As the Jed Foundation model makes clear, wellness programming is an essential element of a college’s plan for addressing and improving the mental health of its students. While better wellness programming should help reduce the demand for counseling, it will not improve the access, quality, or cost of a school’s behavioral health services.  Those fundamental dimensions of health services delivery need targeted solutions.

Colleges will need to fundamentally change their approach to delivering behavioral health services

The CHE special report on college behavioral health is titled “Overwhelmed”, and its key quote is: College students are more distressed than ever before. But that’s not the campus mental-health crisis. The crisis is that the traditional model of serving them is broken. Colleges will need to fundamentally alter their current approaches to delivering behavioral health services.  The “classic” model for college counseling involves lengthy intake assessments followed by hourly sessions of one-on-one counseling. This approach is costly to deliver and very costly to scale up in the face of increasing student demand. Colleges must increase their use of short initial visits and focus on immediate problem solving during those visits. Colleges should also consider a stepped care approach and offer a range of treatment alternatives for students with different levels of need. Counseling centers must increasingly steer students to treatment options that do not involve the use of in-house professional staff.

Navigating the COVID-19 era is going to be challenging for every organization. It’s going to be particularly challenging for college counseling centers that need to navigate through a perfect storm of rising demand, restricted funding, and delivery model change. Successful centers will be those that thoughtfully implement comprehensive new approaches to the delivery of student behavioral health services.

About Christie Campus Health

At Christie Campus Health, we are dedicated to improving the behavioral health and wellbeing of college students by helping colleges and universities expand the way they reach and support students in need.  Our CONNECT@College platform offers four integrated components that include a broad range of options for students with varying behavioral health needs.

We believe today's students will respond well to increased options and entry points for assessment and support in ways that are comfortable and empowering for them. We believe counseling centers can be well served by partners that are committed to helping them be more effective and efficient in their efforts. 

About Dr. Robert Meenan 

Dr. Meenan served as Dean at Boston University School of Public Health from 1992 to 2014, and retired from BU in 2016 as Professor of Health Policy and Management in the School of Public Health and Professor of Medicine in the School of Medicine.. He holds a BA in government from Harvard College, an MD from Boston University School of Medicine, an MPH in Health Administration and Planning from the University of California Berkeley and an MBA in Health Care Administration from Boston University School of Management. He was a Robert Wood Johnson Foundation Clinical Scholar at UCSF.  Dr. Meenan serves on the Boards of the Mary Christie Foundation and Massachusetts Blue Cross Blue Shield.

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