COVID-19 and Behavioral Health Equity

COVID-19 and Behavioral Health Equity

Robert Meenan
Christie Campus Health

The COVID-19 pandemic has highlighted the deep inequities in US society. The risks of contracting and dying from the virus are much higher among people of lower means who generally do not have the same options as wealthier people for working from home and maintaining social distancing.  COVID-19 has further increased the strong negative impact of social determinants of health such as race, color, housing status, and neighborhood density.

In addition to causing over 100,000 deaths, COVID-19 will have major negative effects on the behavioral health of the US population that are similar to the deep and lasting effects that have been found in survivors of major national disasters. The behavioral health damage from COVID-19 comes from multiple sources, including deaths among family and friends, job and income losses, and fears of contagion.

The prevalence of behavioral health problems among college students has been rising steadily in recent years, and the arrival of COVID-19 has greatly amplified that trend. College students from less advantaged strata of society are especially vulnerable to the behavioral health impacts of the COVID-19 pandemic.  In addition to having greater risk based on their social determinants of health, they have to deal with other major challenges. They are often the first members of their family to attend college, and they thus bear the twin burden of high expectations from parents who have no ability to offer guidance based on their own educational experiences. Less advantaged students also have to deal with the many challenges that COVID-19 poses for all college students, including disruption of their friendships, their educational pathway, their living situation, and their financial plans. Dealing with the sheer scope of these disruptions is a challenge for all college students, but it is an especially daunting challenge for less advantaged students.

Much of the research on the behavioral health of less advantaged students has focused on students of color.  Findings indicate that students of color are more likely to experience anxiety and depression and less likely to access services than their white peers. Thus the vicious cycle of social determinants and worse health plays out at the individual as well as the group level.  The Steve Fund, a widely recognized thought-leadership and program design organization that focuses on the behavioral health needs of  students of color, has partnered with the JED Foundation, another national leader in young adult mental health, to develop The Equity in Mental Health Framework. The framework provides recommendations to colleges and universities on how to support the behavioral health need of students of color. Among the recommendations are: offer a range of supportive programs and services, promote campus awareness of behavioral health problems and programs, emphasize cultural relevancy, and engage a diverse staff.  These principles apply in varying degrees to students from other less advantaged groups.

The COVID-19 pandemic has made it starkly clear that there is another fundamental inequality that underlies the US health and behavioral health systems: money.  Less advantaged students have far fewer dollars to spend than students from higher social strata, and they and their families have significantly less wealth to fall back on in trying times. For these students, copays and other costs are a major barrier to accessing behavioral health services. Efforts to address inequity in college behavioral health must therefore address the issue of financial inequality by limiting or eliminating service costs for students.

Christie Campus Health is focused on increasing the benefits and lowering the costs of behavioral health services for college students. Our CONNECT@College platform addresses a number of the recommendations in the Steve Fund/Jed Foundation equity framework. It offers multiple options and modalities of behavioral health support that students can move between to best meet their mental health needs. CONNECT offers two online support resources - an online cognitive behavioral training course and tele-counseling – that provide alternatives for those who find that in-person sessions with a therapist are not the right fit. CONNECT’s broad in-person and tele-counseling networks also provide students with access to a more diverse group of practitioners and this enables students to develop trusting therapeutic relationships based on mutual understanding.

CONNECT also addresses the critical issue of financial inequity by reducing what it costs students to obtain behavioral health services. Students can receive five free sessions of counseling in the form of online CBT, tele-counseling sessions, and/or in-person visits. We strive to link students up with a counseling option that will be covered by the student’s health insurance plan following the initial five visits. These approaches greatly facilitate counseling entry and retention for less advantaged students, many of whom are seeking behavioral health services for the very first time.

COVID-19 has exposed and magnified the inequities in our behavioral health system at both the national and individual school levels.  It has also created an opportunity to mitigate the impact of the social determinants that underlie these inequities. Christie Campus Health is committed to working with colleges to address inequity as a key aspect of improving student behavioral health services, with the ultimate aim of fostering academic achievement. Particularly for less advantaged students.

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