Robert Meenan, MD, MPH, MBA, Christie Campus Health President
Students at America’s colleges and universities are struggling to cope with rising rates of anxiety, depression, and other behavioral health challenges.
Administrators at America’s colleges and universities are struggling to cope with the rising cost of providing mental health services to their students.
Colleges have traditionally viewed the costs of providing student behavioral health services solely as an administrative expense. However, a strong case can be made for viewing student mental health care as an investment that can generate financial returns to the institution.
Investing in Student Behavioral Health Has Long-Term Financial Benefits
Ensuring college students are emotionally healthy, in addition to being well-educated, is a recognized goal throughout higher education, A recent monograph from the American Council of Education entitled “Investing in Student Health” shows how colleges can realize financial benefits from their investments in student mental health services as well. The key insight is that mental health problems, especially depression, are strongly linked with academic performance which in turn is strongly linked to student retention. Every student who drops out of college due to poor academic performance associated with a mental health problem represents a tuition income loss for the college. Conversely, tuition paid by students who remain in school thanks to better mental health care represents a return on investment for the college.
Using a model developed by the Healthy Minds Study, the ACE monograph enables a college to estimate its mental health care return on investment by entering three data points into a spread sheet: enrollment size, retention rate, and per student tuition rate. In addition to estimating retained tuition for the college, it also estimates future earnings increases for the retained students.
An Integrated Solution with Retention in Mind
Christie Campus Health, a student behavioral health and wellness services company, developed a Campus Savings Model that extends this emerging perspective of college mental health care as an institutional investment. The model looks at investment returns in three categories - retained tuition, foregone counselor hires, and reduced health insurance costs – each of which can generate financial benefits.
The retained tuition element of the Campus Savings Model uses the Health Minds Study calculator and the same key data points of enrollment, retention rate and tuition. Retaining freshman is especially important in this model as it produces three additional years of tuition income return.
Christie Campus Health built an additional element of the model that addresses foregone counselor hires. This element recognizes that certain investments in mental health care can reduce the need to hire additional professional staff at a college’s counseling center. Approaches such as internet-based cognitive behavioral therapy (iCBT) and telehealth can substitute for on-site counselor time and can be substantially less expensive, especially when the fully loaded counselor hiring costs of salary, fringe benefits and space are factored in.
The health insurance element of the Christie Campus Health model was built by a very experienced student health insurance consultant. Investments in better campus mental health care that lessen the use of community-based counselors can reduce the number of visits covered by the college’s student health insurance plan. This will in turn improve the plan’s experience rating and reduce the annual premium. Given the high cost of health insurance even modest premium mitigation in the range of 1 to 2% can generate substantial savings, a portion of which will be retained by the college.
Christie Campus Health has run this model for a number of schools, and the projected savings from each of the three elements varies based on the situation at each school. In all cases, however, the savings model makes it clear that investing in better mental health care can generate substantial financial returns for a college - in some cases producing savings that exceed the investment. That represents the always-sought but seldom achieved positive return on investment.
For the foreseeable future college leaders will continue to deal with increasing demands for campus mental health services. As they do so we encourage presidents, provosts and EVPs to move beyond a traditional cost perspective and begin to consider expenditures on student mental health from an investment perspective. Counseling center heads and student health directors should utilize an investment approach when making the case to their superiors for additional funding to support their important efforts.
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 Solution, CONNECT@College offers four integrated components that provide a student behavioral health safety net, as well as 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 can assist them in appropriate areas, helping them to be more effective and efficient in their efforts. We take a public health approach to student behavioral health, focusing on the entire student population in our efforts to increase knowledge, reduce stigma, and address a full range of behavioral health care needs.
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.