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How to Improve Student Access to Mental Health Services

Episode 191

April 9, 2024 28 minutes


EAB’s Ed Venit hosts a conversation with Nathaan Demers from Mantra Health and Joe Cooper from Montana Technical University regarding ways to meet surging student demand for mental health services. The three acknowledge that colleges can’t hire enough licensed clinicians to meet demand, so the conversation focuses on ways to expand the use of telehealth to give students fast access to one-on-one counseling, self-care content, peer-to-peer support, and more. They also share advice for other university leaders who may be looking to expand telehealth services for their students.


0:00:12.8 Speaker 1: Hello and welcome to Office Hours with EAB. Today’s episode explores ways to close the gap between the surging demand for mental health services on college campuses and the scarcity of licensed clinicians. Our guests examine what mental health services typically look like on a college campus today versus a newer model that helps to ease the crunch by expanding access to telehealth services. So give these folks a listen and enjoy.

0:00:45.9 Ed Venit: Hello and welcome to Office Hours with EAB. My name is Ed Venit. I’ve been on the podcast a few times before. I’m a managing director here. I spend a lot of my time researching students success and what happens when students fall short of their goal of reaching a degree? Increasingly that conversation is around mental health, as we have emerged from the pandemic. And indeed, this was a trend beforehand, the numbers are very clearly showing us that the number one reason why students are considering leaving school is, it’s mental health, either our prior diagnosis or just the stress of the college experience. And what’s interesting about this is how that intersects with other parts of it. For instance, academic performance and mental health. You can see the cycle there. You can see the same cycle with finances. So increasingly, schools are realizing, Hey, we got to do something more about this.

0:01:30.9 EV: And we’re not terribly well set up for it quite yet, simply because this hasn’t been a area of focus for the larger student success community up until now. The numbers are pretty sobering. We’ve seen a doubling in diagnoses around anxiety and depression since 2013 to 2023. We’ve also seen a doubling in the use of therapy. You can see these patterns in all sorts of stats around, young people’s mental health, and they are increasingly aware of their own mental health and demanding more services from the institutions they get involved in, which is you, their colleges. So what are we gonna do about this? Because, there’s clearly an issue here where we’re going to need to help students along this regard and help them through to graduation. We’re gonna have to spin up some, services and programs pretty quickly, or expand what we have. So in that light, I have two guests with me today, that I’d like to have introduce themselves, both of whom are experts in student mental health. Our first is Dr. Joe Cooper. He’s from Montana Tech, and I’ll let him introduce himself right now.

0:02:35.0 Joe Cooper: Thanks, Ed. So grateful to be here today to talk about this important topic. I’ve been working in higher education as a practitioner and administrator for nearly 20 years now. I have the unique vantage point that I’ve worked in both enrollment management and in student affairs. And so what that means is, I’ve really gotten a chance to see students a lot before they start at college and during their journey through college as well. I’ve worked at both public and private institutions. In terms of my interest in this, it is just so relevant. You cannot have a conversation about student success, about recruiting students, about retaining students. You cannot have that conversation without including and addressing student mental health. Just like you just mentioned, more and more of this are things that we’re seeing and that we need to be prepared for, to address and support our students. It is more relevant now, more than ever, given the disruptions that our incoming students have seen during their K-12 experiences, and I would say the overall trauma that this generation has experienced and likely will continue to experience as well. So, very important topic, and again, glad to be here to talk about it.

0:03:42.1 EV: Thanks, Joe. Our second guest today comes from an organization called Mantra Health, where he sits at the interesting intersection between Psychology, health administration, and technology. This is Nathaan Demers. I’ll let him introduce himself right now.

0:03:58.6 Nathaan Demers: Awesome. Thank you, Ed, and really great to be here with you both. So, my name’s Dr. Nathaan Demers. I’m a clinical psychologist. A quick bit of how I got here. I started my career working in college counseling, then joined the nonprofit sector, supporting states and universities with the Western Interstate Commission for Higher Education. And then for the last eight years, I’ve actually been working specifically at the intersection of behavioral health technology and higher education, which brings me to what I do at Mantra Health. So here I am the Director of strategic partnerships, and we implemented Mantra Health end-to-end mental health solutions on campus to be able to address a lot of the needs that you’ve been alluding to Ed, and we’ll get into what that looks like in just a little bit.

0:04:41.6 EV: Yeah, that’s right. Nathaan and I have gotten to really know each other over the last few months, getting to talk a lot about stepped care models and the different ways that Mantra is helping schools. And as he alluded to, we’ll be discussing just a moment, a little bit of our collaboration. If you were at Connected our student success conference, you may have met him or seen his presentation, so really impressive stuff. We’re gonna dive right into the collaboration in a few minutes, but I wanna start with asking Joe a few more questions. Joe, what do mental health services typically look like on a college campus today? I think would be good to get, some grounding in that, especially for folks who are not as deep in it as you are. So not really just your campus specifically, but feel free to use examples. But what is the typical college student likely to encounter, generally speaking, when they want to go talk about their problems?

0:05:29.1 JC: Sure. Of course, most college campuses are gonna promote or boast that they have counseling services. It’s gonna look like something different on every campus. But most campuses are gonna say, Yes, we have counseling, we have therapy. And when they advertise that, that means that, they’re gonna have, one, clinician, clinical counselor, or maybe multiple, maybe a counseling center with multiple licensed clinicians. The reality of that though is what does that actually translate to? And the reality that we’re seeing today, and of course, this isn’t something that is gonna come out in the marketing and things like that, but with the challenges we’re facing, what really is happening on college campuses is that we’re going to encounter vacant positions in those clinician positions, long wait times to be seen and also just limitations on options, which ultimately, makes it question, how inclusive and accessible are these services actually for students?

0:06:26.3 JC: And so, I think you might have referenced before, Ed, that some of our students may have already been connected with services prior to college. Some, many have not. And so it can be a big barrier just to reach that decision to say, you know what? I’m going to go see someone. [laughter] And then what happens when you go, you get in there and then realize, shoot, I can’t see a clinician for one, two, six weeks given wait times. Or there’s only one clinician at my campus and I don’t have anything in common with them. They don’t identify with any of my identities. And so that too can create another major barrier, that stops students from receiving services that could make or break their ability to stay in college.

0:07:11.3 EV: Nathaan, I’d like you to double click on that a little bit and expand out, from your awareness. I know having seen you present many times that this is a key issue for you, that access to mental health services. From your perspective, what are some of the reasons why you see that, that students are having a hard time accessing these services? And, also, how has this demand changed in your world?

0:07:33.1 ND: Yeah, as you know, we could do a full hour and a half workshop on this, so I’ll try and do my best to be concise. But first, Ed, you did a really good job setting up the challenge that we’re confronted with here in that the reality is 60% of students have a diagnosable behavioral health condition, which is a 50% increase in the last decade. And furthermore, we know these challenges are drastically bleeding over into the academic world with over 75% of students saying that their mental health is negatively impacting their academic performance in the past four weeks. So, again, that speaks to the changes in demand, whether we like it or not, mental health is surfacing in nearly every department on campus, whether I work in housing, athletics, advising or anything in between. But to jump over to the topic around barriers, this, again, is very much multifaceted as with anything related to human behavior, but without being too much of a nerd.

0:08:29.4 ND: One thing I relay it back to is this idea of what I call psychoeducation. So mental health literacy. So we know that this younger generation is much more tied in with their mental health generally than previous. So to use a physical health analogy. Right now, if a student breaks their leg, most students know I should probably go to the doctor. On the other hand, if they have a hangnail, they know like, you know what? I can probably handle this one on my own. But when it comes to mental health, on either end of those spectrums, a lot of times when a student is away from home for the first time, they’re having difficulty sleeping, they’re not engaged and enjoying things that they used to, they’re feeling withdrawn. A lot of times students don’t know that those are symptoms of depression and that that’s actually a very treatable condition.

0:09:15.7 ND: And then on the other side, we also have students who are also feeling homesick, a little bit stressed out by academics. Maybe they haven’t found their friend group, they’re having a conflict with their roommate, then they go and WebMD themselves and they diagnose themselves with X, Y, or Z mental health conditions saying, I need a therapist. So one of the jobs right now in my opinion is helping students understand what is mental health and what is mental wellness and what is it not? When should I be reaching out for support and to what level of care? And then the last piece, oh, sorry. The last piece I’ll mention and Joe, please feel free to elaborate if you agree, but stigma is on the decline. But we also know that stigma remains a challenge for many, especially diverse groups on campus.

0:10:01.3 EV: Joe, I’d love to hear a little bit more from the ground, on the ground working with, obviously don’t reveal any names, but working with actual students at Montana Tech, could you elaborate a little bit on what Nathaan was saying, in real life, what does this look like for folks who maybe aren’t working in counseling centers or aren’t as close to this problem, but maybe their faculty or other kinds of administrators from other parts of the campus. We’re gonna have a lot of those folks listening to this pod. So what would you like them to know about how you see students in real life?

0:10:33.3 JC: Yeah, what Nathaan said about mental health literacy is key. That is a foundation that we really have to build, but not but, but and as you build mental health literacy, ideally your services should be being built up as well. Because if we’re succeeding at building mental health literacy, ideally that means more students getting connected to services. And so then mental health literacy. As we build that up with our students, ideally we’re trying to build that up with our faculty, our staff, our key partners and stakeholders. And so, no, it shouldn’t just have to be me as, a dean of students office representative or a resident assistant. Ideally, we should be able to have faculty, staff, other folks that interact with, engage with the students in other areas. The problem then that many campuses and ours too can run into is what happens then when, they do that, they refer them, or even literally physically walk them to the counseling office and then we’re not at a place where we can immediately serve them due to capacity due to those barriers.

0:11:39.2 JC: And so that I think is something that not only where I’m at at Montana Tech, but also many colleges and universities across the nation are seeing right now. The stigma is real. Nathaan mentioned that I believe the stigma is still very much a real thing that we have to work through. Ultimately, we can have all the best in marketing in the world. We can make promo materials that are sexy, for lack of a better word. Counseling is cool, counseling is sexy. But if we can’t actually get students there, students are going to doubt the system. Students can’t be seen. They’re gonna doubt this system and we may lose them for good after that. Because if you’re someone that has anxiety or condition, you know that it might have been, enough as it was just to get you to that point to consider and say, I’m actually gonna go do this, then you face a barrier, we might lose them for good. And so that is something that’s a genuine concern for us.

0:12:36.3 EV: Nathaan, I’d love to circle back to the accessibility issue from Mantra’s perspective here, because this is a huge part of what you do, is to bridge some of those gaps that Joe was talking about. So explain to me like I’m five years old here. Why at times is it so hard for students to make an appointment? I think we’ve all, including myself, have experienced the challenge of finding a provider and getting in with them. So I can only imagine the experience for students must be, just as much fun, so to speak. [laughter]

0:13:08.0 ND: Yeah, absolutely, and I’d love to take this a little bit, from a sidebird’s lens before diving into that. But one thing I’d like to think about and conceptualize is that the therapeutic window, what I mean by that is the time that a student is willing to say yes, I need therapy, is often very small. Think of students, they’re, away from home for the first time, they’re building this independence. And it’s not awesome to say, I’m not doing well. I’m not where I wanna be. I need support. So if I’m a student and let’s just say I failed a test, right then and there. If they’re ready to seek therapy, if they can’t find that quickly and easily, or they’re worried about a four week wait list, they might just not try. And that goes back to what Joe was mentioning is if we miss them in those moments, we might ultimately never be able to serve them.

0:13:55.3 ND: And to contextualize with some data, we know that 50% of students who stop out due to a behavioral health condition have actually never used services for that condition from their campus. So that comes down to an awareness issue of how do we make sure that we are embedding these mental health supports across the campus? And that’s one of the things I’m most excited about with working with you in EAB, Ed, is when it comes to navigate and student success, we know that whether students like it or not, they are in their LMS, they are being pinged by their CRM weekly. And I think the stat is over 90% of students are in the LMS on a weekly basis. With that, if we can have mental health front and center and change the narrative to not only say, Hey, you are on campus to thrive academically, but you’re also here to thrive with your mental and physical wellbeing. And then we populate it there.

0:14:45.8 ND: So one way to mitigate a lot of the challenges that we’re experiencing on campus is through the implementation of stepped care models. So to translate that into English, what stepped care models are are a intervention that offers a variety of mental health solutions within one door, if you will. So what I mean by that is, sometimes students they know something’s not going well, but they’re not quite ready to reach out to therapy for whatever reason. Whether that’s stigma or just feeling like that’s a little bit too far for them. So within our stepped care model, which we call Whole Campus Care, we have multiple interventions. So we have self-care modules, which are again, psychoeducation modules that help students learn about how to cope with everyday stress, how to be effective in interpersonal relationships, effective communication. And those are confidential.

0:15:36.6 ND: They’re anonymous. Students can complete them in five to seven minutes on their own time without anyone ever knowing which might feel more comfortable to a student who hasn’t been exposed to therapy. But then we also offer services in the here and now. So if I’m a student and I’m in a crisis and I want to connect with a clinician ’cause I just failed a test, worried about losing my scholarship, I can within 10 minutes get on a call with a licensed clinician to talk about that challenge. And going back to what Joe was mentioning, that’s nearly impossible. If you have one clinician on campus, it, it can’t be done if they’re in the middle of a session. With that therapeutic window being very small, this is can be an amazing way to catch students who might not reach out and end up either just stopping out unknowingly or surface in Joe’s office, quite frankly, in some sort of subsequent crisis.

0:16:23.9 ND: And then we also offer, of course, telehealth services. And the reason this is so important as an and not a but. Joe, I really like your emphasis on that, is that we can offer after hours services, for example. Most college counseling centers work 9:00 to 5:00. When we talk about non-traditional students, students who are caring for aging parents, kids working jobs, sometimes 9:00 to 5:00 doesn’t work or getting back to campus is just too difficult. So with that, we can offer after hours and weekend appointments, which can really increase the likelihood that students can actually schedule and get to those appointments with a provider who ideally matches their identities.

0:17:04.2 ND: And one other piece that can be really helpful, as you may or may not know, clinicians are bound by their licensure to practice within the state that they are in. So let’s say I’m at Montana Tech, but I actually am from Wyoming and I’m going back to visit my family. All of a sudden I can’t see my therapist who’s only licensed in Montana. So with that we have 50 state coverage, which can go a really long way in supporting that continuity of care for students.

0:17:31.9 EV: A really, really important point, especially in this world of hybrid learning where the scenario you described is not one that would be uncommon at all. We’ll have students moving around all over the place. I’ve been really interested in stepped care myself since I started learning about it. I’m obviously not a mental health professional, I’m a paleontologist, but what I’ve learned about it is it’s very similar to a concept that many of our navigating Starfish members will be… Our partners will be familiar with, which is population health management, something we borrowed from the healthcare industry. And the idea, if you’re familiar with this, listeners, is that you have broad-based, relatively low intensity support capped off with, in sort of acute intense support, but very, very small number of students. It’s a way to deploy your resources more efficiently. So if you’re already familiar with that, step care is gonna be a breeze, at least for understanding it.

0:18:20.9 EV: Implementing it is a different story. That’s where you might need help from somebody like Mantra. When EAB was exploring this, one of the things we realized, one of our big insights was that some of the base of stepped care, if you will, the mass communication stuff, where you’re messaging to students or collecting information, we already had a lot of those tools in place. That’s a lot of the CRM like capabilities that are in Navigate 360 and Starfish. What’s really nice about that for our schools was it was an opportunity for quick wins. So if you already have the tech in place, you can within a matter of days, have a messaging strategy up and running. It won’t solve your entire mental health challenge of course, but it’s better than nothing and it’s something you could do right away. So this is where the intersection of R3 worlds is super interesting where we have a technological platform that can get out to students. We’ve got the content from Mantra that we want to get to them, and the additional support and capacity to be able to deal with all that student interest that might be coming in which will really help out Joe and any of the other folks who are on campuses, actually address some of these gaps that we’ve been talking about here. Joe, I know you talked about improving both the inclusivity and accessibility of mental health supports. Tell us what you mean by this and why both are so important for student success.

0:19:36.3 JC: Yeah, so, our students that are coming to our colleges, they are smart, they have expectations and this is where there can be a disconnect between that marketing and the reality. And so when we say, yes, we have a counselor. Yes, we have counseling services, their next question or thought may be, Okay, but what does that actually mean? If you just have one person. Do you have somebody that doesn’t identify with me at all? Campuses are incredibly diverse environments. Our students, that are coming to our campuses have so many different diverse and intersecting identities and they all have different lived experiences. You think about, population on a college campuses, you might have graduate and undergraduate students. International students from all over parts of the world, and talk about different stigmas that come with that as well for mental health services, students of all ages, students that may be parents themselves, BIPOC students, LGBTQ+ students, students with different religious beliefs, student veterans, we could go on and on.

0:20:38.8 JC: And Nathaan I’m sure is well aware of this too with the work that Mantra does. And this is certainly a challenge for us. Because how, when I’m at Montana Tech and I have one clinician here who is an amazing clinician, how does that person effectively connect with and identify with all these different students of all different identities, all different lived experiences? And so I think that’s a challenge that campuses really have to start addressing if they’re not already. Because students are gonna ask, do I identify with this counselor? Do I feel comfortable with this counselor? And if they don’t guess what? They are not going to continue or seek those services there. This is one of the reasons, for instance, at Montana Tech, why we have partnered with Mantra Health just because we can then authentically say, Yes, we have this one campus based clinician and it’s not a but, and we have a network nationally of, an incredibly diverse list of clinicians. And that goes a long way with students knowing that chances are they’re gonna find someone that they feel good about and can connect with.

0:21:45.9 EV: Gentlemen, we’re running a little bit short here, so I want to just cut to the chase and do a quick lightning round on the way outta here, and get both of your perspectives. I’ve got some questions. As I think a lot about the future. What do you hope, the future holds for improving student mental health services? So where is this all going? Where do you see the advancements and what are you excited about going there? How do we get there? And what do you want other higher education leaders to understand about what it will take to meet student needs on their campus? So Joe, let’s start with you and come back to Nathaan.

0:22:13.9 JC: Yeah. So, look, the need for support and services in this realm is only gonna grow probably exponentially. It is happening and the generation I mentioned before, as all of us have mentioned have been through some heavy stuff and they’ll continue to go through some heavy stuff. There was just a report the other day that came out, that talked about, okay, gosh, or those looking to buy a home in this economy right now, they say you have to make X number of dollars a year in order to comfortably and be able to afford a home. Okay. How many of our graduates right out of college are making, six figures or that number that they gave? That’s scary stuff. And that’s something that even though they’re not dealing with it right now, our college students have one more thing on their plate to worry about.

0:23:01.3 JC: And so, adds extra anxiety and that level of nervousness and so the models of the past and that the models that many colleges are still using those alone are not gonna work. And I say those alone very intentionally. They’re not bad models, they’re not bad services, but we have to supplement those. We have to figure out ways to do more and to leverage technology and resources like we’ve been able to do with Mantra at Montana Tech and it’s about using the external tools. I think, like you were saying before, Ed, in a lot of cases the infrastructure is already there with the technology, the messaging, we literally just have to plug it in. It’s simple as that. Students expect individualized services. That’s only gonna continue. Gen Z expects that. They want a custom individualized experience.

0:23:51.6 JC: And if I have one clinician here, I can’t provide that. And so what works for one student may not work for another. And I really do like that concept of stepped care. I look at it almost as a highway model in terms of what are your on-ramps and off-ramps. Because the student may need therapy at one point, maybe then they just need some self-care or some self-paced modules for wellness, for coaching, things like that. And so how flexible can we be. In any case, we have to also find ways to support our existing clinicians and leveraging these resources can also be a retention tool for us to keep those clinicians as well. And that’s something I’m very drawn to.

0:24:33.8 EV: Nathaan, I’d love to hear your final thoughts here.

0:24:36.6 ND: Yeah. Just to build off your perspective, Joe, as a campus with one counselor, I wanna paint a picture of a different scenario. I’ve also worked with many large state universities and one of them in particular had a staff of 30 counselors. This need kept going up, they kept increasing their size over the course of five years. They doubled the size of their counseling center up to 60. They’re right back on a wait list with all the challenges that they have. And why I bring that up is just hiring our way out of this does not seem to be an option. What we need to be doing is thinking more holistically. Student mental health is no longer just the job of the counseling center. We need to make sure that we are embedding it cross departmentally and making sure that we’re getting streamlined referrals from folks like yourself, Joe, from academic advisors and athletics and faculty and staff.

0:25:26.0 ND: So they can have referral mechanisms to students, whether that be self-care. ‘Cause the student’s just feeling like they need some support with time management or something more significant like they’re living with a diagnosable behavioral health condition. And where I think the future can and should go. I’m very happy to be talking with three people who I feel like we’re living it right now. Again, Mantra Health, we’re offering clinical services, Ed, at EAB, you’re offering a student success CRM, Joe, you’re campus who’s utilized both. And I’m really proud to toot your own horn for you that you are actually our first campus where we’ve been able to implement that integration. And it’s been incredible to be getting upstream to some students who might not reach out for therapy but are engaging with self-care, who are exploring other opportunities to get ahead of their mental health rather than waiting till things are so bad that they have to reach out to a clinician.

0:26:22.8 EV: Thanks fellas. I really appreciate the perspective and all your thoughts here. I’d like to close out with just some of my own reflections on this being the most newcomer, if you will, to this space. But also something that I care deeply about having been a consumer of mental health services over the last couple years myself and it’s dramatically improved my life. So really, really excited about the idea that we could be doing more for students here. I’ve been talking about mental health now for about two years and, something has definitely changed in the last six months in these conversations about… Prior to that it would’ve been, hey, we don’t know what to do about this. We’re not a mental health clinic. This is not our core competency. And it was a sort of a continuation of the pre-pandemic trend of maybe if I just ignore it, this could go away. Or isn’t this just the job of the counseling center and I’m a president, I don’t need to worry about that.

0:27:09.4 EV: The tone has shifted. I’ve been doing events recently where folks are proactively asking questions about mental health services. There’s no longer a need to convince them that this is a challenge. It’s there and folks know it. And they’re increasingly looking to organizations like Mantra for outside support. I heard about that just yesterday in a conversation. And it was really encouraging. So there’s a lot of movement here. If you are a listener and you’re on the precipice here, get moving. This is going to be a very important part of your student success strategy going forward, figuring out how are we going to approach this challenge. And you don’t really want to get left behind because looking to the future, what I’m seeing here is possibly this is actually a recruitment tool.

0:27:49.7 EV: And if you can frame your campus as, Hey, this is a wellness campus, you’re gonna come here and we’re gonna take care of you. Well, that’s gonna be really appealing to some students, both from a perspective standpoint and also keeping them in place. Just knowing that you care about their wellbeing. It makes a big difference. So folks, who are listening, I would really love to hear more about all of your stories and journeys that you’re having along the mental health front. Please reach out if you’ve got something that you’d like to share. We’re gathering information as we go, and I hope that today was really valuable and you learned a bit from our two excellent guests that we have here. So thank you very much once again Joe and Nathaan really appreciate it. And have a great day.


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