Welcome to our new section, Thrive on Campus. Alarming new data is making it increasingly clear that college students are struggling with mental well-being. In this multi-part series, Thrive brings you in-depth reporting into the reasons behind the college mental health crisis, unvarnished truths from students, faculty and experts about what needs to change, and science-backed strategies to boost students’ well-being. We will be adding new pieces on an ongoing basis, and if you are a college student, grad, or expert with a perspective to share, we invite you to contribute (please tag your pieces ThriveOnCampus.) Read more here.
There is a well-documented national story around the challenges facing counseling centers on university campuses. The themes are all similar: increasing demand for care, long wait times for students to be seen, and greater complexity of needs. Counseling centers across the country, including Counseling & Psychological Services (CAPS) at Brown University, have been working to find ways to adapt to this shifting landscape.
Most university counseling centers have used the traditional model of service delivery at some point in time. This includes students calling for a counseling appointment and waiting a few days or weeks, going through a formal intake interview, and then having follow up counseling appointments until the process reaches a conclusion, or they are referred to community providers. Many schools are still rooted in this model, but some important evolution has occurred. In the early 2000s, a trend toward a triage model of care emerged from the University of Massachusetts - Amherst, where a step was added before the intake that included a brief phone call or face-to-face meeting to assess student needs. Other innovations away from those models included Central Washington University requiring group workshops that teach self-care skills before doing individual counseling (Pathways/RIO), and Memorial University in Canada developing a wide range of options for care, including apps to match student needs (Stepped Care 2.0).
When I arrived at Brown as the director in March 2017 from the University of Portland, CAPS had just begun a change from a traditional counseling center model with a 7 session limit that had existed at the school since the late 80s, to a triage model without a limit. The larger situation included a quarter of all students seeking mental health care (significantly above average nationally, but similar to other schools like ours), a diverse and open-minded staff, an administration that wanted to get mental health right, and a group of creative and motivated student activists. I soon realized that this was the formula to have a successful reimaging of what mental health care looks like on a college campus.
My first few months were spent learning more about the opportunities we had, what students wanted, and thinking out of the box about our service; everything was on the table. Some really novel ideas emerged in the dialog between staff and students, and that summer, we launched a massive set of changes, specific to our campus, that have worked beyond any of our expectations.
The highlights include hiring a dedicated "urgent care clinician" to see students in the most need that ended our rotating and time consuming crisis coverage, replacing our traditional 50-minute intake interview focused on assessment with a 30-minute consultation session that was completely focused on helping the student manage their immediate concerns, offering a large number of sessions booked the same day throughout the year including full weeks at the start and end of the semester, working with Health Services on campus to expand psychiatric medication prescribing and management, and doing regular check-ins with student mental health leaders on how we were doing.
Those shifts and a batch of others took our average wait time for a first appointment from 14 days to 3.5 days, doubled the number of students we saw in the busiest weeks of school from the previous year, reduced the number of students referred off campus and number of crisis appointments needed, improved staff wellness, and significantly changed the feeling students had toward our office.
Each piece of the situation I walked into was essential in this success. First, our staff was up for experimenting with the clinical model in a way that many other providers struggle with, and is a hidden issue on why many centers have difficulty pivoting to address the modern challenges on their campus. Second, all of the senior leadership above us were genuinely committed to improving mental health on campus and our success. They brought new resources our way and trusted us to make the changes we needed to make, even if some of them sounded unusual. Finally, and most importantly, we had a very creative group of student leaders, many of them part of an organization called Project LETS, that were willing to collaborate and partner with us. This benefited students beyond what either of us could have ever done alone.
We certainly aren't done. Ultimately I think we are on the path of creating an urgent care model of mental health on campus. The principles of this include offering a large number of same-day sessions and as-needed follow up appointments, focusing on meeting immediate needs instead of unpacking broad historical experiences, utilizing partnerships with other resources in the community and trusting them to do a great job, and working as a multidisciplinary team to manage chronic conditions, which allows students with the greatest challenges to fully engage in the academic and social opportunities on campus, stay in school, and graduate.
The big takeaway from my experience is that if we actually listen to what students want, and have the courage and support to deliver it, even if it’s risky, that incredible change can happen very quickly.
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