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Eric Wood, Ph.D., L.P.C. is the Director of Counseling and Mental Health at Texas Christian University, and the author of A New Narrative for College Mental Health. Along with his colleagues at TCU’s counseling center, Dr. Wood has worked to design a comprehensive Collaborative Care model addressing the unique circumstances of serving students with differing needs within college communities. He shared more about his work in a conversation with Cait Scafati at the Within Summit event, “Using a Collaborative Care Model for the Treatment of Eating Disorders on College Campuses.”
The trauma of the pandemic has definitely contributed to the increased need for mental health services. Additionally, as talking about mental health has become more normalized, people have become more likely to realize they need mental health care, and more likely to seek it out.
If [students] come to the counseling center and we have nothing to offer, that’s frustrating. We can talk about mental health, but we also need to have the services.
Starting college and graduating from college are two of the few points in the typical developmental lifespan where everything can change all at once. College also introduces stressors like school work, new social dynamics, and more high-risk behavior. Most college counseling centers were designed to help students cope with these changes, not to treat high mental health needs.
But, dynamics on campus have changed. Improving treatments have made it possible for more people with pre-existing mental health needs to attend college. There are also students with emerging conditions. Many of these students want long term therapy, but our model wasn’t designed for them.
My school has 12,000 students. The administration might ask us to hire enough counselors to provide every student weekly therapy—that’s 461 therapists. No school wants to hire 461 therapists, nor can they afford to. They’re more likely to end up with far fewer new therapists, enough to raise expectations, but not enough to shift the situation on campus.
The second issue is scope of care. If my scope is developmental issues, and someone has a high mental health need, it doesn’t matter if I have five therapists or 500 therapists, I won’t be able to meet that need.
The most significant barriers are overwhelmed systems and a lack of support for students with high mental health needs.
The average wait time to see a counselor can be four to six weeks. That’s actually better than in the general community, but it’s still a long wait, especially for students in crisis. Most campuses don’t have a dedicated triage for crises, so student crises create a backlog.
Students are frustrated because they can’t access appropriate care, and the counseling center is frustrated because there’s no room to care for them. For example, eating disorder rates have increased since the pandemic, but many campuses don’t have effective treatment models in place. Students get caught in a cycle of visiting the counseling center and not getting the treatment they need, or if they do get helpful treatment it goes away as they go into remission, and their issues recur.
We shifted our model to care for high needs students. It sounds simple, but it’s a complete 180 in terms of how colleges traditionally think. What we came up with is our comprehensive collaborative care model, based on four objectives.
Our first objective is collaboration with community treatment partners. We reached out to a nearby treatment center and offered our facilities, and we offered students stipends to cover the insurance copay for attending their programs (which was still a lot cheaper than a hiring blitz). The treatment center expands their program with no overhead, and we can offer a high-needs service on campus. We have around six of these programs, and it doesn’t cost the university anything. We also work with community partners closer to home, by taking advantage of the school’s existing infrastructure for things like homesickness, so students have somewhere to go other than the counseling center.
Our second objective is creating peer support communities. Students are more likely to attend these groups than counseling, and participating makes them less likely to come back to counseling, which helps capacity. They’re more available for one another than we can be, and the universality of their experiences means they understand and comfort each other in ways staff can’t.
Our third objective is establishing a dedicated triage and crisis team, made up of therapists who don’t have a regular caseload and are available for students in crisis.
Our final objective is increasing the focus on creating aftercare resources to follow clinical counseling, instead of stopping care cold once a client is in remission. Most people spend more time in aftercare than they do clinical counseling, and it should be a time of continued recovery and peer support.
The bridge between higher education and community providers is vital, because if you talk about the mental health epidemic in America, where would you start? I would start with college students, because it's a vital demographic and we have access to these young people at a crucial moment in their lives, when a lot of [issues] emerge. We can help get them care during this pivotal time, and by offering resources to these providers, help expand their ability to offer care to the community as a whole.