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September 21, 2020

For colleges, online mental health services are a 'silver lining' of COVID-19 crisis

Digital counseling has become the new norm as students increasingly grapple with anxiety, depression

Mental Health Colleges
COVID-19 Mental Health Services Credit/La Salle University Photography

La Salle University has seen a surge in the number of attended counseling sessions since the coronavirus pandemic shifted its mental health services online. Above, Kate Ward-Gaus, left, La Salle's assistant vice president of student wellness services, and Jessica Brannan, director of the Student Counseling Center.

Francis X. Stanton had no way of knowing the effect the coronavirus pandemic would have on the mental health of college students when he began ironing out the particulars a $1 million gift to La Salle University.

He simply wanted to find a way to provide critical resources to his alma mater and honor his son, Paul, who died of suicide at age 59 in March 2019.

"Paul excelled professionally, academically and athletically, and like many in our country, he suffered from mood swings and challenges to his mental health," Stanton, 91, of Naples, Florida, said in a statement. "The number of students – not just at La Salle, but across the country – who suffer from mental health issues demonstrates the need for the resources that this gift will provide."

The gift, formally announced earlier this month, will allow La Salle to boost its student counseling services by adding another licensed professional counselor, hiring a full-time wellness coordinator and increasing the hours of its consultant psychiatrist.

The timing could not be better.

Various research suggests mental health disorders, particularly anxiety and depression, have sharply risen among young adults since COVID-19 disrupted the college landscape last spring, sending students' educational pursuits and personal lives into a state of flux.

La Salle has felt the impact in a big way. In July, the number of students utilizing its counseling services jumped 240% from the prior year. The number of clinical sessions attended increased by 290%. June saw similar surges.

Much of those increases likely can be attributed to the university offering online counseling sessions for the first time, said Kate Ward-Gaus, assistant vice president of student wellness. But some of the students' presenting issues have shifted to pandemic-related stressors.

"We're getting students who are now in the unsettled mess of decisions changing quickly," Ward-Gaus said. "For the new students who thought, 'We're going to live this college dream,' much like their senior year of high school, now the beginning of their college experience is being disrupted. We're getting some of those issues."

La Salle, like many of the colleges in the Philadelphia area, opted to conduct the fall semester remotely. Its campus is mostly closed, with no clear timeline for reopening. But its student counseling center is operating, albiet virtually.

"We actually did a number of sessions with faculty and staff to say 'We're not closed,'" Ward-Gaus said. "You're teaching classes. We're still providing wellness services."

The public health crisis has forced colleges to rework their mental health services, shifting confidential, face-to-face counseling sessions to secure online platforms and rethinking group therapy sessions. Outreach looks different, too.

'Everything is still there'

Many of those changes were implemented within days of colleges shifting to virtual learning models last spring. Student health staffers recognized face-to-face counseling sessions would no longer be an option. But they still needed to find a way to continue ongoing counseling.

"One of the the ethical guidelines in the field of counseling is to not only do no harm, but to not end abruptly," Ward-Gaus said. "If we had to do old-school phone sessions, we would have done that."

The one thing that still feels so salient, because it's always on the minds of students, is not having to wait to get in. We'll get back to a student within 24 hours and often it's long before 24 hours. – Daniel Dengel, Temple University

La Salle quickly adopted telehealth services, developing a secure platform and ironing out confidentiality requirements. So did many other colleges. And many states, including Pennsylvania, waived regulations restricting the delivery of teletherapy across state lines.

It took time for counselors to adjust to a new modality. Their non-descript counseling settings have been replaced by their personal environments. And students sometimes have to get creative to find a private space to attend their online sessions.

Now, those virtual services comprise the backbone of many college counseling centers.

"I'm glad the technology is here to keep us both safe in the COVID world, but also to offer the same services that we've been able to," said Daniel Dengel, interim director of Temple University's Tuttleman Counseling Services.

Temple briefly brought students back to campus before a COVID-19 outbreak upended the fall semester. Now, the semester is being conducted remotely.

Like La Salle, Temple has seen an increase in its attended counseling appointments since it began offering virtual services in the spring. They were up by 24% in June, 10% in July and 15% in August, Dengel said.

The university has maintained short wait times for new patients, the result of intake changes made just prior to the pandemic's onset.

"The one thing that still feels so salient, because it's always on the minds of students, is not having to wait to get in," Dengel said. "We'll get back to a student within 24 hours, and often it's long before 24 hours. We're still able to see students quickly and help them get a referral to whatever service may be best for their needs."

The center's biggest hurdle was finding ways to continue offering its skills-based therapy groups, designed to help students develop their psychological well-being, and interpersonal support groups, which provide forums for people to process a wide range of experiences, like grief, sexual violence and family difficulties.

Some of the skills-based sessions are now prerecorded, enabling students to view them at their convenience. The support groups moved to a virtual platform. So have additional resiliency workshops.

"Everything is still there, it's just going to be remote," Dengel said.

Anxiety: A pressing concern

At the pandemic's onset, many people hoped the widespread shutdown efforts would squelch the coronavirus within a few months. But normalcy still appears a long way off.

"The uncertainty of that really, really weighs on students and affects their well-being," said Michal Nina Saraf, senior clinical director of the University of Pennsylvania's Counseling and Psychological Services. "People feel isolated. People feel they can't plan for the future. People feel really cut off from their connections.

"They're being invited to behave in ways that, particularly for undergrads, are challenging developmentally – to social distance, to wear masks and be very thoughtful of all. ... I think that can create stress for students who really want to connect and build a community."

The research backs that up.

More than 60% of adults ages 18 to 24 had an anxiety or depressive disorder in June, the highest percentage of any age demographic, according to report released last month by the Centers for Disease Control and Prevention. More than 25% had seriously considered suicide within the previous 30 days.

The findings, while alarming, weren't necessarily surprising.

College students are especially prone to feelings of loneliness. And they already had higher rates of anxiety and depression than the general population. A 2019 report from the American College Health Association found more than 40% of college students felt "so depressed that it was difficult to function."

"When I started here at La Salle in 2006, the more common pressing issues were relationship issues and academic stress," Ward-Gaus said. "But it has transitioned over the course of time to be just more anxiety and depression."

The number of La Salle students diagnosed with anxiety jumped by 9% between 2017 and 2019, Ward-Gaus said, citing the National College Health Assessment. Panic attacks, a subset of anxiety, also increased.

In addition to the students who are struggling to cope with the uncertain nature of the pandemic, others are anxious about loved ones falling seriously ill.

Stanton's gift will allow La Salle to increase its ability to meet their needs through direct care services, but also through skill development.

"Part of our goal is to not only reach out to find and provide services to individuals who have acute mental health concerns or disorders," Ward-Gaus said, "but also to teach resiliency and coping strategies for students who their mental health concerns might not need a counselor, but they do need some self-care."

Reaching out in a virtual world

At La Salle, prior to the COVID-19 pandemic, it wasn't uncommon for a resident assistant or a faculty advisor to walk students over to the Student Counseling Services building. But how do you reach them when college life is completely remote?

La Salle has boosted its digital outreach – "I literally mean advertising," Ward-Gaus said. And Student Counseling Services staffers continue to urge university employees to be on the lookout for students who may need help.

We're looking forward to a time when we can see people in person and have a three-dimensional experience that includes some more casual interactions. But I do wonder whether we will retain an element of this. – Michal Nina Saraf, University of Pennsylvania 

"We have done all these trainings with our faculty to say when you get information, give it to us," Ward-Gaus said. "We will find a way to reach out to that student and get them into Student Services."

Penn has moved all of its CAPS services online, including two of its outreach efforts – Let's Talk and I Care.

"We're trying to create connection and community in the virtual domain through the range of services that we have available, which include individual psychotherapy, group psychotherapy and psycho-education support groups," Saraf said.

The Let's Talk program, launched last fall, is a drop-in service that allows students to discuss whatever is on their minds with a counselor in a casual setting. The program is designed to reach students who are unsure about formal counseling, particularly those who are members of marginalized groups. It also helps Penn identify students who may benefit from additional services.

The I Care program trains students, faculty and staff to recognize people facing distress and intervene in a beneficial way. Penn also has conducted online outreach to help familiarize students with its mental health services. Some of those efforts are specifically designed to reach struggling students in the moment, Saraf said.

"We're functioning in a very dynamic environment," Saraf said "We have a plan, for now, but we're poised to shift. Students have just come back (to class) and we're going to read their needs to figure out if they need something more or something less."

Despite all the juggling the pandemic has prompted, Saraf sees a "silver lining" in the flexibility it has created.

Penn's shift to virtual counseling was "remarkably seamless," she said. Students have indicated they enjoy the ability to chat from their rooms and then quickly move on to their next commitment. Counselors found ways to feel supported and connected. 

"We're looking forward to a time when we can see people in person and have a three-dimensional experience that includes some more casual interactions," Saraf said. "I think everyone is looking forward to that. But I do wonder whether we will retain an element of this."

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