Abstract
Purpose of Review
To review and synthesize the previous, current, and proposed models of care in college mental health in order to identify best practices that will address the mental health needs of today’s students. To highlight data that supports existing or proposed models and describe areas where more data is needed.
Recent Findings
Despite the potentially appealing attributes of integrated care, empirical evidence supporting these systems and structures in campus settings is mixed. Recent surveys show less than half of campuses have an integrated mental health care model. Overall, there is only partial consensus on optimal models of campus mental health care.
Summary
Mental health needs in college student populations are greater and more complex than ever. While the resources available are vast and varied, there is limited evidence to support which models and programs can best meet students’ needs.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Hussar WJ, Bailey TM. Projections of Education Statistics to 2022 (NCES 2014-051). U.S. Department of Education, National Center for Education Statistics. Washington, DC: U.S. Government Printing Office; 2013.
Choy, S. Access and persistence: findings from 10 years of longitudinal research on students. Educational Resources Information Center (ERIC) Digest. Washington, DC: American Council on Education, 2002.
Raghavan R. Improving the identification of mental health need on college campuses. J Adolesc Health. 2014;55:598–9. https://doi.org/10.1016/j.jadohealth.2014.08.007.
Blanco C, Okuda M, Wright C, Hasin DS, Grant BF, Liu SM, et al. Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions. Arch Gen Psychiatry. 2008;65:1429–37. https://doi.org/10.1001/archpsyc.65.12.1429.
Eisenberg D, Hunt J, Speer N, Zivin K. Mental health service utilization among college students in the United States. J Nerv Ment Disord. 2011;199:301–8. https://doi.org/10.1097/NMD.0b013e3182175123.
• Turner JC, Keller A. College health surveillance network: epidemiology and health care utilization of college students at US 4-year universities. J Am Coll Heal. 2015;63:530–8. https://doi.org/10.1080/07448481.2015.1055567. Data from over 800,000 college students show trends in utilization and the importance of primary can behavioral health care services on campuses.
Perou R, Bitsko RH, Blumberg SJ, et al. Mental health surveillance among children—United States, 2005-2011. Morb Mortal Wkly Rep (MMWR) Surveill Summ. 2013;62(2):1–35.
• Olfson M, Blanco C, Wang S, Laje G, Correll CU. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. 2014;71:81–90. https://doi.org/10.1001/jamapsychiatry.2013.3074. Examines over 440,000 national ambulatory medical care surveys and finds that by 2010, visits resulting in a mental disorder diagnosis increased significantly faster for youths as compared to adults.
Jennings KS, Cheung JH, Britt TW, Goguen KN, Jeffirs SM, Peasley AL, et al. How are perceived stigma, self-stigma, and self-reliance related to treatment-seeking? A three-path model. Psychiatr Rehabil J. 2015;38:109–16. https://doi.org/10.1037/prj0000138.
• Sontag-Padilla L, Woodbridge MW, Mendelsohn J, D’Amico EJ, Osilla KC, Jaycox LH, et al. Factors affecting mental health service utilization among California public college and university students. Psychiatr Serv. 2016;67:890–7. https://doi.org/10.1176/appi.ps.201500307. Online survey data for over 33,000 students and 14,000 staff are compiled and reveal that more campus-based clinics are needed.
• Downs NS, Alderman T, Schneiber K, Swerdlow NR. Treat and teach our students well: college mental health and collaborative campus communities. Psychiatr Serv. 2016;67:957–63. https://doi.org/10.1176/appi.ps.201500465. This selective review provides best practices for the psychiatric treatment of college student populations.
Kraft DP. One hundred years of college mental health. J Am Coll Heal. 2011;59(6):477–81. https://doi.org/10.1080/07448481.2011.569964.
Barreira P, Snider M. History of college counseling and mental health services and role of the community mental health model. In: Kay J, Schwartz V, editors. Mental Health Care in the College Community. West Sussex: Jonn Wiley & Sons, Ltd; 2010. p. 21–31. https://doi.org/10.1002/9780470686836.ch2.
Reetz et al. The Association for University and College Counseling Center Directors Annual.Survey. Reporting period: September 1, 2015 through August 31, 2016: 1–118
Considerations for Integration of Counseling and Health Services on College and University Campuses. J Am Coll Heal 2010: 58; 583–596. DOI: https://doi.org/10.1080/07448481.2010.482436.
• Francis PC, Horn AS. Counseling services and student success. Midwestern Higher Education Compact Research Brief. 2016:1–22. The findings of multiple national surveys are reviewed to estimate the prevalence of mental illness, describe prevention and treatment programs, investigate improvements in academic performance associated with counseling and improve the effectiveness of counseling services on-campus.
Chaudhary A, Salinas E. The college mental health caucus survey. APA Annual meeting 2011. http://www.mhec.org/sites/mhec.org/files/201602counseling_services.pdf
Wyman PA, Inman J, Guo J, Brown CH, Cross W, Schmeelk-Cone K, et al. Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. J Consult Clin Psychol. 2008;76(1):104–15.
Sokolow BA, Lewis WS. Second Generation Behavioral Intervention Best Practices: NCHERM White Paper 2009: 2–13. DOI: https://doi.org/10.1037/0022-006X.76.1.104, 76.
Morrill WH, Oetting ER, Hurst JC. Dimensions of counselor functioning. Journal of Counseling & Development. 1974;52(6):354–9. https://doi.org/10.1002/j.2164-4918.1974.tb04041.x.
Pace D, Stamler V, Yarris E, et al. Rounding out the cube: evolution to a global model for counseling centers. Journal of Counseling & Development. 1996;74(4):321–5. https://doi.org/10.1002/j.1556-6676.1996.tb01874.x.
Blau GM, Caldwell B, Fisher SK, Kuppinger A, Levison-Johnson J, Lieberman R. The building bridges initiative: residential and community-based providers, families, and youth coming together to improve outcomes. Child Welfare. 2010;89(2):21–38.
College Mental Health Program Retrieved November 17, 2017, from http://www.mcleanhospital.org/programs/college-mental-health-program
Atkins MS, Frazier SL. Expanding the toolkit or changing the paradigm: are we ready for a public health approach to mental health? Perspect Psychol Sci. 2011;6(5):483–7. https://doi.org/10.1177/1745691611416996.
National College Depression Partnership. Retrieved November 17, 2017, from https://collegehealthqi.nyu.edu/ncdp/
The Jed Foundation and EDC. (2011) Retrieved November 17, 2017, from https://www.jedfoundation.org/wp-content/uploads/2016/07/campus-mental-health-action-planning-jed-guide.pdf
Home - Set to Go: A JED ProgramSet to Go: A JED Program. Retrieved November 17, 2017, from https://www.settogo.org/
Home Page JED Campus. Retrieved November 17, 2017, from https://www.jedcampus.org/
The Healthy Minds Study. Retrieved November 17, 2017, from http://healthymindsnetwork.org/research/hms
Equal Chance at Mental Health Framework Retrieved November 17, 2017, from http://www.stevefund.org/mental-health-framework/
McAleavey AA, Youn, S, Xiao H, et al. Evaluating routine practice and evaluating the methods of evaluation: How effective are routine practices for different symptom types, and what can different methods tell us? Paper presented as part of a panel at the conference of the North American Society for Psychotherapy Research (NASPR), Memphis, TN. 2013.
Eisenberg, D, Golberstein, E, Hunt J. Mental health and academic success in college. BE Journal of Economic Analysis & Policy 2009: 9(1) (Contributions): Article 40.
Wilson SB, Mason TW, Ewing MJ. Evaluating the impact of receiving university-based counseling services on student retention. J Couns Psychol. 1997;44:316–20.
Minami T, Davies DR, Tierney SC, Bettmann JE, McAward SM, Averill LA, et al. Preliminary evidence on the effectiveness of psychological treatments delivered at a university counseling center. J Couns Psychol. 2009;56:309–20. https://doi.org/10.1037/a0015398.
Snell MN, Mallinckrodt B, Hill RD, Lambert MJ. Predicting counseling center clients’ response to counseling: a 1-year follow-up. J Couns Psychol. 2001;48:463–73. https://doi.org/10.1037//0022-0167.48.4.463.
Lockard AJ, Hayes JA, Graceffo JM, Locke BD. Effective counseling for racial/ethnic minority clients: examining changes using a practice research network. J Coll Couns. 2013;16(3):243–57. https://doi.org/10.1002/j.2161-1882.2013.00040.x.
• Locke BD, Bieschke KJ, Castonguay LG, Hayes JA. The Center for Collegiate Mental Health: Studying college student mental health through an innovative research infrastructure that brings science and practice together. Harvard Review of Psychiatry. 2012;20(4):233–45. https://doi.org/10.3109/10673229.2012.712837. This review examined 10 studies focused on college student mental health using data collected from multisite counseling center clients or staff. These studies suggest that students’ presenting concerns are changing, that students who identify as ethnic minorities experience slightly more distress than their white counterparts, and that matching students and counselors relative to ethnicity does not improve outcomes. The authors discuss the importance of establishing an infrastructure that helps researchers elucidate trends, effective treatments, and risk factors that will be useful to clinicians treating this population.
American College Health Association. Considerations for integration of counseling and health services on college and university campuses. J Am Coll Heal. 2010;58:583–96. https://doi.org/10.1080/07448481.2010.482436.
• Brunner JL, Wallace DL, Reymann LS, Sellers JJ, McCabe AG. College counseling today: contemporary students and how counseling centers meet their needs. J Coll Stud Psychother. 2014;28:257–324. https://doi.org/10.1080/87568225.2014.948770. This article examines literature about the characteristics and concerns of today’s college students along with how counseling centers are responding to student needs. They describe findings from surveys by the Association for University and College Counseling Center Directors and American College Counseling Association, which revealed counseling center collaboration and consultation activities across campus. The survey also indicated a variety of administrative and structural arrangements in how counseling centers are situated on campus. The authors suggest a framework for planning, executing, and evaluating counseling center and campus initiatives.
Masters KS, Stillman AM, Browning AD, Davis JW. Primary care psychology training on campus: collaboration within a student health center. Professional Psychology: Research and Practice. 2005;36:144–50. https://doi.org/10.1037/0735-7028.36.2.144.
Tucker C, Sloan SK, Vance M, Brownson C. Integrated Care in College Health: a case study. J Coll Couns. 2008;11(2):173–83.
Westheimer J, Steinley-Bumgarner M, Brownson C. Primary care providers’ perceptions of and experiences with an integrated healthcare model. J Am Coll Heal. 2008;57:101–8. https://doi.org/10.3200/JACH.57.1.101-108.
• Funderburk JS, Fielder RL, DeMartini KS, et al. Integrating behavioral health services into a university health center: patient and provider satisfaction. Families, Systems, & Health. 2012;30(2):130–40. https://doi.org/10.1037/a0028378. This study described an Integrated Behavioral Health Care program within a university health center and assessed provider and patient acceptability and satisfaction with the program. Providers and patients found the program beneficial to clinical care. The authors concluded that integration helps support regular screening for mental and behavioral health issues and increases access to needed mental health treatment.
Butler M, Kane RL, McAlpine D, et al. Integration of mental health/substance abuse and primary care. Evidence Report/Technology Assessment. 2008;173:1–362.
Alschuler K, Hoodin F, Byrd M. The need for integrating behavioral care in a college health center. Health Psychol. 2008;27:388–93. https://doi.org/10.1037/0278-6133.27.3.388.
Chung H, Klein MC, Silverman D, Corson-Rikert J, Davidson E, Ellis P, et al. A pilot for improving depression care on college campuses: results of the college breakthrough series–depression (CBS-D) Project. J Am Coll Heal. 2011;59(7):628–39. https://doi.org/10.1080/07448481.2010.528097.
• Lipson S, Speer N, Brunwasser S, Hahn E, Eisenberg D. Gatekeeper training and access to mental health care at universities and colleges. J Adolesc Health. 2014;55(5):612–9. https://doi.org/10.1016/j.jadohealth.2014.05.009. This is a randomized control trial of the gatekeeper-training program, Mental Health First Aid. In a study on 32 campuses, the training was found to increase trainees’ self-perceived knowledge, self-perceived ability to identify students in distress, and confidence to help, but there were no apparent effects on utilization of mental health care in the student communities.
Lipson S. A comprehensive review of mental health gatekeeper-trainings for adolescents and young adults. International Journal of Adolescent Medicine and Health. 2013;26(3):309–20. https://doi.org/10.1515/ijamh-2013-0320.
Acknowledgments
We appreciate the help and support of the National Network of Depression Centers (NNDC) college mental health work group, in particular, Susan Hinton and Drs. Leigh Anne White and Michelle Riba.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Complex Medical-Psychiatric Issues
Rights and permissions
About this article
Cite this article
Downs, N., Galles, E., Skehan, B. et al. Be True to Our Schools—Models of Care in College Mental Health. Curr Psychiatry Rep 20, 72 (2018). https://doi.org/10.1007/s11920-018-0935-6
Published:
DOI: https://doi.org/10.1007/s11920-018-0935-6