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A holistic approach is key to student mental health, and retention

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Photo provided to MLive by Western Michigan University
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The RSO X-Hale worked with the Western Student Association to help coordinate a chalk-writing event during Mental Health Awareness Week.

KALAMAZOO, MI — Perci, 17, is a double major in philosophy and art history at Western Michigan University. He is one of hundreds of students at the university who have sought mental health care through the Sindecuse Health Center on campus.

“I cannot begin to list the number of times I have pushed myself past my limit of mental stability because I knew my struggles would not be taken seriously in the eyes of the academic world,” said Perci, who asked that his full name not be used for privacy reasons.

Perci has visited the Sindecuse Center multiple times for mental health assistance; each timehe had a positive experience, having been treated well and with respect, he said.

While students seek mental health therapy for a multitude of reasons — anxiety and depression being among the most common, studies show — there is a theme that Perci’s experience illustrates: When students need mental health care, they go to the health center.

But that is changing. It has to change, say local and national experts, because the needs are great, with a high demand for services well beyond what a campus clinic can offer.

The key to that change is an institution-wide culture of support around mental health.

“The burden lies with the entire campus,” concluded a national expert-driven effort to study the problem of college students’ struggles with mental health. The 2021 peer-reviewed report entitled “Mental Health, Substance Abuse and Wellbeing in Higher Education” was published after months of research for the National Academies((CQ)) of Sciences, Engineering, and Medicine.

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American Council on Education)
Results from a pulse point survey of college and university presidents on COVID-19, from September 2021.

A comprehensive analysis of these “universal” mental health prevention programs for college students observed that “Emotional distress, in the form of depression, anxiety, heightened stress, or general psychological distress, is one of the most common problems appearing in higher education populations. Such problems often are associated with other negative outcomes including poor academic performance and dropping out of school.”

Mental health services are no longer isolated to university counseling centers; a holistic approach is the best practice to address the needs of students, say officials at WMU, Kalamazoo College and Kalamazoo Valley Community College. Keeping students healthy also keeps them in school.

Establishing and maintaining an institution-wide wellness culture looks different for each campus in the Kalamazoo area, but the range of services includes a system of identifying students in crisis that involves peers, staff and faculty; teletherapy (video sessions between students and therapists); group counseling and peer counseling; and mental health apps that provide daily coping strategies and mood check-ins. Student mental health challenges such as anxiety and depression may have been ignited by the isolation and stressors of the pandemic, but other realities are creating the need for ongoing changes to mental health to young adults. These realities include expansive issues such as the inevitabilities of climate change and the uncertainty of the world order to daily pressures such as student loans and rising inflation that increases grocery and gas bills.

A spring 2021 WMU report on student health found that more than 37% of students reported that stress was impeding their academic success, and almost 32% stated that anxiety was hindering that success. The annual survey of students on campus is part of the Healthy Campus 2020 effort by the American College Health Association to improve wellness on U.S. college campuses using best practices. Notably, only 26.2% of students reported they were seeking mental health service by the campus counseling center.

In an effort to connect students with resources they need for mental health and substance abuse, WMU partnered with Integrated Services of Kalamazoo to provide training for students, faculty and staff to identify, understand and respond to signs of mental illness and substance abuse.

Another source for guidance is the Western CARES training, which is specifically for University faculty, staff and graduate assistants, according to a university press release issued last spring. Known as “gatekeeper training” for those on the front line, the program focuses on how to recognize when a student is struggling and how to respond and share resources.

Breanna Traynor, assistant director of mental health outreach at WMU, said it’s important that any employee, regardless of job title, knows how to connect students with resources because employees such as faculty are often the ones to witness warning signs. According to the press release, “They are the eyes and ears of our students. They are the ones interacting with them,” Traynor said.

The awakening to student mental health needs was spurred by Covid-19, but the retreat, for now at least, of the virus in the U.S., has not meant that psychological needs of students have diminished. If anything, say local experts, the needs are more severe. And happily, national and local strategies for addressing the needs are in agreement: Wrap-around services provide the most sustainable, successful outcomes. Seventy-three percent of university presidents ranked student mental health concerns as their most pressing issue, according to a September 2021 survey by the American Council on Education.

“(Counseling services) has seen an increase of students who report symptoms of anxiety, stress, depression and insomnia,” said Brian Fuller, the director of mental health counseling at WMU’s Sindecuse. Fuller and his team have seen an increase in the number of students seeking mental health help since the pandemic began.

“Students have been presenting with increased anxiety and stress given the spread of Covid-19 and the disruption to their routines and isolation. There has been some grief associated with losing out on experiences as a result of cancellations and also frustration. Students also present with uncertainty with regards to how long this may last.”

Since the start of the pandemic, 82% of college students have reported they have experienced increased anxiety, 68% have reported struggling with isolation/loneliness, and 63% have dealt with depression, according to a 2020 survey conducted by the Jed Foundation.

A March 2021 national survey of college and university presidents by the American Council on Education indicated that institutions plan to keep some of the changes made as a result of the pandemic, with more than 70% stating student counseling and mental health service adaptations would remain.

“Some of the problematic trends have been ongoing for decades,” stated the National Academies of Sciences report. “Some have been exacerbated by the COVID-19 pandemic and resulting economic consequences. Some are the result of long-festering systemic racism in almost every sphere of American life that are becoming more widely acknowledged throughout society and must, at last, be addressed.”

The document takes as its starting point that student wellbeing is essential to academic success. Dropout rates for students with a diagnosed mental health problem range from 43% to as high as 86%, according to the report.

“While dealing with stress is a normal part of life, for some students, stress can adversely affect their physical, emotional, and psychological health, particularly given that adolescence and early adulthood are when most mental illnesses are first manifested,” the report stated. “In addition to students who may develop mental health challenges during their time in postsecondary education, many students arrive on campus with a mental health problem or having experienced significant trauma in their lives, which can also negatively affect physical, emotional, and psychological wellbeing.”

Kenlana Ferguson, director of counseling at the Kalamazoo College Counseling Center, said that Kalamazoo College’s increase in demand for mental health services is not due to the number of students presenting, but the severity of the needs of students seeking help.

“While our numbers are fairly steady, the severity of presenting concerns has increased,” Ferguson said. “The students we see now, versus five years ago, have more significant and diagnosable mental health issues. Similar to many college counseling centers, we use a brief therapy model, which doesn’t meet the actual therapy needs of some and they are needing to be referred to the community. We are also finding ourselves involved in more crisis intervention than years before. So, our increase in demand has less to do with numbers and more to do with severity, which continues to tax our system.”

Every campus needs to convene a task force responsible for thinking about the community’s health and well-being, said Ethan Fields, director of Higher Education Program Outreach and Promotion for The JED Foundation.

“There has to be emphasis on prevention and intervention, and postvention,” Fields said. “All faculty and staff should get some type of training on mental health. They should all be trained to recognize warning signs and know how to have those hard conversations if a student is struggling.”

But does this holistic approach to college students’ mental health work? Alternatively called the “whole university” strategy and “mainstreaming mental wellbeing,” the approach does work, particularly when supervision and feedback are incorporated into the care, an analysis of 103 interventions reported between 1967 and 2012 found.

Supervised skills training involves a two-step process: First, the skills needed to manage anxiety or depression, for example, are identified and taught. Second, a series of repeated activities seek to incorporate the skills into real life. It makes a lot of sense, as one-off classes or training without follow up don’t equate to lifestyle changes. To teach the skills, whether it is meditation, relaxation techniques or identifying negative thinking patterns as they occur in real life, feedback by a trained professional is essential, concluded the analysis, a 2015 article in the scholarly journal Prevention Science.

To summarize the tactic: Identify the mental health challenge, offer a strategy to address it, practice that strategy in simulation and in real life, get professional feedback, followed by more practice. With supervision and guidance by a trained professional, the healthy habit is incorporated into a student’s life.

“The magnitude of effects achieved for depression, anxiety, and stress” – three areas among the most common experienced by higher education students – “is impressive,” concluded the analysis. “Skill-training interventions that contain supervised practice and target higher education students now join the ranks of other effective preventive programs.”

But providing a robust array of services to address students’ varying levels of psychological challenges is difficult, local higher education institutions as well as national experts are quick to note. Universities and colleges need much more funding for these wrap-around services, more therapists – particularly therapists of color – on campus and in the community, and a systemic approach to developing a campus-wide capability to identify students in crisis as well as to track the status of student mental health on campus.

Kalamazoo Valley Community College has implemented several new resources for students, and has worked on further publicizing their existing ones, according to Nkenge Bergan, associate vice president for Student Development Services. One of those new services is a “red card” system in which students in crisis can present the card at the community college’s counseling service to get the next available appointment.

The college is also making students more aware of life resources staff on campus. These staff who are responsible for connecting students with resources they may need in their day-to-day life. While KVCC has not implemented group counseling, it has begun offering telehealth therapy to students.

“A shift we have made has been the ability to be more convenient for students,” said Bergan. “Before this, we didn’t have an online version of some of our services.”

One way that WMU responded to the isolation of students during COVID was with an app that students download to their phones. In September of 2020, WMU released the WellTrack app, a self-help resource hub on which students can access wellness techniques through videos, relaxation exercises, mood tracking tools, and written exercises to improve emotional health.

According to Fuller, over 1,700 students have downloaded the app since its launch. Lilly, 19, a WMU student majoring in psychology who didn’t want her name used for privacy reasons, is one of them. Lilly said the app may be helpful at times, it’s not a long-term solution to mental health needs.

“I think especially when talking about something as important as mental health it is important to have a conversation with professionals. I think videos, relaxation exercises, and tracking tools can only help so much,” Lilly said.

Lilly reiterated the importance of providing easier access to services financially as well as transitioning to long term treatment options. “With so much stigma around mental health, it can be really hard for people to reach out to those services so making it accessible financially or otherwise is very important.”

WMU has also responded to the increased need for services by expanding teletherapy access, but it’s not enough, said students such as Emma, 22, an occupational therapy major.

“It’s hard not getting the personalization,” said Emma, who also didn’t want her full name used for privacy reasons. “Any time I go to therapy I have to make sure that my roommates aren’t home and listening, it’s an added stresser and there are so many more layers on top of it.”

Sindecuse announced recently that it would transition back to mainly in-person counseling services as the pandemic has subsided.

In effort to begin making a more comprehensive approach to mental health services on campus. WMU and K College both joined The Jed Foundation and the Steve Fund’s Equity in Mental Health Pilot Cohort in 2017. In 2019, each participating school submitted at least three goals to meet the needs of their communities. JED and the Steve Fund helped the schools refine their goals to be specific, measurable, and attainable, according to the cohort’s website.

“Over the course of our four-year participation, we’ve gained a deeper understanding of the holistic wellness needs of our students,” said Ferguson. “In particular, we’ve learned more about the unique mental health needs of our students of color and started addressing these needs through collaborative program enhancements across campus.

We endeavor to create a culture of wellness at K; one in which students understand the importance of caring for themselves around all dimensions of wellness (not just professional/academic) and all members of our community understand their role in supporting student wellbeing.”

As the National Academies of Sciences report stated with practical bluntness: “Colleges and universities of all types and sizes will have to deal with this likelihood, if not for the benefit of their students and the nation that needs their graduates, then certainly for the sake of their financial situation—every student that drops out of school because of a mental health issue is a student who is not paying tuition.”

This story is part of the Mental Wellness Project, a solutions-oriented journalism initiative covering mental health issues in southwest Michigan, created by the Southwest Michigan Journalism Collaborative. SWMJC is a group of 13 regional organizations dedicated to strengthening local journalism. For more info visit swmichjournalism.com.