Challenges in Student Mental Health Care

Students in pursuit of secondary education have increasingly become a high-risk group in regards to mental health crises. According to the American College Health Association, suicide among young adults has tripled since the 1950s and has become the second-leading cause of death among students today. Nationally, 64% of college dropouts have directly associated their departure to mental health concern.

Survey data from the University of California, Davis supports these increasing statistics. In comparing ACHA-NCHA II data from Spring 2015 to Spring 2017, a steady increase has been reported.

Within the past 12 months:

• 64.8% of UC Davis undergraduate students felt overwhelming anxiety (3.3% increase since 2015),
• 49% were so depressed they could not function (5.5% increase since 2015),
• 8.8% intentionally self-harmed (2.1% increase since 2015).

The figures for graduate students are slightly lower:

• 58.4% feeling overwhelming anxiety,
• 43.6% so depressed they could not function, and
• 5.3% causing intentional self-harm.

It should also be recognized that mental illness disproportionately affects certain communities, particularly communities of color, the LGBTQIA+ community, disabled, and low-income communities.

These communities face institutional and structural barriers which prevent further access to proper care. The most serious manifestation of growing student mental health concern is suicidal ideation and behavior.

Within the last year:

• 15.5% of undergraduates seriously considered suicide (3.6% increase since 2015)
• 2.6% had attempted, nearly doubling the since 2015’s 1.5% (ACHANCHA II Spring 2015 and Spring 2017)
• 8% of graduate students reported seriously considering suicide
   

Summary of Existing On-Campus Services

 

On campus, mental health services are provided by Student Health and Counseling Services (SHCS), formerly Counseling and Psychological Services (CAPS). SHCS offers two major types of mental health resources: Counseling Services and Psychiatric Services. Combined, these provide many services including:

• Individual counseling
• Couples counseling
• Group therapy
• Skills groups
• Case management
• Career counseling
• Outreach to the campus community

In general, Counseling Services provides issue focused, short term care, typically eight sessions or less. Within this time, the therapist and student will determine whether a referral to an outside provider is necessary. Psychiatric services include psychiatric assessment, medication management, and medication monitoring.

All of these services are funded by the Student Service Fee and the Mental Health Fee, a subset of the Student Service Fee earmarked exclusively for mental health.

Counseling Services are offered free to all registered students while psychiatric services are $35 per visit, which can be billed to the student account or the Student Health Insurance Plan (SHIP). SHCS does not bill insurance plans other than SHIP.

These services are distributed in a variety of different locations. The Student Health and Wellness Center offers crisis counseling within the Acute Care department and non-crisis counseling services within the Behavioral Health Clinic. Psychiatric Services is also located in the Behavioral Health Clinic. The bulk of Counseling Services providers are located in North Hall. There are also counselors embedded within academic satellite locations including Graduate Studies, each of the four undergraduate colleges, and the professional schools. CAN counselors, who bring unique expertise related to student diversity, are embedded within the communities they serve. The ways of accessing these services differ.

Students in crisis can walk into Acute Care at the Student Health and Wellness Center during their hours of operation.

The Acute Care Clinic is open:
8:00am - 5:00pm   Monday, Tuesday, Thursday and Friday
9:00am - 5:00pm   Wednesday  

Non-crisis counseling services can be accessed by appointment only.

These appointments can either be scheduled personally (via phone or in person) or through the assistance of a SHCS provider. In order to participate in group counseling, students must be referred by a SHCS provider and undergo a screening beforehand.

For psychiatric services, a student must be referred by SHCS provider in order to see a psychiatrist.

The student will be asked to complete a brief survey to assess the crisis. Afterwards, the student will meet with a counselor to determine what the best course of action is moving forward.

Additionally, there is a 24-hour phone line (530-752-2349) and e-messaging for students which can provide both crisis assessment and counseling support.

There are also first responders under the UC Davis Police Department (UCDPD) and City of Davis Police Department for students living in Davis. However, as indicated in survey results, students may not feel comfortable or safe contacting the police department while in crisis due to fears of police violence.

There are numerous student groups who advocate for mental health awareness, self-care and expanded services on campus and in the community. These groups include but are not limited to: National Alliance for Mental Illness (NAMI) at UC Davis, the Mental Health Initiative (MHI), Each Aggie Matters, and Students Against Suicide, etc., who are specifically focused on mental health advocacy and de-stigmatization. However, since mental health is an intersectional issue, there are also non-mental health centered student groups who touch on mental health such as Student Disability Services (SDS) and other groups that work with traditionally marginalized student populations.

Student Mental Health Task Force Recommendations

 

1. Reduce the nonclinical workload of licensed clinicians in Counseling Services

• This reduction can be achieved by hiring more case managers and support staff to take over the nonclinical workload of clinicians.
• Utilize nonclinical workers to facilitate outreach opportunities instead of licensed clinicians.

Student Health and Counseling Services (SHCS) has two mental health advocacy specialists and just added a full-time case manager at Counseling Services. The case manager will assist with referrals and connect students to appropriate campus and community resources.

In addition to assisting students in getting connected to campus and community resources, the mental health advocacy specialists also provide psycho-educational workshops that are designed to help build personal awareness, develop coping skills and promote self-care.

They also coordinate outreach for Counseling Services and help Counseling Services stay connected to the counselors in the community. This provides an opportunity for more effective referrals for students who would benefit from longer-term counseling. Furthermore, SHCS is currently assessing ways to strengthen administrative support at North Hall.

Lastly, in regards to outreach activities, SHCS is in the process of assessing all outreach activities provided by its Health Education and Counseling Services departments to determine synergies and to reduce redundancies. As we prioritize access, we are working to maximize the efficiency of our services and focus our outreach efforts during times of the year in which we are less impacted. SHCS hopes that these actions and the additional nonclinical staff resources will allow counselors more opportunity to provide clinical services, thereby improving access to students.

Update:

Two psychoeducational workshops have been added to increase personal awareness, coping skills, and promote self-care. 

2. Establish a well-known and welcoming hub for crisis services, which also acts as a resource for directing students to available counseling services on the Davis campus and UC Davis Health in Sacramento.

     a. Student mental health care survey findings support elevating North Hall as the hub.

          i. Students report that they may not feel comfortable disclosing their mental health within the general medical setting of the Student Health and Wellness Center (SHWC).

          ii. The distribution of services between North Hall and SHWC is confusing for many students – as indicated by a lack of awareness for mental health services, which could be a barrier to receiving services.

     b. We recommend that the acute care crisis counselor is moved into North Hall in order to maximize both urgent and nonurgent visits per day.

SHCS clinical teams are currently assessing how best to provide crisis services at North Hall in the safest, most efficient and effective manner. SHCS will not implement crisis services at North Hall until it can ensure that there is adequate clinical support to safely care for students in crisis at both the North Hall and SHWC locations.

Once implemented, SHCS will access and monitor the effectiveness of its mental health crisis services to determine if barriers to services have been mitigated.

Update:

Beginning Winter Quarter, Crisis Consultation Services will be available at North Hall from 11 a.m. – 4 p.m., Monday-Friday and at the Student Health & Wellness Center in Acute Care from 9 a.m. – 5 p.m., Monday-Friday.

Student Health and Counseling Services (SHCS) has partnered with Live Health Online and Anthem Blue Cross to provide UC Davis students with access to online visits for counseling, psychiatry, and medical services. To better meet your busy schedule, Live Health Online provides students with another option for obtaining the care you need. Live Health Online allows you to schedule a visit with a provider 24/7 via online video conferencing. You can access Live Health Online from any smartphone or tablet using the Live Health Online app or through a desktop computer with a webcam at www.livehealthonline.com. Students will not pay the co-pay for these services during the 2018-2019 academic year if the coupon codes are used.

Beginning on Dec. 22, Counseling Services will offer online scheduling for You Got This (psychoeducational workshops), Mental Health Advocacy Specialists (getting connected to campus & community resources), Initial Consultations (first counseling appointment), One Time Visits (one time counseling appointment). Online appointments can be scheduled via Health-e-Messaging on the SHCS website.

3. Establish and publicize a long-term hiring plan to ensure that Counseling Services meets the needs of a growing student population. In particular, the hiring plan should acknowledge importance of the following counseling services.

    a. Increase the number of Community Advising Network counselors to directly reach out to marginalized and underrepresented student communities. SHCS should consult with the student leadership within various Diaspora and Community Centers to determine which communities will receive CAN counselors within the scope of the hiring plan.

    b. Increase the number of satellite counselors from 0.5 FTE (full-time equivalent) to 1.0 FTE within each of the schools and colleges. This was strongly called for and supported by the various schools and colleges.

As recommended in the 2017 Audit and Management Advisory Services (AMAS) Audit of Counseling Services, SHCS is currently working with the Division of Student Affairs and the Office of Budget and Institutional Analysis to develop a new recruitment and funding plan for achieving a suitable number of counselor positions within a reasonable period of time to satisfy student mental health needs as student enrollment continues to grow on campus.

Update provided Feb. 22, 2019:

Two counselors have been hired; one more expected in the next six to eight weeks.

Update:

Counseling Services is currently interviewing candidates for three counselor positions.

4. SHCS, the Office of the Chancellor, and Student Affairs should take an active role in the advertisement and consolidation of mental health resources on campus.

a. The creation and distribution of a singular standardized guide which lists and explains all mental health resources provided on-campus and off-campus (within Yolo and Sacramento Counties).

          i. Consult with other organizations, particularly Yolo County Health and Human Services Agency and Health Education and Promotion and UC Davis Police Department (UCDPD), when compiling any materials listing or explaining resources and services.

          ii. This guide should be distributed to all incoming students (freshman, transfer, graduate, and nontraditional students) during the various orientations.

          iii. The guide should be regularly reviewed, at a minimum annually, to ensure that information is accurate and up-to-date and should be posted on SHCS website as well as other relevant websites (i.e. Aggie Compass and my.ucdavis.edu).

b. An annual systemwide email sent by the chancellor at the beginning of the academic year containing a list of on-campus and off-campus mental health resources, which students can utilize. A reminder of these resources and a mental health check-in should be sent in the middle of each quarter, as this is a period of high stress for both graduate and undergraduate students.

c. All mental health related educational materials and messages should adhere to using gender inclusive and non-ableist language.

The Office of the Chancellor, Division of Student Affairs, and SHCS will inventory and assess all current mental health resources on campus.  A UC Davis mental health resource guide will be created and regularly updated and distributed to students, leveraging many available avenues of distribution such as orientation, the Each Aggie Matters, myucdavis.com, and Aggie Compass websites and the UC Davis NOW app.

Update:

Emilia Aguirre, Mental Well-Being Health Promotion Specialist, has developed an interactive Google map on the Each Aggie Matters website. The pilot phase of this map featured primarily SHCS locations but will be expanding to any resource on- and off-campus that provides support for UC Davis students. This map is not limited to clinical support, but any department, organization or location that can support student mental health and well-being.

Next steps involved include the creation of an online survey to gather specific data from various on- and off-campus locations. Once the map has updated all locations, we plan to infuse messaging about the mental health map and Each Aggie Matters across different campus channels including UC Davis Now app, myucdavis.com, orientation for all incoming UC Davis students, Aggie Compass and other campus and community avenues. Furthermore, this map will be updated at least once per academic year (within 45 days prior to the start of fall quarter) along with a communication plan to increase awareness on campus.

Update, provided Jan. 15, 2019:

We created a Qualtrics survey to gather data from different campus partners for the map and emailed the survey link out along with a description of the request.

Formation of a suicide prevention and ‘postvention’ protocol

 

1. Create a resource-based training similar to the small online trainings provided to incoming students. This training would be designed to educate individuals about the different types of mental health resources provided on- and off-campus.

The Division of Student Affairs and SHCS will investigate and determine the most effective way to deliver information about mental health resources to incoming students, utilizing the resources referenced above.

2. Form a Postvention Committee that rapidly convenes following a suicide on campus in order to provide immediate support, circulation of resources, and relays systemwide communication regarding instances of suicide.

a. The committee should comprise individuals from various campus disciplines in order to provide a unified and organized cross-campus response.

b. The committee should regularly review its approach and strategies in order to refine its outcomes.

c. The committee should include at least one student representative such as the ASUCD president.

d. The committee could use the Suicide Prevention Resource Center’s “After a Suicide: A Toolkit for Schools.”

The interim vice chancellor of Student Affairs has commissioned a Postvention Committee comprising individuals from various campus departments and a student representative to develop a postvention plan for UC Davis utilizing best practices as described in the guide “Postvention: A Guide for Response to Suicide on College Campuses” from the Higher Education Mental Health Alliance and other resources. The Postvention Committee's charge will be to develop a plan to respond and provide immediate support in the event of a student death by summer 2019.

Update provided Jan. 29, 2019:

Follow-up decision to refer to protocol as ʺsudden student death.ʺ Draft protocol in progress.

3. Institute systemwide emails following campus deaths, including instances of suicide and following best practices for such communication. At the least, the email should contain a recognition of the death and a list of on-campus and off-campus resources that students can access. Any personal information regarding the student can be kept private.

The Postvention Committee described above will determine, recommend and implement appropriate communication practices following a suicide for the UC Davis community.

 

Information Transparency for Quality Improvement

 

1. SHCS should create a Student Health Advisory Board to monitor departmental utilization, access and student satisfaction. They should review utilization for specific groups (graduate, undergraduate, year in school, program, etc.) and historically underserved populations.

SHCS is in the process of establishing a Student Health Advisory Board to educate students about available medical and mental health care services and collect and provide feedback about suggested improvements to SHCS programs. SHCS anticipates the Student Health Advisory Board to be created in fall 2018.

Update:

The committee has been formed and will meet in January. The committee consists of 10 students, six undergraduate and four graduate.

2. Query students who have not accessed SHCS, looking for barriers to services that can be mitigated.

SHCS will partner with the Division of Student Affairs to develop an evaluation tool to regularly query all students about access and ways to mitigate barriers to mental health services. SHCS hopes to implement this evaluation tool by spring 2019.

Update provided Feb. 22, 2019:

Survey has been launched.

Update:

Considering utilizing the ACHA-NCHA II Survey and the Student Affairs Student Satisfaction Survey.

Create a culture of student mental health beyond the clinical setting that includes all members of the campus community who regularly interact with and support students

 

1. Enhance the mental health support provided by Student Housing and Dining Services (SHDS) to its residents.

a. Coordinate with SHCS to facilitate annual trainings (i.e. Mental Health First Aid and Question, Persuade, Refer, or QPR) for their resident assistants (RAs).

b. Work with SHCS to solidify an official protocol for responding to and supporting students in crisis. Coordinate with SHCS and Yolo County to facilitate annual trainings (i.e. First Aid and QPR) for their RAs and other SHDS-affiliated staff.

c. SHDS should collect anonymous feedback from RAs regarding the quality and success of these trainings.

d.  SHDS should meet regularly with the Student Mental Health Advisory Committee (SMHAC) in order to discuss their protocols.

Student Housing and Dining Services (SHDS) currently has its own QPR-certified trainer who collaborates with Counseling Services staff to offer trainings.  SHDS has an internal protocol for assisting students in crisis and regularly collaborates with and participates on the Campus Crisis Response Team. SHDS currently offers QPR training on a voluntary basis for SHDS staff and will review ways in which staff can anonymously offer feedback regarding the quality and success of the trainings. SHDS would gladly attend SMHAC meetings once the committee is created.

2. Support the ongoing training efforts to enhance mental health practices undertaken by the UCDPD.

a. In addition to already existing officer training provided by UCDPD, ensure that there is a continued emphasis on training for all officers in de-escalation and the use of other nonviolent strategies when officers are responding to situations of crisis intervention. These approaches were strongly supported by Chief Farrow in person and in his open letter sent on May 22, 2018, on his website.

b. Develop procedures to connect first responders and students calling in crisis with the on-call SHCS counselor.

c. Undertaking further training beyond the Critical Incident Training (CIT), such as QPR and First Aid.

d. UCDPD should post and promote a copy of their protocol for handling crisis situations.

Chief Joe Farrow: The Office of Chancellor and Provost has generously supported the training of our officers. Per the Commission on Peace Officer Standards and Training (POST), all of our sworn personnel meet the state’s training standards on mental health response; however this is only the cornerstone, and I’ve challenged our team to support and prioritize mental health response and de-escalation trainings in the coming years. With the support of the chancellor and his administration we have many efforts well underway:

By January 2019, 50 percent (19 of 32) of our sworn officers will have at least 20 hours of mental health training or Crisis Intervention Training (CIT), some of which was provided here on campus through Crisis Prevention Institute’s Nonviolent Crisis Intervention Course.

• In January 2019, we are coordinating with CBL Training and Consulting an on-campus training course mandatory for all sworn officers titled “Impulse Control and Cued De-escalation Training.”

• Lt. Michael Green and SHCS’s Health Promotion Specialist on Mental Well-Being, Emilia Aguirre, have met to discuss inviting the Vera Institute to campus for future trainings and explored possible grant prospects for CIT courses.

• UCDPD staff is working with Emilia Aguirre to promote some of SHCS’s mental health initiatives such as the “Out of Darkness Walk” in September, which sworn and civilian staff will participate in.  We have also worked to promote via social media the counseling text support line, and we look forward to participating in other opportunities as this team develops.

• I regularly meet with CARE Director Sarah Meredith to discuss collaboration, and the UCDPD staff work with her team to develop ongoing programs and partnerships.  We are exploring some ideas of critical incident response that may include trained clinical professionals responding with our officers to mental health crisis calls 24 hours per day.

• The UCDPD Detective Unit serves on the campuswide Crisis Response Team communicating with SHCS and other campus units monitoring known critical incidents.

Chancellor May has also supported my nomination to the California Board of Directors for the National Alliance on Mental Illness (NAMI), recognizing the need for collaboration between law enforcement and mental health professionals. We are in the final stages of developing a user-friendly website, and we look forward to bringing attention to these serious issues and recognizing our current and future partners. We currently have my open letter on mental illness on our website, and would be willing to again promote our support of mental health through social media, our website, and other means. On this site we can publish our policy on crisis intervention incidents, which discusses how officers respond to mental health calls. As we continue to train and develop programs with campus partners, we look forward to sharing those with our community.

Update provided Jan. 31, 2019:

The UC Davis Police Department has been successful in training 20 of the 32 officers in the 20-hour Mental Illness response course. In addition, 16 officers attended the Gate Keeper training sponsored by the Behavior Health Center of Excellence. In regards to de-escalation, we trained the first half of the department earlier this month and have scheduled the second half in the near future. Finally, we trained all of our officers and staff in Nonviolent Crisis Intervention.

3. Implement a Peer Support Program.

a. SMHAC can analyze different peer support programs from other universities and assess viability.

b. Consult with nonprofits and organization that are centered on training peers regarding how to administer peer support (i.e. Project Let’s Erase The Stigma).

c. The program should comprise individuals from diverse backgrounds, experiences and identities

SHCS currently employs a diverse group of mental well-being student coordinators focused on the following content areas: sleep health, stress management, suicide prevention, happiness/gratitude, and stigma reduction, with the ability to collaborate on overarching related mental well-being projects and programming.

These coordinators work on projects that support students including: developing strategies and student-centered messaging related to healthy sleep/napping, gratitude, positive psychology and other mental well-being practices, and working with campus partners to identify how environmental strategies and institutional policies can best support UC Davis students in reducing stress and improving sleep on campus.

In addition, mental well-being student coordinators are responsible for implementing programs in residence halls, classes, student organization meetings and other on-campus settings targeting areas such as sleep health and happiness, and they partner with student organizations to promote Each Aggie Matters during Mental Health Awareness Month.

4. Promote and utilize existing trainings on campus (i.e. Peer Education And Community Empowerment and LGBTQIA+ Ally Training) in conjunction with a standardized mental health training.

The campus currently offers Mental Health Gatekeeper Trainings, which are standardized, resource-based, and prevention-focused for all mental health challenges including suicide. The Mental Health Gatekeeper Training increases mental health awareness, decreases stigma, and improves communication for mental health concerns on campus. The training has been well received by faculty, staff and administrators.

Update provided Feb. 22, 2019:

Funding secured for three years of training.