Friday, September 30, 2022

Can Teletherapy Companies Ease the Campus Mental-Health Crisis?

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In the summer of 2021, as Covid case numbers ebbed and vaccination rates shot up, Nicole Ruzek, the director of Counseling and Psychological Services at the University of Virginia, saw the “writing on the wall”: When students returned to in-person classes in the fall, demand for in-person counseling services would rise again.

But over the summer, counseling-center staff had noticed a new barrier to care that was making it difficult to relieve their caseload — when they tried to refer students out to local providers for longer-term care, a lot of them were full.

They needed another solution.

Enter TimelyCare, a virtual platform that provides students with 24/7 mental-health care, with their colleges picking up the tab. UVa’s counseling center contracted with TimelyMD — the Texas-based telehealth company that runs TimelyCare — in the fall of 2021. Now, instead of waiting weeks for care at the campus counseling center, students can speak to a counselor or psychiatrist within days, and receive emergency mental-health support within minutes.

UVa is one of 170 campuses in the U.S. to contract with TimelyMD, which says it serves more than 800,000 college students nationwide through its mental-health and medical services.

During the pandemic, colleges have increasingly relied on virtual solutions to treat their students’ mental health concerns, contracting with a variety of telehealth companies to offer around-the-clock care, even when students and providers aren’t physically on campus. Counseling-center leaders say that the agreements have made a critical difference in helping the centers meet students’ growing mental-health demands, and that while the third-party providers are not always solving capacity issues, they are helping colleges stay on top of the mental-heath needs of a broader population of students.

Teletherapy’s Golden Age

Before the pandemic shut down colleges, campus counseling centers were many students’ go-to providers for mental-health support. According to fall 2019 data from the American College Health Association, 26 percent of students reported receiving mental-health care during the previous year; of those students, 53.5 percent said they had received it on campus.

“What we’re seeing at counseling centers nationwide is that the demand for services far exceeds the number of staff at university counseling centers,” said Ryan Patel, the chair-elect of the American College Health Association’s mental-health section and a senior staff psychiatrist at Ohio State University. “And so there are more and more students needing mental-health services than there are providers.”

What we’re seeing at counseling centers nationwide is that the demand for services far exceeds the number of staff.

Ryan Patel, of the American College Health Association

Data show the pandemic has created even more need for mental-health care among college students. In the fall of 2019, the ACHA’s National College Health Assessment surveyed more than 38,000 students from 58 colleges; 18 percent reported serious psychological distress. By the fall of 2021, that number had risen to 22 percent, according to a survey of 33,000 students at 41 colleges.

The rising need among college students mirrored that of American society at large, as providers and patients alike were isolated in their homes. Governors passed executive orders permitting out-of-state mental-health providers to practice in their states. Online mental-health technologies took off as a way for therapists to continue to see existing patients and connect with new ones.

Colleges invested in the platforms as campus counseling centers faced skyrocketing demand. Telehealth companies boasted 24/7 availability, diverse provider networks, and licensed clinicians in all 50 states. Students could get help over video, phone, text, or chat — sometimes within minutes.

Data from the Association for University and College Counseling Center Directors’ 2019 to 2020 annual report shines a light on colleges’ quick transition to virtual care: In the eight and a half months leading up to March 15, 2020 — the moment the pandemic upended American higher education — counseling centers averaged a total of 17.1 video sessions; in the same time period afterward, they averaged 1,164.8 sessions, an increase of nearly 7,000 percent.

Students say they have had mostly positive experiences with teletherapy and other virtual care, and college counseling-center leaders say they’ve received mostly positive feedback.

Rebecca Schell, who graduated from Susquehanna University in Selinsgrove, Pa., in 2021, said she appreciated that she could just “lie in bed and do therapy” when her appointments were over Zoom.

“I don’t have to deal with the taxation of therapy that comes with going to therapy,” Schell said. “I think it’s a great tool … because it helps allocate resources to students who may not want to come out to therapy or who cannot.”

A New Expense for Colleges

Today, campus teletherapy is a big business. TimelyMD received a $60 million investment from a private-equity firm in January 2021 to expand its teletherapy and telemedicine services. At the time, it served 80 campuses — a number that’s more than doubled since then. Contracts can run into the hundreds of thousands of dollars; last year, the Connecticut State Colleges and Universities, a system of 17 campuses, entered a $660,000 two-year contract with TimelyMD to offer telehealth and counseling services to students, paid for with federal Covid relief funds. Leaders at TimelyMD told The Chronicle the costs of its contracts depend on the college’s needs and size.

That expenditure could be well worth it for campuses struggling to hire counselors and meet the ballooning demand for services.

Among the advantages: Reduced wait times for service, which may be especially long when counseling staff members are out for Covid-related reasons.

“We would have staff who were sick or who were taking care of kids and were not able to come into work for a Covid-related reason,” Ruzek, of UVa, said. “We really needed a backup plan for how to fill in the gap.”

And with many counseling centers operating on a 9-to-5 schedule, tele-mental-health providers can help round out coverage and triage needs. Luke Hejl, the chief executive of TimelyMD, said about 40 percent of their visits occur after hours.

“That’s something that, many times, counseling centers just can’t meet that need,” Hejl said. “Additionally, what we’ve found is that many times there’s about a two-week wait” — students can’t immediately get into the campus clinic. Counseling-center directors are trying to get students to talk to a provider as quickly as possible, he said, and that’s where TimelyCare can come in.

In some cases, the added support from a teletherapy provider frees up campus counselors to offer services that are only possible in person. At Reed College in Oregon, for example, an agreement with the digital mental-health solutions company Uwill has given the counseling center the capacity to offer outdoor group therapy, bringing students who are feeling isolated into community with one another.

But counseling-center leaders say it’s inaccurate to say their workload has decreased. Rather, they say, these technologies have encouraged more students to reach out — including those who haven’t been touched by college counseling before.

Pre-pandemic, the Johns Hopkins University’s counseling center was seeing about 19.5 percent of its eligible population, said Kevin G. Shollenberger, the vice provost for student health and well-being. That percentage dropped slightly when Hopkins contracted with TimelyCare during the pandemic, Shollenberger said, but has since gone back up, even though 4 percent of students are still using TimelyCare.

“I think it’s more about us reaching a broader population,” he said. “It has helped us focus more on students who might have ongoing needs.”

The services can also help colleges that lack on-campus mental-health care but that serve a generation that increasingly expects those services.

In a 2020 survey by the American Council on Education, 21 percent of presidents at public two-year colleges reported that their institutions didn’t provide mental-health services. The rate was 9 percent for higher-education institutions overall (more recent data from ACE was not available).

Not a Replacement

Counseling center leaders made clear they were not eliminating in-person services, which, they say, may still be the best option for some people.

That could include students who don’t have a private place at home to talk to a professional about personal difficulties, said Nathaan Demers, a former campus psychologist and the vice president and director of clinical programs at Grit Digital Health, a tech company that designs digital mental-health solutions. Plus, Demers said, on-campus counselors’ familiarity with their institutions can be an asset that most third-party providers wouldn’t have.

Many counseling centers view teletherapy as an extension of their work. At Johnson C. Smith University, a historically Black institution in Charlotte, N.C., the arrangement with TimelyMD reflects the diversity of its student body.

“We have requested that there are some therapists of color that look like our students so that it could help to address the stigma around mental health and make our students a little bit more comfortable with accessing and utilizing the services,” said Tierra Parsons, the college’s director of counseling services. “Even down to the marketing — we specifically requested that the images and promotion have persons of color to represent different cultures.”

Campus counseling centers also coordinate with teletherapy providers to transfer students to the best form of care, sharing student records within the bounds of HIPAA and FERPA laws.

“TimelyCare has their own kind of record system that is confidential, and like our records here at the counseling center, are protected by HIPAA,” said Shollenberger, of Johns Hopkins. “We do have an arrangement with them as a third party that those records can be shared if needed. So we don’t review those records, but if a student was being seen by TimelyCare, and the clinician thought it might be better for them to be transferred to care here at Hopkins, that they could share those records, or if a student was in crisis and we needed to know that.”

Parsons, of Johnson C. Smith, said the agreement with TimelyMD gives staff members “peace of mind.”

“There are some that may be quiet about their mental-health concerns, and they may be giving it a try for the first time with the service,” Parsons said. “And so we are just happy that we’re able to meet their needs in this way, especially on an HBCU campus.”

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