A wide range of patient populations benefit from telemental health services. From people living in rural communities and assisted living homes, to those admitted to emergency departments, the potential reach of these services is expansive. However, there is one commonly overlooked population that stands out as a particularly well-suited match: College students.
This post will discuss the phase of life experiences, mental health status and vulnerability factors pertaining to college students, followed by an exploration of the points of compatibility between college students and telemental health services.
College Students’ Phase of Life Experience
The transition from adolescence to the “emerging adulthood” phase of life, which spans the typical college age range of 18-24, ushers in a number of profound changes. During this time, young people living in Westernized societies begin to feel more responsible for themselves. They are confronted with greatly impactful decisions to make and must consider a number of identity-defining matters: “What do I want out of my education, relationships, career? Who am I? How do I fit into the world?”.
Though their growing sense of personal agency points to a more adult state of being, 18-24 year olds are not quite there yet—hence the modifier “emerging”. In decades past, these years of life were marked by developing a career, getting married and starting a family. Times have changed, however, and the transition from adolescence to adulthood is prolonged.
A career, marriage and family are more commonly delayed by emerging adults who attend college. Instead, they choose to pursue further education. Consequently, the 18-24 phase has become an in-between period where college students have some of the autonomy associated with adulthood but are still closely tied to, and often dependent on, their parents.
This paradigm can be confusing and makes it difficult for college students to successfully balance their increasing responsibilities and develop an independent adult identity.
Thus, when students leave home to attend school, the pressure to do well academically, build a social life, manage finances, decide between the seemingly endless career paths and try to find answers to questions like “who am I?” and “who do I want to be?” can all be exceedingly overwhelming.
The marked decrease in support and guidelines for how to develop this adult identity often leaves young people feeling lost. The path ahead seems is unclear and many struggle amidst the fog of this transitional phase.
Mental Health on Campus
With all they have to navigate and balance, it’s not surprising that a 2004 survey conducted by The National Alliance on Mental Illness (NAMI) and Abbott Laborites found that 50% of college students rate their mental health as below average or poor.
The American College Health Association (ACHA) found that within the course of one year, 85% of students felt overwhelmed by everything that had to do, 30% reported that stress negatively impacted their academic performance and one in three felt so depressed that is was difficult to function (ACHA, 2015). These statistics are startling and clearly demonstrate that stress and a host of other psychological issues are an all too common part of the college experience.
In fact, one in four college students are living with a diagnosable mental illness and 75% of lifetime mental illnesses first emerge by the typical college age of 18-24 years (Gallagher, 2008; Kessler, Berglund, Demler, et al., 2005). Furthermore, suicide is the number two leading cause of death among college students, even surpassing alcohol-related mortality (Turner & Keller, 2001). With an alarming 90% of U.S. college or university counseling directors reporting an increase in psychological problems among students, this is an especially important demographic to attend to (Gallagher, 2008).
The high prevalence rates of mental illness, coupled with the age of onset statistics, suggest that college students are a high risk population, which makes it all the more concerning that the 18-24 age group shows the lowest rate of seeking help (Substance Abuse and Mental Health Services Administration [SAMHSA], 2006).
The Importance of Early Intervention
In consideration of all of the aforementioned factors, it is essential that college students receive care for their psychological distress as soon as possible. When these problems are left untreated, the impact can be devastating. Not only can compromised mental health lead to social withdrawal, substance abuse, impaired academic functioning and dropping out of school, but also a possible increase in severity and difficultly of treatment.
Research largely supports the advantages of early intervention as it has been found to improve both immediate and long-term outcomes and to reduce the risk of symptoms developing into a diagnosable mental illness (Koenen, Rudenstine, Susser & Galea, 2013; Mental Health and Drug & Alcohol Office, 2001).
Why Telemental Health?
Despite one in four college students having a diagnosable mental illness, 40% of these individuals do not seek help, according to NAMI. Why is this the case? Social stigma remains the number one barrier to accessing care for this population (NAMI, 2012). The fear of being judged negatively by others, including peers and faculty members, is a major deterrent for students to seek help.
Here’s where telemental health can play an important role. Unlike traditional, face-to-face therapy, students can access care without having to leave their dorm room. Because students do not have to visit their brick-and-mortar campus psychological services center they no longer run the risk of being seen by peers and/or professors. In turn, they might perceive increased levels of privacy and control.
Additionally, telemental health helps increase access to care, another barrier to receiving mental healthcare for college students. Due to the nationwide shortage of mental healthcare providers, coupled with a lack of funding, many campuses are inadequately staffed when it comes to mental health professionals. In fact, approximately one third of schools lack a psychiatrist on campus altogether (Korn & Chen, 2015)
So even if a student does seek help from the mental health clinic on campus, it is possible that the facility will not have adequate staffing resources to treat them. The scarce supply of providers can limit provider availability, making it more challenging for students to receive care on campus due to incompatible schedules.
Students themselves also have busy schedules with sporadic windows of time open during the day to see a mental health provider. With the scarce supply of clinicians at campus mental health clinics, the providers on staff might lack the availability to accommodate these scheduling requests and thus, students are be turned away.
The flexibility and ease of access associated with telemental health services allows college students to see their provider at a time that is right for them. Additionally, because virtual visits are less disruptive to student schedules compared to face-to-face visits, this may increase treatment compliance (Khasanshina, Wolfe, Emerson & Stachura, 2008).
Another point of compatibility is that technology use is second nature to college students as it is so engrained into their day-to-day lives. Their familiarity and comfort with using various video-chat platforms make them ideal candidates for using telemental health.
For college students who have entered treatment prior to leaving home to attend school, telemental health enables them to continue their care remotely. Students can remain under the care of a provider who is familiar with their mental health-related issues and needs, and who the student has already established a therapeutic relationship with. Additionally, it can eliminate the stress students experience when feeling like they have to “start over” with an unfamiliar provider.
But how do students feel about telemental health services?
Preliminary data supports college students’ positive perceptions of telemental health services. After launching a telepsych program at the University of Florida, their exploratory study revealed that students rated the acceptability of telepsychiatry high in comparison to group therapy and many even preferred it to face-to-face meetings.
Though the psychological issues and phase of life experiences of college students are complex, the fit between this demographic and telemental health services is clear. Access to care early on in the course of a psychological disorder is vital and it is certain that telepsych services are a well-suited channel through which college students can receive the care they need.
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American College Health Association (2015). American College Health Association-National College Health Assessment II: Reference Group Executive Summary Spring 2015. Hanover, MD: American College Health Association; 2015.
Gallagher, R.P. (2008). National survey of counseling center directors. Alexandria, VA: International Association of Counseling Services.
Kessler, R.C., Berglund, P., Demler, O., Jin R., Merikangas K. R. & Walters E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602.
Khasnishina, E. V., Wolfe, W. L., Emerson, E. N. & Stachura, M. E. (2008). Counseling center-based tele-mental health for students at a rural university. Telemed J E Health, 14(1), 35-41.
Korn, M. & Chen, A. (2015). Mental-Health Crunch on Campus. The Wall Street Journal. Retreived from: www.wsj.com/article_email/mental-health-crunch-on-campus-1430082408-lMyQjAxMTA1MTI0OTIyNDk0Wj.
Ligenza, D. (2015). Colleges struggle to meet students’ mental health needs. Barton Associates. Retrieved from: www.bartonassociates.com/2015/05/15/college-mental-health.
National Alliance on Mental Illness (2012). College Students Speak: A Survey Report on Mental Health Arlington, VA: National Alliance on Mental Illness.
National Alliance on Mental Illness (2004). Mental Illness Prolific Among College Students. National Alliance on Mental Illness. Retrieved from: www.nami.org/Press-Media/Press-Releases/2004/Mental-Illness-Prolific-Among-College-Students.
Mental Health and Drug & Alcohol Office (2001). Getting in early: A framework for early intervention and prevention in mental health for young people in NSW. Mental Health and Drug & Alcohol Office. Retrieved from: www.health.nsw.gov.au/mhdao/publications/Pages/Getting-In-early.aspx.
Turner, J. & Keller, A. (2011, October 29-November 2). “Leading causes of mortality among American college students at 4-year institutions.” Paper presented at the American Public Health associated annual meeting. Washington, DC.