Dispatches from the Presidents’ Convening on College Student Behavioral Health
On September 23 and 24, 2019, Georgetown University and the Mary Christie Foundation hosted “The Presidents’ Convening on College Student Behavioral Health” at Georgetown’s Riggs Library.
From the early planning stages, Georgetown President John J. DeGioia had a goal for the unique forum that drew from his own long-standing inquiry into the topic – to gain a deeper understanding of the role of higher education in the behavioral health and wellbeing of students.
For the Mary Christie Foundation, DeGioia’s perspective matched its own mission to apply a broader, public health lens to the examination of young adult behavioral health.
“We have a great opportunity to go beyond the news clips to understand and respond to the distress of our students in a way that sets a precedent for future generations,” said John P. Howe III, MD, President of the Mary Christie Foundation.
“Moving from crisis to structure within a new reality” became the tag line for the dinner and forum where 30 college and university leaders came together to talk exclusively about student behavioral health, the improvement of which has become one of their highest priorities.
The presidents who attended the event (see list) committed to sending leading members of their teams to a follow on convening on March 2 and 3, also at Georgetown.
The events began with a dinner on the 23rd where sociologist Corey Keyes opened the door to new thinking when he presented his work on flourishing. Keyes teaches the “Sociology of Happiness” course at Emory University and is well known for his theory that the absence of mental illness does not translate into the presence of mental health.
According to Keyes, colleges and universities should strive for students to “flourish”— meaning to exhibit high levels of emotional, psychological and social well-being.
He told the audience of leaders and experts that not flourishing can be as negative as having a mental illness.
Keyes suggests that many of today’s students may suffer from a sort of “flatness” that does not include positive stimuli like sense of purpose, self-acceptance, and good relationships with others.
His theory dictates that just as illness can be prevented and treated, wellbeing can be taught and nurtured.
The Practitioners’ View
Keyes’ thought-provoking remarks permeated the next day’s discussion as the presidents gathered again at Riggs Library for a series of expert panels and facilitated discussions. President DeGioia described the forum as an opportunity to synthesize what institutions are experiencing, what experts are advising, and what the data is showing us to create new approaches to student behavioral health.
The audience first heard from practitioners who provided insights from their work in college counseling and psychological services (CAPS). Paul Barreira, M.D., Director of Harvard University Health Services and Zoe Ragouzeos, Ph.D., Assistant Vice President and Director of Counseling & Wellness at New York University had an on-stage discussion where they exchanged their own experiences and took questions from the presidents.
When asked about national prevalence numbers showing one in three students screening positive for depression and anxiety (American Psychological Association), Ragouzeos confirmed that these were the top two reasons for which students report seeking counseling on her campus. Both doctors said that demand has escalated, causing capacity problems even at the best-resourced schools.
But when asked about how to address the escalating rate of symptoms and rising demand for services, their answers suggested a more complex problem with a range of considerations that extend far beyond the counseling center.
“In looking at students coming to CAPS last fall, it was clear so many of them were really seeking meaningful, empathetic conversations that they couldn’t find elsewhere,” said Barreira. “But that’s not a good use of resources.”
Ragouzeos suggested that wellness programming, together with training for campus community members, can broaden capacity and allow CAPS to serve patients who are at higher risk. In the Q and A portion of the discussion, Ragouzeos responded to a question about the role of faculty.
“Faculty intervention can be on a wide spectrum from noticing a problem and referring it to the Counseling Service to approaching students of concern directly. Regardless, it starts with thinking about their students as whole people,” she said. “This means if they are giving bad news (grades), being pre- pared with information about resources; or sharing their own struggles with wellness which can have a significant influence on students in ways that the mental health professionals on campus alone cannot.”
Dr. John Howe suggested that to craft smarter responses to student mental health, higher education leaders need to better understand the cause of the distress. While the evidence is inconclusive in this regard, both experts pointed to legitimate anxieties that have become the norm in a post-9/11, post-recession world with a 24/7 news cycle.
“The world in which students live is different than when we were in their shoes,” said Ragouzeos. “They feel guilty about tuition. They have lived through active shooter trainings. And they are preoccupied with curating their lives for social media.”
Barreira delivered one of the most memorable quotes of the meeting when he said, “What we are seeing is a crisis of the human spirit; many of our young people are unsure of who they are and where they want to go. And if this is a crisis of the human spirit then the whole community has a responsibility.”
Both Ragouzeos and Barreira cited additional stressors on international students and students of different ethnic backgrounds who may be the first in their families to go to college, which can result in enormous pressure.
College behavioral health involves a complex set of stakeholders with potentially contradictory responsibilities and constraints.
Gabrielle Starr, President of Pomona College, led the next session which involved working in groups to think through the unique concerns of the different stakeholders, both internal and external.
Starr prompted the discussion by asking “Who do students expect to care for them and how?”
The presidents and experts identified stakeholders – from students and faculty to trustees and staff members – and weighed their varying concerns. They then took a “deep dive” into the perspectives of one stakeholder group as the Mary Christie Foundation presented its survey report on college student parents’ perspectives on mental health on campus. (See The Parents’ View, p. 18)
The Presidents’ Panel
If not already evident by the attendance in the room, the critical role that college presidents play in improving their student’s behavioral health was acknowledged throughout the day – from setting tone and policy to sitting down with counseling staff to understand their challenges.
President DeGioia moderated a panel of three college presidents: Sylvia Burwell from American University, Kurt Syverud from Syracuse University and Barbara R. Snyder from Case Western Reserve University, each of whom shared challenges and inroads that resonated with their peers.
Syverud’s opening remark spoke volumes about the gravity of the issue and its place among presidents’ priorities.
“I am so grateful for a whole day to talk about an issue so important to us all. It is like water in the desert,” he said.
Burwell concurred as she explained the motivation for her recent article for Foreign Affairs on student health and wellbeing.
“I am on the Council of Foreign Relations and was asked: ‘What is the one thing we do not know about higher ed that we need to know?’ and the first thing that came to mind for me was the importance of mental health on campus,” she said.
The response she received from this community and others, she said, was indicative of the ubiquity of the concern for these issues across the country.
In seeking examples of new strategies, DeGioia asked Syverud and Snyder about initiatives at their respective campuses. Each has recently implemented major health facility improvements that make it easier for students to access services.
Case Western Reserve University’s new health education campus integrates all of the university’s health schools as well as CAPS and student health into one location, which Snyder says reflects the school’s larger approach to health and wellness on campus.
The new Barnes Center at Syracuse is one integrated building in which CAPS, health, wellness, and recreation services are intermingled. Syverud says its location, on the main quad on campus, is both practical and symbolic.
When DeGioia asked the panel: “Are things different today?” Snyder was optimistic and reminded the audience that a greater focus on health and wellness was good for colleges and that college itself has shown to be a protective factor in young adult mental health.
But she also said there is far more work to be done in this area – particularly around creating connections for students – and noted this is a bigger challenge at larger schools. She cited a new student success initiative at Case Western Reserve where students are assigned a guide for both academic and co-curricular activities throughout their four years on campus.
In closing, DeGioia asked of everyone, “How might higher ed institutions, both individually and together, advance our understanding of these issues?”
In a timely pivot to the next panel, the president of the University of Miami, Julio Frenk, MD, PhD. said, “Universities are criticized for preaching change but not enacting change ourselves. We have an opportunity to apply the knowledge we produce through our scholarship and insight and update our policies and practices simultaneously.”
Turning Research into Practice
As a world-renowned public health expert, Frenk was the appropriate lead conversant for a discussion on how to use data to address – and anticipate – student behavioral health issues.
“Looking at this from a public health perspective, if we take populations and identify patterns, we can devise anticipatory solutions,” he said.
The panel was made up of national experts in college student behavioral health whose data is cited and utilized frequently by colleges throughout the country:
Sarah Ketchen Lipson, Ph.D., Ed.M., Assistant Professor, Health Law, Policy & Management, School of Public Health, Boston University and Associate Director of Healthy Minds Network; Nance Roy, Ed.D., Chief Clinical Officer, The JED Foundation; Amelia Arria, Ph.D., Professor, Department of Behavioral and Community Health, University of Maryland School of Public Health; and Ben Locke, Ph.D., Executive Director, Center for Collegiate Mental Health, Penn State University
Ben Locke opened the discussion by describing his dual roles at Penn State where he is both the director of counseling and psychological services and the director of the Center for Collegiate Mental Health (CCMH).
The center combines counseling center data from 600 institutions, reaching 1.25 million students in higher education. Its sought-after reports provide counselors throughout the country population-level data that tell them what works and what doesn’t.
“Treatment works,” he said, “when it is available.”
Locke said that students seeking services at CAPS are not just the “walking wounded,” with many experiencing serious mental health concerns. Meeting the needs of these students is the focal point of the center’s work.
Locke is currently working on a clinical load index that compares 500 institutions and their staffing levels as it relates to the number of students served. He says the index will eventually become a web-based tool that allows schools to understand what it would take to serve their number of students.
Sarah Ketchen Lipson said her work at the Healthy Minds Network is complementary to Locke’s in that it provides colleges and universities with population-level data, generated by students themselves. The Healthy Minds Survey is used at over 300 schools and by 300,000 students, both graduate and undergraduate, to provide insight into a range of issues, from prevalence and risk to sexual assault, substance use and help-seeking behavior.
Lipson says the Network’s mission includes translating this data into useful tools for practitioners. As example, she cited the Healthy Minds’ return on investment (ROI) calculator that helps schools understand what mental health investments would equate to in terms of retained tuition.
Amelia Arria, who is a national expert on untreated mental health and substance use among college students, talked about the importance of recognizing that academic issues are often rooted in mental health and related substance use.
“If your bottom line is academic retention and success, then you should be concerned about drug use and mental health,” she told the presidents, citing data that show that 43% of frequent marijuana users are skipping class regularly making them academically disengaged.
The foundation of Arria’s work is the College Life Study, a large prospective study of more than 1,200 individuals who were originally assessed as first-year college students and followed up into adulthood.
That study has made significant contributions to the scientific literature regarding the mental health needs of young adults and the risk factors and consequences of substance use among college students.
In her opening statement, JED Foundation Chief Clinical Officer Nance Roy said, “With- out a public health approach, in conjunction with your (the presidents’) support, it will not be possible to effect any long- term, systemic change.”
She spoke of the highly acclaimed JED Campus program, which provides an evidence-based framework that assesses schools’ policies, programs, services and systems and develops a stra- tegic plan to improve campus climates to better support student mental health.
She said the foundation collaborates with the Healthy Minds Network to measure the impact of the JED Campus program on student outcomes.
Much of the experts’ advice underscored the practitioners’ experience that identifying and understanding student need helps provide the right supports to the right students.
“We need to hold up our end of the bargain,” said Locke. If they come, we must serve. But it is important to remember that distress is normal and not everyone requires professional help. This will help navigate the true need for CAPS.”
Roy agreed. “We need to create caring, compassionate communities on campus where everyone has a role to play and there is no wrong door for a student to walk through for support. We may avert a crisis if folks across campus reach out and provide support when a student may be just beginning to struggle. Of course we also need to ensure that everyone knows where the professional resources are to manage acute situations.
In the Q and A portion of the discussion, the presidents were eager to learn more from the experts about a host of issues from evidence on environmental interventions to how to comply with potentially unrealistic mandates.
Arria reiterated that leadership is critical, as is more cohesion between academic affairs and student affairs. All agreed that continuing to bring experts together with policy and decision-makers will lead to progress.
Onward and upward
The last hour of the day focused on preparing for the second convening to be held in March 2020 involving provosts and student affairs leads from these same institutions.
Georgetown’s Vice President for Strategy, Eugenie Dieck, led an exercise where presidents reflected on their time at the convening, and identified topics they wanted their leaders to address at the March meetings.
Dr. Howe and President DeGioia expressed their gratitude to the presidents for their engagement and participation amidst schedules filled with competing priorities.
In his closing remarks, DeGioia said, “I am not sure there is another sector that could meet for a conversation such as today’s and emerge with this sense of promise. The hope is that we can set the standard for improved wellbeing for many others.”