JED’s POV on Student Mental Health and Well-Being in Fall Campus Reopening
August 27, 2020
In the last five to six months, the United States has been hit by a wave of public health and other societal challenges that are already having an impact on how colleges and universities reopen in the fall. First and foremost, the COVID-19 pandemic has turned our world upside down and, according to the Center for Disease Control, has disproportionately affected people of color more than white people, due to inequities in health care and racism. Additionally, police brutality against Black Americans has been graphically demonstrated in the media accompanied by protests across the nation. Many citizens are confronting the fact that such brutality has occurred for a very long time in this country. Video-recordings, such as the one showing the horrific murder of George Floyd by police in Minnesota, have gone viral on social media and have given Americans a sobering reminder to these realities. Furthermore, xenophobia has negatively impacted many Asians and Asian Americans who are being blamed wrongfully for COVID-19 and subjected to violence and discrimination. The financial impact of the virus also has been devastating, with millions of people losing their jobs and needing to apply for unemployment. Collectively, these issues have created a perfect storm that has taken a toll on society. As students, faculty, and staff return in the fall, institutions of higher education must be prepared to support their campus community members as they work through experiences of anxiety, pain and trauma toward healing.
Data recently collected by the 1) American College Health Association (ACHA) and the Healthy Minds Study, 2) Hope Center for College, Community, and Justice, and 3) a recent national survey of college students by a higher education marketing firm shows that students are coming to or returning to campuses with higher rates of anxiety, depression, suicidal ideation, financial stress, and insecurities around basic needs than before the pandemic. Many students also express a general lack of confidence in their school administrations for ensuring their safety and well-being. Amidst the self-reported student emotional and psychological distress, however, some recent research out of Germany offers some insight into how certain coping strategies and mindsets may improve overall psychological well-being and coping. Higher education institutions would do well by their campuses and students by infusing more positive perspectives as discussed in the research.
The Jed Foundation (JED) has been supporting and connecting with hundreds of colleges and universities during the global COVID-19 pandemic as well as through the pain of the racial injustices and economic hardship. Our established JED Campus program and higher education team has quickly pivoted to provide increased consultations, connection calls with campuses across the country, webinars, and enhanced learning community offerings in order to address pertinent student mental health and well-being challenges and opportunities.
Campus re-openings this fall will be like no other in history and, in some cases, several key questions still loom. Will classes be in person, remote, or hybrid? Will students return to residence halls? Will plans change in the middle of the term? According to a joint tracking system being coordinated by The Chronicle of Higher Education and Davidson College’s College Crisis Initiative (C2i) of over 3,000 institutions, the current (as of August 17, 2020) plans for schools are as follows: primarily online (25%); primarily in-person (21%); hybrid (14%); fully online (5%); fully in-person (2.5%); other (6%); and to be determined (26%). Of course, these percentages are changing rapidly given the evolving landscape of public health recommendations/directives and the trajectory of new COVID-19 infections.
Below we offer some considerations for our college and university campuses as they continue to prepare and work through supporting the mental health and well-being of their communities during the fall reopening, in whatever format it will take for each campus. We have organized our recommendations by the various domains of JED’s Comprehensive Approach to Mental Health Promotion and Suicide Prevention for Colleges and Universities. Because each of the domains are not discrete or mutually exclusive, the reader will find that some recommendations can be applied across several domains. We would like to emphasize that the list of recommendations is not meant to be exhaustive and may or may not work on every campus. We put them forward for consideration only and each campus can determine if/how they will work for their specific communities.
Employing a comprehensive, public health approach and engaging in an active and dynamic strategic planning process is the most important first step that higher education institutions can do to facilitate the future success of their mental health, substance misuse, and suicide prevention efforts. Now, strategic planning must be inclusive of and consider the impact of the COVID-19 pandemic and racial injustice issues on programming, personnel and financial resources, health and counseling services, and institutional communication. In addition, institutions would do well to call upon the various experts on their campuses to provide strategic guidance around reopening generally, but more specifically around student mental health and well-being. For example, inclusion of mental health professionals and health promotion staff would offer campus planning teams those critical perspectives.
Understandably, priorities have shifted during the pandemic, and schools are scrambling to adjust to meet new demands. However, we know that student mental health does not exist in a vacuum and is largely impacted by the pandemic and current events, so it is important that existing mental health and or suicide prevention campus task forces/committees continue to address student health and well-being needs. One example to consider is the 8 Recommendations identified by a task force at Harvard University for ways emotional wellness on campus can be improved by addressing a mix of academic, social, and institutional issues. Campus planning also should be inclusive of graduate/professional student needs in addition to undergraduates, a point that was accurately and eloquently made by a current graduate student at Cornell university.
It is critical that campuses learn more about trauma and how to incorporate a trauma-informed approach that will help in creating healing communities. A great resource for learning more about trauma and a trauma-informed approach is Substance Abuse and Mental Health Services Administration (SAMHSA) Concept of Trauma and Guidance for a Trauma-Informed Approach. Now, more than ever, there is a greater need for trauma-informed healing spaces for students to process the toll of recent current events and adjustments. An American Psychological Association (APA) article entitled Life After COVID-19: Making Space for Growth references the theory of post-traumatic growth and suggests people can emerge from trauma even stronger. It is important for schools to create spaces that nurture this post-traumatic growth and plant the seeds for positive change. A great example of this strategy can be found at Appalachian State University, where a Racial Trauma Healing Space dedicated to the needs of Black students on campus is being offered. JED recommends reviewing practices around Diversity, Equity, and Inclusion to inform ways to engage diverse student populations, actively addressing current events, and creating a trauma-informed approach to strategies for campuses. The Equity in Mental Health Framework and Toolkit developed by JED and the Steve Fund can provide some concrete ideas and actions steps to follow.
As students are inundated with constantly changing updates and information regarding plans for the fall, it is important for communication with the campus community to be intentional, clear, timely, relevant, and concise. In addition, leadership qualities of curiosity, flexibility, risk tolerance, and ability to focus on what is most important enhance community trust in processes and decisions. Communication should include mental health language and resources. The American Council on Education published a guide entitled Mental Health, Higher Education, and COVID-19 with strategies for leaders to support campus well-being through consistent and clear communication. As campuses increase virtual communications to convey important messaging and updates regarding critical moments such as those experienced during COVID-19, the use of the right tone in social media has become essential. JED’s Webinar on Communication Strategies for Institutional Leaders discusses how social media can be used in a way that shows authentic empathy and care, and tips for leveraging social media channels to reach out to campus communities.
Life Skills Development
Supporting life skills education is a valuable strategy for helping students cope with stressors, make wise lifestyle choices, foster resilience, and achieve academic success. According to data collected by ACHA and the Healthy Minds Study before and during the pandemic, levels of resilience have increased during the pandemic. Conversely, rates of positive psychological “flourishing” have decreased in correlation with a sharp rise in mental health problems that are impeding academic performance. The conclusion that can be drawn from these data and from feedback JED is hearing from students nationwide is that campus communities need to have a renewed focus on teaching life skills that will foster the development of resilience and benefit overall well-being.
JED continues to emphasize that building academic and personal resilience should be infused into the curriculum and learning environments. This can be accomplished through ongoing faculty and staff development and through specific courses, workshops, and online training modules. The Student Resilience Project at Florida State University and the Resilience Lab at the University of Washington are two excellent examples of resilience programs that include interdisciplinary engagement from faculty, staff, and students. It is important to ensure that the content is responsive to current needs; for instance, FSU sent out new content that focused on coping skills during the pandemic. It may be beneficial to include specific resources for faculty and staff as they are also facing unexpected challenges and stressors. Vanderbilt University Medical Center created a Resilience Toolkit for faculty and staff with a variety of content addressing attitude, skill sets, and lifestyle.
JED recommends planning workshops and programs for the fall in a variety of formats depending on the extent to which the institution is physically open and what public health practices are recommended or required. Programming should replicate what is happening with most academic courses. There should be opportunities for synchronous, live programming, and asynchronous online modules that students can view on-demand. A few JED Campuses, such as Rowan University and Carnegie Mellon University, have updated event calendars with tags that are specific to well-being skills and delineate the mode of program delivery. The University of Wyoming has created a virtual Campus Recreation Center with physical and mental well-being programs and services, including virtual intramural sports teams. Other important life skills that campuses should focus on for the fall are gratitude, compassion for self and others, empathy, processing grief, and mindfulness as personal, community, national, and international challenges will continue. JED Campuses like Virginia Commonwealth University, Hamilton College, and Wake Forest University have highlighted these skills and others on their new comprehensive resource pages, and the University of Pittsburgh will be cancelling classes on October 14, 2020 as a Student Self-Care Day to provide opportunities for students to discover and rediscover their self-care routines.
Research has shown that loneliness and isolation are significant risk factors for mental health problems and/or suicidal behavior. We know that feelings of loneliness have been exacerbated by social distancing during the last several months, and the effects of social isolation are being felt widely. Supportive social relationships and feeling connected to the campus and local community, family, and friends are protective factors that can help lower risk for suicide.
Consider ways to facilitate interpersonal relationships among students virtually, promote cultural inclusiveness, and support connectedness among underrepresented or higher risk student groups. One way of emphasizing diversity and inclusion in programming is to ensure support spaces are replicated in the digital space. A great example of this is Appalachian State University’s “Engagement, Interrupted” Podcast that was launched during the COVID-19 outbreak in the spring. It features stories from students of how they are coping, surviving, and thriving while their classes, jobs, lives, and connection to the Appalachian community are interrupted.
It is more important than ever for staff and family, including academic advisors, residential advisors (RAs), and parents, to ask about loneliness and isolation during virtual meetings and at home, and to be able to identify warning signs and communicate concerns. Health, Wellness, and Prevention Services at Eastern Washington University has highlighted a webinar for parents on Supporting Your Student During COVID-19.
JED recommends creating or adapting positions for virtual RAs or peer advisors to be responsible for regular connection calls with students via Zoom meetings (both 1-on-1 and group). Robert Morris University’s Peer Outreach Program, Thrive, has excellent examples of virtual outreach and engagement via Instagram. Faculty and staff at Northeastern Junior College are reaching out individually to all enrolled students to see how the transition is going for them and what resources/support they may need.
In a Quadcast episode by the Mary Christie Foundation, two college health care experts encourage faculty to utilize break-out rooms during online classes to give students an opportunity to connect and initiate study groups, especially first-year students, to promote interaction outside of the classroom. They also emphasize the importance of creating outdoor programming (i.e. outdoor movie nights) and online interactive games to create a sense of belonging, especially for first-year and transfer students.
Student activism may be another way for students to connect and may serve as a way to foster healing in the midst of racism and other social injustices. We encourage campuses to work with their students to ensure that appropriate supports and structures are in place for students to do this type of expression. We know that activism can also be emotionally exhausting, therefore, it will be critical to provide a variety of support resources for students to access. JED’s Chief Diversity and Inclusion Officer, Dr. Sofia Pertuz recently co-moderated a webinar with the Steve Fund’s, Dr. Jan Collins-Eaglin on the topic of supporting the mental health of students speaking up against racial injustice.
Identifying Students at Risk
Early identification of students at risk is a critical campus suicide prevention and mental health promotion priority. JED’s three key recommendations for expanding an institution’s mental health safety network remain important for this fall: supporting the transition to college for incoming students, providing robust screening opportunities at diverse touchpoints in the student experience, and training campus community members and parents and families to identify, reach out to, and refer students at risk to appropriate resources on campus. As students’ mental and physical health needs continue to grow, and as many students may be far from their physical campuses, an institution must expand the reach and strength of their response systems.
Training “gatekeepers” who interact most frequently with students, such as faculty, academic advisors, support staff, residence hall staff, and fellow students, is just as important as before the pandemic. Faculty members in particular may often be the only connection a student will have with their college or university, especially if they are only completing courses online. Campuses should evaluate existing gatekeeper training programs that were typically completed in person and adapt them for a virtual format. JED’s You Can Help a Student and You Can Help a Friend gatekeeper training programs are available to all JED Campuses and for purchase for institutions not participating in the program. The Suicide Prevention Resource Center (SPRC) also has a list of online-only gatekeeper training programs that institutions can refer to.
Beyond formal training for the campus community, JED recommends that institutions make a concerted effort to promote resources for faculty, staff, students, and parents and families to recognize warning signs, respond, and refer students with up-to-date information about support services. Information should be featured prominently throughout an institution’s website, not just on the counseling or wellness center webpages. JED’s Chief Diversity and Inclusion Officer, Dr. Sofia Pertuz facilitated a webinar during the pandemic for faculty on managing and responding to student stress in online learning environments that all institutions can share with their campus communities. To reach parents and families, Eastern Washington University hosted a webinar with tips on supporting students through the pandemic. JED’s Seize the Awkward campaign is continually updated with content that institutions can use in helping students recognize warning signs and engage in conversations about mental health.
As physical health screenings will have a renewed importance to cover COVID-19 symptoms, JED recommends that campuses also integrate mental health, substance use, and suicidal ideation screening questions in those processes. Adding these screening questions will provide useful data on what underlying mental health or substance use problems students may be experiencing and can allow the clinician to facilitate quick referrals to services on or off campus. Additionally, online screening tools should be promoted to students as resources for checking in on their mental health. Mental Health America recently released statistics demonstrating increased usage of their online screening tool, the highest rates in six years of operating, and more than a quarter of a million screened positive for a mental health problem in the month of July. JED’s self-evaluator is a free online screening tool offered to colleges and universities that provides relevant campus resources for students who screen positive for a mental health or substance use problem and provides the campus administrator basic analytics and statistics on screening results.
Increase Help-Seeking Behavior
Promoting help-seeking behavior is an important early intervention for students experiencing mental health or substance use issues or those that are actively in crisis. Students experiencing emotional distress are often reluctant for a variety of reasons such as skepticism about the effectiveness of treatment and/or prejudices/stigma associated with mental illness, to name just a few. In a report by the Healthy Minds Network and ACHA on the Impact of COVID-19 on College Student Well-Being, 60% of students reported the COVID-19 pandemic has increased the difficulty of accessing mental health care.
JED recommends increasing physical health, mental health, substance use, and suicide prevention campaigns specific to COVID-19. Advertise public health and social services resources that students may need and point them to online directories, like Aunt Bertha which lists free or reduced cost care and basic needs services by zip code. Feature information about services available in newsletters, like The College of New Jersey’s Health & Wellness Newsletter, or create specific landing pages for mental health resources during the pandemic, like this one at Washington University in St. Louis.
In the virtual world, it is important that reliable information about available resources and referrals, including cost of treatment, and insurance coverage, etc., be easily accessible. Ensure that accurate resource information is displayed prominently on websites, including COVID-19 landing pages. Colorado College features wellness and mental health on their Coronavirus Updates & Resource page, including a video message about managing anxiety and stress. Pacific Lutheran University links to resources for coping with COVID-19 anxiety on their website, including JED’s Love is Louder Action Center, which provides resources and tips for taking care of physical and mental health, and supporting each other during this time of uncertainty. Lastly, the Quadcast episode by the Mary Christie Foundation, emphasizes the importance of outreach directed to underserved populations.
Provide Mental Health and Substance Use Services
JED always has asserted that institutions should offer accessible, consistent, and high-quality mental health services to students. To make mental health and substance misuse care more comprehensive, approaches to care should include adequate staffing levels, staff diversity reflective of the student population, flexibility in treatment approaches, and strong partnerships with off-campus providers that can offer supplementary and specialized services. As detailed throughout this document, we can predict that our students are going to need mental health and basic needs support to address pre-existing, consequential, and environmental challenges on a wide scale. We are still learning the impact of telehealth on student utilization and access to services across regulatory boundaries, institutional type, and other variables. Campuses that have seen lower utilization rates have attributed the lower numbers to students having privacy concerns, access to effective technology and reliable internet, and increased informal support from being at home or a different environment. Conversely, some institutions have seen utilization rates climb as a result of effective outreach and referrals, an increased need in services during these challenging times, and the fact that teletherapy has removed pre-existing barriers to services for more individuals.
As most campuses have had time to build telehealth infrastructures, JED recommends that pre-COVID outreach and quick access programs should be adapted as appropriate for the virtual space. Many institutions have created “Let’s Talk” drop-in hours that were strategically placed across campus for brief, walk-in consultations with clinicians. Montclair State University and the University of Pittsburgh are two JED Campuses that have transformed that program into “Let’s TeleTalk”. Campus counseling and wellness centers should ensure that their websites are updated with their updated service models, scopes of care, virtual offerings, and relevant resources. Goucher College’s Student Counseling Center and Pacific Lutheran University’s Counseling, Health, and Wellness Services websites are great examples of revamping existing websites to relay pertinent information.
As students return, it is important for counseling and health staff to be proactive in addressing current events around racial injustice by posting statements on their websites, offer diverse mental health resources, and be transparent about on-going diversity, inclusion and equity staff training. JED has put together a database of diverse mental health resources including many types of resources targeting a range of demographics. Schools like University of Washington Seattle, Wake Forest University, Virginia Commonwealth University, and UC Davis offer examples of websites with statements and resources. As schools are updating counseling websites, it would also be helpful to include resources about issues with increased screen time and its effects on mental health and well-being. NPR and the NY Times report on “doomscrolling” and tips for stopping the cycle.
Developing or strengthening Memoranda of Understanding agreements (MOUs) and referral partnerships with local health services to aid with testing, contact tracing, and emergencies are needed more than ever. JED recommends scheduling virtual calls with providers to discuss standards of care and services before the academic year begins and regularly throughout the fall. ACHA’s recommendations on reopening campuses includes establishing MOUs with hospitals, service providers, and hotels for quarantine purposes. And, as Counseling Centers continue providing services, it is important to ensure clinicians are trained in providing trauma-informed care.
Strategies should be put in place to ensure that healthcare providers are being supported. Care for the caregiver is even more critical during these times. There is high potential for vicarious traumatization, video-conferencing fatigue, and burnout. Further suggestions might include frequent de-briefings with peers, additional training, and regular in-services focused on relieving clinician stress. Also, we know that this is a challenging time for faculty and staff members. Faculty members who are asked to teach in person also are asked to balance the risk and efficacy of their instruction. Staff and faculty are tasked with processing their own experiences and the impact of the pandemic and racial injustices while also supporting the needs of students. JED’s Director of Higher Education and Student Engagement, Erica Riba, collaborated with EverFi and Active Minds to write A Letter to Student Mental Health Providers highlighting the important players in the college mental health space who have been serving students during this uncertain time and offer strategies to support their continual impactful work. Care for the Caregivers is top of mind at JED, and we encourage everyone to take care of themselves and seek support during this time.
Follow Crisis Management Procedures
Having clear crisis management policies and protocols in place, including a focus on crisis prevention and effective responses when crises occur, is central to the safety of students and the campus community. Clear and accessible emergency and postvention protocols help guide faculty and staff when a student is struggling and provide readily accessible emergency information, including crisis phone numbers, chat, and text services. As fall classes begin, COVID-19 policies and protocols should be in place and available to faculty and staff.
Behavioral Intervention Teams (BIT) or At-Risk Teams serving to collect and respond to reports of students of concern should be adjusted for the online environment. Additionally, BIT teams should be widely publicized, especially to parents and families. For example, Roger Williams University links their Students of Concern reporting form on their Parent/Family webpage. Santa Clara University informs parents of how to recognize and help students in distress as part of their culture of CARE. Moreover, faculty and staff should be clear, especially working with students virtually, on how to find crisis resources. A strong example of this is Stonehill College’s Red Folder initiative, designed as a guide to help faculty, staff, and community members to recognize, respond, and refer distressed students.
JED continues to emphasize the importance of postvention protocol and recommends looking at how protocol is applied if/when a campus experiences a death due to COVID. Some colleges and universities have already created online memorials for faculty, staff, students, and alumni lost during the pandemic, like the CUNY Online Memorial. Reference the HEMHA Postvention Guide to revisit or create institutional policies, like UC Davis’ Postvention Guide. Utilize ACHA’s Considerations for Reopening Institutions of Higher Education in the COVID-19 Era to include draft messages for COVID-19 deaths in postvention guides.
In light of the trauma created by police brutality and efforts calling for defunding of police, campuses who utilize police to transport students to hospital emergency rooms for mental health reasons should assess whether that continues to be the best approach. Police intervention in these highly sensitive situations has the potential of being triggering for those involved. Working with campus police to encourage the use of non-uniformed officers and unmarked cars for this purpose may be helpful. Partnerships with local mobile crisis units and behavioral health care providers could be another alternative depending on your community’s resources and how effective those services are considering response times, cultural competency, and experience with student mental health, among others. SAMHSA provides a comprehensive guide on best practices in mental health crisis care services that can be useful to evaluate services in the community. One example of an effective program is Northwell Health’s Behavioral Health Partnership program with colleges and universities.
Restrict Access to Potentially Lethal Means
As the most empirically supported measure to prevent suicide, it is essential to implement means restriction activities on college campuses. One of the most effective strategies we have learned from our work at JED is for a campus to conduct an annual environmental scan to identify and mitigate access to potentially lethal means. However, many students will not be physically attending classes or residing on campus this fall. JED recommends that campuses promote resources for means restriction in the home to parents and families and students and to students who reside in apartments off-campus. The Harvard University Means Matter Campaign includes recommendations around firearms, medication storage and disposal, and substance use/misuse. It is also important to note the correlation between access to firearms and suicide as there has been a significant increase in firearms sales during the COVID-19 pandemic.
Ongoing means restriction practices should continue to occur on campuses regardless of the stage of reopening. With fewer people on campus, it could be an opportune time to complete environmental scans, renovate spaces with breakaway closet rods, and create and install crisis signs in appropriate spaces. Campus security personnel should continue to monitor and restrict access to rooftops, windows, other high places, and toxic substances. JED’s recommendations for means restriction reflects best practices from the SPRC.
The JED higher education team hopes that these resources, recommendations, and considerations prove helpful to your campus. We encourage you to share in our learning community any strategies you are using on your campus that are promising in aiding your community in navigating these very distressing and unpredictable times. As usual, thank you for your dedication and compassion in supporting your students’ emotional and psychological well-being.