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Colleges are moving toward 24-7 mental health services.

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The COVID-19 pandemic created a greater need for college mental health services as students struggled with the social and economic consequences of shuttered campuses, online learning and, in some cases, the illness or death of loved ones. Now, as most institutions resume more normal in-person operations, they are leaning on telehealth mental health services to deliver help to students, whether they are on campus or off.

“We’ve seen that a lot of schools are focusing more on their services and making sure that they have an offering for health and well-being such as telehealth and teletherapy,” said Seli Fakorzi, director of mental health operations at TimelyMD, a telehealth provider. “Campuses are now thinking about whether they’re offering enough services that provide virtual and in-person support.”

In June 2020, TimelyMD found that 85 percent of college students said they were experiencing increased stress and anxiety due to the pandemic and uncertainty about continuing their education. Another poll from the Beginning College Survey of Student Engagement found that 53 percent of first-year students reported a substantial increase in mental and emotional exhaustion. Because of the increased need for services, institutions are beefing up their mental health resources for the fall semester. And given the wide range of student needs and living and learning situations -- on campus, off campus, in person, remote, hybrid -- many institutions are using technology in innovative ways to provide counseling and support services for all who seek them.

T. Anne Hawkins, director of West Virginia University’s Carruth Center for Counseling and Psychological Services, said she and her team recognized that they needed to do something “outside the box” for the upcoming fall semester. So they established a yearlong partnership with Talkspace, an online platform and app that connects students with licensed therapists. Students can send their therapist text, audio, photo and video messages at any time, as well as schedule live video sessions. Hawkins said the partnership is especially helpful for out-of-state students because of telehealth licensure laws. Since the semester started Aug. 18, 178 students have signed up for the app, Hawkins said.

“We know that some of our students have not returned and are out of state or somewhere else in the state navigating virtual learning,” Hawkins said. “Our goal really is to increase mental health services to support students and to help them process the events of the pandemic and transition back into in-person learning.”

She added that the university has a “wide menu” of mental health resources, both in person and virtual. In addition to seeing counselors on campus during business hours, WVU students have 24-7 access to the Crisis Text Line, a mental health service where they can text a live, trained counselor who responds to messages privately. Students can text back and forth with the counselor, who asks questions, empathizes and actively listens. ProtoCall is another mental health service students can call for crisis intervention and stabilization, as well as to get referrals for network providers and other resources.

Such programs show great promise in helping students. Studies have found that teletherapy can be just as effective as in-person therapy for treating post-traumatic stress disorder, depression and anxiety, as one researcher told The New York Times. Even before the pandemic, researchers from the Milbank Memorial Fund, a nonprofit health foundation, drew similar conclusions, also pointing out that telebehavioral health can cost less than in-person visits and reach more people as well.

“What we’ve seen is that telehealth is essentially just as effective as face-to-face psychotherapy -- and retention rates are higher,” David Mohr, director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, told the American Psychological Association.

At Belmont University in Tennessee, Katherine Cornelius, director of counseling services, said students are split between wanting in-person or virtual mental health services. During the first two weeks of classes, the institution saw a 60 percent increase in the number of counseling appointments compared to 2019, Cornelius said. Her office has been working to increase mental health access to nontraditional students -- including graduate students or those with full-time jobs.

“We’ve really been focusing in the last several years on increasing access to care and decreasing barriers,” Cornelius said. “Telehealth has been a huge benefit for that. Students don’t have to travel to campus, and we saw a lot of students were really concerned about their health, so they really feel more comfortable doing virtual visits.”

Before the pandemic started, Belmont purchased Therapy Assistance Online, a virtual self-help platform that offers self-guided tools, educational and interactive modules, journals, and progress trackers, to which all Belmont students, faculty and staff have free access. This fall, the school also purchased Timely MD’s TimelyCare, which provides free virtual physical and mental health support and is accessible 24-7 to all Belmont students, Cornelius said.

“Students’ lives don’t end at 4:30 p.m. when our office is closed. A lot of them just start,” Cornelius said. “So TimelyCare is kind of filling in the gap for after hours.”

At the University of Virginia, Nicole Ruzek, director of counseling and psychological services, said students were struggling with issues beyond the pandemic. Many felt the impact of racial injustice following the deaths of George Floyd and Breonna Taylor, among others, at the hands of police, as well as anxiety over the climate crisis and the divisive 2020 presidential election. She said students seemed to like both in-person and virtual counseling, so her department is providing hybrid options. In 2018, the university contracted with SilverCloud, a virtual mental health platform that focuses on digital therapy, to give students access to informational videos, mental health questionnaires and interactive tools.

In addition, the university signed a contract with TimelyMD “to continue to meet that demand for service,” Ruzek said. The contract allows students to have 24-7 virtual access to one-on-one counseling, psychiatric services and on-demand support with a health professional.

“Some students really appreciate having telehealth as an option. It can be much more convenient if they don’t want to travel,” Ruzek said. “To have that option to be able to engage with a mental health provider, through remote service, I think is really helpful. Then there are other students who really want to be seen in person.”

Cooper Union, a private college in New York City where the majority of students commute, has had to develop mental health resources that meet students while they’re on campus and when they are at home, said Chris Chamberlin, dean of students.

“We’re small and we try to capitalize on our geography and all the resources that are available to us here in New York City and in our neighborhood to provide students with a significant amount of access to care,” Chamberlin said.

In partnership with TimelyMD, Cooper Union created Cooper Care, an app and online platform that give students 24-7 access to virtual health-care providers. Chamberlin said the use of Cooper Care with the institution’s own counseling program has created “maximum flexibility” for students to meet their needs. He added that students are instructed during Welcome Week to download and set up the Cooper Care app so when a crisis occurs, they can immediately access help.

And it’s not hard to get students engaged in telehealth resources if campuses normalize their use, Fakorzi of TimelyMD said. Round-the-clock services like TimelyCare can connect students with help during late and early hours when in-person care is unavailable if they run into a crisis.

“If issues overflow at 4 in the morning, I think it’s definitely a benefit for campuses to have a backup program to say, ‘Hey, this is also a place where you can get some help,’” Fakorzi said. “But it also gives the campus the security of knowing help is there.”

There’s still a stigma around getting mental health help, Cornelius, of Belmont, said. Some students have concerns around confidentiality, while others come from backgrounds where treating mental health isn’t the norm. And there’s a greater stigma against students struggling with mental health issues other than depression and anxiety, she said, including bipolar disorder and trauma.

Ruzek at the University of Virginia said the switch to more virtual mental health resources has opened up access for students from families or cultural backgrounds that typically don’t seek mental health help.

“They don’t have to even walk through our doors anymore,” Ruzek said. “They can connect with us electronically and we can get them connected to the right resource without their parents knowing, if they don’t want their families to know, or even without their peers knowing if they’re in a private location.”

Chamberlin agreed, saying the switch to telehealth “created access in a way that didn’t exist before,” when many mental health resources were confined to a certain time and place on campus.

“More and more students are engaging with our virtual programming, whether that’s actually seeing a therapist remotely or participating in a workshop that they wouldn’t normally be able to do,” Chamberlin said. “I also think we’ve continued to do a number of things virtually that we could have done in person because we also know people learn differently and people engage differently.”

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