Coping with a crisis: how can universities provide mental health resources during a pandemic?
Georgetown University junior Rebecca—who asked to be identified only by her first name—thought therapy helped her move past her fear of death. Then the coronavirus pandemic hit. “Seeing everybody else panic sort of makes me panic. It’s been hard to not get back into old thoughts,” explained Rebecca.
“Because one of the things I struggled with in therapy a while ago was the intrusive thoughts of thinking that everyone was gonna die. So that’s kind of resurfaced a little bit. And it’s hard, because there’s a degree to which it would no longer be irrational to fear for my loved ones.”
In the wake of the pandemic, most college students have been sent scrambling to their homes as institutions started switching to online learning. For some, this has also meant losing crucial mental health resources like group therapy sessions, access to mentors, and the routines that their universities provide. What kind of rapid responses can students expect from their universities? Psychiatrists agree that college students are particularly vulnerable to mental illness. There are a myriad of explanations for this: difficulties adjusting to college, anxiety stemming from classes, and differences in how children are growing up now compared to previous generations, among other reasons. Whatever the exact cause or causes may be, the data points in one direction: a rising trend in mental health issues among students.
According to the National College Health Assessment from spring of 2019, out of 67,972 students from 98 different colleges surveyed, more than half were experiencing overwhelming anxiety, exhaustion, loneliness, hopelessness, and sadness.
Georgetown University’s Counseling and Psychiatric Resources—commonly known as CAPS—had already been struggling to meet a growing demand before COVID-19 hit. This academic year, CAPS initiated a waitlist system due to the high number of students that were trying to use their services. CAPS staff psychologist Saryn Levy wishes that her service didn’t have these problems, but “resources are being divvied up among a number of really, really important areas on campus. It doesn't feel like resources are being wasted. But certainly, we see a pretty high demand for mental health services; and I know it pains all of us when we have to say, ‘Hey, I know you really need this. I know there are other options. We're so glad you came. Can we put you on a waitlist for a couple of weeks?’”
One Georgetown student, Isa Martinez, had to wait for months before being given an individual therapy slot. She first tried to schedule an appointment in early November, but was told there was a waitlist for the rest of the semester. When she tried again during the first week of classes in January 2020; the same problem occurred: “They told me they were still processing patients that had been on the waitlist since last semester.”
While Martinez waited to be assigned an individual therapy appointment, she attended an interpersonal mindfulness group that her initial counselor recommended during her consultation. This was something that she had never thought about trying due to her struggle with social anxiety.
“The reason that I felt like I should do this group therapy is because I wanted help. I wanted help now.” Martinez said, her voice heated. “And I didn’t want to wait until March 3rd, or whenever. Because they don’t give you any indication of how long it will take. So I was just waiting and,” she paused, “I didn’t want to f------ wait any more.”
For some students, group therapy has been a more accessible alternative to one-on-one therapy—a way to bypass the long, uncertain wait times CAPS is currently experiencing and expedite access to a therapist. Therapy groups are confidential support groups, each designed to tackle a specific subset of issues that college students face.
Martinez was also quick to express the benefits of the therapy she’s received. “It’s a very small group, it’s free and it’s limitless, so you can go semester after semester.” Unlike CAPS’s individual therapy—which is designed to treat short-term cases and is capped at 6 sessions per semester—group therapy is an option for students who need therapy long-term, like Rebecca, who participates in a support group for students with eating disorders.
However, the novel coronavirus has now eliminated this resource. On March 17, Rebecca received an email from the facilitator of her therapy group.
“Given concerns related to the spread of COVID-19 and Georgetown's move to remote learning, we are cancelling all CAPS groups moving forward,” read the email. “We're deeply saddened by the loss of this shared space, but also recognize the need to prioritize everyone's safety above all else.”
This came as a disappointment to Rebecca. “I do think that an online group would’ve been feasible if people would be willing. I just don’t know. The only thing I could think of is maybe there are problems with confidentiality over Zoom. I hope they reconsider, but I don’t know if they will.” CAPS staff psychologist Levy echoed disappointment over this change stating: “I co-led two groups on campus. I love group [therapy]. I think it's such a useful, meaningful modality. ” But switching to internet platforms presents challenges.
Teletherapy has been a great alternative for Kathryn Burner, a licensed therapist who works with college students across the DC metropolitan area, who otherwise would have had to give up her face-to-face sessions with clients. But, she notes a downside: “The fact that my clients and I are doing teletherapy is a reminder that life is not as it once was, and that routines are being affected.”
Burner herself has been adjusting to the changes and admits that her practice “had never done teletherapy as an agency.” In an email she stated: “there was quite a bit of work involved in making that transition, including: notifying clients of the change, making sure clients had access to resources to do teletherapy, confirming with insurance providers that they would cover teletherapy visits, and finding a secure and HIPAA-compliant platform to use.” Nevertheless, she was able to pivot quickly and was already practicing teletherapy by mid-March.
Students have had to wait as their college-based services considered how to handle legal complications with using technology. In March Phoebe Velez, a sophomore at Syracuse University, discussed the uncertainty of her own group therapy’s future due to New York state’s law that therapy cannot be given over the phone to someone out-of-state. This poses an issue to her own group, as many of the members do not live in the state of New York.
The American Psychological Association website confirms this, stating, “For most states … you may need to be licensed both in your own state and in your clients' state in order to practice.” As many policies regarding telepractice have been adjusted or temporarily disbanded during the coronavirus pandemic, the APA has created a special page on its website dedicated to practice guidance during COVID-19.
Licensing requirements still pose a problem for many students, including Martinez, whose CAPS individual therapist isn’t licensed to practice in Florida. However, her student health insurance qualified her for BetterHelp, an online counseling service plagued with controversy. “It’s been a good experience so far, but pretty rough to start at square one with a new person,” Martinez said.
Velez, however, still remains at a loss; an integral part of her mental health routine is missing. “[This] really sucks because I tried for over a year to get into a group, because given how few counselors there are on campus, individual therapy is intended to be a short-term service,” Velez wrote on March 30th. The inadequacy of university mental health services to provide quick and long-standing care for students already sets the bar pretty low, and the emergence of COVID-19 has just added extra stress to an already fragile system.
Patients are not the only ones frustrated with the legal constraints around teletherapy; Levy has had to confront the same problems. “If I have someone reach out who's in North Dakota, [CAPS doesn’t] have anybody on staff who's able to practice in North Dakota at this point, and North Dakota hasn't changed licensure laws to allow any of us temporary provisions. How do we make sure we're not leaving that student hanging and really work with them for a comprehensive referral experience?” Levy also raised HIPAA as a constraint.
By April 10th Syracuse University was able to find a way to provide digital group therapy through the purchase of a HIPAA compliant Zoom extension. Burner’s practice is using a similar service, doxy.me, a video conferencing platform made specifically for telehealth.
Georgetown’s CAPS has adopted a different approach to substituting in-person group therapy. On Friday, April 3rd CAPS sent out an email with the subject line, “*NEW* CAPS 2020 Online ‘Groups.’” Inside were descriptions of five different email blasts that students could sign up to recieve on a weekly basis.
The resources in these email blasts vary: some include interactive messages, such as meditation playlists, mindfulness podcasts, and lists of activities for maintaining a social life while in quarantine. Others deal with more personal topics, like managing trauma or recovering from eating disorders while at home. All but one of these blasts correspond with preexisting CAPS therapy groups. As the CAPS communication notes, “We've reconfigured our group content for an online format.”
Levy thinks that these email blasts provided by CAPS are a smart way to work around the legal restrictions of telehealth and to reach a larger audience. “I'm doing a recovery while remote newsletter blast each week and demand for that has been great. We're seeing far more people than who were in the group registering for those newsletters.”
One student, who preferred to remain anonymous, pointed out that the Alcohol and Other Drugs Exploration Group received no similar substitute. The student conceded that “one might expect things to fall through the crack” in this transition, but also emphasized that the COVID-19 pandemic presents fresh challenges for students struggling with substance abuse.
While these newsletters provide helpful information and tools for dealing with trauma and anxiety while in isolation, they don’t make up for the in-person group therapy that some students rely on. Students in distress have to sort through all this material to figure out what would be a good fit and web resources still leave students isolated and missing the group therapy that has become an integral part of their routine.
The email blasts do recognize there are new emerging mental health issues stemming from the coronavirus. But whether that manifests as anxiety about the virus or dealing with resurfacing mental health struggles in isolation, it still requires adequate healthcare and access to resources including personalized counseling and group therapy.
Phil Meilman, the director of CAPS, acknowledged the impact this pandemic has had on students’ mental health. In an emailed statement, Meilman said: “We have seen periodic urgent requests for services since the start of the COVID-19 pandemic and have been adapting our services to meet the needs of our students and our campus community. Our counselling staff have seen many students, both on the Main Campus and with our Medical Center and Law School, experiencing significant stress and tension.”
He emphasized the services that CAPS is offering virtually: consultations to guide students to adequate resources and “where needed and appropriate,” virtual counseling, psychotherapy, and psychiatry appointments. He did not specify what “needed and appropriate” might entail.
However, neither he nor a university spokesperson acknowledged the reasoning behind the email blasts, nor how they planned to address flaws in the online system.
With the usual stress that the end of the school year brings, coupled with the additional stressors of our present socio-economic and global health situation, email blasts simply are not enough to satisfy college students’ demands for mental health services. This crisis is making existing flaws within CAPS come to the surface, namely long wait lists and an overreliance on group services in lieu of individual treatment. As the pandemic shows no sign of disappearing, Georgetown needs to look at how other universities and private practices are finding ways to adapt, and to speed up its innovation in delivering services to students. Demand is only likely to increase as students grapple with disrupted summer plans and uncertainty about whether they can return to campus in the fall.