By James A. Baumann
The afternoon light beams through the window as Professor Hampton sits in his campus office. Hanging on the walls are his diplomas. On the shelves behind his desk are photos of his family among a smattering of books. The plant in the corner needs to be watered.
Slumped into the chair across from him is a student, Alberto. Alberto had missed the deadline on a recent assignment and had seemed tired and uninterested in class for several days. Asked about the assignment, Alberto shrugs and suggests that it really doesn’t matter. He’s getting Fs in all his classes and seems resigned to the fact that he will have to drop out of college at the end of the semester. After Hampton offers additional support, the student responds that he shouldn’t waste time on him. Asked why, Alberto replies, “Tomorrow, my car may be in the lake. Maybe I’ll still be in it.”
This isn’t the only critical conversation that is happening across campus. A staff member, Mr. Nathal, video-chats with Maya, a student who is having difficulty connecting with other students on campus, and encourages her to learn more about different student organizations. Kelly Knight, the director of student life, shares an incident when a student admitted that she had been researching the least painful ways to commit suicide. A student stops by a stressed-out friend’s room to check how they are doing and let them know they haven’t seen them for a while. Meanwhile, another staff member responds to an email from a student concerned about a friend who had an uncharacteristically angry outburst in the middle of a class. “I don’t know what to say. That’s why I came to you,” the student writes.
Scenarios like these are common at almost any college or university. In these cases, though, they are not happening on campus but are on my computer screen as part of the Kognito online learning system. And instead of flesh and blood people, the characters are computer-generated images. If I respond to a student in distress incorrectly, a speech bubble will tell me so and offer advice for a more productive comment. I only need to click on “undo” to have another try at assisting the student and connecting them to the proper resources. The stakes are much lower than if they were real life. And that’s sort of the point.
Online education is just one of the resources increasingly in demand as campuses respond to a growing student mental health crisis in which the numbers continue to tell a challenging story. The most recent National College Health Assessment from the American College Health Association showed that more than 75% of the undergraduate students surveyed experienced moderate or serious psychological distress. More than 12% had “intentionally cut, burned, bruised, or otherwise injured themselves within the last 12 months.” The National Alliance on Mental Health reported that one-third of college-age (18-25) young adults in the United States “experienced a mental illness” and 3.8 million of them “had serious thoughts of suicide.” These feelings were exacerbated during the pandemic, with 23% saying it had a “significant negative impact on their mental health.” Active Minds reports that 39% of college students “experience a significant mental health issue” and that 67% of people between the ages of 18 and 24 “with anxiety or depression don’t seek treatment.”
This state of student mental health has, in turn, put additional pressure on individual campus counseling centers and case managers. The Center for Collegiate Mental Health 2021 annual report showed that, in reporting campus centers, the “average length of individual treatment grew from 4.35 appointments in 2019-2020 to 5.22 in 2020-2021, an increase of 20%.” It also included the warning statement that, “Over the last two decades, college counseling services have experienced a well-documented soaring demand for services, while the capacity to treat the growing number of students seeking care has not been equivalently increased. CCMH has demonstrated that this trend has led to consequences for counseling centers, including models shifting from traditional treatment to short-term crisis support and rising caseloads of clinicians, which are both associated with reduced treatment and less effective care. This trend has caused distress for nearly all stakeholders and generalized assertions that institutions are experiencing a mental health ‘crisis.’”
While several campuses are trying to increase staff numbers to meet demand, for those that don’t have the resources to hire additional staff, or can’t find qualified candidates quickly enough, the responsibility falls more and more to the student-facing professionals like faculty, resident assistants, and live-in housing professionals. These groups, however, likely are not experienced or thoroughly trained in such areas; they achieved their positions through other areas of expertise, be they engineering, community building, or educational programming. To fill in the gaps amid this rising challenge, campuses are turning to new and updated resources.
The Kognito system provides interactive role-play simulations similar to what might occur during face-to-face training exercises like Behind Closed Doors. Being online, though, lets it reach a wider scope of individuals. The software offers a module aimed at students and another one for faculty and staff. In them, users are led through scenarios and are asked to facilitate conversations with students in varying levels of distress using prepared statements from a drop-down menu. The most appropriate statements are open-ended and show empathy, a connection, and that someone is listening. Less appropriate ones may sting with their harshness or close a person off with a judgment-filled tone. Prompts periodically appear at the bottom of the screen to let the user know how they are doing and to offer suggestions for more productive approaches. Overall it helps users to recognize signs of distress, better understand support options, and make referrals to additional support resources.
While lessons to strengthen these skills are valuable for anyone interacting with students, reports have shown them to be particularly so for faculty. When the Healthy Minds Network and Boston University teamed up to survey faculty about student mental health, they learned that while nearly 80% of them had a one-on-one conversation with a student regarding mental health in the past year, only half felt they could recognize a student in distress, and nearly three-fourths admitted to needing additional professional development in this area. Those results match what Kognito has heard from its customers. Any inaction that accompanies a lack of training is a constant concern. “If people are not confident in what to say, they don’t say anything,” says Dawn Bornheimer, Kognito’s Director of Higher Education and Healthcare Partnerships.
Texas A&M University is one campus that has had success with Kognito. There, Megan Higginbotham was a case manager for student assistance services for almost five years, helping connect students to various support services. She also leads communications and marketing for the Higher Education Case Managers Association. She explained that Kognito, along with other programs like Green Dot (for bystander intervention) and Tell Somebody (a reporting system that forwards information to the campus’s Special Situations team members), are all part of the strategy to prepare students and staff to address incidents and concerning behavior in a way that recognizes the appropriate boundaries.
As she notes, the goal of these training options is not to turn the trainees into psychiatrists or counselors. Rather, it is to prepare individuals to offer preliminary support, recognize if additional support is needed, and make an appropriate referral. “It’s okay to ask someone you are concerned about if they are thinking about harming themselves or someone else,” Higginbotham says while acknowledging that it is not always easy for someone to say, especially for the first time. She echoes Bornheimer when she adds, “The worst thing you can say is nothing.”
When students and staff do receive in-person mental health training, that often comes through partnerships between the campus housing and counseling center departments. At William Peace University, the housing department utilizes the campus Wellness Center staff to facilitate training for resident assistants. During this program, the student staff are taught to recognize when a student is in stress or distress, to identify the differences between stress and distress, to have conversations with students who are showing warning signs of distress, to use successful coping mechanisms, to understand the different resources offered through the Wellness Center, and to know how to correctly refer students who are experiencing mental health issues to counseling services.
“Our priority is to be able to recognize signs and symptoms of stress and to intervene proactively,” says Cody Greene, associate director for residence life and housing at William Peace. “Our goal is always to practice preventative care for our students. We as professional staff also serve on a CARE Team Committee to discuss students who are experiencing signs of stress or distress to collectively prepare an action plan of support for the student.” Greene adds that, while the counseling center provides presentations and readings for RA training around mental health, departmental training then puts it into practice, “mainly through small group discussions and role-play scenarios. For us, our biggest learning objective is to be able to identify the difference between stress and distress, and how to help students navigate those feelings.” Additionally, staff training focuses more on operational aspects such as on-call responsibilities if a student is in crisis after hours, transport protocol, and the re-entry process for students hospitalized due to mental health concerns. “We have always used a similar training, but with the rise in campus mental health issues, we have made this a priority as an institution to support these students. We do this through campus-wide programming and spreading awareness around the topic,” says Greene.
A growing training option for campuses is to partner with local mental health care providers. Jake McLean, assistant dean for campus life at Knox College, notes that the housing staff on his campus receives training from the staff of the nearby Bridgeway, Inc., a nonprofit organization that provides “health and human services to a wide range of individuals in need.” McLean learned about these additional educational opportunities after his school hired on-campus counselors who previously had worked with Bridgeway. Now they leverage Mental Health First Aid, a training program managed, operated, and disseminated by the National Council for Mental Wellbeing. “The Mental Health First Aid training covers how to identify, understand, and respond to signs of mental health illnesses and substance use disorders,” McLean explains. “While the training covers national and local resources for students experiencing crisis and non-crisis situations, we also supplement with campus resources available to students. There are also more specific action plans to respond to crisis situations like self-harm, suicide ideation, etc.”
The support offered by this training allows staff to refer students to the necessary resources. “The line for our staff is to gather information, get an initial sense of harm and risk to students and their community, and report up to campus safety and our on-call staff structure,” McLean adds. “RAs are not expected to do any triage or do anything at a higher level in the moments of crisis once campus safety or the on-call staff are involved, but they do have responsibility with their professional staff supervisor to support the residential community after a crisis has happened.”
Thorough mental health training for staff will also address the issue of self-care for the students and staff tasked with responding to incidents. In its module on the subject, Kognito uses the analogy of individuals as drinking glasses and stressful situations and conversations as the water that can quickly fill them up. By practicing various techniques, resident assistants and others can expand the capacity of their metaphorical glass and their resiliency to stressful situations. The Kognito program lays out a regimen of psychological, emotional, physical, spiritual, and social self-care practices that one can follow. The program also compiles the users’ responses about what steps they currently are taking and what steps they may consider for the future to create an individualized self-care plan that they are then encouraged to print for future reference. Similarly, the Mental Health First Aid curriculum encourages students to set a routine and stick to it, to get enough sleep, to exercise, to eat nutritiously, to drink plenty of water, to practice mindfulness and gratitude, and to declutter their space. Doing so, they say, will encourage a self-care routine.
At the University of Washington, Nick Vitalone, the residential life training and selection specialist, responded to staff feedback and created a program that connects the value of self-care and resiliency to the stressors that often accompany campus housing work. With input from Doyanne Darnell, an assistant professor at UW and a clinical director at the Seattle-based Harborview Mental Health and Addiction Services, he leads staff through a presentation on what they refer to as emotional labor, described as “managing one’s own emotions and the emotions of others to effectively complete work and meet workplace role expectations.” In the lesson, he explains how some experiences can be distressing, that they can physically affect people long after the experience is over, and that the fallout can negatively impact their views of themselves, of other people, and of the world at large.
The program offers a number of actionable tips staff can turn to for handling challenging situations. Exercises help them better understand what others are trying to communicate, through verbal and nonverbal means, during a heated exchange. They learn to demonstrate that they are listening and understand the frustrations or challenges of others. They learn healthy responses to intense emotions that, hopefully, will reduce their intensity and frequency. The program concludes with a list of potential symptoms – such as exhaustion, sleeping difficulties, panic attacks, suicidal thoughts, or challenges carrying out usual or important activities – that could signal the need for a person to seek additional support. In this case, the critical conversation is with oneself.
Whether the lesson is delivered through a computer screen or person-to-person, the learning outcomes for addressing at-risk mental health concerns are consistent. By recognizing signs of distress, responding in an empathetic and caring manner, and referring the individual to the appropriate resources, anyone – not only clinicians and counselors – can play a vital role in nurturing a supportive community.
James A. Baumann is editor of Talking Stick magazine and the director of publications for ACUHO-I.
