The pros and cons of virtual mental health services, according to experts

They increase access, but lack crisis intervention capabilities

Student demand for mental health services is skyrocketing. To keep pace, some schools are offering counseling services online and through text messaging. Writing for Inside Higher Ed, Jake New highlights what experts say are the pros and cons of these approaches.

PRO: Wider access to services

According to a survey from the Association for University and College Counseling Center Directors (AUCCCD), schools with enrollments of 25,001 to 30,000 students experience waitlists at their in-person counseling centers an average of 23 weeks a year. At institutions with even more students, this frequency increases, and the waitlists often exceed 50 students in length.

With online counseling—also called telepsychology—students do not experience waiting periods for appointments.

On Colorado State University's  (CSU) "YOU@CSU" website, for instance, students can access services to communicate with a virtual counselor immediately at any time.

Because telepsychology is available around the clock, students in distress can seek help—even if they need it overnight. Schools that have implemented 24-hour mental health hotlines include Amherst College and Willamette University.

How to structure and deliver student mental health services

PRO: Anonymity

Many students with anxiety, depression, or suicidal thoughts need to seek help, but are hesitant to do so. They fear the stigma of seeking help, have anxiety about voicing their problems out loud, or are afraid their peers might see them entering a physical mental health building.

Nathaan Demers, a clinical psychologist and director of clinical programs at Grit Digital Health, says he worries most about the students who do not seek out help.

"We have an ethical responsibility to connect with people who are not knocking on our door," says Demers. "Digital technology is the first place where millennials are going to look for help."

PRO: Customized service

Dan Jones, chair of the Higher Education Mental Health Alliance and former president of AUCCCD, says telepsychology is not meant to replace face-to-face counseling, but rather to supplement it.

Students might recognize that they need help, but are unsure which on-campus service to seek.

With CSU's YOU@CSU, students answer a series of questions evaluating their mental and physical health, and then receive a recommendation for a campus resource.

Students wondering about a club or center on campus where they can meet like-minded people clearly have very different needs than students with serious suicidal thoughts. Online systems like CSU's sort and direct individual cases.

Anne Hudgens, executive director of the CSU Health Network, adds, "It's now about how you support students with a whole range of concerns." 

Related: Help first-generation students understand your range of campus services

CON: Staffing needs similar to in-person services

Victor Schwartz, the medical director of the Jed Foundation, which works to prevent college student suicide, says, "Online assessment platforms and text message counseling can be a mixed bag... [institutions] should ensure they are staffed with the kinds of counselors that officials would want working in their campus health centers."

The counselors on the other end of 24-hour hotlines and anonymous text message platforms must be qualified and licensed, and able to deal with pressing situations like suicide threats appropriately.

CON: Crisis intervention a challenge with some services

Allowing students to seek help anonymously can come with tradeoffs—in certain cases, it can be difficult to quickly identify and send emergency help to anonymous students. 

Also see: Best practices for behavioral intervention teams

"There's always been a struggle between knowing that students are more willing to open up if they aren't worried about police knocking on their door, and knowing that if we allow that level of anonymity we may not be able to help them in time," says Schwartz.

CON: Jury's still out on effectiveness

Researchers at the University of York in Britain recently found that people using telepsychology did not experience improvement in their ability to deal with depression over a four-month period.

The participants of the study reported wanting more clinical support, since they tended to disengage with the computer programs.

Schwartz argues that telepsychology is similar to MOOCs in that "there's that same challenge, where the novelty wears off and participation drops off" (New, Inside Higher Ed, 10/19).

4 items your behavioral intervention team should add to their to-do list now

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