CWU Mental Health Services

MentalHealthInformation

Report Regarding the Current State of Mental Health Services at Central Washington University Prepared by Cindy M. Bruns, PhD, Interim Director of Counseling With additional data by Marissa Howat, MEd, MCHES, Director of Wellness and Health Promotion Kristin Karns, ARNP, Interim Medical Director. November 6, 2018 This report is prepared in response to Trustee Gary Epp’s request for information regarding the current state of mental health services on campus, particularly their availability, their current level of use, how services are promoted to CWU students, and what is known about current barriers to usage of mental health services among the student body. Attached to this report are several data sources that are hopefully helpful in beginning to understand these concerns at Central and how multiple service providers are working to address the mental health needs of our students. Below, I will summarize the data, but I encourage a close look at the source materials for a fuller picture. First, to capture a snapshot of the mental health and illness concerns of the general CWU student body, the Healthy Minds Survey, administered by Wellness and Health Promotion services, is a significant source of data. The 2016-1017 Health Minds Summary Data report is attached. Based on a sample of 1581 Central students, the Healthy Minds Survey suggests that approximately 32% of Central students have a positive screen for depression and 27% for anxiety. Another 10% screen positive for an eating disorder. Twelve percent of students report suicidal ideation within the past year and 23% report non-suicidal self-injury in the past year. On the other side, 38% of students surveyed reported positive mental health. Seventy percent of students reported that they at least “somewhat” knew of campus mental health services and 50% agreed or strongly agreed that they possessed this knowledge. Thirty-two percent of students agreed or strongly agreed that they needed mental health services in the past year, while 40% agreed or strongly agreed that they had a current need for mental health services. In terms of barriers to services, the most frequently cited reason from those who had sought treatment in the past year was no current need for services (37%). From there, in descending order, were not enough time (31%), prefer to deal with concerns on own or with family/friends (27%), financial reasons (27%), difficulty finding an available appointment time (15%), not sure where to go (14%), “other” (13%), and planning to obtain services but not having a chance (1%). Twelve percent indicated no barriers. More information regarding the Health Minds Survey in general can be found at www.healthmindsnetwork.org A variety of avenues are used to promote mental health services to students. Wellness and Health Promotion services engages in numerous campaigns and educational events to help educate students regarding lifestyle approaches that promote positive mental health as well as events to help screen students for possible mental health concerns and to destigmatize help-seeking behaviors. They also sponsor an online screening tool that helps students evaluate their current mental health concerns and provides information regarding services. The screening tool can be found at

https://www.cwu.edu/wellness/mental-health-screening-tool. In addition, Wellness makes direct referrals to Counseling Services on a regular basis. Wellness and Health Promotion Services is also the leader in facilitating substance abuse evaluations through a partnership with Merit Services in Ellensburg, and supporting students in recovery through their Recovery Outreach Community. Support for students who have experience power- based interpersonal violence is also an important part of Wellness and Health Promotion. Students who experience interpersonal power-based violence can be at risk for mental health concerns if not properly supported. In collaboration with Counseling Services, Wellness has begun offering a sexual assault survivor support group in Fall 2018. Wellness and Health Promotion also offer Mental Health First Aid training to the university community and is the leaders in the JED Suicide Prevention work on campus. Counseling Services partners with a variety of campus areas to help ensure students are informed about and know how to access mental health services. Working closely with Orientation (presentations to parent and student groups attending orientation), Residence Halls (1 st 6-weeks presentations), Case Management, Wellness and Health Promotion, Disability Services, other Student Success members, faculty and staff (through classroom presentations), information campaigns (recently sending service flyers, crisis information, and how to handle distressed students to Student Success member departments and next to faculty chairs), and tabling events with information and giveaways, staff strive to help students know about Counseling Services. A wide variety of mental health services are provided by Counseling Services and are covered completely by the quarterly medical and counseling fee. Initial consultation appointments last 30 minutes and give students an opportunity to talk about their needs and explore service options. Same day crisis appointments are available to students on a walk-in basis. If a student walks in with an urgent need, they will be seen with a minimum of delay (usually no more than 30 minutes). Additional services include skills workshops, group therapy, short-term individual therapy, couples therapy, consultation to students, faculty, and staff, limited psychological testing, and coordination of referrals if a student’s need exceeds the expertise or capacity of Counseling Services. Annually, Counseling Services sees approximately 8-10% of the Ellensburg campus community. According to the Association of University and College Counseling Center Director’s (AUCCCD) 2017 survey, institutions of similar size to Central see, on average, 926 unique students for 4326 talk therapy appointments. In FY18, Central Counseling Services saw 914 unique students for 4454 individual therapy appointments. Students attended an additional 1668 group therapy or workshop appointments during the same time frame. By comparison, the AUCCCD survey shows that similarly sized institutions have an average of 351 group appointments per year. Counseling Services at Central has work hard over the past seven years to grow our group program, as research suggests that group therapy is more effective than individual therapy in 25% of the cases and just as effective as individual therapy in another 25% of the cases. Our Pathways program, which serves as an entry point for services for many students (after an initial consultation), is now a model program nationally, with research to support its efficacy. See http://www.cwu.edu/cwu-provides-pathways- students-overcome-concerns for a recent press release and more information about this innovative program. The demand for counseling services has steadily grown over the past several years. The etiology for this is certainly multi-factorial, with a combination of increased enrollment at the Ellensburg

campus, decreased stigma regarding counseling for many students, and increased general distress in the population at large due to economic and other factors likely contributing to the increase. Due to increased demand, along with inadequate staffing, the Counseling Services experienced significant difficulty meeting the demand for counseling services during FY2018. Demand typically outweighs supply to some degree, but not in the way that was experience last year, particularly in the Fall 2017. For the first time in its history, the Counseling Clinic created a waitlist for initial consultation appointments, as all scheduled screening appointment slots for the quarter were filled by the beginning of November. The average time from call to the clinic to screening appointment was 11 business days, an increase of 200% over Fall 2016. The median wait time was 8 business days, and only 44% of students seeking an initial appointment were seen within 7 business days of contacting the clinic. Over the course of the quarter, 99 students were placed on the waitlist for individual services, a 36% increase over the same timeframe in 2016. The average time on the waitlist was 14 days. 58 students on the waitlist were sent regret letters at the end of Fall quarter. The situation improved throughout FY18, as Counseling Services made adjustments to practices and resource allotment. By Winter 2018 the average wait from call to initial consultation was 6 days; in Spring 2018 it was 4 days. Counseling Services also made significant progress in FY18 on access to individual therapy services for those who wanted that particular service. The wait time for ongoing individual services was, on average, 2 weeks during Fall Quarter and decreased by 50% over the year to 1 week in Spring Quarter. Of those who had to wait for individual services, approximately half (49%) were offered an on-going individual therapy spot during the same quarter in which they went on the waitlist. In addition, 32.2% of students ever placed on the triage list for individual services were concurrently enrolled in other services while waiting for individual therapy. A greater percentage were offered other forms of service (such as group therapy or a workshop) and declined these services. The reader is encouraged to review the quarterly reports for Counseling Services to see the progression of service access over the course of FY18 as the program made adjustments in order to better meet student needs. It should be noted that improvement of access to care was achieved while still being significantly understaffed. Counseling Services was able to hire a full-time temporary staff person for the Spring Quarter, which was of significant help. However, Counseling Services currently has 2 vacant positions and the shift in the job responsibilities of the Director of Counseling (a role that used to provide significant clinical service delivery) means that we are really down something closer to 3 positions as we have gone into FY19. One of those vacant positions is a new position funded through the Board of Trustee’s approval of an increase to the student medical and counseling fee. Unfortunately, the search to fill that position failed and had to be restarted this fall. The recommendation from the International Association of Counseling Services (IACS) is 1FTE permanent (IACS excludes interns or trainees in their ratio calculations) counseling position per 1000-1500 students. Currently, Counseling Service ratio is around 1:2277. If one were to count doctoral interns and master’s interns into the formula, the ratio becomes 1:1250. Going into Fall 2018, Counseling Services have made a number of adjustments that have allowed significantly more students to be seen this Fall with less wait than last fall. The below table compares the first six weeks of Fall 2017 to Fall 2018.

Statistical Overview:

1 st Six Weeks Fall 2018

1 st Six Weeks Fall 2017

% change

Number of clients seen

306 200

278 169 978

+10% +18%

Number of first time in clinic clients

Number of attended appointments (individual/grp) No show rate for all appointments (individual/group)

1057 5.7%

+8%

4.3%

+1.4% -20% +45% +25%

Number of crisis appointments

Percent of crisis clients seen the same day as requested Percent of crisis clients seen within 1 day of request Percent of individual therapy appointments that are weekly, on-going appointments Number of students on triage list for individual therapy services at end of 1 st six weeks Average wait for Initial Consult/Screenings (days) Number of Outreach Presentations/Services to University Community FTE Permanent Line Staff ( currently filled positions )

96%

51% 75%

100%

28.1%

54.8%

-26%

-97% -49%

4.42

8.61

+73%

4.39 0% Of note, with respect to the question of how students are informed of mental health resources and services, Counseling Services has provided 11 more outreach activities to the campus community (primarily student audiences) so far this Fall Quarter over last. Not only is Counseling Services seeing more clients, but are also out in the wider university community interacting with students more. These are opportunities to let students know about services as well as to provide population based interventions. In terms of who seeks services from the Counseling Services, the Counseling Services are proud that many diverse groups feel comfortable accessing our services. In terms of ethnic diversity, the percentage of Counseling Services students who reported identifying as an ethnic minority closely mirrors Central’s overall student population. Students who identify with a variety of diverse sexualities and gender identities are also strong consumers of Counseling Services. Another issue affecting mental health services at Central is the increasing acuity of mental health concerns facing students. Below are data comparing treatment seeking Central students (2017-2018) to the most recent data (2016-2017) from the Center for Collegiate Mental Health (CCMH). The CCMH data represents findings from over 200,000 treatment seeking students at universities across the US. 4.39

• Received Prior Counseling: 66% (Central) vs 53% (CCMH) • Have a previous suicide attempt: 16.5% (Central) vs 10% (CCMH)

• Thoughts of ending your life in the past two weeks: 27.3% (Central) vs 38% (CCMH) • Thoughts of hurting others in the past two weeks 7% (Central) vs 11% (CCMH) • Experienced abuse in the past: 43.1% (Central) vs 39% (CCMH) In FY18, 30 students connected with Counseling Services either presented to services with a recent suicide attempt or serious suicide plan with intent to die or experienced one of these concerns while enrolled in counseling services. Counseling Services has made significant progress in reducing barriers to services for students, with a focus on quick access to initial services so that students can be assessed for their needs and provided crisis services and short-term therapy services. For students needing long-term care, either due to severity of concerns or simply personal preference, a barrier exists in terms of community service providers. Kittitas County lacks sufficient mental health resources for the population at large. Most Central students who come to the Counseling Services are not referred to the community. Ninety-four percent of service seeking students in Fall 2018 have not been referred to the community as of the date of this report. There are many more data points regarding Counseling Services contained within the attached reports. Medical Services is also a provider of mental health services to Central students, along with being a significant referral source for Counseling Services. The below graph shows the number of medical patients that qualify for a mental health diagnosis and its steady increase. In the calendar year 2017, 1306 patients had a mental health diagnosis. With two and half months left in 2018, the number is currently 1094. Providers in Medical Services are one of the primary prescribers of psychotropic medications for students at Central. Medical providers are able to prescribe many medications that general practitioners in the community typically feel uncomfortable prescribing, such as antipsychotic medications. The close collaboration between Medical and Counseling Services, as well the demands of rural healthcare practice, make this possible.

Work on telepsychiatry services continues, also a mandate from the Board of Trustees. The cost of telepsychiatry services is proving to be a difficult barrier to overcome. A well-qualified company (Insight) has been identified and a partnership with KVH to share a provider is being actively worked toward. All agree it would be a wonderful partnership and fill a significant need, but the reimbursement for services is a barrier that is still being worked through at this time. Case Management Services is another significant element of mental health services to Central Students. Case Management staff are on the front line of following up with students who are identified as in distress of some sort, providing not only their own support services, but educating students about all of their service options. Case Managers also actively work with students to reduce barriers to access for all sorts of services, including mental health services. While the exact data is not available to me, a significant portion (at least 50%, I believe) of students in their service are classified as mental health concerns. Case Management and Counseling Services are close partners in service provision and support of students with mental health concerns. Disability Services is also a close collaborator with Counseling Services. A high proportion of students registered with Disability Services are registered for mental health or neurocognitive developmental concerns. In addition to all that is reported in this summary and attachments, other work to develop resources to address student needs are at work, including exploring legislative initiatives to increase funding and access to care, new programs to provide out-of-office access to counseling staff, attempts to increase support of faculty, who often find themselves on the front lines of student crises, among other activities. The development of the new Health and Wellness area within Student Success will

increase collaboration efforts and elevate the conversation regarding not only mental health but health in general across campus. Hopefully, this report provides a starting point for an on-going conversation. I am happy to meet with any and all stakeholders to continue the conversation for how Central can adequately staff its support services and work together to creatively and through best-practices support the mental health needs of its students. Respectfully submitted, Cindy Bruns, PhD, Interim Director of Counseling Attachments provided: • Healthy Minds Survey Data Summary • Counseling Services Overview Powerpoint • Wellness and Health Promotion Overview Powerpoint • Fall, Winter, Spring Quarterly Counseling Services Reports • Fiscal Year 18 Counseling Services Report • Counseling and Medical Services Satisfaction Survey from Spring 2018 • 1 st Month Fall 2018 (update on progress on accessibility for Counseling Services) • 1 st Six Weeks Fall 2018 (second update on Fall 2017/Fall 2018 services) • Center for Collegiate Mental Health Report (2016) (for comparison purposes) • Association of University and College Counseling Center Director’s Report (2017) (for comparison purposes)

Central Washington University

2016-2017 Data Report

ABOUT THE HEALTHY MINDS STUDY (HMS)

STUDY TEAM

Principal Investigators: Daniel Eisenberg, PhD & Sarah Ketchen Lipson, EdM, PhD

Research Study Coordinators: Adam Kern, BA, Peter Ceglarek, MPH & Megan Phillips, MA

REPORT TEAM

Graphic Designer: Sarah Fogel, University of Michigan School of Art and Design, Class of 2014

Report Automation: Andy Inscore, BS

TABLE OF CONTENTS

STUDY PURPOSE

STUDY DESIGN

ABOUT THIS REPORT

KEY FINDINGS

SAMPLE CHARACTERISTICS

PREVALENCE OF MENTAL HEALTH PROBLEMS

POSITIVE MENTAL HEALTH

HEALTH BEHAVIORS AND LIFESTYLE

ATTITUDES AND BELIEFS ABOUT MENTAL HEALTH SERVICES

USE OF SERVICES

REFERENCES

STUDY PURPOSE

The Healthy Minds Study provides a detailed picture of mental health and related issues in college student populations. Schools typically use their data for some combination of the following purposes: to identify needs and priorities; benchmark against peer institutions; evaluate programs and policies; plan for services and programs; and advocate for resources.

STUDY DESIGN

The Healthy Minds Study is designed to protect the privacy and confidentiality of participants. HMS is approved by the Health Sciences and Behavioral Sciences Institutional Review Board at University of Michigan. To further protect respondent privacy, the study is covered by a Certificate of Confidentiality from the National Institutes of Health.

SAMPLING Each participating school provides the HMS team with a randomly selected sample of currently enrolled students over the age of 18. Large schools typically provide a random sample of 4,000 students, while smaller schools typically provide a sample of all students. Schools with graduate students typically include both undergraduates and graduate students in the sample. DATA COLLECTION HMS is a web-based survey. Students are invited and reminded to participate in the survey via emails, which are timed to avoid, if at all possible, the first two weeks of the term, the last week of the term, and any major holidays. The data collection protocol begins with an email invitation, and non-responders are contacted up to three times by email reminders spaced by 2-4 days each. Reminders are only sent to those who have not yet completed the survey. Each communication contains a URL that students use to gain access to the survey. NON-RESPONSE ANALYSIS A potential concern in any survey study is that those who respond to the survey will not be fully representative of the population from which they are drawn. In the HMS, we can be confident that those who are invited to fill out the survey are representative of the full student population because these students are randomly selected from the full list of currently enrolled students. However it is still possible that those who actually complete the survey are different in important ways from those who do not complete the survey. The overall participation rate for the 2016-2017 study was 23%. It is important to raise the question of whether the 23% who participated are different in important ways from the 77% who did not participate. We address this issue by constructing non-response weights using administrative data on full student populations. Most of the 54 schools in the 2016-2017 HMS were able to provide administrative data about all randomly selected students. The analysis of these administrative data, separated from any identifying information, was approved in the IRB application at the University of Michigan and at each participating school. We used the following variables, when available, to estimate which types of students were more or less likely to respond: gender, race/ethnicity, academic level, and grade point average. We used these variables to estimate the response propensity of each type of student (based on multivariate logistic regressions), and then assigned response propensity weights to each student who completed the survey. The less likely a type of student was to complete the survey, the larger the weight they received in the analysis, such that the weighted estimates are representative of the full student population in terms of the administrative variables available for each institution. Finally, note that these sample weights give equal aggregate weight to each school in the national estimates. An alternative would have been to assign weights in proportion to school size, but we decided that we did not want our overall national estimates to be dominated by schools in our sample with very large enrollments.

ABOUT THIS REPORT

This data report provides descriptive statistics (percentages, mean values, etc.) from the sample of respondents at your institution for a set of key measures.

EXPLORING YOUR DATA FURTHER There are two options for exploring your data beyond what is in this report. First, you can use statistical software (e.g., SPSS, Stata, etc.) to analyze the full data set for your students, which has been provided to your school. Second, you will be able to log on to a user-friendly website with drop-down menus, at data.healthymindsnetwork.org.

KEY FINDINGS

This section offers a quick look at results that may be of special interest to your institution.

Estimated values of selected measures for Central Washington University

Percentage of students

Major depression (positive PHQ-9 screen)

15%

Depression overall, including major and moderate (positive PHQ-9 screen)

32%

Anxiety disorder (positive GAD-7 screen)

27%

Eating disorder (positive SCOFF screen)

10%

Non-suicidal self-injury (past year)

23%

Suicidal ideation (past year)

12%

Lifetime diagnoses of mental disorders

39%

Psychiatric medication (past year)

23%

Mental health therapy/counseling (past year)

20%

Any mental health therapy/counseling and/or psychiatric medication among students with positive depression or anxiety screens (past year)

47%

Personal stigma: agrees with "I would think less of someone who has received mental health treatment."

Perceived public stigma: agrees with "Most people would think less of someone who has received mental health treatment."

46%

SAMPLE CHARACTERISTICS (N=1581)

Age (years)

Gender

20%

16%

14%

13%

12%

11%

10%

53%

Female

44%

Male

Other

18 19 20 21 22 23-25 26-30 31-35 36-40 41+

Race/ethnicity

OTH Other PAC Pacific Islander ASIAN Asian/Asian American ARAB Arab/Middle Eastern or Arab American AMIN American Indian/Alaskan Native LAT Hispanic/Latino BLA African American/Black WHI White or Caucasian

10% 20% 30% 40% 50% 60% 70% 80% 74%

14%

3% 1%

3% 3%

WHI

BLA LAT AMIN ARAB ASIAN PAC OTH

Living arrangement

Degree program

OTH Other ND Non-degree student PHD PhD or equivalent MD MD JD JD MA Master's degree BA Bachelor's degree ASS Associate's degree

88%

10% 20% 30% 40% 50% 60% 70% 80% 90%

24%

Campus residence hall

Fraternity or sorority house

10%

Other university housing

54%

Off-campus, non-university housing

Parent or guardian's home

0% 0% 0% 1% 2%

Other

ASS BA MA JD MD PHD ND OTH

PREVALENCE OF MENTAL HEALTH PROBLEMS

DEPRESSION SCREEN Depression is measured using the Patient Health Questionnaire-9 (PHQ-9), a nine-item instrument based on the symptoms provided in the Diagnostic and Statistical Manual for Mental Disorders for a major depressive episode in the past two weeks (Spitzer, Kroenke, & Williams, 1999). Following the standard algorithm for interpreting the PHQ-9, symptom levels are categorized as severe (score of 15+), moderate (score of 10-14), or mild/minimal (score <10).

Severe depression

Moderate depression

Any depression

15%

18%

32%

ANXIETY SCREEN Anxiety is measured using the GAD-7, a seven-item screening tool for screening and severity measuring of generalized anxiety disorder in the past two weeks (Spitzer, Kroenke, Williams, & Lowe, 2006). Following the standard algorithm for interpreting the GAD-7, symptom levels are categorized as severe anxiety, moderate anxiety, or neither.

Severe anxiety

Moderate anxiety

Any anxiety

12%

15%

27%

EATING DISORDER SCREEN

Eating disorders are measured using the written U.S. version of the SCOFF, a five-item screening tool designed to identify subjects likely to have an eating disorder (Morgan, Reid, & Lacey, 1999).

Eating disorders

10%

SUICIDALITY AND SELF-INJUROUS BEHAVIOR

Suicidal ideation (past year)

Suicide plan (past year)

Suicide attempt (past year)

Non-suicidal self-injury (past year)

12%

23%

LIFETIME DIAGNOSES OF MENTAL DISORDERS

Have you ever been diagnosed with any of the following conditions by a health professional (e.g. primary care doctor, psychiatrist, psychologist, etc.)? (Select all that apply)

25% Depression or other mood disorders (e.g., major depressive disorder, bipolar/manic depression, dysthymia)

27% Anxiety (e.g., generalized anxiety disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder)

11% Attention disorder or learning disability (e.g., attention deficit disorder, attention deficit hyperactivity disorder, learning disability)

3% Eating disorder (e.g., anorexia nervosa, bulimia nervosa)

1% Psychosis (e.g., schizophrenia, schizo-affective disorder)

1% Personality disorder (e.g., antisocial personality disorder, paranoid personality disorder, schizoid personality disorder)

2% Substance abuse disorder (e.g., alcohol abuse, abuse of other drugs)

61% No, none of these

POSITIVE MENTAL HEALTH

ACADEMIC IMPAIRMENT

In the past 4 weeks, how many days have you felt that emotional or mental difficulties have hurt your academic performance?

Positive mental health (psychological well-being) is measured using The Flourishing Scale, an eight-item summary measure of the respondent's self-perceived success in important areas such as relationships, self-esteem, purpose, and optimism (Diener, Wirtz, Tov, Kim-Prieto, Choi, Oishi, & Biswas-Diener , 2009). The score ranges from 8-56, and we are using 48 as the threshold for positive mental health.

Positive mental health

6 or more days 16% 3 - 5 days 24% 1 - 2 days 33% None 27%

38%

HEALTH BEHAVIORS AND LIFESTYLE

Drug use

Over the past 30 days, have you used any of the following drugs? (Select all that apply)

27% Marijuana

2% Cocaine (any form, including crack, powder, or freebase)

0% Heroin

0% Methamphetamines (also known as speed, crystal meth, or ice)

1% Other stimulants (such as Ritalin, Adderall) without a prescription

1% Ecstasy

2% Other drugs without a prescription

72% No, none of these

ATTITUDES AND BELIEFS ABOUT MENTAL HEALTH SERVICES

KNOWLEDGE

Knowledge of campus mental health resources

Perceived need (past year)

If I needed to seek professional help for my mental or emotional health, I would know where to go on my campus.

In the past 12 months, I needed help for emotional or mental health problems such as feeling sad, blue, anxious or nervous.

23%

Strongly agree

18%

Strongly agree

27%

Agree

14%

Agree

20%

Somewhat agree

17%

Somewhat agree

Somewhat disagree

15%

Disagree

17%

Disagree

Strongly disagree

28%

Strongly disagree

Perceived need (current)

I currently need help for emotional or mental health problems such as feeling sad, blue, anxious or nervous.

17%

Strongly agree

23%

Agree

29%

Somewhat agree

12%

Somewhat disagree

13%

Disagree

Strongly disagree

USE OF SERVICES

Psychotropic medication use, all students (past year)

In the past 12 months have you taken any of the following types of medications? Please count only those you took, or are taking, several times per week. (Select all that apply)

5% Psychostimulants (e.g., methylphenidate (Ritalin, or Concerta), amphetamine salts (Adderall), dextroamphetamine (Dexedrine), etc.)

13% Anti-depressants (e.g., fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), venlafaxine (Effexor), buproprion (Wellbutrin), etc.)

1% Anti-psychotics (e.g., haloperidol (Haldol), clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), etc.)

8% Anti-anxiety medications (e.g., lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), buspirone (BuSpar), etc.)

2% Mood stabilizers (e.g., lithium, valproate (Depakote), lamotrigine (Lamictal), carbamazapine (Tegretol), etc.)

5% Sleep medications (e.g., zolpidem (Ambien), zaleplon (Sonata), etc.)

2% Other medication for mental or emotional health

77% None

Psychotropic medication use among students with positive depression or anxiety screens (past year)

In the past 12 months have you taken any of the following types of medications? Please count only those you took, or are taking, several times per week. (Select all that apply)

7% Psychostimulants (e.g., methylphenidate (Ritalin, or Concerta), amphetamine salts (Adderall), dextroamphetamine (Dexedrine), etc.)

24% Antidepressants (e.g., fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), venlafaxine (Effexor), buproprion (Wellbutrin), etc.)

1% Anti-psychotics (e.g., haloperidol (Haldol), clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), etc.)

12% Anti-anxiety medications (e.g., lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), buspirone (BuSpar), etc.)

4% Mood stabilizers (e.g., lithium, valproate (Depakote), lamotrigine (Lamictal), carbamazapine (Tegretol), etc.)

7% Sleep medications (e.g., zolpidem (Ambien), zaleplon (Sonata), etc.)

4% Other medication for mental or emotional health

64% None

Mental health counseling/therapy, all students (past year)

Informal help-seeking

In the past 12 months have you received counseling or support for your mental or emotional health from any of the following sources? (Select all that apply)

In the past 12 months have you received counseling or therapy for your mental or emotional health from a health professional (such as psychiatrist, psychologist, social worker, or primary care doctor)?

12% Roommate

37% Friend (who is not a roommate)

30% Significant other

20%

32% Family member

5% Religious counselor or other religious contact

3% Support group

Mental health counseling/therapy among students with positive depression or anxiety screens (past year) In the past 12 months have you received counseling or therapy for your mental or emotional health from a health professional (such as psychiatrist, psychologist, social worker, or primary care doctor)?

2% Other non-clinical source

40% None of the above

Barriers to help-seeking

In the past 12 months, which of the following factors have caused you to receive fewer services (counseling, therapy, or medications) for your mental or emotional health than you would have otherwise received? (Select all that apply)

32%

1% I haven't had the chance to go but I plan to

Mental health counseling/therapy, all students (lifetime)

37% No need for services

21% Financial reasons (too expensive, not covered by insurance)

Have you ever received counseling or therapy for mental health concerns?

31% Not enough time

14% Not sure where to go

15% Difficulty finding an available appointment

40%

27% Prefer to deal with issues on my own or with support from family/friends

13% Other

Mental health counseling/therapy among students with positive depression or anxiety screens (lifetime)

12% No barriers

Note: Due to a survey programming error, the barriers questions were not asked of students who reported never receiving counseling or therapy.

Have you ever received counseling or therapy for mental health concerns?

54%

REFERENCES

MENTAL HEALTH SCREENS

Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2009). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247-266.

Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders BMJ, 319(7223), 1467-1468.

Spitzer, R. L., Kroenke, K., Williams, J. B., & Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282(18), 1737-1744.

Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.

SELECTED ARTICLES PUBLISHED WITH HMS DATA

Eisenberg, D., Golberstein, E., Hunt, J. (2009). Mental Health and Academic Success in College. B.E. Journal of Economic Analysis & Policy 9(1) (Contributions): Article 40. Eisenberg, D., Hunt, J.B., Speer, N., Zivin, K. (2011). Mental Health Service Utilization among College Students in the United States. Journal of Nervous and Mental Disease 199(5): 301-308. Eisenberg, D., Chung, H. (2012). Adequacy of Depression Treatment in College Student Populations. General Hospital Psychiatry 34(3):213-220. Eisenberg, D., Speer, N., Hunt, J.B. (2012). Attitudes and Beliefs about Treatment among College Students with Untreated Mental Health Problems. Psychiatric Services 63(7): 711-713. Eisenberg, D., Hunt, J.B., Speer, N. (2013). Mental Health in American Colleges and Universities: Variation across Student Subgroups and across Campuses. Journal of Nervous and Mental Disease 201(1): 60-67.

Lipson, S., Gaddis, S.M., Heinze, J., Beck, K., Eisenberg, D. (2015). Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities. Journal of American College Health, 63(6): 388-396.

Lipson, S., Zhou, S., Wagner, B., Beck, K., Eisenberg, D. (2016). Major differences: Variations in student mental health and service utilization across academic disciplines. Journal of College Student Psychotherapy, 30(1), 23-41.

Email: healthyminds@umich.edu Website: www.healthymindsnetwork.org

Student Medical and Counseling Clinic COUNSELING SERVICES PRESENTED BY: CINDY BRUNS, PHD, INTERIM DIRECTOR OF COUNSELING SEPTEMBER 7, 2018

Student Medical and Counseling Clinic Vision and Mission u Vision: Support the academic success, maturational development, and responsible citizenship of the students at Central Washington University through the provision of professional medical and mental health services. u Mission: To meet or exceed the community standards of our medical and mental health professions in providing high quality and compassionate care within an affordable, accessible, culturally- sensitive, responsive, and efficient organization.

MISSON: The mission of Central Washington University Counseling Clinic is to support and improve the mental health, well-being, and academic success of our Central Washington University student community by empowering students to create meaningful and fulfilling lives. Quality professional services and care are at the heart of our clinic. VISION: We strive to serve all CWU students seeking mental health care through providing high quality, outcome driven, evidence-based, short-term therapy services.

Our Values

Ø Caring/Concern/Compassion: Our work is driven by dedication to students we serve and an understanding of the importance of community in each of our lives. Ø Dignity/Respect: We nurture and build on the variety of cultural strengths of the students we serve and our clinic staff by recognizing, valuing, and responding to individual and community cultures. We seek diverse input regarding our services, processes, and decisions.

Our Values

Ø Equity/Access: We will ensure equity by recognizing, respecting, and attending to the diverse strengths and challenges of our students and minimizing potential barriers to counseling access. Ø Integrity/Trust: We strive to build an atmosphere of trust and transparency in which every person is treated respectfully, fairly, and ethically. Ø Innovation: We challenge the way it has always been done. We learn from experiences to shape a better future for our students, our clinic, and the university community.

We live out our mission by…

u Empowering students to recognize and express accurately their mental health needs; u Educating students about the system of mental health care; u Facilitating student ability to actively make changes that increase the meaning and fulfillment in their lives; u Providing training and supervision in counseling/psychotherapy skills and professional development for doctoral interns and master-level practicum students; u Providing psychologically-oriented consultation and outreach to students, faculty, staff, and administration; and u Working toward continual improvement of services, procedures, processes, and operations of the Counseling Clinic.

“

We view ourselves as the facilitators of change – and students as the agents of change.

”

Staff

u Director of Counseling – Interim (Cindy) u Training Director/Psychologist (Cindy) u 3 Psychologists (licensed – Nate/Marcia; unlicensed – Jeanette) u 3 Mental Health Counselors (Melissa/Gwen/Vacant) u 3 Doctoral Interns (Taryn/Max/Kimberly) u 2 Master’s Interns (Avery/Heather) u Total 13 staff

Total Students Seen for Therapeutic Intervention - 914

PERCENT OF CLIENTS SEEN

Women

Men

Trans*

White

People of Color

Heterosexual

LGBQ

Veteran

Disability

Services

Education and Training Educational presentations on psychological topics to students, faculty, staff Doctoral Internship, accredited by American Psychological Association since 2005 Master’s Internship since 2010 Conference presentations and publications

Intervention Initial Consultation Pathways Intake

Consultation Consultation to faculty, staff, and students concerned about others Consultation to programs regarding psychological impact of program or best practices Consultation to university committees (SCT, BIT) Consultation to Medical Providers Consultation with Community Providers

Group Therapy Skills Workshops

Crisis Intervention Individual Therapy Assessment/Testing Couples Therapy

u Provides concrete, practical skills for being with distressing internal experiences u Moves focus from external to internal u Builds insight, self-compassion, and awareness of values u Gain specificity of pain over vague pain u Encourages students to still act in a values-consistent way, even when distressed u Develops universality u Socializes students to group experience u ACT concepts underpin many other services

Why Pathways?

YOU ARE HERE

Scope of Practice (condensed and simplified)

Service Initial Consultation Crisis Intervention Intake Pathways* Skills Workshops* Group Therapy* Short-term Individual Therapy Assessment/Testing Couples Therapy

Best Fit All students All students All students

Caution NA Frequent, reoccurring need NA Psychosis, recent trauma, ESL, IP Same as Pathways

Most students Most students Most students Many students – Moderate distress, clear goal, internal locus Attentional/mood/personality Specific relational difficulty

Psychosis, recent trauma, lack of clear goal Chronic high/low distress, need for intensive care, lack of clear goal, external locus No LD, ESA, Forensic, Threat to Others Both members must be students

Scope of Practice = Good Stewardship, Increased Accessibility Overall, and Ethical Practice

USAGE OF INDIVIDUAL SERVICES

< 1 1 S E S S I O N S

> 1 5 S E S S I O N S

1 1 - 1 5 S E S S I O N S

% O F T O T A L I N D I V U S E D

Goals for the year

u Faster access

u Initial consultations u Crisis u Reduced individual therapy triage list u Fully staffed u Implementation of telepsychiatry u Reaccreditation of doctoral internship u Diversity Statement u Public Scope of Practice Statement

TL;DR • We direct health promotion education, policy and environmental initiatives • Meet expectations for Title IX, Drug Free Schools & Campuses (DFC), Violence Against Women Act (VAWA) • We are a training resource for campus staff, faculty and students • Bystander intervention, alcohol risk reduction, mental health first aid, suicide intervention, sexual health, and more • We provide one-on-one confidential/private resource for students who need assistance • Victims of power based personal violence, alcohol and other drug concerns, students experiencing transition issues, general “wellness coaching”

Vision/Mission

CWU is a healthy, engaged campus community where the people, programs, practices, policies and environment support well-being.

The CWUWellness Center supports well-being by promoting positive health behaviors, providing comprehensive advocacy and response, and collaborating to create a healthy campus community.

Who are we? • 4 (soon to be 5!) professional staff • Director of Health Promotion andWellness • Assistant Director for Collegiate Recovery, Alcohol and Other Drug Prevention/Education • Violence Prevention and Response Coordinator • Health Education Coordinator • Hiring – Office Assistant • 6 part time student staff • Funded primarily by self support student fees, additionally some S & A quadrennial funds

Marissa Howat

Doug Fulp

Erin Reeh

Kristen Perry

Guidance/Standards of Practice

Our Priority Areas • Using data and feedback from our students, we addresses issues that are important to our students. • We promote positive health behaviors, prevent negative consequences associated with high-risk behavior, and encourage the social connections that support student success. • The topic areas we are currently prioritizing are: • Alcohol, marijuana and other drugs • Sexual health • Violence prevention • Nutrition and physical activity • Positive mental health and resiliency • Recovery support • Positive body image and eating disorder prevention • Sleep

We try to always be PIE • P ositive • Non-judgmental • Optimistic • I nclusive • Collegial • E mpowering

• Confidential/private • Evidence informed • Forward/upstream thinking

A day in our office…

• Delegate time: 30/30/30 • Direct Service • Prevention

• Strategic plan, collaboration, supervision • Documentation: dedicated violence prevention response database • Assessments and reports: quarterly, annual, biennial, quadrennial, strategic planning • NCHA • Healthy Minds • Campus Climate Survey

Violence Prevention & Response Prevention • Broad campus-wide efforts • OnlineWorkshop • In-person Education • UNIV 101 • Campus wide programming: Undie Run, The Hunting Ground, Rock Against Rape, etc. • Group training options • Step UpWildcats! • EscalationWorkshop • ESC partnerships • Individual opportunities • One-on-one consult • Violence prevention club/organization

Violence Prevention & Response

Response • Campus

• Clery Report – Timely notification

• Group

• Survivor support group (partnership with Counseling Clinic)

Violence Prevention & Response Individual Response

• How we receive referrals • What outreach looks like • Case notes & documentation • What a meeting looks like • Resources & Referral • Conduct Meetings, Appeals & Support

Recovery Outreach Community • AA • NA • SMART • Student Organization • Referral for assessment: Merit Resource Services

Our pals (who we work with) AKA we will work with anyone! • Student Medical and Counseling • Recreation

• ASPEN • Comprehensive Healthcare • MERIT • Kittitas Valley Healthcare • Eburg/County Police • Other community organizations • Dining • Faculty/academic departments • Athletics

• Academic advising • Veteran’s Center • DEC • CLCE • ASCWU • Student clubs • Radio station • …and more! J

• Residence Life/Housing • Rights & Responsibilities • Case Management • University Police • Disability Services • Dean of Students • Title IX Coordination

How are we doing?

What we do well: • Informing “big picture” understanding, organization and mobilization for systems change in health and wellness • Policy, practices, resources • Connections, power dynamics • Settings, narrative, cultural dynamics • Identifying and connecting with on and off campus partners • Collecting baseline student data • Generalized education and training for students, staff and faculty • Violence and alcohol/other drug response

What we need help with: • Specific and/or specialized information or treatment • Useful dissemination of baseline data • Identifying target population(s) for education and training • Accessing executive staff for “big picture” conversations • Cross-training professional and student staff

How can we work better together?

December 2017 Prepared by: Cindy Bruns, PhD Director of Counseling

CWU Counseling Clinic Fall 2017 Quarterly Report

Record Numbers Seeking Counseling Services

Demand for Services Outpaces Capabilities 432 students sought services from the counseling clinic in Fall Quar- ter 2017. This is a 13% increase over Fall Quarter 2016. In response, Counseling staff scheduled 1892 individual appointments, 1416 of which were attended by students. For the first time in its history, the Counseling Clinic created a waitlist for screening appointments, as all scheduled screening appointment slots for the quarter were filled by the beginning of November. The average time from call to the clinic to screening appointment was 10 business days, an increase of 200% over Fall 2016. The median wait time was 8 business days, and only 44% of students seeking an initial appointment were seen within 7 business days of contacting the clinic. Over the course of the quarter, 99 students were placed on the waitlist for individual services, a 36% increase over the same timeframe in 2016. The average time on the waitlist was 14 days. 58 students on the waitlist were sent regret let- ters at the end of the quarter. Staff also provided 34 outreaches to the university community, while serving a record number of students in counseling. Crisis Services Increase Dramatically The Counseling staff saw 109 clients for 138 crisis appointments to- taling 150 hours of crisis intervention. That is an average of 15 hours per week of crisis intervention during a 10 week quarter. These numbers represent a 41% increase in crisis appointments, 52% in- crease in the number of hours devoted to crisis intervention, and a 36% increase in the number of students receiving crisis services over the same period last year. Crisis appointments accounted for nearly 10% (9.7%) of all individual appointments and 25.5% of all students seen by the Counseling staff had at least one crisis appointment this quarter. Twelve clients reported either a recent suicide attempt or having created a suicide plan with intent to die. 27.5% of new clients reported suicidal thoughts in the last two weeks, 19.7% reported a previous suicide attempt, and 70% reported feeling hopeless that things would improve in their lives.

Inside this report

Group Therapy............................2

Referral Sources..........................2

Serving a Diverse Students..........2

Academic Standing/Age..............2

Pathways Research Presented....3

Training Program ........................3

Retention Data............................3

New Staff and Transitions ...........4

Special points of interest

 432 students sought services

 1416 individual appointments

 483 group appointments

 138 crisis appointments

 12 students with recent suicide attempt or serious suicide plan with intent to die  99 students placed on wait list for individual services

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