Summary and Policy Implications In summary, the data and visualizations reviewed above help to further articulate the complex practice of mental health treatment in higher education and offer a number of policy implications worthy of consideration: • Counseling center treatment is effective, even comparable to RCTs, however centers must have adequate treatment capacity to address the range of primary presenting problems experienced by students. • Arbitrary and/or rigid treatment limits may prematurely terminate services for students who otherwise would have improved with more treatment. • The growing prevalence of anxiety and depression represents a substantial challenge for colleges and universities. Institutions and counseling centers will need to work together to develop and offer a continuum of options to educate and support both students seeking counseling services as well as the general student body (e.g., prevention, education, self-help, and expanded treatment capacity). • Policy makers should take into consideration the potential conflict between institutional priorities and the treatment capacity of the counseling center (including both wait for treatment and treatment length). For example, a well functioning counseling center may still be unable to meet an institution’s articulated commitments (e.g., supporting survivors of sexual assault or managing suicidality in students of concern) if policy/funding decisions are not properly aligned with these priorities. Consequences of poor alignment between priorities and resource allocation can include inadequate treatment capacity (overall or for specific concerns), an arbitrary treatment limit (e.g., 3 sessions) that does not consider institutional expectations or student needs, or an uninformed response to rising demand (e.g., mandatory bi-weekly treatment) that is not clinically indicated. • While treatment limits may be a reasonable response to managing rising demand with limited resources, the data reviewed herein suggests that such limits need to be administered in a flexible manner that actively accounts for individual student situations. Additionally, the alternate costs associated with limited or incomplete treatment for students, stakeholders, and the institution should be considered in advance so that all parties understand the natural consequences of each decision point. Examples might include recurrent depression or anxiety due to incomplete treatment, inadequate treatment for survivors of sexual assault,
lack of support for highly distressed students living in residence halls, or impact on retention and persistence to graduation for distressed students. • The complex relationship between treatment response, presenting concerns, treatment length, and service utilization suggest that counseling center treatment cannot, and should not, be reduced to “symptom reduction.” Rather, treatment must incorporate broader institutional goals and values. The fiscal and operational demands faced by colleges and universities are very real as are the complex mental health needs of our students and the treatment provided by counseling centers. While each institution must make individualized policy and funding decisions regarding mental health services, the information reviewed here suggests that these decisions should be data driven, clinically informed, and aligned with the institutional values. 2017 Publications • Lefevor, T.G., Janis, R.A., Park, S.Y. (2017). Religious and sexual identities: An intersectional, longitudinal examination of change in therapy. The Counseling Psychologist, 45, 387-413. • Perez-Rojas, A.E., Lockard, A.J., Bartholomew, T., Janis, R.A., Carney, D.M., Xiao, H., Youn, S.J., Scofield, B., Locke, B.D., Castonguay, L.G., & Hayes, J.A. (2017). Presenting concerns in counseling centers: The view from clinicians on the ground. Psychological Services, 14, 416-427. • McAleavey, A.A., Youn, S.J., Xiao, H., Castonguay, L.G., Hayes, J.A., & Locke, B.D. (2017) Effectiveness of routine psychotherapy: Method matters. Psychotherapy research, 2-17. http://dx.doi.org/10.1080/10503307.2017.1395921 • Scofield, B.E., Stauffer, A.L., Locke, B.D., Hayes, J.A., Hung, Y., Nyce, M.L., Christensen, A.E., Yin, A.Y. (2017). Examining the relationship between students’ contact with counseling centers and long- term educational outcomes. Psychological Services, 14, 461-469. • Xiao, H., Carney, D.M., Youn, S.J., Janis, R.A., Castonguay, L.G. Hayes, J.A., & Locke, B.D. (2017). Are we in crisis? National mental health and treatment trends in college counseling centers. Psychological Services, 14, 407-415.
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