Twenty years ago, college students with depression, anxiety, bipolar disorder or other mental health concerns faced an uphill battle to find services and support on their campus.

Meanwhile, the health care and counseling teams at their college or university often lacked good evidence about what might work to meet those students' needs.

But that has changed, thanks in part to the Depression on College Campuses Conference held at the University of Michigan since 2003.

For years, the conference has brought together hundreds of academic researchers, campus mental health providers, student advocates and representatives from nonprofit organizations and startup companies from across the country. Recently, they gathered virtually to share new findings and innovations, and to connect with one another.

The conference, presented by the Frances and Kenneth Eisenberg and Family Depression Center, has become a nexus for new ideas and evidence to guide campus staff and student leaders across the country.

A few months ago, it was even the subject of an academic paper tracing its evolution and impact.

Published in Academy Psychiatry, the paper concludes that the conference "has been and will continue to be a way to address important issues on campus, shape service delivery, use campus resources to improve college mental health, and, in the process, enhance both educational and mental health/brain-behavior objectives."

Data from surveys of past participants showed that 90% planned to use or implement what they learned at the conference on their own campuses.

Experts involved in the event reflect on the need for attention to college-age mental health, and innovations in addressing specific needs.

What's unique about convening experts on this topic?

Michelle Kees, Ph.D., associate professor of psychiatry at the U-M Medical School and faculty lead for the Eisenberg Family Depression Center's Outreach and Education Programs:  

Events are so important because they provide a level of awareness about mental health issues. They have a real impact on reducing stigma and making it OK to talk about depression much as we would about any other disease or disorder. To have engagement from faculty, and from students, opens up the line of communication and awareness between both groups. Combine that with cutting-edge research and information — it's increasing people's knowledge about the latest in the field. It's also an interesting opportunity from a student's perspective who might consider careers in this direction. We have seen so many changes in the last two decades about the willingness to talk about depression and other mental health conditions. When you take something that used to only be talked about behind closed doors, and you examine it at all angles — that's how you allow people to heal and get access to care.

Christine Yu Moutier, M.D., medical director of American Foundation for Suicide Prevention and keynote speaker at the conference: 

Mental health distress and conditions commonly emerge during the college years, and we have seen rates of distress increase during the pandemic. I worry about our ability to meet their mental health needs, to support resilience upstream, and about the longer-term impact on overall health and functioning. Untreated or undiagnosed mental health conditions have a significant impact on college students' academic and personal functioning. In fact, 64% of students who leave college do so for mental health related reasons. Suicide is the second leading cause of death for college students.

Todd Sevig, Ph.D., director of U-M Counseling and Psychological Services since 2001, chair of the campus-wide U-M Mental Health Work Group and co-chair of the conference: 

It really was the vision of the Depression Center's founding director, John Greden, M.D., that gave the energy to this conference. At U-M, we realized we needed to take a "campus-wide" approach, involving students, faculty, staff, mental health professionals and making our support mechanisms campus-wide. It takes all of us in our different roles on campus to fully support the mental health of students. I've long thought that the strength of our conference is that we bring together medical and psychology and social work fields, we bring together mental health professionals and non-mental health professionals, and we present a mix of specific topics as well as culture and campus climate change efforts.

How has the need changed in recent times?

Kees:

Now during the pandemic, every place you look, we're talking about mental health. Every study that has been done has shown elevations in depression and anxiety—experientially in college students. Having this opportunity for connection and learning is vitally important. Collectively, we need to see that it's not about "getting through this" — it's about living again. It's having joy, purpose, meaning. It's more than just what we have to do today. There needs to be much intentionality around our path forward, after a period where we've not had much control.

Ed-Dee G. Williams, Ph.D., M.S.W., postdoctoral fellow, Level Up Lab, University of Michigan School of Social Work, and conference keynote speaker: 

COVID-19 has shined a bright light on many of the inequities that exist in our society. It is most blatant for young people. Most people have not realized how reliant we are as a society on our schools to provide mental health support, identify abusive home situations, provide access to food, and security for young people. Many students that are experiencing mental health challenges rely on school counselors, teachers, and other school staff for support. Studies have shown that this tends to be the case for many Black students and students of color.

Are there specific groups of students who need extra attention or special outreach?

Kees, who oversees peer support programs for military veterans enrolled in higher education: 

What we have continued to find very effective for students who are veterans is peer support. The challenge in the veteran community is getting them into care. We want them to know there is care, that they need it, and lastly how to get it. With our veteran college student program PAVE, peer support is a key part of it. We have veterans helping other veterans know about all the different kinds of support. Peer connection programs like PAVE are linked to improved graduation rates and greater academic success. Any kind of approach we can utilize to help college students feel connected is going to have a positive effect on mental health.

Moutier: 

We need to support youth from all backgrounds, ages, genders, race, or ethnicities. We know some youth have higher rates of suicidal thoughts and behaviors (pre-pandemic), (e.g., LGBTQ students, students with health and social disparities, and concerning trends in Black and Latinx youth) and so keeping in mind there are known risk factors that were present before the pandemic is critical.

Williams:

The effects of COVID-19 on Black communities have been clearly documented, including greater rates of mortality, longer bouts of illness, greater financial strain, and job insecurity. Combine this with everything that is happening in regards to racial conflicts in our society and we can see a perfect storm that is affecting the overall mental health of Black youth. Many programs are developed and then assume that student is going to seek them out when they are in need. But if we consider many cultural norms, many marginalized groups avoid openly seeking help for mental health challenges due to fears of being stigmatized. And often students will report that they were not aware that these support groups existed. So, it is important for these support groups to actively recruit students and seek out students that may need mental health support or just general social support.

What innovations are helping improve mental health support on campus?

Sevig, who has led U-M's effort to transform student mental health and well-being on its campus: 

The energy of our student body is fantastic around mental health — energy in advocacy, providing peer support, and providing peer education efforts. And involving a mix of "in-person" support as well as using technology — apps, online supports, phone supports, that are all available when students need them, 24/7.

Moutier: 

There are evidence-based steps and tools for clinicians and health systems, detailed in the newly released National Youth Suicide Prevention Blueprint (a partnership effort between the American Academy of Pediatrics and AFSP). Additionally, clinical care standards for reducing suicide risk were released in 2018 in the National Action Alliance for Suicide Prevention's Recommended Standard Care for People with Suicide Risk, that can be implemented in routine medical care for patients, including universal screening for suicide risk, safety planning, lethal means counseling, and providing caring communications that bridge transitions in care. AFSP encourages colleges and universities to implement policies and procedures for how to support students experiencing a mental health condition or suicidal crisis, and to consider implementing AFSP's Interactive Screening Program. Talking openly about mental health, training peers and mentors on campus, correcting unfair policies, and linking students with mental health supports and treatment have the power to save lives.

Williams: 

We need greater representation in the field at all levels. At the policy level, at the research level, at the clinical and community level. I would encourage more BIPOC individuals to pursue careers in mental health, intervention development, evaluation, implementation, etc.

Nathaan Demers Psy.D., vice president and director of clinical programs, YOU at College/ Grit Digital Health and conference presenter: 

Mental health is being talked about in ways and in spheres it never has before. I am hopeful that this trend continues while also ensuring the field of digital health maintains its roots in providing rigorously tested care. Medicine realized that treating high cholesterol is better than treating heart attacks in the ER. Similarly, let's strive for ways to alleviate stress, mild depression, anxiety, substance use, etc., before it becomes an issue. We are at a point in time where we need to focus on creating and encouraging students to find positive digital experiences, as opposed to any digital experiences that are entertaining. Education on the difference is also essential. Whether that be through evidence-based apps, using technology to facilitate connections that would not otherwise be possible (i.e. connecting with friends from high school who are at another college), or engaging in meaningful dialogue about meaningful experiences."

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Paper cited: "Depression on College Campuses Conference: Addressing an Evolving Crisis, Academic Psychiatry," Academic Psychiatry. DOI: 10.1007/s40596-021-01575-z