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Committee on Educational Policy #E3

Report of the Student Mental Health Oversight Committee

March 18, 2009

Professor Joel Dimsdale, UCSDVice Chancellor Michael Young, UCSB

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UC Timeline

Parents Victor and Mary Ojakian speak at Regents

Senate Administration Taskforce formedto study student mental health

Taskforce presents assessment of risk analysis to Regents

Registration Fee increase of $22 per student ($4.6 million systemwide)

Registration Fee increase of $39 per student ($8 million systemwide)

The Regents approve principles underlying the determination of Registration Fees

Sept 2005

Dec 2005

Sept 2006

March 2007

Sept 2007

Sept 2008

Student Regent requests a reviewDec 2004

Jan 2007 Provost convenes Student Mental Health Oversight Committee

March 2008 Campus Security Taskforce presents findings to Regents

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Student Mental Health Oversight Committee Tasks

Accountability:• Trends in need • Trends in operation• Actual & Planned Expenditures• The Path Ahead

Accountability:Accountability:•• Trends in need Trends in need •• Trends in operationTrends in operation•• Actual & Planned ExpendituresActual & Planned Expenditures•• The Path AheadThe Path Ahead

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Trends: Stress, Depression, & SuicideTrends: Stress, Depression, & SuicideTrends: Stress, Depression, & Suicide• 45% of UC students reported stress & 17% reported depression

interfered with their academic success “frequently” or “all the time”;

• About 1 in 10 UC students seriously considered attempting suicide, and 1.4% attempted suicide, consistent with national data.

Source: American College Health Association-NationalCollege Health Assessment (ACHA-NCHA), UC Data: UCB, UCD, UCLA, UCSD & UCSC

Stress and Depression: UC Undergraduate Experience Survey

(2006)

45.7%

17.5%

0%

10%

20%

30%

40%

50%

Being stressed interferedwith academic success

Being depressedinterfered with academic

success

Source: University of California Undergraduate ExperienceSurvey (2006)Number of Respondents: 10,777

Students Seriously Thinking About and Attempted Suicide in Last School Year: UC

and Nationwide (ACHA-NCHA 2004-07)

10.0%

1.4%

9.8%

1.5%

0%

2%

4%

6%

8%

10%

12%

Seriously consideredAttempting suicide

Attempted suicide inlast school year

Five UCs U.S. Colleges

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Trends: Hospitalizations and Completed Suicides

Trends: Hospitalizations and Trends: Hospitalizations and Completed SuicidesCompleted Suicides

Suicides and Psychiatric Hospitalizations at UC Campuses 2005-06 to 2007-08

16

256

12

249

11

446

050

100150200250300350400450500

Completed Suicides Psychiatric Hospitalizations

2005-06 2006-07 2007-08

Source: Data reported from Counseling and Student Health Centers from 2005-2008

•Psychiatric hospitalizations increased 79% in 2007-08;

•Suicides at UC have not increased (11 in 2007-08).

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• There has been a 70% increase in UC students receiving mental health services since 2000 (12,384 to 21,076), four times greater than the rate of enrollment growth (17%).

• The largest one-year increase was in 2007-08 (18%).

Trend: Increasing UtilizationTrend: Increasing UtilizationTrend: Increasing Utilization

UC Students Seeking Mental Health Services

0

5000

10000

15000

20000

25000

2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08

Source: Data reported from 8 Counseling Centers (excluding UCSF and UCM)2000-2008

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Trends: Special Populations

Trends: Trends: Special PopulationsSpecial Populations

Reprinted with permission © 2008 The Daily Californian

Psychiatric Disabilities: At three UC campuses with reliable historical data (UCB, UCLA, UCSB), there was a five-fold increase for registered students between 1996-97 and 2007-08 (avg. 37 to 193).

Psychiatric Disabilities: At three UC campuses with reliable historical data (UCB, UCLA, UCSB), there was a five-fold increase for registered students between 1996-97 and 2007-08 (avg. 37 to 193).

Graduate Students: UC Irvine and UC Berkeley surveys:43-45% reported mental/stress problems or needing help, but only 25-31% sought mental health services.

(Hyun et al., 2006; Louden & Skeem, 2008)

Graduate Students: UC Irvine and UC Berkeley surveys:43-45% reported mental/stress problems or needing help, but only 25-31% sought mental health services.

(Hyun et al., 2006; Louden & Skeem, 2008)

Veterans: 31% of U.S. military deployed in Iraq and Afghanistan meet criteria for traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) or major depression. (Rand Corporation, 2008)

Veterans: 31% of U.S. military deployed in Iraq and Afghanistan meet criteria for traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) or major depression. (Rand Corporation, 2008)

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Framework for Actual and In-process Expenditures

Framework for Actual and In-process Expenditures

Tier 1

Critical MentalHealth and Crisis

Response Services

Tier 2Targeted Interventions

Tier 3Creating Healthy Learning Environments:A Comprehensive Approach to Prevention

Total New Funding in 2007-08: $4.6 MillionTotal New Funding in 2008-09: $8 Million (in-process)

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Tier 1 ExpendituresTier 1 ExpendituresTier 1 Expenditures

• Tier 1 Actual Expenditures in 2007-08: $3.5 Million

• Tier 1 Planned Expenditures in 2008-2009: $4.1 Million

• 41 new FTE in 2007-08, 35 FTE anticipated in 2008-09

Top Five Spending Areas in Tier 1

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

Increase disability service staff

Crisis response

Case management strategies

Equity adjustments to retain mental health professionals

Increase mental health professionals

2007-08 2008-09 (in-process)

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• Tiers 2 & 3: Modest Actual Expenditures in 2007-08: $443K

• Tiers 2 & 3 larger role planned in 2008-09: $3.8 Million

• 3 new FTE in 2007-08, 31 FTE anticipated in 2008-09

Tier 2 & 3 ExpendituresTier 2 & 3 ExpendituresTier 2 & 3 Expenditures

Spending Areas in Tiers 2 & 3: Targeted Interventions & Creating Healthier Learning Environments

$0

$250,000

$500,000

$750,000

$1,000,000

$1,250,000

$1,500,000

$1,750,000

Promote wellness

Expanded support and learning services

Targeted intervention

Integrated prevention

2007-08 2008-09 (in-process)

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Areas of Substantial ProgressAreas of Substantial ProgressAreas of Substantial Progress

• Counseling wait time is down from 31 days to 8 days• However, psychiatrist wait times will take longer to improve

Average Wait Time in Days for Counseling and Psychiatry

Appointments

8

31

1110

0

5

10

15

20

25

30

35

2005 2007

Counseling Psychiatry

Systemwide Average: Psychologists to Student Ratios

1700

2300

0

500

1000

1500

2000

2500

2005 2007

IACS Recommended Ratio: 1000-1500

• Psychologist-to-student ratio improved 26%• UC is getting closer to the IACS recommended

range for psychologist-to-student ratio

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New InitiativesNew InitiativesNew Initiatives

• 24-hour phone counseling at nine campuses

• Peer Programs: At UCSB campus newspaper has mental health column, student interns design campus campaigns, student group established for reducing stigma

• Prescription for Wellness Recreation Voucher at UCSD: Counseling and Student Health providers identify students with depressed mood; students given voucher for free fitness orientedrecreation class & info on the impact of exercise on mood. In 2008-2009 800 students will receive vouchers.

• Alcohol, tobacco, and other drug intervention services at UCD: Intervention specialist provides services to students with substance abuse disorders. From July-November 2008 160 students received services.

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Funding StructureFunding StructureFunding Structure• Registration Fees are the primary fund source for SMH Services;• Long-term erosion in purchasing power of Registration Fees is the principal reason UC’s SMH services became overtaxed.

Historical Representation of UC Registration Fee (Resident Undergraduate)

$0

$200

$400

$600

$800

$1,000

$1,200

1987

-88

1989

-90

1991

-92

1993

-94

1995

-96

1997

-98

1999

-00

2001

-02

2003

-04

2005

-06

2007

-08

Reg Fee Reg Fee adjusted for 3% CPI

$864

$1081

$564

$581

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• UC has made progress, including hiring additional mental healthprofessionals, lowering wait times and providing 24-hour phone services. However, there is much more that we can and must do.

• UC has made progress, including hiring additional mental healthprofessionals, lowering wait times and providing 24-hour phone services. However, there is much more that we can and must do.

The Path Ahead

The Path The Path AheadAhead

• Continued growth in Registration Fees is critical, and is consistent with the Regents’ 2007 approval of principles for a multi-year plan.

• Continued growth in Registration Fees is critical, and is consistent with the Regents’ 2007 approval of principles for a multi-year plan.

• Further advances in accountability require that all campuses commit to enhanced data collection and reporting practices.

• Further advances in accountability require that all campuses commit to enhanced data collection and reporting practices.

• Increase psychiatry staff to reduce wait time, decrease the student to counselor ratio, further outreach and training to faculty.

• Increase psychiatry staff to reduce wait time, decrease the student to counselor ratio, further outreach and training to faculty.

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• The Student Mental Health Oversight Committee is focused on accountability, compliance and reducing risk.

• We are cognizant of cost and our campuses are employing a variety of interventions, services, and staffing models to delivery the most responsive care we can provide.

• We have a moral and legal obligation to continue this work.

• The Student Mental Health Oversight Committee will continue to focus on identifying best practices, assessing the goals of this work, and improve service delivery to our students, and the University Community.

The Path AheadThe Path AheadThe Path Ahead

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Committee Members

Jeff Gibeling, Ph.DDean of Graduate Studies, UCD

Homaira HosseiniUndergraduate student, UCLA

Janina Montero, Ph.DVice Chancellor for Student Affairs, UCLA

Patty Robertson, M.D.Professor of Obstetric and Gynecology UCSF

Drew WaltherGraduate student, UCSB

Liz Gong-Guy, Ph.DDirector of Counseling Center, UCLA

Steve Lustig Associate Vice Chancellor Health and Human Services, UCB

Thomas Parham, Ph.DAssistant Vice ChancellorCounseling and Health Services, UCI

Judy Sakaki, Ph.DVice President of Student Affairs, UCOP

Joel Dimsdale, M.D. (co-chair) Michael Young, Ph.D (co-chair)Professor of Psychiatry Vice Chancellor for Student AffairsUCSD UCSB

Staff support to the committeeAngela Andrade (UCSB), Maria Blandizzi (UCOP), William Kidder (UCR)