Board of Trustees

Committee on Academic and Student Affairs

May 30, 2018

Student Mental Health:The National Dilemma and Local Responses

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Nance Roy

The JED Foundation

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Sources: NAMI, SAMHSA, JED Harris Poll, 2017 County Health Rankings 6

Source: ACHA-NCHA Survey 2016

2016 – 17 Healthy Minds Survey DataN = 8000 first year students, 48 campuses

Positive

Negative

1/3 of first year students screened positive for depression

30%

56%

Positive fordepresssion

Negative fordepression

Students that strongly agreed they would persist to graduation:

94% reported that mental health difficulties had

impaired their academic performance over the

past month.

Of all first year students with diagnosed depression:

2005 – 08 Healthy Minds Survey Data

From the University of Michigan

Students with a depression diagnosis are at

2x the risk

of dropping out of college and not graduating than those who were not depressed

Depression and anxiety also have a negative impact on GPA.

Campus Capacity

• Average of 10% of students seen at campus services

• Many very symptomatic students do not see themselves as having “psychiatric problems” (less likely to seek treatment)

• Many in most serious risk do not present on their own

• 20% of campus suicides were seen at CC/80% no contact

We believe in a comprehensiveto

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Campus Reports on Innovations

Student Affairs Advisory Council (SAAC)

UMass AmherstUMatter at UMass

Core Concepts, Priorities and Outcomes

Spring 2018

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UMatter @ UMass

College Students Are Disconnected

at UMass Amherst

• 1:3 believe violence is a problem

• 1:5 observed or experienced violence in the

past year

• 1:3 know how to report an incident

• 1:4 ‘unlikely’ to report harassment/violence

• 55% had sleep or study interrupted by

others’ use of alcohol

• 28% have no cross-racial/ethnic friendships

• 18% have never had an important cross-

racial/ethnic conversation

Undergraduate Campus Climate Study

UMass Amherst Alcohol Survey Data

Core ConceptsCare • Community • Compassion • Connection • Inclusion

UMatter Key Purposes

• Reinforce UMass’ longstanding

commitment to inclusion, care, compassion

and collective action

• Reduce student isolation

• Increase feelings of connection and

belongingness

• Create a community of care and a culture

of active bystandership

College Students Are Increasingly

Disconnected - Nationally

• 86% feeling overwhelmed

• 59% lonely

• 54% overwhelming anxiety

• 42% hopeless

• 32% so depressed – difficult to function

• 8% considered suicide past 12 months

• 80% had not sought assistance from a

counseling center or other resource

• Suicide is second leading cause of

death for college students

AUCCCD Survey 2014, NASPA/ACHA Summary 2013

Suicide Prevention Resource Center – sprc.org

Key Practices

• Environmental Messaging

• Responsive Reporting

• Bystander Intervention

• Motivational Interviewing

• Targeted Education Programming

• Assessment & Data Collection

Climate Priorities – Aspirations

• Healthy Lifestyle and Wellness

• Belonging in Community

• Active Inclusion

• Respectful Relationships

• Mindfulness and Mental Health

• Digital Citizenship

Intervention Focus – Preventions

• Isolation

• Depression/Anxiety

• Alcohol/Drug Misuse

• Sexual Assault

• Hazing

• Bias/Hate Acts

• Bullying/Harassment

• Violence

UMatter Outcomes• 5,000 incoming undergraduate students are trained each year in active

bystandership to prevent and respond to incidents of bias, violence, sexual

assault, bullying, hazing, high-risk drinking and other community impacts

• 8,000 copies of the Maroon Folder to help staff and faculty recognize and

effectively respond to students in distress*

• Since 2013, UMatter at UMass has run messaging campaigns on local buses

and digital signage on sexual assault prevention, preventing harassment on

buses, and most recently, profiling bystander intervention strategies

• 10,000 UMatter at UMass guides are distributed to incoming students and

their families to increase early connection to campus support resources

• 26,000 students receive weekly and monthly messaging on connections,

self care, and campus resources

• 5,973 returning students had active bystander training in their residence halls

• 30+ support groups for distinct student populations

• Conference for Compassionate Leadership

*The UMass Amherst Maroon Folder framework is now used by 30+ colleges and universities across the U.S.

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UMass Boston:JED Self-Evaluation

UMass Boston

JED Self-Evaluation

Policy Systems & Strategic Planning

• Medical Leave/ Return Policy

• AOD Protocols

• Medical Amnesty Policy

Means Restriction

• Pill Collection

• Breakaway Closet Rods in Residence Hall

• Access Restriction

IdentifyStudents at Risk

• BIT and Care Teams

• Questions on Health Forms

• Outreach to Entire Student Body

• Maxient

Student Wellness

• Recovery at UMass Boston

• Engaging Faculty

• Residence Life Living Option

Developing Life Skills

• DBT Skills and Panic Coping Workshops

• KORU Mindfulness

• UMB-UR-Best Workshop and Coaching

Implementation Completed

Implementation In Progress

Policy Systems & Strategic

Planning

Means Restriction

IdentifyStudents at

Risk

Student Wellness

Developing Life Skills

UMass DartmouthBasic Needs InsecurityAn Impediment to Mental Health

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• Food insecurity is the limited or uncertain availability of nutritionally adequate

and safe foods, or the ability to acquire such foods in a socially acceptable

manner. The most extreme form is often accompanied with physiological

sensations of hunger.

• Housing insecurity is the inability to pay rent or utilities or the need to move

frequently.

• Homelessness means that a person is without a place to live, often residing in

a shelter, an automobile, an abandoned building or outside.

Basic Needs Definitions

Wisconsin Hope Lab Survey Report April, 2018

Basic Needs Insecurity

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Wisconsin Hope Lab Survey Report April, 2018

National UMassD

University students reporting

food insecurity in the last 30

days

36% 41%

University students reporting

housing insecurity in the last

year

36% 33%

University Students reporting

homelessness in the last year

9% 11%

Arnie’s Cupboard

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Food donations:

• Faculty/Staff donations

• "Food for Fines" program

• "The Cupboard is Bare" UMD Announce emails

• External donors such as Gold Medal Bakery

Monetary donations:

• Knights of Columbus

• UMassD Annual Fund (one-time or recurring

contributions)

• Trustee Maria D. Furman

Other support:

• Three work-study student positions

• Center for Religious & Spiritual Life Volunteer

Supervisor

Period Guests Visits lbs Volunteers

2016-2017 371 NA 2,731 NA

Summer 2017 22 47 448 29

2017-2018 389 742 5,396 202

UMass Lowell

Healthy Minds

Healthy River Hawks

A Community of Support at UMass Lowell

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Learning with Purpose

STUDENT STATES OF

MENTAL HEALTH

CRISIS

SEVERE DISTRESS

MEDIUM DISTRESS

MILD DISTRESS

POSITIVE WELLBEING

• Restrict Access to Potentially Lethal Means

• Follow Crisis Management Procedures

• Provide Mental Health & Substance Abuse Services

• Increase Help Seeking Behavior• Identify Students at Risk

• Promote Social Connectedness• Develop Life Skills

JED Foundation Model

Intervention

Prevention

Mental Health Continuum

www.mindyourheadyork.org/what-is-mental-health/

Learning with Purpose

CRISIS INTERVENTION

Learning with Purpose

COMPREHENSIVE

APPROACH TO

PREVENTION

Capes and Healthy Hawks

Student and Academic

Affairs Support Staff

Training

FYE Classroom

Presentations

Onboarding, Orientation

and First Year Experience

Facilitated Student Support Groups

Faculty and Staff

Onboarding and Resources Targeted

Prevention to Student Groups

Engaging Parent and

Family Partners

Leveraging Social Media

Role Modeling Healthy

Behavior

Sleep and Mindfulness

Planning: Financial, Life,

Future

Campus Ministry and Spirituality

STUDENTS

Developing Life Skills

Promoting Social Connectedness

UMass Medical SchoolUnique Issues Associated with Graduate and Medical Students

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Medical School Global Trends

• Burnout, depression and suicide are more prevalent in physicians and trainees as compared with the general population

• 300-400 physicians die by suicide each year1

• 1 in 4 medical students shows signs of depression globally2

• 11% of medical students experience suicidal ideation (SI) during medical school2

• 9.3% similar age general population experience SI during the same time

• Attention to mental health issues and wellness have not been embraced in the profession historically

• Cultural factors encourage suffering in silence; fear and shame predominate

1. Center C, Davis M, Detre T et al. Confronting Depression and Suicide in Physicians. A Consensus Statement. HAMA 2003;289(23):3161-3166. 2. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical StudentsA Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214–2236.

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• Physician burnout is costly in the short and long term

– Measurable impact on patient care outcomes, patient safety and

measures of satisfaction and productivity

– National assessment of cost of physician turnover: as high as $500K-

$1.5M for a single physician

• Physician burnout impacts learners

– Learners observe and learn, watching their teachers

– Physician burnout mistreatment, the learning environment

– Burnout begins in medical school, grows in residency

Burnout/Suicide Garnering Increasing Attention

PubMed Search: “physician” and “burnout”

2016: 2752017: 3022018: 134

National Academy of Medicine: Action Collaborativehttps://nam.edu/initiatives/clinician-resilience-and-well-being/

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• Learning Communities: mentoring, coaching

• Curriculum

• Wellness Initiatives

• Student Counseling Services

The UMMS Model

Growing Challenges• Substantial increase in volume over past 5 years

Increased intakes

More complicated cases

Large percentage of students seen over tenure

• UMMS students are a unique population that require more nuanced care and

support.

• Medical and Nursing students are different due to current clinical duties

and future medical/nursing licensure concerns

• Graduate students generally are at a different stage of life

Sarah Ketchen Lipson

Healthy Minds Study

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Healthy Minds Study (HMS)

• Started in 2005

• Annual, web-based survey

• > 200 schools; > 200,000 students through 2018

• Random sample at each participating institution

• 20-25 minutes to complete

• After survey, informs students about mental health resources

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HMS Survey Topics

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How does mental health predict academic success?

Data: random sample of undergraduate and graduate students

Baseline

2-year follow-up

Outcomes: GPA, retention

Mental health: depression, anxiety, eating disorders

GPA

Within semester

Depression lower GPA

+15 points on PHQ-9 (“mild” (4) to “severe” (19) depression)

-0.2 in GPA

-0.4 drop in GPA if co-occurring anxiety

Over time

Negative associations: depression, panic disorder, generalized anxiety, eating disorders

Co-occurring anxiety-depression have an additional negative association

Retention

Drop-out rate at UM

25%: <3.0 GPA, screen positive for a mental health problem

9%: <3.0 GPA, no mental health problems

Each point on PHQ-9 +0.3% in drop out probability

+15 points on PHQ-9 +4.7% in drop out probability

Implications for Practice

Anticipating drop-out

Low GPA in previous semester

Positive screen for a mental health problem

Adding mental health criteria would increase drop out identification

On campuses with higher drop-out rates, screening would be more cost-effective (fewer “false positives”)

Economic Case for Mental Health Services

Return on Investment (ROI) Calculator

Parameters (customizable)

Student population (enrollment)

Percentage of students depressed

Institutional drop-out rate per year

Tuition

Cost of mental health providers

Outcomes

Number of drop-outs averted due to programs/services

Total additional revenue for institution

Total additional lifetime earning (productivity) for your graduates

Economic Case Illustrated

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Infographic from kognito.com, based on findings from 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.

Example: University of Michigan

Example: University of Michigan