The Cost of Crisis: Making the Budget Case for Telepsychiatry on Campus

The importance of quality mental health care on campus comes into focus when we turn our attention to the experiences of students in crisis. One of our team members shared a personal story about his nephew that offers valuable framing for this discussion:

"He began college in September 2020 but withdrew four months later due to mental health challenges that went untreated. He was experiencing depression and anxiety and didn’t get the kind of help he needed. Despite his track record as a happy high-achiever in high school, after his brief college stint he was left with unfinished courses, substantial debt, a relationship breakup, and an overwhelming sense of defeat. At the heart of his crisis was mismanaged medication. Now, he’s back home with parents getting help he didn’t know how to find on campus but with greater uncertainty about how to succeed in college going forward. He has a tarnished relationship with the college experience, in general, and his university, in particular."

Stories like these are too commonand perhaps what is most devastating about them is their preventability: 83% of students believing their academic performance has been hampered by poor mental health. Depression and anxiety are manageable with quality mental health services. It is widely accepted among mental health providers that combining medication management and psychotherapy drives the most effective outcomes for common disorders including anxiety, depression, and bipolar disorder. However, most centers only staff psychologists with patient session caps, and less than two thirds of centers offer psychiatric services at all. 

With telehealth emerging as a strong candidate to help fill these resource gaps, universities are faced with the choice of how to invest in mental health services that are indispensable to student success. 

University Leadership Is Advocating for Students

There is a new wave of empowered students and parents who recognize that mental health services are essential to student success. As stigma around psychiatric illness dissipates, student affairs and counseling leadership can usher in new technologies and approaches onto campus to meet student demand and propagate meaningful change.

Budgeting for mental health pays off.

A simple Cost-Benefit Analysis by the American Council on Education illustrates the ROI of investing in mental health services:

Consider a university onboarding clinicians to care for 500 additional depressed students. The investment to provide these services costs $500,000 at most ($1000 per student is a generous estimate of treatment cost). By averting student dropout rates, this program would yield $1,000,000 in tuition revenue for the institution. Lifetime economic returns for students are predicted to be over $2 million. 

Mental health services yield economic returns for universities far exceeding their cost. The ROI suggests a huge potential to deliver a better academic experience to students while also realizing important incremental revenue. This analysis does not even account for less tangible, yet still meaningful, benefits of quality mental health care to student wellbeing and institutional reputation.

Investing in psychiatry drives quality care.

Psychotherapists, or talk-therapists, are often more accessible to college students than psychiatric providers. But high quality care requires access to both psychotherapy and psychiatry. A meta-analysis of 101 studies on treating moderate depression found that combined treatment was more effective than both psychotherapy alone and pharmacotherapy alone. 

According to a recent large-scale study, while the proportion of college students taking psychiatric medications has risen in the last decade, the proportion of students receiving medication management via psychiatric providers has been stagnant. There is also a trend towards polypharmacy, with 40.8% of college students using multiple categories of psychiatric medication in the last year. As college students seek care for complex conditions, the imperative to connect them with psychiatric providers is heightened. 

Despite the fact that psychiatrists provide the most informed mental health care, primary care doctors are prescribing the majority of psychiatric medications in useprescribing 58.8% of psychiatric medications versus psychiatrists prescribing 36.1%. While it can be challenging for colleges to afford in-house psychiatric providers, telepsychiatry offers a compelling solution to the need for highly qualified practitioners who can manage complex treatments for college students.  In light of extensive evidence that general outcomes do not differ between in-person treatment and telepsychiatric treatment, telepsychiatry has the potential to fill in gaps in care.  

Telehealth solutions make quality care scalable. 

Telehealth in general is well-suited for college students with busy schedules, enabling greater appointment availability and remote therapy sessions. According to a review of recent literature, “College students find Telemental Health to be convenient, accessible, easy to use, and helpful. Telemental health also helps to overcome the barrier of stigma, which may help ethnic minority students in particular to seek care.”  

While the efficacy of telehealth in treating moderate to severe psychiatric illnesses has been met with skepticism, treatment results are proving that virtual therapy is an effective complement to face-to-face treatment. Supporting ease of collaboration and oversight, telehealth enables universities to employ non-M.D. licensed clinicians like Psychiatric Nurse Practitioners who deliver high quality care with the supervision of a psychiatrist.  Without telehealth, schools often lack the resources to provide that supervision. Colleges often lack access to Psychiatric Nurse Practitionersparticularly in rural areasso telehealth connects universities with qualified, affordable clinicians, removing barriers of geography and scheduling. 

Empowering Students through Telemental Health Services

Students care about having access to quality mental health care. In a 2020-2021 American Council on Education survey series, college and university presidents consistently designate student mental health as the most pressing issue on campus. 

Students’ enthusiasm for improved mental health services suggests that treatment is likely to be highly effective. One of the most powerful predictors for treatment efficacy is internal motivation of patients. As stigma around mental health treatment lessens and students are empowered to gain control over their mental wellness, institutions have a responsibility to offer robust and flexible care.  

At Mantra we believe that high quality mental health care is a right of every student. Practitioners have long waged the battle to increase awareness and support for the treatments that help students thrive. Now is the time to augment face-to-face services with affordable, effective and critical telepsychiatry care and teletherapy services, so that each semester leaves students more empowered, capable, and motivated than before.