Patient Engagement in Virtual Mental Healthcare Requires Deep Understanding, Flexibility and Creativity
It’s a dangerous combination: Students on America’s college campuses are undergoing an unprecedented mental health crisis at the same time the nation is facing a shortage of behavioral health professionals.
Today more than 150 million people live in federally designated mental health professional shortage areas, and the problem is only expected to grow worse, according to the Association of American Medical Colleges. Within a few years, the U.S. may face a shortage of more than 30,000 psychiatrists during a time when psychologists, social workers and others will also be overextended.
College students are likely to bear a significant portion of this burden, as mental health issues have accelerated in recent years among this group. In October 2022, for example, the American Psychological Association (APA) reported that more than 60% of college students met the criteria for at least one mental health problem and 73% of students reported moderate or severe psychological distress.
The best approach to addressing this shortage of behavioral health professionals is more widespread adoption of virtual mental healthcare, a method of care delivery that is particularly appealing to college students. Certainly, the patient’s perception of their care and its impact on their mental and emotional health will ultimately determine their engagement level. Yet mental health professionals who deliver the care and the technology developers creating virtual care platforms can encourage long-term access and engagement through a deep understanding of their patients’ needs and optimizing the opportunities that virtual care offers in convenience, flexibility and creativity.
College students: An ideal population for virtual care
College student demand for mental and behavioral healthcare was growing before the pandemic, with more than 87% of college leaders reporting an increase in requests for counseling services and student-patient volumes rising by an average of more than 12% from 2018 to 2019. The APA reported that the pandemic and associated remote learning in 2020 and 2021 only increased student mental health and well-being challenges.
As a generation of digital natives that has never known a world without the internet , college students are an ideal population for measuring the efficacy and engagement-enhancing properties of a virtual care platform for mental health. Given their technology fluency, college students often evaluate and discern quickly if a virtual offering is meeting their needs. Growing up with the internet, text messages and social networks, this population also has different communication expectations, preferences and perceptions. Results of a 2018 study, for example, showed that while older adults (35 to 70 years old) most associated voice communication with friendship satisfaction and social support, adults ages 18 to 34 more often related social network connections with social support and psychological well-being.
Many college students also have non-traditional schedules and additional extra-curricular, digital and in-person distractions. Hour-long, face-to-face counseling sessions during weekday business hours may not be a feasible or preferred way for students of any age to access such care.
Another roadblock that often prevents students from accessing mental healthcare is their desire to be self-sufficient and manage care on their own terms. For example, many students prefer to take care into their own hands and are more likely to seek support from peers rather than through professional counseling services.
Stigma is another access barrier facing college students, though they are increasingly willing to open up about their mental health. For example, 66% of students say their family is aware that they are experiencing mental health issues, with an overwhelming majority (84%) reporting that their family is supportive of them seeking professional mental health support, according to the anonymized survey – a positive development as long as resources are available to them.
Lastly, a student’s racial or ethnic background, sexual orientation, gender identity and expression, or other intersecting identities can be barriers to mental healthcare access considering mental health diagnoses, medication use and therapy are lower among students of color relative to white students. For example, nearly half of White students received a diagnosis in one study of mental healthcare on campuses compared to less than one-quarter of Black students, while 80% of conditions among Asian students went largely untreated. In addition, according to research published this year from The Trevor Project, 33% of LGBTQIA+ college students reported that they did not feel comfortable going to in-person mental health services on their campus.
Meeting students where they are
Given that college students tend to compare virtual care platforms to their experiences on other social media platforms (e.g., TikTok, Snapchat, etc.), a virtual platform for this unique population should offer more entry points and therapeutic options based on their experience, perceptions and comfort with mental healthcare. For example:
- Time flexibility – all day, every day. Offering a virtual version of an in-person clinic visit can be effective, but students may not always want or need an hour or even half-hour appointment with a mental health counselor. Short, 5- or 10-minute encounters can help students manage an immediate emotional crisis in a safe, effective and clinically validated format. Likewise, if a student is having a crisis, they need help immediately, even if it’s 2 a.m. on a Sunday. An urgent need requires an urgent response, so services should be available on-demand within minutes instead of days, and at all hours.
- Multimodal. A virtual care platform for mental health opens the opportunity to deliver therapy beyond traditional one-on-one counseling – or even talking. Through a mobile device or computer, students could access on-demand, self-care content that is continually refreshed and personalized, including yoga, meditation and text-based conversations on topics from healthy relationships to the importance of rest, can be designed for students to foster a sense of calm.
- Peer support groups. Similarly, text-based discussion among other students facing the same mental health and well-being challenges – moderated by a healthcare professional – can offer a more approachable and comfortable forum for some students who may be unfamiliar and/or concerned about a one-on-one encounter with a mental health professional. Our experience is that half of students have not taken the next step to connect with a live provider, underscoring the need to empower students with easy and self-guided on-ramps for support.
- Diverse perspectives. Provider networks that include Black, Indigenous and people of color (BIPOC) and professionals who identify as LGBTQIA+, speak multiple languages, and/or have various religious and spiritual beliefs, can accelerate emotional connections and build trust in therapeutic relationships, which, in turn, engender engagement.
Personalized care regardless of need
Obviously, all types of healthcare delivery are personal, but mental healthcare is deeper. In most instances, mental healthcare requires us to contemplate and deconstruct our emotions, beliefs and motivations, cutting to the core of our identities, fears and aspirations. The highly intimate and personalized nature of mental healthcare requires an equally personalized approach aligned with the patient’s sense of self and emotional considerations. This can be achieved through a virtual care platform accessed with the patient’s needs, preferences and goals at the center.
By personalizing care pathways and offering patients numerous approaches to achieve their goals, healthcare leaders can foster consistent care access and long-term engagement, regardless of the patient’s experience or background.
Photo: franckreporter, Getty Images