The Practical Wisdom of Elizabeth Cracco, PhD

Elizabeth “Betsy” Cracco does not take herself too seriously, avoids jargon, and explains public health and community wellbeing strategies with analogies involving frogs and ponds and building houses.  

Cracco’s plain-speaking approach may serve her well as she continues her role as assistant vice chancellor for Campus Life and Wellbeing, a newly-created position at the University of Massachusetts, Amherst, aimed at one of the biggest challenges facing higher education today — improving wellbeing among a generation of students reporting high rates of anxiety, depression, and loneliness. Cracco’s office oversees Recreation and Wellbeing, Residential Life, and the Center for Counseling and Psychological Health, a three-legged stool supporting students’ psychological and physical health.  She said the nexus of all of these domains underpins her mission.  

“One of the biggest prescription pads we have is making connections and creating a sense of belonging–and you can’t do that from a seat in the counseling center alone,” she said. 

Cracco said cabinet-level wellness positions like hers are becoming more common on college campuses, due to the increased concern over student mental health and the growing acknowledgment that what has been called the campus mental health crisis is more of a public health problem, meaning multiple departments need to get involved to address it. In many ways, Cracco’s professional trajectory aligns with this expanded view. 

After graduating from College of the Holy Cross in Worcester, Massachusetts, Cracco received a master’s degree in counseling from Boston College, then a doctorate in counseling psychology from the University of Wisconsin Madison.  Holy Cross, a Jesuit school, had a strong sense of community and it was there that she took an interest in mind-body practices and attending retreats. Her first job was in residential life, living in a dorm, where she quickly learned that the position functioned as a way for students to share their personal stories, from eating disorders to relationship issues.  Her professional training included the relational culture model out of Wellesley College, a feminist ideology that puts the emphasis on the individual in context within the community. This led her to apply a public health approach to her work. 

“It occurs to you after you go from client to client in direct care that something else is wrong,” she said. “There is a systemic problem here we need to think about.  In other words, if all of the frogs in the pond are sick, why are we still asking, ‘What’s wrong with this frog?’” 

Cracco said her metaphorical move up-stream started early. When she was head of counseling at the University of Connecticut, she began a retreat program called C2 for “Connect and Challenge,” involving whitewater rafting, storytelling, and meditation. When the new position of (then called) executive director of wellness opened at UMass Amherst, the state flagship campus, Cracco went for it.  In her pitch presentation, her first slide included Maya Angelou’s advice on what we need to ask each other when we move into any social setting:  “Do you see me? Do I know that you care about me? Is it important I am here?” 

“If all of the frogs in the pond are sick, why are we still asking, ‘What’s wrong with this frog?’”

“If we could enact this same approach at a community level, it would mean that no matter what your struggles are, you would be held and you would not be alone because your community mates would be there, many going through the same struggles,” said Cracco. 

When she got the job in 2019, Cracco asked herself, “Am I hired to create a cohesion across three units on a campus, or am I hired to promote wellbeing across the entire campus?” She figured, either way, it was about crossing silos and making connections, something that became surprisingly possible during the pandemic and would lead to UMass signing on to the Okanagan Charter: An International Charter for Health Promoting Universities and Colleges. 

“During the pandemic, we really demonstrated how we could work together as a campus and how the academic side of the house can provide real, on-the-ground services. The public health students, the nursing students, they ran the clinics, gave the vaccinations, all of it.  After that, our dean of public health, dean of nursing, and vice chancellor of student affairs got together and said, ‘How can we keep this going?’  We figured the starting point was signing on to the Okanagan Charter.” 

Having the buy-in from then Chancellor, Kumble Subbaswamy, a prerequisite in signing the charter, meant that everyone on campus had some responsibility to promote wellbeing, including faculty.  Cracco said the tie-in to student success helped make the case.  

“You are not going to do well academically if you never sleep, eat trash, and have no social life, and we need to communicate that to students,” she said. “We all need to get out of the boxes we’ve made.” 

As an example of out-of-the-box thinking, Cracco’s team introduced a curriculum developed by the Benson-Henry Institute for Mind Body Medicine at Mass General Hospital, called Positivity and Relaxation.  The nine-session, credit-bearing course is taught in small groups and helps students self-regulate around anxiety in particular, but also depression.  It is not an alternative to therapy for those who need it, but an option for all students on campus. Cracco said they are running 300 to 400 students a year through these small group sessions and they’re receiving data on its effectiveness from the school of public health. 

“You are not going to do well academically if you never sleep, eat trash, and have no social life, and we need to communicate that to students.”

“We are seeing tremendous reductions in stress, increases in wellbeing, even increases in sense of belonging,” said Cracco.  

The course is funded by her office, but not owned and operated by any one department.  As she tinkers with its scale, Cracco is working with professionals within and beyond campus on developing other courses, some involving storytelling, and working closely with a colleague on courses specific to building resilience and belonging in students of color. As big a fan as she is of retreats, she said representation is an important consideration to watch in mind-body practices. “Who is teaching these practices?” she asks. “How do students feel when they are in them? There’s definitely a privileged, “Lululemon” subculture that exists here and we need to be aware of that.” 

As far as other programs go, whether it’s pond fire chats or another unnamed project involving swings she is secretly plotting, Cracco is full force as long as it is about making connections and forming relationships.  One of her latest efforts is to create quiet dining spaces for groups to eat “family style.”   

“We should be structuring connections at every turn,” she said. Asked about how this work plays out in the classroom, Cracco made an interesting point about technologies like ChatGPT. 

“We are no longer in a system where we have a person who has all the knowledge and people who receive that knowledge, because knowledge is everywhere,” she said. “Now, the process of learning is the process of learning together, like we do in the real world, and that is going to force a structure that is more communal, more experiential.”  

Cracco is optimistic about the wellness work taking place at UMass: “I think people are getting the upstream thing,” she said.  At the same time, the down-to-earth Cracco is realistic about how much can be done, given what she calls “the tyranny of time.” As an example, she leans into her first higher ed job in residential life and compares that to the myriad of duties and trainings that those professionals now need to complete.   

“What these people really want to be doing is making space for students,” she said. “We need professional staff to attend to those crisis situations, and these can be incredibly time consuming. How do we develop the human capital to make space for connection beyond, before and apart from the crises?”

Welcoming Wellbeing into the Classroom

In 2005, Georgetown professor Joan Riley was walking across campus when she had an epiphany that would change the way she thought about teaching.  Riley has just been to an evening meeting of the “Friends” group—an intradepartmental team of administrators, students, and faculty members who were working together on harm reduction strategies to combat student alcohol misuse.  The silo-crossing activity was unusual for higher ed and got Riley thinking from a different perspective.

“I remember stopping in the middle of campus and asking myself, ‘What can I, as a professor, do to help address this problem?” The next day, she told the undergraduate students in her Health Promotion and Disease Prevention course to throw away their syllabi. For the rest of the semester, they studied the effects of alcohol throughout one’s lifetime, from the metabolic breakdown of alcohol, to familial alcohol patterns, to binge drinking, all in a way that engaged students both academically and personally.

“When you bring topics like these into the academic setting and use evidence to describe them, students listen in a way they don’t with other interventions,” said Riley.  “I started asking, ‘Why aren’t we talking about these subjects inside the classroom?’”

Riley’s seemingly simple question would lead to a precedent-setting initiative in curriculum infusion called the Engelhard Project for Connecting Life and Learning. Launched in 2005, out of Georgetown’s Center for New Designs in Learning and Scholarship (CNDLS), the Engelhard Project engages faculty in making connections between students’ academic studies and their broader life experiences, especially in the areas of well-being, flourishing, and mental health. You don’t have to be in health studies or psychology to teach an “Engelhard course,” as it is not so much about the topic as it is about the technique of combining learning with personal growth. While this approach is often touted, it is reluctantly applied in higher education, even at schools like Georgetown that seek to teach to the whole person.

“The tradition of academe, especially in highly competitive settings, was the radical mind-body split,” said Randy Bass, who led the creation of Engelhard as executive director of CNDLS and now oversees an education innovation unit at the school. “Classrooms were places for your head and the rest of the campus was the place for your body and soul.”

Building the Bridge

For Georgetown, the Engelhard Project’s effort to fuse these personal dimensions has been a steady progression, starting shortly after Riley’s course shake-up, and continuing to this day with the full weight of the president’s office behind it.  Georgetown President John J. DeGioia sees the project as the embodiment of the Jesuit school’s mission and is quick to thank the other woman who made it possible. Sally Engelhard Pingree funded CNDLS’ first proposal to infuse wellbeing into the classroom through Bringing Theory to Practice (BT2P), a fund she launched with Don Harward, who was, at the time, president of Bates College. Motivated by the personal experiences of Pingree’s daughter when she was a student at Bates, BT2P seeded campuses with the support to craft programs that focus on the intersection of student well-being, engaged learning, and civic engagement.

At an early BT2P conference, Riley met a faculty colleague in the Department of Philosophy named Alisa Carse and learned that she, too, was doing similar integration. Together with a student and the head of the counseling center, the Georgetown team began to explore how to make curriculum infusion its own program.  Under the leadership of Professor Randy Bass and Todd Olson, who was then vice president of Student Affairs, and others, Georgetown sought and received two rounds of multi-year funding to establish the framework, staff, and criteria for the new inter-disciplinary program. They named the program the Engelhard Faculty Fellows, with a nod to the professors who were recruited to mold the classes to their own design and comfort level. In 2010, they received an endowment gift from Pingree for what is now called The Engelhard Project for Connecting Life and Learning.

“The tradition of academe, especially in highly competitive settings, was the radical mind-body split. Classrooms were places for your head and the rest of the campus was the place for your body and soul.”

“I wanted students to be healthier and supported and Georgetown was a perfect fit as a campus already dedicated to looking at the whole person,” said Pingree. “I feel very lucky to be included and able to interact with faculty and staff doing this work in the Engelhard community of practice and to witness the positive impacts on faculty and the Georgetown community.”

“Georgetown leaned into something that was deeply connected to their mission and then went about engaging faculty in ways that honored their time and seeded ownership,” said Ashley Finley, who was a national evaluator for BT2P and is now vice president for research and senior advisor to the president for the American Association of Colleges and Universities (AAC&U).  In addition to the “faculty first” mentality, Finley said the intra-departmental nature of the work, led by an advisory committee of faculty, staff, and administrators, created a unique and powerful learning community.  

What began as five original classes has grown to over 500 courses in a wide variety of disciplines, with a combined student enrollment of 25,000 and the involvement of over 150 faculty members. Joselyn Lewis was a graduate associate at Georgetown when Engelhard first launched and she now leads the project as part of her education development work for faculty and graduate students at CNDLS.

Lewis is responsible for a large portion of faculty coming into the program and is adept at identifying the “sweet spot” that might get them engaged in designing or redesigning their course to integrate an element of student wellbeing.  Part of the recruitment involves reassuring faculty members who worry they will cross a boundary by bringing personal issues into the classroom or will “screw up” the unfamiliar approach.  Lewis addresses this by offering a robust orientation session and continued support along the way.  Monthly meetings and social gatherings for all Engelhard participants, past and present, are another level of security and offer friendships with colleagues one might not otherwise get to know. 

Part of reducing the barrier to entry is the program’s intentionally simple criteria. Faculty are asked to choose a wellbeing topic that connects to the course they teach. For one course meeting, they bring in a partner from a student-facing service area. This can be a clinician from Counseling and Psychological Services (CAPS), an expert in healthy eating, a Title IX coordinator, a DEI officer, even a financial aid advisor.  They then ask students to do a reflective writing piece about the experience.  

What does this look like for students? Lewis said most are unaware that they are in an Engelhard course as the wellbeing topics are so well integrated into the subject matter. They may study mental health within Foundations of Biology; examine sexual assault as part of Introduction to Ethics; or discuss anxiety in The Physics of Climate Change. The difference, whether they know it or not, is that the courses are designed to make connections that build relationships with their professors and with each other. 

Lewis said while the student affairs professionals appreciate the effectiveness of sharing important information inside the classroom, the program’s effects on teaching and learning at Georgetown have been profound. She said some faculty choose to do just the basics which allows students to make a connection between the content they are learning and their own wellbeing. Others do “All Engelhard, all the time,” embracing a full pedagogical shift that welcomes students’ interior lives into the learning process.

“I have faculty say to me ‘Engelhard gives me permission to teach the way I’ve always wanted to,” said Lewis. “I just didn’t know that it would be valued.’”

Just Breathe

Jennifer Woolard was one of the first faculty members to teach an Engelhard course at Georgetown and continues to do so today. As a psychology professor, she was eager to find a way to humanize mental health topics and found that forging a partnership with a professional from CAPS was a powerful statement that said, “Mental health is part of life.”  She begins every class with a breathing exercise as a way to ground students and ask that they pause and be present. For high achieving “perfectionists” like many of those who attend Georgetown, taking a moment like this can mean a lot.

“For me, Engelhard is about modeling,” said Woolard. “Taking the time out of class to discuss these issues, to invite colleagues from other departments in to join me, says to my students that I care about their wellbeing.”  Woolard said that the student reflections confirm this. One student reported, “I felt cared for—like the professor was genuinely interested in our wellbeing rather than us just churning out good grades.”

“I think the most powerful thing about being an Engelhard faculty member is that it allows you to communicate to your students that you care about them as people,” said Bass.

“I have faculty say to me, ‘Engelhard gives me permission to teach the way I’ve always wanted to,’” said Lewis.  “‘I just didn’t know that it would be valued.’”

In the near two decades since Engelhard was launched, rates of anxiety and depression reported by college students have nearly doubled.  During the 2020–2021 school year, more than 60% of college students met the criteria for at least one mental health problem, a near 50% increase from 2013, according to the Healthy Minds Study.  The stress and isolation of the COVID-19 pandemic exacerbated these issues.  A 2021 survey of over 1,000 faculty across 12 diverse institutions by the Mary Christie Institute, the Boston University School of Public Health and the Healthy Minds Network found a strong majority (87%) believed that student mental health had “worsened” or “significantly worsened” during COVID-19. Almost 80% had one-on-one phone, video, or email conversations with students about their mental health. 

“There isn’t a faculty member in this country that doesn’t see that our students are struggling,” said Riley, pointing to a list over her door of the mental health issues she asked her students to identify having experienced. Loneliness topped the list.

“At the beginning, we didn’t talk a lot about addressing mental health issues in recruiting professors,” said Lewis. “They were really concerned about crossing that line into counseling, which is why our early work focused more on awareness of the campus safety net and referring students to CAPS.” Now, she said, faculty are becoming more comfortable with discussing mental health with their students; many open up about their own struggles. “A lot of our faculty say, ‘If I’m asking my students to come as whole people, I have to be able to model that.’”

While many professors value the Engelhard Project’s role in prioritizing mental health issues amidst alarming prevalence numbers, others resonate with decades of strong evidence on the impact of relationship-based learning on a range of positive student outcomes.  In their book, Relationship-Rich Education: How Human Connections Drive Success in College, Peter Felten and Leo M. Lambert cite ample evidence of this, including Mathew Mayhew’s book How College Affects Students, and write, “Students’ interactions with peers, faculty, and staff positively influence the breadth and depth of student learning, retention and graduation rates, and a wide range of other outcomes, including critical thinking, identity development, communication skills, and leadership abilities.”

Lewis said referencing literature on the strength of the pedagogy has convinced many professors to join the Engelhard Project and is one reason its appeal has crossed over into numerous departments.  While the faculty representation skews heavily female, the program has a good ratio of humanities and STEM courses.  One neuroscience professor told Lewis, “It’s not my job to know who my students are, but I am open to doing this because I believe it will make them better scientists.”  

Randy Bass said that some of the places the Engelhard Project has worked the best are those that are the least obvious, like in the sciences.  “If you ask students to examine the biological basis of any mental health issue,” as they do in a long-running Engelhard course taught by Heidi Elmendorf, “they will choose topics such as their mother’s alcoholism, their brother’s autism, their own eating disorder, or someone they know who was suicidal.  These are unbelievably personal connections that deepen their knowledge and appreciation of what it means to study biology.”

Can this Idea be Scaled?

Engelhard leaders are not aware of the existence of another wellbeing curriculum infusion program, to this degree, on any other US campus. They receive a fair amount of requests for information from other schools and try to respond among limited time and information. Outcomes for the project are largely anecdotal, but they have begun a check list for other schools on what needs to be in place for a program like this to gain traction, starting with a multi-stakeholder leadership team, an academic orientation, and the availability of willing student affairs professionals. This last category can be a problem for schools with fewer resources, but for the most part, the project is low cost, particularly when compared to more direct mental health interventions.  It is an important equity consideration as advocates like Felton and Lambert argue that high-impact practices, like those within the Engelhard Project, are particularly beneficial for first-generation, low-income students, and students of color.

At Georgetown, enrollment in the project has stayed about the same for several years despite a growing acknowledgement of its many benefits. Part of the plateau may be a continued reluctance, on the part of some faculty, to embrace the personal side of students. While this appears to be changing, Woolard says professors who view Engelhard as too “touchy feely” should probably sit out.  “There may be some faculty members for whom this is not a good option,” she said. 

Riley, who also recruits for the Engelhard Project, said professors are worried the project will take time away from their many responsibilities.  “The irony is the Engelhard method makes you a better teacher—like exercising over time—and that works in your favor when it comes to managing multiple roles.”

Another theory is that the Engelhard Project may still be ahead of its time. “I think what education will become about is the development of the inner self in relationship to the capacity to do external work, what we’ve called “the inner/outer” problem,” said Bass.  “That’s the next frontier in higher education, but most of higher education doesn’t know that yet.”

New Classroom Tech Tool Gets Students Talking

As faculty consider which technology tools to try this school year, they may be interested to know there is now one available that helps their students speak up in class. AskClass is a simple teaching tool that gets students talking and lets professors know who to call on next.  Part AI and part behavioral science, AskClass may appear rudimentary, but founders hope that it can help higher education address new concerns about academic disengagement and social anxiety among Gen Z students. 

Damon Moon, a management consultant turned adjunct business professor at San Jose State University, created AskClass with a development partner.  He uses the tool in all his classes and has made it available as a commercial product for professors across the country. Moon said the absence of normal conversation caused by students’ preoccupation with phones and social media, coupled with the emotional side-effects of the pandemic, served as motivation to create a tool that would bring robust conversation back into the classroom.  

“Today’s students can go for hours without talking and the first thing they’ll likely ask is, ‘Do you have a charger?’” Moon joked, though he believes the ramifications of this are serious from both a teaching and a mental health perspective.    

He described the tool as a combination of gamification, data analytics, and a little bit of nudging. The formula is simple and straightforward.  When students enter class, they are met with classical piano music and an “icebreaker” question projected on the AskClass screen, often side-by-side with class content.  The question could be anything from “If you have $100 to donate, where would you give it and why?” to “What is your favorite movie?” Students are asked to discuss their answers with their classmates, as music continues in the background.  Those that share with the entire class are given points that are tallied in real time on the roster on the AskClass screen which displays all of the students’ first and last names.

The point system continues throughout the lecture with many opportunities for students to speak up and get credit.  Professors are encouraged to create class experiences that naturally lead to discussion, like team projects that require a “report out,” providing another chance at points.  A timer helps guide the more introverted students, letting them know there’s a start and finish to their efforts.  Professors, acting more like coaches, yell motivational instructions like “Lucas, you have two minutes to recap the discussion. Go!”

An advantage for faculty, particularly those teaching in large lecture halls, is that they can see who has not participated and can welcome them into the conversation.  Another tactic, the Random Person Selector, calls on students indiscriminately, removing any perception of bias on the professor’s part.

“Raising your hand can be really uncomfortable for some students, particularly those from Eastern Asian countries where it is contrary to our culture,” said Moon, who is from Korea.  “But at the same time, being asked to participate, or having your name randomly come up on the screen, can be the onramp many students need to join the conversation.”

Outcome data from Moon’s classes show that 96% of students said they are more comfortable speaking up in class; and 95% of students said they had better team dynamics compared to other classes. Additionally, 98% of students made a new friend as a result of AskClass.

“AskClass is pretty much your best friend starting the conversation for you in a group of kids,” said Diamon, a senior at San Jose State who is originally from East Africa. “And the points are awesome,” he said. 

Moon said the point system is a reinforcing mechanism that works well with students in direct and subtle ways. Students are familiar with “rewards” programs, like those at Starbucks or their credit cards, and are comfortable competing in digital games.  For classes where professors offer participation credit toward grades, as Moon does, it is a significant motivator.

Outcome data show that 96% of students said they are more comfortable speaking up in class; and 95% of students said they had better team dynamics compared to other classes. Additionally, 98% of students made a new friend as a result of AskClass.

“I am a very competitive person, so for me to be able to see in real time the points I get, made me really want to participate every single day,” said Lily, a student at San Jose State.  “It makes participation fun; It’s like a game.”

Bob DuBois, PhD, known as ‘Dr. Bob,” is associate director of undergraduate studies and a senior lecturer in the psychology department at the University of Tennessee, Knoxville. He said any way to get students talking in class was of interest to him as a professor. When he heard about AskClass from a podcast featuring Moon, he decided to pilot it in his classroom. He now says it has played a big role in building community in his class.   

“It just changed the entire dynamic,” he said.  “What was once the same three or four students dominating the discussion suddenly became everybody wanting to join in because they could see that they were getting credit for that and watching their points go up.”

DuBois believes students learn more as a result, particularly first-generation students (of which he was one), who often lack the confidence to take risks within the classroom.  He also sees AskClass as a way for busy students to make friends in a place where they spend so much of their time.  “I see AskClass as kind of a scaffolding for building relationships, which is incredibly important on modern campuses where students are so busy that they are not prioritizing making friends.” 

Building relationships that lead to better mental health is an intended benefit of AskClass and one that Moon talks about in his sales pitch. Keith, a recent San Jose State graduate who met his girlfriend through Moon’s class said, “Just being able to put yourself out there in a low stakes environment, especially a learning environment, is so good for your mental wellbeing.”  

“You no longer feel like a spectator. You’re not just sitting there, getting the information and storing it in your brain. Instead, you feel a part of everything.”

Nareg, a former student in Moon’s class, said AskClass creates an environment where people can freely share what’s going on in their lives.  “I think it really creates a sense of belonging for students of any kind of background.  Anyone can come into engagement and find something to talk about, something they have in common with the person next to them.  And then when the professor ties it all together, it creates a holistic environment where everyone has a sense of belonging.”

For Julia, who is from Brazil, the five-minute icebreaker that gets students talking doubles as a stress reliever when moving from one content-rich class to the next. But what she appreciates most about AskClass is the way it gives students agency in the classroom. 

“You no longer feel like a spectator,” she said. “You’re not just sitting there, getting the information and storing it in your brain.  Instead, you feel a part of everything.”

AskClass is now being used by 700 professors at 130 institutions across the country, and Moon is eager for it to expand even more. The tech entrepreneur and business professor said generating a profit from the relatively modest licensing fee is not his motivation, and it is unclear if his technology-based engagement tool is the real differentiator in the satisfaction his students so eagerly reported.  Is it good technology or just good teaching?

Dr. Bob said, “AskClass makes the process of asking questions and soliciting answers structured in a way that we don’t forget how important that is.”

Q&A with Marcus Hotaling, Director of the Eppler-Wolff Counseling Center at Union College and President of AUCCCD

In March 2023, the Association for University and College Counseling Center Directors (AUCCCD) released a policy paper that provides a foundation for structuring how higher education can approach mental health support. “Navigating a Path Forward for Mental Health Services in Higher Education” lays out some of the issues facing the field, including staff burnout and turnover, misallocation of resources, lack of coordination between campus stakeholders, ineffective or incongruous treatment models and the proliferation of third-party vendors. The paper offers some recommendations for addressing these concerns with an overarching theme that campus stakeholders must work together to create a realistic, agreed-upon, campus-wide approach–and then act on that plan with consistent messaging and communication to all constituents. This month, LearningWell (LW) magazine interviewed Dr. Marcus Hotaling, director of the Eppler-Wolff Counseling Center at Union College and president of the AUCCCD, to discuss the paper and “the path forward.”

LW: The AUCCCD recently published a paper that lays out a path forward for college mental health services amid high rates of mental health concerns and help-seeking among college students, and at the same time, increased burnout and dissatisfaction among counselors. What led the AUCCCD to develop this paper?

MH:  I think we’ve all been feeling the burnout for some years. Every year, up until the pandemic, my counseling center was seeing increased utilization—more students and more sessions. And while more students is understandable, we continuously saw more sessions with the same amount of staff, going above the national standard of about 65% face-to-face time for counselor. When I became president of AUCCCD in 2021, we had started to look at themes as to why people were leaving. We have 895 active members. In that first year, 81 of our members left for various reasons. Burnout was a huge factor, due to, in large part, getting pressure from all directions. You’re getting pressure from the students who want to be seen right away. You’re getting pressure from parents calling you. And then you’re getting pressure from the higher-ups who are getting called by parents or faculty members.

We also looked at where these counselors were going. The majority of them, two thirds, left the field of higher education and went into private practice. And there were two factors that led to that. The first was salary—you can make more in private practice. Some people went to the local hospitals and the salary is $50,000 more than their institution was paying. And the second reason was that, when you’re in private practice and you’re full, you just say, “I’m sorry, I’m not accepting new patients.” You can’t do that in a college setting. So, we started to look at the burnout piece and how higher ed and counseling can work together to try to resolve this problem.

LW: What were your goals in issuing this paper? What was it meant to convey?

MH:  We didn’t want to just say, “Colleges, you just need to hire more people,” because we know that’s not realistic. But what is realistic is everybody coming to the table and saying, “What services do we want to offer?” Let’s all be on the same page; let’s all have the same messaging around that, and then let’s actually do that. Because, in the counseling center, we can develop whatever service model we want, but if admissions or faculty or someone else is telling a student they could be seen six times a week, that’s not helpful. If we have people saying there are session limits when we don’t have session limits, that’s not helpful.

It’s important for counseling center leadership and student affairs leadership, and presidents, to come up with a plan of action to determine, based on the staffing we have, what we can provide. There needs to be a plan of action.

LW: The paper points out that colleges are making decisions about the service delivery model based on meeting the volume of demand, rather than taking an outcomes-based approach. Why, in your view, are institutions approaching mental health care that way? 

MH: I think part of it is that, for the most part, it’s really just fallen onto the counseling center staff to say what we need to do. And the reality is, that can be really hard when you don’t have the opportunity to step back and try something different or think about how it can be done differently.

I’m going to use my center as an example. There was one day that I opened up the schedule and there were just tons of appointments. And I said to my associate director, “Look, I’m seeing your schedule today. That’s not healthy. Your last patient is getting nothing from you. You’re exhausted.” So, we sat down over a school break and looked at how to change things. Everything was on the table. And that takes time, and it takes trust. We did get some pushback from our staff, but the approach was to give it a shot until the end of the year. And if it didn’t work, we’d change it again.

The reason why the usual approach is all over the place is that we’re just trying to meet the demand. And it’s like a dam that’s breaking where we plug one hole, and then all of a sudden there’s another hole over here. It’s still coming in; the water’s still flowing. And how many fingers do I have to plug these holes? And it’s only when you can take that step back that you can come up with a new way of doing things.

The demand is so high and you’re just trying to bail water out of the boat before you can actually sit down and plan. And that’s what we were trying to say in this paper: Do the planning, take the initiative to sit down with your leadership and say, “What can I do? What do you want? What does this school want to offer?” And we will work around that with the current staff. And maybe we’ll need to grow staff in the future.

But we are starting to see the numbers fall. One of the positives that came out of the pandemic is that states are starting to look at patients being able to cross over state lines for care. Clinicians are also more comfortable using telehealth and teletherapy. So, if you’ve been working with somebody for a long time, rather than saying, “Go see somebody at college because you’re two hours away,” counselors can continue to see their patients. So, the numbers are falling a little bit, but a little bit from a flood is still a flood.

“Do the planning, take the initiative to sit down with your leadership and say, “What can I do? What do you want? What does this school want to offer?”

LW: You point out that there is a mismatch of expectations, like having admissions promote a certain number of sessions that does not align with the reality of what can be offered. But even if you fix that inconsistency in messaging, do you think there’s also a cultural expectation that students, when they get to college, are going to be cared for in this way and they’re going to have access to therapy? And if so, is there going to be a difficulty in pushing back against that cultural expectation?

MH: Absolutely. Look, students are paying a lot of money to go to college, and with that comes a certain level of expectation across the board. When it comes to the expectations that parents have or families have, we also need to move away from the normalcy that every student is going to get through in four years. And that taking some time off isn’t a bad thing if you’re making good use of that time by working on yourself and getting healthy, so that when you come back, you’re going to be in a better place.

LW: So many issues, like leaves of absence as you suggest, involve more of a public health approach. What is the role of the counseling center in this approach?

MH: This whole thing is a public health problem. And I say that not to remove our responsibility or the individual responsibility of the students or counseling center. There are two reasons I say this is a public health problem. One, counseling centers and mental health for the past 20 years has been pushing for parity. We should be treated just like physical health. Let’s reduce the stigma. And it worked and that’s good. And then you have a challenging outside world. There’s war, there’s political unrest, a recession, a pandemic, school shootings. All these things create anxiety. On top of that, we have these expectations, real or imagined, that everybody else’s life is perfect, which we can see on their Instagram reel.

So, for a public health approach, yes, the community needs to do better about addressing gun violence and addressing systemic racism. But once they’re on our campuses, we can give students the tools to stay happy and healthy, while also recognizing that [every person is] going to have bad days.

We also need to help our constituents around campus recognize when somebody actually needs therapy versus when they might just need empathy or a listening ear. We need to help faculty and staff understand that referring a student to counseling is not the first thing you do. The first thing to do is say, “Are you okay? What do you need? I’m so sorry.”

These are public health approaches that are very, very simple and need no training from a mental health professional. All of us on a college campus can be approaching this from a public health perspective. It’s a public health issue, and now we need to be using our public health solutions.

LW: All of this – counseling staff wellbeing, policies and procedures and service delivery–its all about overall student health, correct? 

MH: Absolutely. Because if we’re not healthy, how are we helping anybody?

And evidence shows that students who utilize mental health services are retained and graduate at a higher percentage than those who don’t receive mental health care. And in theory, those are the students that are most at risk—the ones that are unhappy, the ones that have a mental health diagnosis. In a National Association of Mental Illness report, 64% of students that are no longer enrolled in higher ed list mental health as the main reason. So, it’s about student success as well.