1. BOARD of GOVERNORS State University System of Florida
Mental Health Overview
Dr. Kirk Dougher, Assistant Vice President Health & Wellness
November 7,
Work Plan:
 Provide mental health data from the ACHANCHA (national & SUS data) & other institutional sources
 What are the most prevalent mental health issues among SUS students?
 What has changed in the last three years?
 How is mental well-being encouraged & promoted among on-campus, commuter, & online students?
 How are short- & long-term mental health issues handled?
 How is student care coordinated among various health providers for on-campus, commuter, & online students?
 Update on counseling center staffing levels as of the end of AY
*: Work Plan
1)* National mental health data (Kirk)
2)* Most prevalent mental health issues among SUS students (Kirk)
3) How does crisis management occur? (Kirk)
4) What kinds of students are walking in? (Kirk)
5) What kinds of symptoms are being treated? (Kirk)
6) What diagnoses are we treating? (Kirk)
7)* Update on Counseling Center staffing ratios – will send this shortly.
8)* How is mental wellbeing encouraged and promoted among on-campus, commuter, and online students? (q. 7, 8, 9, 12 – students, 13 – student #, 14, 15)
9) Are there differences in access to services, treatment options, or alternative treatment strategies for residential, online, or commuter students (q. 19)
10)* How are short term and long term mental health issues handled? (q. 20, 21)
11)* How is student care coordinated among various health providers? (q. 22)

2. Driving Forces Could narrate this in previous slide or next slide:
Factors that impact students mental health
Substance Abuse
Social Media
Political Climate
Intensified Expectations
Parenting Style
Source EAB: Escalating Demands in Mental Health
Need to review:
If Interesting, read source materials for possible integration/mention on this slide

3. Prior Treatment Trends (7 years)
National SUS
With this slide and with most of the data points across a very wide spectrum of information, our SUS is very close to the national averages on most mental health related issues.
Students arriving at our universities present with an an increasingly rich therapeutic history
Of those presenting in our CAPS
More than 50% have received therapy before
There is a continuous national trend
30% have/are taking psychotropic medications
Not much change in hospitalizations
National Data Source: Center for Collegiate Mental Health Annual Report
~140 schools
~150,000 clients
5-year national trends
Emerging narrative with applications for most
SUS Source: CCMH Special Report for Florida SUS N: 62,585
WorkPlan #1 Provide mental health data from the American College Health Association National College Health Assessment (national & SUS data) & other institutional sources
WorkPlan #2 What are the most prevalent mental health issues among SUS students?
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report Source: CCMH Special Analysis 2018

4. Threat to Self Trends (7 years)
National SUS
Alarmingly, there continues to be a rise in the self-harm markers
Trend is replicated in the SUS
Reliable increase in self injury
This can include cutting or other harm WITHOUT suicidal intent, often as a coping mechanism
Reliable increase in Serious Suicidal Ideation
Flat numbers presenting with suicidal ideation within the previous month prior to coming to CAPS
WorkPlan #1 Provide mental health data from the American College Health Association National College Health Assessment (national & SUS data) & other institutional sources
WorkPlan #2 What are the most prevalent mental health issues among SUS students?
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report Source: CCMH Special Analysis 2018

5. Risk Assessment, Access, and Treatment
Rapid increase in demand is real
Primary change is ”threat to self”
A decade of "identify and refer" interventions have been successful
Desired outcome, don't blame the "victims”, recognize that ”we” asked for this increase
Perfect storm (increasing utilization, risk, length of treatment)
Tilting towards crisis – impact on flat funding systems?
Focus on “treatment capacity” and institutional ownership of a defined capacity within the context of a comprehensive CC model and campus-wide plan.

6. Institutional vs. Counseling Center Growth
CCMH members counseling center utilization vs. institutional enrollment over the past 5 years. (2015)
What we found is that
Counseling center utilization has increased by almost 30% (5 x greater)
Attended appointments has increased 38.4% (7x greater)
While institutional enrollment has increased by just 5.6 %
Administrators typically suggest that counseling center utilization is consistent with institutional enrollment. We are seeing that this is not the case, and in fact, counseling center use is surpassing institutional enrollment by at least 25%.
Source: Center for Collegiate Mental Health (CCMH) 2015 Annual Report

7. SUS Counseling Center Utilization AY 2017-2018
8% of students enrolled across the SUS
have been served by the counseling centers
Range: 3% of students at University of
South Florida Sarasota Manatee to
30% of students at New College
Source: Data submitted by SUS institutions October 2018
FAMU FAU FGCU FIU FSU FL Poly NCF UCF UF UNF USF UWF USF-SM* USF SP
# students
served
fall enrollment
% 7% 6% 12% 6% 11% 4% 30% 9% 10% 9% 8% 7% 3% 7%
*served by New College

8. Rapid Access vs. Routine
2016 CCMH Annual Report
Increased amount of time used per client in each endeavor
Graph is in hours. .50 is a half hour.
Point of Slide: Trend of increasing/degreasing time for each side of these scales.
Source: Center for Collegiate Mental Health (CCMH) 2016 Annual Report

9. CLICC Top 10- Top Concern by Percentage Endorsed
So, what are our students coming into the counseling centers for?
Data included the SUS (Red) and National numbers (Blue)
Numbers are percentage points of students who endorse the issue.
Top-Most Only Concern that students are presenting in counseling centers for.
Anxiety and Depression continue to be the most disconcerting to our students.
Yet to be released 2018 Data(N=69650): Depression: 19.2, (Anxiety Collapsed: 18.9), Gen Anx: 11.7, Relationship Problem: 7.6, Stress: 5.8, Family 4, Anxiety 3.9, Social Anxiety: 3.3, Grief/Loss: 3.2, Interpersonal Functioning 3.1, Adjustment to New Environment 2.9
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report and CCMH Special Analysis 2018

10. CLICC Top 10- “Check all that Apply”
When we include all issues they are coming in for (more than one category selected is possible), what we see is a similar top two and some variation in the top 10.
Yet to be released 2018 Data (N=69650): (Anxiety: 61.8, Depression: 49.9, Stress: 43.3, Gen Anx: 41.6, Family 31.0, Academic Performance 25.2, Relationship Problem: 24.2, Interpersonal Functioning: 21.7, Self Esteem 20.2, Social Anxiety 19.6
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report and CCMH Special Analysis 2018

11. CCAPS-34 Self-Reported Distress: 7-year Trends SUS Data
Trends are what matters here:
Upward trend in Depression, Anxiety, Social Anxiety, and Distress Index
Flat Academic Stress, Eating Concerns, and Hostility
Decline in Alcohol Use
This slide gives a sampling of presenting problems and the relative increase or degrease of the issue over the past seven years.
Point of Slide: Anxiety and Depression remain top concerns and their trend is escalating.
Source: CCMH Special Analysis 2018

12. CCAPS-34 Self-Reported Distress: 7-year Trends National Data
National data set is a near mirror of SUS data.
Upward trend in Depression, Anxiety, Social Anxiety, and Distress Index
Flat Academic Stress, Eating Concerns, and Hostility
Decline in Alcohol Use
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report

13. Suicidal Attempt Trends (7 years)
National SUS
No statistical significance in difference
Small N
Point: National Trend is VERY slightly inclined.
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report Source: CCMH Special Analysis 2018

14. Threat to Other Trends (7 years) National Data
National Data Only (They didn’t pull this data for us. Given the similarity of the other slides, it is likely the same for the SUS for these)
A finer differentiation on the hostility scale presented earlier are the Considered hurting another and Intentionally caused harm charts
Source: Center for Collegiate Mental Health (CCMH) 2017 Annual Report

15. Impact on clinical services, treatment
7-year Trends: Recap
Impact on clinical services, treatment
Critical importance of maintaining concept of treatment
Rapid Access vs. Routine
Crisis and Referral Sites or Treatment Sites
Importance of multiple treatment pathways based on need
Previous slides show comparisons across the past seven years.
The demand has impacted the clinical services focus and provision
We must make decisions about what the purpose of the CAPS sites are.
Unless there is unlimited funding there will be a balance between a Crisis/Risk/Referral strategy and a strategy that favors Treatment
We are listing toward the Crisis site at this point
Multiple treatment pathways and stepped care can help alleviate some of this but wont eradicate it
Stepped Care is where varying levels of format and treatment intensity are available to meet the needs of the various presentations
Source:

16. Promotion of Well-being
Common strategies for encouraging and promoting mental well-being among on-campus, commuter, and online students
Freshman course that includes wellness and life-skills development (e.g. Freshman Experience, Student Life Skills)
Student Mental Health Literacy Training
Institutions reported utilizing online self-help modules
Therapist Assisted Online (TAO), WellTrack, guided mindfulness and breathing exercises

17. Promotion of Well-being
Emerging strategies for encouraging and promoting mental well-being among on-campus, commuter, and online students
PepTalk – FAU
Healthy Living Program – FIU
– FL Poly
Animal Interaction Experience – UCF
Stress Free Café - UWF
*PepTalk – FAU – newly implemented collaboration between CAPS and Student Government designed to provide information and screenings to student populations.
*Healthy Living Program – FIU – Comprised of health educators, Masters level professionals, and peer educators trained to promote awareness and provide interventions in time and stress management. One modality is Heart Math – a computer-based relaxation program.
*Implemented and phone line for those needing support.
*Animal interactions experiences with therapy dogs and cats – UCF
*Stress Free Café – UWF – event involving campus partners and offers depression screenings, teaches coping skills, and informs of resources.

18. Short-term and Long-term Issues
How are short- & long-term mental health issues handled
Short Term
Stepped Care
Brief Therapy Model
Long Term
Some options
Clients Exceeding Scope
Short Term
Tension for Risk/Referral and Treatment
Short-term mental health issues are handled in-house. The student comes in or calls to schedule an intake appointment. They are scheduled with the first available counselor unless they have a preference. Before seeing the counselor the day of the intake, the student completes demographics and several assessments on-line. Once the intake is completed, the counselor usually schedules a counseling appointment with the client in two weeks. On the average, students attend 4-6 sessions.
Stepped Care 2
Triage/Walk In
12 Session Limit 2
All do brief therapy
Long Term
Generally, long term, high risk and chronic issues are managed by care managers at Counseling and Psychological Services
Seeking long term solution or higher level of care is found in the community.
Students assigned to Care Managers presented with a level of severity that requires frequent contact, management of risk, and complex referrals to other treatment services.
(q. 20, 21)

19. Student Care Coordination
How is student care coordinated among various health providers for on-campus, commuter, & online students?
Liaisons
Care Managers
9 of 11 CAPS Sites
Inter and Intra Departmental Referrals
Community Providers
Referral Database Options
Care Coordinators
CAPS maintains a database for referrals available in the community,
We established relations with community providers through professional groups, offers to present at informal staff meetings, and an annual workshop with a nationally known provider.
Through liaison relationships referrals on made to offices on campus (eg. CAA and DOS) when appropriate.
Case management for mental health issues with student health and Adaptive Service (student with disabilities) with signed ROI is a collaborative practice.

20. Mental Health Enhancement Plans: Overview of Current Progress
Institutions provided an update on their current mental health enhancement goals.
Additional staff hired in various capacities based on the needs of the institutions
Increased access via extended hours on campus, with community providers, and online services
Enhanced mental health training
Some plans revised based on student needs, availability of resources, quality of applicant pools
Background: At the request of Governor Kuntz, university plans were developed to outline how the mental health needs of our students would be met. These plans were submitted to the Board in November 2017.
There are positions also currently advertised.
Additional progress has also included:
Implementation of online self-help modules
Pilot program for coaching services
New programs developed and implemented
Pilot for biofeedback station
Please find a detailed summary of current progress by institution in the Work Force meeting documents.
We have representatives from two institutions to highlight current progress: XXXXX from the University of South Florida and XXXXX from the University of West Florida.