Business Proposal

What comes to mind when you think of a person with mental illness? For the average Joe, it’ll most likely be the crazy man depicted in movies who lives in a mental asylum and takes medications to stay sane. However, as you and I both know, a mental illness or psychiatric disorder is one that affects people of all ages and simply changes the way a person feels, behaves and/or thinks about themselves and others. Many people also forget how especially vulnerable the college student population is. It’s during these stressful years that they’re required to transition from being coddled as high schoolers to taking on adult responsibilities, pressured to perform well academically and expected to figure out their purpose in life. If this wasn’t taxing enough, they’re also at the age when mental illness gets so severe that it can no longer be avoided (Levine, 2018). Therefore, it’s only logical for colleges to be providing additional mental health support for their students, especially at schools like Rutgers, where tens of thousands of students study every year. Unfortunately, this is not the case, as the school lacks sufficient resources and student needs are unmet (Zapata, 2017).

Mental Illness: A Serious Problem at the National Level

According to the National Institute of Mental Health, there are over 43 million Americans currently dealing with mental health conditions, and almost 10 million Americans have what is called a “serious mental illness” (“Mental Illness,” 2017). This means that their condition has become so severe that they have “serious functional impairments that substantially interfere with one or more major life activities” (“Mental Illness,” 2017). Not surprisingly, adults aren’t the only ones dealing with mental illness today, as an even greater percentage of American teens (21%) and over 10% of children between the ages of 8 to 15 are reported to have already experienced at least one severe mental disorder in their lifetime (National Alliance on Mental Illness, 2015). For these teens, having to live with mental illness has had an enormous negative impact. They make up a whopping 70% of the juvenile delinquent system and 40% of these teens become high school dropouts, which is “associated with negative employment and life outcomes” (“High School,” 2015; “Mental Health,” 2015). What’s even more shocking is how unlikely it is for a person with mental illness in America to actually go out and obtain the psychological or medical treatment he or she needs. According to a study done by Park-Lee, Lipari, Hedden, Kroutil & Porter (2017), less than half of adults with any mental illness (AMI) and only 65% of adults with serious mental illness (SMI) actually seek out the treatment they need. They also found that, for adults, cost of care is a huge barrier and the most commonly cited reason for not seeking help. Even more eye-opening is the fact that barriers such as cost and stigma have a more profound effect on adults who need treatment the most; those with serious mental illness (Fig. 1).

Figure 1: Reasons for not seeking mental health support (Park-Lee et al., 2017, p. 19).

Children aren’t any more likely to get help either. Studies have shown that only about 50% eventually use mental health services, and the average delay between onset of mental illness and intervention for teens can reach almost a decade (“Mental Health,” 2015; “Mental Health Screening,” n.d.).

Is the Situation any Better at College Campuses?

Despite being a major issue at the national level, this epidemic has blindsided college campuses and is gradually becoming more and more problematic. According to the National College Health Assessment carried out by the American College Health Association, over a third of undergraduate students report “feeling so depressed it was difficult to function” (Hunt & Eisenberg, 2010). A survey by the National Alliance on Mental Illness found a similar trend, with almost a third of students diagnosed with clinical depression, a quarter with bipolar disorder and over ten percent with anxiety disorder (Pelt, 2013). What makes it incredibly difficult for colleges to deal with all of this is the fact that there is an increasing number of students coming into college with severe forms of mental illness and an expectation that their college can and will replace any treatment they have been receiving (Pelt, 2013). Since college is the time when arguably everyone is put under the immense pressure to perform well academically, build a new social support system and take on adult responsibilities, the burden is placed on schools to make sure students receive the mental health support they desperately need. However, the reality is that an overwhelming majority of students aren’t receiving help. According to Blanco et al. (2008), less than a fifth of students dealing with any mental disorder, about 15% with anxiety disorder and 5% with substance abuse disorder actually received mental health treatment. More recently, a National Alliance on Mental Illness survey found that about half of students chose to never disclose their mental illness due to the stigma associated with being mentally ill, and a little under half of students never used campus services for a variety of reasons (Gruttadaro & Crudo, 2012).

Why aren’t students obtaining the help they need? It all boils down to a lack of campus resources to adequately meet the growing demand for health services, and as mentioned earlier, students fearing how they’ll be perceived by others if they choose to get help. According to Thielking (2017), a survey of fifty schools across the country has shown that students usually have to wait days or weeks for just an initial review of symptoms, and even then may be paired with a part-time employee or counselor in-training. This is not ideal, since most students only cough up the courage to open up and share how they truly feel once they’ve formed a strong relationship with their counselor. The situation is even worse at larger institutions such as Indiana University or University of Illinois where they may have one mental health provider for every 3500 students (Thielking, 2017). Stigma is responsible for the other half of the issue. According to Corrigan (2004), students have a fear of being labeled as mentally ill because they know it can lead to stigmatizing responses from others and elicit negative stereotypes. This leads to prejudice and finally, to discrimination. People labeled as mentally ill are therefore less likely to be employed, find the housing they need or obtain standard medical care. Corrigan (2004) further explains that the public isn’t the only source of this negative judgement and avoidance, as family shame is commonly cited as another reason for avoiding treatment. As a result, these students find it easier to just deny “their group status by not seeking the institutions [such as mental health centers] that mark them” (Corrigan, 2004, p. 616).

Dividing in Deeper: The Problem at Rutgers University

Rutgers University, in particular, is in deep water when it comes to making sure that students have access to and are comfortable utilizing mental health services. In 2016, students made 30,000 visits to the two counseling centers, and this number is on the rise every year (“Editorial,” 2017). In fact, during that same year, the counseling office recorded just over a 5% increase in initial appointments and over a 15% increase in the number of students utilizing group therapy from the previous year (“Editorial,” 2017). This slight increase in student demand wouldn’t have been much of an issue if the state university had the resources to deal with it, however, that was and still is not the case. Despite having a roughly estimated counselor to student ratio of 1:1000 (including professionals and interns), which just meets the ratio recommended by the International Association of Counseling Services, the Rutgers Counseling, ADAP and Psychiatric Services (CAPS) is still struggling to handle their caseload (CAPS representative, personal communication, June 6, 2018; Koray, 2012). Commonly cited issues brought up by students include the fact that the school of about 50,000 students only has two counseling centers that both close before 5pm, the treatment offered is similar to shock therapy, and that the services provided are not reliable (Zapata, 2017). Given that students generally have stressful coursework throughout the day, extracurricular activities, part-time jobs and other adult responsibilities, it makes total sense why the reasons for not receiving treatment during college (listed in the figure below) make up the top five reasons reported by students. However, it makes little sense why one of the largest schools in the country hasn’t taken this into account and made significant modifications to make sure quality mental health care isn’t compromised.

Figure 2: Common reasons for not seeking mental health support during college (Gruttadaro & Crudo, 2012, p. 15)

                       .

Robert Barchi, the President of Rutgers University, has echoed these sentiments and made it clear that the University does “not have enough resources to accommodate [student] needs,” and that CAPS currently serves more of a “triage service” (“Editorial,” 2017). In other words, students need to look elsewhere if they’re looking for anything more than standard, acute care. This also means that students need to be able to afford mental health care, which unfortunately isn’t the case, as a majority of young adults either lack proper health insurance, can’t find a provider who can take their insurance if they have it and/or can’t afford the incredibly high copays after attending only a few sessions (Singh, 2014). If we then assume that a student’s parent has the proper health insurance to fully cover the student until the age of 26, we’re forgetting about the research pointed out earlier by Corrigan (2004) that found that family shame is a big reason for avoiding treatment. As a result, if it came down to relying on parents for mental health services, there’s a great chance of that student not receiving the treatment he or she needs. That being said, even if students do have the required funds to independently seek out community based professional support, the fact that Rutgers lacks the means necessary to properly meet student wellness needs despite it being the breeding grounds for menta+69l illness is counterintuitive. I described it as the breeding grounds because college has been proven to be the time when “most psychiatric symptoms declare themselves or get bad enough that people can’t ignore them anymore,” and adapting to college and adult life places even more stressors on a brain that has yet to fully develop (Levine, 2018). Consequently, it only makes sense that schools prioritize this student need and provide a significant amount of support.

Conclusion

Ultimately, there is clearly a problem with the quality of the mental health support that students are receiving, especially when quality is being compromised at schools to try and meet as many as many students as early and fast as possible. It is also clear that there exists a whole host of reasons for why a student may not seek treatment, including stigma, lack of time, low confidence in treatment and lack of information on available resources. Thus, solving this problem requires an innovative approach that not only addresses many of these reasons, but also one that prioritizes the quality of the mental health support that students receive.

Literature Review

Introduction

Before taking a look at proven strategies and models for dealing with this multifaceted problem, it’s imperative that we make it clear what the issues are that need to be addressed. The most obvious problem that Rutgers itself has identified for us is a lack of resources to meet the growing student demand. The second area that needs improvement is ease of accessibility or making it easier for students to confidently go out on their own and seek proper help. That being said, this can only be accomplished if the campus environment is conducive to help-seeking. Accordingly, the following theories and models directly address each of these issues and provide practical solutions that can be immediately implemented at Rutgers University.

Theory - Mobile Health

The first solution aimed at maximizing the availability of resources to college students is called mobile health (mHealth) and is defined as:

Any psychological or mental health intervention that is delivered or supported by the use of mobile technology...That enhances the treatment or assessment...Or provides clients with greater choice for accessing treatment activities. (Clough & Casey, 2015, p. 1)

Following a systematic review and meta-analysis of annual college counseling reviews and studies on mHealth, Johnson & Kalkbrenner (2017) concluded that mobile health has successfully been utilized by schools to increase awareness of campus resources, to effectively communicate health promotion information, and to support students with mental health disorders. In fact, in a 2013 literature search, Donker et al. (2013) looked into the use of multiple mobile health applications and found that they caused significant reductions in mental illnesses, such as substance abuse and depression. In addition, these mobile applications or online programs are the best way to connect with students, since digital channels such as these are nowadays the preferred method of receiving information for students, and since they function as a repository of reliable mental wellness information that students can tap into at any time (Platt, 2011).

Model 1 - Colorado State University

Colorado State University is one such school that has implemented an online wellness platform for its students. The online portal, called YOU, “optimizes and expands university resources and connects students with personalized content curated and vetted by behavioral health experts to help them navigate life and campus” (“Student Wellness,” 2016, p.1). After just one year of YOU, over 80% of freshmen students reported being better able to handle stress, as the interactive portal provides personalized resources and identifies issues before they turn into crises (“Student Wellness,” 2016). The portal, accessible on both computer and mobile devices, has students take a set of online health assessments. Then, using an advanced algorithm, YOU connects every student to both on and off-campus resources that will be most helpful to that student. This not only makes it easier for students to learn about all the resources that are available for them to make use of, but also details which resources to use, explains what steps to take next and monitors progress (“Student Wellness,” 2016). This incredible feature in and of itself is essential, given the reasons for why a majority of students who need mental health support don’t end up using it. According to Czyz, Horowitz, Eisenberg, Kramer & King (2013), an overwhelming majority of students don’t believe that their problems are serious enough. Other reasons included discomfort with opening up about mental issues with a professional, lack of confidence in the treatment and not knowing where to go. A system like YOU resolves all of these issues, greatly simplifies the help-seeking process and gets students directly where they need to be, rather than having them wait days or weeks for an initial screening at the campus counseling office.

Model 2 - Gustavus Adolphus College

Another college that has successfully introduced mobile health to its students is Gustavus Adolphus College in Minnesota. After facing a significant spike in the number of students reporting mental health issues, the school partnered with a web-based behavioral therapy program called “Learn to Live” (Steiner, 2016). After identifying the specific issues that they are dealing with, students are able to sign up for an online program designed to teach them the skills they need to tackle their issues. According to the director of the Gustavus Health Service, in only a matter of a couple months, over a hundred students had taken advantage of this new therapy option for two major reasons. First, it provides greater flexibility and allows students to take charge of their own treatment, making time and a lack of confidence in the treatment a non-issue. In addition, unlike walk-in group and individual sessions, the online system is 100% confidential and can reach students who are uncomfortable with walking into a mental health center or speaking to a professional (Steiner, 2016). Critics might argue that this is a poor idea, since the web-based support system is preventing students from going out and talking to a professional, but according to the school and the creators of Learn to Live, the system has actually become a means of educating students and empowering them to get professional help when needed (Steiner, 2016).

Model 3 - Texas Universities

A third example of the successful implementation of mobile health is the recent addition of online counseling services at multiple Texas universities, including Baylor, Texas A&M and UNT. The online program replaces most of the in-person sessions and “provides informational videos, online exercises and video consultations that cut the time spent on each individual by nearly 70 percent” (Pattani, 2016). Similar to other mHealth programs, this one allows students to take charge of their treatment, while counselors monitor progress and address any issues during video meetings. According to the counseling directors at these schools, they’re now able to see more students, especially those who don’t live on-campus, have children or work a day job. Critics argue that the shorter video sessions may be less effective because students aren’t able to form the same connection with their counselor or share enough information. However, even if this is the case, these sessions are still a step up from having to rely on anonymous counseling services like the Crisis Text Line or informal drop-in sessions (Pattani, 2016). In addition, students can always opt to go with the in-person sessions if this isn’t the right fit for them.  

Theory - Social Media Presence

Similar to mobile health, social media has also proven to provide an additional layer of support for those with mental illness and nowadays has become the focus of mental health research. As college counseling centers continue to rely on things such as flyers and pop-up booths to reach students, they fail to recognize the massive online community and the benefits that come with building a social media presence. In fact, according to Seidel, Ethan & Basch (2013), about four out of five people between in their twenties uses social media and 85% of adults report positive experiences. But aren’t students only using social media to post pictures and keep up with the latest sports news? Not quite. Moreno et al. (2011) evaluated 200 randomly selected Facebook profiles belonging to college students and found that a whopping one out of four displayed symptoms of depression. This means that students aren’t afraid to openly share their thoughts and feelings with the world, making it the perfect platform for counseling centers to reach out to students and stimulate discussion on mental illness. In addition, the Center for Disease Control has already done most of the heavy lifting when it comes to identifying the major benefits of using social media to address mental health. According to their published guidelines, social media not only allows you to target a specific population across time and space, but also allows you to share evidence based content that can be used to engage in meaningful conversations with followers and allows them to share that content and become health advocates themselves (“The Health Communicator’s,” 2011). In return, this fosters a community that is more connected and knowledgeable, open to talking about mental illness and willing to share personal experiences. This was proven by Naslund, Grande, Aschbrenner & Elwyn (2014), when they examined nineteen videos posted to YouTube by individuals with serious forms of mental illness and identified the four most common types of peer support: “providing hope; finding support through peer exchange and reciprocity; sharing strategies for coping with day-to-day challenges of severe mental illness; and learning from shared experiences” (p.1).

Model 1 - “Time to Change”  

“Time to Change” is a large-scale mental health campaign and the perfect example of how impactful social media can be. With now over 350,000 people following its Facebook page, the campaign relies primarily on shared personal experiences to engage, educate and grow its audience. For example, the page recently posted the following: “In the final part of her vlog, Katie busts the third common myth about mental health problems. What's the one thing you'd rather people said about mental illness?” (“Time to Change,” 2018). Posts like these garner a slew of comments, hundreds of shares and thousands of views. How successful has this campaign been? Based on a survey carried out by Time for Change, almost two thirds of people admitted that they’re now more likely to open up about their mental illness with family and friends and 90% admitted that they now have the confidence they need to stand up against mental health discrimination (“100,000 Join,” 2012).

Model 2 - The LADbible's “UOKM8?”

Social media is also incredibly useful for targeting a specific audience and that is exactly what the LADbible Group has taken advantage of with its “UOKM8?” social media campaign. Given the fact that suicide is the number one killer of men under the age of 45 in the United Kingdom, and that men are significantly less likely to talk about their mental health, the UOKM8? campaign was started to provide an online space where men can comfortably share their feelings and support each other (Doward, 2016; “The LADbible,” 2016). Within three months, the campaign had reached millions of people by sharing the stories of influential people with mental illness and articles on the mental health stigma (Keane, 2017). Even though this model isn’t focused on making sure its audience is aware of what resources are available, it does a great job of spreading mental health awareness and getting people to learn and talk about this “taboo” topic.

Theory - Promoting Mental Health Literacy

Literature also points towards interventions that promote mental health literacy as a means of reducing the stigma associated with mental illness and boosting help seeking behavior. According to Kelly, Jorm & Wright (2007), community and school based interventions have been shown to improve awareness and knowledge of mental illness, increase help-seeking behavior and decrease stigmatizing attitudes. They also found that the presence of a consumer-educator or someone to provide personal experience had the greatest effect on stigmatizing attitudes. Putting this research into action on a college campus, Loreto (2017) found that college students who took part in a three-hour mental health program demonstrated significantly less stigma towards those with mental health issues and were overall more accepting as compared to their counterparts.  

Model 1 - Brown University

Brown University has without a doubt taken the lead when it comes to making sure it’s students fully understand mental illness. A student run organization called Project LETS (Let’s Erase the Stigma) holds an annual mental health orientation for all students that covers a broad range of topics (“Orientation,” 2018). The organization hopes to end the stigma surrounding mental illness, the largest barrier that people with mental illness face, by raising awareness and educating the masses. The orientation they run not only covers what resources are available to students on campus, but also the various types of mental illness, cross-cultural differences, accommodations available to students, coping mechanisms and adjusting to the stress culture. Interestingly enough, many of these topics were brought up by students in a national survey conducted by NAMI as areas they wished were addressed better by their colleges (Gruttadaro & Crudo, 2012). In addition, the organization also brings in students who have dealt with mental illness to share their experiences (“LETS at Brown,” 2018). As mentioned earlier, personal experience has a strong impact and is very beneficial.

Model 2 - Ohio State University At a much larger scale, Ohio State University has taken similar steps to ensure that students are comfortable with seeking the help they need. Even before classes begin, incoming students are taught about mental illness, how to recognize suicidal ideation and how to properly engage others who may be in serious distress and point them in the right direction (Wallace, 2015). In addition, groups of trained students called “Peers REACHing out” and the “Buckeye Campaign Against Suicide” hold weekly meetings where they discuss various mental health topics and larger events throughout the semester to educate students, raise awareness and break the mental illness taboo. The students spread the “REACH” message, which “stands for recognizing warning signs, engage with empathy, ask about suicide, communicate hope, help access care and treatment” (Etchison, Drummer, Vaughn & Bernard, 2015).

Rutgers Model 1 - Community-based counseling

Rutgers University currently follows its own models for reaching as many students as possible. The most recent and innovative program run by Rutgers CAPS is the community based counseling or “meso” practice (CAPS representative, personal communication, June 6, 2018). It’s called a “meso” practice because it combines aspects of both individual and community counseling in order to have a broader impact and to connect with students at multiple levels. Students can meet with counselors who have similar interests both individually for personalized therapy or in groups for workshops on topics such as mental wellbeing and self-care (Kim, 2018). From my conversation with a CAPS representative, the main goal behind the program is to increase accessibility by embedding counselors throughout the four campuses and to reduce the stigma associated with visiting mental health clinics (personal communication, June 6, 2018). She also added that the program has been so successful over the past year and a half, that two more community counselors are in the works of being added. That being said, this program is not the best long term solution. It is certainly effective and has fished out many students who feared the idea of having to walk into the main CAPS locations, but it does nothing to address the students who don’t have mental illness. These other students without mental health issues will continue to unknowingly believe the same stereotypes about those who do and will continue to be discriminatory, as was explained in Corrigan (2004). This means that the negative stigma will continue to thrive and those with mental illness will continue to feel isolated and ashamed. This is why my plan will for sure require all students to take part in an intensive mental health workshop, just as students are currently required to attend academic advising sessions or workshops on bullying/micro-aggression, drinking/texting and driving, rape and consent, etc.

Rutgers Model 2 - Group Therapy

Another program that Rutgers CAPS relies on heavily as an effective resource for students is group therapy. Currently, the school offers over twenty different types of group therapy that run anywhere from one to twelve weeks long. They’re run by clinical psychologists, social workers or other mental health specialists, and many of the groups, such as the mindfulness and behavioral therapy groups, are based on years of research that prove their effectiveness (Cantor, 2016). There are also programs for students who may be going through specific and unique experiences. These include groups for seniors who are stressed out about having to now re-adjust and start a new chapter of their lives, and another for minority men who are given the opportunity to reflect on their unique experiences and the effect that oppression may have had on their lives (“Group Sessions,” 2018; Munoz, 2017). You might be asking why the school is so heavily focused on this group therapy model. According to Lockwood, Page & Conroy-Hiller (2004), group therapy is just as effective as individual therapy, and both are significantly more effective than no treatment at all. The added benefit of group therapy is just that participants can interact and learn from others, while receiving treatment as a group (Schectman & Kiezel, 2016). In essence, the school can provide students who are open to listening to others with group therapy, which is just as effective as individual sessions.

However, there are also a few major problems associated with relying on the group therapy model. With such a large variety of groups to choose from, it can be difficult for students to decide exactly which one to go with. For example, should someone commit to the stress management group or the eight-week stress reduction group? Also, what about the attention 101 versus the focus group? This is especially true for students who don’t want to have to discuss their situation with a professional, and therefore don’t get extra guidance. In addition, literature makes it clear that people are more likely to choose nothing when faced with too many options. According to Dr. Liraz Margalit (2014), this is due to innate human cognitive limitations. We can’t properly evaluate more than a certain number of choices, and so when we do become overwhelmed, we may become frustrated and avoid the situation. Another reason brought up by the doctor is time. Unless we have all the time on our hands to make the best decision, we again won’t be able to compare and contrast all available options and will opt to go with nothing rather than making a rash decision. This is an important factor, given that many students consider a lack of time to be a massive barrier to seeking treatment (Czyz et al., 2013). Students desperately need someone or something to tell them what the best resources or groups are for their situation, and unless they seek out individual therapy first, which has a low likelihood, they aren’t getting this feedback. In addition, the second major problem is that there is no information directly on the website that explicitly mentions the effectiveness of group therapy. In fact, the only benefit mentioned is that the interactions can give “you useful feedback that you may not get among friends” (“Group Sessions,” 2018). This is concerning, given that another major barrier to seeking treatment is a lack of confidence in treatment effectiveness (Czyz et al., 2013). Even if students are open to talking about their experiences with their peers, why would they do so if they don’t have a reason to believe that it’ll actually work?

Conclusion

After concluding this literature review, it becomes clear that there is no one theory or model that can adequately address all the issues inherent in the way that mental health is dealt with at the national or local level. A more realistic approach is to combine the most effective aspects of each model and theory described earlier, while keeping in mind the local models that are already in effect at the location of interest. This is exactly what I will do in the following section, where I describe my plan of action.

Plan of Action

Introduction

Taking into account the research and models presented above as well as the problems inherent in the way that Rutgers CAPS has been dealing with this grand issue, it becomes clear that this is a two-part problem that requires more than just a simple increase in resources. If we stay focused solely on making sure that we’re meeting the needs of the rapidly increasing number of students who are seeking treatment, then we’re forgetting about the entire other side of the problem. An effective plan is one that also addresses those who don’t have mental illness in addition to those who need treatment, but aren’t seeking it. The following evidence-based plan targets all three sub-groups by building a strong online presence, promoting mental health literacy and addressing the biggest barriers to seeking mental healthcare services.

Phase 1 - Building an Online Presence

The goal of this phase is to increase mental health awareness and to bring all the resources offered at Rutgers right to students’ fingertips. This will be carried out by implementing the same online, interactive mental wellness portal (YOU) that is used at Colorado State University. Once synced to every student’s RUID, the portal can begin providing personalized assistance to every student. This will be especially helpful for when students are waiting days for their next appointment. In addition, it also addresses two of the main barriers to help seeking, which are busy schedules and lack of information on available services. Students will now know exactly which resources fit their schedules and which options are the best for them.

Along with this interactive platform, the “RU Ready to Overcome Mental Illness?” Facebook page will also be active. It will not only be used for sharing evidence-based tips for dealing with mental illness, as was recommended by the Center for Disease Control, but also for advertising and live-streaming informational workshops and other relevant student events. This will ensure that all students have access to accurate information regarding mental healthcare and will help eliminate the stigma commonly associated with mental illness. Throughout the year, similar to what the “Time to Change” campaign has been doing for almost a decade, the page will be used to share student experiences. This has been shown to not only engage more followers and stimulate discussion, but also to boost help-seeking behavior.  

Phase 2 - Comprehensive Mental Health Workshop

This phase is aimed at directly increasing help-seeking behavior and reducing the stigma associated with mental illness. Specifically, this will consist of a mandatory four-hour workshop on mental health for all new students at the annual incoming-student orientation. The workshops, similar to the interventions and workshops described in the literature review, will be broken into four segments. The first segment will be for explaining all the available resources and their benefits, so that students are aware of all the options and when to use each one. The second segment is based on the research done by Kelly et al. (2007) and will be focused on promoting mental health literacy. This means discussing the various types of mental illness and their corresponding signs, understanding the harmful effects on the mind and body, etc. This segment should be led by trained students, since a study by Shin, Roseth & Ranellucci (2017) has shown that students are more motivated to learn when the importance of learning the material is emphasized by peers instead of by a professional instructor. The third segment will be set aside for explaining how and when to use the YOU portal. In addition, students will be shown and instructed to follow the “RU Ready to Overcome Mental Illness” Facebook page. Finally, the last portion of the workshop will be set aside for a successful individual with mental illness to talk about his or her experience, since this was shown to have the biggest impact on an audience and is a recommended strategy by mental health experts (Corrigan, 2004; Kelly et al., 2007).  

Phase 3 - Nighttime Support for Those in Need

And lastly, the goal of this phase is to hit three birds with one stone by hiring a nighttime tele-therapist. The tele-therapist will provide students with someone they can talk to face-to-face from the comfort of their homes after the main CAPS locations have closed for the night. This is perfect for students who either work or have busy day schedules and need someone reliable they can talk to besides an anonymous crisis-hotline worker. In addition, as mentioned in Gruttadaro & Crudo (2012) and as shown in the figure below, students prefer having face-to-face and individual counseling (Fig. 3).

Figure 3: Most essential mental health services for success in college (Gruttadaro & Crudo, 2012, p. 16).

Figure 4: Summary of Proposed Plan

Figure 5: Contribution of various models to proposed plan

Conclusion

This plan is bound to make a positive impact on all Rutgers University students. Unlike any other model currently used by Rutgers to address student mental health, the first two phases of my plan ensure that every single student has at least a basic understanding of mental illness and knows exactly when and how to access mental health resources. Even without directly addressing the negative stigma associated with mental illness, enacting these two phases normalizes and raises awareness for mental health issues across campus, while promoting help-seeking behavior. If that isn’t enough support already, phase 3 has the potential to replace the “innovative” community-based counseling program currently used by Rutgers, while providing additional flexibility and confidentiality. Ultimately, this plan will make Rutgers campus a happier and healthier place for all students.

Budget for Plan

I am requesting Tomara Baker, Grants Management Specialist at the Substance Abuse and Mental Health Services Administration, to help fund this plan. As the specialist, she will be one of the key reviewers of my official SAMHSA grant application that can easily be filled out on the SAMHSA website. The “Mental Health on Campus Improvement Act” requires that SAMHSA provide funding to colleges with the goal of expanding and improving mental health services (“Mental Health on Campus,” 2016). According to the same act, a comprehensive plan with an effective approach to expanding mental health services - like the one proposed here - should also be given special consideration. In addition, SAMHSA awarded $4.9M to 17 universities throughout the United States who requested funding to support their mental health and suicide prevention programs in 2017. The schools included Wayne State, Johns Hopkins, Carleton, New Jersey’s Montclair State and many more (“HHS Announces,” 2017). Given SAMHSA’s goal to improve services on college campuses and the massive amount of money at their disposal, this plan should not have any trouble receiving the necessary funds. The budget for this plan is detailed below:

Figure 6: Budget for proposed plan

Justification

The total cost for phase 1 covers the implementation of YOU@RUTGERS and management of the “RU Ready to Overcome Mental Illness” Facebook page. According to a representative from Grit Digital Health, the creators of YOU, the implementation and maintenance of the online portal will cost $30,000 (Nolan Tesone, personal communication, June 8, 2018). Moreover, a student eligible for the federal work-study program will be hired to manage the Facebook page. Since the minimum wage for student workers at Rutgers University is $11/hour, the student will be paid $12/hour x 7 hours/week x 40 weeks for a total of $3,360 (Johnson, 2018). Advertising the Facebook page will be free, since it will be shared to the many public Rutgers Facebook groups (e.g. “Rutgers University Class of 2020 official” group with over 20 thousand members) for students to learn about and follow the mental health support page. Because the incoming student orientation already runs annually and CAPS is willing to provide workshops free of charge, the only expense in Phase 2 is for inviting a celebrity speaker to speak to students (“Educational Workshops,” 2018). According to Karen Simon, a representative from Celebrity Mental Health Speakers, the cost of inviting a speaker with powerful personal experiences such as Frank King or Andrew McKenna is roughly $5,500 (personal communication, June 6, 2018). Finally, the cost of Phase 3 will consist of the annual salary of a part-time tele-therapist as well as the cost of a laptop. Assuming the tele-therapist will be working a four hour-shift Monday through Friday, employed for the Fall and Spring semesters and making $34/hour, the annual salary will come out to be $21,760 (“Tele-therapy Salaries,” 2017). The tele-therapist will also be given a $1,900 Alienware laptop because it currently tops the list for video quality, speed and connection (“Alienware,” 2018).

Discussion

Mental illness, affecting millions of people all over the country, is on the rise, yet it still hasn’t gained the same traction that other issues have. Even in 2018, few people truly understand what it is or how to deal with it. In fact, most of the information that is available to the general public is erroneous and stigmatizing. This then leads to the dreadful situation that we’re in now, where those who have mental illness are either afraid to get treatment or don’t know if and how they should seek help. The way most institutions have dealt with this is by actively increasing the number of resources, speeding up intake appointments and emphasizing group therapy. Just like affirmative action, this approach taken primarily by universities around the country was a great first attempt at turning things around, however, it was not and should not be treated as a permanent solution. For a decade, the mental health literature has been booming, as more and more researchers have become interested in battling this epidemic. Ironically, however, it’s become clear that academic institutions have failed to keep up. Research shows that one of the most effective ways to combat the negative stigma associated with mental illness is by emphasizing mental health literacy. It’s difficult to feel empathetic and to help those suffering when you yourself don’t know what they’re going through. In addition, this solution is also great because it benefits both those with and without mental health issues. Moreover, research has made an even bigger impact by showing us what barriers we need to specifically target in order to make mental health support more accessible. Instead of aimlessly diversifying mental health resources, colleges should be strategically funding initiatives that knock down these barriers.

Coming from a “Rutgers family,” it’s been particularly difficult seeing how much Rutgers University has been struggling to meet the student demand for mental health services. Granted, the school has never backed down and has constantly been trying to solve this issue. However, unlike the popular saying, it’s not just the effort that counts. A long term solution shouldn’t be focused on treating the issue, but on preventing it. In order to finally turn things around at Rutgers, this proposal addresses all the major issues that the students and administration is facing. In the way that this plan utilizes a comprehensive workshop and strong online presence to keep all students aware and informed, I’m confident in its ability to finally change the campus dynamic and cultivate a happy and healthy student body. Rutgers CAPS will no longer be burdened by initial intake appointments as students will know exactly what they’re dealing with and how to get help on their own. Furthermore, the addition of tele-therapy ensures that professional support is readily available for students who need it throughout the night. Ultimately, by funding this comprehensive plan, we would not only be improving mental health outcomes at Rutgers University, but would also be sending a message to all the other academic institutions around the country to find similar solutions. By honing in on this local problem, we can cause change at a national level.

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Appendix

Appendix A - “RU Ready to Overcome Mental Illness” Rutgers Mental Health Facebook Page

Appendix B - Email correspondence with Nolan Tesone (Grit Digital Health)

Appendix C - Email correspondence with Karen Simon (Celebrity Mental Health Speakers)

Appendix D - Transcript of interview with Rutgers CAPS representative