Treating students’ mental health needs during the pandemic
COVID-19 is not the only public health emergency sweeping America’s college campuses. Another one is rising to crisis levels. For this one — the rising incidence of mental illness among college students — the treatments are proven and safe.
Therapies are available in ample supply. The problem is that a disconnected patchwork of licensing requirements for health care providers is preventing help from getting to the people who need it. In the last few weeks of this Congress, our political leaders can unite to fix that. Doing so would make us healthier both medically and politically.
All Americans are suffering from the stress of a global pandemic, but for college students, a perfect storm has converged. In normal times, many of them struggle with the dual challenges of emerging adulthood and academic stress. Long before the pandemic, college students reported serious mental health challenges at troubling rates. In one pre-COVID-19 survey, more than half had felt hopelessness in the previous 12 months, and nearly four in 10 reported depression serious enough to impair their functioning.
Then COVID-19 hit. It has disrupted all of our lives, but for students, those disruptions have been uniquely intense at an already difficult time of life.
Whether they live on campus or at home, the social-distancing measures necessary to contain COVID-19 have taken a toll in loneliness and isolation. The distractions these measures also entail have increased academic stress. Meanwhile, college students, too, are bearing the strains of the COVID-19 recession. Some are struggling to pay for food and rent, much less tuition. Others worry about graduating into an economy in which they will be unable to repay their student loans.
It’s no surprise, then, that the pandemic has accelerated an already growing mental health crisis on campus. In April, 91 percent of college students surveyed said that COVID-19 had added greater “stress and anxiety” to their lives, while 81 percent reported the pandemic caused them “disappointment and sadness.”
As a college president, I am witness to their distress (and the potential long-term impact). As a physician with a background in public health, I am convinced we can address it — and must.
The pandemic has correctly absorbed the attention of our political and health care systems. Medical researchers, like health care providers, have performed miracles. Therapies and vaccines have been developed at an astonishing pace.
That places the irony of the mental health crisis in even sharper relief. Imagine we knew exactly how to treat COVID-19, had adequate supplies of effective and approved therapies in place, but laws simply prevented them from being delivered across state lines?
That’s exactly the situation with mental health — not just on campuses, but around the country. Students often come to campuses away from their home states having spent years developing relationships with clinicians. Others develop those relationships on campus and want to preserve them when the pandemic forces them to return or remain at home, often to places where there are shortages of mental health services. Disrupting these clinical relationships worsens mental health, and there’s no medical reason for doing so.
The patchwork system of medical licensure doesn’t just affect mental health. The pandemic is erupting in different parts of the country at different times. It doesn’t respect state borders. Confining clinical licenses to a single state makes it harder to move resources to where the most serious problems are, and makes it harder for patients to travel for care.
That’s why, early in the pandemic, the federal government urged states to grant reciprocity for clinical licenses nationwide. Not all did, and many that acted are allowing those orders to expire. That’s where the Temporary Reciprocity to Ensure Access to Treatment — TREAT— Act comes in. During the COVID-19 emergency and similar public health crises in the future, it would allow providers who are licensed in good standing in any state to practice either telehealth or in person in other states. It doesn’t cost a dime — far from it. By facilitating prevention and timely medical care, it promises savings.
For two reasons, the TREAT Act is especially timely now. The first is medical. As COVID-19 cases rise precipitously at the onset of a second wave that appears far more intense than the first, the bill would permit providers who treat the disease and related ailments — whether in person or by telehealth — to fill needs as they arise across state lines. COVID-19 is a national medical crisis. It demands a national response. What is true for the disease itself is just as true for its effects on other medical conditions, like mental health.
The second reason has to do with our civic health. We’ve been through a period of bruising division. But the TREAT Act has bipartisan support in both the House and Senate. It is one thing this Congress can still do. Everyone can agree it will help make America healthier. It might also be a dose of preventive political medicine too. There would be no better way to end a divisive political season — and make way for a fresh start — than for our leaders to come together on something that can genuinely unite us.
Dr. Paula A. Johnson is the 14th president of Wellesley College. She was previously the Grayce A. Young Family professor of medicine in Women’s Health at Harvard Medical School and a professor of epidemiology at the Harvard T.H. Chan School of Public Health.