During this on-demand webinar, Dr. Victor Schwartz:

  • Answers Live Questions from Higher Ed institutions about better supporting students during COVID;
  • Reviews the difference between stress in response to the real-life challenges of the COVID pandemic and diagnosable psychopathology;
  • Explores how Higher Ed institutions can help students navigate stress and mental health during COVID;
  • Shares resources. 

Webinar Notes: 

Dr. Schwartz shared several resources during the webinar. The following are links to these resources.

Healthy Minds Network Survey on COVID impact on students: https://healthymindsnetwork.org/wp-content/uploads/2020/07/Healthy_Minds_NCHA_COVID_Survey_Report_FINAL.pdf

Center for Collegiate Mental Health: https://ccmh.psu.edu/

Teens Did Surprisingly Well in Quarantine, by Dr. Jean Twenge:

https://www.theatlantic.com/family/archive/2020/10/how-teens-handled-quarantine/616695/

Collaborative Care Models and the State of Child Psychiatry

https://www.psychiatrictimes.com/view/collaborative-care-models-and-the-state-of-child-psychiatry

Thinking Clearly During COVID-19: Thoughts on Fear, Stress, and Mental Illness

https://www.psychiatrictimes.com/view/thinking-clearly-during-covid-19-thoughts-fear-stress-and-mental-illness

Website and resources for Dr. Schwartz: https://www.mindstrategies.com/

Webinar Transcript:

My name is Preston Clark president here at Get Inclusive. I'm here today with Dr. Victor Schwartz. Who's going to be leading the presentation. I'm just here to moderate and make sure that the wheels stay on the car. If you're having any audio issues or any visual issues or otherwise you can let me know, you should see a Chatbox and a Question box that you're welcome to use. We'll get started right about the top of the hour, and I'll go through sort of the blocking and tackling of the event. It is recorded and we'll send it out. And all the things that you would expect on a webinar, and then I'll get out of the way and let Victor present.

Thanks, Preston

Yes, thank you. Okay, it is top of the hour, 1:00 PM Eastern and 10 Pacific. Thanks everyone for joining, again my name is Preston Clark, I'm the president here at Get Inclusive. We are an online prevention and compliance training company. And from time to time, we get these opportunities to host experts in the field that tend to be adjacent to training content that we present or that we deliver to Higher Ed. So, it's a very timely subject talking about Student Stress and Mental Health in the Time of COVID.

I think we have just about the best person out there presenting with us today, Dr. Victor Schwartz who most recently was the Chief Medical Officer in the JED Foundation, and now is struck out on his own, which I want to give you an opportunity to tell us about today, Victor. Quick blocking tackling, this will run an hour. Please ask questions. I'm sure everyone is familiar with Zoom. But ask questions, I will be looking at those and we will reserve 15 minutes at the end to do a formal Q&A. But if you ask questions about a poignant issue that Victor brings up, I will interject those and then we can have this as conversational style as possible.

The recording will be sent later today. So, I promise you'll get a recording with Zoom. It takes a couple of hours post-webinar for it to process. And so, we just need the time to get it online and then we'll email it out. No slides today. So, other than these slides right now, Victor is going to be speaking lecture style. So and Q&A style. So please ask questions. There's a post-webinar survey that is not a post-webinar survey. So I wanna take three seconds on this. So, if you have to leave and a survey pops up, the survey is for Get Inclusive's 2021 Title IX Vendor Study.

So every year we put out a vendor guide of all of the organizations from us Get Inclusive to EVERFI to Vector Solutions to others. And part of the job is to do a survey of what you like, what you don't like, what you value, what you don't value, what you use the most. And we republish that anonymously as a part of the study. So, if that doesn't relate in any way, shape or form to your work, feel free to disregard the survey. But since it does pop up automatically upon completion or departure from the webinar, I just want to make sure you know about it.

And if you have any questions for us, either about the webinar or if somehow you leave early and you're like, "Hey, I didn't get "Victor's contact information," whatever it is, hello@getinclusive is the best way to reach us. Dr. Victor Schwartz, we really, really appreciate you being with us here today. Before we get started and sort of as a segue and to me stepping back and letting you run the show here, we'd love for you to tell us about the news that you've gone out on your own. I know you were with JED Foundation for many, many years as Chief Medical Officer, but would love to hear about what you're doing and your perspectives that you're bringing to this presentation today before we get started.

Sure, thanks, Preston. And it's a pleasure being here with all of you today. So the quick version of my history is I'm now a 30 years into working in Mental Health and Suicide Prevention in Higher Education. I've been a clinical director of counseling service. I've been a founder and director of the counseling services. And strangely enough for a psychiatrist for seven years was the Dean of Students at a university. I think maybe the only one in the country, but, you know, I can't promise that, but the only one I've run into so far, which was a really kind of interesting and eyeopening experience and gave me a tremendous appreciation for the kind of public health community health model, which is so important in settings like colleges and universities.

I was the Chief Medical Officer and Medical Director at the JED Foundation, which many of you are probably aware is a Suicide Prevention and Mental Health Promotion organization that started with a very specific focus on Higher Ed, but has, you know, expanded over its 20 years into the teen and young adult Mental Health Promotion and Suicide Prevention space left. I guess over the summer, as I turned 65, had a late mid-life crisis and decided that it would be nice to be my own boss and not be an employee anymore. And have decided to kind of prioritize the more interesting and gratifying pieces of the work I've been doing for the last eight years or so.

Working at advising colleges, advising universities, working with youth facing organizations. I've had the honor of being a Mental Health Advisor to the NBA for the last couple of years, which probably came through some work I did with the NCAA and have worked with a number of media projects over the years. Was very involved in the mental health response to "13 Reasons Why" several years ago, I think I was never in the media more than in the six weeks after the release of "13 Reasons Why", which was as many of you probably remember was somewhat controversial because of its messaging problems around suicide prevention. So I've worked in a number of different facets of Suicide Prevention and Mental Health Promotion in this you know, youth and young adult space.

That's great, so you are the right person to be with us here today. And with that, I'm going to stop sharing my screen. I'm gonna go on nonvideo mode. So the screen can be all yours, but I'll be here in the background moderating questions as they come in. And I may interject time from time to time as we go through this today.

Okay, sounds good. Thanks, Preston, and you know, the first thing I want to say to everyone, you know, I appreciate you taking the time to be here and I'm going to warn you from the outset that what we're all facing now is something in which there is no expertise. So, you know what I'm saying, these are novel circumstances, the confluence of COVID the political and social upheavals of the last number of months. And the level of uncertainty I think, has presented us with challenges that are kind of unique.

Although I'm going to argue, you know, there've been other times where there've been very challenging things going on, and what I'd like to do is first really present a kind of perspective, a way of thinking about the mental health ramifications and how we can understand, and actually talk about what many of us are experiencing currently and also why it matters. Also talk about what are some of the psychological stresses and challenges that young people are experiencing. And in fact, that all of us are experiencing in different ways. What are some of the practical ramifications of these things for college and university students? What little we know about what's happening to them on the emotional and mental health front, and, you know, couple of comments about just how we can think about helping them and, you know, what we can do both for ourselves and for the people around us, and the students that at least many of us are working with and are responsible for. And again, there's no magic bullet here.

I mean, obviously, in terms of COVID, you know, definitive treatments and vaccines would make a tremendous difference, but, you know, obviously in terms of what we're talking about in the impact on the uncertainties around Higher Ed and some of the challenges that flow from that there's no real rule book or guidebook for this. And we're all, I think just making our best guesses based on our experience and the knowledge that we have, and that we've accumulated over the years. So to just start with a little bit of a historical note in 1918, I guess, maybe not completely by accident, there was a worldwide flu pandemic, and it was in the midst of World War I. At that time, actually a Sigmund Freud wrote a very important paper called "Mourning and Melancholia".

And, the point of his paper was actually an attempt to really come up with an understanding of what's the difference between mourning, which is a kind of taken to be a normal, natural human process that responds to, you know, significant loss versus melancholia, which was the term used at the time for what we now call clinical depression or major depression. And it's not so much important to go into the details of what he argued. But I think the important point that was the basis of posing this question is that mourning and depression phenomenologically, that the symptoms of them are the manifestations of mourning and depression are almost indistinguishable from each other. So one of them though, we don't consider to be a pathological process, the other we do. And I think this is important because I've been concerned since the beginning of COVID, that there's been a tremendous amount of coverage in the media, both in general.

And you know, some of the stuff that's been done and written about Higher Ed and college students that I think has unhelpfully muddied and confused these ideas. And I'm going to give you one example to hopefully explain what I'm talking about. What I'd like to suggest is that as you know, as a world, as a country, and certainly particularly areas where now COVID has become fairly widespread across the country, we're all experiencing a completely reasonable, increased stress level, which is totally rational, which is non-pathological and makes perfect sense. And in fact, if people are not stressed under these circumstances, you actually need to wonder a little bit about what's going on with them. And, the analogy I'd like to use is from a physical stress.

So think about a person who's carrying a load of heavy bags, and you know, it's a hot day, it's cooling off at least here in New York, but you're carrying these bags and you know, what's happening as you walk along is your pulse rate goes up, your body temperature goes up, your blood pressure is probably going up. You're starting to sweat. You're actually manifesting a lot of things, which under somewhat different circumstances if I were just sitting at my desk and speaking, I would be concerned that maybe I have some kind of illness, but in fact, in the process of carrying those bags, what I'm experiencing is a perfectly natural physiological response to the stress of carrying heavy stuff, you know, for some distance.

Now to take the analogy a little bit further, it is possible that that stress could precipitate a physical illness. If I have arthritis, it could, you know, act up, if I have a lung or heart problem and actually could precipitate an incident, or whether I have those things or a vulnerability to those things, it could precipitate an illness, but in and of itself, the things we're seeing with that, you know, bag carrier is I'm carrying, these bags of groceries up the street, that's not an illness. And I would argue that what we're experiencing now emotionally is akin to the bag carrier that the differences that in this circumstance, we don't know how far it is to get home with those bags. And that, you know, certainly adds to the strain. It also doesn't mean I wouldn't appreciate someone coming along and either offering me a ride or offering help with the bags. So again, to take the analogy further, I don't necessarily need to have an illness or a pathological event in order to be, you know, benefit from some kind of help or support.

What's the point of this and what's the difference? Why does it matter? Well, I think there are a couple of things at play here. And if you now go back and look at some of the surveys that have been done both in general and with college students, you'll see that they pose the question in a very curious way. Very often the survey will ask has COVID had a deleterious impact on your mental health? And, you know, very often the people say, "Well, I certainly feel worse than I did, you know, before COVID," so sure it's had a deleterious effect on my mental health, but it's the wrong question. You know, if you think about what I've been saying, the question should be, do you feel worse on the basis of what's been going on? Has this been an emotional strain? Has your sleep been impacted?

As you know, is it harder to concentrate after sitting on Zoom for long periods of time? Are you worried about family members or your own health, or, you know, are you worried about losing a job or having a family member? Those are all perfectly reasonable things. And because the question is asked in terms of, is it, you know, having a deleterious impact on your mental health, then the news picks these things up and says, "Oh, COVID is causing this mental health crisis." Now COVID is making people more vulnerable to, again, come back to my analogy that if you have a propensity or a vulnerability to a mental health problem, it's certainly stress is adding to the challenge and adding to the risk and adding to the danger. It could also be causing problems that are making it difficult to function. So if you're not sleeping as people, again, going back to the original example, people who are mourning often have trouble sleeping, have trouble concentrating.

All of those things are things that clearly we might be seeing to label those things as mental illness, I think does people a disservice, first of all, it's just confusing categories. So it's unhelpful to call these things mental illness when it doesn't really make sense to do so. The other thing is I think it just telling somebody that they are or will become mentally ill is just another source of stress. So in itself that's an unhelpful claim to be making because it's just giving people one more thing to worry about. And Lord knows there's enough to worry about.

And by virtue of doing that, it's actually, again, increasing the likelihood by adding to the stress that they actually might develop a significant problem. So you have this kind of, you know, it's almost a kind of circular process of by telling people they're going to get ill. You actually are potentially increasing the risk that they might get ill because they're both anxious and we'll interpret what they're experiencing as a manifestation of illness, rather than as a manifestation of a response to perfectly reasonable circumstances that they're experiencing. So that's just the way I think it's helpful to think about these things.

What are the stresses that are being evoked? What are the challenges psychologically? And, you know, I just want to, again, touch on this quickly, but you know, these are real things. I mean, we have a kind of innate fear of illness and death. So obviously that's the simplest thing. And, you know, on top of that, given the circle of the unpredictability of this thing, you know, it's certainly early on, we didn't know a lot of the parameters of what increased or decreased risk. We are learning more from a kind of statistical population-wide basis, but still, you know, obviously there's much both uncertainty, confusion and misunderstanding, and you know, that's not helping people feel more confident about the decisions.

You know, everybody's constantly engaged in these kinds of risk benefit analysis of, you know, if I go out and do this, if I go to this store, eating outside with people versus, you know, eating inside, but with all the windows open, you know, everybody's become a risk assessors and actuaries, but we don't often feel like we have all the information we need. So that's clearly creating certain challenges. I mean, I think, again, as a society, some people have developed some degree of agoraphobia that we're going to need to, you know, really address as things open up more. Unfortunately, we're also seeing somewhat used to in the old days, be called counter phobic behaviors and thinking where, you know, people are saying, "There's no risk."

And you know, this is all, you know, this is all made up, so we won't get into that. But one of the other things that has been a challenge and I think is something that's really crucially important for people in Higher Ed and Higher Ed Administration to be thinking about is the extent to which in the last 10 months or so, the faith and leadership and the reliability of leadership has been shaken. I'm going to try in this, you know, week and a half before the election, not to get political, but I think you know, the sense that there's been a lack of progress, the fact that it's not clear now who, and when authorities can be trusted in ways that we hope would not have been the case under other circumstances, just to add to the stress and level of anxiety that I think people are having to live with now.

What's happening for students in Higher Ed? I mean, there are, we know that as school's almost all closed in the spring and have now opened or partially opened, or, you know, open virtually, I guess you can go to the Chronicle of Higher Education, or I think it's them who keep, or maybe it's inside Higher Ed. One of those two has a kind of a daily update of what sorts of models and how many institutions are using which model. And of course these things have been shifted, which just adds to the sense of, you know, sort of unpredictability and uncertainty. Another challenge, both for students and administrators.

So we know, and you can find a good bit of data for those of you who aren't familiar, be really useful to look up the Hope Center out of Temple University that is run by Sara Goldrick-Rab who's, you know, over the last couple of years, gotten quite a bit of press because she's really the first person I think, who has kind of been able to publicly demonstrate the extent to which our college and Higher Ed students struggle with food insecurity, with housing insecurity. I mean, obviously finances, even, you know, proximate to that, even before you get to the extremes of people who are, you know, living from place to place and are not sure where they're going to get food from, but finances in general are a major challenge to many, many students in Higher Education. And of course, you know, virtual learning has been something that faculty in universities and colleges have had to sort of figure out on the fly.

I mean, we've all been flying the plane while it's being built. You know, for many faculty, this isn't, you know, many don't love technology. It's hard enough lecturing live to a group of students, but, you know, it's certainly much harder, to do this things like simply exam security have become way, way more complicated. And, you know, and the lack of equity and people's resources have been a source of major challenge. And of course, as always the students on the lower end of the socioeconomic spectrum are placed in the position, of usually having more obstacles and impediments to either places to do their work, to Wi-Fi access, to computer access, to, you know, all of the above are challenges which have just made shifting to online learning that much more difficult.

So, you know, clearly there are these very, very serious practical challenges that both students and, you know, in faculty and administrators are having to contend with while figuring out how to keep budgets intact, which, you know, has clearly been a challenge. I mean, there's no doubt that at a time where there's never been as much of a demand for counseling services, for support services, the schools by and large are having their budgets hammered and have fewer resources to, you know, provide those kinds ends of things. So what do we know about how students are responding to the situation with COVID and one of the best recent surveys that's done, although again, they use some language that I wasn't thrilled with, but, you know, putting that aside, the healthy mind study out of, well, it used to be out of University of Michigan, all of the people involved in that have dispersed to other places.

But if you look up the healthy minds network and Preston is going to, I think, put the link on the site, they together with the American College Health Association did a good survey, Active Minds also did a survey, but I'm gonna focus, I think the Healthy Minds and ACHA joint survey was a bit larger population. And, you know, the results of it were quite mixed and not as bleak and disturbing completely as we might've expected. You know, and you have to wonder sometimes when some of these surveys are done, there are often perceptions that students report, which are inconsistent with their personal experiences. So one of the things, 50% of the students said that they had some degree of difficulty accessing mental health services. Although there's no question that 50% of them didn't access mental health services in a more recent survey suggests that the use of mental health service, I think this was at Penn State, this was out of the Center for Collegiate Mental Health, that Ben Locke runs that said that there had been something like a 30% drop of usage of counseling services.

Sorry Preston, I didn't mention that one to you before, but Center for Collegiate Mental Health is easily trackable down but so many students say they had trouble accessing it, but, you know, it's not clear that all of those students actually tried, or they just assumed it would be more difficult. And, the actual reports about emotional health are kind of curious, because, you know, on the one hand students in the healthy minds segment of the study, there was a slight increase in reports of depressive symptoms. So this was based on a screening tool called the PHQ-9. There was actually curiously, a reported decrease, and these are compared to the fall of 2019 data that they had. So this is fall 2019 to March versus March to May, 2020 suicidal ideation in the Healthy Minds data actually went down slightly among the students that did the survey anxiety reports were flat. Flourishing, went down at one point from 38% to 37%. The interesting, but not so surprising finding that came out of both the ACHA's data and the Healthy Minds data was the dramatic drop in substance use, which if you think about it, given a significant number of students shifting to living at home, a drop in substance use illicit substance use went from 26% to 21%. And binging was dramatically, dramatically down.

Binge drinking went from 38% in the fall to 24% in the COVID period. So, you know, again, the numbers speak to some levels of stress, but, you know, maybe not as dire, as people would have imagined the ACHA study curiously, their assessment of suicide risk went up slightly, but by the same token, the responses around serious psychological distress went down slightly. Interestingly resilience went up. So students self-reports of their own resilience were seem to improve in the face of the challenges of COVID. And that's an important point I want to file away and come back to and loneliness reports went down. So, and that's actually consistent I think Preston will put up just last week. There was an article in the Atlantic by Jean Twenge who's a well-known psychologist written about narcissism and the use of social media and teens, and at least in teenagers. So this is a little younger than our standard population, but she said that this survey that she did in the spring time among teens suggested that in fact, for many of them, their mental health seem to improve, spending more time with families. Although, you know, many of us comically have thought about, you know, all of the dire, potential consequences of family spending too much time with each other. And, you know, clearly there's real risk here, and there can be real concerns under the wrong circumstances, but by and large, for the larger segment of the population, it seems that kids were getting more sleep.

They were using social media in a seemingly more, more productive and healthy ways. And it seemed like spending time with their families actually turned out to be, you know, benign or actively beneficial for many young people. So I think it really, again, adds some perspective to the dire predictions about the, you know, the crisis that was going to unfold in the disaster, which I'll remind you, you know, in a cynical way, was being used by some to argue for the premature opening of schools, that there were these arguments being made that the, you know, the mental health and suicide risk consequences of COVID were so dramatic that we needed, you know, come hell or high water to reopen schools as aggressively and broadly as possible. And, at least the data we're seeing, you know, in the shortish word, I mean, we don't know what will happen. And I have concerns that, you know, as things persist too long or even worse in areas where there is improvement and then a backsliding significantly that people will find then, including kids extremely discouraging. But, you know, it's also discouraging to have your teachers get sick or your, you know, your grandparents get sick or die if you're in fourth grade.

So again, we need to not jump to conclusions about what the mental health consequences of COVID are. And I think this is important, you know, in terms of the way we do talk about this too, because you know, it's obviously a very challenging time. And, you know, for people who've tragically lost a family members or been sick themselves, or for people who've lost jobs and really been put in difficult economic circumstances, these are really terrible times, but for large segments, of the population people remarkably, and this, you know, I thought if this had happened 20 years ago before the age of Zoom and so much capacity to do things virtually the economic, educational and personal consequences of COVID would have been way, way more dire, but it's been remarkable to see how, you know, how colleges and businesses and other kinds of activities have successfully pivoted to being largely virtual. You know, hopefully it won't be continuing forever, but we've realized we can provide a lot of mental health care virtually, and it's maybe not 100% is good, but it's pretty good. So when you know, let's go back to our bag carrier, when should people be getting help? You know, when do you think about it, if we're sort of backing away from this primary focus on what's pathological, how do you decide when the bags are too heavy? And, you know, that's really a way to think about it. What you can do and this is a little bit challenging under the circumstances since the foundation is so inconsistent.

But what I like to tell people is look for change. You know, if your students, if your kids, if your own function is dramatically different from what it usually is, that certainly could be a sign of a problem, look for persistence of the problem. So if you have, you know, one or two sleepless nights, but then, you know, can get a decent night's sleep or you know, find your concentration is off one day, but, you know, you're able to get some stuff done the next day. That's probably, you know, you're managing those bags okay. But if you're really can't catch your breath and simply can't lift them off the ground and can't hold them to beat the daylights out of this analogy, I'm sorry for that. Then, you know, you should think about then finding a therapist, getting some help and, you know, learning about what resources are available for you for, you know, the college based community. I mean, you know, what resources are there, what are the student services that are available to support students, know how to access your counseling service, make sure you know, what model they're using in order to help support, the students that are, you know, on your watch, but there are simple things you can do, obviously self care is important in this context.

So making sure that you are trying to get decent nutrition, you know, as in a safer way as you possibly can getting exercise, trying to maintain sleep are all things that make a difference, any sort of mindfulness practices, hobbies, anything that makes you feel calmer or better, or you know, makes the people around you or the people who you're responsible for feel calmer or better are all fine. You know, as long as they don't involve doing things that are dangerous or illegal. So, you know, think about how to feel better. Certainly trying to find balance in this situation has been, I think, a challenge for many, many people, you know, figuring out how to balance screen time and time with family and friends and other people in ways that are safe and time alone, people have had to sort of rebalance those things in ways that they, you know, haven't had to when circumstances were normal. I think, you know, I alluded before to the fact that there've been difficult times. I mean, it's not an accident. I think that Freud was writing about what he was during the flu pandemic when mourning, you know, was such a prominent issue.

And I've in a number of these talks also sort of wondered about the extent to which if you go back, I mean, Franz Kafka was writing. Most of his major works in the 1920s, you know, after World War I and the flu pandemic. And I think that period of time left many people, I mean, it's one sort of existential philosophy was burgeoning and World War I was I think, an internationally transformative event. So thinking about, you know, how these things have challenged society, how we're facing the challenges of society currently, but also recognizing that there have been hard times before and helping people keep perspective that there are, you know, people there, I mean, there are people who are now living in places that are at war and, you know, many people who continue to be refugees and, you know, have homelessness and in all of the challenges that we experienced. So I think it's helpful to help our kids and the students around us recognize, you know, take a broader perspective of things and keep some perspective that, you know, people have risen to challenges and it doesn't mean it's easy or, you know, or enjoyable, or that we would wish this on anybody, but it is an opportunity for people to learn, you know, resilience and problem solving.

And I think as either parents or teachers or administrators, we have an opportunity to actually show our kids and our students, the value of, you know, to facing challenges, confronting challenges. I'm going to just mention, again, the comment, the notice that, you know, many students are themselves saying they're more resilient as a result of facing this. I think many young people that in many of our schools, while, you know, many have faced all kinds of challenges from immigration to homelessness, to all sorts of financial challenges, many have also grown up very much on the other side of the coin and have many, many things that have been taken care of for them and facilitated for them. And, you know, it's useful for young people to recognize that there are things we can control and it turns out there are certain things, even with it, you know, all the resources in the world, certain things cannot be controlled. And it's an important realization to come to, even though it might be difficult in many ways. So--

Vic here.

Yeah, go ahead.

We have a question and I think it's timely.

Yeah.

It came in, but I think it's timely with the track you're down now. So let me read it to you.

Sure.

And a lot of several folks have uploaded too. So let's jump to my question relates to concern that students, at least on my campus are seeking mental health resources less frequently than pre-COVID. Although the need is clearly there. How do we motivate students to engage with us despite our new circumstances, Zoomed out, concerned about being face-to-face, et cetera.

Yeah, so I was actually just about to get to what can campuses do. And I think this, you know, so the answer to this as a couple of the points I was going to make, I mean, it's really, really important for the campus leadership to be communicating in ways that acknowledge the, you know, the challenges while not calling this mental, you know, crisis and mental illness. But just saying that, you know, we have a kind of social crisis, which is leading to a tremendous amount of stress. And, you know, so if campus leaders, if presidents and provosts and senior student affairs, people are communicating with students in a way that is acknowledging how challenging this is. And reminding students regularly that, you know, I'm getting help. I'm talking to people who are in my corner and supportive to me and we provide those resources here and here's how you access them. So it's really important to be communicating clearly and communicating honestly.

And I think connecting with students in a way that expresses the honest reality, that we're all sort of floundering here a little bit and flailing around and trying to make our best assessments and our best predictions and best decisions about how to proceed in that. You know, we're all gonna try to work this out together. So I think communication and leadership and communication from leadership are really, really important on the communication front. One of the major challenges I think is balancing how much information do you give? You know, you want to, and this is something that we see unfortunately, commonly in postventions after a campus crisis, after a suicide or a fire or something like this, you want to share enough information to dispel anxiety and the rumor mill and the conspiracy theory mill, but not so much that you're overwhelming people with unnecessary details. So framing communications in a balanced way, you know, communicating in ways that are helpful and human and honest and, you know, convey connectedness, I think is really important. You need to be reminding people and that, you know, the student support services, ironically again, have never been more important and yet are very challenged. Excuse me, the other thing I'll say about, you know, the drop off in students using counseling services, it very well may also be the case that students living at home are simply using home-based resources.

So that if, you know, if a student is attending school across four States, it may not occur to them that their best choice is connecting to the counseling service. Although in many cases, the way to get seen at the counseling service may be briefer than it might be in your local area, unless you're already connected to resources. So we should acknowledge that some of this may not be, you know, may not be terrible. Schools also need to be as flexible as can be about, you know, providing services. There was a tremendous amount of confusion and anxiety about doing cross state counseling. So some schools were being very, very, I would even argue maybe overly cautious about it. You know, just as it's illegal to, or it may be a breach of, well, maybe problematic to provide care across state lines. Although most States in the federal government relaxed those restrictions during the first months of COVID, it's now a little bit more influx.

It's also unethical to abandon patients, you know, and you're putting yourself at some liability risk for abandoning patients. So if somebody has been engaged in treatment and doesn't have access to treatment in their home state, I would argue you're still on safer ground, continuing to see them. One of the challenges of cross state care is actually insurance payment and many of the insurers, again, you know, went along with the government and were increasingly flexible about that. Some have begun to shut that down a little bit. So, you know, be flexible about how you provide services, you know, communicate consistently, be honest and human with the students. And I think you'll be on pretty firm footing if you do those things. And, you know, we're all just kinda making this up as we go along, be ready. You know, this is the time where ever you always need three plans for everything. You know, you have to be ready to pivot quickly. And if something's not working, come up with something else. So with that, I'm going to stop. And I guess it's leaving us about 15 minutes or so hopefully that wasn't the only question that came up 11 times.

Yeah, so that's great. Dr. Schwartz, I think I'll say to everyone, please ask questions. We have time for it. One I'll sort of kick things off on my side with one and hopefully we have about 100 folks on, so please ask questions. It's relating to methods of surveying, or I don't know what the clinical terminology, I don't know if it's pulse checking, but what you would do in order to keep a close watch over your student population mechanisms to do that at scale structures, survey instruments that you've seen work effectively. How can a Dean of students or a provost or someone from the counseling department think about when someone says, how are we doing right when the president walks in or the board walks in and says, "Is everybody okay?" And you're looking out at 30,000 students. And you're like, "Probably not." What is the way to approach this? I know that's a big question, but I think it's one that we keep getting.

Yeah, I mean, so actually that question has two pieces to it, which aren't the same thing. You know, one is a lot of institutions and certainly now institutions need to gather information so that you can answer those questions when the provost or the president says, "How are we doing and how are the students doing?" And, you know, there are the surveys, actually the American College Health Association survey twice yearly and the Healthy Minds survey are both national excellent and detailed surveys, which give a ton of data. I mean, Healthy Minds is more mental health focused. And the American College Health Association is more focused, although it has a significant amount of mental health content. There's also content about, you know, substance use and health behavior, sexual behaviors and things like that. So those are great surveys. And, you know, they give a tremendous amount of useful information.

They are standardized, you know, obviously in the age of COVID, the standards are all different. I mean, you know, we don't know really what to make of these kinds of surveys under these circumstances, but they tend to get pretty good response rates and, you know, are clearly the kind of national standard in terms of, you know, sort of doing stuff. You know, the other piece of that question is how do we find out what students are in trouble so that we can, you know, get people into care or at least alert them to care if necessary, you know, I would argue, and I don't know exactly how to do this, but I would argue that we should be reminding faculty and anyone who has touch points with students now, mostly virtually, but you know, when it's happening, face-to-face as well, we should be reminding them to be sort of, to have mental health and the students' emotional state on their radar.

So in the world before COVID, I used to like to say that, you know, when I was a Dean of Students, one of the things we did was convened a meeting after every semester and looked at students whose GPA had dropped more than 0.5, as you know, among the undergraduate students at the university I was at, because, you know, our assumption and my assumption has always been that if somebody's academic performance is flagging, they probably haven't gotten more stupid between, you know, last semester and this semester, they haven't lost IQ points, unless, you know, maybe they had a head injury or something like that.

But, you know, in 99% of the time, there's something psycho-socially going on. So, you know, it's obviously way more challenging in the virtual world. I think faculty should, you know, beginning of classes, reminding students that they're there, that, you know, they'll have virtual office hours. If they're concerns to reach out, that here are support resources that, you know, the student support resources and counseling services should be included on syllabi and things like that. So, you know, we have to figure out how to be creative because students won't be going past a table. That's set up to do national depression screening day in the, you know, in the commons or the cafeteria, or, you know, out on the campus in the same way that they typically would be. So we have to figure out how to be doing more active outreach, how to be looking for, again, those changes and people who seem to not be really able to function at the level we have historically thought of them as being able to function.

We have more questions.

Okay, good.

Okay, I'm reading through these and I'll prioritize the best I can here. What are good, I mean combine two together. And then we have four total and you combine the first two, and then we can jump to the others. What are good surveys tools to assess wellness that could be provided to both students and faculty staff, free Wars, free resources as available part two or second different question, different person I teach for synchronous classes, 145 students. Might you offer a two question check-in that I could thoughtfully include in a survey monkey instrument, where I would be the only reader.

You know, so the second one's easier. Actually, I mean, I would actually invite students to answer the question, how are you doing? You know, and if you say on a scale of, you know, okay versus terrible. And the second question is, is there anything I can help you with that, you know, that you think would be productive now, of course, a faculty member might be terrified to open up that Pandora's box, but, you know, if you have the contact information for counseling service and you know, the basic support services on campus, you'll be doing a tremendous tremendously, you know, positive thing. And also again, the faculty now, given the circumstances of remote teaching, you're the ones who really have contact with students on a regular basis in the student affairs, you know, really can't, you know, connect to students as directly, unless they are involved in a particular activity or club or, you know, athletics or something like that. So well, so I'm seeing, so if it comes out as terrible, what do you suggest of that?

Well, you know, I think you need to make sure that you have the speed dial number for the Head of Counseling Service on your phone. And I'm only being partially facetious. I mean, there, I think every faculty member now really needs to be, I'm going to back, I think over the last 25 years for a variety of both good and bad reasons, we've made it more difficult for faculty to play this mentoring role that I think was more, and there were good reasons for that. I mean, clearly there are things that were handled terribly over the years and faculty need to be safe and protected, but I think there's a real loss that's come from that. And, you know, if there's a time where faculty can be helpful to their students, who often don't have other places to go, but you need to have done a little bit of homework and to at least know what the basic resources are on campus. And, you know, if something really seems dire, let people know about the national suicide prevention lifeline, and, you know, let really, let the counseling service director know that you have a student that you're very concerned about right away. You know, you shouldn't be sitting.

I used for many years to do trainings with RAs, and I would always quote that great philosopher, The Rock and, you know, remind them, they need to know their role, you know, so you can offer yourself out there as a supportive adult in the student's ecosystem, but obviously you also need to remind them there, you know, you can help connect them to resources, but it's not your role or your job to be, you know, stepping in as a therapist. But, you know, you're really faculty are in the best position in terms of screening tools that, you know, there are these wellness and flourishing screening tools. So it really depends on what you're looking for. Again, both the American College Health Association and Healthy Minds are student-facing studies. I don't know about like just general broad population studies that look at wellness writ large, you know, I'm sure there are some out there, but I don't, you know, I don't know what you would be comparing it to now. So it, it would be sort of challenging to know what to make of data that you would get from those kinds of things, you know, this kind of epidemiology in survey research. You need to check with somebody like Daniel Eisenberg who runs the healthy minds study. I think he's a little bit more of really an expert on what's the range of surveys and really understanding them under these very strange circumstances.

Dr. Schwartz, we will call this the speed round. We have--

I'll try to be brief.

It looks like six, and I'll make the promise to those in the pursuit of brevity, if Dr. Schwartz wants to go deeper, maybe he'll be so kind as to help us with some written responses that we can send out after. But let me jump through six and see if we can get through six in four minutes. What tips might you have for encouraging leadership provost, faculty to engage in the vulnerability of sharing their personal struggles. We're looking to create a culture shift on campus that promotes wellbeing, but it has been challenging to get folks on board who feel like that is not their role.

Yeah you know, listen, I would just argue with the last piece of that. Why isn't it that their role, I mean, education is more than just the imparting of facts. I think, you know, all of any provost to president would agree that there's a developmental aspect we're teaching people to think we're hoping our students actually learn to manage in the real world and being able to be aware of and discussing your feelings, your emotions, and your vulnerabilities, I think is an important part of being able to get along in the world. The inability to do that as we've seen only two clearly in the last number of years leads you into all kinds of terrible circumstances and jams. And I'll stop before I get myself into trouble.

Can we have Dr. Schwartz do another webinar? I'm sure there's more information that he wants to share. Yes, we'll figure that out. So good question.

Okay.

I love the concept that we always need three plans for everything, for flexibility, as a clinical services director on a college campus, that is something we consistently do, but staff have a harder time with this flexibility and reporting, anxiety, anger, dread, and stress with so much unknown, as well as feel like the planning assumes doom. Are there any ideas supporting mental health providers with managing this?

Yeah, you know, I think part of it is the way you frame it. You know, it's certainly easier to at least have a partial plan set up ahead of time, then have to pivot on the fly in the face of a crisis. So, you know, it's worth discussing what is it, you know? Yes, it's more work to do it this way, but you know, doing something in a kind of orderly, somewhat planned way, even though it's difficult work is a whole lot better than responding in the midst of a crisis, you know, and having to figure it out while it's happening. But, you know, with everything we're doing now, I mean, things are so uncertain that we've all become, you know, sort of jazz improvisers. I mean, you know, you presumably know the chord changes of the song, but you always gotta be ready to pivot and somebody might just decide to change keys on you. And, you know, you've gotta be able to go with it. So, yeah, it's, I mean, acknowledging that this is challenging and scary is I think the best you can do, and it is, it's acknowledging, it's scary work, and really reminding everybody, we're all making this up as we go along, it's not like we're trying to do this to make your life difficult. We're actually trying to do it to make your life easier.

Okay, I'm gonna combine two questions. I'll apologize to Michelle and Mercy 'cause I made this may be an improper combination, but international students and students out of state, who've never engaged with the counseling services department before counseling services before and there's a desire to help them, but there's a geographic distance and maybe an unfamiliarity with local resources. So if we can combine that together in terms of dealing with disparate distributed student populations.

Yeah, I mean, the way I've been trying to suggest to people to think about this as using a kind of harm reduction model of, you know, would you rather, if a student is out of state, if a student is even out of the country, you know, it's reasonable to say, are there resources that you can reasonably access closer to home that would, you know, provide you with your needs basically well enough because it's still better to have the option of being able to see somebody face-to-face, if a question comes up, if a need comes up, but that said, if a person is really in trouble and has no other access, I think that would, you know, you could make the argument that constitutes an emergency. And those of us who've been in, you know, in private practice for many, many years, I mean, you have patients who travel and have a problem. They run out of medication or they have a crisis. Most of us would not hesitate to speak with them on the phone. And I think if, you know, if those are emergent, if COVID isn't an emergency, I don't know what is, right. So, and I just, I can't see the Department of Health when all of this is said and done. I can't see the Department of Health in Nebraska coming after someone in Massachusetts, because they spoke to a student who was, you know, having a hard time while they were home in Omaha. I just, I don't see the risk here as being really substantive. And I, you know, maybe I shouldn't be so glib about it, but I think there's risk and, you know, and sort of not taking care of the person who needs care as well.

Dr. Schwartz, thank you. We have a parting gift for those who are still on. We asked Dr. Schwartz a couple weeks ago, books that he recommends "The Stressed Years of Our Lives" was one, if you would like a copy of this book, we will mail one to you, or we'll send you a Kindle version or whatever your preference is. Send me an email, Preston@get inclusive.com and we will send you a copy. I'll give a quick plug before I do that. If you're on your way out right now, you are going to get a survey. That survey is only relevant to you. If you have a relationship to prevention in compliance, training and Higher Ed, if you don't feel free to disregard it, but it's an annual survey that we conduct when we generate a report that we send back out to everyone to help you better understand your options in for online training to deal with critical topics like Mental Health and Mental Well-being. We recently launched a course a couple of weeks ago that Dr. Schwartz helped us develop along with the folks at the JED Foundation. So I want to plug that quickly, Jeremy Beckman and Dr. Carmen Poole, were the authors of that. But Victor, Dr. Schwartz was critical in that I'll move through these slides only to say that if you'd like any information about this, let us know I'm going to pop up a quick poll because we have lots of campuses that have asked for it. And so I just want to make sure that that gets launched here. And then I will let everybody jump off and get back to whatever you have planned for today, which I'm sure is a lot. So that's up right now, Victor, Dr. Schwartz, we will send information in the follow-up email with the recording about how people can get in contact with you. It sounds like there may be some interest in doing another webinar, so I'll reach out to you.

Okay, sounds good.

Can you schedule for meeting? Hey, we know that this is a very difficult time for everybody. We really appreciate you taking some time out of your day to be with us and Dr. Schwartz, I can't thank you enough, this was an incredible presentation and I hope we get to do it again.

Thank you all, I had a great time. Thanks, stay well everybody.