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Campus Conundrum: How Providers Can Break Down Barriers to Mental Health Treatment for Minority Students

October 30, 2020

As college students have returned to campuses this fall—or, in many cases, adapted to remote or hybrid models of learning—the mental health impacts of the COVID-19 pandemic are still being felt.

About 80% of college students say the pandemic has negatively impacted their mental health; 20% say their mental health has significantly worsened this year, according to a recent study published by Active Minds, a not-for-profit organization that supports mental health awareness and education for young adults. Students have reported feelings of stress/anxiety (91%), disappointment/sadness (81%), loneliness/isolation (80%), concern over financial setback (48%), and struggles with relocation (56%).

The toll is particularly acute for students of color, who research indicates were nearly twice as likely not to seek treatment when experiencing feelings of depression or anxiety pre-pandemic.

Why are minority students less likely to seek mental health treatment? There are several factors in play—and several ways in which behavioral healthcare organizations can reshape their operations to overcome these barriers, says Stephanie Pinder-Amaker, PhD, chief diversity, equity and inclusion officer and director of the college mental health program at McLean Hospital, a Harvard Medical School psychiatric teaching hospital.

Pinder-Amaker recently discussed these topics with Behavioral Healthcare Executive, and offered a series of action items for provider organizations.

Editor’s note: This interview has been edited for length and clarity.

Why are minority students less likely to seek treatment for mental health?

There are lots of contributing factors. Some of this can be campus-specific, but generally, I would say many underrepresented minority students or students who identify as Black, indigenous or people of color will experience a lack of culturally responsive providers being available to them on campus. Many students feel reluctant because there is a lack of shared identity represented among campus mental health systems. Going into a campus health center and not being able to sit down with someone who might share your identity of race or ethnicity can often be a barrier. An important thing is that I would like to remind campuses specifically and providers in general is that these guiding theories are helpful, but it’s really important that campuses make the effort to explore the barriers for their students who are Black, indigenous or people of color on their particular campus. Frequently, we jump to assumptions, but the best way to find out what’s getting in the way of help seeking by underrepresented minority students is to go to the students directly and ask them. Often, the findings are surprising.

Can you share some examples?

We worked with a campus to meet with students who were protesting. Among their demands, they were asking for more culturally responsive treatment being made available through campus-based mental health services. We were asked to come in and consult with the school, and we met with the students to learn first-hand. We had our theories on what those barriers were, but not until we were sitting down and talking with students did we learn about very specific barriers that we were able to report back to the institution, and the institution then addressed.

An example of one of those barriers was students of color reported that they noted that when they showed up on campus, the campus health services frequently asked them to show their student ID whereas white student were not asked. This is a significant barrier—students feel singled out and unwelcome in that environment. That’s the kind of barrier that can only be learned by campuses taking the time to speak directly to students to find out what is getting in the way. Sometimes it’s a perception about care—or a misperception about what is or isn’t available.

When I worked at the University of Michigan with oversight of campus student mental health, some campus counseling centers would set session limits. That’s a model that has often been put into place to address the needs of as many students as possible. What we learned is that even when colleges and universities remove those session limits, students see the limits as a barrier, meaning they’ll say to each other, “Don’t bother to go there, they’ll only see you six times the entire year. You’re better off seeking treatment elsewhere.” Once that messaging gets out among students, it can be difficult to correct that, even when those session limits have been lifted. That perception will persist among students. You can’t know that unless you actively engage students and ask them on a fairly regular basis what’s getting in the way. Once you learn that, you have the opportunity to address those barriers.

Help-seeking behavior among college students on campus across the board is surprisingly low. It varies, but approximately two-thirds of students who require mental health services will be extremely reluctant to seek those services. Those are for some of the reasons I mentioned, but also concerns about stigma, persistent concerns that somehow, there will be some form of academic retaliation if it becomes learned that a student is receiving mental health treatment. We’re finding more recently from research specifically for students of color and people of color beyond college students that whereas previously we focused quite a bit on stigma and lack of awareness as barriers, a significant barrier right now seems to be access, which points back to some of those initial factors we discussed—not being able to schedule an appointment with someone who you feel shares an identity and therefore has a better understanding of your lived experiences.

If students feel they don’t identify with those who are working on staff, a logical step would seem to be making diversity a priority in hiring. But from what you’ve described, there are also a lot of steps that can also be taken by those who are already on staff, right?

Yes, that’s absolutely right, and I put that under the realm of how important it is for all campus counselors, all mental health professionals, regardless of how they identify relative to race, ethnicity, sexual orientation, gender and so forth, but the need for all campus providers to be culturally responsive. Campus counseling centers will never be able to hire their way out of this challenge. It would be really challenging to hire for the range of diversity that would align with the identities of all students coming in. But what they can do is make sure their providers are all culturally responsive. They’re trained in the practice of cultural humility and culturally responsive care.

Another important strategy for removing barriers to mental health support and psychoeducation is thinking about switching the paradigm, creating new models for engaging students in supportive groups and interventions. Many schools are picking up on this approach, going to meet students where they are. This applies across all identities. If students are coming in to seek treatment, then we have to get better about going out and meeting them where they are and specifically in the places on campus where they feel welcome and safe. That’s a model that seems to be working much more effectively in supporting the mental health needs specifically of Black and indigenous students of color.

Are there off-campus groups and resources that universities should be looking to for help in making treatment more accessible for students?

Yes. The Steve Fund is largest non-profit organization dedicated to addressing the mental health needs of young people of color. It’s an excellent resource with a range of services, as well as opportunities that can be tailored for the specific campus. The Steve Fund has also, in collaboration with the Jed Foundation, released an equity in mental health framework. Our program (the McLean College Mental Health Program) worked with them to create this framework, which is a set of evidence-based recommendations that schools can look to, to figure out how they’re doing in terms of addressing the mental health needs of their students of color, and then prioritize some of these action items on their campus to begin to close the gap.

Another nice model for off-campus resources—and there are several emerging, especially in the virtual base—in the Washington, D.C. area is a non-profit called the AAKOMA Project, which was started by an African-American psychologist, Dr. Alfiee Breland-Noble, who has done a lot of work in bridging the gap between mental health services and communities of color in innovative ways. If people aren’t coming to you for treatment in your traditional model of care, you have to go to the places where people are and where they feel safe. She’s done a lot of her work in safe space communities and partnering with churches and faith-based organizations, building collaborations for mental health in those spaces, really going directly to address what has been a longstanding, significant barrier, including the idea in some communities historically that you don’t seek treatment for mental health, you look to your faith to resolve some of these issues. The AAKOMA Project and Dr. Breland-Noble said we’re going to counter that specific idea by partnering with those faith-based communities to build trust and increase awareness about mental health.

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