Collegiate Basic Needs

1. Collegiate Basic Needs Addressing the Intersections of Mental Health, Homelessness, and Hunger Carla D. Chugani, Ph.D., LPC University of Pittsburgh

2. Disclosures Funding: Research reported in this presentation was supported by the National Institutes of Health (R01AA023260 & T32HD087162; PI: Miller) and the Fine Foundation (PI: Chugani). Conflict of Interest: Dr. Chugani receives financial compensation for her work as a consultant related to implementing DBT programs on college campuses.

3. College mental health problems are on the rise • Mental health and homelessness • Mental health and hunger • Barriers to accessing care • Need for specialized care • Campus-Specific Barriers Part One:Challenges in Collegiate Mental Health

4. College Mental Health • Internationally, about 1/3 of first year students screen positive for a common DSM diagnosis • Depression and anxiety are top mental health complaints • NCHA survey found that over the preceding 12 months, 9.6% seriously considered suicide, 6.5% intentionally self injured, and 1.6% attempted suicide • Note that students rated these items in past 12 months, not lifetime.

5. College Mental Health in Our Region • Survey of 1,136 college students from 27 campuses in PA and WV • Overall, 55% report lifetime history of suicide ideation, 26% score as currently at risk for suicide • 32% with significant emotion dysregulation, 22% with significant interpersonal problems, 15% with significant distress intolerance – all of these are significantly related to both suicide ideation and risk

6. Youth Experiencing Homelessness (YEH) • Includes anyone who lacks traditional housing, living in shelters, missions, transitional housing, on streets, or “couch surfing” • Associated with myriad negative outcomes including substance abuse, medical problems (including STI), poor access to health care and low employment • Youth have often experienced substantial trauma and violence victimization

7. Mental Health • Overall, YEH have been found to have mental disorders at a rate that is TWICE that of youth in community samples, with estimates ranging from 48-82% • Particularly high rates of depression, anxiety, PTSD, and suicidal behaviors. • As many as 69% endorse self injury, 62% endorse suicidal thoughts, and 39% endorse suicide attempt

8. Mental Health and Homelessness • Complex, bi-directional relationship • Mental health may contribute to homelessness and/or be exacerbated by homelessness • Mental health problems can interfere with employment, relationships, and social resources – homelessness can also interfere with these!

9. Hunger in College • Estimates of food insecurity in students range from 14-59% at some point during college. • Rates on the higher end often observed at rural and community colleges. • College and University Food Bank Alliance (CUFBA) started in 2007 with 1 bank – currently 641 members!

10. Challenges for Students • Those who cannot access Federal Student Aid (e.g., financially independent from parents) are at particularly high risk of financial difficulties and food instability • Food insecurity associated with low GPA in college • Hunger is a vulnerability factor for emotional distress and mental health problems • Food insecurity should be viewed as one part of a complex series of problems rather than the sole cause of poor outcomes

11. Student Experiences of Food Insecurity - Barriers • Stigma, shame, and awkwardness – avoidance of going out with food secure friends or seeking off-campus food pantries or other assistance • Transportation to stores with affordable food • Need for foods that can be stored and prepared easily when living in dorms without a kitchen • Sharing meal cards with friends, trying to find jobs in food service with access to discounts, stealing

12. Hunger and Mental Health • School-aged children with severe hunger have parent-rated anxiety that is double that of children without hunger, as well as significantly higher chronic illness and internalizing behavior • Childhood hunger has been found to be associated with thoughts of death or suicide even into older adulthood (age 60+).

13. Mental Health - Barriers • Many barriers to housing and food stability are also barriers to receiving mental health care: • Shame • Stigma • Financial Insecurity • Lack of insurance or assistance in navigating aid programs • Previous trauma or bad experiences with the mental health system/hospitalization • Transportation • Difficulty affording or accessing treatment on a regular basis and/or taking medications regularly

14. Need for Specialized Care • Populations with high rates of suicidality and trauma need expert care from providers who are able to meet their needs through: • Accessible, affordable treatment/medication • Evidence-based practice to help students break cycles contributing to food/housing insecurity • Structured assessment and management of suicidal behavior • Key Barriers: Level of care noted above takes time and expertise to develop – it’s expensive and emotionally and intellectually demanding

15. Campus Barriers in Managing/Treating Suicidal Behavior • Interviews with Student Affairs Professionals in our region, who noted: • Administrative/Structural Barriers: Staff shortages, low accessibility of services on/off campus, session limits, wait lists, lack of staff to respond to urgent concerns, challenges facilitating off campus referrals • Clinical Barriers: Challenges communicating with parents, lack of training, lack of models of response, difficulty with screening/assessment, lack of time needed to adequately manage the situation

16. Passive Programming • Student-Focused Solutions • Build Resilient Students • Case Management • Build Campus Capacity to Address Mental Health • Build Community Capacity to Address Mental Health Part Two: Solutions at Every Level

17. Passive Programming • Our research has shown that students want messaging that is hard to miss – put the resources everywhere to ensure that people who need to know can find out what resources are available • Normalize: Provide food at campus events (as opposed to other incentives) that all students can partake in • Consider privacy: Put tear off flyers on the inside of bathroom stalls where students can take information discretely

18. Student Focused Solutions • Given the challenges with students accessing off campus resources, include traditional food items as well as college student specific items (school supplies, clothes for job interviews, etc.) • Get the student body involved by organizing food drives to help stock the pantry and raise awareness. • Food recovery programs to make the most of left over food from campus dining halls (off-campus, third party run) • Reduced-fee meal plans, meal vouchers, donation system for students to donate meals to others • Work for food programs, including work study and campus gardens – bonus for dealing with the issue of access to healthy, nutritious food

19. Build Resilient Students • Courses like freshman seminar are a great intervention point for prevention and wellness • Using skills training from evidence-based approaches such as Dialectical Behavior Therapy (DBT) may be one way to build resilience and healthy coping in your student body • If you are interested in implementing a program like this, please contact me as we are working on a research project in this area, and funds may be available to support you in receiving training and support

20. Case Management • Many campuses have BIT or SOC teams • What would it look like if we extended the services of these teams to include food/housing insecure students? • Is it possible to have case managers on campus who can assist students with obtaining insurance, affordable housing, and/or access to other Federal Aid programs or institutional emergency funds? • Can campus case managers/outreach professionals partner with those in the community serving homeless/food insecure youth to receive training in navigating some of these areas?

21. Build On-Campus Capacity • Leverage Existing Resources by: • Build interdepartmental communication and collaboration – support the people who support these students to avoid burnout and turnover • Develop detailed protocols and models of response for dealing with high-risk students to increase comfort and confidence for those responding to high risk situations • Anonymous surveys of campus administration, faculty, and staff for ideas on what/where to improve • Faculty from social sciences can contribute assistance in innovative program design and assist with program evaluation • Clinical training programs in social work, counseling, and psychology have many students who need internships – start a campus training clinic to increase accessible affordable therapy services

22. Build Clinical Capacity • Make experience and interest in working with high-risk young people part of the job requirements for campus clinical staff • Support staff in receiving training and supervision in evidence-based approaches for complex mental health concerns and suicidality • Provide reinforcers and emotional support opportunity for staff (not just clinicians!) engaged in working with challenging students/situations • Do not remove supports once programs are established, continue to give support to ensure long term feasibility and sustainability

23. Implement Evidence Based Programs for Complex Mental Health Needs • McKay’s work with Canadian youth experiencing homelessness: • 12 weeks of DBT individual+group = significantly improved depression, anxiety, hopelessness, social connectedness, resilience, and self esteem • DBT programs for college students are already well researched – we know how to do it! • For a list of ALL papers in this area, go to www.carlachugani.com/dbt-in-college-counseling

24. Build Community Capacity • We need to partner to greatly increase the availability and accessibility of high quality mental health care for young people • Co-STAR program at WPIC • Long Term Goal: Center for Excellence in Collegiate Health, providing a range of specialized care and supporting our local campuses to care for the wellbeing of all students

25. Questions? My Contact Information: Carla.chugani@chp.edu Tel: (248) 910-2771 Website: www.carlachugani.com Please contact me anytime and I will do my best to support you!