Hostname: page-component-848d4c4894-v5vhk Total loading time: 0 Render date: 2024-07-05T06:43:34.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Transforming mental healthcare in higher education through scalable mental health interventions

Published online by Cambridge University Press:  23 June 2023

Adam D. Brown Open the ORCID record for Adam D. Brown [Opens in a new window] ,
Nicole Ross ,
Manaswi Sangraula ,
Andy Laing  and
Brandon A. Kohrt
Adam D. Brown*
Affiliation:
Department of Psychology, New School for Social Research, New York, NY, USA Department of Psychiatry, New York University School of Medicine, New York, NY, USA
Nicole Ross
Affiliation:
Department of Psychology, New School for Social Research, New York, NY, USA
Manaswi Sangraula
Affiliation:
Department of Psychology, New School for Social Research, New York, NY, USA
Andy Laing
Affiliation:
Department of Social Work, University of The Bahamas-North, Freeport, Bahamas
Brandon A. Kohrt
Affiliation:
Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
*
Corresponding author: Adam D. Brown; Email: brownad@newschool.edu
Rights & Permissions [Opens in a new window]

Abstract

A significant number of young people throughout the world are experiencing mental health concerns. Many young people will develop their first mental health concerns or will be managing their symptoms while enrolled in institutions of higher education. Although many colleges and universities are aware of the significant mental health needs among their students, the mental health and psychosocial needs of students often exceed the availability of resources and cultural and contextual barriers, such as stigma, may further impede access to care. Such gaps and barriers in mental health may lead to poor prognosis as well as negative educational and social outcomes. We propose that non-specialist delivered mental health and psychosocial interventions may play a critical role in reducing the gaps in care for students in higher education. In particular, non-specialist delivered care can complement existing specialized services to provide stepped models of care. Importantly, the adaptation and implementation of non-specialist delivered mental health and psychosocial support interventions in higher education may lead to innovative strategies for increasing access to care in this context, but may lead to adaptations that could apply to contexts outside of higher education as well.

Topics structure

Topic(s)

Teaching and learning

Subtopic(s)

Expanding capacityTraining non-mental health professionals

Keywords

community-based initiativeseducationglobal mental healthmental health
Type
Perspective
Information
Cambridge Prisms: Global Mental Health , Volume 10 , 2023 , e33
Check for updates
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Impact statement

Higher education, such as college and university settings, has long symbolized opportunities for personal transformation, intellectual growth and learning, the discovery of new ideas, vocations, and the forging of long lasting personal and professional relationships. However, increased attention is being placed on the significant mental health challenges university students face. At the same time, there are often not enough mental health specialists within universities to address the numbers of students seeking help and stigma, previous negative experiences with counseling, and long wait-lists have been identified as additional barriers to care. How might universities begin to address these major gaps in mental healthcare? We propose that a vital strategy to increase capacity and reduce gaps in mental health support for university students is through the delivery of brief mental health interventions by nonmental health specialists. In particular, we recommend universities begin to contextualize and integrate nonspecialist delivered interventions that have been thus far employed primarily in the humanitarian context to the university setting. There is a growing evidence base for nonspecialist interventions such as Problem Management Plus and Self-Help Plus and which may enrich the availability of mental health resources for students. Universities may be ideally set up for the training of nonmental health specialists given the number of individuals who play supportive roles in student’s lives. For example, student leaders, tutors, coaches, might be well positioned to integrate these strategies into their work. Although mental health specialists play a critical role in supporting the mental health needs students the burdens are far outpacing the availably of resources and the integration of evidence-based nonspecialist strategies can fill some of the urgent gaps in care in universities worldwide.

Introduction

Higher education, such as college and university settings, has long symbolized opportunities for personal transformation, intellectual growth and learning, the discovery of new ideas, vocations, and the forging of long lasting personal and professional relationships. The role of higher education institutions often extends well beyond learning and training by offering a wide range of services for students, including many that seek to support their health and wellbeing. Within these ecosystems, however, there is an urgent need for higher education to address the growing mental health needs of their students (Duffy et al., Reference Duffy, Twenge and Joiner2019). Students with mental health issues are often at greater risk for poor educational, social, health, and economic outcomes (Niederkrotenthaler et al., Reference Niederkrotenthaler, Tinghög, Alexanderson, Dahlin, Wang, Beckman, Gould and Mittendorfer-Rutz2014; Scott et al., Reference Scott, Lim, Al-Hamzawi, Alonso, Bruffaerts, Caldas-de-Almeida, Florescu, De Girolamo, Hu, De Jonge and Kawakami2016). Moreover, for students from historically marginalized and underrepresented identities (LGBTQIA and BIPOC), colleges and universities can be a source of stress, due to factors such as separation from social support networks and a lack of culturally responsive services (Clark and Mitchell, Reference Clark and Mitchell2018).

In recent years, there has been a growing recognition and the development of policies seeking to address mental health concerns among university students. For example, in the UK, national multi-sector guidelines have identified ways that barriers to mental health support are negatively linked to educational outcomes and, as such, have developed frameworks to reduce such challenges in accessing support (Universities UK, 2015).

Yet, recognition, policies, and frameworks continue to be met with a wide range of challenges that underscore the need to identify novel pathways to reach university students requiring mental health support. For instance, universities continue to respond to the mental health needs of students in light of the disruptions and negative consequences of COVID-19. Although the full mental health impacts of COVID-19 are yet to be known, initial studies indicate that the pandemic is associated with an increase in the onset of new mental health conditions as well as relapses or the worsening of existing conditions for current students (Chen and Lucock, Reference Chen and Lucock2022; Wood et al., Reference Wood, Yu, Sealy, Moss, Zigbuo-Wenzler, McFadden, Landi and Brace2022). For many students, COVID-19 was just one of many stressors and upheavals taking place in the distal and immediate landscapes of their lives. Throughout the world, young people are encountering complex and often unprecedented political, environmental, and social upheavals. In the face of forced migration and persecution, universities and colleges play an important role in providing intellectual havens for students – a role which is likely to increase due to protracted conflicts and climate-related threats (Casellas Connors et al., Reference Casellas Connors, Unangst and Barone2023).

Although the need to address mental health concerns in higher education is well documented, so too are the multiple factors that may impede care. Multiple factors such long wait times, overextended counselors, language barriers, peer- and self-stigma, cost, and the lack of representation from historically marginalized groups among mental healthcare providers, represent the challenges students face in terms of seeking care (Giamos et al., Reference Giamos, Lee, Suleiman, Stuart and Chen2017; Broglia et al., Reference Broglia, Millings and Barkham2021; Hingwe, Reference Hingwe, Riba and Menon2021). Additionally, although there is considerable evidence that interventions such as mindfulness and cognitive behavioral therapy (CBT) are effective treatments for mental health concerns such as anxiety and depression in university students (Huang et al., Reference Huang, Nigatu, Smail-Crevier, Zhang and Wang2018; Worsley et al., Reference Worsley, Pennington and Corcoran2022), this population does not always seek care from specialists due to previous negative experiences in counseling, poor understanding of the existing services, and lack of availability for on campus counseling or long-term care (Bray and Born, Reference Bray and Born2004; Giamos et al., Reference Giamos, Lee, Suleiman, Stuart and Chen2017).

Nonspecialist delivered interventions in higher education

As universities continue to develop policies and invest in programs and resources for students, it is important to consider the role of nonspecialists in filling mental health gaps. One approach is to build on the growing body of work indicating the benefits of peer-led interventions, such as art, mindfulness, exercise, and general support. In fact, a review showed that a pooled analysis of non-CBT interventions, which included peer-based programs, were associated with a greater effect size in reducing depression and anxiety in university students when compared to mindfulness or CBT interventions (Huang et al., Reference Huang, Nigatu, Smail-Crevier, Zhang and Wang2018). Furthermore, although not limited to higher education contexts, a recent scoping review examining the potential mental health benefits of peer-support (support provided by an individual(s) with a shared lived experience(s) for young adults, showed that peer-support was associated with greater levels of happiness, self-esteem, positive coping and lower levels of loneliness, depression, and anxiety (Richard et al., Reference Richard, Rebinsky, Suresh, Kubic, Carter, Cunningham, Ker, Williams and Sorin2022)).

An important addition in addressing this urgent public health issue in higher education is to consider the potential role of brief, culturally and contextually adapted scalable, nonspecialist delivered forms of mental health and psychosocial support. Higher education would benefit from the growing knowledge base of nonspecialist delivered interventions that have thus far been primarily implemented in humanitarian contexts. Such scalable mental health interventions, either delivered or facilitated by nonspecialists, are often manual-based and are designed for broad uptake and dissemination – primarily focusing on strengthening existing coping skills to manage adversity and challenges. Current interventions range in format from individual (e.g., Problem Management Plus [PM+]), to group (Group PM+), to self-directed formats (Self-Help Plus [SH+]) (World Health Organization, 2017). Although longer term follow-up data are needed, there is now considerable evidence across a wide range of humanitarian contexts that nonspecialist delivered interventions are effective (van’t Hof et al., Reference van’t Hof, Sangraula, Luitel, Turner, Marahatta, van Ommeren, Shrestha, Bryant, Kohrt and Jordans2020; Purgato et al., Reference Purgato, Carswell, Tedeschi, Acarturk, Antilla, Au, Bajbouj, Baumgartner, Biondi, Churchill, Cuijpers, Koesters, Gastaldon, Ilkkursun, Lantta, Nose, Ostuzzi, Papola, Popa, Roselli, Sijbrandij, Tarsitani, Turrini, Valimaki, Walke, Wancata, Zanini, White, van Ommeren and Barbui2021).

Moreover, World Health Organization (WHO), strongly encourages the importance of cultural and contextual adaptation of the manualized interventions prior to implementation (World Health Organization, 2017). There already exist a number of frameworks such as DIME (Johns Hopkins Bloomberg School of Public Health, 2013) and the cultural adaptation and contextualization for implementation (mhCACI) (Sangraula et al., Reference Sangraula, Kohrt, Ghimire, Shrestha, Luitel, van’t Hof, Dawson and Jordans2021) procedure that can be used to help in the tailoring of interventions to reflect the needs of the local university. This crucial practice may increase the likelihood of treatment-seeking behaviors, and the adoption of scalable interventions.

In many ways, higher education offers an ideal context for the integration of scalable interventions into an overall stepped model of care, in which given limited resources and barriers, there is a tailoring of resources based on the severity and intensity of mental health needs. Often, stepped care seeks to provide low-intensity interventions whereby the individuals are “stepped up” or “stepped down” based on the severity and acuity of their mental health concerns. Therefore, multi-level strategies ranging from health promotion, detection and referral training, the delivery of low-intensity interventions, and direct clinical care from specialists, are all integrated into the fabric of the community (Hermens et al., Reference Hermens, Oud, Sinnema, Nauta, Stikkelbroek, van Duin and Wensing2015; Cornish et al., Reference Cornish, Berry, Benton, Barros-Gomes, Johnson, Ginsburg and Romano2017). While each institution has its particular structures and resources, many schools are comprised of students, staff, and faculty who routinely engage in the social and emotional lives of students, and who are therefore well positioned to promote mental health education and to implement mental health and psychosocial interventions. For example, student-led organizations, resident assistants (students who live with other students but assume a type of caregiving role), diversity and equity officers, as well as faculty who might work closely with student mentoring and professional development, may be ideally positioned in their university to contribute to mental health promotion and literacy, and to the delivery of brief mental health and psychosocial interventions, along with making referrals to specialized services.

At The New School in New York City and at University of The Bahamas-North in Grand Bahama, we are currently disseminating PM+, a brief, nonspecialist delivered psychological intervention developed by WHO for adults with common mental health concerns and practical problems (Dawson et al., Reference Dawson, Bryant, Harper, Tay, Rahman, Schafer and Van Ommeren2015) on several college and university campuses. Interviews with trainees and the use of the Ensuring Quality in Psychological Support (EQUIP, Kohrt et al., Reference Kohrt, Schafer, Willhoite, Van’t Hof, Pedersen, Watts, Ottman, Carswell and van Ommeren2020) platform indicate that individuals with minimal training in mental health and psychosocial support exhibit core helping competencies central for delivering interventions such as PM+ (Pfeffer, Reference Pfeffer2023).

In pilot work with psychological first aid (PFA), an evidence-informed modular approach to help in the immediate aftermath of stressful and potentially traumatic events, we have found high levels of engagement in the training of staff and student leaders (Ross, Reference Ross2023). Whereas PFA may be an important framework for responding to someone in immediate distress, other nonspecialist delivered interventions may be effective for university students experiencing ongoing distress or mental health concerns, such as anxiety and depression. In such cases, PM+ may be employed to strengthen coping skills to manage ongoing symptoms for a number of syndromes, as it is intended to be a transdiagnostic intervention (World Health Organization, 2017). Given that this intervention was meant to be delivered by nonspecialists, it could be well integrated into the work of existing roles (e.g., college life staff and resident assistants) and support structures (e.g., tutoring and professional development programs). Additional resources will strengthen the systems of student support already in place at many institutions. Critically, such strategies will reduce some of the burden on overtaxed health centers and serve as critical conduits for those with severe mental health issues and imminent risk to be connected to specialist providers. A growing number of studies also indicate that students from historically marginalized or underrepresented communities may be less likely to seek care at their university (Bouris and Hill, Reference Bouris and Hill2017; Sigal and Plunkett, Reference Sigal and Plunkett2023). Interventions delivered by nonspecialists who share similar lived experiences may help to increase engagement in mental healthcare.

Future directions

Finally, integrating scalable interventions into mental healthcare in higher education will drive innovation. Mental health interventions are only as effective as students are willing to utilize them. The promotion of rigorous adaptation strategies within these highly creative and forward-thinking communities will likely generate a wide breadth of training and dissemination materials. In fact, new nonspecialist delivered mental health and psychosocial support interventions may be employed to provide a continuity of care in post-secondary contexts. Whereas higher education is a major life transition, so too are the challenges one might face in certain contexts after graduation. After the formal and informal supports associated with a university community, individuals may have even less access to care post-graduation. As such, new tools to facilitate the bridge between secondary and post-secondary contexts offers a novel area of work for nonspecialist delivered interventions. Furthermore, the materials developed for students in higher education are also likely to have relevance for a wider range of contexts, and could serve as a catalyst for new strategies well beyond colleges and universities. Higher education can be pivotal positive experience in one’s intellectual, professional, and personal trajectory. It is also evident that for many students, it is also a time in which they are in need of mental health and psychosocial support. Although a number of approaches may help to reduce gaps in mental healthcare in colleges and universities, the training of nonmental health specialists offers a novel evidence-based strategy for building much needed capacity for mental health services in higher education.

Open peer review

To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2023.29.

Author contribution

A.D.B., N.R., M.S., A.L., and B.A.K. contributed to the conceptualization, and writing and editing of the manuscript.

Financial support

This work was supported through a Fulbright Specialist Scholar grant awarded to A.D.B. and A.L. and a National Institutes of Mental Health grant, 1R01MH127767-01 awarded to B.K. and A.D.B.

References

Bouris, A and Hill, B (2017) Out on campus: Meeting the mental health needs of sexual and gender minority college students. Journal of Adolescent Health 61(3), 271–272.CrossRefGoogle ScholarPubMed
Bray, S and Born, H (2004) Transition to university and vigorous physical activity: Implications for health and psychological well-being. Journal of American College Health 52(4), 181–188.CrossRefGoogle ScholarPubMed
Broglia, E, Millings, A and Barkham, M (2021) Student mental health profiles and barriers to help seeking: When and why students seek help for a mental health concern. Counseling and Psychotherapy Research 21(4), 816–826.CrossRefGoogle Scholar
Casellas Connors, I, Unangst, L and Barone, N (2023) Supporting displaced students in US higher education: Examining institutional policy and practice. Race Ethnicity and Education, 1–19.CrossRefGoogle Scholar
Chen, T and Lucock, M (2022) The mental health of university students during the COVID-19 pandemic: An online survey in the UK. PLoS One 17(1), e0262562.CrossRefGoogle ScholarPubMed
Clark, I and Mitchell, D (2018) Exploring the relationship between campus climate and minority stress in African American college students. Journal Committed to Social Change on Race and Ethnicity 4(1), 67–95.Google Scholar
Cornish, PA, Berry, G, Benton, S, Barros-Gomes, P, Johnson, D, Ginsburg, R and Romano, V (2017) Meeting the mental health needs of today’s college student: Reinventing services through Stepped Care 2.0. Psychological Services 14(4), 428.CrossRefGoogle ScholarPubMed
Dawson, KS, Bryant, RA, Harper, M, Tay, AK, Rahman, A, Schafer, A and Van Ommeren, M (2015) Problem Management Plus (PM+): A WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry 14(3), 354.CrossRefGoogle Scholar
Duffy, ME, Twenge, JM and Joiner, TE (2019) Trends in mood and anxiety symptoms and suicide-related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health 65(5), 590–598.CrossRefGoogle ScholarPubMed
Giamos, D, Lee, AYS, Suleiman, A, Stuart, H and Chen, SP (2017) Understanding campus culture and student coping strategies for mental health issues in five Canadian colleges and universities. Canadian Journal of Higher Education 47(3), 136–151.CrossRefGoogle Scholar
Hermens, ML, Oud, M, Sinnema, H, Nauta, MH, Stikkelbroek, Y, van Duin, D and Wensing, M (2015) The multidisciplinary depression guideline for children and adolescents: An implementation study. European Child and Adolescent Psychiatry 24(10), 1207–1218.CrossRefGoogle ScholarPubMed
Hingwe, S (2021) Mental health considerations for Black, Indigenous, and people of color: Trends, barriers, and recommendations for collegiate mental health. In Riba, M and Menon, M (eds), College Psychiatry. Cham: Springer, pp. 85–96.CrossRefGoogle Scholar
Huang, J, Nigatu, YT, Smail-Crevier, R, Zhang, X and Wang, J (2018) Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials. Journal of Psychiatric Research 107, 1–10.CrossRefGoogle Scholar
Johns Hopkins Bloomberg School of Public Health. (2013) The DIME Program Research Model: design,implementation, monitoring, and evaluation. Retrieved from http://www.jhsph.edu/research/centers-and-institutes/center-for-refugee-and-disaster-response/response_service/AMHR/dime/index.htmlGoogle Scholar
Kohrt, BA, Schafer, A, Willhoite, A, Van’t Hof, E, Pedersen, GA, Watts, S, Ottman, K, Carswell, K and van Ommeren, M (2020) Ensuring Quality in Psychological Support (WHO EQUIP): Developing a competent global workforce. World Psychiatry 19(1), 115.CrossRefGoogle ScholarPubMed
Niederkrotenthaler, T, Tinghög, P, Alexanderson, K, Dahlin, M, Wang, M, Beckman, K, Gould, M and Mittendorfer-Rutz, E (2014) Future risk of labour market marginalization in young suicide attempters—A population-based prospective cohort study. International Journal of Epidemiology 43(5), 1520–1530.CrossRefGoogle ScholarPubMed
Pfeffer, K (2023) Remote delivered psychosocial support to improve the wellbeing and functioning of adults affected by COVID-19 in New York City: Remote Problem Management Plus (PM+). World Public Health Congress [Poster Presentation], Rome, Italy.CrossRefGoogle Scholar
Purgato, M, Carswell, K, Tedeschi, F, Acarturk, C, Antilla, M, Au, T, Bajbouj, M, Baumgartner, J, Biondi, M, Churchill, R, Cuijpers, P, Koesters, M, Gastaldon, C, Ilkkursun, Z, Lantta, T, Nose, M, Ostuzzi, G, Papola, D, Popa, M, Roselli, V, Sijbrandij, M, Tarsitani, L, Turrini, G, Valimaki, M, Walke, L, Wancata, J, Zanini, E, White, R, van Ommeren, M and Barbui, C (2021) Effectiveness of Self-Help Plus in preventing mental disorders in refugees and asylum seekers in western Europe: A multinational randomized controlled trial. Psychotherapy and Psychosomatics 90, 403–414.CrossRefGoogle ScholarPubMed
Richard, J, Rebinsky, R, Suresh, R, Kubic, S, Carter, A, Cunningham, JE, Ker, A, Williams, K and Sorin, M (2022) Scoping review to evaluate the effects of peer support on the mental health of young adults. BMJ Open 12(8), e061336.CrossRefGoogle ScholarPubMed
Ross, N (2023) Building mental health and psychosocial support capacity in higher education: Psychological first aid training to support displaced Afghan student refugees. World Public Health Congress [Poster Presentation], Rome, Italy.CrossRefGoogle Scholar
Sangraula, M, Kohrt, BA, Ghimire, R, Shrestha, P, Luitel, NP, van’t Hof, E, Dawson, K and Jordans, MJ (2021) Development of the mental health cultural adaptation and contextualization for implementation (mhCACI) procedure: A systematic framework to prepare evidence-based psychological interventions for scaling. Global Mental Health 8, e6.CrossRefGoogle ScholarPubMed
Scott, KM, Lim, C, Al-Hamzawi, A, Alonso, J, Bruffaerts, R, Caldas-de-Almeida, JM, Florescu, S, De Girolamo, G, Hu, C, De Jonge, P and Kawakami, N (2016) Association of mental disorders with subsequent chronic physical conditions: World mental health surveys from 17 countries. JAMA Psychiatry 73(2), 150–158.CrossRefGoogle ScholarPubMed
Sigal, M and Plunkett, SW (2023) Gender and ethnic differences in university students’ attitudes about mental health services. Journal of College Student Psychotherapy.CrossRefGoogle Scholar
Universities UK (2015) Student Mental Wellbeing in Higher Education: Good Practice Guide. London: MWBHE/Universities UK.Google Scholar
van’t Hof, E, Sangraula, M, Luitel, NP, Turner, EL, Marahatta, K., van Ommeren, M, Shrestha, P, Bryant, R, Kohrt, BA and Jordans, MJD (2020) Effectiveness of group Problem Management Plus (group pm+) for adults affected by humanitarian crises in Nepal: Study protocol for a cluster randomized controlled trial. Trials 21, 343.CrossRefGoogle ScholarPubMed
Wood, CI, Yu, Z, Sealy, DA, Moss, I, Zigbuo-Wenzler, E, McFadden, C, Landi, D and Brace, AM (2022) Mental health impacts of the COVID-19 pandemic on college students. Journal of American College Health 10, 1–6.CrossRefGoogle Scholar
World Health Organization (2017) Scalable Psychological Interventions for People in Communities Affected by Adversity: A New Area of Mental Health and Psychosocial Work at WHO. Geneva: World Health Organization. Available at https://apps.who.int/iris/bitstream/handle/10665/254581/WHO-MSD-MER-17.1-eng.pdf?sequence=1&isAllowed=y (accessed 24 February 2022).Google Scholar
Worsley, JD, Pennington, A and Corcoran, R (2022) Supporting mental health and wellbeing of university and college students: A systematic review of review-level evidence of interventions. PLoS One 17(7), e0266725.CrossRefGoogle Scholar

Author comment: Transforming mental healthcare in higher education through scalable mental health interventions — R0/PR1

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr1 [Opens in a new window]
Adam Brown [Opens in a new window] New School for Social Research, United States
Revision round: 0
Role: author

Comments

January 9, 2023

Re: MHPSS in Higher Education Comment

Please find enclosed our submission to Global Mental Health entitled “Transforming Mental Healthcare in Higher Education Through Scalable Mental Health Interventions” as an Editorial.

It is now well established that mental health issues are an urgent public health issue in higher education. Rates of mental health issues were on the rise prior to COVID-19 and it appears that the pandemic has led to a worsening of mental health for many young people in college. Additionally, despite more attention and resources being allocated to support student mental health and wellbeing in higher education, significant barriers to care remain, with many students not being able to access care. In this Comment, we propose that brief scalable mental health intervention delivered by non-specialists can help to address some of the critical gaps in mental healthcare throughout higher education. Strategies such as “task sharing” have been found to be effective in humanitarian contexts, but have yet to be adapted and studied in a higher education settings. Such work would not only lead to innovative task sharing adaptations for young people, but such adaptations may then help to inform work beyond the university context.

This manuscript is original and has not been published elsewhere. The authors have no conflicts of interest to disclose with regard to the submitted work. All authors have agreed to the order of authors and to submission of the manuscript in its present form.

We very much look forward to hearing from you.

Sincerely,

Adam

Adam D. Brown

Vice Provost for Research

Associate Professor

Department of Psychology

New School for Social Research

Review: Transforming mental healthcare in higher education through scalable mental health interventions — R0/PR2

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr2 [Opens in a new window]
Date of review:  02 March 2023
Revision round: 0
Role: reviewer
Recommendation/decision: major-revision

Conflict of interest statement

Reviewer declares none.

Comments

Reviewer Summary Statement:

This is an important perspective paper which highlights the critical importance of addressing the mental health needs of university students through integrating culturally sensitive, scalable interventions into mental healthcare in higher education. The authors develop their argument by noting some limitations in current services (e.g., barriers to accessing services) and propose alternative task-sharing strategies and the integration of existing programs as scalable approaches adaptable for higher education contexts. These are excellent points and appropriate for the perspective paper, however the arguments throughout would benefit from increased clarity and the addition of specific evidence as suggested in the comments below.

Abstract suggested revisions:

The sentence “Additionally, the adaptation and implementation of task-sharing strategies in higher education settings may help to stimulate new research and thinking beyond colleges and universities as well.” requires further clarification. For example, what is meant by task-sharing strategies as it is not mentioned or elaborated further in the main text of the paper.

Main text suggested revisions:

1. The organization of the paper would be greatly enhanced by using Cambridge Prisms: Global Mental Health journal’s perspective paper subheadings as recommended (e.g., introduction, main text divided into sections, conclusion and potentially future directions; see: https://www.cambridge.org/core/journals/global-mental-health/information/author-instructions/preparing-your-materials)

2. The focus and logic of the arguments in the paper could be improved with elaboration on some of the main points. Given the authors have additional space as per the guidelines (limit 2000-3000 words; currently 1700 words), areas to strengthen the manuscript have been suggested below.

- On page 3, the authors write “Importantly, students indicate that they are pursuing information and support for mental healthcare online, but it remains difficult to assess the extent to how and if the rapidly growing marketplace of websites, podcasts, and social media platforms are contributing to positive mental health outcomes”– Do the authors suggest that the programs should be offered online, that they can be provided by a non-mental health professional or both? It is suggested that the authors further develop this point.

- In addition, on page 4 the point is made “Higher education would benefit from the growing knowledge base in off-campus contexts”(reviewers’ underline emphasis), however, the authors should first include examples of non-specialist-delivered interventions for student mental health from within higher education contexts, especially as this is also a growing research area (e.g., Worsley et al., 2022).

- The following statement on page 4 would also benefit from elaboration regarding stepped models of care and how the proposed integration of programs fits with a stepped-care model. “In many ways, higher education offers an ideal context for the integration of scalable interventions into an overall stepped model of care”. Relevant citations should also be provided.

- There are sporadic mentions of differing levels of stress and distress (e.g., page 4: For more moderate levels of distress... or page 5: serve as critical conduits for those with severe mental health issues). It is unclear if the authors are suggesting the different programs (PM+, SH+) to address different issues based on severity. The argument needs clarification.

3. Furthermore, the paper could be significantly improved with the inclusion of citations supporting statements and/or effectiveness of the recommended alternative programs.

- For example, on page 3, the statement “For many students, COVID-19 was just one of many stressors and upheavals taking place in the distal and immediate landscapes of their lives...” appears to be missing a citation or the source of evidence for this claim.

- A central tenet of the perspective paper is that these alternative services have the potential to supplement existing services to the benefit of students. However, there is very little elaboration on what are common elements of these alternative services and the evidence for their effectiveness. Adding some detail around the outcomes associated with these programs and evidence of their effectiveness would be more persuasive. For example: when the authors note on page 4 “Thus far, our preliminary results show that staff and students can be effectively trained, and that students receiving this find it beneficial in addressing their concerns.” please specify, staff and students can be trained using what methods? Students receiving this program find it beneficial in what ways?

- Additionally, the authors highlight issues related to accessibility and lack of representation from historically marginalized groups, but do not provide evidence for how the suggested programs address these issues. It is suggested that the authors provide additional evidence on how these programs address these issues specifically, to make the link between this statement and the paper or remove the statement.

4. In the concluding comments on page 5, the authors end the paper with two imprecise statements, which weaken the focus of the argument. “The promotion of rigorous adaptation strategies within these highly creative and forward-thinking communities will likely generate a wide breadth of training and dissemination materials. These materials can be used within the higher education context, but will also serve as a catalyst for new strategies well beyond colleges and universities.”In place of these sentences, the authors are encouraged to emphasise the potential of integrating these scalable, non-mental health professional delivered services into post-secondary contexts in terms of access to support and wellbeing of a greater number of students, particularly marginalized students.

5. In summary, this perspective paper is timely, based on an excellent premise and suggests innovative solutions to address the pressing issue of student mental health and well-being in higher education contexts. With the suggested revisions to streamline and strengthen the arguments this paper has the potential to be a worthwhile contribution to Cambridge Prisms: Global Mental Health.

Editorial/Typographical :

“the mental health and psychosocial needs of among students often exceed”

“multiple factors such as long wait times,” - Please review manuscript for any typos/grammatical errors.

References should be reviewed for AMA (varying capitalization in article and journal titles)

Review: Transforming mental healthcare in higher education through scalable mental health interventions — R0/PR3

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr3 [Opens in a new window]
Date of review:  09 March 2023
Revision round: 0
Role: reviewer
Recommendation/decision: major-revision

Conflict of interest statement

Reviewer declares none.

Comments

The broad concepts covered in this perspective piece are relevant and interesting, however the article needs substantial elaboration throughout. Several points made in this piece require more information with concrete examples and links to the literature. The abstract would also benefit from explicitly stating what the key messages are from this paper. The authors broadly list a few challenges and initiatives but not enough information has been provided to support the arguments being made despite there being plenty of relevant literature that could be cited. Examples include citing literature that supports the effectiveness of adapting interventions and the recent movement in the UK to bridge gaps between mental health services for university aged students.

Further information is also needed to explain the following interventions and strategies mentioned in the paper:

- Cultural and historically marginalised students - please elaborate and provide concrete examples about this group, their unique challenges and interventions

- Stigma is a broad statement and could include many types with differ t impacts. More detail about student challenges is needed throughout.

- Adapting and implementing interventions - these concepts are vague and justifying their use would be strengthened by providing concrete examples and links to the literature

- Task-sharing - elaborate or define what this is and provide examples.

- Non-mental health specialists - this includes a long list of people and some of whom would be inappropriate to work with students in distress. Please define, elaborate and provide concrete examples.

- Unwelcoming campus climates - please define and elaborate

- Some statements require citations - please check throughout

- Non-specialist forms of support - this is too vague and needs concrete examples

- PM+ intervention - some elaboration on what this is would help support the authors argument. In the current format, readers would have to read the original WHO paper to gauge what the interventions involves and how it’s been implemented in the named institution. This is particularly important given the results reported in this piece. The implications of the results cannot be gathered without this further information.

While there are several required edits to this piece I do believe it will shape up to be an interesting perspectives piece. More clarity and information throughout the article will adequately support the arguments being made.

Recommendation: Transforming mental healthcare in higher education through scalable mental health interventions — R0/PR4

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr4 [Opens in a new window]
Rahul Shidhaye Pravara Institute of Medical Sciences, India
Date of review:  10 March 2023
Revision round: 0
Role: Handling Editor
Recommendation/decision: major-revision

Comments

No accompanying comment.

Decision: Transforming mental healthcare in higher education through scalable mental health interventions — R0/PR5

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr5 [Opens in a new window]
Judith Bass [Opens in a new window] Johns Hopkins University Bloomberg School of Public Health, United States
Revision round: 0
Role: Editor in Chief
Recommendation/decision: major-revision

Comments

No accompanying comment.

Author comment: Transforming mental healthcare in higher education through scalable mental health interventions — R1/PR6

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr6 [Opens in a new window]
Adam Brown [Opens in a new window] New School for Social Research, United States
Revision round: 1
Role: author

Comments

Dear Drs. Bass and Shidhaye,

My co-authors and I are sincerely grateful for overseeing this manuscript. We are thankful for the careful reviews and input provided by the reviewers. We have responded to each of the points raised in the review process and believe the manuscript is much stronger as a result.

Thank you very much again.

Best,

Adam

Review: Transforming mental healthcare in higher education through scalable mental health interventions — R1/PR7

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr7 [Opens in a new window]
Date of review:  24 May 2023
Revision round: 1
Role: reviewer
Recommendation/decision: minor-revision

Conflict of interest statement

Reviewer declares none.

Comments

We thank the authors for their careful consideration of reviewer feedback and associated edits which have strengthened the clarity of arguments within the manuscript. The addition of further research, elaborations regarding the WHO programs, as well as the re-organization using subheadings contributed to a substantially improved manuscript. However, we are requesting some final minor revisions, most of these revisions focus on the new material that has been added. We have listed these below including the page numbers.

General Feedback:

A thorough editorial review is needed to correct typos, grammar, punctuation, and capitalization throughout the manuscript.

Page 1 Abstract: “the mental health and psychosocial NEEDS OF AMONG students often exceed the availability of resources and cultural and contextual barriers, such as stigma, may further impede access to care.”

Page 4: “IntroUDCtion”

Page 4: “The role of higher education institutions often extends well beyond learning and training by offering a wide range of services for students, including many that seek to support THE health and wellbeing.”

Introduction:

Page 6: We recommend not using the term ‘recent’ (e.g., a recent review) when the review is from 2004

Page 4: We would suggest the authors consider using a more inclusive acronym than “LGBT”, alternatively using a broader, more current acronym such as “LGBTQIA+”

Page 4: Please clarify the sentence below. Specifically, do the authors mean that stressors NEGATIVELY associated with help seeking are linked to ADVERSE educational outcomes?

“For example, in the UK, national multi-sector guidelines have identified ways that stressors associated with help seeking are linked to educational outcomes and have developed frameworks to reduce barriers to care (Universities, UK., 2015).”

Non-Specialist Delivered Interventions in Higher Education:

Page 6: The following statement requires clarification/elaboration. Were the peer-based programs comparable to the CBT or mindfulness programs? What was the content of the programs? If the content is comparable, it would be important to highlight that this is evidence that non-specialist delivered programs can be more effective than traditional programs. “In fact, a recent review showed that peer-based programs were associated with a greater effect size in reducing depression and anxiety in university students when compared to mindfulness or cognitive behavioral therapy (CBT) interventions (Huang et al., 2018).”

Contextualizing and Integrating into Higher Education Systems:

Page 9: We recommend the authors not use acronyms that may be unfamiliar to the audience (e.g., EQUIP). “Interviews with trainees and the use of the EQUIP platform indicate that individuals with minimal training in mental health and psychosocial support exhibit core helping competencies central for delivering interventions such as PM+ (Pfeffer et al., 2023).”

Future Directions:

Page 10: We feel that the authors could strengthen the final concluding statement to focus more directly on the main thesis of the manuscript, i.e., the potential change in university service provision rather than the extension beyond colleges and universities. "Furthermore, the materials developed for students in higher education are also likely to have relevance for a wider range of contexts, and could serve as a catalyst for new strategies well beyond colleges and universities.”

Reference:

Page 11-14: Correct APA formatting in the reference list (italics, hanging paragraph, doi, punctuation)

Recommendation: Transforming mental healthcare in higher education through scalable mental health interventions — R1/PR8

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr8 [Opens in a new window]
Rahul Shidhaye Pravara Institute of Medical Sciences, India
Date of review:  02 June 2023
Revision round: 1
Role: Handling Editor
Recommendation/decision: minor-revision

Comments

No accompanying comment.

Decision: Transforming mental healthcare in higher education through scalable mental health interventions — R1/PR9

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr9 [Opens in a new window]
Judith Bass [Opens in a new window] Johns Hopkins University Bloomberg School of Public Health, United States
Revision round: 1
Role: Editor in Chief
Recommendation/decision: minor-revision

Comments

No accompanying comment.

Author comment: Transforming mental healthcare in higher education through scalable mental health interventions — R2/PR10

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr10 [Opens in a new window]
Adam Brown [Opens in a new window] New School for Social Research, United States
Revision round: 2
Role: author

Comments

Dear Editors,

Thank you very much for this encouraging news. Please see our responses to the reviewer below. We hope that you feel that we have now addressed their remaining suggestions. Thank you again.

Reviewer: 1

Page 1 Abstract: “the mental health and psychosocial NEEDS OF AMONG students often exceed the availability of resources and cultural and contextual barriers, such as stigma, may further impede access to care.”

This has been corrected.

Page 4: “IntroUDCtion”

This has been corrected.

Page 4: “The role of higher education institutions often extends well beyond learning and training by offering a wide range of services for students, including many that seek to support THE health and wellbeing.”

This has been corrected.

Introduction:

Page 6: We recommend not using the term ‘recent’ (e.g., a recent review) when the review is from 2004

This has been corrected.

Page 4: We would suggest the authors consider using a more inclusive acronym than “LGBT”, alternatively using a broader, more current acronym such as “LGBTQIA+”

This has been corrected.

Page 4: Please clarify the sentence below. Specifically, do the authors mean that stressors NEGATIVELY associated with help seeking are linked to ADVERSE educational outcomes?

“For example, in the UK, national multi-sector guidelines have identified ways that stressors associated with help seeking are linked to educational outcomes and have developed frameworks to reduce barriers to care (Universities, UK., 2015).”

This has been clarified.

Non-Specialist Delivered Interventions in Higher Education:

Page 6: The following statement requires clarification/elaboration. Were the peer-based programs comparable to the CBT or mindfulness programs? What was the content of the programs? If the content is comparable, it would be important to highlight that this is evidence that non-specialist delivered programs can be more effective than traditional programs. “In fact, a recent review showed that peer-based programs were associated with a greater effect size in reducing depression and anxiety in university students when compared to mindfulness or cognitive behavioral therapy (CBT) interventions (Huang et al., 2018).”

We now more clearly state that the comparison was part of a larger pooled analysis of non-CBT interventions. We also included an additional study showing the benefits of peer support on young adults, which includes college students. However, the pooled analysis can not be compared specifically to a CBT intervention given the range of interventions included in this category. However, we hope this will address your careful comment. Thank you.

Contextualizing and Integrating into Higher Education Systems:

Page 9: We recommend the authors not use acronyms that may be unfamiliar to the audience (e.g., EQUIP). “Interviews with trainees and the use of the EQUIP platform indicate that individuals with minimal training in mental health and psychosocial support exhibit core helping competencies central for delivering interventions such as PM+ (Pfeffer et al., 2023).”

This has been corrected.

Future Directions:

Page 10: We feel that the authors could strengthen the final concluding statement to focus more directly on the main thesis of the manuscript, i.e., the potential change in university service provision rather than the extension beyond colleges and universities. "Furthermore, the materials developed for students in higher education are also likely to have relevance for a wider range of contexts, and could serve as a catalyst for new strategies well beyond colleges and universities.”

We added a new final sentence to bring this back to the main thesis of the paper.

Reference:

Page 11-14: Correct APA formatting in the reference list (italics, hanging paragraph, doi, punctuation)

We believe the formatting is now aligned with the guidelines.

Review: Transforming mental healthcare in higher education through scalable mental health interventions — R2/PR11

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr11 [Opens in a new window]
Date of review:  12 June 2023
Revision round: 2
Role: reviewer
Recommendation/decision: accept

Conflict of interest statement

Reviewer declares none.

Comments

We are pleased to inform the authors that following the implementation of the requested edits, we are recommending the manuscript for publication. The manuscript provides valuable insights and offers significant contributions as a perspective paper. It successfully highlights the critical importance of addressing the mental health needs of university students and underscores the urgency of integrating culturally sensitive, scalable non-specialist delivered care within higher education settings.

Recommendation: Transforming mental healthcare in higher education through scalable mental health interventions — R2/PR12

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr12 [Opens in a new window]
Rahul Shidhaye Pravara Institute of Medical Sciences, India
Date of review:  14 June 2023
Revision round: 2
Role: Handling Editor
Recommendation/decision: accept

Comments

No accompanying comment.

Decision: Transforming mental healthcare in higher education through scalable mental health interventions — R2/PR13

Published online by Cambridge University Press:  23 June 2023
DOI: https://doi.org/10.1017/gmh.2023.29.pr13 [Opens in a new window]
Judith Bass [Opens in a new window] Johns Hopkins University Bloomberg School of Public Health, United States
Revision round: 2
Role: Editor in Chief
Recommendation/decision: accept

Comments

No accompanying comment.