Teletherapy: Campus Counseling Center Friend or Foe?

Demand for behavioral health care, whether among college students or other groups, is at an all-time high due to a variety of reasons, including COVID-19, racial stress and oppression, a polarizing political environment, a (welcome) reduction in stigma about mental health, and an increasing general understanding of the importance of taking care of one’s mental health. The fact that mental health was mentioned in President Biden’s 2022 State of the Union is not insignificant, nor is the money toward mental health–related initiatives in the American Rescue Plan.

Many college and university counseling centers have experienced significant increases in utilization rates over the past 10 years. Mental health issues have consistently been shown to be a top impediment to academic performance and college completion: a National Alliance on Mental Illness survey of students found that 64 percent of respondents who were no longer enrolled in college cited mental health as the reason they stopped out. Ensuring access to mental health care on campus is essential, yet counseling centers remain overwhelmed with student demand, wait lists and increased acuity.

The pandemic only made mental health worsen nationally, and teletherapy’s star rose as a viable treatment option. The quick transition to teletherapy during the spring of 2020 undoubtedly saved lives by making mental health care accessible during extremely difficult times. One can applaud the increased use of technology, as it allowed for greater access to treatment for people in need. At the same time, teletherapy may be seen as competition and potentially a replacement for on-campus counseling resources. The reality, however, is that on-campus resources remain necessary for multiple reasons (e.g., crises, familiarity with campus specifics and immediacy of care).

For my part as the leader of a campus counseling center, I am approaching the partnerships with teletherapy companies with cautious optimism. I believe there are many positives that come with offering teletherapy services as a supplement to on-campus support services.

To start, partnering with a teletherapy company allows for a reduction in wait times for treatment (with the potential to minimize or possibly even eliminate wait lists for services significantly) and allows students to access care outside traditional business hours. Additionally, it allows students to access clinicians who have connections to a student’s identity (e.g., LGBTQ+, BIPOC, student athlete), which traditional staffing models would not typically allow for. Finally, it allows treatment for students who want to access resources not affiliated with the campus—without them having to worry about finding a nearby clinician (who in many cases will likely have significant wait times) or arranging for transportation to an off-campus provider.

With all of the potential positives, as I was doing my investigation into partnering with a telehealth company (which our college ultimately did, through the financial generosity of a donor), I found that there were reasons for me to be hesitant. First, I have heard reports from colleagues of teletherapy companies canceling contracts only to reoffer the services via a contract for more money. Are teletherapy companies going to get colleges to buy into a service at a low cost and, once they become dependent, raise prices significantly, thus creating increased operating budgets for counseling centers—or worse, compelling colleges to remove a valuable service once offered?

Second, while teletherapy services have the advantage of being able to offer services with any provider within a state, and thus can offer shorter wait times for appointments, the problem arises in that there are still too few service providers. Once more colleges sign up for teletherapy, there is the potential for many of these clinicians to have wait times that rival, if not exceed, the wait times seen at counseling centers during peak times. Many clinicians in private practice already have wait times that exceed counseling center wait times and, with more consumers, there is the potential for this to happen in teletherapy as well.

Finally, I have concerns about teletherapy companies becoming publicly traded companies, as some already have. A publicly traded behavioral health treatment provider may make decisions in the best interest of the shareholder, rather than the client. I certainly expect that licensed practitioners will continue to treat their clients ethically, but the influence of a company’s policies and service structure may create conflicts between the business and the provider. When a company accepts large financial investments, the relationship with the consumer inevitably changes.

As behavioral health care has been more widely utilized, I appreciate the necessity and convenience of this form of treatment delivery. Additionally, the rise in demand for mental health care indicates that years of efforts to reduce stigma have been effective. Whatever we can do to continue to increase access for our students is of the utmost importance, and teletherapy and digital technologies can undoubtedly be effective in these efforts. If done correctly, teletherapy and campus counseling resources can co-exist and have long-standing collaborative relationships.