LAWRENCE — Nearly one in five adults in the United States live with a mental illness, according to the National Alliance on Mental Health. Yet many people who experience mental illness don’t seek treatment. A study by the National Council for Behavioral Health cites several factors: high cost and insufficient insurance coverage, lack of awareness, access to providers and social stigma.
To help address these issues for faculty and staff, the University of Kansas Staff Fellows Program made mental health its focus for the 2019-2020 program year. The fellows recently released their findings about resources available for KU employees.
Each year, 12-15 KU staff members are selected for the Staff Fellows Program. The 2019-2020 cohort was led by Catherine Johnson, director of the KU ADA Resource Center for Equity & Accessibility (ADA RCEA), whose office’s work on a comprehensive KU mental health resource guide led to the topic selection.
“There’s a stigma around mental health that is nearly impossible to break down, and it prevents people from seeking help,” Johnson said. “It prevents people from understanding that they might need treatment. We don’t have at KU the knowledge and resources to help people in real crisis.”
A personal connection to the work
The topic is personal for some of the staff fellows involved with the project.
“I have a son who experiences some mental health conditions, which we have been navigating over the last decade,” said Courtney Foat, assistant director of communications at KU Libraries. Foat must work with institutions and large systems — from medical and behavioral health to public education — to address her son’s needs.
Other fellows felt called to the topic.
“Over time we realized we’re not working to make things better for some unknown person, we’re working to make things better for each other, for our kids, for our students,” said Megan Belaire, graduate academic adviser in the College of Liberal Arts & Sciences. “We had a lot more motivation than people working on other topics might have had, and then when the pandemic hit, we were even more motivated to help people.”
Both the Centers for Disease Control and Prevention and the World Health Organization report rising anxiety levels attributable to the COVID-19 pandemic; however, the work of staff fellows began prior to the pandemic, and its focus goes beyond stress and anxiety.
“If you look at mental health programs on campuses,” Johnson said, “you will find they often get paired with this concept of wellness. I did not want (the resource guide or the work of the fellows) to be about wellness. I wanted KU to focus on mental health diagnoses in the DSM (the Diagnostic and Statistical Manual of the American Psychiatric Association) and how we provide support for people who have a diagnosis.”
Research, focus groups and a survey
The staff fellows divided into two groups: The internal group assessed resources available on campus, and the external group looked outward to resources at peer institutions and relevant corporate organizations.
When research concluded earlier this year, the fellows held focus group sessions with KU faculty, staff and graduate student employees across the Lawrence campus and also sent an anonymous online survey to faculty and staff.
What the fellows learned
Internal research overview
The staff fellows group that focused on internal resources found that mental health resources are available on the Lawrence campus, but they are not widely known and are sometimes hard to find:
- The KU Psychological Clinic offers mental health services to staff and their families through a sliding-scale fee.
- KU Counseling and Psychological Services (CAPS) provides mental health services to students, including graduate students. However, it does not provide counseling services for staff or faculty. CAPS also offers a formal, eight-hour Mental Health First Aid training to groups of faculty and staff.
- The resource guide created by the ADA RCEA connects users with several resources but can be hard to locate online.
- The State of Kansas EAP offers eligible KU staff and faculty access to mental health resources, including up to eight counseling sessions per year, per issue.
External research overview
The staff fellows group that focused on external resources found many of the agencies it contacted relied heavily on Employee Assistance Programs (EAPs).
ComPsych and Silver Cloud are EAP and mental health contractors that came up often in the research. Lyra Health, which provides mental health services to companies, published a white paper suggesting traditional EAPs, insurance companies and some therapies (up to 80%) are ineffective, and that communications and technology fall short in supporting organizations’ mental health efforts. The assessment also found:
- LMH Health is exploring ways to incentivize engagement with mental health resources, and it developed the Lavender Project as a model to provide services to employees who have experienced trauma.
- Bert Nash Community Mental Health Center is attempting to shift the culture around stigma by moving beyond a focus on crisis intervention to emphasize education around “mental health hygiene.”
- Within university law enforcement, the most robust program the fellows found was at Iowa State University, which has a full-time mental health advocate working within its police department. The advocate responds to mental health crises on campus, including incidents involving staff.
Focus groups in brief
The stigma around mental health made it somewhat difficult for the staff fellows to conduct their research. It also became clear during the focus groups that attitudes toward mental health vary greatly from department to department at KU. The focus group process also revealed:
- 53% of participants were aware that mental health diagnoses were covered by the ADA and that individuals can receive workplace accommodations.
- 47% of participants indicated an awareness of how to seek mental health support.
- 33% of participants reported making use of on-campus mental health resources.
Employees also reported perceived barriers to resources. Some wanted to know KU’s definition of mental health, and some reported confusion as to Human Resource Management’s position on the use of sick days for mental health purposes. Additionally, some reported concern at being unprepared if a colleague was in need of a mental health intervention.
The survey in review
Almost 10% of the KU workforce participated in the survey. Sixty percent of respondents were staff, 25% were graduate student employees and 14% were faculty. One percent preferred not to state their affiliation. Six percent of respondents reported attending a focus group. Among the results:
- More than half of respondents said KU employees have positive attitudes toward mental health.
- More than two-thirds said they were aware that the ADA applies to diagnosed mental health conditions.
- More than two-thirds are aware KU provides resources for employee mental health.
- Fewer than 50% of respondents said they are comfortable discussing personal mental health issues at work.
- Nearly 25% of respondents said they have experienced barriers to accessing mental health resources provided for employees.
- 61% of respondents reported witnessing or experiencing stigma related to mental health.
The major conclusions
The Staff Fellows report highlights four “levers” the university could enact with regard to mental health at KU. The levers, as articulated to the fellows by Barbara Bichelmeyer, provost and executive vice chancellor, are hiring with capacity, increasing skills and knowledge, providing resources and motivating people. The levers touch what the fellows identified as five key areas where applied change could be most effective: leadership, policy development, support services, communication and recommendations for further research.
As for what specifically could be improved, many fellows cited the Employee Assistance Program.
“One thing we kept seeing was that the EAP could be a really limiting factor in terms of accessibility,” said Leah Terranova, assistant dean for academic & student affairs in the School of Law. “Employees sometimes were unable to find support, and also one of the biggest factors was that a lot of local counselors that the EAP contracts with, in many cases, are no longer taking new patients.”
Terranova and the other fellows also discovered some organizations and institutions that provide mental health care are not vetting their providers rigorously or on a frequent-enough basis, and some are not investigating the methods providers employ, meaning they might not be using leading evidence-based practices.
Terranova said she would like to see more transparency from the EAP, including the kind of providers available and how many of those are actually capable of seeing new clients.
“And, what is the feedback in terms of measuring the effectiveness of six or eight free sessions, which is what we’re entitled to as employees?” she asked. “Is there a way to rate that? Is there a way to do a survey of employees at the start of their treatment and then after eight sessions to see if we have met the goal of offering people support? Has it made an effective change?”
As for the report’s full list of recommendations, the realities of COVID-19 and its associated effects on both the state and KU budgets means all the recommendations won’t be implemented at this time. So a subgroup of the fellows met to identify what they saw as lower-cost, relatively easy-to-implement recommendations that could be put in front of KU leadership. The subgroup recommended the following:
Adopt a mental health peer program: The fellows learned that Douglas County runs a Peer Fellows Program with the aim of training a group of county employees to provide mental health first aid. These first-line individuals provide peer-to-peer support to colleagues and direct those colleagues to more involved services. KU offers a student version of this program via CAPS, and Douglas County is purportedly interested in liaising with KU, according to Roberta Woodrick, staff fellow and assistant conservator at Watson Library.
Develop strategic communications surrounding mental health: Communication came up repeatedly during the fellows’ interviews with KU community members. A list of resources is available on Human Resource Management’s website, but the group said more extensive communications are needed. Many respondents said the university needs a strategic communications plan that addresses mental health. The plan should outline communications needed to both identify available resources and break down barriers to access — primarily stigma.
Offer a mandatory mental health awareness module: The third recommendation also came up repeatedly during interviews. KU mandates an annual sexual assault awareness and prevention training, but could a mental health module be incorporated? One that focuses on what to do for a co-worker who is having trouble. How does one approach such a co-worker? How does one best help them? The fellows felt the module could also offer guidance on how to negotiate the EAP and other programs and resources, such as the ADA filing process.
Peering into the future
Johnson’s goals for KU’s ADA RCEA are clear: She wants to take the staff fellows’ work and build on it, creating a robust crisis kit that anyone at KU — student, faculty or staff — could use to help themselves or their friends or loved ones.
With the pandemic, current social justice struggles, political and other issues, some staff fellows noted that discussions about mental health needs and challenges are more important than ever.
“Even people who haven’t reported mental health issues in the past are reporting mental health issues,” Woodrick said.
Foat and others said changing the narrative on mental health will come down to individual decisions to make connections.
“I personally have become a stronger proponent for vocal advocacy,” Foat said. “I feel like it’s really the only way forward. I see how much it has benefited the journey with my son — owning it, trying not to steer away from it in discussion. I think it’s critical to forge a culture where people feel like they can be that candid. There are enough challenges and barriers to mental health care. The least we can do is try to make KU a supportive place where people can reach out and safely express a need for help.”