JED Campus Case Study: Kent State University
When a college invests in the emotional health of its students, the results can be monumental.
Consider the ideal scenario. A college offers programs that promote the development of essential life skills for students while fostering social connectedness, inclusivity, and a sense of belonging to the institution. The campus climate is such that students are encouraged to seek help for themselves and others, and a system is in place to identify and help students who might be at risk for mental health issues. The college has support services in place that address mental health and substance use concerns, making students feel cared for and secure. The college regularly monitors and restricts access to lethal means, by proactively minimizing environmental risks for suicide on campus. Strategic planning is done to promote the campus-wide adoption of practices that promote student mental health.
This is the Comprehensive Approach to Mental Health Promotion and Suicide Prevention for Colleges and Universities that forms the basis for the work at The Jed Foundation (JED), a non-profit organization which aims to protect emotional health and prevent suicide among this nation’s young teens and young adults. JED Campus, its signature program, is a 4-year partnership between JED and higher education institutions, in which nearly 350 colleges have participated since 2013. In this partnership, schools are guided through a collaborative process of comprehensive systems, program, and policy development with customized support to build upon existing student mental health, substance misuse and suicide prevention efforts at the school. JED Campuses assess and enhance the work that is already being done and create a plan to strengthen their approaches, which ultimately helps to create positive, systemic and sustained change in the campus community.
JED’s Comprehensive Approach is an evidence-based model developed in collaboration with the Suicide Prevention Resource Center (SPRC) and adapted from a suicide prevention effort developed by the U.S. Air Force. The Comprehensive Approach includes seven strategic domains that should be addressed in any community-wide effort to support mental health and to limit substance misuse and suicide. This model broadly addresses four major thematic areas: enhancing protective/preventive factors and resilience (life skills and connectedness); early intervention (identifying those at risk and increasing help seeking); availability and access to clinical services; and environmental safety and means restriction.
University/nonprofit partnership to support student mental health
In 2015, Kent State University began its formal partnership with JED, beginning their four-year journey in the JED Campus initiative. At the time, the University had several mental health programs, initiatives, and services in place but knew they wanted to enhance and more strategically coordinate support for student mental health. Dr. Jennifer Kulics, Associate Vice President for Student Affairs describes this partnership as groundbreaking in the way it opened the door to new campus and community partnerships, long-term funding, addition of resources to directly service students, as well as national recognition for champions in college student mental health: “The partnership with JED has changed the trajectory of our future,” states Dr. Kulics.
This partnership began with a comprehensive assessment and evaluation of all mental health services and programs that existed on all eight regional Kent State campuses. Dr. Kulics explains that after seeing the analyses from JED, it was clear that mental health needed to be prioritized at Kent State. “What JED gave us was the validation behind all the anecdotal information that we knew to be true about student mental health on our campuses.”
Two guiding principles form the foundation of JED Campus. First, support for emotional well-being and prevention of suicide and serious substance misuse must be seen as a campus-wide responsibility. Second, these efforts that promote emotional health, suicide prevention and substance misuse prevention must have support from leaders on campus. It is imperative that senior leadership, including the President and Board of Trustees, not only acknowledge the importance of supporting student mental health and well-being, but make this work a priority and a shared value for the entire campus community. Dr. Kulics says that they took the initial assessment data to the University President, and in 2015, mental health and emotional well-being became a top priority.
In the first year of the JED partnership, Kent State hosted a Healthy Campus Summit on the Kent Campus, which led to the creation of Kent State of Wellness (KSoW), a university-wide effort to promote student health and wellness, focusing on eight key areas: mental health, alcohol and drug use, nutrition, physical activity, preventive care, safety, sexual health, and smoking and tobacco use. KSoW aimed to foster a culture of health and wellness for students and employees at all Kent State campuses. KSoW was developed collaboratively by a broad coalition of Kent State community members – faculty, staff and students, under the leadership of the Vice Presidents for Student Affairs and Human Resources. Kent State took the American College Health Association’s Healthy Campus Pledge, declaring its commitment to promote and support a healthier campus community. The KSoW continues to be the leading charge for all health and wellness at the University.
Understanding the impact of a mental health intervention
Between 2015 and 2019, Kent State underwent a formal strategic planning and implementation process for mental health, emotional well-being and substance misuse programming, doubled their mental health clinician staff size and established new counseling centers at nearly all of their eight regional campuses; conducted its first campus-wide environmental scan to reduce access to potentially lethal means, and established a number of high profile campus-wide collaborations and funding opportunities to support the overall wellness of its students.
With JED’s support and guidance, Kent State developed new initiatives, trainings and technologies to create campus-wide prevention and intervention strategies, while examining best-practice policies, programs and services. For example, individualized strategic plans were created for each of the eight campus locations, and these plans have been executed through the four-year partnership. Each campus had a dedicated JED liaison, who worked with campus staff on their specific needs and prioritized action steps to guide their work toward better supporting students on campus. Campaigns and programs were established and strengthened to prevent suicide and violence by helping students, faculty and staff identify and intervene with disruptive or distressed students.
The summary below highlights the key changes made on the campuses of Kent State between 2015 and 2019, and explains how these changes are consistent with JED’s Comprehensive Approach and the work of JED Campus.
1. Strategic Planning and University-Wide Support
It is central to JED’s comprehensive model that mental health and suicide prevention activities should be approached through the lens of strategic planning. The particular structures, problems, needs and resources of each campus need to be examined and thoughtful decisions should be made around prioritizing and choosing specific tactics. Engaging in an active and continuing strategic planning process allows schools to evaluate clinical and programming needs and to examine how they deploy both personal and financial resources to address student mental health challenges. It also gives schools a platform from which to evaluate the effectiveness and impact of programs.
Prior to 2016, Kent State did not have a formal strategic plan for mental health, emotional well-being, and substance misuse programming. Today, their strategic plan is integrated into the larger university strategic plan, includes an evaluation component, and is accessible to various stakeholders on campus, including students. It is consistent with JED/EDC’s Campus Mental Health Action Planning (MHAP) guide. The plan includes individualized action plans for each of the regional campuses.
Establishing a task force with broad campus representation to engage in strategic planning is the first action step in participation with the JED Campus Program. Planning and programming are more likely to succeed when there is broad ownership and a shared commitment to meet common goals. It is important to initiate strategic planning activities that will identify national and campus-specific problems and trends; prioritize the problems to be addressed; use campus specific data to inform planning and programming; define strategies and actions for addressing problems; and collect and analyze campus-specific data to assess the impact of actions.
At Kent State, the Campus Mental Health Coalition (CMHC), comprised of clinicians from all eight campus locations, revitalized a clinician centered approach to meet more consistently, serve students more effectively, recommend programming and training, and ensure that all clinicians’ voices were heard. This coalition reports up to the Kent State of Wellness Mental Health Committee, which is the primary mental health committee at Kent State University to support wellness goals related to the mental health priority within the KSoW framework. The CMHC provided feedback to support the expansion of mental health services at all Kent State regional campus locations. Through the CMHC’s advocacy, new counselors are provided with support, consultation, materials and in 2019 created a regional campus mental health services manual. Additionally, the Vice President for System Integrations of Regional Campuses provided support through the purchase of Titanium Schedule for all regional campuses, which standardizes and streamlines access to care across multiple campuses. Per JED Campus recommendations, the CMHC wrote an advocacy letter supporting bringing mental health services and support resources to the forefront of Kent State University’s mobile sites, including Flashline, the main Kent State University student portal, and, in the upcoming year, the Kent State Mobile App.
The Campus Mental Health Coalition now collects an annual report from all mental health providers. This report brings together data regarding service utilization, trends in services, outreach, funding, accomplishments, goals and obstacles.
2. Enhancing Protective Factors through Innovative Programs and Interventions
JED’s Comprehensive Approach states that it is important to take action to identify students at risk for mental health problems and/or suicidal behavior, and also to promote emotional health awareness among those who interact with students the most — “gatekeepers” such as residence hall staff, academic advisors, faculty and even fellow students — as it is vital for these people to be able to recognize and refer a student who might be in distress. All Kent campuses began participating in National Depression Screening Day at Kent State University in 2018. Several campuses conduct in-person screenings and utilize the online screening option. A comprehensive suicide prevention campaign, Step Up & Speak Out was implemented to educate University community members on protocols and resources designed to assist in disruptive situations or with distressed individuals. This program is further enhanced by a campus-specific 24-hour hotline (for medical and mental health assistance) and a state-wide text line. Several office at Kent State collaborated to deliver this suicide prevention campaign: Kent State University Psychological Services, University Health Services, the Office of the Dean of Students, the Office of the Vice President for Student Affairs, and Police Services. In addition, the College of Public Health developed a mental health training program, Project Aware, which trained 730 students, faculty, and staff in the comprehensive eight-hour Mental Health First Aid curriculum over three years.
Supporting life skills education is valuable in teaching healthy ways to cope with the stress of college life. Some of the life skills that are important to a student’s well-being include managing friendships and relationships, problem solving, decision making, identifying and managing emotions, healthy living, and finding life purpose, meaning and identity. Research has shown that loneliness and isolation are significant risk factors for mental health problems and/or suicidal behavior. Therefore, supportive social relationships and feeling connected to campus, family and friends are protective factors that can help lower risk.
Key programs that were enacted to address these areas included Resiliency Training for First Year Experience – collaborations with academic departments and psychoeducation groups to help with coping and conquering anxiety at health services, and a Mental Health Festival in 2018 aimed to destigmatize mental health disorders and inform students of resources on campus.
The addition of mental health clinicians at the regional campuses also supported the expansion of outreach and mental health related programming at the regional campuses. This included individual class visits (First Year Experience and discipline specific classes) to discuss stress management, distress tolerance, critical thinking, decision making, communication, suicide prevention, Kognito training, on and off campus services, and mental health advocacy. Regional campuses utilized both on and off campus resources to expand programming into wellness, including having wellness fairs, programs on sleep and events centered on nutrition.
The Nightingale Project and an Active Minds chapter were added as student organizations in 2017. Active Minds, a nonprofit organization dedicated to raising mental health awareness among college students, announced Kent State as a winner of the prestigious 2018 Healthy Campus Award.
Under the auspices of KSoW (which included the JED Campus work in 2018), funding was granted for nutrition and wellness, to establish new vendors within the dining facilities to ensure a larger selection of healthy options and more flexible meal options for students taking classes at multiple campuses.
Programs promoting life skills and wellness include Meditation Across Campus, development of an outdoor playground to support student health and wellness, and programs which provide sleep assessment technology to help students assess their sleep hygiene.
To further demonstrate University-wide support for student emotional health, the University recently established a Fall break for students, to allow a chance for students to decompress and return feeling renewed for the remainder of the Fall semester and final exams. The campus embraces student wellness as a whole – where physical and mental health exist along a continuum, rather than soiled areas of health which are granted attention only when problems occur.
3. Increasing Access to Clinical Services
According to JED’s Comprehensive Approach, it is essential to offer accessible, consistent and high-quality mental health services to students. To make mental health and substance misuse care more comprehensive, it should include strong and flexible services, adequate staffing levels and staff diversity reflective of the student population, a variety of treatment approaches, and clinic hours that are reflective of student schedules. Since most college clinics are free, the length of treatment is often limited. Therefore, it is important that campus mental health services can assist students in finding off-campus resources that can provide long-term or speciality care if needed.
Prior to engaging with JED Campus, the Kent State regional campuses had counseling services at three campuses: Stark (2011), Salem and East Liverpool (2012) and Trumbull (2013). Since working with JED, KSU has added clinical mental health services at all regional campuses (Ashtabula, College of Podiatric Medicine, Geauga, and Twinsburg Regional Academic Center) except Tuscarawas which utilizes their local community clinical resources. The range and staffing of services was structured to meet the estimated needs of the campuses, so some staff positions are full time while others are part time. This was concluded through examining the size of the campus enrollment, other accessible community resources, budgetary implications, and how each new hire would impact the student to counselor ratio for the campus and the university.
Psychiatric clinical staffing also increased by 50% improving care and reducing student wait times. Appointments in psychological services increased by 9 percent and individual students served in psychological services increased by 4 percent. At the Stark Campus, the relationship between the Counseling Center and the faculty/staff has strengthened. Faculty and staff promote counseling services in their classes, sharing stories and information. There are window decals in bathrooms indicating where to find help, and students speak positively of their experiences with the Counseling Center.
These changes are critical to the Kent State campuses since data from the Healthy Minds Study shows that levels of depression and anxiety among their students trended higher than the national average, as of the year the 2016-2017 academic year. For example, 31% of Kent State students had a lifetime diagnosis of anxiety versus 24% of students across the nation. 27% of students had a lifetime diagnosis of depression or another mood disorder at Kent State, versus 23% nation-wide. Additionally, 75% of students reported feeling sad, blue, anxious, or nervous (versus 70% nationwide).
Expansion of mental health services to the regional campuses allowed students to make a connection when they were ready to reach out, and then know they would be contacted. They didn’t have to wait for an office to be open to take the first step.
4. Restricting Access to Potentially Lethal Means
It has been well established that if the means to self-harm are removed or limited in an environment, it can prevent suicide and even limit accidental deaths. This is called “means restriction.” Limiting students’ access to weapons, poisonous chemicals and rooftops, windows or other high places are all means restriction activities. Each campus should do an environmental scan for potential access to lethal or dangerous means. The restriction of access to potentially lethal means of self-harm and suicide, or means restriction, is a recommended and evidence-based approach to reducing suicide on college campuses. After 2016, Kent State campuses began conducting environmental scans to reduce access to lethal means in partnership with the local police department, with an architect, and facility management.
5. Increasing Staffing, Improving Diversity, and Collaborating Across Campus
The campus culture to partner and collaborate within departments at the University is strong at Kent State. Collaboration efforts throughout the Kent State University community provided education, support and services by breaking down barriers between divisions, colleges and programs. A Brain Health Summit partnered with faculty in four different colleges to promote student health and wellness and present actionable information. The Department of Psychological Services and Intercollegiate Athletics partnered to reduce mental health stigma in a Mental Health Summit in 2016.
Support for students with disabilities has been a key priority for Kent State University. Stark campus and the College of Podiatric Medicine, two regional locations, have both seen an increase in the number of students applying for accommodations who are diagnosed with a mental illness. A full-time licensed counselor is located on campus to help refer students to seek accommodations for mental health disabilities and to seek counseling. Kent State recently has hired a Neurodiversity Coordinator in the Student Accessibility Services Office to support and recognize students with neurological differences such as Dyslexia, ADHD, Autistic Spectrum, Tourette Syndrome and others.
Regional campuses created targeted outreach for student populations based on the culture of their campuses. This includes LGBTQ+ students, nontraditional students, parenting students, veterans, and students who have been impacted by the opioid epidemic in the state. Regional campuses do not have Greek systems nor residence halls although many have active student groups. Increased attention is now being paid to supporting international students as well, including programming about what mental wellness is at their temporary housing during evening hours.
Mental health services offices also increased their visibility and outreach to students – including non-clinical programs such as Coloring for Calmness, and Stressbuster Week. The Dogs on Campus program, which brings teams of therapy dogs to campus for students, is an unexpected avenue of student connectedness – students often end up talking to each other or in small groups around a dog about their own pets and make a connection.
Outcomes and Future State
Kent State is now a JED Campus alumni school. The JED Campus evaluation of 56 schools that have completed both pre-and-post assessments shows that these completed schools are more likely to view student emotional health as a campus-wide issue, with significant involvement of multiple departments and stakeholders on campus. These schools are also more likely to screen students for mental health issues at campus health centers, as a preventative effort to support more students. JED Campus alumni schools also are more likely to have done a campus environmental scan to limit access to potentially lethal means, an evidence-based approach to reducing suicides.
Kent State’s four-year partnership with JED came to a close in 2019, but the work continues. In 2020, Kent State partnered with GradGuard to provide their students and their families with the option to purchase voluntary tuition insurance to protect their investment in higher education. This supplements Kent State’s tuition credit policy by reimbursing students and families, for tuition, room, board, and other fees in cases where a student must withdraw. This tuition insurance policy covers several reasons for withdrawal including a mental health disorder, such as severe depression or anxiety.
Although personnel enhancements were made, Kent State is still falling short in their clinical ratio standards as set forth by the International Association of Counseling Services. The University is advocating for the support of the state legislature to assess a mental health and substance use fee. If approved, a fee structure may be recommended to the Board of Trustees to support a revitalized vision for student mental health and wellness. Support for mental health and wellness also included a Dean’s Fellow Position – a faculty member from Public Health working full-time in health services to support mental health initiatives and health promotion. Intentional collaborations between the Division of Student Affairs and Kent State University’s Brain Health Research Institute are being explored.
A comprehensive approach aimed to promote the mental health of young people as well as reduce the risk of suicide and substance misuse takes time to plan, implement, execute, and sustain. It requires support from all levels of administration in a University setting, and as Kent State did in 2016, requires the university administration to make student mental health and emotional well-being a top priority on campus. Schools should consider student mental health across all work. It is the responsibility of everyone on campus to promote and protect the emotional health of the student body. Student emotional health directly ties to whether a student is able to excel in their classes, keep up with their coursework, remain at their institution, and graduate on time.