At 4 a.m. one day early in her freshman year, a student at Solano Community College in Fairfield, California, reached for her phone. In her mind, everything felt like it was piling up — financial worries, academic stress and a relationship that had spun out of control. That night, she was feeling so anxious, she needed to talk to somebody right away. (The student’s name is not being used to protect her privacy. Another student in this story will be identified by first name only.)
With her bedroom door closed so her parents wouldn’t hear, the student opened an app she’d heard about on campus, one that gave students free access to a trained therapist for emergencies, anytime day or night. With her heart racing, she pressed a button in the app that said “TalkNow.” Within five minutes, she was connected to a therapist who asked if she was thinking of harming herself.
The student responded “no” but still felt like she was having “personal mental warfare” inside her own mind. She’d been struggling with her mental health for years — at one point, her depression became so debilitating she considered dropping out of high school. She never asked her parents to see a therapist; she didn’t want to burden them financially and felt they wouldn’t approve of her seeking therapy. The app made seeking help private and fast.
In their 30-minute session, the therapist gave her some coping tools. More than anything, it helped to talk to someone. “It felt better to be heard instead of silence, when I truly needed someone to talk to the most,” she said.
Colleges are making sweeping changes to how mental health support is delivered to students on campus, with teletherapy — in which patients receive mental health services via phone, text or video call — at the top of the list. Teletherapy spread to prominence during the pandemic, especially for colleges that moved online while youth mental health problems like anxiety and depression skyrocketed. Tech companies like Uwill, Bettermynd and TimelyCare — provider of the blue-button “TalkNow” 24/7 crisis line — partner with colleges and universities to offer students mental health services beyond the 9-to-5 schedule of the counseling center, focusing instead on students’ convenience, and often for no cost to the student.
While research on teletherapy is still in its early stages, experts agree that the service has great potential especially for community college students, who are often low-income and under- or uninsured and lack access to mental health care. While many schools are still in their first or second years of offering teletherapy, community college administrators interviewed for this story agreed that the technology has been a game-changer for students.
“For us, it’s a retention effort,” said Emily Stone, Dean of counseling and student success programs at Diablo Valley Community College in Pleasant Hill, California. Pointing to Maslow’s hierarchy of needs and the research-backed idea that students who are mentally unwell can’t learn, she said, “Our well-being, our mental health, are all foundational for a student being able to show up to class, be productive and be successful.”
For community colleges, a different mental health crisis
Most colleges and universities were already seeing a climb in mental health issues among students before the pandemic made them considerably worse. According to the Healthy Minds survey of campuses across the country, by 2021 more than 60% of college students met criteria for at least one mental health problem, with the most common being anxiety, depression and suicidality.
Yet mental health challenges look slightly different for the nation’s roughly 4.2 million community college students, who constitute about a third or more of all undergraduates. According to a 2021 national analysis, community college students ages 18-22 had significantly higher prevalence of anxiety and depression than their four-year undergraduate peers and at the same time were much less likely to seek treatment — especially those from historically marginalized backgrounds.
For community college students, more than a third of whom are low-income and a quarter of whom are first in their families to attend college, finances play a big part in mental health, not only as a cause of stress but also as a reason to avoid seeking treatment. “Financial stress was a strong predictor of mental health outcomes,” researchers in the 2021 analysis wrote, “and cost was the most salient treatment barrier in the community college sample.”
Related research has shown that uninsured patients with depression and anxiety are less likely to receive mental health care compared to their insured counterparts, suggesting that cost plays a role.
Anecdotally, community college administrators said that worry over finances is one piece of a bigger picture: Community college students are more often engaged in a balancing act that includes full-time work, child care and caring for other family members on top of their studies.
“We have students from all walks of life. Some of them are married. Some have kids. They are juggling a lot,” said Maureen Delaney at Germanna Community College in Stafford, Virginia. “For a lot of students, this is their chance to try and do better for themselves or their families, and they struggle.”
At the same time, community colleges themselves are struggling to provide students with mental health services. One out of four community colleges offer no mental health services, and less than 10% offer psychiatric services to students. And enrollment continues to decline nationally, threatening to squeeze some schools’ already limited resources.
Teletherapy’s potential to change the game
Teletherapy, with its anytime-anywhere model that is often paid for by the colleges and offered to students at no cost, has the potential to revolutionize mental health support for community college students.
Teletherapy’s greatest strength, according to psychotherapists, is its ability to expand access, and early research shows it has the potential to provide the same outcomes as in-person therapy, especially when performed by a well-trained, licensed therapist.
College students find teletherapy “convenient, accessible, easy to use and helpful,” mostly due to the expanded number and availability of therapists. Campus counseling centers often are open only during regular business hours and are short-staffed. Getting an appointment can take weeks.
“We are there when the counseling office is closed, holidays, vacations and peak times when there’s not enough capacity,” said Michael London, CEO of Uwill, a web-based teletherapy platform serving more than 100 colleges and universities. “There’s video, phone, chat or messaging. The student drives the way they want to be helped.”
Most teletherapy services also offer a crisis line like the “TalkNow” button, which gives students who are having a mental health crisis or even a panic attack someone to chat with within minutes.
Teletherapy startups are also eliminating the web of medical and insurance bureaucracy that can stand in the way for students who don’t have insurance or can’t pay hourly fees to therapists who don’t take insurance. One recent study showed that a majority of college students, especially Black, Hispanic and Asian students, would consider teletherapy if no cost were involved.
Colleges that hire teletherapy services can choose from a variety of plans for students, but according to the representatives of the teletherapy services interviewed for this story, many offer a certain number of therapy appointments to students for no cost, removing a barrier that can prevent low-income students from seeking mental health care.
Beyond cost and convenience, teletherapy has the potential to break down other stubborn access barriers, especially for the most vulnerable groups of college students. Students of color and LGBTQ students, for example, are often looking for therapists with similar backgrounds, and teletherapy’s wide net of therapists can make that easier than the one or two found in the counseling center. In a recent New York Times story, Virginia psychologist Alfiee M. Breland-Noble noted that having this kind of cultural competence “is not how much do you know about individual cultures, it is more how do you show up in any space in a way that allows other people to feel welcome, to feel heard and to feel understood.”
Teletherapy services also hold great potential for students in rural areas, where mental health care service shortages are the greatest and stigma against treatment is the highest.
Promise and pitfalls ahead
Teletherapy is still so new that questions remain about its effectiveness and accessibility. Researchers interviewed for this story agreed that easier access for people like community college students is promising — but more research needs to be done.
Barriers to teletherapy remain for some groups as well, due to lack of internet access or a smartphone. The public doesn’t always realize how many college students are struggling with basic needs like food, housing and transportation, said Sara Abelson, senior director of training and education at The Hope Center for College, Community and Justice at Temple University. In a 2020 national survey of college students, the Hope Center found that more than one third of community college students often did not have enough food to eat, and 14% experienced homelessness at some point during the year.
Abelson said the Hope Center’s future research into basic needs will include collecting data on mental health, with attention to its relationship to lack of food and housing. “We believe and know colleges have to connect their dots,” she said. “When [students] go one place for SNAP, another for mental health support — [schools] have to think holistically about the supports that serve students.”
At the same time, the fast rise of teletherapy startups is calling quality into question. Some online therapists have complained that teletherapy appointments are too short, and some startups appear to be more focused on growth than helping patients. A recent Time story revealed that federal investigators are currently looking into teletherapy services Done and Cerebral for possible over-prescription practices.
Yet many community college students who have used teletherapy said it has helped them. After the student at Solano Community College sought help with teletherapy, she began telling other students about it. “I remember this one student, he was really struggling,” she said. “He was considering dropping out of school. I told him to use the ‘TalkNow’ button and find someone to talk to about it.”
As teletherapy becomes more popular and maybe even the norm, colleges are looking to expand, with digital help, what they can offer students, hoping to head off mental health challenges before they become crises. Many teletherapy apps have added wellness components — online yoga classes, meditation and other preventative measures students can access on their smartphones anytime. And at least one app, TimelyCare, has added help for basic needs like food, housing and transportation, all at the touch of a button.
Alessandra, a second-year computer science major at Germanna Community College, said she thought she was having a panic attack on the night she hit the “TalkNow” button. She was feeling overwhelmed with thoughts of failure, worried about her GPA, and she couldn’t breathe.
When Alessandra got connected to a therapist, the professional walked her through some breathing techniques and meditation exercises to calm her down. “What I liked was, she was calm, and her calmness made me calm,”she said. “We just breathed together, and I loved that. I never paid attention to that before, but the breathing techniques helped me a lot.”
Colleges are making sweeping changes to how mental health support is delivered to students on campus, with teletherapy at the top of the list. MindShift