Dan Artamenko, Seward County Community College

Nefer Bovea, City University of New York

Amanda Harrison, American University

Laura McCann, Vanderbilt University

Molly McKeon, Providence College

Abstract

College students across the US report increasing levels of anxiety and depression, straining campus mental health resources. This can increase strain on existing campus mental health resources; requiring college administrators to pursue innovative options to meet this increasing demand.  Simultaneously, student populations are becoming increasingly diverse and engaging in culturally responsive care via counseling centers and school resources for added support. This case examines the impact of barriers to accessing mental health care through the experience of an undocumented, queer woman of color and the fallout from administration’s response to student concerns.

Keywords- culturally responsive care, mental health, community college, non-citizen student, undocumented students, Latinx, Hispanic Serving Institution, counseling, rural community college, student support services, LGTBQ+ students, Intersectionality 

Setting

Springfield is a small, rural town of approximately 20,000 people, with 65% identifying as Hispanic or Latinx.  The town is 80 miles from another comparable size town and over 4 hours from a city of over 100,000 people. The major economic driver in Springfield is the agriculture industry, including livestock processing plants. Due to the agriculture industry, the town is very stable and has all the necessities required to support its citizens. From major big box stores to medicine, the town is self-sufficient, albeit with limited options.

Mid-Valley Community College enrolls 2,467 students, with approximately 39% of the students enrolled full-time. Designated as a Hispanic Serving Institution (HSI), over 60% of the students are of Hispanic or Latino descent, and over 70% identify as racial minorities. While Mid-Valley Community College is part of the state system and primarily serves to offer transferable classes to a 4-year program, it also offers multiple technical degrees to meet the growing workforce demands of Springfield. Mid-Valley Community College has developed great partnerships throughout the entire community of Springfield. 

Through public and private partnerships, any graduate of Springfield High School can receive a full tuition and book scholarship to Mid-Valley Community College for two years.  This includes non-citizen/undocumented students who do not qualify for federal financial aid. Despite being a small college with limited services, Mid-Valley Community College students can take advantage of plenty of community partnerships, including mental health services with a local counseling center.

Case Scenario

Simone is a 19-year-old sophomore student who attends Mid-Valley Community College. She identifies as a queer woman of color from Venezuela. Simone is an undocumented student, uninsured, and recently came out as queer to her partner. This identity shift has produced feelings of anxiety and depression. She is considering seeking mental healthcare for support and for stressors stemming from her newfound identity. 

On a Friday afternoon in October, Simone decided to go to the Student Success Center, where she has built a good rapport with staff. She met with Cassie, her trusted academic advisor, and shared her feelings of anxiety and lack of focus. Cassie suggested a referral to the local counseling center. Mid-Valley Community College has a contract with the local counseling center, The Greater Good Counseling Center, where free counseling services are supplied to insured and uninsured students. The policy at the Student Success Center is that once a referral is needed, a request must be made to Dr. Brown, Dean of Student Success, who then makes the official referral to the counseling center.

Simone appeared reluctant to go ahead with Cassie's referral for fear of feeling found out as queer and going against her cultural values, where privacy is sacred. Cassie shared her limitations as an advisor and explained the counseling center would be better able to help. It is a quarter to 5:00 pm and Cassie needs to head home to tend to her own family. She then explains that getting an appointment can take a few weeks, so the earlier Simone decides, the better.  Simone shared her hesitation with accessing and using the off-campus resource, but with some additional coaxing, Simone finally agreed at 4:55 pm to be referred off campus. Cassie quickly submits the request to the Dean of Student Success, who coordinates a meeting with Simone for the Wednesday of the following week.

After an hour-long meeting that Wednesday with Simone, Dr. Brown submits the referral to the Greater Good Counseling Center. Simone calls to make an appointment, which is scheduled for two weeks away. Dr. Brown typically facilitates around 10-12 weekly requests to the off-campus counseling center. The Greater Good Counseling Center is across town from the Mid-Valley Community College campus and requires 2 buses or a 15-minute car ride from campus. The Director of the Greater Good Counseling Center, Dr. Goldie Klein, works closely with Dr. Brown to process the referrals and assign cases to her small team of certified mental health counselors.

Many students do not follow up with their appointment, including Simone. 

Recently, there has been a high volume of feedback and complaints across campus from students to the Student Success Center about the lack of mental health support and demand for a counseling center to be on campus. Enough complaints come in to reach, Dr. Thomas Hunter, the vice president of student affairs. He requests a report from the Dean of Student Success on the number of referrals and a report from the Greater Good Counseling Center on the number of appointments scheduled and kept by the students. He consults with the Strategic Planning Team and Institutional Research to find a solution to the complaints.

In early January, Dr. Hunter sends the following email to the entire student body:

Dear Students,

As we begin the new semester, I would like to share with you some reflections on our student health care resources, particularly our mental health resources.

Over the past semester, many students have expressed concerns over access to mental healthcare. This is feedback we take very seriously. Emotional wellbeing is critical to thriving in college and beyond. 

Over 200 students were referred this fall to the mental health service provider, Greater Good Counseling Center, in Springfield that offers free care to full-time Mid-Valley College students.

Yet clearly several students have frustrations related to access. To gain a better sense of what may be impacting these concerns and how we can improve access, we have looked at the data. I would like to share with the community a troubling trend that emerges.

Our partner provider is experiencing a significant rate of unkept mental health appointments.

·       Over 50% of all referrals to a provider did not result in the scheduling of even an initial appointment.

·       Around 20% of all appointments made with our partner provider were not attended.

·       Out of the 200 referrals to Greater Good Counseling, there were 48 late cancellations (canceled on the same day, which is often not enough notice to fill the appointment).

·       Around 31% of all students served by our partner provider were no-shows at some point.

We ask that students be mindful of the realities of scheduling and the needs of others by making and keeping appointments and providing notification well in advance if an appointment cannot be kept. We understand this can sometimes be difficult, but it is important.

Let us all work together to ensure that services to support the emotional wellbeing of our community are utilized thoughtfully so that those who seek them can benefit.

Sincerely,

Dr. Thomas Hunter

Vice President of Student Affairs

After voicing her concerns about the challenges of accessing and using the off-campus mental health services, Simone was hurt and surprised by the campus-wide email she received. Simone turned to one of her closest friends at the college, Taylor, to share her distress. She shared with them how it felt like a slap in the face to be told that the difficulty in accessing mental healthcare was somehow her fault. Taylor was not just a fierce friend, but passionate about speaking truth to power in their role as the college’s student newspaper editor. 

In a fiery editorial, Taylor called out the administration for the victim-blaming nature of its email: “The university is blaming students for showing mental health symptoms to excuse their inadequate services. This email shows the lack of understanding the administration has and the disregard for student voices.” The article also included two anonymous staff statements from the Student Success Center, supporting the movement for better access to mental health support. The opinion piece’s post received scores of student responses in the comment section agreeing with its contents and providing a variety of personal stories outlining their struggle to attend appointments off-campus. Shortly after the op-eds posting, local news sources picked up the story, running quotes from several angry students.

Three days following the article’s release, the college administration sent out a new email, stressing how much they care about the health and wellbeing of their students and promising to “undertake a study of the cost and feasibility of providing on-campus counseling services” during their next strategic planning cycle.

Key Players

Simone, Student: Simone is a 19-year-old sophomore attending Mid-Valley Community College. She identifies as a queer woman of color from Venezuela. She immigrated with both of her parents via Mexico when she was 5 years old and does not remember her home country too much, but places high importance on the cultural values set by her parents at home. Simone is an undocumented student, uninsured, and recently came out as queer to her partner. This identity shift has produced feelings of anxiety and depression. She has a 4.0 GPA and is heavily involved in student clubs across the campus but is considering seeking mental healthcare to support her new identity and stressors stemming from her newfound identity. Cultural norms in her family and community dictate that you keep secrets to yourself and if you need to share any confidential information, you go to church on Sundays and confess privately to the Catholic priest. Simone is under a significant amount of pressure to keep up her grades, as she does not want to disappoint her parents and be the talk of her community. She wants to express who she really is and to earn her degree, which will allow her to pursue creative writing at a 4-year university in California.

Dr. Goldie Klein, Greater Good Counseling Center Director: Dr. Goldie Klein has lived near Mid-Valley Community College her entire life and is an alum of Mid-Valley. She identifies as a white woman of Jewish ancestry and is proud of the collaboration she has forged with the Dean of Student Success, Dr. Brown. She has 5 counselors available, 2 full-time and 3 part-time. All the counselors identify as white females. Dr. Klein acknowledges the importance of diversifying her staff to serve the town’s population better but is frustrated by the “lack of qualified candidates.” Dr. Klein is passionate about helping immigrants who come to the community to escape poverty and violence. She believes in serving all students and is eager to support uninsured students and/or undocumented students. 

Dr. Brown, Dean of Student Success: Dr. Brown has been a seasoned professional at Mid -Valley Community College for 22 years. He assumed the role of Dean 6 years ago after earning his doctorate in educational leadership. He is proud of his own experience as an immigrant, working his way up the ladder. His expertise is in Career and Professional Development, and he is passionate about preparing students for the workforce. Dr. Brown has seen a significant increase in the number of referrals for mental health over the past few years and is frustrated by the lack of resilience in today’s student body. 

Dr. Hunter, Vice President of Student Affairs: Dr. Thomas Hunter has been at Mid-Valley Community College for the past 12 years. He leads with a data-driven and adaptive leadership style and is careful to show limited emotion when problem-solving and negotiating new strategies for the college. He assumed the Vice President (VP) of Student Affairs role after the former VP left with little notice. He was the interim for 6 months and became the official VP a year ago.  Since assuming the role, Dr. Hunter has endured pressure from the Board of Trustees to reduce expenditure. Student retention is low, contributing to an impending budget crisis. 

Cassie, Student Success Advisor- Cassie is a dedicated professional who strives to help and advocate for her students while being a supportive mother to her three young children. She grew up in the area and when she was allowed to join the Student Success Center, she realized she had found her purpose; however, Cassie is finding her role increasingly challenging, and struggles to meet the demand of student needs. She meets with anywhere from 15-20 students a day, whose challenges and situations typically extend beyond the type of support she can provide. Cassie feels exhausted at the end of each day and struggles to meet work-life balance. She is frustrated by her supervisor’s lack of awareness and concern for staff and student needs. Cassie was asked to interview for the editorial by Taylor, however she was unsure how to respond. She wants to stand up for students' rights and well-being, but fears being fired. Cassie has roots in this town and does not feel she has other options, especially because the next closest college is a 2-hour drive away.

Teaching Notes

Increasing College Mental Health Needs & Culturally Responsive Care at the Intersections     Increased Prevalence of Mental Health Issues: Lipson et al. (2022) analyzed data from a Healthy Minds survey conducted from 2013-2021. The data comes from over 350,000 students (about half the population of Vermont) across 373 college campuses. The survey and analysis highlight how the prevalence of mental health issues is outpacing the number of students finding and receiving support. This is most true for non-White identifying students (Lipson, et al., 2022). In 2020–2021, more than 60% of students met the criteria for one or more mental health problems, a 50% increase from 2013 (Lipson, et al., 2022). The highest annual rate of past-year treatment for Asian, Black, and Latinx students was at or below the lowest rate for White students (Lipson, et al., 2022). Additional statistics from the National Alliance on Mental Illness (2012) share that 64 percent of students who drop out of college do so because of mental health problems, and 50 percent of those who dropped out did not access mental health services before doing so (p. 8).

Minority Stress Theory & Intersectionality: Kalibatseva et al. (2022) define Minority Stress Theory as the postulation that minoritized individuals are at greater risk for health and psychological problems due to the “excess stress to which individuals from stigmatized social categories are exposed, often as a result of their minority position” (p. 295). Researchers have utilized the theory to explain higher incidence of psychological problems in minoritized populations. The theory incorporates intersectionality, which refers to “analytic approaches that simultaneously consider the meaning and consequences of multiple categories of identity, difference, and disadvantage” (Kalibatseva et al., 2022, p. 297). Individuals identifying with multiple, intersecting nondominant groups increased the client’s risk for depression (Kalibatseva et al., 2022). For example, evidence supports higher risk for mental health incidence among LGBTQ racial/ethnic minoritized students compared to LGBTQ whites (Kalibatseva et al., 2022). It is imperative to supply culturally responsive services to diverse individuals, especially those at the intersection of multiple marginalized identities (Kalibatseva et al., 2022).

Contextualizing Latinx Mental Health Care: Mental health is often a stigmatized topic resulting in delayed access to care, especially for the Latinx/Hispanic community. According to Mental Health America (2019), this delay compounds the range of experiences that may lead to mental health conditions, including “immigration, acculturation, trauma, and generational conflicts” (para. 2). Research suggests Latinx individuals are more likely to experience mental health disparities relative to the majority non-Latinx white populations (Zvolensky et al., 2021). Beyond experiencing an increase in mental health symptoms, they may lack access to care or evidenced-based therapeutic approaches for such problems (Zvolensky et al., 2021). As a further barrier of access to care, 18% of Latinx/Hispanic people in the U.S. do not have health insurance. In 2018, 56.8%  of Latinx/Hispanic young adults 18-25 and 39.6%of adults 26-49 with serious mental illness did not receive treatment (Mental Health America, 2019).

Vulnerabilities associated with Undocumented Student Status: Undocumented status further compounds mental health challenges. According to Enriques et al., one out of every 50 students enrolled in postsecondary education in the United States identify as undocumented (2021). It is important to note undocumented students’ experiences are contextualized and nuanced based upon state, local and institutional law and policy (Enriques et al., 2021). Structural marginalization and exclusionary experiences at each of the aforementioned levels results in “discrimination, social exclusion, the threat of deportation, and economic insecurity” (Pierce et al., 2021, p. 246). These experiences have direct effects on depression and anxiety symptomology and impact undocumented students’ access, retention, and performance within higher education (Enriques et al., 2021).

 A survey study conducted in California found 76% of undocumented students report academic distraction to their own immigration issues, and 66% due to family immigration issues (Enriques et al., 2021). Further, 38% of undocumented students report thoughts about their own deportation once a week or more, and 50.4% think about parental deportation once a week or more (Enriques et al., 2021). The shifting political landscape leaves many students feeling increased vulnerability, fear and anxiety (Pierce et al., 2021).  In addition, research indicates food insecurity, experienced by 59.1% of the California survey study (Enriquez et al., 2021), is associated with mental disorders among children and adolescents in the U.S. (Pierce et al., 2021). According to Pierce et al., “the accumulation of chronic stressors, whether anticipated or experienced, is associated with higher levels of allostatic load, which is a pathway for adverse health, including affective disorders, susceptibility to infections, and an earlier onset of disease” (2021, p. 248). These chronic stressors culminate in 30.8% of undocumented students from the California survey study reporting anxiety and/or depression symptoms at a level warranting clinical treatment (Enriques et al., 2021).

Addressing Needs of LGBTQ+: It is widely known sexual minorities face prejudice and discrimination (Bourdon et al., 2021). A study exploring mental health service utilization among LGB+ college students identified that compared to students identifying as straight, LGB+ students were 105% more likely to receive treatment for anxiety, 206% more likely to receive treatment for depression, and 194% more likely to see a counselor/ therapist (Bourdon et al., 2021); however, the increased mental health concerns does not necessarily result in specific, culturally responsive programming. 70% of college websites do not mention individual service options for LGB+, and only 16% employed counselors who discuss experience with LGB+ population (Bourdon et al., 2021).

Guidance for Discussion and Analysis

Questions

Instructors may divide the class into four small discussion groups and assign each to a key player and set of issues to unpack in the question clusters below. After coming back together to share what was discussed, the instructor may prompt students to delve more deeply into several critical topics relevant to the case study (see Potential Topics to Explore). Finally, as a full group, instructors can explore the larger issues of institutional responsibility for student mental healthcare and how to develop and communicate non-performative solutions under constrained budgets.

Small Group Questions:

• Review Simone’s key player description. Describe the barriers uninsured and/or undocumented students may have to have mental health care. How does the institution attempt to remedy these barriers? Where do they fall short?
• Review Dr. Hunter’s key player description. How can data be used to evaluate the state of mental health on campus? How effectively did Dr. Hunter, use data in this scenario? What data was available? What data was needed?
• Review Dr. Brown and Cassie’s key player descriptions. How might Dr. Brown’s leadership style influence the staff of the Student Success Center? What adjustments or strategies may he used to support Cassie and other staff better? How may this affect students, and student outcomes? 
• Review Dr. Klein’s key player description. Describe the intended and unintended consequences of not having a diverse counseling staff. Describe what Dr. Klein could do to be more culturally responsive in the care provided by the clinic.

Large Group Questions:

• What should be the role of institutions in the mental health care of their students? How should it change? 
•  How can the institution work towards non-performative resolutions? Who needs to be at the table of these decisions/ resolutions? How does social media factor into the institution’s response?

Potential Topics to Explore

The following topics emphasize elements of the case that can be explored deeper within and/or beyond the discussion of the questions above. The instructor may provide additional prompting to develop the discussion on these critical issues further.

• Data in decision-making: collection, analysis, disaggregation
• Serving non-citizen students
• Serving LGBTQ+ students
• Intersectional identities
• Mental health stigmas
• Mental Healthcare: location, quality, quantity
• Culturally responsive
• Student media, mass media, social media
• Employee burnout
• Student support policies and process

Note about the use of the phrase “Victim blaming”: The authors do not intend Simone or other students in her position to be viewed by readers as victims. The use of the phrase is meant to convey the strong feelings of students in the face of an administrative response that does not seem to acknowledge or support their needs.

References

 Bourdon, J.L, Liadis, A., Tingle, K.M., & Saunders, T.R. (2021). Trends in mental health service utilization among LBG+ college students. Journal of American College Health, 69(7), 750-758.  https://doi.org/10.1080/07448481.2019.1706537

Enriques, L., Chavarria, K., Rodriguez, V., Ayon, C., Ellis, B.D., Hagan, M.J., Jefferies, J., Lara, J., Hernandez, M.M., Murillo, E.G., Najera, J.R., Offidani- Bertrand, C., Fujimoto, M.O., Ro, A., Rosales, W.E., Sarabia, H., Soltero Lopez, A.K., Valadez, M., Valdez, Z., & Pierce, S.V. (2021). Toward a nuanced and contextualized understanding of undocumented college students: Lessons from a California survey. Journal of Latinos and Education, 20(3), 215-231. 

Kalibatseva, Z., Bathje, G.J., Wu, Ivan H., Bluestein, B.M., Leong, F.T., & Collins-Eaglin, J. (2022). Minority status, depression and suicidality among counseling center clients. Journal of American College Health, 70(1), 295-304. https://doi.org/10.1080/07448481.2020.1745810

Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M., & Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ethnicity: Findings from the National Healthy Minds Study, 2013–2021. Journal of Affective Disorders, 306, 138–147. https://doi.org/10.1016/j.jad.2022.03.038

Mental Health America. (2019). Latinx/Hispanic communities and mental health. Retrieved January 5, 2023, from https://www.mhanational.org/issues/latinxhispanic-communities-and-mental-health

National Alliance on Mental Illness (2012). College Students Speak: A Survey Report on Mental Health. Retrieved January 10, 2023, from https://www.nami.org/Support-Education/Publications-Reports/Survey-Reports/College-Students-Speak_A-Survey-Report-on-Mental-H National Alliance on Mental Illness (2022). Hispanic/Latinx. Retrieved January 10, 2023, from https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Hispanic-Latinx

Pierce, S.V., Haro, A.Y., Ayon, C., & Enriquez, L.E. (2021). Evaluating the effect of legal vulnerabilities and social support on the mental health of undocumented college students. Journal of Latinos and Education, 20(3), 246-259. https://doi.org/10.1080/15348431.2021.1949990

Zvolensky, M.J., Kauffman, B.Y., Bogiaizian, D., Viana, A.G., Bakshaie, J., & Peraza, N. (2021). Worry among Latinx college students; relations to anxious arousal, social anxiety, general depression, and insomnia. Journal of American College Health, 69(5), 529-536.  https://doi.org/10.1080/07448481.2019.1686004

About the Authors

Dan Artamenko currently serves as the Director of Athletics at Seward County Community College.  Dan provides strategic leadership for over 200 student-athletes and guides the department across campus. He is currently enrolled as a doctoral student at the University of Colorado Denver-Anschutz School of Education and Human Development with a focus on Educational Equity in Higher Education.

New York State certified mediator, change agent, and higher education practitioner with 15+ years of equity-focused leadership. Experience building collaborative solutions to implement organizational change initiatives rooted in program development, assessment, and evaluation to achieve sustainable outcomes. Nefer is an Associate Director for ASAP at Kingsborough Community College. She enjoys connecting with others and loves to knit. 

Amanda Harrison serves as the Assistant Director of Honors and Scholars Programs at American University in Washington, DC. She is also an adjunct instructor in community-based research, fostering responsible, solidarity-based connections between undergraduate students and the local DC community. Amanda is pursuing her doctorate in leadership for educational equity with University of Colorado Denver’s School of Education and Human Development.

Laura McCann serves as the Assistant Director of Student-Athlete Enrollment at Vanderbilt University in Nashville, TN. In her role, she liaises between coaching staffs and the admissions office to get student-athletes admitted and acclimated to the University. She is currently a doctoral student at the University of Colorado Denver-Anschutz School of Education and Human Development with a focus on Educational Equity in Higher Education.

Molly McKeon is an experienced administrative leader and educator. Molly is the Assistant Director for Accessibility Services and Adjunct Faculty for the Master’s in Higher Education program at Providence College. She is also serving an elected term as Treasurer on the board of New England's Association of Higher Education and Disability (AHEAD) Chapter. Prior to joining Providence College in 2020, Molly was a special education teacher in South Carolina and served as Director of ACCESSibility at Mercy University, an Hispanic Serving Institution (HSI) in New York. Molly is pursuing her EdD in Leadership for Educational Equity at the University of Colorado Denver, where she is focusing on institutional adoption of Universal Design for Learning pedagogy. 

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