Equity in Mental Health Framework Launches

Ashira Morris / December 21, 2017

The Steve Fund and the Jed Foundation co-created the unprecedented recommendations for students of color

As diversity and inclusion continue to top higher education priority lists, there is now a framework for colleges and universities to better support the mental health and well-being of students of color.

Co-created by the Steve Fund and the Jed Foundation, the Equity in Mental Health Framework consists of 10 expert-informed recommendations, each with strategies for implementation. The framework suggests steps that schools can take through both policy and practice to improve mental health care for students of color.

Students of color tend to face higher barriers to mental and emotional health care on campus, a compounding effect of being less likely to arrive with a diagnosis than their white peers, more likely to feel isolated, and less likely to seek help from a mental health professional, according to a 2016 survey by the Steve Fund and the Jed Foundation.

The framework provides an evidence-informed way to address those barriers. Based on an extensive literature review, a survey of colleges across the country, and input from campus leaders and mental health professionals, the framework is an unprecedented and promising tool to help colleges provide the necessary access and opportunities for students of color, who make up 40 percent of the 20 million students attending college in the U.S.

Only 9 percent of students accessing mental health services identify as African American compared to 68 percent who identify as white, according to the latest annual report from Penn State’s Center for Collegiate Mental Health. Those numbers don’t even reflect the number of students on campus who may have needed mental health services but didn’t access them.

“I believe it is our most important endeavor to date,” Evan Rose, President of The Steve Fund said at the foundation’s annual Young, Gifted & @Risk conference in November. “When we started the Steve Fund in 2014, we knew that colleges and universities had a vital role to play in filling urgent gaps to better support the mental health of young people of color. We did not suspect, however, that the situation would become even more dire as developments have unfolded over the recent year.”

Away from a race-blind approach
The first recommendation is to “identify and promote the mental health and well-being of students of color as a campus-wide priority.” To implement this recommendation — and to improve a campus health system — requires shrugging off a color-blind approach from the top down.

Students of color face a host of challenges, from microaggressions to stigma around mental health care. When naming the framework, the foundations deliberately chose “equity” over “equality” to reflect that everyone is not starting from the same point due to forces beyond their control, like race or ethnicity.

“Equality doesn’t do much for people who experience life differently due to their greater likelihood of exposure to bias or discrimination,” said Alfiee Breland-Noble, Senior Scientific Advisor to the Steve Fund, who worked extensively on the framework.

The response to the framework has been powerful. The foundations have connected with more than 500 higher education professionals interested in implementing it.

Some college presidents have been on board from the beginning. John DeGioia, president of Georgetown University, spoke to the need for such a framework to a closed-door meeting of 130 higher education professionals in February before the recommendations were public.

“This is a very special moment and we need to seize the opportunities present here to provide the best communities for all of our students,” he said. “I think every college and university president must understand how urgent it is to tend to these dynamics.”

Beyond centering the issue administratively, the third recommendation goes a step further — advocating for efforts to actively recruit, train, and retain a diverse and culturally competent faculty and professional staff.

LeAnna Rice, a campus advisor with the Jed Foundation who is helping disseminate the framework, was a counselor before joining the foundation. She was often the only non-white counselor on staff, and as a result she had many students of color on her caseload. It’s no accident: when students are seeking help, they want to be understood. For a student of color walking into an all-white counseling center, the persistent question is, “Is this space for me?”

“I feel so very strongly about this one,” Rice said while presenting the framework at Young, Gifted & @Risk. “Students want to feel there are people they can identify with in high positions that they can see themselves in. I don’t know how many times students have told me, ‘I didn’t know there were black people studying science at Ph.D. levels’ or, ‘I didn’t know I could be a black therapist.’“

The recommendation encompasses not only bringing diverse faculty on board, but investing in their success. It steers schools away from hiring young faculty of color only to ignore their professional advancement and encourages a cycle that can inspire the next generation.

“It’s not just about bringing people in to let them rot on the vine,” Breland-Noble said. “Students need to see that you’re not just here today but that they can be where you are tomorrow.”

While most of the research was conducted at historically and/or predominantly white institutions, Historically Black Colleges and Universities (HBCUs) and Latinx-serving schools where students of color are the majority on campus can also benefit.

“At HBCUs, the issue is centering mental health within race and culture instead of centering race and culture within mental health,” Breland-Noble said.

When the Black Lives Matter movement started, for example, Howard students were at the vanguard of the movement. The fourth recommendation suggests creating opportunities to engage around national and international events. In the context of a predominantly white institution, that conversation might be a safe space for black students to discuss the national movement. At a HBCU, it is still a necessary dialogue but for different reasons.

“How do we help campuses teach students that activism is integral part of their culture as HBCU students, but also that they can do better than their ancestors by prioritizing their mental and emotional well-being?” Breland-Noble continued. “It becomes a process of working with the recommendations to infuse self-care into the conversation.”

Grounded in evidence
The work began in 2015, when the foundations contacted Stephanie Pinder-Amaker, Director of the McLean College Mental Health Program, to collaborate on a comprehensive literature review of programs for the mental health and emotional well-being of students of color.

It was about a year before students of color started receiving national media attention for coming to their school administrators and asking for change. Their requests often were for the types of services the framework now suggests.

“The timing was really interesting because as that was evolving on campuses nationally, we were already entrenched in the study,” Pinder-Amaker said.

Recommendations like engaging students to provide guidance and feedback on programs for their own well-being (the second recommendation) and actively training a diverse counseling staff (the third) have frequently been on the list of changes students of color advocate for on their campuses.

Although they found numerous studies indicating that students of color have higher levels of distress and are less likely to receive services on campus, none of the studies in literature review included evidence-supported programs.

They also asked 1,500 schools what programs they had in place for students of color, and how they assessed the success of those programs. Responses from 23 schools included a total of 84 programs. None were evaluating their success.

Recommendation #9 addresses the lack of data on current programming, encouraging the higher education community to use culturally relevant programs and collect data on its effectiveness.

“It’s critical that we’re not going on gut instinct,” Pinder-Amaker said. “We have to connect our programming and practices to data if we want to be successful in improving mental health outcomes. We also need to share that information to move the dial forward in a timely way.”

Anyone can access the recommendations online, where a representative from the foundations can lead them through a conversation about what they currently have available on their campus, and what they can do going forward. Administrators can choose from a menu of options, and the organizations will collaborate to help schools decide what to “order,” from in-person trainings to webinars to campus workshops — a wealth of opportunities for schools to implement. Ultimately, it’s in the university administration’s hands to choose what to pursue.

“We’re the GPS, not the driver,” Breland-Noble said. “You can choose to follow it or not.”


“A life-saving checklist”

The recommendations come nearly a decade after Atul Gawande wrote about the life-saving power of checklists in hospital Intensive Care Units for The New Yorker. The list, written by a doctor at Johns Hopkins Hospital, laid out specific steps toward preventing infection. The items to check were often simple, but before the checklist was implemented, doctors often forgot to do them. After a year of using the checklist in at the hospital, the infection rate in the ICU dropped from 11 percent to zero.

A decade ago, the Steve Fund didn’t exist. The foundation’s explicit mission is to advance the mental health and emotional well-being of students of color. They believe that the Equity in Mental Health Framework has similar life-saving potential.

When Breland-Noble was in grad school, she remembers feeling “in the hinterlands” researching these issues. Now, with an organization putting them on a national stage, “you have a galvanizing force,” she said.

“There’s a shared interest and a shared vision,” she continued. “Twenty years ago, we talked about it. Ten years ago, we wrote about it. Now we’re doing it. Ten years from now, I think people will say, ‘They gave us a foundation.’ They will have a model that can go even farther.”