Challenges and Gaps

The literature indicates that there is very limited evidence available on best practices for mental health crisis response in colleges and universities. Moreover, in the context of the COVID-19 pandemic, crisis services focus on crisis lines and forms of online counselling; however, considering the unprecedented nature of the pandemic, literature on this subject is still emerging. Outside the context of the pandemic, the existing literature focuses primarily on crisis prevention and utilizing behaviour/crisis intervention teams and community partnerships to support students in crisis. Specifically, a common recurring theme is close communication and collaboration with both internal and external stakeholders. By including a variety of stakeholders in the dialogue around campus mental health, campuses are able to expand upon the resources made available to students, as well as learn from the valuable perspectives of different stakeholders to improve program and service delivery (Drum, Brownson, Denmark & Smith, 2009).

One major gap in the literature involves the efficacy of existing interventions, including virtual care options, that are currently prevalent. Given the difficult scope of the problem, these crisis interventions are lacking in monitoring and evaluation. This highlights the need for better assessment and evaluation of existing protocols, as well as a comprehensive approach to mental health crisis response.

In 2006, The Jed Foundation published the Framework for Developing Institutional Protocols for the Acutely Distressed or Suicidal College Student as a response to a lack of consensus among post-secondary institutions surrounding what entails a comprehensive crisis response (The Jed Foundation, 2006). The framework covers the key points to consider when developing a safety protocol, including:

• What the roles of campus staff are and who holds the ultimate accountability for the response
• When students are required to sign a Release of Information (ROI), whether to involve a student’s potential off-campus mental health clinician
• How to support students in crisis outside of regular business hours
• How to determine if hospitalization is the best option
• Whether there is an affiliation agreement with local hospitals
• What the process is for transporting students to hospitals

The framework emphasizes collaboration with stakeholders on- and off-campus. Despite being over a decade old, the framework accurately encompasses the idea of student mental health as a community and campus-wide issue. This is in line with the ongoing shift to involve all campus personnel in supporting student mental health and increasing mental health literacy and knowledge of resources across the whole-campus. Furthermore, a part of the framework encompasses suicide prevention efforts that consist of matching the resources available to the demands for service; however, many students continue to experience long wait-times to access services which can contribute to an increased number of mental health crises. Counselling centres were already overwhelmed with the mental health crisis on campus prior to the pandemic, and now are experiencing increased demand for service. It is also important to acknowledge the exacerbated effects of vicarious trauma on support staff in the context of the pandemic. The framework provides institutions with guidance on issues to consider during the development of protocols related to suicide but does not provide concrete steps on implementation. This is reflective of the current state of the literature and existing interventions, as there is a lack of established best practice protocols to support campus-wide mental health.