UCLA helps California community colleges address depression

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The University of California, Los Angeles, has launched a new center dedicated to studying and treating depression among students at California community colleges.

Leaders of the new ALACRITY center, or Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, plan to launch multiple research projects focused on the mental health of students starting this upcoming academic year. The research builds on an ongoing partnership with the Los Angeles County Department of Mental Health and the university’s Depression Grand Challenge, a large-scale effort spearheaded by UCLA scholars to combat the toll of depression. The projects are being funded by a five-year, $12 million grant from the National Institute of Mental Health.

Michelle Craske, co-director of the ALACRITY center and the Depression Grand Challenge at UCLA, said depression not only affects the person suffering but has an “extensive” ripple effect on societies at large.

“It affects not only the individual’s well-being and emotional functioning [but also] job performance, parenting and involvement in the community,” said Craske, who is also a distinguished professor of psychology, psychiatry and biobehavioral sciences at the university. Depression is “very impactful. It’s common, and yet existing treatments are only partially effective.”

She and her colleagues want to figure out how to extend “gold-standard” care to community college students, who are disproportionately from low-income backgrounds and experience a unique set of mental health challenges while typically having less access to mental health resources on their campuses. A 2021 report by the Hope Center for College, Community and Justice at Temple University found that 39 percent of students at two-year institutions faced food insecurity compared to 29 percent of students at four-year universities.

“In community colleges, there’s a very diverse array of life contexts that I would say collide with and mutually exacerbate mental health problems,” Craske said. “This is a group that’s underresourced, facing enormous life challenges and yet highly resilient. Because despite the food insecurity, despite the financial problems, despite being a single mom, despite being a veteran with PTSD, they’re going to college and they’re trying to advance their lives.”

Researchers at the center will conduct a five-year study that enrolls about 200 East Los Angeles College students each year in the Screening and Treatment for Anxiety and Depression, or STAND, program, starting this fall. The program, introduced at UCLA in 2017 and rolled out at East Los Angeles College in spring 2021, surveys students online about whether they’re experiencing anxiety, depression and suicidal ideation and then guides them to one of three levels of care depending on the severity of their symptoms.

The students are either led through an online curriculum that teaches stress coping mechanisms, connected with trained peer coaches over video chat or sent to clinicians who can provide them with in-person counseling and medication as needed. Researchers will check in weekly with students who opt in to the study as they move through the STAND program over the academic year. They’ll be asked about a range of factors that could affect their mental health and treatment needs, such as substance abuse issues, medical and family history, and food and housing insecurity. Those variables will be used to inform an algorithm tested in the study to potentially improve how students are sorted into different tiers of care.

Craske said the goal of the study is to assess how “the whole context of the individual”—including childhood trauma or adversity, medical problems, past experiences with mental health treatment and their level of social support from friends and family—affects the level of treatment students might need.

“This has huge value for the clinical world in general,” she said. “Almost everyone relies upon symptom severity, but you can imagine, for example, someone who’s only moderately anxious or moderately depressed, but they’ve got no social support in their life, they’re financially stressed, they’ve got medical issues going on. They might actually benefit from a clinician even though their severity level is moderate.”

Jessica Olivas, coordinator of the Student Health Center at East Los Angeles College, said many students on campus are the first in their families to go to college and may be unaccustomed to reaching out for help.

One of the advantages of rolling out the STAND program at the college has been “students can easily pick up an electronic device, their phone, their tablet, and have mental health care accessible,” which is a major asset during the pandemic, she said.

Sonia Lopez, dean of student services at East Los Angeles College, added that the program can be a less intimidating entryway to mental health care since it starts with online questions rather than a meeting with a therapist. She hopes the ALACRITY center’s research at the college can be a resource to administrators at other two-year institutions looking to improve their mental health services.

“As educators, we’ve known that mental health is something that we need to address, definitely with our students at the community college level,” she said. “And there’s very little research that is done on this population” in terms of their mental health. She believes that’s partly because two-year institutions lack the research infrastructure of many universities and because they’re often commuter campuses, “so it’s really difficult to see and observe students for a long period of time, other than the time that they’re in class.”

She’s grateful the college will be a part of an expanding the body of research on the mental health needs of community college students.

ALACRITY center researchers also chose 10 community colleges in the Los Angeles area, including East Los Angeles College, to participate in another study involving the Healthy Minds survey, an assessment of student mental health conducted at colleges and universities around the country for the last 15 years by a team of scholars. The survey will be given to a sample group of at least 5,000 students on each of the campuses to assess rates of depression, anxiety and substance use among their student bodies, plus their use of various mental health services available on their campuses and any barriers to accessing them.

Daniel Eisenberg, a professor of health policy and management at UCLA who heads the Healthy Minds survey, said the goal of the project is to “help the schools get a more precise picture of what their students might need” and “further make the case for bringing more resources toward student mental health at these schools.”

Each community college will ultimately receive a report with survey results from their individual campuses. A comprehensive report will also be sent to the California Community Colleges chancellor’s office to help system leaders advocate for more funding from the state for mental health resources on their campuses, Craske added.

Nance Roy, chief clinical officer at the Jed Foundation, an organization dedicated to emotional health and suicide prevention among young people, pointed out that community colleges enroll traditional-age students, an age group known for high rates of depression and anxiety, but they also disproportionately serve older adult learners who wrestle with a different set of challenges.

Older students may be confronting situations like “dealing with aging parents or childcare or trying to juggle jobs and school or jobs, school and family, financial constraints,” she said.

Meanwhile, the pandemic shed light on and exacerbated already increasing mental health challenges among college students.

“During the pandemic, many, many people suffered losses, whether it was people dying that they know or family members, maybe parents, who lost jobs, fighting housing insecurity and food insecurity that ensued as a result, certainly isolation and loneliness for young people,” she said. “Just because the pandemic is perhaps on a decline doesn’t mean the impact of those traumas goes away. They are coming to campus grieving and with losses and with anxieties.”

Markie Pasternak, senior manager for higher education at Active Minds, an organization focused on promoting young adult mental health, said now feels like a fertile moment for an initiative such as the ALACRITY center’s because there’s a lot of “buy-in” among higher ed leaders and funders to support efforts to develop better mental health services.

“We’ve done a really great job I think in the last 10, 15 years of destigmatizing mental illness and mental health treatment,” she said. “I think a lot more people now want to talk about mental health and are more open to the conversation, but the next question a lot of folks have is, how do you talk about mental health? The awareness is there, especially after the pandemic, but now that we have the majority of people on board with mental health in a destigmatized way … how do we now mobilize that?”

Eisenberg noted that the ALACRITY center is starting its work at a time when virtual mental health services are garnering more interest and the potential benefits are being explored.

“We’re at a point where we know digital mental health resources can be very helpful, but we haven’t quite figured out how to deliver them at scale,” he said. “The key is going to be integrating digital resources with in-person communities that people are already a part of,” because otherwise these resources are often ignored or overlooked. “I think the fact that we’re working with community college communities, like real communities where people live and where people work, in tandem with digital resources, I think that’s really the power of this whole approach.”

Craske hopes the reach of the ALACRITY center eventually extends beyond Los Angeles and beyond California.

The long-term goal is to build “a template that can be transported” to community colleges across the country to improve their mental health services, she said. And that template can “make the life of these college students who are showing such resilience and motivation to keep going … easier and make their academic success more likely by addressing their mental health needs.”

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