CLINICAL HEALTH SERVICES

Clinical Health Services in Higher Education:

Serving Students in Body, Mind, and Morale

Samuel Fairbanks, Cristina Valencia

Department of Educational Leadership, California State University, Fresno

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Abstract

This paper documents the importance of Clinical Health Services on college and university

campuses as outlined in The Council for the Advancement of Standards in Higher Education.

Clinical Health Services plays a salient role in the well-being of students in Institutions of Higher

Education across the country. Within this document we provide a history as well as current

issues facing Clinical Health Services, such as the COVID-19 global pandemic. We also

highlight an important and insightful interview with the Director of Counseling and

Psychological Services at California State University, Fresno.

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Introducing Clinical Health Services

Over the course of the past several decades, American society has increasingly

recognized the need for accessible and affordable healthcare. The American Higher Education

system is no exception. Clinical Health Services (CHS) are an ever-evolving field that play an

important role on college campuses throughout the nation. The function and logistics of CHS

provided by educational institutions varies widely depending on institutional mission, student

population, and available monetary and staff resources (The Council for the Advancement of

Standards in Higher Education [CAS], 2019). Modern issues CHS professionals are facing

include a concern for issues such as alcohol and other drug use, sexual health and sexual

violence, sleep hygiene, and mental health issues (CAS, 2019). More recently, CHS has been

bombarded by the COVID-19 pandemic. CHS professionals, students, and Institutions as a

whole have had to overcome and adapt in ways that they never have before in order to maintain

simple functions during the COVID-19 Pandemic. When examining the history of CHS,

similarities can be drawn to the world CHS operates in today.

In the latter part of the 19th century, Edward Hitchcock, physician and professor of

hygiene at Amherst College, spearheaded the first initiative on advancing the health and

wellbeing of students (CAS, 2019). Hitchcock focused on physical fitness and hygiene strategies

for students enrolled at the college as part of a holistic approach to student development (CAS,

2019). Hitchcock’s efforts marked the beginning of health services becoming a legitimate

component of student affairs at Institutions of Higher Education. In the early 20th century,

campuses began forming infirmaries and student resource centers in response to outbreaks and

pandemics, much like we are seeing in 2020 (CAS, 2019). By the World War II era, health care
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services became commonplace on college campuses and continued to expand in size and

function as Veterans and later, baby boomers, began attending college (CAS, 2019).

While the importance of the physical health care provided by CHS cannot be understated,

this paper will focus more on the psychological needs of students that are serviced through CHS.

The research conducted in this study also focuses on the effects that the COVID 19 pandemic has

had on students psychological and mental health. Consequently, we also examine how CHS has

had to adapt their services to better serve students during the pandemic. Ultimately, mental

health issues college students were facing before the pandemic have been amplified. In fact, a

study conducted at a public university in New York found that individuals with more exposure to

COVID‐19–related stressors were more likely to experience depression and anxiety symptoms

than individuals who came across fewer COVID‐19–related stressors (Rudenstine, 2020). This is

a critical time for CHS to be fully funded and fully supported on college campuses.

This paper also discusses a very insightful interview conducted with the Director of

Counseling and Psychological Services at California State University Fresno, Dr. Malia

Sherman. Dr. Sherman shares insight into the field of CHS and discusses some modern issues

that are currently being addressed. Lastly, this paper examines conclusions and recommendations

based on the contemporary issues presented through relevant literature, interview, and course

content.

Clinical Health Services and COVID-19

CHS on college campuses aim to provide clinical health care and health information for

the campus community. With that being said, we are currently living through a time that is

perhaps the most unique challenge that CHS, in all realms, has ever faced. The COVID-19

pandemic has presented a set of challenges that has stretched the capabilities, structure, and
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funding of the area. Most recently, thousands of college students are returning to colleges and

universities after months away of sheltering in place. A survey in an October New York Times

study found, more than 1600 colleges identified more than 26,000 COVID-19 cases at more than

750 colleges across the nation by August 26; more than 51,000 COVID-19 cases at more than

1,020 US colleges by September 3; and more than 130,000 cases at 1,300 colleges by September

25” (Cai, 2020). As of November 19, with the fall semester almost over, there have been over

321,000 COVID-19 cases across 1,700 campuses; the number of cases on our college campuses

continue to rise. The CHS departments at colleges and universities are oftentimes heavily

involved in the testing, tracing, and care of its students. Likewise, the CHS professionals at

colleges and universities where remote learning is still taking place are tasked with similarly

daunting challenges such as providing basic health care remotely, administering flu shots while

following protocols, and disseminating valuable information to the community.

The increasing rate of COVID-19 infections among college students highlights the need

for mitigation strategies, prevention efforts, and increased testing (Honein, 2020). All of the

aforementioned strategies put colleges and universities' CHS departments at the epicenter of

fighting the COVID-19 Pandemic. Furthermore, the importance of CHS expands far beyond its

response to COVID-19.

CDC Guidelines for Institutions of Higher Education

Guidelines provided to institutions of higher education from the CDC to fight against

COVID-19 include but are not limited to reviewing, updating, and implementing emergency

operation plans (Centers for Disease Control and Prevention [CDC], 2020). This also includes

planning for reopening or keeping the institutions opened safely during the pandemic; promoting

behaviors that reduce the spread of COVID-19, such as staying home when ill or when exposed
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to COVID-19, practicing proper hand hygiene, wearing a mask, and disinfecting high-touch

surfaces and personal items; updating ventilation systems in order to help reduce airborne

particles that may carry COVID-19; modifying layouts such as installing physical barriers or

moving desks/furniture so that they are at least six feet apart; closure of communal spaces such

as gymnasiums, dining halls, and lounge areas; providing COVID-19 testing; and adequate staff

training. The CDC also encourages institutions of higher education to promote and encourage

staff, faculty and students to utilize mental health services when they are feeling overwhelmed,

or stressed due to the pandemic, and also to promote healthy habits such as taking breaks from

watching the news, eating well, getting enough sleep, and exercising. CHS is one of the

departments across campuses tasked with disseminating this crucial information to the entire

campus community.

Clinical Health Services and Mental Health Needs of Students

College student demographics have changed significantly since the new millennium;

campuses are now more diverse than ever across race, ethnicity, age, gender identity, sexual

orientation, ableness, and class. These changing student populations have put an increase in the

demand for CHS. At the forefront of services most needed by students are alcohol and drug

counseling; sexual health and sexual violence intervention; sleep hygiene education; mental

health counseling for issues ranging from anxiety, depression, suicidality, substance abuse, and

interpersonal relationships. Mental health counseling continues to be one of the most needed and

salient services on campuses. Some CHS departments on campuses have in house pharmacies

(Student Health and Counseling Center, 2020) which stock items ranging from over-the-counter

medications; feminine hygiene products; to psychopharmaceuticals, such as antidepressants

(CAS, 2019). According to the American College Health Association (ACHA, 2015, as cited in
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CAS) the mental health issues that affect students’ academic progress the most are stress,

anxiety, sleep disturbances, and depression.

Every day, students face an increasing amount of stress brought on by various factors

such as mounting coursework with pressing deadlines, work, relationships, and family

responsibilities. It may often feel impossible and extremely overwhelming to find a balance

between school and the student’s personal responsibilities. These increasing demands on

students’ lives puts them at a higher risk of developing mental health issues. One group that is

disproportionately affected by mental health related issues are students of color, often making

academic success a challenge (The Steve Fund, 2020). Sadly, this group is oftentimes less likely

to seek mental health treatment when compared to White students; contributing factors can range

from perceived stigma to financial difficulties. It is important to keep in mind that within the

CSU system if a student has paid their campus fees, they have access to all student health

services (Student Health Services, n.d.).

As students continue to struggle and find various ways of coping with their existing

mental health issues, they now face a new challenge—a global pandemic. COVID-19 has

disrupted the lives of many, but perhaps mostly those of the students that were previously

struggling with stress, anxiety, and depression, most notably students of color (The Steve Fund,

2020). According to The Steve Fund, Blacks and Latinos reported higher rates of anxiety and

depression when compared to Whites as a response to the pandemic. Students of color are also at

a higher risk to preexisting health conditions, including mental illness. Unfortunately, this

population is also three times more likely to die from COVID-19 complications. Luckily, student

health services departments across higher education campuses staff counselors, psychologists,

and psychiatrists willing and ready to help all students who are in need of psychological services
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(CAS, 2019); even providing counseling services virtually, during a time in which most

campuses have switched to online learning due to the pandemic (Student Health and Counseling

Center, 2020a).

Due to the global pandemic most students have had to transition to an online format; this

transition alone can be stress provoking, especially for those who have little to no experience

with online courses. Where students were once on a lively campus interacting with peers and

faculty, they are now at home trying to adapt to a different learning environment, which can lead

to feelings of isolation in a time where social distancing is a must. According to an article

published in Inside Higher Ed (2020), transitioning to online learning in response to COVID-19

has caused increases in mental health issues in students, faculty, and staff, and the full impact of

these mental health issues are yet to be known, especially since the pandemic is an evolving

situation. It is crucial that student health services departments across institutions of higher

education do all they can in terms of outreach and support to students and staff, even if doing so

virtually.

The global pandemic has also caused other severe implications for students; many are

facing food, job, and housing insecurity, as well as feelings of extreme loneliness. Due to the

move to virtual learning, many students have lost jobs and internships (The Steve Fund, 2020),

leading them to face more uncertainty and more despair. Some students have the added

responsibility of taking on the role of teacher to their school-aged children. As Morabito (2020)

points out, many of her students (which are mostly first-generation, low-income, women of

color) are struggling with the shift to online learning while at the same time trying to balance

their household responsibilities. Oftentimes, these students are faced with constant interruptions

by the needs of their small children or younger siblings who are also learning from home, or by
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other pressing needs such as facing financial uncertainty due to the pandemic. All of these things

combined are increasing stress, anxiety, and depression among the student population

(Schroeder, 2020). It is critical that students reach out to their campus health services department

and seek counseling services if they are feeling stressed, overwhelmed, depressed, or perhaps if

they just feel the need to socially (virtually) connect with a professional for guidance and

support. It is also critical that campus health services departments remain fully funded and

staffed.

Practitioner Interview

As part of this assignment, we had the privilege of interviewing a practitioner within the

CHS department at California State University, Fresno. The professional interviewed was Dr.

Malia Sherman Psy.D., who is the director of Counseling and Psychological Services at CSU,

Fresno. The interview consisted of 12 questions and was 25 minutes long; the complete list of

questions can be found in Appendix A. The interview began by asking Dr. Sherman how she

came to be in the field of CHS. She explained that she is a licensed psychologist, who, right out

of graduate school, began her career by working for the state prison system; she remained in that

role for five years where she also held the role of supervising psychologist. After leaving her role

at the prison, she was hired at Fresno State as the director of counseling and psychological

services.

We asked Dr. Sherman what the most common mental health related issues students seek

support for. Per Dr. Sherman, the most common reason why students seek mental health services

is for anxiety. She states this is not just at Fresno State, but on most campuses nationally. The

next most frequent concerns of students are stress and depression. The most common causes for
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these mental disturbances can be attributed to relationship issues, trouble with family, financial

difficulties, and the overall stress of being a college student while juggling other responsibilities.

Dr. Sherman notes one of the biggest changes to counseling services on campuses within the last

ten years has been in the types of issues students seek support with and the types of issues that

are treated within the college counseling center. For example, a decade ago students might come

into the college counseling center with “lower-level concerns” such as a failed course or a

romantic relationship breakup. While students who suffered from chronic mental health issues or

who were suicidal, were referred out to the community. Today, this is much different; mental

health services on campuses now treat chronic mental health issues including students who may

be suicidal. While they now try to address the lower-level issues by finding alternative solutions

such as the Fresno State program “Let’s Talk” which is an informal counseling service that

students can utilize to address smaller stressors.

We then asked what she felt was the most challenging issue facing CHS due to COVID-

19. Dr. Sherman noted that there is a current trend on campuses, on a national level, where

students are expressing very high rates of mental disturbances such as anxiety, stress, depression

and loneliness. Within this trend, students are also expressing a high desire for wanting mental

health services and connection to professionals, yet the number of mental health services being

utilized by students has dropped. In response to this trend, she states that mental health services

departments are doing all that they can to let students know that mental health services are still

available, while also reassuring students that counseling appointments over Zoom can oftentimes

be more comfortable. One step that CSU Fresno took before the Thanksgiving break was to host

a campus wide mental health forum as a way to further reach out to students. She states that
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various campuses are also trying different methods to reach out to students, but she is alarmed by

this trend and directors across the nation cannot pinpoint exactly why this is happening.

Dr. Sherman points to another issue that has been at the forefront of mental health

services, which is the increasing use of electronic devices and the amount of screen time that is

inundating the student population. She states this was a serious problem before COVID-19, but

the pandemic has made it exponentially worse. This tends to have the most negative impact on

male students. Dr. Sherman explained that in Pre-COVID-19, counseling services were seeing

large increases in students reporting video game and pornography addiction, along with a

dramatic decrease in social skills. She says this is an alarming trend that might possibly worsen

as the pandemic continues, as most students are currently learning from home while mostly only

interacting virtually be it on social media, playing video games, or surfing the internet. She is

concerned because students are not exercising or socializing. She says it will be very interesting

to see what happens once the pandemic is over; will people get used to only interacting virtually,

with minimal social interaction, or will people come to appreciate socializing with people and

being out in nature again.

Dr. Sherman also provided us with insight into how professional development takes

shape within the counseling and psychological department. She states that her department is very

fortunate to have a separate budget that is dedicated to professional development. In order to

maintain licensure, professionals are required to undergo 36 hours of continued education every

two years. There are also California State mandated courses that professionals within this

department are required to take every few years, such as courses in suicidality, and courses in

how to respond to abuse. She is also part of a California counseling directors association as well

as a national counseling directors association which help in her continual professional

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development. She attends the yearly American College Health Association conference as part of

her continuing education. The counselors that she supervises participate in professional

development by attending conferences and webinars on topics that are specific to the population

of students they serve.

Dr. Sherman says her favorite part of the job is being a helping professional and getting

daily gratification from her career; especially being able to see students succeed after receiving

help and support from mental health services. Dr. Sherman attributes her success and her passion

for helping students to both her undergraduate and graduate education as well as to her mentor.

She credits her mentor for her practical and functional skills, and states she still keeps in touch

with him; it is no doubt that having a mentor can play a significant role in how you develop as a

professional.

Conclusions and Recommendations

Ultimately, one of the most pressing concerns for people today is mental health;

especially as folks progress through important life changing events such as college, job

searching, and gaining more independence (Watkins, 2011). For many students, the only

physical, emotional, and mental support that they have access to is their health services

department at the institution they are attending. This increased need for services leads to a strain

on campus budgets and staffing. For example, 96% of health services and counseling directors in

the United States have reported a significant increase in treating students with severe mental

health issues compared to years past (Watkins, 2011). Due to this increase, 64% of the same set

of directors surveyed also reported instances of staff “burnout” and staffing shortages during

busy times (Watkins, 2011).

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Through our research, it has become clear that health services, mental health counseling,

and healthcare professionals play an integral part in the function and success of an Institution of

Higher Education. Furthermore, we propose that Administrators should make funding health

services fully and making sure all health centers are completely staffed a priority in their

Institutional mission and budgetary oversight. We also propose that Administrators should be

planning ahead for the impact that the COVID 19 pandemic will have on students as it continues

to evolve in nature. It became clear through interviewing Dr. Sherman that professional

development opportunities and forums that include Administrators, staff, faculty, students, and

the community should be a consistent feature on campuses for the foreseeable future. Through

our research it becomes evident that students of color are being disproportionately impacted by

the stressors of being a student in the 21st century (Student Health Services, n.d.). Institutions

and Administrators should take special attention and effort to service minority students on

campus through the health services department during these challenging times. College’s

respective states, the campus administration, and staff need to be mindful of the way that campus

climates will continue to change in the near future and will need to adapt accordingly to keep

their students safe and connected to Clinical Health Services.

References
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