The pandemic has been tough on all health care workers, from providers on the front lines of COVID-19 to mental health clinicians. Mental health clinics across the state continue to serve their communities, despite the toll the pandemic has taken on workers and students.
The Boynton Mental Health Clinic at the University of Minnesota began remote care at the start of the pandemic and continues to do so via telehealth, meaning that clinicians see their patients using digital communication technologies, like Zoom. The clinic’s interim director, Matthew Hanson, Ph.D., spoke with me about the shifts in the clinic’s care, such as adjusting to virtual formats and supporting the community’s needs as they develop.
This interview has been edited for length and clarity.
MinnPost: Students at the University of Minnesota are four weeks into the spring semester. The majority of classes continue to be online, like the fall semester. What has it been like seeing how students are grappling with stress, zoom fatigue and isolation as we near almost a year since quarantine began?
Matthew Hanson: It’s been hard. I would say that as this pandemic has gone on, students have struggled increasingly. Students are in different places, obviously with their experience of the pandemic. I really do think that things like social isolation are really catching up with students. It has been harder and harder for a lot of students to stay motivated with their classes. As the pandemic has extended, it has really impacted a lot of students in ways that have made it harder and harder to cope with. So it’s been a struggle.
MP: Have you noticed a change in the amount of energy your staff is able to give?
MH: I think staff have had to find ways to maintain their energy with remote telehealth. Then, there are some staff that actually prefer that modality. But a lot of staff have had to find ways to stay motivated to do that too. So I don’t think that that’s necessarily been perceived by students, but I do hear about that in our staff meetings and in our peer consultation groups. We have taken extra steps as a leadership group to try to support our staff and check in with them and make sure that they feel supported. But it’s harder to do that remotely than it is to do in person. That same kind of disconnect that happens for students is also happening for our clinicians.
MP: The Boynton Mental Health Clinic has been providing remote appointments since last March. Considering that students might not be as receptive to remote appointments, what challenges has the clinic faced with the virtual format?
MH: I think it’s the unknown about where students are. So my comment before about students feeling fatigued from screen time, I believe that to be true. There are some surveys that are coming out from a national database, from a group called the Center for Collegiate Mental Health. They’ve been doing some survey analyses around the student experience since the pandemic. So we’re learning from that about where our students are. There’s been some other smaller surveys around, and I know that some of those have indicated that students have transitioned to telehealth pretty seamlessly. My hypothesis is that there is some reduction in initiation of care because of the screens.
MP: I’ve noticed that mental health is slowly becoming de-stigmatized among mainstream audiences. So how has your outlook on mental health changed since the beginning of the pandemic?
MH: I think more people are struggling. We’ve known that even before the pandemic, more people were struggling than were getting help. So because of the stigma or because of other issues, access to care, insurance, coverage, availability, I mean, there are a lot of reasons why people didn’t access mental health care. But that was a phenomenon before the pandemic, knowing that a lot of people were struggling on their own. I still think that’s happening. There are people that are struggling on their own that aren’t getting the care that they need. I think telehealth has made that more accessible for some and less accessible for others. I do know the pressures that people are under just in terms of how they’re coping with this uncertainty, financial pressures, or trying to manage work-life balance and then trying to navigate all of that. I think there’s a lot of stress going around for everybody. And I know more and more people are able to, or willing to, ask for help. And that has put some pressures on the mental health system, which was already stretched pretty thin.
MP: So would you say there is maybe an increase in the number of people who are reaching out?
MH: We hear about that nationally, but we haven’t necessarily seen that on campus. The number of new students that have sought care during the pandemic is actually lower year over year from last year. Our intake numbers are down for therapy compared to where they were last year. I think some of that is just due to the fact that there are fewer students on campus, so there are just fewer students that are dropping in to initiate care. There are more students who are going back to their home state, and there are licensing laws about how we can provide care across state lines. I do think that students aren’t necessarily as excited about telehealth as they are about seeing somebody in person. I think by and large, students are wary of more screen time, especially when they’re doing all that learning online and all their activities online. So they’re fatigued. They’re burned out from the screens and maybe they need a break from that.
MP: Since starting in March, Zoom has probably become second nature for many people. After nearly 10 months of providing remote care, I’m wondering if the mental health clinic’s approach has shifted on the best ways to care for patients virtually. And how has that approach maybe changed since when you first started back in March?
MH: I don’t know if that has changed significantly. We’re still using the same platform. I think we’ve probably gotten more efficient with it in terms of communication with students. One of the things that we learned quickly is that despite the advances in technology, there were still a lot of processes that weren’t really equipped to be handled online. The Zoom platform was the easy part, that was already ready-made and it was HIPAA compliant. So we were able to start utilizing that quickly, but it was the other things related to the operations of our practice that were a little bit more challenging. If we were able to send a fax, for example, there are secure ways to do that, but very few students have fax machines. In terms of those operational features, we really had to enhance some, create some and fine tune them over time. And so I think we’ve gotten a lot better with that.
MP: I’m also wondering how the Boynton Mental Health Clinic’s care differs from non-university affiliated clinics. Have you been seeing the response of other clinics in Minnesota or even nationally that have taken a different approach or is there something you think they do really well?
MH: I think we’re right in line with where other universities and colleges are. Most university counseling centers and clinics continued to provide mental health remotely. That is by far the most common approach that universities have taken. There are smaller schools that are doing more in-person services. University of Minnesota-Morris, for example, is a school that is providing a combination of in-person and telehealth care. It just kind of depends on the size of the university and what’s happening in the local environment. There are some community clinics that are providing more care over the telephone, based on their patient population maybe having less stability. Other clinics really have been open the whole time during the pandemic. That really is dependent on the patient population. Some of the community clinics that have been doing that serve a population that doesn’t have access to telehealth care, doesn’t have a stable internet connection, might not have a safe place to talk to somebody remotely. We have got a slightly different population. Most of our students are accessible remotely. So there’s so many different models. I think each clinic and counseling center has had to figure out what works best for their campus, their student population, within the context of what’s happening locally, in terms of the virus.
MP: 2020 was unpredictable. Looking back, what have you learned as a leader in the mental health community?
MH: As a clinic director, I think I’ve had to strike a balance between flexibility and consistency. The changes that we went through early on in the pandemic were very quick. Having to be flexible, finding consistency as much as possible, recognizing that there is such a thing as change fatigue. Asking people to do too many changes too rapidly is perhaps asking too much of them. Communication is essential. And we have changed our practices in terms of our communication with our staff, because we felt like we had to stay connected. We’ve always been a group that really values our staff and seeks to support them in the work that they’re doing, knowing that mental health care work is really difficult. But finding creative ways to do that has been a task that leadership has taken on.
This sounds like some of the things that one might expect from a director or leader, communication and consistency and managing change. It is all those things but amplified because of the dynamics of the pandemic and the dynamics of a racial uprising that was unpredictable also. Sometimes, challenges are also good teachers about what needs to be strengthened and what might be missing. For as hard as this has been, I can’t help but think that anything in the future has to be a little bit easier by comparison. If we can survive this and adapt to the circumstances around us for this one, then I have confidence that we will be able to manage changes as they come up in the future.
MP: Looking forward, are these systems and solutions that you’ve put in place for this pandemic sustainable for the future?
MH: It’s hard to imagine what normal will look like. I do think there’ll be a time when we will return to more of our practices that we had in place before the pandemic. In other words, most of our staff will be back in-clinic and most of our services will be delivered face-to-face. It’s hard to imagine not doing telehealth at least in some capacity; it has benefits in terms of convenience. Students then are able to stay in contact with us if they go to different parts of the state, or if they go home for an internship for the summer or whatever it might be. There are things now that we have in place that I think will be permanent parts of our operations moving forward. The proportion of that is hard to know.