For years, college counseling centers were overrun, unable to keep up with students’ demand for mental-health services. Getting them help fast became increasingly urgent.
One by one, colleges started contracting third-party, higher-ed-focused teletherapy providers to assist their in-house counselors. Now hundreds of colleges use these companies. New Jersey recently purchased teletherapy access for every college student in the state; on Wednesday, the state extended that partnership through the spring of 2025.
Colleges still often struggle to meet students’ needs; waitlists for in-person treatment persist. But with 24/7 and virtual availability, many counseling-center leaders report that teletherapy has changed their campuses for the better, offering flexibility for students and allowing administrators peace of mind.
The most widely used teletherapy providers — BetterMynd, Mantra Health, TimelyCare, and Uwill — started popping up in 2017 and have grown exponentially since the pandemic hit, when colleges began relying more on online mental-health resources. Today, according to client data from the providers, these services are available to a combined 4.8 million students at more than 700 campuses. These figures are approximate; a handful of colleges contract with more than one company and may be counted twice.
TimelyCare, a Texas-based telehealth company, claims the largest market share, with over 350 colleges on its roster. It ranked No. 175 last year on Inc. Magazine’s Inc. 5000 list of fastest-growing companies, with 3,015-percent growth in the past three years.
Campus officials who spoke with The Chronicle said the investment — which, in some cases, costs hundreds of thousands of dollars each year — has been worth it.
Fifty-seven percent of college students reported needing help for emotional or mental-health problems over the past academic year, according to the most recent Healthy Minds Study, which surveys tens of thousands of students each year. As stigma about mental health has gradually decreased, more students are asking for that help.
Still, skeptics of teletherapy companies say it can be difficult for colleges to exercise oversight and quality control over a third-party vendor. They also argue that virtual care from far-flung therapists can’t replace the institutional, cultural, and local connection that college counselors have with students.
As more and more colleges sign on to get 24/7 mental-health care to students through teletherapy, David Walden, counseling director at Hamilton College, pointed out that higher ed is still new to these partnerships. Hamilton College has contracts with two teletherapy companies.
“We’re still defining our relationships to one another,” Walden said.
‘In Good Hands’
Two years ago, the student government at Coastal Carolina University asked administrators to bring TimelyCare to campus. Student leaders proposed a small health-and-wellness fee to pay for it, which the university approved.
As of this fall, almost half of the university’s 10,000 students have registered for the service. Lee Carter, assistant vice president for student wellness and health equity at Coastal Carolina, reported almost 10,000 TimelyCare visits since its arrival on campus.
I’m able to go home at night and know that our students are in good hands.
Telehealth vendors offer a smorgasbord of services online and on mobile apps. Colleges foot the bill for the contracts so students aren’t paying for services out of pocket. Students can access everything, from scheduled counseling visits, psychiatry, and on-demand call centers to crisis intervention, health coaching, and medical visits. Some companies also offer messaging with therapists, peer-support groups, self-help modules, and wellness workshops.
At El Camino College, a community college near Los Angeles, the faculty coordinator for student-health services, Susan Nilles, said students have about 120 teletherapy visits each month. With her own counseling center overrun and months-long waitlists at the local practices El Camino usually refers students to, “that’s 120 visits that would not have happened,” Nilles said. The number of visits per month has since climbed into the 140 to 150 range.
TimelyCare wasn’t able to give an average utilization rate; company representatives said it varies at every college. But Bob Booth, the company’s chief care officer, said there have been about 200,000 visits with TimelyCare providers in the past year. That number encompasses all counseling and medical visits, psychiatry, health coaching, and calls to its 24/7 hotline, TalkNow. The company said there were also over 500,000 peer support and 400,000 interactions on the self-care module in the app, including students reading articles or watching videos on self-help, or making posts or comments in the peer groups.
Not long ago, campus practitioners were deeply unsure of teletherapy, saying they didn’t think it could be as effective as in-person treatment. But early research suggests that the outcomes of virtual and in-person therapy are largely similar, and that the more important variable is the relationship between the therapist and patient.
Teletherapy provides flexibility that students value, administrators said — giving them the option of doing therapy at any time from anywhere, including from another state.
Students on some campuses have reported mixed reviews of the teletherapy companies, saying they appreciate the flexibility but that there are limitations to virtual counseling.
Several administrators said using nationwide teletherapy companies opens a wider pool of therapists for students to choose from. State licensing laws have traditionally limited what campus counselors can do for students who aren’t physically in the same state. The most widely used teletherapy vendors contract with providers in all 50 states, so even if a student isn’t on campus, they can access treatment.
Students can also find therapists from different racial, religious, and LGBTQ backgrounds. Especially at small colleges with only a few counselors and a small pool to hire from, it can be difficult to have diverse staff members available.
“The more you can offer variety, the more you’re going to be able to reach a larger group of people,” said Nance Roy, chief clinical officer at the Jed Foundation, an organization that works with colleges to improve mental-health policies and resources. Roy wrote a report last year outlining considerations for colleges before they contract with teletherapy vendors.
Teletherapy also allows students with busy schedules, jobs, or caretaking responsibilities to seek treatment whenever they can fit it in. About half of TimelyCare visits are outside of the typical eight-to-four or nine-to-five business hours offered by counseling centers. A visit might be at 7 a.m. before class or 7 p.m. after work, or even in the middle of the night. Mike Daniels, dean of students at Snow College, a community college in Utah, said TimelyCare gives him peace of mind.
“I’m able to go home at night and know that our students are in good hands if they need it,” Daniels said.
Crises and Prices
The 24/7 availability of teletherapy means that students may turn to these apps when they are in crisis. Typically, the companies work with colleges to get on-the-ground support to a student in danger as quickly as possible.
BetterMynd coordinates response plans with each college during its onboarding process, and Mantra Health offers referrals to Charlie Health, a provider that offers more intensive, specialized therapy.
For TimelyCare, if a student indicates they’re at risk for self-harm or suicide during a session or on TalkNow, Booth said the TimelyCare provider will stay on the call with the student while notifying TimelyCare’s crisis-response team. This team runs logistics with the college and gets in touch with on-campus or local resources.
“Nothing has stopped in the care of the student,” Booth said. “They’re still working with the individual person they’re talking with, but it’s launched a whole system of people behind the scenes that are immediately beginning to operate to get that student to safety.”
That seems to be the greatest value for higher ed — to have a therapist readily available when a student needs someone to talk to. And it’s costing colleges five, six, or even seven figures.
Depending on how many students a college has and how many visits and services it wants to purchase, the price varies greatly. El Camino College, which has about 20,000 eligible students, said Nilles, the student-health-services coordinator, pays $12.75 per student for TimelyCare, which works out to roughly $255,000 per year.
What on-campus resources can provide is completely unique and really can never be duplicated by an external provider. At the same time, we can’t do it all alone.
Bryan Moulton, counseling director at Snow College, said his institution pays almost $82,000 per year for a contract with TimelyCare that allows 3,500 students and 400 employees to use the service. Daniels, the dean of students, said 11 percent of students have used its services.
At Texas State University, which has nearly 39,000 students, its counseling director, Bonita Lynne Reeder, said the administration is paying about half a million dollars over the course of a three-year contract with TimelyCare.
BetterMynd models its pricing based on how many sessions a college purchases. Cody Semrau, BetterMynd’s founder and chief executive, said some colleges buy 100 sessions per year, which usually costs between $15,000 and $20,000. Some institutions with larger demand purchase several thousand and receive a reduced rate for buying more, he added.
Sarah Ketchen Lipson, an associate professor at Boston University’s School of Public Health and a principal investigator for the Healthy Minds Study, agreed that increasing capacity, providing 24/7 availability, and having a diversity of providers are compelling arguments for teletherapy. However, she said, it should be “part of a broader menu” of resources instead of “a one-stop shop.”
Many colleges see teletherapy as a worthwhile extension of their own services. For some practitioners, though, the jury’s still out.
Concern About Oversight
Skeptical counseling directors are uncertain about quality control, privacy, and the effectiveness of remote care. And why, some ask, isn’t the money for teletherapy contracts being used to hire more full-time staff in the counseling centers?
Philip Rosenbaum, counseling director at Haverford College, is worried that colleges increasingly see teletherapy vendors as a silver bullet. Often, he said, those companies are subjected to the same pressures that college counseling centers encounter, like supply and demand. Haverford doesn’t have a contract with a teletherapy provider.
The companies, Rosenbaum said, “are in some ways held as a panacea.” They market themselves as if “they’re supposed to have all of the answers to problems that they don’t necessarily have all the answers to,” he said.
Rosenbaum added that he fears colleges don’t provide enough oversight of the third-party services. “I’m sure there’s a lot of really good therapists doing work, but we actually don’t know what happens in those sessions,” he said.
Third-party vendors employ hundreds of independent contractors to serve students. BetterMynd has about 500 therapists in its ranks, and Mantra Health plans to expand to about 200 in 2024. TimelyCare declined to disclose its number of providers.
Many college administrators said they have regular communication with their teletherapy partner and collaborate on providing care. The companies themselves said they have strict qualifications and licenses they require for therapists, like board certification.
TimelyCare is accredited by the Utilization Review Accreditation Commission; in other words, it’s verified and meets the accreditor’s standards of care just like any hospital, pharmacy, or other health-care company. The commission monitors many well-known health-care companies in the United States, including CVS Pharmacy and Vanderbilt University Medical Center. TimelyCare is the only accredited higher-ed-focused teletherapy company.
As for privacy concerns, teletherapy providers are bound by the Health Insurance Portability and Accountability Act, or HIPAA, to only share medical information from one health-care professional to another. A provider’s notes can only be shared with other licensed clinicians and aren’t shared with anyone else, like college administrators, Booth said.
Lipson emphasized that colleges should integrate external providers into their campus mental-health systems, ensure they follow up with students who have been referred to teletherapy, and regularly evaluate the third-party service.
Third parties can’t replicate the work done by on-campus counseling centers, some campus officials said.
External providers aren’t embedded in the community and thus can’t relate to students or understand the college’s culture as well as campus therapists can, said Walden, the director at Hamilton College.
“What on-campus resources can provide is completely unique and really can never be duplicated by an external provider,” he said. “At the same time, we can’t do it all alone.”
Colleges Plan to Renew
Rosenbaum sees teletherapy vendors more as a last resort than a long-term solution. Ideally, he said, the companies will serve as a temporary safety net while colleges make more permanent plans to address student mental health.
Some patients and types of therapy are best suited for in-person therapy, such as treating those in crisis or who have an eating disorder or trauma to work through, counseling directors said. They also said most students continue to prefer in-person counseling if it’s available.
“Students are craving connection, are craving being known in an intimate and deep way,” Rosenbaum said.
For Walden, contracts with these companies allow him to expand the caseload that Hamilton’s center can manage. Hamilton has worked with both Mantra Health and BetterMynd for several years.
Walden likes the additional clinical hours and values the demographic variety of providers, given that Hamilton is located in a predominantly white area in upstate New York.
For a new generation that’s tech-savvy, telehealth may exist in its own right, just as a different form of medical care.
“Students aren’t necessarily comparing us to a visit in their doctor’s office,” said Becky Laman, chief strategy officer at TimelyCare. “They access health care differently than 10 years ago, than five years ago, so they’re comparing us to an experience on Instagram or Snapchat, where they’re in control.”
Even if only a few students use it, many colleges told The Chronicle that they are prepared to keep renewing their contracts. The value could simply be the presence of these companies on campus and the option for students to get help at any time, Walden said.
“It’s human nature that when you’re told help is out there,” he said, “sometimes that in and of itself is helpful.”
