Reading, Writing, and Resilience

Every Tuesday night, a group of students at the University of Southern California shuffles into a lecture hall carrying no pencils, papers, or laptops. This course comes with no assigned readings or grades. Students have class twice a week — on Tuesday for the lecture, on Thursday for smaller group discussions called “connection sessions.”

The program is a one-credit course, “Thrive: Foundations of Well-being,” that USC will soon require for all undergraduates. It’s one way the university is trying to support students’ mental health, but it is more than that: The course has an intellectual component that asks students to assess abstract concepts like success and happiness. That’s meant to show students that overall wellness, including mental health, is as serious as any academic matter.

At colleges nationwide, students have grown vocal — agitated, even — for increased mental-health services. The use of counseling centers increased by 30 percent, on average, from 2009 to 2015, according to the Center for Collegiate Mental Health. One in four college students reports being diagnosed with or treated for a mental illness, according to a 2018 study in the journal Depression and Anxiety. And the next generation of college students — 70 percent of teenagers — see mental health as a major problem among their peers.

Even with campus counseling services booked weeks in advance and students often referred out of the campus clinic, universities are in a crisis. But not all colleges can afford to “buy their way out of a mental-health crisis” by hiring more clinicians, said Sarah DeWitt, coordinator of health education and wellness promotion at the University of Dayton.

Many colleges are looking to take preventive measures. At a few, that includes incorporating mental-health and wellness training into the curriculum. After all, administrators point out, wellness is an important life skill, one that students can carry into their careers. And students are responding positively to the new curricular approach, administrators say.

‘Culture of Care’

The move reflects a more holistic approach taking hold across higher education. On many campuses, mental-health training is introduced at freshman orientation and applied in residential programs, alongside sexual-assault prevention and substance-abuse education.

Before registering for classes, first-year students are typically required to complete an online, 30-minute course on mental-health awareness. They are guided through simulated conversations with an at-risk peer. They’re taught how to mindfully support others and direct them to available resources.

Dayton took this one step further, adding a training module to its optional curriculum for students in campus housing so that they can retake it whenever necessary. Mental-health awareness isn’t a skill learned once, DeWitt said: It requires practice and consistent exposure to build “a culture of care.”

The Roman Catholic institution’s residential program — which 90 percent of its undergraduates are part of — encourages community engagement. Those who participate in local programming, service events, or the mental-health module accumulate points in the residential system. The more points a student has, the better his or her odds are to select student housing the next year. It’s a recurring incentive for students to participate, DeWitt said.

The module is created by Kognito, a company that creates simulations designed to help people change their behaviors. Essentially, it helps students recognize signs of emotional distress. They are not required to use the program before they get to campus, although administrators want them to “engage with it more than once,” DeWitt said. About 25 percent of the university’s undergraduates completed the module this past year.

Dayton measures the success of the program in multiple ways, said DeWitt. It gathers data on the number of students who complete the module and how well they perform on assessments before and after the activity.

The college worked with an external consultant in 2014 to revamp its health system. In 2017, it started using Kognito’s module as a programming option, one that residential assistants and student leaders are encouraged to take.

College leaders initially debated whether the Kognito simulation should be a first-year requirement, DeWitt said. As Dayton refines its wellness strategy, administrators want to take a holistic approach, because, ultimately, the college wants to ensure that students are equipped to handle problems even after they graduate.

“Our counseling center is busy, just like everybody else’s, but that can’t be the only solution to the trends we’re seeing on campuses,” DeWitt said.

A holistic model means investing in resources across the board. In addition to the Kognito module, the university offers an eight-hour training called Mental Health First Aid, and “mini” one-credit courses on wellness, personal relationships, and mindful learning. It also works with student advocacy groups for campus programming.

As the instructor of the wellness minicourse “Health, Balance, and Talents,” Dewitt said, that the feedback from students has been “overwhelmingly positive.” Some even suggested that the course be required.

A mandatory course isn’t feasible yet, she said. More resources are needed and, before expanding its wellness programming, Dayton wants to ensure that current options are widely promoted and available.

But the interest, DeWitt said, shows that wellness and health behavior is at the forefront of many students’ minds. If institutions capitalize on that student energy, she believes there is great potential for change.

Self-Reflection, Curiosity

At USC, student leaders have long advocated for a mandatory wellness course. They proposed the idea to administrators around 2014, but “the time wasn’t yet ripe” for the course, said Debbie Lee, president of the student government. And the process to approve student-led proposals moves at “glacial speeds,” she said.

It wasn’t until last summer that an advisory committee comprising administrators, students, and professors was formed, and the one-credit course finally piloted in the fall, continuing this spring.

The Tuesday lectures, which are presented by a different guest professor each time, encourage silent self-reflection and curiosity. Meanwhile the Thursday group sessions, capped at 20 people and guided by a professor and a graduate assistant, provide room to share personal insights. Among other things, the course encourages students to connect better with others on campus and to grow in self-awareness.

“It’s a form of self-processing,” said Ashley Uyeshiro Simon, an associate professor of clinical occupational therapy at USC. She helped develop the course — a collaboration among the university’s occupational-science division, the Office of Campus Wellness and Crisis Intervention, and the undergraduate student government — and is teaching it this semester.

There is no homework, although the syllabus provides a list of optional readings on occupational therapy and positive psychology. The discussions are combined with hands-on group activities. One week, students focus on their identity, mapping out a visualization they would share with others in their group. Then the group talked about the concept of identity and what it means to students.

An in-person course is a game changer when it comes to addressing topics like mental health, loneliness, and wellbeing, the course developers said. Lee and other student leaders who advocated for the course also enrolled in its pilot sessions.

“It can’t be a one-and-done kind of deal,” Uyeshiro Simon said, adding that it is “a meaningful thing” for students when a self-help course is offered for credit.

In one class, Lee and her peers charted out how they spend their time daily and weekly. The purpose of the practice, she said, was to help students become more mindful about the activities they make a priority.

And the course looks to do more than provide resources, Uyeshiro Simon said. It asks existential questions students don’t often think about: What does success mean to you? What about happiness? How do you live your best life?

The intimate setting encourages vulnerability. For some, the course brought clarity and personal guidance.

“Just that one lecture on success really helped me determine more of my career path,” said Blake Ackerman, vice president of the student government. He was studying business, a major that focuses “more on the bottom line” than on social change. The course inspired him to pick up a minor in social entrepreneurship, he said.

Lee expects the course to be mandatory in the future but has been told that logistics, such as at what point students would be required to take it, are still being ironed out. The diverse academic backgrounds of students in the pilot program have prompted administrators to reconsider mandating the course only for first-year students. The fall and spring pilots were open to undergraduate and graduates for enrollment.

“The content is incredibly valuable for students at any stage in their college career,” Uyeshiro Simon said. “Graduate students are even saying they want something for them, too.”

The university created a “pretty rigorous method” to evaluate students’ perceptions of the course, she said. Students fill out surveys after every class meeting. The data collected from last semester found that 93 percent of participants thought about life in new ways after the course, and most felt closer to their peers.

Though USC may be the first large private university to require such a course, other colleges have dabbled with similar approaches. Since 2011, Emory University has required first-year students to enroll in a one-credit personal-health course to fulfill a general-education requirement. The course, led by upperclassman “peer health partners,” emphasizes physical health but also addresses health behaviors, stress, and time management.

Wellness as a ‘Legal Skill’

When a college requires a course, there has to be an academic basis for the decision, said John Hollway, associate dean of the University of Pennsylvania Law School.

Law students grapple with high rates of emotional distress, placing them at higher risk for mental illness and substance abuse. A 2016 survey at 15 law schools found that 42 percent of students thought they needed emotional or mental-health support. But only half that number received counseling.

Students can be hesitant to participate in optional wellness programming, said David Jaffe, associate dean of student affairs at American University’s Washington College of Law. His work focuses on mental health and substance-abuse prevention for law students. In such a competitive environment, he said, they worry they’ll fall behind after taking even a quick break.

But with an integrated curriculum, students don’t have to make that choice. At Penn’s law school, a required upper-level course addresses wellness through the lens of professional responsibility. The school, which developed it in part as a response to a 2017 report by the American Bar Association on wellbeing, is trying it out this spring.

“Wellness is a set of life skills,” Hollway said. “Those life skills are legal skills.”

The pilot program was integrated into the professional-responsibility course that second- and third-year students take. Hollway, who has a master’s degree in positive psychology, helped develop the curriculum, which is rooted in interventions such as resilience training, optimistic vocabulary training, and stress management.

Reframing wellness as a life skill shows that institutions care about the issue beyond prevention, Hollway said. Law students — and lawyers — should have “an obligation for self-care,” he said. “It is hard for a lawyer to meet your ethical responsibilities to take care of your clients and your cases if you are in a crisis.”

To measure the course’s impact, Penn will survey the students about its usefulness and their feelings of self-efficacy. The survey will measure whether “the interventions we discuss and practice can actually be deployed in their daily lives as students and as professionals,” and if students would like additional wellness training, Hollway said.

Offering tangible, lifelong practices that encourage students to think critically about mental health can’t solve everything, said USC’s Uyeshiro Simon, but it does lower barriers to the resources they might need.

“Having a multifaceted wellness approach means that you’re able to meet the diverse needs of every student,” she said. “It means they’re more comfortable seeking that help out.”

Correction (2/27/2019, 12:20 p.m.): A pilot program on wellness at the University of Pennsylvania’s law school is for second- and third-year students, not third- and fourth-year students. The article has been updated accordingly.

Follow Terry Nguyen on Twitter at @terrygtnguyen, or email her at terry.nguyen@chronicle.com.