New Conversation: Mental Health Services in 21st Century Higher Education

Mental Health Services in 21st Century Higher Education

A Conversation with Dr. Aresh Assadi, University of Arkansas at Little Rock

On May 4, 2023, JPHE Senior Editor Z.W. Taylor spoke with Dr. Aresh Assadi. Dr. Assadi received his doctorate from the University of Arkansas at Little Rock where he currently works as the Director of the Counseling Center. Dr. Assadi also serves on the board of the American Foundation for Suicide Prevention, the Arkansas chapter, and is the research connections chair.

Dr. Assadi’s work has required him to set up different mental health literacy programs, bringing in different speakers from around the nation to come, do webinars, and open up conversations about mental health in higher education contexts. As someone who just completed his doctoral work, Dr. Assadi shared his professional experience as a counselor, a scholar-practitioner in the space of mental health and wellness, and what higher education needs to do to better serve the mental health needs of its stakeholders.

Dr. Aresh Assadi:

I obtained my doctorate from the University of Arkansas at Little Rock and currently work there as the director of the counseling center. I have been with the university for 13 years, making it the longest place I have ever worked. I love it here. I am also a member of the board of the American Foundation for Suicide Prevention (AR Chapter), serving as the research connections chair for the Arkansas chapter. My role involves organizing mental health literacy programs that bring in speakers from around the nation to conduct webinars and educate the community. I also help with community and campus Suicide Prevention Walks.

Zach Taylor:

Excellent. And I wouldn't say we're in a post-pandemic environment, but it's something like that. It's a pandemic on pause, maybe something like that. A lot of research that emerged from that time really showed that if people's physical health wasn't suffering through the pandemic, the isolation and the mental health were really impacted and had a significant effect on college students. It affected their persistence and their overall experiences in higher education. So, from your perspective, in terms of research, what do you investigate? What was your focus in your doctoral project, and what did you learn about mental health services during COVID?

Dr. Aresh Assadi:

Mm-hmm. So, I actually had to do my study during COVID, which was not very easy. You know, my topic already contains very sensitive subject matter. As you already know, recruiting participants for a study is already difficult enough. Getting men to talk about suicide, mental health, vulnerability, and stigma while dealing with a pandemic just made things that much more difficult. Instead of using a bunch of jargon like mental service utilization, let's keep it simple so everyone can kind of understand what we're talking about here. So, men historically do not go to therapy as much as women. Now, that would be ok…if let's just say women were just way more mentally ill than men, or that they had worst mental health outcomes. But that is not what you find in the literature, in fact, men have a lot of worse outcomes when it comes to matters such as alcohol abuse, violence, and drug abuse.  For example, when it comes to negative mental health outcomes such as suicide the ratio is 3 to 1 or 4 to 1 male to female. But then if you look at the service utilization ratio, it's flipped the other way. Women, well at least at universities, according to large-scale surveys by college directors. Like the ones conducted by the AUCCCD demonstrate that the ratio is 3 to 1 women to men. So, there's a disconnect or a treatment gap that exists. This just doesn't add up, you know. And like I said, based on the research, women haven't been shown to be significantly more emotional or have a more significant propensity towards mental illness or something like that. So why does this treatment gap occur? There are three areas in the literature that helps us understand this phenomenon. So, you can't study why men or anyone, in general, doesn't seek services without understanding these three research areas. They are Adherence to Traditional Masculine Gender Norms, Stigma, and Mental Health Literacy.

Zach Taylor:

So, based on your dissertation or doctoral work, knowing that mental health is not necessarily a gender-specific issue, it can affect people of various genders. We also know that men tend to utilize mental health services less than women. What was the focus of your work and what did you learn from it? Furthermore, what implications does it have for college students?

Dr. Aresh Assadi:

So, let me tell you some things we know from the review of the literature: We know that early detection and treatment lead to better mental health outcomes. However, people from the ages of 16 to 24, which is college-aged students, routinely have more stigma when it comes to seeking help, and young men are far more likely to feel stigma than young women when it comes to seeking help. And this is this occurs despite the fact that mental health interventions have been shown to be equally beneficial despite gender. Another thing we know about those three research areas I told you about earlier… is that most of those studies we conducted using a quantitative approach. So that's where I think my research added to the literature.  I used a qualitative approach to this topic because I wanted a deeper understanding of the perceived barriers that kept men from seeking help, and a more robust understanding of the perceptions, attitudes, and beliefs men had towards mental health and mental health help-seeking. I really wanted to understand the barriers that kept men out of therapy. Another thing that I looked into was mental health literacy, and essentially that's someone's ability to recognize mental health issues, be able to observe it in themselves and in others, be able to prevent it and understand it.

In general, many of the quantitative studies in the literature found that men score significantly lower than women when it came to Mental Health Literacy, and men tend to demonstrate more negative views and stigma toward mental health help-seeking. A lot of that is a result of men wanting to be perceived as masculine. So, like I said before, the researchers in the field, they believe that masculinity is socially constructed. You can't take blood from someone and tell how much they adhere to masculine norms. Now some people may ask… what about testosterone? I actually looked into that and there is no significant relationship between higher levels of testosterone and adherence to traditional masculinity. So, what is masculinity? Well, even though there is not an all-encompassing definition of masculinity because what it means to be a man changes so much from person to person based on history, geography, nationality, race, and all these other factors. Researchers do agree on a set of traits that make up what is called Western masculinity, or hegemonic masculinity.  Which is the notion that men are supposed to be stoic, tough, independent, responsible, emotionless, and providers.

So now put yourself in the mind of a young man in need of help. Think about the desire to be perceived as masculine and traits like independence, strength, and toughness. Ok, now think about the counseling process or the help-seeking process. Things like recognizing that you have an issue, admitting to yourself that it is more than what you can handle and that you have to reach out for help, and talk it out with a stranger…You can see how there'd be a disconnect in that and I think understanding this phenomenon and trying to get deeper insights into why and how this all plays out would help counseling centers better market to and serve young men. Understanding this would get more men through those Counseling Center doors. It takes a lot of courage to open that door and admit you have a problem and go talk to somebody. Addressing the barriers would be a big help.

Zach Taylor:

It's fascinating work that you've done, and one immediate connection I make, at least in the higher education space and among college students, is that we're witnessing a decline in male enrollment. It wouldn't be accurate to call it a mass exodus, but men are not enrolling at the same rates they were 10 or 15 years ago. It seems that many men not only feel that higher education is not suitable for them, but they also fail to recognize its benefits or perceive how they can afford it. Additionally, they may not feel a sense of belonging in that environment. Whatever the reasons may be, the fact remains that men are not enrolling in higher education.

In my experience working in colleges and universities, particularly in student services and mentoring programs, we encountered significant challenges in encouraging men to mentor others, such as pre-service teachers or those pursuing careers in social work. The numbers are imbalanced in these fields, with men only constituting 20 to 30% of the workforce. In my own teacher preparation program, for instance, there were only three men compared to approximately 25 women entering the field of education. The gender imbalance is evident in the social sciences, and when you consider the additional stress men may experience in higher education, along with potential declines in their mental health, it becomes even more challenging to make them feel that education is meant for them and that there are benefits to pursuing it. Moreover, even if they have doubts, it's crucial for them to know that there are available services they can access if they need help.

In broader society, it has been extensively documented that men tend to avoid seeking help for themselves. They often feel compelled to adhere to masculine norms, which equate asking for help with weakness. This mindset affects various aspects of their lives.

Dr. Aresh Assadi:

It's like those old TV shows, those old sitcoms about asking for directions. I know that's not an issue anymore because of GPS. But remember how men would just rather be lost than to like, you know, admit that they're not manly and they couldn't find their way. Isn't that so symbolic? Like you know where you want to go, you know what you want, but you can't get there, and you don't want to ask anyone how. So, you'd rather be lost? And I think that's just, I don't know, just really symbolic in showing the complexity of this problem.

Zach Taylor:

So, guiding those individuals towards higher education is one aspect, while assisting them in accessing resources and support within higher education is an entirely different challenge. This raises the question of what motivates individuals to seek help. I'm interested in learning more about the men who actively seek help and are proactive in addressing their needs. Who are they? What are their backgrounds? And what factors led them to seek assistance?

Dr. Aresh Assadi:

So, a lot of it comes from our environments, which really impact us. Many of the participants in my study shared stories about the pressure they felt to be viewed as masculine. These messages come from family, coaches, social media, movies, etc. These messages from the environment they grew up in told them what a man is supposed to be and how a man is supposed to act. Stuff like boys/men should not cry.

It is probably a little like how women might feel about how their appearance should be due to media and societal beauty standards. I think men get a lot of similar messages but more toward being emotionless, financially independent, and having high status. Men have these standards pushed on them from multiple places throughout their lives. And I found that the men that had families that were more supportive of mental health help, or maybe that they knew a man, a role model… those are big. If there's a role model that talks to them about getting help, says that there is nothing wrong with that. “Go ask for help if you need it. Why would you not do that? Take care of yourself.” That really helps.

One way the findings in my study differ from similar studies is the Mental Health Literacy (MHL) component.  Most studies found that men score poorer on MHL vignettes. I think it's more complicated than men just having low MHL. I think the reason they might present that way is that they want to protect their masculine status. They don't want to be viewed as crazy or feminine or weak or anything like that. So, they deploy different strategies like compartmentalization, minimizing their feelings/problems, bottling things up inside, masking, numbing, and using distractions like drugs or alcohol or different things while they wait for the problem to go away. Several of the participants spoke about waiting the problem out. “Maybe it will just go away if I just ignore it long enough. It'll just pass.”

Men who had good previous experiences with asking for help. So, I had 12 participants in my study, and four of them actually had previous mental health service utilization. And the ones that had, reported higher mental health literacy, also reported fewer negative views towards asking for help. But the ones that had never been and only heard what society tells you about it, expressed more reluctance toward seeking help. And I even saw this in the recruiting aspect. It was so hard for me to recruit for this study. I know it's always hard to recruit for studies, but it wasn't because I wasn't persuasive or from a lack of trying. I mean, there was a $25 gift card for an hour of your time. The broke college students were all for it when I made the pitch, they loved it. But there's this little thing called informed consent. You gotta tell them what the study is about. And once I started talking about the topic…"Hey, we're gonna talk about mental health. We're gonna talk about suicide. We're gonna talk about masculinity. We are going to talk about stigma" A lot of the men turned me away after that. They were initially interested, most probably because of the gift card. But once I mentioned the topic it was all, “No, No. No thanks, man. Never mind. Don't worry about it."

Zach Taylor:

You know what's intriguing to me, and I find myself using the word intriguing because it resonates with my own personal experiences. I have had very few men in my life with whom I felt I could have meaningful conversations about serious matters. We would communicate about goals and stereotypically masculine topics like competition, sports, money, progress, and status. However, when it came to deeper, more humanistic conversations about emotions, reactions, difficulties, and depression, those were rare. I can probably count on one hand the number of truly profound conversations I've had with a man in my entire life, let alone someone I would consider a role model.

 

This makes me wonder about the role modeling I received from a young age and how it relates to mental health later in life. It has also been widely demonstrated that women tend to have higher literacy scores and excel in communication. They perform better in English tests, communicate more effectively, and demonstrate greater fluency at a younger age compared to men. This is particularly evident in primary schools where teachers often need to accelerate the progress of girls in reading while focusing on teaching boys the basics. This gender disparity begins at a very early stage.

Returning to our main topic of integrating mental health services within higher education, what can we learn from long-standing and well-documented issues that may have originated during childhood? How can higher education address and mitigate some of these deeply ingrained patterns, whether it's related to communication skills or role modeling? And what role does higher education play in all of this?

Dr. Aresh Assadi:

Well, that is what higher education does best, and that's to educate. So, the three reasons that men don't go to therapy are wanting to adhere to masculine norms, stigma, and mental health literacy.  What do all three of those have in common? They're all attitudinal. As a therapist, I like seeing that because attitudes can be changed through education and raising awareness.

And you made a good point about men having issues with communication, you know, I do a lot of couples counseling, and one thing that I hear when I'm working with male and female couples is the whole… “I want to talk to him about problems or vent to him. But he always wants to just offer solutions or tell me what to do, and I really just want to be heard.” And this is something you see in old sitcoms also and in movies, this idea that men are more task-focused, and solution-focused. Let's get to the issue, let's get to the solution. And women tend to want to process things out a little bit more and talk about it and just be heard instead of being told how to handle something.

Now think about a counseling session, like what you've seen on TV, or maybe with something that you've done yourself, think about the whole process. You could see how it's not conducive to masculine norms or how men tend to want to operate. It's a lot of sitting around and processing and exploring and talking with a stranger and being very vulnerable and opening up, and that just doesn't fit.

But there are things that the researcher shows us that does help: workshops, which could definitely help with mental health literacy, perhaps a training where things are broken down to a few tips on how to handle a situation. It can be done by using destigmatizing gender-sensitive language in programming and marketing efforts.

When you see a lot of counseling marketing, it's usually like two ladies sitting down and talking or something like that. A lot of it seems to be not geared toward men. A few ad campaigns have had some luck by interjecting things that men like, like grilling or things that tend to be more masculine like sports. Really it can be anything like that. Like you said, using those kinds of things to get men's attention and that brings them in. Instead of talking about how to manage your depression, it can be called, how to become more productive. Anything to make the services more appealing to the ears of a man. That can go a long way in getting them into sessions.

Zach Taylor:

I was actually thinking the same thing, and I made a few notes while you were speaking. I don't personally know any man who doesn't enjoy finding solutions to problems and getting a good deal. For many men, Black Friday holds more significance than Christmas because of the opportunity to secure a great deal. It's an amazing feeling to optimize efficiency and exercise intelligence, aspects that men often take pride in. Thus, I believe that changing the messaging surrounding mental health could have a significant impact.

Imagine conveying to men that when they invest in higher education, they are paying for more than just sitting in a classroom and learning. There are additional services available to them. Wouldn't they want to make the most of what they've paid for? It's uncommon for a man to purchase a product warranty without understanding its benefits and then not utilizing it when needed, such as replacing a refrigerator light bulb or fixing a malfunctioning garage door. They ensure they get their money's worth. Applying a solution-oriented approach to mental health could resonate with men. If they view their mental health struggles as a problem to be solved, they might be more inclined to engage with available solutions. This shift in perspective could potentially improve grades, persistence rates, and overall success in higher education.

The hesitation among men to seek help may stem from the perceived threat to traditional hegemonic patriarchy and masculine norms. These norms are deeply ingrained and often feel threatened when mental health struggles are acknowledged or when someone perceives a man as having such struggles.

Dr. Aresh Assadi:

You know what, there has been some research done that flips those masculine traits that might be keeping men out of session on its head. I actually wish I thought of this. They got those traits that I told you about earlier like being independent, responsible, strong, and all that, and they flipped it on its head. So just like there is something called toxic masculinity, that we have all heard of. There is also something called ‘positive masculinity.’ This is important because these traits may be strengths in certain contexts. Well, the same trait can be a weakness in other contexts. This is just like the whole Golden Mean thing discussed by Aristotle.

So, let’s take something like courage for instance. There is a certain point when something is no longer courageous, and it actually becomes reckless. Or humor… is it good to be funny? Of course, but maybe not at a funeral or not when you're a best man giving a toast to the bride and groom, and you end up saying something super inappropriate. Certain traits are good at certain times.

So back to this positive masculinity thing. What the researchers did is they got those traits that men might view as a perceived reason for not going to therapy. And they used them as ways to get men into therapy. For example, a man is supposed to be responsible, right? Well, shouldn't you be responsible for your own mental health? And it's not just mental health that men don't get help for. It's also things like heart disease, diabetes, etc. There are all kinds of controllable, preventable diseases that men have worse outcomes than women at…it’s not just mental health.

Men have worse health outcomes than women. This is probably because they generally do not comply with treatment or forgo it altogether. So, a man, if you're supposed to be responsible and masculine, and you are supposed to take care of others, why don't you take care of yourself first so you can better take care of others afterward? How about strength? The same thing. A man is supposed to be strong, right? Well, what's stronger? Putting your head in the sand like an ostrich and pretending that the problem doesn't exist or being courageous, being vulnerable, and opening up and telling someone about what is going on. And, actually resolving it. I just thought that was genius, how they did that. Just use the stuff that's keeping men out of therapy and spinning it to a positive.  I don't like to use the word spin, but, you know, reframe it in a different way to make it more palatable to men.

Zach Taylor:

And when we discuss the importance of doing things differently, I had a conversation with Dr. Hampton regarding the urgent need for higher education institutions to prioritize faculty diversification. It is crucial to ensure that young people of color have role models and can envision themselves as both students and future faculty members within universities. I assume that this need extends to people of color and specifically to men of color. Particularly, if they require a role model, it would be beneficial to have mental health services specifically designed for black men, provided by black men, or for Latinx men, allowing them to see themselves represented in these services. Are higher education institutions making progress in diversifying in this manner? What have you discovered in your research?

Dr. Aresh Assadi:

It's so hard, Zach.

Zach Taylor:

Who is delivering mental health services?

Dr. Aresh Assadi:

We try our best, but there are so few. In higher education, it's a supply and demand thing.  There's just a low supply of male therapists. Back when I was working on my master’s to become a clinician.  I was usually the only male in most of my classes. Most of my classes were comprised of Caucasian women and that is what makes up most of the field. And there are just very few men and, in particular, very few minority men. And I actually asked this question to the 12 participants in my study: “Would you care who you're talking to?” And most of them stated that relatability was so important to them. They did not necessarily have to be the same race as them or necessarily the same gender. But being able to relate to the therapist was really important to them.  And you could see how having a therapist from a similar background, nationality, etc. could be a shortcut for building rapport.  "Oh, you look like me. You probably had similar life experiences. You might have faced similar issues to the ones I am dealing with." I'm not saying that it has to happen or there's no way around it, but better representation would be nice, and I am not sure how we can improve that. Hopefully through education and raising awareness.

Zach Taylor:

It's undeniably challenging. Men, in particular, tend to avoid pursuing higher education in what I refer to as "caring careers," such as education, social work, counseling, and human services in general. There is a significant underrepresentation of men in these fields. Consequently, there is a shortage of qualified male professionals available to work with men, resulting in resistance and difficulty in finding suitable counselors.

I can personally relate to this difficulty. When I was a teenager, my family went through a difficult divorce, and I distinctly remember feeling somewhat uncomfortable talking to a female counselor. However, I also had reservations about confiding in a male counselor at that time due to my struggle to trust men. It highlights the complex intersection of identities that men may face when seeking mental health support. They question whether the counselor not only resembles them and shares their background but also shares any identities with their oppressor or the perceived cause of their mental health issues. Finding a counselor who is a good match and establishing a successful therapeutic relationship can be extremely challenging for men.

Returning to the topic of masculine norms, men are often conditioned to believe that their worth is determined by their ability to provide. If they don't have a job or cannot support a family financially, they are seen as failures. Pursuing higher education and entering careers such as counseling, where the salaries may range from $40,000 to $60,000 or more depending on the level of education, is often considered insufficient for raising a family and fulfilling traditional notions of providing. Thus, the field itself is perceived as inadequate or not masculine enough for men to pursue.

These difficulties raise an important question. Despite the hardships brought about by COVID, which affected people's physical and mental health, as well as causing immense loss and grief, were there any positive aspects for mental health services? It is worth considering the fact that many services transitioned to online platforms, making them more accessible for individuals with disabilities. Additionally, educational opportunities for people with disabilities may have expanded, surpassing previous limitations. Can we find a silver lining in the integration of mental health services and the changes brought about by COVID?

Dr. Aresh Assadi:

I've noticed that even though our enrollments have been going down on our campus, we wouldn't know it through the lens of the Counseling Center here… because of our usage. The usage of our services has only grown over the past few years. And then it's grown a lot more, leaped up since COVID hit. I don't know exactly why, but my theory was that we were all suffering together. So, like, everyone was kind of in the same boat, so it kind of took away the whole stigma around, "I'm not doing as well as everyone else" and all that. We're all in the same boat. Mental health was really in the spotlight. It was in the news every day. They were talking about how some mental health issues were going up, substance abuse was going up, and alcohol use was going up. All these things were in the news all the time.  We kept hearing how stress is at an all-time high and I think it really normalized it, like, "Hey, we're all going through this together," and I think it just put a spotlight on mental health like I've never seen before in my 13 years of doing this.

As a result, we had faculty and staff members, you know, just left and right asking, "Hey, can you do a presentation on this top?” Or “hey, how do I help this student with this issue." They were just more in tune about it and talking about it and making it a part of their everyday life, being more proactive instead of reactive, knowing that it was coming. I think that really helped.

And also, I think I told you this in our first conversation, there was no infrastructure whatsoever to do remote or telehealth at all at our center before the pandemic. But then, you know, with the emergency order being put in place by the State, they really relaxed the rules so we could do Zoom sessions and other things we used not do. And it all just rally opened it up. And at first, I was going in kicking and screaming, like, "Oh, that's not how I was trained. You know, you lose so much online, you can only see what they show you, you can't see their hands fidgeting, it's just not as personal as I would like it." But I'll tell you, man, it really helped with lessening stigma. As I told you before, opening that door and coming into a counseling center, it takes some courage. And I think if we lower barriers, it makes our services so much more accessible. Like, it's just so much simpler to open up your laptop, in your PJs from the privacy of your dorm room, and just come log into a session. I wasn't a fan of it before, but now there's no way I would get rid of this service. I mean, so many people use it now. Even though we are all back on campus, we're still seeing a ton of people online. I don't think we can get rid of it even if we wanted to. It's just so popular now. I think 30 to 40% of our sessions are online now. So, from 0% to 30 or 40%. At one point it was 100% online.

Zach Taylor:

The demand for mental health services is evident. It reminds me of the past, where anonymous helplines, suicide prevention hotlines, and Alcoholics Anonymous hotlines existed. I still have a few close friends today who have gone through the steps and put in the necessary work to gain a deep understanding of themselves and their addictions. They have managed to overcome challenging times with the support of others and therapy. The anonymity provided an entry point for them. It allowed them to start with a clean slate, reinvent themselves without the burden of dependency. They had the freedom to disconnect or walk away if they felt uncomfortable. In many ways, it was a blessing that COVID has compelled higher education institutions to expand virtual student services. I would much rather engage in a conversation with someone who has their camera off, using an anonymous name on Zoom audio, than never hearing from that person at all. Preserving anonymity provides an outlet for individuals to express themselves without fearing personal judgment. This approach has proven successful in drug and alcohol rehabilitation programs, as it offers individuals a sense of control and the opportunity to connect with others facing similar challenges. These networks of support can help individuals navigate their struggles using strategies that have worked for others. Perhaps mental health services in higher education can adopt similar approaches, recognizing that anonymity and distance can help break down barriers associated with masculine norms. For instance, a person could have a few virtual sessions with Dr. Assadi over Zoom, gradually turning on their camera after a few meetings. Eventually, they may feel comfortable using their real name and sharing more about themselves. Ultimately, this progression could lead to face-to-face sessions where a genuine connection between individuals can be established, resulting in a powerful therapeutic experience.

Dr. Aresh Assadi:

Yeah, of course. And that's what I found in my study. So, what do I want people to take from my study? What I found is that men are capable of talking about mental health and that they see the benefits of seeking help.  However, socialization of masculine norms, stigma, and the need to protect their masculinity keeps them from getting the help they need. The participants that I interviewed, all stated that mental health is important and that if one of their friends needed help, they'd be more than happy to help them. They also expressed the importance of emotional openness and that you shouldn't keep things bottled up inside.

Though many of the participants were able to see this as important and necessary for the men in their lives. They had difficulties giving themselves the same grace. “It is okay for other men to do it but not me. I'd rather be the helper than the person being helped,” you know. And that is where the disconnect is. If they could just see that they deserve the same leeway for themselves. Like, if it's okay for all your friends to do this and you would be upset if they did not tell you they were struggling. Some of the participants said stuff like, “I would be mad if my friend hurt himself or was going through something serious and didn't tell me. I would be upset at him.”

However, when it came to them, it was okay for them to bottle stuff in and not ask for help. You know, and if you can show young men that disconnect, which I think I did with some of them, they're like, “Well, yeah, that doesn't quite make sense, does it? You know, I should be able to get the same help that I would want my friends and family to get if they were going through something.” This whole issue goes to show how strong socialization is. All that messaging that men get from society to be like John Wayne, Clint Eastwood, or some sort of superhero… you should be allowed to be a regular person that has regular struggles like everyone else.

Zach Taylor:

That is indeed logical, and what also resonates with me is the importance of institutions consciously considering how they communicate these services. Let's delve into the topic of communication and the innovative approaches you mentioned earlier, such as using offices as satellites and engaging in discussions in various campus spaces. Please elaborate on how you are conveying the services and share some of the creative methods you have employed.

Dr. Aresh Assadi:

I wish I could take credit for this, but this actually came from the study participants and the research. They were talking about counseling centers being more proactive instead of reactive. If the counselors were out of their offices (more visible), instead of in their offices waiting for people to come to them. If we would go out to where the students are, not just men, students in general, and just be around them... It might help with the barriers that keep students from talking to a counselor. It would go from, "Oh, I'm going to talk to a therapist. I'm going to talk to a shrink or whatever," to "Oh, I'm gonna talk to Dr. Assadi. He's just a regular guy. He's the guy that's always at the lobby over here. He's the one always passing out brochures and stuff" Stuff like that really simplifies the help-seeking process. That is why we do these things called "Let's Talk," it is a very informal psychoeducational thing where a couple of us will just set up a table, pass out brochures, and talk to students as they pass by getting ready to go to classes. You know, we go to the Law School, Multicultural Center, we go to the dorms, we go to the Rainbow Center (LGBT lounge), anywhere we can. 

We have these different satellites around campus that we just sit and wait for people to walk by. It really helps with our visibility and accessibility. We pass stuff out, and we find that it just takes a lot of the negativity or the bad connotations with therapy away. You're just talking to some student development specialists or talking to some educators. You're just having a simple conversation with us…nothing intimidating. And hopefully what ends up happening is we convert them into sessions really easily after having those talks. We hear things like "You know what? I've been meaning to go to therapy. Hey, how hard is it to make a session? Oh, well, I'll just do it right here then.” Our counselors usually have their laptops with them, so it is easy to go ahead and set an appointment up right there and then.

We have Zoom Mindfulness sessions…Another thing we do is called "Movement Mondays." We just walk. We encourage students to exercise because physical health is tied to mental health. We meet at noon right at the head of the trail. We all get together, and we just walk, and if they want to talk to us, they can. If they don't, they don't. Each week that they participate they get put into a drawing for a gift card afterward. And we've had a lot of luck with those people getting converted into sessions down the road because as they get to know us, as they relate to us, they don't view the counseling process as a threat or something negative.  They learn about confidentiality, and they learn that we're not going to tell anyone what they talk to us about.

Zach Taylor:

Excellent points, and there are parallels in other fields. One example that comes to mind is being added to a safe sender list for emails. This serves as a priming communication that conveys the message, "I am here to help." By saving the contact information in your phone or email list, and by recognizing the mental health service provider on campus, you establish a sense of familiarity. When you seek mental health services again, you are already familiar with them and have a level of trust. This process eliminates much of the unknown and empowers the student to have greater control, aligning with the idea we discussed earlier regarding men desiring control over situations—a norm often associated with masculinity.

Dr. Aresh Assadi:

Well, why not use them? I love what you're saying. If it works, why fight against the current? Like if they want to be viewed as masculine and stick with these traits, sure, as long as they're healthy, I don't care. You know, who am I to say what you are or are not? As long as you're getting the help that you need.  Because this is a retention issue. I mean, I don't know, we don't have to get into personal stuff, but I had some depression issues when I was going through college. When you look at most of the DSM disorders, lack of motivation and lack of focus is tied to most of these mental health issues, especially when untreated. So, think about someone with untreated mental illness. How are they going to focus? How are they going to pay attention? If your brain is not working right, you're going to have difficulties being successful. And that's what I try to communicate to anyone that will listen. College mental health is a retention issue. How many people drop out just because of mental health issues?

Zach Taylor:

Indeed, admissions departments also employ similar strategies, and the institution embraces such approaches. They take the initiative to bring their services directly to the students, meeting them where they are. It's interesting that you mention retention because, while some institutions may not struggle with enrollment, particularly prestigious and well-funded ones, it becomes an enrollment management and retention issue when students leave due to mental health challenges. These challenges often manifest in behaviors such as skipping classes, earning poor grades, disengaging from campus activities, and missing out on the transformative experiences higher education offers.

To conclude, if you were President Assadi or in a position of leadership at an institution, what would you do?

Dr. Aresh Assadi:

Well, you said a key piece right there, and that's a lot like not going to class and stuff like that. A lot of staff and faculty see stuff {mental health issues} way before I do, like the RAs, staff on campus, the financial aid folks, and anyone that has more face time with students. We don't get to see these issues until it's an emergency. Usually because of stigma, students delay seeking help. Imagine if we did trainings for staff where they learned more about having difficult conversations with students about mental health. It could be intimidating for a staff member to be like, "Hey, I notice you haven't been going to class. You know, you were making good grades and you were so engaged. Then the last few weeks, you haven't been as engaged.” And I know it's hard to do if you're not trained, but if they had some training, they could be like, "Hey, you know, John or Susie. I've noticed you're not coming to class. Or you seemed to not be yourself lately. What's going on? Is everything OK?" And then that student might open up and say, "Well, I've been having issues with this, or I am grieving the loss of my grandma”, or whatever the problem is. And that would be such a perfect time to do a referral. "Well, you know, we have an amazing counseling center on campus.” Then they could use a name like “Dr. Assadi, or Rachel or Tara is there. They're so easy to talk to. Would you like for me to walk you over there and we can set up an appointment?"

Could you imagine how powerful that would be? I think that would be huge, but we have to equip the campus community who see these things way before the counselors do, with the know-how. Because I think a lot of people are scared like, "Well, what if I make things worse?" or there's some myths on how “if I talk to a student about suicide, then I'll put that idea in their head.” Well, we know that the research doesn't support that. You won’t hurt the student by showing that you care. It may seem difficult but with some training, staff members, faculty, and fellow students will be more prepared on how to handle mental health issues and how to properly refer clients to resources on campus.

Zach Taylor:

Yes, absolutely. The issue has significant implications for communication and calls for increased collaboration on college campuses. At its core, it is a problem that demands a proactive strategy. There are far too many students suffering from mental health challenges, and the resources available on campuses are often insufficient. It's remarkable that despite the high demand for your services, there seems to be a decline in enrollment at many institutions when one would expect the opposite.

To address this, it is crucial to take a more proactive approach and effectively communicate with students. They need to perceive mental health services as a solution-oriented value that enhances their college experience and aligns with their expectations. It's about ensuring they feel they are receiving the support they paid for and that it adds genuine value to their lives.

Dr. Aresh Assadi:

I love that it's positive psychology instead of like, "What's wrong with you and how to get you to normal?" We take the view of “Where are you at now and how do we get you to the person you want to be… the vision that you have for yourself?” I think anyone, men, women, whatever you identify as would look at that a lot better, you know. That just seems a little bit easier on the ears, you know, "Where do you want to be in terms of your mental health goals? Let's get you from wherever you are to where you want to be."