Integrated Care in College Health: A Case Study

This case study describes 1 international student's treatment experience with an integrated health program on a college campus. This program uses a multidisciplinary, mind-body approach, which incorporates individual counseling, primary care, psychiatric consultation, a mindfulness-based cognitive therapy class, and a meditation group. ********** Today's college counseling centers are being used by students who have mental health concerns that are increasingly severe and accompanied by symptoms that threaten academic success and retention (Benton, Robertson, Tseng, Newton, & Benton, 2003; Gallagher, 2007). According to the 2007 National Survey of Counseling Center Directors (Gallagher, 2007), 91% of the 272 college counseling center directors who were surveyed reported a growing trend of students experiencing more severe psychological problems (Gallagher, 2007). Directors indicated that 49% of clients are experiencing severe psychological difficulties, with 7.5% confronting symptoms sa serious that they either cannot stay in school or can only do so with extensive mental health support (Gallagher, 2007). Furthermore, in one study, 18% of college undergraduates seriously considered a suicide attempt in their lives, with 6% seriously considering an attempt within the past year (Drum, Brownson, Burton, & Smith, 2008). Addressing these concerns is one responsibility of contemporary counseling centers. Meeting the needs of international students using effective, appropriate, and culturally responsive methods is also an important responsibility for counseling centers. Sometimes this important goal requires that staff members reexamine the service delivery models used to meet the needs of international students to increase their access to services (Yi, Lin, & Kishimoto, 2003). For example, one way of responding to such diverse needs is to provide multiple points of entry for mental health services. In an integrated health care system, students can access bath health and mental health services in a primary care setting, thus decreasing the possible barrier of stigma present in many cultures that are associated with stand-alone mental health treatment. Furthermore, the respect accorded to the medical profession within some cultures tends to increase the palatability of mental health treatment within the health care context. From an integrated health care perspective, primary care is a crucial environment in which to provide mental health services. As much as 75% of primary care appointments are related to mental health needs (Levant, 2005), and 55% of individuals experiencing mental health disorders are treated in primary care (Wang et al., 2005). In turn, we believe that primary care is an ideal environment for mental health providers to partner with medical teams, not only to provide more responsive and accessible mental health services to patients but also to collaborate on psychological, behavioral, and supportive interventions that better serve patients with more traditional "physical health" problems. According to Migas (2007), "the nature of integrated service delivery supports short-term, solution-focused interventions, which can be accessed multiple rimes if necessary, and can support progressive work toward greater mental and physical health care" (p. 17). Various integrated care models have been proposed (cf. Blount, 2003; Seaburn, Lorenz, Gunn, Gawinski, & Mauksch, 1996), and the Counseling and Mental Health Center (CMHC) at the University of Texas at Austin has developed one such model with a focus on a mind-body approach to care. In addition to an integrated, multidisciplinary approach, one of the core components of the treatment discussed in this case study is mindfulness, a therapeutic approach increasingly used at various counseling centers and within health and mental health care systems worldwide (Baer, 2003; Stanley et al., 2003). Kabat-Zinn (2003) defined mindfulness as "the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment" (p. …