Studies show that COVID-19 severely affected university students’ mental health during the last school year, with 83% reporting an increased level of stress, anxiety, or depression. Many international students also report post-traumatic feelings and thoughts, including helplessness and grief for lost loved ones back home. The Cleveland State University Global team realized that students from different countries had different pandemic-related needs and teamed up with Cleveland State’s Counseling & Academic Success Clinic (CASC) to find a way to help. Together, they are building a one-of-its-kind resource just for international students focusing on the importance of mental health.
Meeting the Mental Health Needs of International Students from India and Beyond
More than 90% of the 1,400 international students enrolled at Cleveland State are from India. India has the second-highest confirmed coronavirus infection rate of any country and the third-highest death total, accounting for more than 10% of all reported COVID-19 fatalities worldwide. A large population of students on campus felt the effects of the pandemic back home, but didn’t know where to turn.
“There was a COVID uptick in India in May, and I observed our students spending an extraordinary amount of time with their heads in two different places, here and at home,” said Dr. Sarah West, associate academic director at Cleveland State Global. “We had one student who, at one time, had both of her parents and a sibling in the intensive care unit at the hospital.”
Based on her extensive experience working with international students, Dr. West knew that not all cultures view mental health, therapy, or counseling the same way. With the counseling center on campus overwhelmed by the domestic student population, she saw an opportunity to provide services designed specifically for Cleveland State students from India and other countries around the world.
“I could see what these kids were going through and I knew that it was something we [had] to address, but I am not a licensed therapist,” said Dr. West. “That’s when I thought of CASC.”
CASC is part of the Counseling, Administration, Supervision and Adult Learning (CASAL) department at Cleveland State. The mission of CASAL includes engaging students in real-world learning experiences. Through CASC, clinical graduate students meet — under supervision — with international student-patients as they train and accrue hours in preparation for licensure. The meetings are entirely confidential, and many international students report feeling more at ease with clinicians who don’t use confusing medical jargon and are closer in age to themselves.
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“We are learning about cultural barriers to asking for mental health services,” said Claire Campbell, LPCC-S, ATR, Director, CASC. “We’re working closely with Global and conducting as much research as we can into [students’] unique situations. Whether students know it or not, the COVID experience was traumatic. We want students to learn how to explain how they are feeling and tell us whether they are able to cope with the many facets of being an international student in the US.”
Making a Space for Self-Care and Mental Health on Campus
Cleveland State received CARES Act funding from the federal government in 2021 and was able to apply some of that money toward paying salaries and building more of a physical presence on campus for the project. According to Campbell, students respond better when they can come in and talk with other students, therapists, and counselors face-to-face. Campbell and West hope to have three satellite offices (their well-established central CASC office and two additional locations flanking the furthest edges of campus, including a new space in the same building as the Global offices).
“We really want our Global students to come,” said Campbell. “The space is designed to reduce anxiety: We don’t have any overhead lights, we’ve got sound machines, we’ve got some pleasant [scents] from essential oil diffusers, and we’ve got this really eager and interested group of graduate students who want nothing more than to talk with students and offer support.”
Students can drop by and just hang out. There’s no pressure to talk with a therapist. Students are greeted by an open door, a smile, and no judgment. Some come to borrow books or have casual conversations; others come to meet and talk through their problems with clinicians. Some find it harder than others to break through the taboo of talking to someone about their feelings and emotions, but all reports so far show that each student benefits from trying.
“What we’ve known all along is that some students need to walk by our offices maybe 10 or 15 times before they get enough nerve to walk in,” said Campbell. “That’s why our doors are always wide open. We just want to be really transparent about what this is that we’re offering and eliminate as many barriers as possible.”
Adding to Cleveland State Global’s Academic and Social Support Systems
The Cleveland State Global team is excited to bring focused mental health services to their program of comprehensive student care (that also includes social and academic support). The new services available to international students soft-launched over the summer, and this fall, Cleveland State Global staff is paying particular attention to the new students transferring to Cleveland State from other universities.
“Not only will they receive intense academic advising and the social support that we can provide through groups and events at [Cleveland State] Global, but those kids are now going to be filtered straight into CASC,” said Dr. West. “That three-part approach is going to carry them through the entire year.”
It’s also a one-of-a-kind opportunity for Campbell’s graduate students to work with a specific segment of the student population and further their development as clinicians.
Becoming Agents of Growth In and Out of the Classroom
Both Campbell and West point out the interrelationship between mental health and academic performance — and how it is just as essential to care for your mind and spirit as it is for your body. Last year, many students struggled, pushing themselves academically while the world felt like it was falling apart around them. Together, Campbell and West see how the two groups working together are helping students build coping skills and resilience techniques they can use for the rest of their lives.
“Can we identify the things that are the most challenging for a particular student? Can we address them so that, at the end of the year, the students will show growth?” said Dr. West. “We want to be agents of growth. Not only academically, not only emotionally, or even socially, but in the way the brain processes information and allows a student to make appropriate choices.”
Working to Make a Positive Impact for International Students
Both Campbell and West report fantastic early results, even with students who at first felt uncomfortable sharing their feelings with a stranger. After having difficulty connecting with students remotely, Campbell and her team of graduate students met with their first one-on-one student, who felt a lot better after talking things through.
“I couldn’t have asked for a better soundbite,” Campbell said. “One international student reported, ‘This is the first person I’ve ever talked to about any of my problems, and she understands my problems.’ And what Sarah and the Global team have really helped our team understand is that if we get a couple of students on board, then others will follow. They become stewards and they destigmatize mental health.”
CASC director Campbell points to results from student-conducted CCAPS-34 surveys at the beginning and throughout their time working with CASC. The CCAPS 34, created by the Center for Collegiate Mental Health (CCMH), screens for distress areas common to college students. Campus counseling centers such as CASC use the results to determine how best to help.
“The CCAPS-34 looks at the areas of distress that are common with college students: generalized anxiety, depression, hostility, eating concerns, substance use, and then there’s the general distress index,” said Campbell. Students will take the CCAPS-34 periodically throughout their treatment to chart changes in their well-being. “Usually, students come in and their distress levels are high and, at first, when they start working with clinicians, their distress levels go up even higher because they are starting to unload and unpack. But then, those levels plummet, because, finally, these students have a place they can go to just process,” she said.
Campbell and her team plan to continue conducting research and measuring their exciting work with participating Cleveland State Global students. She hopes their work can be published and used for the greater good of international students studying around the globe.
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