How much should colleges and universities spend on student mental health?
As an academic researcher, I couldn’t possibly give you a simple and straight answer, but here are a few thoughts.
First, let’s start with a rough estimate of how much schools are currently spending on mental health. Keeping in mind there is plenty of variation across schools, consider a typical 4-year public institution with an enrollment of 15,000 students. According to an annual national survey of counseling directors, a school in this category has a counseling service staff of 9 full-time-equivalents (FTEs) on average, which would translate to approximately $600,000 in spending including benefits, if you assume the FTEs are mostly psychologists, professional counselors, and social workers, with a smattering of psychiatrists, marriage and family therapists, and other types of providers. Adding in overhead costs (administrative support and facility use) and assuming that other units on campus are also employing a bit of mental health provider time for students, we can add another 25%, bringing the total to approximately $750,000 in mental health care costs.
Mental health-related crises often require significant staff time from campus personnel other than mental health professionals, in units such as residential life staff, academic advisors, and legal staff. According to the survey of directors, on average a school with 15,000 students has about 50 students hospitalized for mental health reasons each year. In the absence of hard data, let’s roughly assume these incidents require an average of about $3,000 in staff time (beyond the mental health staff, whose FTEs we’ve already accounted for), which would add another $150,000 in total staff costs.
It is harder to come up with an estimate of campus resources dedicated to the prevention of mental health problems, because national statistics are less available. If campus health systems are anything like the overall national system, it is safe to say that spending on prevention is much lower than spending on treatment: perhaps on the order of $150,000 as a generous estimate for our generic school with 15,000 students.
So now we’re up to a bit over $1 million for mental health treatment and prevention combined, or approximately $70 per student. This is about $1 for every $400 of total institutional expenditures on college students, which are around $28,000 per student at public universities.
So $1 for every $400, give or take, depending on the school. Is this the “right” amount? What is the right amount?
From an economic perspective, schools, and society more generally, can approach this question by focusing on value per spending, or cost-effectiveness. Schools could ask themselves:
1. What value are we getting from our current investments in mental health?
2. What would be the expected value of alternative or additional investments we could make in mental health?
3. How do our answers to the first two questions compare to the value we are getting, and could be getting, from investments in areas other than mental health (i.e., the other $399 for every $400 of the budget!)?
You can see why there are no easy answers to the question at the beginning of this post. How do we define and measure “value” for investments in mental health, and then compare this to a wide range of other investments in students’ well-being and development? One place to start would be student retention, which has a clear link to mental health, as I’ll address in my next post. In the meantime, please add your comments about how your school or organization invests in the mental health of young people, whether you think it’s the right amount, and anything else related to these issues.