Seeking more help for students in crisis, Cal State weighs options for after-hours mental health care

California State University System Grapples with Expanding After-Hours Mental Health Care Amidst Union Pushback

A significant challenge looms over the California State University (CSU) system: how to provide essential mental health support to students when campus offices close. As the university explores a new partnership for round-the-clock crisis intervention, a vocal union representing campus counselors argues for a different approach, sparking a debate that could redefine student well-being across the state.

The Growing Need for 24/7 Student Support

The urgency for expanded mental health services is palpable, with students experiencing anxiety and distress that extends far beyond typical academic hours. Jazmin Guajardo, a student at CSU Channel Islands and a member of the CSU Board of Trustees, shared firsthand accounts of how mental health struggles can "consume" students, impacting their academic success and overall lives.

These experiences underscore a critical gap in current services. While campus counseling centers offer valuable support, their limited operating hours leave many students without immediate assistance during evenings, weekends, and holidays. This reality is forcing university leaders to consider innovative solutions to ensure no student feels isolated in their time of need.

Data Reveals Alarming Trends in Student Mental Health

University officials have pointed to concerning statistics to highlight the demand for enhanced mental health resources. In the 2024-25 academic year alone, CSU students accessed over 5,400 walk-in or crisis appointments during regular business hours. Furthermore, the system recorded at least 3,500 after-hours crisis calls, with 177 instances requiring student transport to hospitals.

These figures paint a stark picture of the mental health landscape facing university students. The sheer volume of crisis interventions suggests that existing resources are stretched thin, and the need for immediate, accessible care is more critical than ever. The university's commitment to student welfare, or "duty of care," is being tested by these escalating demands.

A Closer Look at Suicidal Ideation Data

In a recent presentation to the Board of Trustees, a statistic suggesting CSU students reported suicidal ideation at double the national average was cited. However, it was later clarified that this comparison involved data from two different surveys, leading to a misinterpretation of the figures. When data from a single, consistent survey—the National College Health Assessment (NCHA)—was used, 28.3% of CSU students reported thoughts of suicide in the past year, a figure slightly lower than the national average of 29.4% from the same survey.

Despite the clarification, CSU leadership emphasized that any double-digit percentage of suicidal ideation is unacceptable. The university acknowledges the need to address these critical mental health needs proactively. This situation highlights the complexities of data interpretation in public health discussions and the importance of using comparable metrics to accurately assess student well-being.

Exploring a New Frontier: After-Hours Virtual Care

To bridge the gap in after-hours support, CSU is actively exploring a systemwide partnership with a private vendor specializing in virtual mental health crisis care. The proposed solution involves expanding services through a company that offers immediate support via video conferencing and telephone.

This approach aims to provide students with a readily accessible, confidential avenue for help, particularly for those who might feel hesitant to seek traditional on-campus counseling. The convenience and anonymity of virtual care could significantly reduce barriers for students struggling with acute distress outside of standard operating hours.

The Promise of Reduced Barriers

Carolyn O’Keefe, CSU's systemwide director for student wellness and basic needs, highlighted a key advantage of this model. She noted that the virtual platform offers a less traditional entry point to mental health support, which can be crucial for students who are uncomfortable or unfamiliar with on-campus counseling centers.

This "doorway that isn't through that more traditional doorway" is designed to encourage help-seeking behavior. By offering a discreet and easily accessible service, the university hopes to reach more students in need, ensuring that support is available whenever and wherever it is required, thus bolstering the overall health and safety of the student population.

Union Voices Concerns: The Case for In-House Counselors

While CSU leaders see potential in the virtual after-hours care model, the California Faculty Association (CFA), representing campus counselors, has raised significant objections. The union argues that contracting out these services undermines the role of existing in-house mental health professionals and could compromise the quality of care.

The CFA's primary concern is that outsourcing crisis support to external providers, potentially utilizing "gig economy workers," means students' mental health is placed in the hands of individuals who have not undergone the same rigorous vetting process as CSU employees. This raises questions about continuity of care and the deep understanding of the university's specific student population.

Contracting Out vs. Building Capacity

Loren Cannon, a philosophy lecturer and CFA board member, voiced strong opposition to the proposed contract. He argued that the logic of contracting out mental health services is flawed, especially when the stated need is for more psychological counseling. "You can have all the premises about why our students need psychological counseling," Cannon stated, "But then saying, ‘let's contract that to this other company based in Texas’ — that's a complete non sequitur."

The union's stance is clear: the substantial funds allocated for after-hours care should instead be invested in hiring and retaining more in-house counselors. This would not only create more stable employment for mental health professionals but also ensure that students receive care from individuals deeply embedded within the university community, fostering trust and a more holistic approach to student well-being.

The Financial Equation: Cost vs. In-House Investment

The financial implications of expanding after-hours mental health care are a significant factor in the CSU's decision-making process. O’Keefe estimated that an annual contract for systemwide coverage through the virtual vendor would cost approximately $2 million.

Conversely, she suggested that recreating a similar infrastructure in-house would incur substantially higher costs. This would involve building a system capable of managing fluctuating student demand, efficiently routing students to available counselors, ensuring compliance with patient privacy laws, and recruiting professionals willing to work overnight shifts. The university views the external contract as a more cost-effective solution to meet immediate needs.

A Matter of Bargaining and Precedent

The CFA has a history of challenging the CSU's use of external vendors for services that could be performed by their members. In 2022, the union contested a similar decision by Cal Poly Humboldt to contract with the same company, then known as TimelyMD. The dispute centered on the university's alleged failure to engage in collective bargaining with the union before outsourcing work.

This past conflict has set a precedent for ongoing discussions. CSU has been in communication with union representatives since the fall regarding the potential expansion of its relationship with the virtual care provider. Jason Conwell, a senior representation specialist with the CFA, confirmed these discussions, reiterating the union's position that investment should prioritize internal hiring and development of the existing workforce.

Navigating the Path Forward for Student Health

The CSU system stands at a critical juncture, tasked with balancing the immediate need for accessible after-hours mental health crisis care with the long-term implications of its service delivery model. The debate between contracting with external virtual providers and investing in more in-house counselors reflects a broader conversation about how universities can best support the complex mental health needs of their students.

As the university continues to weigh its options, the focus remains on ensuring that students have timely and effective support when they need it most. The ultimate decision will shape the future of mental health services within the CSU, impacting the well-being and academic success of hundreds of thousands of students across the state.