University students today are very diverse in every dimension of their lives. Their lives are also very complex in that they take place in a complex world at a complex time in world history. Today’s students are grappling with global political and economic forces that did not exist for their parents or grandparents. These issues present a kind of psychological labyrinth through which they must navigate into adulthood and complete their education. Universities must take these factors into account if they hope to successfully carry out their missions. The realities of students’ lives in today’s world must then manifest in the activities of every department or unit on campus.

In Delivering Effective College Mental Health Services, available from the Johns Hopkins University Press, I seek to provide a template or roadmap as to how administrators can develop a helping campus culture and orient the counselling or mental health service to current needs and sensibilities. Historically, too few university counselling practitioners, and the upper administrators to whom they report, receive substantial training on how to build a counselling service from the ground up. In most mental health and higher education training programmes, there may be an overview of the business and financial aspects of practice, but even this is often cursory at best, due to the necessary constraints posed by a curriculum. Less available is information concerning such profoundly important details of service construction.

There are crucial questions to answer:

• From what paradigm should the centre operate?
• What type of model will guide the day-to-day operations of the centre?
• What options exist regarding service paradigms and models?
• How should the centre be oriented in order to match a specific campus culture and the needs of its students?
• What does such an orientation have to say about the rising demand for services?
• What are the strengths and limitations of this orientation?

These issues are profound in their importance because all the work that is done with developing adults will flow from these details. They affect how we see, define, and approach the advancement of their well-being, thus potentially affecting the rest of their lives. Due to their strong sense of caring, work ethic, and professional obligations, counselling personnel and others provide competent and effective responses to student needs every day. In this book, an overarching goal is to make that work somewhat easier for them, provide a means to achieve philosophical consistency in all the various aspects of centre operations, and give them a template from which to launch discussions and assert centre needs on campus.

The workflow of the construction process should ideally move from global issues such as paradigms, through models of service, to specific details such as the organisational structure of the service. The book provides a framework for this workflow by outlining choices that administrators may make.

First, a view of paradigms is offered:

The intrapersonal paradigm

In this motif, the location of both human problems and their resolution exists within the person. Of primary interest are patterns of symptoms, disease or disorder, diagnosis, and matching interventions borne out through experience and research. Examples of models based on this paradigm include the medical, health service, psychoanalytic, and, to the degree that physical and emotional growth is of interest, the developmental.

The extrapersonal paradigm

Here the focus is on the full context of the person, their total environment. Aspects of context may be seen as psycho-pathogenic, such as abuse, neglect, discrimination, harassment, extreme stress, and poverty. Related models may include the contextual, ecological or systems, and, if life stage and adaptation of the individual are of prime importance, developmental models. Common factors in behaviour change, the root of contextual approaches, may be of higher relevance than treatment-specific factors.

The societal paradigm

In this view, broad societal influences are the target for the reduction or elimination of human problems in living. Issues such as social justice, addressing racism, sexism, gender discrimination, inequity in law and policy, and so on, are the focus of both the client’s and practitioner’s work. This may be most similar to the traditional training and approaches of the social worker and the community psychologist. Most consistent with this paradigm are the human service, public health, ecological or systems, and feminist models of service.

The spiritual-existential paradigm

Spiritual or existential foci are about the place of humans in this world and their transcendence of the harsh realities of life. It involves superordinate goals and the most ‘cosmic’ view of pathology, which may be seen as maladjustment to universal truths. Various faith-based service models and Buddhist or other eastern practices may be most consistent with this paradigm.

Service models

From here, the book moves to options regarding service models, that is, how one can put form and structure to the paradigm(s) of choice. Ten models in current use are offered, though, certainly, hybrids are possible:

• Comprehensive counselling centre
• Consultation and organisational development model
• Contextual model
• Developmental model
• Ecological or systems models
• Faith-based or Eastern spirituality models
• Feminist or social justice model
• Human service model
• Medical or health service model
• Public health model

Just as with paradigms, each model has strengths and limitations, and, for this reason, campus personnel should undertake a comprehensive and honest study of campus culture and needs. One cannot make reasoned choices about such matters without this examination, much less effectively manage time, economic, or political forces, which often affect service formulation.

Campus needs

Developing a picture of campus needs also requires addressing questions relevant to mental health, quoted here:

• What is known about the prevalence of diagnosed mental illness, including substance abuse and addiction, in the community? Are some disorders more common than others? In whom? What is the state and range of campus and local medical health services? What are the state and range of campus and local counselling and psychotherapy resources? What is the state of health insurance in the area? Do all practitioners understand, respect, and work within each other’s professional cultures and values?
• What are the most common physiological stresses for students and others? What is the state of housing, food supply and desserts, clothing needs for the climate, and safety and exposure or vulnerability to crime? What are the most common criminal offences and who are the most frequent victims? Where can one go to get help about everything on this list?
• Describe the psychological ‘ecosystem’ of the area. Identify the major components in this system. In what areas might one feel unwelcome or threatened? In what areas may one find affiliation and support? How difficult is it to get there and to gather? How easy or difficult is it to belong?
• What is the prevailing social, religious, and political climate of the area? Who are the privileged? Who are the disenfranchised or marginalised? Who or what is assisting the latter? Does the institution provide or connect to these resources?
• Who works in the intersections of diverse groups? Who are the joiners and the peacemakers? Who are the dividers, the splitters, the separators? How quickly can people find or avoid these groups? What is the state of spiritual and ethics resources in the community?
• What opportunities do people have to increase esteem in themselves and others? How can they safely explore, create, express, and manifest or actualise their identities and gifts? With whom and where would this happen? Would anything or anyone interfere with these growth processes?
• What key laws, regulations, and policies provide for or constrict the well-being of the people? Is the institution involved in advocating for enhancements or corrections of these issues?

The book provides further guidance on working through this process, much more than space provides here. It is my hope that it may help a campus make fully informed choices such that services are congruent with the full range of student and community needs.

Lee Keyes, PhD is a licensed psychologist. He is also an emeritus director and consultant with Keyes and Polychronis Consulting.