Episode 99: Dr. Christopher Holstege on How Mental Health is More than Counseling
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How can you make experiential learning not just something your college does but part of who you are? As you move from doing it ad hoc to integrating at scale, how can you overcome resistance to change? What's the right mix of communications, incentives, and training? On a special 100th episode, we dive into these questions with Brian Rosenberg, author of "Whatever It Is, I'm Against It", Visiting Professor at Harvard Graduate School of Education, and former President of Macalester College.
In the current landscape of higher education, student mental health has reached a critical tipping point. While the immediate reaction from many administrators is to simply hire more clinicians, Dr. Chris Holstege, Senior Associate Vice President of Student Health & Wellness at the University of Virginia, argues for a more radical, proactive approach.
The "mental health crisis" is not a challenge that can be solved by clinical intervention alone. Instead, it requires a fundamental shift in how universities design their environments, schedules, and communities. By moving away from a reactive model and toward a holistic, integrated wellness strategy, institutions can help students thrive both academically and personally.
Transitioning from Reactive Care to Proactive Prevention
For decades, the standard model for campus health was clinical and compartmentalized. If a student was sick, they went to medical services; if they were struggling emotionally, they went to Counseling and Psychological Services (CAPS). However, this siloed approach often ignores the "front end" of the problem—the stressors and environmental factors that lead to crisis in the first place.
Dr. Holstege emphasizes that while clinical services are essential, they are only one piece of the puzzle. At UVA, the strategy has shifted toward "health promotion." This involves educating students early in their academic careers about the importance of sleep, nutrition, and downtime. By catching issues before they escalate into an emergency department visit, universities can create a more sustainable support system.
The Power of the "Holistic" Student Experience
One of the most striking insights from the UVA model is the role of non-clinical activities in mental health. Dr. Holstege points out that for many students—especially those in high-pressure programs like medicine or law—the "quick fix" of medication is often sought after, but not always the most effective first step for mild to moderate anxiety.
Instead, the university encourages students to engage with their environment. This includes:
Nature and the Outdoors: Utilizing local resources like Shenandoah National Park to provide a much-needed perspective shift.
The Arts: Encouraging students to attend free musical performances or visit art galleries to decompress.
Physical Activity: Integrating kinesiology and functional exercise into the daily routine.
When a student takes "downtime," they aren't losing productivity; they are becoming more efficient. A balanced student is a successful student.
Breaking Silos with Embedded Support
A major barrier to student success is the stigma and physical distance associated with seeking help. To combat this, UVA has seen tremendous success by "embedding" counselors directly within specific schools, such as the School of Law.
When a counselor is part of the local community, they understand the specific pressures of that academic environment. They become a familiar face rather than a distant clinical resource. This "busting of silos" allows for earlier intervention, as faculty can easily consult with an embedded professional when they notice a student struggling, rather than navigating a complex referral process across campus.
Data-Driven Wellness: The Future of Higher Ed
To ensure these interventions are effective, the next decade of student wellness must be rooted in research. Higher education leaders are now looking to move beyond anecdote toward definitive studies. By measuring the physiological and academic outcomes of wellness initiatives—such as the impact of movement or meditation on cortisol levels—universities can prove the ROI of a holistic approach.
The goal is clear: create a "connected college" where health, academics, and community are not separate entities, but a unified ecosystem designed to help every student succeed.
Episode 99 Transcript
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Chris Holstege: It's also really thinking through prevention or how do I, if I'm coming in, I'm a bright student, there's a lot of pressures then in coursework. I find that they don't take advantage of many of the things that would help to mitigate some of the stress the anxiety that they're having. They'll be more efficient at being a student if they can take some downtime and actually engage with some of these other things that I see and others see as part of a holistic look at our own wellbeing.
Elliot Felix: That was Dr. Chris Holstege Senior Associate Vice President of Student Health & Wellness at University of Virginia. We had a fascinating conversation about student health and wellness, talking about uva's journey to a more holistic, collaborative, and proactive approach and what other instititons can learning. What struck me from this conversation is that so often, people think mental health and they go right to "more counseling" and while that may be needed, it's so much more than that. I think you'll really appreciate this so let's dive in.
Elliot Felix: Welcome to the Connected College Podcast. I'm your host, Elliot Felix. I've helped more than a hundred colleges and universities change what they offer, how they operate, and how they're organized to enable student success. And if you're a leader in higher ed, and you think that the silos and separations get in the way of student success, then this podcast and The Connected College, are for you. We're here to learn and work together to bust silos, question tradition, and forge partnerships so that students feel connected to their college, their community. Their coursework and their careers.
Elliot Felix: Mental health plays such an important role in student success and I'm delighted to hear from you today. And I think a great way to get started is to hear how you did. So tell us a little bit about how you got started in higher ed and do all the great stuff you're doing at UV.
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Chris Holstege: Thanks. Got involved in the University of Virginia in 1999. Came here as a young faculty member in the School of Medicine. Started what's known as the Division of Medical Toxicology, taking care of poisoned patients or overdose patients. Did my training in emergency medicine after medical school and then my fellowship in medical toxicology. And 2013, the executive director of student health at that time was retiring. And Pat Lampkin, who I think is just a phenomenal leader, as previous vice president of the University of student Affairs asked if I'd come in the interim to take a look at student health and wellness in that time, just student health and what things could be done to enhance it. I pulled data, very data driven compared with our peers, universities presented to the Board of visitors and, um, we had a lot of dialogue about where we should enhance what we're doing for services for students in this arena.
Elliot Felix: What were some of the findings from that about what you were doing well, how you compared.
Chris Holstege: So University of Virginia Student Health at that time had really four main entities under its roof. One was caps known as counseling and psychological services. Where the mental health services are provided. One is medical services, which is the biggest unit. One is the Student Disability Access Center where all the accommodations occur. And then the fourth is the Office of Health Promotion. It's doing the prevention efforts and it's a multi collaborative group and, our goal was to really work as a multi collaborative team holistically for the student. And that group has grown significantly. And what we saw initially was we were really behind our peers in regards to clinical services provided space. And then one of the things that's starting to evolve was how do we look at, again, the holistic student looking at it as a multi collaborative team and wellness.
Chris Holstege: Presented to the Board of Visitors who said, we're a top tier university. We're not looking to be average. We're actually looking to excel and, the donors got behind it. We had an anchor donor to actually help start the building process. The university put in and another donors came forward so that the students didn't have to incur the cost of a new building. We enhanced funding for personnel. It's not all about the building, but it's also making sure we have the personnel right. And as you can imagine, there's tremendous debates for example, mental health services. What do we provide in-house and what would be referred to the community? And really we should be providing the majority of the services to our students. One, because there aren't many mental health services in the community, and it's not fair to take those services away from our, 25,000 students or so. The other is our mental health providers really know the university well, the pressures that the students are under.
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Chris Holstege: And so we really enhanced the counseling and psychological services. We also enhance medical services. We have more students who are traveling abroad. We really want to invigorate our travel clinic. A lot of students are coming in now with allergies and then expanding our allergy clinic. And then we have students, thankfully because accommodations are given that actually do have some pretty significant chronic medical issues that we also wanna make sure we have top providers who are caring for. And then we certainly work with UVA Health on when we need to refer. And then for accommodations we had a really limited testing facilities and the new building really allowed us to expand and have top of the line testing facilities too for students who need accommodations.
Chris Holstege: And then finally the prevention activities the Office of Health Promotion. You can imagine really important with this demographic to assure that there's appropriate prevention, activities and education and health. And then as time went on, became more apparent that we really needed to talk about wellness and wellbeing and how do we look at those things. And that's really a big initiative now as we start moving forward. We've really provided a lot of services when we talk about the mental health crisis. But how do we get it early on so that we're not getting to the point of the mental health crisis and what things can we do and what can we do in a multi collaborative fashion there too.
Elliot Felix: First of all, thank you for taking on all that with your colleagues and garnering that support. And I think in that story, there were some key ideas about collaboration, a holistic approach, promotion and prevention, wellness, and I'm curious how those factor into how you define student success.
Chris Holstege: I do define it as part of that. If you think about our students coming in, when it comes to health, it's a multidisciplinary grouping, right? The medical providers and medical services associated with our counselors, associated with our case managers associated with our combination specialists. They're really multidisciplinary teams that are working with the students as they navigate the university or have certain needs. It's also really thinking through prevention or how do I, if I'm coming in, I'm a bright student, there's a lot of pressures then in coursework. A lot of pressures of, for example, if I'm a pre-health student, I'm looking at graduate school. How do I navigate that in a balanced fashion? And what I was seeing with some of my students, I give my medical students as an example 'cause I was teaching this morning to the medical students. I find that they don't take advantage of many of the things that actually I personally think would help to mitigate some of the stress the anxiety that they're having, for example.
Chris Holstege: A lot of our fourth year medical students don't know what old Kabul Hall is and doesn't know there's music and there's free music. You can just step in and I don't know about you, but when you're here, for me to go listen to music at Old Cabell Hall, really talented musicians on an evening, and then walk out and see the lawn and on a, evening night kind of soft sounds. A lot of pressure comes off your shoulders and it puts life in perspective. The other thing we realized is our students aren't getting out and enjoying the environment again. My fourth year medical students are rotating with me and I'd ask the question, how many of you have been to Shenandoah National Park? They very few. It's 30 minutes away. They all have cars for the most part. Or just around here, have you gone down the hiking, some of the trails there's some beautiful places just to get out in nature. Exercise is another one. We have the fitness centers. There's a lot of different club sports that are out there. There's if you look at the various clubs as the CIOs, huge opportunities. Pretty much anything you can think of. There's a group out there that's doing it that you can get together and engage.
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Chris Holstege: And so we're looking at this, that when students come in. Really focused on their careers, their academics, but also on their taking time for themselves too. And I personally think they'll be more efficient at being a student if they can take some downtime and actually engage with some of these other things that I see and others see as part of a holistic look at our own wellbeing.
Elliot Felix: I think that holistic approach is so key because I think a lot of people they hear mental health, and they jump right to caps, but what you're laying out is, those services are a part of it and the right space to deliver them in. But it's music. It's the outdoors it's the environment, it's exercise, it's student organizations. It's finding your people in these places. It's all those things. I love that.
Chris Holstege: It is. And I think we have an opportunity, again, some of the research that we're doing right now in the student health and wellness realm, that we can actually research this too. So we're making sure that we're making good use of resources. Some of the donors have given money towards this initiatives. They certainly have in regards to the building. But also some of the research that we're doing. I'd really like to see in the next decade that we're helping to lead some of the research especially in this demographic with the student population, which I think we can then actually take some of what we've learned and extrapolate them to high school and middle school students too. To look at this a little differently. I'm a toxicologist. I don't like giving medications unless we have to. The answer is not giving medications to many of these, and I'm afraid, we're in a society that people want a quick fix.
Elliot Felix: And
Chris Holstege: I think the clinicians at times, I have a son who's an intern in psychiatry. I have a sister who's a psychiatrist. There's time certainly for giving certain medications, but there's many other ways to mitigate mild to moderate depression anxiety that I think we need to look at too. And then also trying to educate as the students are coming in early on in their careers, that some of these other opportunities exist so that it isn't all driven um academic success. But I worry as a toxicologist and some of the things that brought me in, people are trying to mitigate that with other things. That may be medications, pharmaceutical, or it may be I'm smoking cannabis, maybe I'm doing alcohol. Those are not the answers that we want. That's not a good response to the stresses. There's much better responses.
Elliot Felix: And even if you do these things together, even if you're, even if there is medication, right? Like exercise is part of it, right? It's never any one thing.
Chris Holstege: You know for mild mental health aspects, exercise still tops up there to help actually mitigate. I give Barbara Free a lot of credit. One of the donors that started the Free Center. Um, that gets into exercise and functional exercise where we have physical therapists and then students who've been trained to work with students on appropriate exercise, which I think is an important part of our health. And we're now integrating that in, as kinesiology is in the building too. They certainly have a lot of interest in this. We're doing a lot more with UVA Rec, which is fantastic. They have outdoor clubs they're doing, trying to get more engaged. We had referrals from caps for exercise and physical therapists to try to mitigate too, which I think are all great programs.
Elliot Felix: So it sounds like in terms of the big kind of shifts in you all are trying to make as you address mental health. It's leaning much more into the proactive health promotion and prevention and leaning into a holistic approach where it's not the quick fix. It's not one thing it's many things working together. Are there other big things that you see like coming down the pike that you're, keep you up at night as you think about student mental health and that are gonna require us to think differently or act differently?
Chris Holstege: This mental health crisis is not slowing, it's actually escalating. We're gonna have to look at how to mitigate that. And what are the causes for it? A lot of different thoughts on how to mitigate it. And so that certainly keeps me up at night. 'cause we will be inheriting, more of the stress, anxiety, depression based on what we're seeing unless this starts to resolve. The other is, I do have a lot of concerns, but I'm a toxicologist of the substance use. We're seeing a little bit of an upswing in alcohol use post pandemic with decriminalization of cannabis that's being used more, which has some of its own problems. Hallucinogenic agents are being decriminalized now across the country, and that's starting to bleed in and we've had some adverse consequences. And so I am concerned about some of the substances that are coming into society for our students too, as they look to mitigate this a different way. I think it's really important for us to look at things that we can do, such as good sleep, good nutrition, exercise, outdoors, and getting enough outdoors. Getting other things that actually are relaxing to you, whether that's music, other art forms sports. There's a number of things I think that the students should be engaged with. Now that I don't know about you, I've a, I've got a busy career, but I certainly find time to go hike in the mountains to listen to music, to play with my kids grandkids. It's about, carving out time. And I think I'm much more efficient when I work, when I do have some of that time carved out.
Elliot Felix: Yeah, I think that's really, that's like time management skills. Are not only valuable to make sure you get your paper or your project on time, but I think that like maybe that's gonna play an even larger role in students' lives so that they can create the time and be more balanced as you're saying, that might be one of the unlocks for some of these other activities.
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Chris Holstege: And, go back to the research. We really need to study this and I'm, it's another big initiative that we have is to actually study what we're doing as we're interacting with the students to see if the outcomes are different. There's challenges in that, but we don't want simply, anecdote. And that seems to help. We really would like to show that there's definitive studies that some of this works and there's some good work that's coming out with this. And my hope is to, in the future, lead in this arena at the University of Virginia, we've gotten the space. I actually have the research and some grants right now. And I think we have some good potential to get some good data here to help too.
Elliot Felix: Yeah, I had the good fortune to work on the contemplative commons, and I know, part of that is a research agenda, right? Where you're like. Before someone's doing yoga or movement or meditation, you measure cortisol before and after and you start to, this is my cursory understanding of, a complex subject. But you start to understand like the impact of certain activities on stress and that kind of research I think is really great. 'cause we're, there's so many people that are pushing. An evidence-based approach to student success. In the academic arena, I think it only makes sense that you're, you'd apply the same approach to mental health and wellness. What are some of your favorite examples at UVA or elsewhere? Of programs that do the kinds of things you're talking about where it's, proactive promotion and prevention and it's a holistic approach and it's not defaulting to caps or, or medication as the kind of, only answer.
Chris Holstege: Yeah, and I think, for example, Dartmouth much smaller university does a great job of orientation of getting the students involved with the outdoors and what's out in the outdoors around the area. I wish we could with all the incoming students and we do have a formal partnership with Shenandoah National Park, for example. We're looking to expand on that. They've been good partners. We have a joint website right now. We are expanding and plan to expand on the website areas for where there's great trails where the students can talk with each other things that are adjacent to grounds where they can easily just walk off or, within an hour's drive and I can get out to certain hikes and such. And I think there's some groups that do a very nice job on that. So that's one example of the outdoors, for example. There's been a few examples out there. It's not how do we look at exercise and fitness? As we're looking at the functional exercise right now, um. Some of this, some of the areas that we're looking at are a bit limited though, right? The data hasn't been, I wouldn't say the programmatics or the data has really been out there in this demographic group primarily because so many people have been so busy on the back end providing the services. After they've had anxiety and depression as opposed to really trying to address it on the front end. And I think that's where we actually can be pretty cutting edge. 'cause there aren't a lot of programs out there. I do think there's some data out there and some of the data that's out there, there's it's always challenging and we've been talking about this and some of the initiatives that we wanna move forward. Um. The biases that come in when you do the initiatives, right? We wanna make sure if we do an intervention, can we really tell the results that they're valid? And I think that takes a multidisciplinary team too. And we have, we're talking about that again, I'll go back to the outdoors. We're talking about that with the outdoors. If we were to do initiatives to see getting the students more engaged with the outdoors, if we got the students engaged out there, had transportation out there. Would that make an impact? What about those students who are working with IM rec and the outdoor programs does that help to mitigate, but it's always hard matching cohorts. I'll just put that out there.
Elliot Felix: Yeah. It sounds like you could keep the Office of Institutional Research and Assessment busy forever on understanding the efficacy of the various interventions you've got going.
Chris Holstege: And we have a very complex database right now directly with student health, where we can actually track in a de-identified fashion some of the, students as they're flowing through. And again, that's one of the big initiatives we have is the research arm of this.
Elliot Felix: Are there any promising early results or thing things that have surprised you or
Chris Holstege: one thing that worked really well, I think in the mental health realm and the decreased barriers is embedded counselors in the schools. So still part of caps, but we embedded counselors and we started with the law school first. Then that kind of expanded out from there. And that's worked really well because then the counselor becomes part of the community of that school and it's easy for students just to pop into the office and say, Hey, can I talk to you? Which is in mitigating issues before they start to escalate. And so we saw huge jumps in utilization and I wouldn't say extreme cases, but it was just good utilization and talk. And the first one in the law school, was also a lawyer. Really knew how to communicate with the law Students, I think, did a phenomenal job there of launching that program, and that's worked well in all the other schools to help mitigate some of this early on. That makes it easy for the faculty to stop in and say, Hey, this one student is having some problems. Would you mind talking with 'em as opposed to taking them across grounds to student health. And that also takes away some of the stigmas too, if I have someone who's embedded right with us. So I think we've had some tremendous success one, enhanced utilization. And I think earlier interventions that have occurred with those embedded positions. We just embedded someone with a student disability access center in one of the schools too, for the same thing to help with accommodations. Early interventions as opposed to letting things really, get extreme where they, have to come into, for example, the emergency department at the University of Virginia Health.
Elliot Felix: In our last couple minutes here, you're learning these great things about embedding counselors. How do you learn and where do you go to learn about what peer institutions are doing to understand what's working and what isn't for them? Or do you have what are your go-tos for for that kind of learning?
Chris Holstege: When we first looked to build the building and expand our programs, we actually did a tour a lot through the south, but also through the United States as we were traveling to look at some peer institutions. So you can imagine the ACC schools. We did a driving tour and stopped at them all. We visited Duke, UNC, Georgia other schools and try to bring back some of the best practices that we thought and aspects of the building. And you're absolutely right. Right now part of it is visiting where we think, for example. We were talking with Rutgers, who has enhanced intensive outpatient programs for students where they're hard to find around UVA. Do we look to expand in that area? We just started recovery housing for students in recovery. And there's some Texas actually has Houston. University of Houston has a great, yeah. So it's, trying to see who's got some of the, kinda seen as some of the top programs in the country to emulate. And then certainly at the national meetings, we have our various national meetings. We try and get our team members to the American College of Health Association, various Director meetings occur for the various units. And then certainly we talk with our peer institutions here in the Commonwealth too. There's some unique things that William and Mary is doing. Virginia Tech is doing George Mason University, and we're all trying to learn from each other and what are the, trying to, what are the best that things that you're doing and what are you trying to expand on?
Elliot Felix: I know I look at the, the National College Health Assessment every year, and that's my kind of benchmark for. One third with an anxiety diagnosis in one quarter with depression and so forth, and what the various stressors are. it sounds like checking out the conference proceedings of the American College Health Association would be would be good too.
Chris Holstege: There's different data streams that we look at. The counseling directors, for example, have one data set. There's a number of 'em that are out there.
Elliot Felix: Thank you so much for your insights about a really important topic and the progress you're making and where we should go next together. Appreciate it.
Chris Holstege: No, thanks. Thanks for your interest. great to talk to you.
Elliot Felix: Thanks for listening to the connected college podcast. Subscribe to my Connected College Newsletter at ElliotFelix. com for insights and excerpts from my upcoming book, tools you can download, and special offers. You can also find more information about talks I've given, articles I've written, and upcoming events there, and please support the podcast by rating and reviewing it wherever you're listening. Let's create connected colleges where students will succeed.