Telehealth programs and groups have been expanded at JMU's counseling center.

With the impact of COVID-19 on JMU has come a breadth of operational changes, including to the Counseling Center. For the Center, that’s meant continuing a transition begun in the spring semester — a shift from in-person services to a telehealth model.

The JMU “Fall 2020 Return to Campus Plan” states the following about new procedures being implemented in the Counseling Center:

“JMU’s Counseling Center is committed to prioritizing rapid access to mental health services and [meeting] the growing mental health needs of students. As a result of COVID-19 … the CC will be exclusively providing services via telehealth after initial intake.”

According to the document, while initial intake appointments will still happen in person at the Counseling Center, subsequent appointments will be held via a “telehealth modality,” with room left for possible necessary exceptions. But while a plan has been mostly finalized and put into place, David Onestak, director of the Counseling Center, said the transition to what he called “tele-mental health” was a process akin to “playing chess at a pretty high level.”

“It’s a very complicated process to take what you used to do in person and put it all into a tele-mental health model,” Onestak said. “You’re going to struggle with certain aspects of it, and you learn things as you go along, but overall, I think people have adjusted really well to it.”

The transition brought several technical challenges, Onestak said — one of the reasons students will still have initial intake appointments in person. Onestak said that in the summer, there were less people requesting services, so the Center could afford to take a little longer on the new tele-mental health processes development, but now, with the increased demand, “We can’t have things taking twice as long as they could be.”

“In order to do things exclusively through tele-mental health, meaning that the student never comes into the Counseling Center at all, you know, particularly for their first appointment, that is extremely challenging,” Onestak said. “From a technical standpoint, it’s just getting all these forms signed and all the rhythms of this. Like, it was taking hours for that whole process to take place over the summer.”

Additionally, group counseling presents its own set of challenges, Onestak said, as having multiple people in a small, enclosed room is impossible right now. Onestak said the Center will be using an encrypted form of the Zoom teleconferencing software for group sessions, but other than that shift to a remote call from wherever the students and clinician are located, the process will remain largely the same. He said groups will be formed by clinicians based on the needs presented, and the clinicians will continue to work through the constant process of getting students placed into groups that will be beneficial for them.

A large-scale shift to tele-mental health also brings up the question of who still qualifies for in-person counseling services. The JMU Fall 2020 Return to Campus plan states the following:

“As a result of COVID-19, with the exception of circumstances in which an individual student’s needs might require an accommodation (e.g., significant levels of risk), the CC will be exclusively providing services via telehealth after initial intake.”

Onestak said that while the decision is multifaceted, a main component of deciding who requires in-person counseling is an assessment of risk the individual poses to themselves or others. The risk assessment itself is one of the few things that “is going to remain pretty consistent” in the Counseling Center, Onestak said, and now, it informs clinicians on the ways they’ll meet with their clients.

“There’s going to always be an assessment of risk that a student might pose to themselves or someone else,” Onestak said. “And so then, we’re getting into the clinical judgement of, you know, these licensed professionals who are saying, ‘Given this particular context and given this person’s context and given the risk variables that we see present, then we might make a decision to have them come in.”

That assessment, Onestak said, measures factors such as past attempts at suicide, suicidal ideations and “judgements about a person’s sense of hopefulness,” along with “types of biases and experiences of prejudice” and several new items exclusively based around COVID-19. That process, he said, gives the clinicians the information they need to make the best decisions for the students they’re serving. 

“I think we arrive at good decisions about the levels of risk that students pose,” Onestak said. “There’s no guarantee in this area. It’s still a judgement, it’s still an art, but I think we collect the types of data that allows us to make the best decisions possible.”

Onestak also recognized that the Center may face an increased need for counseling services among JMU’s student body, even as the Center works through a mass shift to an online format. Onestak said that the Counseling Center formed a working group to study the impact of the U.S. response to the pandemic on mental health, which found negative results and that “citizen mental health has significantly worsened.”

“It seems increasingly likely that, you know, the anxiety and fear associated with [COVID-19] and all the isolation and, you know, the various aspects of the experience of lockdowns and all the restrictions have had a significant mental health impact,” Onestak said. “We want to be able to have the barriers as low as they possibly can so that students will find our services in a time where, you know … ‘Everything I’m used to, it’s been kind of disrupted.’”

Everyone’s trying to adjust to a new normal, Onestak said, and he said that for many students, that can mean an entirely new way of going about deeply ingrained routines and other long-term mental mainstays. 

“I think students are just trying to grapple with, ‘How do I make it through the day now? What does my day look like?’ … Nothing feels quite right,’” Onestak said. “I wonder … whether that’s going to be a cumulative impact that maybe not right now a student is going to be coming in because they’re just trying to cope with what’s going on, like, right in front of them, but over time, that’s going to wear people down, and the seeking of service might peak a little later in the semester.”

Onestak said that so far, what he’s heard from his clinicians is that “it’s the same things that typically tended to bring students into the Counseling Center, but [COVID-19’s] making everything worse.”

Onestak also noted that behind the operations of the Center are its clinicians — many of whom have had to quickly adjust to a new way of fulfilling their roles — who are also working through developing a new way of life during the pandemic.

Katie Weaver, a senior anthropology major, has been through the Counseling Center before, and she said she “wouldn’t be surprised” if the Center’s staff were feeling overworked in the current climate. Onestak commended his staff for their willingness to adapt, but he recognized that like others, they’re experiencing the hardships associated with the pandemic.

“Our clinicians are not robots, you know — they’re not,” Onestak said. “They also are going through all the changes and all the stresses and the anxieties that everybody else is. And yet, you know, they kind of put on their clinical clothes each day and kind of bracket that off and work to serve students in the best ways that they can.”

But even with the added pressure the Center’s facing right now, while Onestak said that the Center hasn’t yet received its yearly client evaluations, he said that from what he’s seen, students have assimilating well to the new process. However, he said, a true evaluation of effectiveness won’t be possible until later.

“The narrative that I’m hearing is that students have been very, very appreciative of the service, feel it’s been beneficial to them,” Onestak said. “I think especially for students … who may not have access to financial needs or family support, I’ve heard stories of those students being particularly appreciative of the ability for us to continue to provide the service.”

Onestak said that overall, though many of his clinicians and the students they serve would prefer to be working within a counseling model that allows for face-to-face interaction, right now, the best option is the one that’s best suited to the public health schema, and it’s “broadened [the Center’s] scope of some people that [it] could serve.”

“I think we would all prefer to still have the in-person experience with students, and I would imagine that the majority of our students would feel the same way,” Onestak said. “But, you know, in furtherance of their safety and the safety of our staff, the tele-mental health model seems to be in everyone’s best interest right now.”

Contact Jake Conley, investigations editor, at For more coverage of JMU and Harrisonburg news, follow the news desk on Twitter @BreezeNewsJMU.