Blog & Webinar: Access isn’t a waiting list. How Northern Arizona University built a mental health ecosystem that reaches the students who need it most

Ask most people what access to student mental health support means, and they will describe a door to a counseling center. A referral pathway. A waiting list that is, ideally, a short one.

Dr. Carl Dindo has a different definition.

“Access doesn’t mean every student should be able to walk into the counseling center whenever they want, it means diversifying the ways students can get to the support they need, when they need it.”

Carl has been at Northern Arizona University for over twelve years, moving from postdoctoral resident to Director of Counseling Services. In that time, he has watched demand grow, complexity increase, and the old model of the counseling center as the single point of contact for student mental health become increasingly unsustainable.

What he has built instead is something different: a portfolio of services, partnerships, and access points that together form a genuine ecosystem of care. Not a waiting list. Not a single door. Many doors, lighter weight, meeting students where they are.

The two principles that drive everything

When Carl talks about long-term mental health strategy at NAU, he keeps coming back to two words: accessibility and sustainability.

Accessibility, in his framing, is not just about making the counseling center easier to reach. It is about creating multiple pathways for students to engage with support in different ways, at different moments, through different channels. Some students need one-to-one counseling. Others need a community. Others need a quick check-in at 11pm on a Tuesday. The question is whether all of those students have somewhere to go.

Sustainability is about building a system that can actually hold up over time, without the counseling center carrying the entire weight of campus mental health need on its own.

“We want to move away from the counseling center carrying primary responsibility for every student’s mental health, towards an ecosystem where wellness is infused into the culture of the university. It’s just part of who we are.” – Dr. Carl Dindo

These two principles, accessibility and sustainability, are not fixed answers. They are lenses that NAU applies continuously as student needs evolve and as the landscape of mental health care changes around them.

Rethinking what access actually looks like

One of the most striking examples Carl shared was NAU’s shift away from traditional group therapy.

For years, the counseling center ran structured therapeutic groups, with formal screening, intake processes, and significant staff time invested in organisation and documentation. Groups were hard to fill. The administrative burden was high. The results were mixed.

So they changed the model entirely.

Instead of formal group therapy, NAU now runs open community support groups, held in the spaces across campus where students already gather, facilitated by a counsellor but run more like outreach than treatment. No formal intake. No individual tracking. Students show up, ground rules are set collaboratively, and the conversation happens.

“You create a flyer, you find a space, you show up, and you work with whoever’s there.” – Dr. Carl Dindo

The results have been significantly better, particularly for students who would never have engaged with traditional group counseling: students in gender-inclusive housing, students in ADHD and autism spectrum support communities, students from specific cultural backgrounds who found the formality of clinical settings a barrier.

The insight is simple but important. Sometimes what makes a service accessible is not its clinical sophistication but its lack of friction.

Meeting students where they are, literally

If the community support groups are one example of NAU removing friction, the Jack’s Care-a-van is perhaps the most memorable.

Using funding from the Higher Education Emergency Relief Fund, NAU built a custom mobile wellness unit: a specially designed RV with a private consultation space that can be driven anywhere on campus or across the state of Arizona.

The services it offers are broad and flexible, from mental health outreach and Let’s Talk drop-in sessions to hearing clinics and HIV testing. The van goes to where students are, rather than waiting for them to find their way to a building.

“We wanted to literally and figuratively meet students where they are,” Carl explained.

It is a tangible, physical expression of the access principle: if the barrier to support is distance, unfamiliarity, or the formality of walking through a clinical door, then take the support to the student instead.

The promotion strategy that generated 150 registrations overnight

One of the most practically useful insights from the conversation was about how NAU promotes its digital mental health services, and what actually works.

NAU has moved away from pamphlets and printed handouts entirely, replacing them with a single business card carrying a QR code that links to all of their service information online. Simpler, cheaper, more accurate, and more likely to be used by students who already have everything they need on their phones.

For Togetherall specifically, NAU worked with academic affairs to place a message directly on Canvas, their learning management system, three times per semester. The first announcement generated 150 new registrations. Each subsequent one brought between 50 and 75 more.

Ben Locke put the underlying logic clearly:

“Students are not taking notes on the services you’re advertising. They’re not going to find it until they’re in a moment of need. If you’re not present in the places they go every single day, you won’t be there when it matters.”

The LMS is where students go every day, multiple times a day. Putting the information there, at the right moment, is the difference between a service that exists and a service that gets used.

The number that matters most

Almost 90% of students accessing Togetherall at NAU are not using any other mental health services on or off campus.

Carl shared this figure himself, without prompting, as the reason NAU was excited to partner with Togetherall specifically. It speaks directly to the population that a portfolio approach is designed to reach: students who are struggling but who will never walk into a counseling center, never join a therapy group, never call a helpline.

“If we think about a community-based approach to wellness, it’s about leveraging partnerships to create accessibility for students who wouldn’t have it otherwise.” Carl said.

This is the both/and argument made concrete. NAU’s counseling center still sees around 7.5 to 8% of the student body through traditional services. The digital and community-based layer reaches a different group entirely. Neither replaces the other. Together, more students have somewhere to turn.

Addressing the concern about outsourcing care

There is a worry in the sector that bringing in digital mental health partnerships means outsourcing care, handing responsibility to a third party and walking away.

Carl pushes back on this directly.

“I don’t believe it’s an either/or. It really is a both/and approach. It leverages where students are and how they’re already engaging with technology and with each other, while continuing to offer what we know other students need.”

The integration at NAU reflects this. When a student using Togetherall reaches a threshold that requires escalation, the counseling center is notified. When a student calls the after-hours crisis line through Protocall, the same. The services are not separate silos. They are connected parts of the same system, designed to make sure that wherever a student enters, they can be routed to where they need to go.

In over a year of partnership, Carl noted, that escalation to the counseling center has only happened twice. The clinical layer within Togetherall, combined with the after-hours crisis support, has handled the rest. That is not a sign that the platform is being used lightly. It is a sign that the clinical governance is working.

Using data to make the case

One of the most resonant moments in the conversation came when an attendee asked about the financial pressures many institutions are facing right now, and how NAU has navigated difficult conversations around budgets and staffing.

Carl’s answer was straightforward: data.

“It’s easy to show data about volumes of students who engage with one-on-one services. But when you add in all of these other services that are engaging with hundreds of other students who wouldn’t otherwise be reached, that starts to build a more complete picture.”

NAU has not reduced headcount in its counseling team. What it has done is use data to inform how resource is deployed and when, adjusting summer contracts where volumes drop, and using outcome evidence to support the broader portfolio of services in conversations with university leadership.

The broader point, reinforced by Ben Locke drawing on his work with the Center for Collegiate Mental Health, is that a slight reduction in total students served in traditional counseling does not necessarily mean a reduction in impact. If the students who do come in are receiving more appropriate, higher-dosage support, outcomes may improve even as the headline number shifts.

What this looks like in practice

NAU’s ecosystem of care includes individual and relationship counseling, drop-in Let’s Talk sessions, after-hours crisis support through Protocol, open community support groups, the Jack’s Care-a-van mobile outreach unit, self-guided tools and mood tracking through WellTrack Boost, therapist matching and referrals through WellTrack Connect, and anonymous peer support through Togetherall, available 24 hours a day.

No single element solves everything. Each serves a different student at a different moment. Together, they expand the ways a student might find support, so that the answer to “where do I go?” is less likely to be “wait for an appointment.”

As Carl put it:

“Sometimes students come to us because they’re not sure where else to go. Part of what we do now is help them find that.”

The question worth taking back to your institution

If there is one thing Carl Dindo’s story at NAU illustrates clearly, it is that building a sustainable mental health ecosystem is not a one-time decision. It is an ongoing process of asking which students you are not yet reaching, which services are creating barriers rather than removing them, and whether the way you define access today is still the right definition for where your students are now.

The counseling center matters. One-to-one support matters. But for the students who will never walk through that door, the question is what else you have in place, and whether they know it is there.

If you’d like to learn more about how Togetherall supports institutions with safe, clinically governed peer support, you can watch the webinar on-demand or get in touch with our team. 

togetherall.com