Growing demand for behavioral health services overwhelms colleges
For Grace Bronkin, the excitement of being away from home for the first time to start her college career was overshadowed by episodes of sadness. She had first experienced them in high school, but they got progressively worse after she began living on campus.
“I think with all of the new pressures of being away from home and drinking and stuff it really got out of hand,” Bronkin, 22, said.
Her condition reached a breaking point one night at a party where she was binge drinking and began crying uncontrollably and repeatedly said that she wanted to kill herself before blacking out. The next day a friend confronted Bronkin about the incident and urged her to seek help.
Bronkin eventually got the help she needed by visiting the counseling and psychological service office at her school, the University of California at Los Angeles.
There she was evaluated by an intake specialist within 10 minutes of her arrival, and she was able to speak with a therapist the same day with a subsequent visit about a week later.
But Bronkin acknowledged scheduling follow-up appointments was difficult at times due to the large demand from students for counseling services.
“They were really good about having me immediately talking with someone that first day—it’s just the follow-ups that can be hard,” Bronkin said.
Her experience is far from unique, with the number of college students seeking help for behavioral health issues rising in recent years. From 2010 to 2015, counseling center utilizations increased by an average of up to 40%, according to a 2017 report by the Center for Collegiate Mental Health at Pennsylvania State University.
Greater stakes
Aside from the overall increase in cases, the types of psychological and emotional conditions college students are seeking help for have become more serious.
Many schools report a rise in the number of students visiting counseling services seeking help for depression, anxiety, suicidal thoughts, eating disorders and sexual assault—issues that often require more comprehensive care than many college counseling services are equipped to handle.
“Most of us were historically trained to deal with kids who have just hit a rough spot—they just had a breakup, or they fail their first class, or they were exposed to things for the first time that they feel has challenged their values,” said Barbara Thomas, director of the counseling and psychological services department at the University of San Francisco. “But that’s a waning population.”
Like Bronkin, the majority of students seeking behavioral healthcare on college campuses these days have long-standing histories of mental health issues that they were dealing with before they arrived on campus. The pressures brought on by being away from home for the first time as well as the overall workload can stress any student, but for those with underlying mental health issues, those same pressures can aggravate their conditions to the point that a college counseling office can be overwhelmed.
Such issues left unchecked can lead to disastrous outcomes. More than three-quarters of all mental health conditions begin before the age of 24, according to the National Alliance on Mental Illness. Nearly one-third of firstyear college students have thoughts of suicide, according to a recent study published in the Journal of the American Academy of Child and Adolescent Psychiatry.
The amount of resources counseling centers have devoted to emergency, “rapid access” services for students has grown 28% over the past six years, according to the Center for Collegiate Mental Health’s report, compared with a nearly 8% decrease in the amount of resources dedicated to more routine treatment.
Such trends have forced many institutions to re-think how they provide mental health services in order to meet changing demand.
“A lot of colleges are adapting the best they can, but I do think there is often a tension between the services offered at a typical campus counseling office versus the need,” said Dr. Nicole Danforth, director of outpatient programs in child and adolescent psychiatry at Newton-Wellesley Hospital in Massachusetts. “It gets pretty complicated pretty quickly.”
Fighting back
But the challenges created by the rising demand for mental health services on campus have prompted a number of institutions to try more proactive approaches toward addressing their capacity concerns. The hope is that doing so will help schools identify and provide interventions to at-risk students sooner, before their conditions become more advanced.
In September, UCLA started offering incoming students free online screenings for depression, which more than 2,600—about a quarter of the current freshman class—have opted to complete. The screenings are part of a larger effort the school has undertaken to fi nd better methods of evaluating and treating depression. “We’re looking long term and really wanting to explore what causes it,” said Elizabeth Gong-Guy, associate clinical professor of psychology at UCLA.
The project began in 2015 and involves one of the only large-scale research studies aiming to identify genetic, biological, cognitive, social and environmental factors associated with depression to provide evidence-based solutions for treatment. With a goal of including 100,000 participants, Gong-Guy said the aim of UCLA’s Grand Depression Chal-
“They were really good about having me immediately talking with someone that first day—it’s just the followups that can be hard.” Grace Bronkin UCLA student
lenge is reducing the impact of depression by 50% globally by the year 2050 and eliminating the burden of untreated depression by the end of the century.
“We knew we needed to provide a scalable treatment,” Gong-Guy said. “We have a large student community that is seeking care, and we don’t have the resources readily available for the whole course of treatment for everyone.”
Addressing mental health became a bigger priority among many colleges and universities after tragedies such as the 2007 mass shooting on the campus of Virginia Tech, where a student killed 32 people.
A growing number of schools have attempted to promote more wellness, teaching students to identify signs of a problem and encouraging students to talk about mental health when they are having issues.
Such was the reasoning behind initiatives like the Fresh Check Day program, a fair-type event designed to engage students in conversations about mental health and promote greater awareness about suicide prevention. Started in 2012 by the Jordan Porco Foundation, Fresh Check Days are held at more than 120 schools across the country, with booths offering students activities on different aspects of mental health issues to help them learn coping skills.
“The intent is to get students to feel comfortable about talking about mental health and to also make sure that they are aware of resources that can assist them during their time at the school,” said Thomas Lane, associate vice president and dean of students at Missouri State University, which began holding such events in 2017.
Mirroring hospitals
But in many ways, the problems college counseling services face in meeting growing demand mirror what many hospital-based, behavioral healthcare specialists encounter. A majority of schools don’t have enough counselors to serve their student populations, which can lead to students waiting several weeks on average before they can see one for non-emergencies, with more immediate interventions reserved for those already in crisis.
The ratio of counseling staff to students on an average college campus is 1 professional for every 1,737 students, according to a 2016 survey by the Association for University and College Counseling Center Directors, below the 1 professional for every 1,500 students recommended by the International Association of Counseling Services.
“If you go to the vast majority of counseling centers on college campuses they can have a month- to two-monthlong wait,” said Risa Stein, professor of psychology at Rockhurst University in Kansas City, Mo. Still, Stein said many school counseling services remain underutilized despite many of them having limited resources to meet the current level of demand.
Stein said her school has tried to address the problem through the Active Minds program, which was developed by a college student at the University of Pennsylvania in 2003 and has since grown to more than 450 chapters at U.S. colleges.
Student members promote professional services offered on campus and help students identify when they may need those services. “If students can support one another and feel like they can talk about these issues, perhaps we can get them to comfort one another at least,” Stein said. “We’re not going to train them to do psychotherapy, but at least we can normalize those experiences, and the sharing of those experiences— sometimes that’s enough to alleviate a sense of depression or anxiety.”
For her part, Bronkin said she is coping with her depression much better since she got help. Now a senior, she volunteers in the counseling office providing peer support.
“Before I got help I didn’t really realize how much it was bringing me down,” Bronkin said. “When that got lifted, I felt like this is what it feels like to be content—I’m not striving to be ecstatic every day, but I’m happy with where I am.”