Counselors find it hard to keep up
concern — is rooted in simple supply-and-demand dilemmas. The need for mental health services has shot up for a variety of reasons.
According to the 2014-2015 report from the Center for Collegiate Mental Health, institutional enrollment grew by 5.6% from 2009 to 2015, while the number of students seeking services increased by 29.6% and the number of attended appointments by 38.4%.
The 2015-2016 report from CCMH reveals that, among students seeking counseling, mental health as a reason for seeking help has steadily climbed from 2010 to 2016.
Medication use, hospitalizations and suicide attempts have also increased.
One reason for the uptick in demand is that mental health treatment has drastically improved. Students who previously wouldn’t even have been able to attend college can go because of advanced medication and other forms of treatment, according to Maggie Bertram, associate director of training and education at Active Minds, a national mental health advocacy organization.
That means more students have access to college education, but it also means university counseling centers have a harder time keeping up with their students’ needs.
“You’re seeing a lot more students who have been diagnosed before they even come into college,” Bertram said. “It’s more possible with mental health difficulties to remain in school and be successful.”
Erica Cooke, a senior at Bridgewater College in Virginia who has been involved in her campus chapter of Active Minds for four years, has seen a rise in the number of students seeking counseling. The counseling services used to be notoriously underused — now there are one- to two-week wait times.
“I’ve definitely seen an increase in my four years of counseling services being utilized and people talking about it more freely,” she said. “But it’s still such a tough topic to get people to talk about.”
More recently, the slow shedding of the stigma surrounding mental health has caused demand to increase. As colleges work to make students more comfortable seeking help, they up the number of students they need to serve.
“The good news is we’ve been successful at increasing referral patterns and decreasing stigma, increasing help-seeking,” said Ben Locke, senior director of Counseling and Psychological Services at Penn State. “The unintended consequences of this culture shift, if you will, is that now we have a demand for services.”
Finding enough funding can be a challenge. Like any part of a university’s budget, the money can be publicly funded through state appropriations or government grants or can come from private hands.
Public schools, whose budgets are constrained by the state, often face a significant challenge getting proper funding to expand services, Bertram said.
“If a state is struggling to balance their budget, it can be on the chopping block just like anything else,” Bertram said. “Everyone’s interested in the success of students — it’s just often a matter of resources.”
Increased demand, Locke said, means colleges are often strapped for resources. For many schools, the most pressing concern regarding resources is simply not having enough counselors.
That can translate into students having to wait weeks before seeing a counselor or getting cut off after a certain number of sessions.
Since counseling is expensive, some schools are forced to charge students for services. Before Georgetown made changes in its counseling system, Johnson said, appointments cost $85 — often unaffordable for students who didn’t want to use insurance or involve their parents.
“It’s hard because mental health services are expensive, and they require space,” Locke said. “In order to meet the demand that we see today, it’s asking for a level of permanent financial commitment from institutions that is strikingly higher than it ever has been.”
It can be especially challenging for larger schools to provide ample counselors. Ideally, the counselor-to-student ratio is one to 1,000 or 1,500, according to Locke.
Though a small school can get by with a handful of counselors, a large institution such as Penn State, which has 46,000 undergraduates, would have to hire hundreds of therapists.
Penn State did recently hire additional counselors and added a student fee that will directly support mental health services to meet the growing demand, Locke said.
If colleges can’t provide students with timely counseling, problems can arise.
One consequence of the upswing in demand, according to the Center for Collegiate Mental Health report, is that colleges have increased their “rapid-access hours per client,” or the appointments they provide on short notice for emergencies.
Simultaneously, annual “routine-access hours per client” — non-urgent individual appointments — have decreased. Unless students are having an emergency, it’s getting harder and harder to see a counselor.
Nathaan Demers, a psychologist at Grit Digital Health, said lengthy wait times for mental health issues can be dangerous, even if the problems don’t immediately seem urgent.
“If they say I can’t see you for four weeks, imagine all the things that could happen in four weeks,” Demers said.
Simply providing counseling services doesn’t necessarily solve the problem. “I don’t think that there is any amount of ‘increasing counselors’ in counseling centers that is actually the right approach,” said Sarah Lipson, a University of Michigan professor who researches mental health. “It is sort of, ‘ What does the ideal campus mental health system look like?’ And I think it would be bent towards wellness and flourishing and resilience and prevention — and those aren’t necessarily efforts that have measurable outcomes.”
Prevention initiatives, Lipson said, can range from putting counseling center hotlines on student ID cards to training faculty in identifying mental health issues.
“Let’s not treat heart attacks, let’s treat high cholesterol,” Demers said. “In mental health, we need to ask ourselves that same (type of ) question.”
Mental health counseling is “still such a tough topic to get people to talk about.” Erica Cooke, senior at Bridgewater College in Virginia