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The Mental Health Squeeze

March 18, 2008

For years, college counselors have seen increasing numbers of students arrive to campus with serious mental health problems and prior treatment histories. The reasons are still partly a mystery, but the fact persists. The real question is what to do about it, but many counseling center directors have found themselves limited in their options by tight budgetary constraints.

Colleges across the country are responding to the higher demand with either longer waits or shorter appointments, and some counseling centers have adopted a phone-based "triage" approach to quickly screen severe cases. Some smaller institutions, meanwhile, have continued to refer patients to other providers. In many cases, the institutions are aware of the problem and are monitoring the response in order to weigh longer-term solutions such as hiring additional counselors or increasing hours. But the reality many counseling centers face is a limited budget and fewer, not more, available resources.

"I do know people have definitely seen an increase in demand and more serious problems over time at counseling centers here and across the country," said Sherry Benton, director of the University of Florida Counseling Center.

But her center is one of the lucky ones. While the volume of patients has increased, the university has been able to add additional counselors with the help of a student health fee. "A lot of centers are dealing with [the increased volume] in different ways. Having a waiting list is not very satisfactory as a way to deal with it, though," she said.

In last year's annual survey of counseling center directors sponsored by the American College Counseling Association, fully 91.5 percent reported observing the "recent trend toward greater number of students with severe psychological problems" on their campuses, while 87.5 percent said they noticed a growing number of students arriving on campus already on medication. They reported that 23.3 percent of "clients" at counseling centers are on psychiatric medication, up from 20 percent in 2003 and 17 percent in 2000. In 1994, the number was even lower, at 9 percent.

At the same time, among the greatest concerns to counseling center directors was meeting the growing demand for services without any additional resources. That priority was eclipsed only by how to deal with students who have long-term or severe problems, illustrating an observed increase in such cases over the past several years as well.

"First and foremost, I think students coming to college are bringing issues with them from the home environment, from the high school environment, that we’re just seeing an increase in the level of students that need some type of counseling services," said Gregg Heinselman, associate vice chancellor for student affairs at the University of Wisconsin-River Falls. But colleges have also gotten better at identifying students who need help and referring them for counseling. "Part of that we’ve created for ourselves, for obvious reasons, and part of that is just the dynamics of the American college student," he said.

The upshot at River Falls, a predominantly residential university with three full-time counselors for 6,400 students (2,500 of whom live on campus), is that “the numbers are working against us right now," a pattern Heinselman said is playing out across the University of Wisconsin system. "The waits have increased; on our campus, depending upon the severity of the situation, it may be three weeks before a student can get in to see a counselor. Are we excited about that, absolutely not, but it’s just the level of workload we’re dealing with."

The problems are compounded by the campus's location, where mental health resources are limited in the surrounding community. For students without health insurance, moreover, there is often nowhere else to turn. The university recognizes the problem, but funding hasn't been forthcoming so far; the center has proposed a student fee (along the lines of the University of Florida model) to raise additional revenue. It will hire a fourth counselor next year, Heinselman said, but it needs at least five or six to cover its current case load.

At the moment, the campus's counseling center is trying to cope by limiting the number of visits for each student, referring students with insurance to outside providers and contracting some functions to a local clinic. But the increasing severity of mental health problems continues to place more stress on the system, especially, Heinselman noted, in the number of emergency detentions for students considered a threat to themselves or others.

“I do think we’re seeing some national trends; we’re concerned, it’s going to continue to challenge higher education across the country.”

A 2003 study co-written by Benton, based on a sample of 13,257 students followed over a 13-year period, revealed a marked increase in the number, complexity and severity of college students' mental health problems. In most areas, counselors reported a major increase in the number of students with difficulties. The number of students with depression who received counseling doubled over that period, while the number of those with suicidal tendencies tripled. If counselors' perceptions today are any indication, these trends are only worsening.

"We’re seeing an alarming number of increases in detentions, and that takes followup work when a student returns to campus," Heinselman said, adding that "we want to make sure that we’re closing that loop … that they can come back to campus and be successful as a student."

He cited some of the usual culprits -- stress, the pressure of academics -- but singled out the phenomenon of "spiraling," in which students who were on medication in high school try to get on with their lives without it once they reach the new college environment.

All of those factors are being overshadowed this year -- at least on a visceral level -- by the Virginia Tech killing spree almost a year ago. Some institutions have seen a recent spike in demand on top of the past several years' mental health trends, and while there's no way to know for sure, it has been attributed to related anxiety among both students and parents. The ACCA -sponsored survey found that over 10 percent of respondents reported a "significant increase in students seeking counseling" in the weeks after the attacks, while almost 23 percent said they received more calls from concerned parents.

"I don’t know what it means, but we certainly felt it," said John Miner, the co-director of psychological and counseling services at Williams College.

The counseling center at Williams is holding off for a year to see if the pattern continues before hiring additional staff to take on the extra case load, so for the moment, the college is resorting to reducing the length of appointments. Instead of 50-minute blocks every hour, counselors now see students for 40 out of every 45 minutes. With nine part-time counselors, Miner said, that amounts to an additional 40 slots every week.

"I think it’s a little bit unique," he said of the approach, "but it depends on the size of the university and whether you have good community resources."

Miner added: "I think institutions will have to beef up their resources and I think they will also have to get better at providing brief, supportive treatment to those students that only need that and then provide more intensive psychotherapy for ... people that need more care."

 

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