Balancing Response and Treatment

Survey suggests that increasing student demand for mental health services -- spurred by prevention and awareness campaigns -- may be leading colleges to focus less on ongoing treatment in order to respond more rapidly to high-risk students.

January 13, 2017
 

National and campus awareness campaigns about mental health have led to increasing numbers of students who seek help at college counseling centers, according to a new report released by the Center for Collegiate Mental Health. That increase in demand, however, may be leading counseling centers to redirect their limited funding away from ongoing treatment in order to more rapidly address the needs of a growing number of at-risk students.

Over the last six years, counseling centers have provided 28 percent more “rapid-access” service hours per student, the center found, and devoted 7.6 percent fewer hours to routine services like ongoing counseling.

“One possible interpretation of this is that counseling centers are shifting resources from routine, traditional forms of treatment toward rapid-access, emergency room-like services,” Ben Locke, senior director of counseling services at Pennsylvania State University and a lead researcher behind the report, said. “Because most counseling centers have relatively flat funding, this comes at a cost, and the cost appears to be the amount of resources committed to ongoing treatment. Of course the concern there is that treatment helps students recover, and if treatment is not provided, then the student’s problems might get worse.”

The center’s sixth annual report includes data from nearly 140 institutions and 150,483 students. The data is not based on a survey, but on information collected during more than a million clinical appointments on college campuses in the 2015-16 academic year. This year’s report included a supplemental survey with counseling centers, which identified the shift in rapid-access service hours. The center is housed within Pennsylvania State University’s student affairs office.

As in previous years, the latest version of the report identified increasing demand for counseling services on college campuses. Since 2010, the average level of counseling center use grew by 30 percent, while average institutional enrollment only increased by 5 percent. During that same time frame, the percentage of students attending counseling who sought help for mental health concerns has increased by five percentage points, to 50 percent. For the sixth year in a row, the report found, prevalence rates of “threat-to-self” characteristics increased.

The mental and emotional health of students has been of increasing concern to colleges in recent years, even as many institutions struggle to find the resources to better address those concerns. Access to services remains a serious worry of many counseling center directors, according to a survey released last year by the Association for University and College Counseling Center Directors. Many directors in the survey noted that a shortage of counselors means they must use triage systems and put some students on waiting lists before they can receive treatment.

At colleges with enrollments of 1,501 to 2,500 students, directors reported an average of eight weeks per year in which waiting lists were used. At colleges with enrollments of 25,001 to 30,000, waiting lists were used an average of 23 weeks a year. At colleges with enrollments greater than 15,000, the average number of students on waiting lists exceeded 50, and the average was as high as 70 for institutions with enrollments of 30,001 to 35,000.

At the same time, more than half of college students say they have experienced “overwhelming anxiety” in the last year, according to the American College Health Association, and 32 percent say they have felt so depressed “that it was difficult to function.” Nearly 10 percent of incoming freshmen who responded to the 2015 American Freshman Survey reported that they “frequently felt depressed.” It was the highest percentage of students reporting feeling that level of depression since 1988, and 3.4 percentage points higher than in 2009, when the survey found the rate of frequently depressed freshmen to be at its lowest.

Despite the new CCMH report finding similarly increasing demands, lifetime prevalence rates for prior mental health treatment remained stable across the previous six years. One in two students who sought treatment had sought prior counseling; one in three had taken prior medications; and one in 10 had been hospitalized. There has been little variation among those categories since 2011. This indicates, according to the report’s authors, that students referred for counseling do not have increasing rates of pre-existing mental health concerns.

“This means students aren’t necessarily getting sicker, but more are seeking help,” Locke said. “It’s likely that the many national prevention and awareness efforts over the past decade have led to more students seeking mental health services.”

The Jed Foundation, a nonprofit organization that works to prevent suicide among college students, has created several such awareness campaigns in recent years. The foundation’s medical director, Victor Schwartz, said he found the new report to be largely heartening.

“Groups like ours have been working to raise awareness and lower barriers for students seeking help, and it looks like our efforts are having some impact,” Schwartz said. “In our work with schools, we are also trying to push to shorter wait times. My feeling has long been that if a 19-year-old kid is asking for help, you want to respond as quickly as possible. Schools are doing more walk-in hours, phone triage and other things to streamline the intake and get kids in need seen fast. Of course, whenever you add resources somewhere, there’s a chance you will have to economize in other areas.”

It’s possible, Schwartz said, that “as schools shift to getting kids in more quickly, they are doing a better job deciding who needs to be referred for longer-term care.”

In the past year, several colleges have tried widening access to mental health services for students in distress. Those efforts have largely focused on expanding the hours and locations at which counselors can be sought out, especially for students facing an immediate metal health crisis, such as feeling suicidal.

Last spring, the University of Iowa announced that it would hire eight new counselors to meet rising demand for more mental health services among its students. Rather than setting up new offices in the university’s counseling center, however, some of the new counselors are being embedded in various buildings around campus. And in April, Penn State’s senior class raised money to create an endowment that would embed a counselor in a residence hall.

After complaints from students last year, Skidmore College in New York hired an additional counselor and contracted with an outside firm to offer a 24-hour telephone hotline. Earlier in the year, following the suicide of a New Jersey woman who attended the University of Pennsylvania, the New Jersey State Senate passed a new law requiring that mental health professionals be available around the clock to assist the state’s college students. Last January, Willamette University in Oregon partnered with ProtoCall, a 24-hour mental health hotline, to provide around-the-clock support to students. Amherst College launched a similar hotline about a year ago.

“The intended outcome of suicide prevention efforts is to identify those in need and get them into counseling quickly,” Locke said. “But, as institutions of higher education, we need to make sure that we are not overprioritizing instant response in comparison to adequate treatment. We need to balance both.”

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