Students struggling with their gender identity or sexual orientation have the longest-term counseling treatment while in college, according to a new report by the Center for Collegiate Mental Health. Students considering self-harm or suicide also participate in more counseling sessions -- and the number of students who reported they purposefully injured themselves or attempted suicide continues to rise. But far from a crisis, this represents more students seeking treatment, experts say.

The annual study draws data from nearly 150 colleges and universities and a little more than 161,000 students who sought mental health treatment at those institutions -- it is not a survey, but rather an analysis of more than 1.2 million clinical appointments during the 2016-17 academic year.

The center, housed at Penn State University, found that students who reported their primary concern was their gender identity participated in an average of 10.6 counseling sessions. Students who expressed anxiety over sexual orientation scheduled an average of 8.4 sessions. However, while these students did engage in the most long-term treatment, matters of gender and sexual orientation occupied little of counseling centers’ time -- 0.5 percent of sessions were devoted to talking about students’ gender identity, colleges reported, and 0.4 percent for sexual orientation.

About 0.6 percent of students in the study -- or about 620 people -- identified as transgender.

Most counseling centers focused on students’ reported depression and anxiety. Nearly 19 percent of sessions dived into matters of depression, and more than 23 percent focused on anxiety. Students who entered treatment for depression or anxiety participated in an average of 6.5 counseling sessions. While students can experience multiple mental health problems simultaneously, clinicians reported the students' top concern for this data set.

Because so much of counseling centers' resources are devoted to treating depression and anxiety, institutions should consider how best to intervene for a broader population of students, said Ben Locke, senior director of Penn State’s counseling and psychological services and executive director of the center. He said that colleges should help students recognize symptoms and learn ways to cope with the conditions to lighten the counseling centers' workload.

Students who indicated they had thoughts about hurting themselves participated in a little under eight sessions, on average, and students with suicidal thoughts had an average of about 7.5 sessions.

The number of students who reported injuring themselves without suicidal intent, such as cutting, has steadily risen every year since 2010. In the 2010-11 academic year, of those students in treatment, 21.8 percent indicated they had purposefully hurt themselves. That number has since jumped more than five percentage points to 27 percent.

The percentage of students who attempted suicide, and were in treatment, rose by two percentage points between 2010 and 2017 -- from 8 percent to 10 percent.

Locke characterized this as positive -- the college campaigns for students to seek help for suicide has succeeded, but it also strains counseling centers’ resources. He said that colleges should align with their priorities when trying to address mental health concerns.

"If we’re responding effectively, we need to recognize that some students may need longer-term care," he said. "Those experiencing suicidality may need longer-term care; someone who has been sexually assaulted, they may need longer-term care. This feels very important, that the resources invested in this area are matching decisions at the institutional level."

It is also worth noting that the number of participating institutions has also increased since the 2010-11 year -- from 97 colleges to 147, and thus the number of students on which the data set is based has nearly doubled, from 82,611 students to more than 161,000.

Last year’s report from the center found that colleges have devoted more time to more emergency-like services -- 28 percent more “rapid-access” hours in the 2015-16 year -- and 7.6 percent fewer hours to the more routine counseling, such as scheduled sessions.

In this year’s report, the center indicated that a vast majority of students attend between two and five appointments. Besides a single session, the largest number of students participated in four sessions -- a little more than 6,000 students.

“Colleges and universities are currently grappling with the question of how to respond effectively and efficiently to the rather sudden and dramatic increase in demand for mental health services nationwide,” Locke said. “The growing demand includes the full range of risk, need, diagnoses and many other factors that can make it difficult to define policies that work. Sometimes, the pressure to identify short-term solutions under pressure can result in overly simplified or rigid approaches that inhibit the potential positive effects that counseling center treatment has to offer.”