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Campus counseling centers with lower student caseloads provided more mental health care to students across the board than high-caseload centers, according to a new report from the Center for Collegiate Mental Health at Pennsylvania State University.

Low-caseload centers were more likely to provide full-length intake appointments and weekly treatment, while high-caseload centers offered fewer appointments further apart, produced less improvement in students’ symptoms and more often referred them to external services.

“When clinicians have smaller caseloads, they’re able to provide more treatment to all students seeking care, including those with safety concerns and critical needs,” said Brett Scofield, executive director of the Center for Collegiate Mental Health. “There were significant questions whether high-caseload centers would be able to provide the same amount of treatment as low-caseload centers to students with high intensity and critical needs. The answer to that is definitively no.”

The report, which covers the 2020–21 academic year, collected data from 180 college and university counseling centers covering 153,233 unique college students seeking mental health treatment, 4,043 clinicians and 1,135,520 appointments.

After increasing steadily for years, rates of depression and generalized anxiety leveled off in 2020–21, the report found. Eating concerns and family distress were slightly more common, while the number of students seeking treatment for academic distress increased substantially over the previous year.

The report also noted a continuation of the divergence in recent years between anxiety and depression, with depression decreasing as a “presenting concern,” while anxiety continued to climb.

The lifetime prevalence rates of “threat-to-self” characteristics, which include self-injury, serious suicidal ideation and suicide attempts, significantly decreased during 2020–21 for the first time in years, the report found. Meanwhile, the average length of individual treatment increased from 4.35 appointments in 2019–20 to 5.22 in 2020–21.