College Counseling Centers Cannot Act Alone

With all the current attention placed on the mental health of college students, it’s fascinating, and quite insightful, to hear directly from students. When Inside Higher Ed and College Pulse surveyed students in spring 2021 about their mental health, one in four reported using any kind of mental health resource on campus; during a spring 2022 survey, four in 10 students reported doing so.

The findings of these Student Voice surveys (conducted with support from Kaplan) coincide with the increase in demand for services that so many college counseling centers are experiencing. At Texas Christian University, we saw a 48 percent increase in demand compared to last year, which was a 45 percent increase from the year before. As staggering as our increase in demand is, I know of counseling centers on other college campuses that reported an 80 percent increase.

Responding to this unprecedented increase in demand is one the biggest challenges facing college mental health centers. Interestingly, when prompted with the question of how to prioritize funding for mental health services on campus, the most popular answer from students (37 percent) was for the expansion of on-campus counseling staff.

As noble as this response might be, it’s readily apparent that colleges cannot hire their way out of this challenge. Expansion definitely helps, and there is a tipping point at which schools can have enough individual counselors to serve every member of the student body. However, at a school of 12,000 students, you would need to hire 423 therapists to reach this tipping point. This also assumes that every student has the same severity of mental health problems, and we know this is not the case.

It’s time to put aside our turf battles, shift away from the traditional model of college counseling and focus on collaborating with established resources in the community as well as other parts on campus.

In reality, if universities were to use the mainstream thinking of “just hire more therapists,” they also would need a hospital, psychiatric departments and residential treatment centers to ensure that the growing demands were met for every student. This would transform institutions of higher education into treatment communities, and the tuition hike required to pay for this would be astronomical! It’s not feasible, and no administrator, student, parent or stakeholder would advocate for this.

Even if we focus on hiring just a small number of new therapists, how much of a campuswide impact would this create?

In the survey, 39 percent of students with substance abuse issues and 30 percent of students struggling with suicide ideation stated they did not even know where to go to seek mental health services on campus. This is a huge problem that adding one to two therapists on staff will not fix. Instead, the solution to this problem, as well as many of the challenges related to college mental health, is that college counseling centers cannot act alone. Indeed, college counselors are the mental health experts on campus, but it’s time to put aside our turf battles, shift away from the traditional model of college counseling and focus on collaborating with established resources in the community as well as other parts on campus.

Steps Toward Collaborative Care

At TCU, I developed and implemented the Comprehensive Collaborative Care Model. The path to creating this model began with focusing on three national trends:

• As reported by the Center for Collegiate Mental Health, 20 percent of students seeking mental health treatment utilize about half of all campus counseling center appointments.
• The common observation is that many current counseling center clients have previously received services, indicating the need for better after-care/follow-up services.
• The fact that responding to students in crisis contributes to high burnout among already burdened counselors.

To address the first trend, we collaborate with local treatment centers and community providers to offer specialized, college-specific programs on campus for the 20 percent of students with high mental health needs.

As cost is a concern for many students, our partners utilize the students’ insurance, and we’ve secured various grants and donations to cover their co-pays. This is a significantly less expensive endeavor than paying the salary of a full-time therapist. This partnership with treatment centers and community providers creates a win-win-win situation in which the community providers expand their programs, the university doesn’t spend money (in fact, some of the providers insist on paying rent for the conference room they use) and the students receive a high level of treatment. Furthermore, this frees up the capacity of our staff therapists to provide more individual counseling to other students.

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Regarding after-care/follow-up services, we follow the principles within the field of substance use disorders. Anyone who works with individuals in recovery knows that clinical interventions are not enough; peer support and having a supportive community is what sustains the gains made from therapy. At TCU, we started hosting peer support communities for a variety of mental health domains. This program is perhaps the most popular aspect of our model. We grew from four to 20 communities during the peak of COVID and have maintained those communities since students have returned to campus. We have found that students within a peer support community return to counseling less often than students who do not participate in them.

Finally, we restructured our staff to include therapists who do not carry a traditional caseload but rather focus solely on conducting intake/triages and crisis response services. These triage and crisis care counselors have the availability to better respond and follow up with students who drop in with a crisis. They also free up the capacity of our staff therapist to provide even more individual counseling to other students.

TCU’s way of college counseling seems to resonate with many institutions. To date, we’ve trained more than 100 schools in various aspects of our model, including the vice chancellors/presidents of universities that are members of the Big 12 Conference. We’ve also received a federal grant and generous gifts from members in the community to keep these programs running.

The past few years have been the most challenging in our field, and these challenges will likely persist for years, if not decades. However, imagine if colleges and universities could meet these challenges! I believe if every school had specialized services for students with high needs, active peer support communities and dedicated triage and crisis response services, then not only would we better serve our current students, but we would also make a generational impact and put a huge dent in the mental health crisis facing America.