For many years, college counseling centers have been in the business of helping students with career choices and academic problems, romantic breakups and separation from parents.
More recently, however, much of the business has been coming from students with complex emotional issues or more serious psychological problems–many of whom also are taking psychiatric drugs.
The reasons behind the increase are not entirely clear. What is clear, however, is that these more severe cases, coupled with a “psychologically savvy” generation of students and rising levels of stress on campus, have forced many colleges and their counseling centers to adopt new strategies for treating such students.
“We’re constantly trying to think of ways to stay balanced ourselves and yet stay ahead of the need,” said Kathy Hollingsworth, director of the center for Counseling and Psychological Services at Northwestern University in Evanston. “We’ve always had these severe and urgent cases; it’s just the numbers have grown and the overall number of clients has grown.”
Many colleges and universities over the years have been adapting to the volume of clients by expanding mental-health services on campus, particularly in the area of psychiatric care. At the University of Chicago, the counseling center has a diverse staff of clinicians, including three part-time and three full-time psychiatrists (up from one part-time and two full-time psychiatrists in 1987).
“We’re seeing more kids and we’re seeing sicker kids. The sense of my staff is that we’re seeing a lot more acuity than we saw before,” said Dr. Thomas Kramer, a psychiatrist who was hired in January as the director of the Student Counseling and Resource Service at the University of Chicago.
Robert P. Gallagher, a psychologist at the University of Pittsburgh, has been studying the activity of college mental-health services for more than two decades. In the late 1980s, he began noticing that college counseling centers across the country were becoming filled with students experiencing more serious psychological problems. At that time he found that more than half of nearly 300 counseling center directors surveyed had noticed a significant increase in severely disturbed students.
The numbers have gradually increased since then. Over the past five years, 83.5 percent of 272 counseling center directors said they sensed an increase in students with more severe psychological problems, according to a 2002 national survey conducted by Gallagher.
Emotional concerns top list
“The nature of counseling centers has changed dramatically over the years,” Gallagher said. “When counseling centers first started they were focused primarily on career problems or developmental problems; personal concerns were a rather small part of their business. Now, the vast majority of time is spent on emotional concerns.”
On average, about 18 percent of counseling center caseloads appear to involve students with serious psychological problems, Gallagher said. That percentage, he said, has doubled over the last 15 years.
“I see two types of serious problems: One is those students who come in feeling suicidal or are going through a significant depressive episode or panic attack who are, at the time, in pretty desperate shape but who we can work with,” he said. “Then there’s the other group whose problems are so serious that we can’t provide the kind of help they need. They’re so depressed that they cannot keep up with their work and are not responsive to the medication.”
Although there has been a rise in the number of students in both those categories since 1988, “I think it’s leveling off now,” he said. “I think we’re going to continue to have these students making it a little harder to get our work done because of the time constraints we have.”
A recently published study of college students seeking help at the counseling center at Kansas State University appears to confirm these findings. The report, which appeared in February in the journal Professional Psychology: Research and Practice, reflected dramatic increases over a 13-year span in the number of students visiting the Kansas State counseling center with more serious and complex problems. The findings were based on the assessments of therapists after treating more than 13,000 students from 1989 through 2001.
The percentage of students treated for depression and the percentage of suicidal students doubled, according to the report. The percentage of students treated for personality disorders nearly tripled.
More students were also treated for problems related to stress and anxiety, grief, sexual assault and family issues. The study also showed a rise in students with more traditional college student problems, such as difficulties in relationships and developmental issues.
“They’re coming in with eight problems instead of two,” said Sherry Benton, the assistant director of training at the Kansas State center and the lead author of the report. “The amount of time you’re going to spend on somebody who has a relationship problem or a little trouble individuating from parents is very different from the amount of time you’ll spend with a student who is suicidal.”
Being helped by drugs
Mental health experts said the rise in severe cases can be attributed to newer antidepressants and other psychotropic medications that have been gaining popularity in the last 10 to 15 years, allowing more students to attend college.
“We have the medication available now that can help people and make them capable of coming to school,” said Dr. Gregory Snodgrass, president of the Association of University and College Counseling Center Directors. “Many years ago, folks suffering from that degree of psychological disorder might not have been able to handle the pressures of going to school.”
The 2002 national survey found that 218 counseling centers hospitalized a total of 1,535 students for psychological reasons. A total of 116 suicides were reported by 55 schools. Only 20 of those students had been seen in a counseling center before taking their lives.
“If we can get a student in here, it’s very unlikely they’ll complete their attempt to end their lives,” said Dennis Heitzmann, who directs the center for Counseling and Psychological Services at Pennsylvania State University. “It’s the ones we don’t know about that we tend to lose.”
Many clinicians said the growth in students turning to counseling centers is a sign of a greater awareness of psychological problems. As counseling and therapy have become more familiar and far less stigmatized, and as newer drugs with fewer side effects have become available, more children have been growing up exposed to therapy and psychoactive medication.
“This is in many respects a more psychologically savvy group of individuals than in previous generations,” Heitzmann said. “They are more steeped in the value of clinical services and are less inhibited about seeking the help.”
Students under stress
Stress on campuses today appears to be more widespread as well, mental health experts said.
The American College Health Association found in a survey last year that college students consider stress to be a major impediment to academic performance. According to the survey, which included responses from more than 28,000 students in 44 colleges and universities, 29 percent of students said stress caused them to receive lower grades or to drop courses.
“In today’s generation of college students, there are so many more demands made on their time; there are many more choices, many more opportunities. It seems like all of life is faster paced. These are students who have kind of grown up with being sort of pushed to be involved in everything. There’s just a lot more pressure,” said Snodgrass, who is also the director of counseling services at Southwest Texas State University in San Marcos.
The college counseling center is still the place students turn to for help in sorting out developmental issues traditionally associated with college, such as adjusting to new life stages and establishing new relationships. But with a rise in the number of students with depression, bipolar disorder and similar problems, many centers have to work at juggling the caseloads.
“We still [help students work through developmental needs], but it’s been more difficult to attend to that in the face of burgeoning crisis appointments,” Heitzmann said. Developmental issues “are still important in the minds of many students. We have to not ignore our role along those lines, but those issues to some degree become sort of squeezed out by the other kinds of things we’ve been forced to deal with.”
Shortening up therapy
That’s why many college counseling centers have turned to time-limited therapy, or brief therapy, approaches. They’ve also increased group therapy sessions, enabling clinicians to serve multiple students in a more efficient manner. Many colleges also have strengthened their referral networks.
“We don’t pretend to be able to meet the needs of every student,” Heitzmann acknowledged. “It used to be that the buck stops here–you bring it on and we’ll find a way to manage it. Those were the old days when a few students kind of monopolized the bulk of services.”
When students require more time for the treatment of serious problems, college clinicians tend to refer them to outside resources. That task can be a challenge as well, as many students are lacking health insurance and cannot afford to pay for medication or further psychotherapy. According to the 2002 national survey, 15.4 percent of college counseling centers charge for personal counseling.
The counseling center at the University of Illinois at Chicago, like most college counseling centers, follows a priority system for students with more severe and urgent concerns.
“If you’re doing a good [initial patient assessment], what you’ll discover is sometimes people are much more depressed or anxious than they’re admitting, and you want to take that seriously,” said Robert Lees, the director of the UIC center. “We have a system where we determine who is more immediate and urgent and basically bump them up in priority. If they can’t wait and we can’t see them for various reasons, we’ll make a referral where they can be seen. We’re trying to move people with more developmental concerns more quickly, so we have room.”
Kramer, at the University of Chicago, pointed out a positive side to the surge in students with more demanding mental health needs.
“To a certain extent, this is a function of success,” he said. “A lot of kids are going to school or graduate school who might have dropped out. The advent of newer medication and newer techniques of psychotherapy have enabled these kids to capitalize on their inherent intellectual abilities. I think we’re allowing people’s strengths and skills to come through.”
