In the past five years, student demand for mental health services on college campuses in the U.S. has grown at more than five times the rate of higher education enrollment. This is according to a 2015 report by the Center for Collegiate Mental Health at Penn State, which tracked students’ use of mental health services. The disproportionate growth in need has spread college counseling centers’ resources thin and left many students feeling like they have nowhere to go for help.
The International Association of Counseling Services (IACS) recommends a ratio of one full-time professional staff member to every 1,000 to 1,500 students. If counseling centers are understaffed, IACS warns that waiting lists will increase, centers will struggle to provide services, and student academic success will decline. In fact, some colleges have been forced to maintain long wait lists for appointments, limit the number of counseling sessions students can attend, and rely on group therapy as demand has outpaced staffing.
At the University of Missouri (MU) in Columbia, for example, student requests for mental health services increased by 62 percent in the last five years, and during protests last fall, expanded counseling services was included among students’ demands.
The MU Board of Curators responded by approving the hiring of six additional counseling staff members over five years, the establishment of a crisis hotline, expanded diversity training, and telepsychiatry.— diagnosis and counseling done remotely through the use of telecommunications.
One theory for the rise in demand is the increased focus on suicide prevention efforts of the early 2000s. Since 2005, the Garrett Lee Smith Memorial Act has provided $60 million in federal funding to colleges and universities to decrease mental health stigma, raise awareness of services and treatment, prevent suicide, and provide training to identify at-risk students; under the act, states have also received more than $275 million for youth suicide prevention. The fact that students are seeking out help more often shows these efforts have been successful, but campus counseling centers are struggling to keep pace.
Earlier this spring, students at Skidmore College petitioned for the hiring of an additional counseling staff member, a crisis hotline, and an emergency crisis counselor. Andrew Demaree, a clinical psychologist and director of Skidmore’s counseling center, says the petition brought attention to students’ mental health needs and the school’s services. However, he says the search for another staff member had already begun.
“Our staff and administration were well aware of the need for additional staffing and broader on-call support, and in fact, initiatives were already well underway to bolster these when the petition began,” he says. “We were in the middle of a search to fill a newly created full-time staff clinician position. And we had already received approval and had redirected funding to contract out a portion of our on-call services.”
Demaree says Skidmore’s counseling center will continue to operate an after-hours and weekend on-call emergency service, but by outsourcing some of these on-call offerings, the center is able to provide expanded services.
He believes the growing acceptance of mental health services is one reason for the explosion in demand.
Kathleen Staley, assistant director for outreach at the University of Iowa’s (UI) counseling center, agrees. As a licensed psychologist, she thinks this acceptance — as well as a changing culture — has contributed to the demand.
“Society is much more complicated today than it was 20 years ago,” she says. “Technology, as wonderful as it can be, can also be a burden. It puts a demand on students and causes a lot of stress and exhaustion.”
Staley says students today are also more open to seeking help for mental health issues, particularly anxiety. In her work, she has noticed a spike in students with anxiety, whereas before, the rates of depression and anxiety were nearly equal. Indeed, the American College Health Association reports that last year, more than half of all college students said they experienced “overwhelming anxiety,” and 32 percent said they were so depressed “that it was difficult to function.”
UI recently announced it would expand its mental health services by hiring eight new counselors, several of whom the university will embed in different departments across campus. Staley says outreach by the counseling center has also fueled interest in and awareness of counseling services; staff members frequently give presentations, offer consultations, and attend events on the UI campus and at the various cultural houses.
The staff of UI’s counseling center is relatively diverse, and Staley says this has been intentional.
“It’s important for students to see that they’re represented at our counseling center, and I’m happy that we’ve been able to do that pretty well,” she says.
Mental health issues are particularly pronounced among underrepresented minority populations; however, people from these groups are also less likely to seek help. Research by the U.S. Department of Health and Human Services (HHS) finds that discrimination, acculturation, and alienation play significant roles in the increased rates of suicide among African American, Hispanic, and American Indian youth, who are much more likely to commit suicide at a younger age than the general population.
Research has shown that protective factors against suicide are the same across all racial populations: effective mental healthcare; connectedness to individuals, family, community, and social institutions; spirituality or religiosity; and a strong ethnic identity. Some populations, however — such as Native American youth living on reservations — lack access to mental health services, and some choose not to seek help.
“I think culture can play a role in whether or not someone gets help,” says Amy Lenhart, past president of the American College Counseling Association and a counselor at Collin College in McKinney, Texas. “For example, in Asian cultures, it’s looked down upon if you [seek] help, and you see this with African American culture, too. Adding to that — for any group.— is being a first-generation college student. Being first-generation is a whole other barrier if you don’t have support from your family.”
Lenhart says her college’s counseling center also sees students who have interpersonal issues — with family, friends, and significant others — or who may be struggling with their sexual identity and coming out, as well as those trying to overcome trauma from military service or sexual violence. But one of the most common situations leading students to seek help, Lenhart says, is the transition into college life.
“We see students dealing with the stress of balancing work and school and learning how to study — because it’s very different from when they were in high school,” she says. “Some schools limit counseling because they’re understaffed or they’re afraid it’s too expensive, but that really puts students at a disadvantage. Counseling helps with retention.”
Lenhart sees the increased demand for mental health services as a good thing, believing it’s evidence of reduced stigmas and growing awareness, but she thinks there is still work to be done.
“There needs to be more legislation — there’s different legislation for health conditions, like a heart condition, but not so much for mental health,” she says. “The brain affects the whole body, and sometimes it needs some help. It’s an organ, too. And this affects society; many people with mental health issues end up on the street. There needs to be more education [around] mental health as a part of overall health.”
As colleges and universities struggle to keep up with the demand for mental health services, there is good news on the state level: Plans are underway in California to designate $40 million in state funding over the next five years to a College Mental Health Services Trust account, which would increase mental health services in the California Community College, University of California, and the California State University systems.●
Rebecca Prinster is a contributing writer for INSIGHT Into Diversity.
![One day after the mass shooting incident at Michigan State University in February, a University of Florida (UF) student called the UF Police Department (UFPD) concerned about a classmate who was researching guns and ammunition. Instead of just police responding to the call, a trained behavioral health specialist was also dispatched. “Our clinicians and officers spent three hours with that person to really flesh out why he was searching what he was searching,” says Meggen Sixbey, PhD, assistant director of the Behavioral Services Division of UFPD and a co-responder. “Do we have evidence to be concerned? In those three hours with him, they learned that he was in fear of his own safety [due to] things that were going on in his own life.” Without UF’s co-responder approach, Sixbey says, the situation could have escalated quickly or ended differently, and the student may not have received appropriate help. Due to widespread concern around mental health and fears of escalation caused by law enforcement response, partnerships between police and behavioral health specialists are growing across higher education campuses. Experts see this collaboration as a way to aid the most vulnerable by connecting them with needed resources and support. Collaborations differ campus to campus based on institutional needs. While some new programs, like the one at UF, dispatch counselors directly to the scene with police officers, others do not involve immediate on-site clinician response to dispatch situations. The University of Colorado Anschutz Medical Campus, for example, works with both municipal and campus police to provide mental health support services to students, all of whom live off campus. University case managers help officers on the scene when there is no perceived imminent danger. Additional support is provided by the Campus Assessment, Response & Evaluation (CARE) Team, which is a common type of program at colleges and universities. The goal is to reach students before their situation becomes critical. The CARE Team reviews referrals for urgent mental health support among students and connects them to campus resources such as case management and additional counseling services. When assessing a threat, each situation is evaluated based on the NABITA Risk Rubric, a tool used in triaging mental health concerns with an interdisciplinary team approach, says Jan Gascoigne, PhD, associate vice chancellor for student affairs, and associate clinical professor. “Often the situation is determined not to be a threat but really just someone who is struggling and needs help,” she says. “We’d rather try to work with that person, figure out what’s going on, and get them the help they need without having to escalate to a police intervention. Our campus police have the same philosophy.” New programs expand mental health services in dispatch situations, with projects being introduced at Johns Hopkins University, The University of Texas at Austin, the University of Oregon, Colorado State University, and California State University, Long Beach. During a six-month trial in the city of Denver, in which mental health specialists were paired with police to respond to calls involving trespassing and other nonviolent events, a 34 percent drop in crimes was reported, or approximately 1,400 fewer criminal offenses, according to the Stanford University report “A Community Response Approach to Mental Health and Substance Abuse Crises Reduced Crime,” published last year. UF’s program launched in July and is the first in the nation led by a campus police department, Sixbey says. Calls are answered by UFPD, which contacts clinicians when there is a mental health component. Situations might include, for example, a student who threatens suicide, someone who was just fired from their job, or an individual whose property was stolen. It’s essential to decriminalize mental health, or mitigate criminal offenses in such calls, Sixbey says. It’s also important to de-escalate situations with clinically trained professionals to help reduce hospitalizations, which are often traumatic, she says. The UF team is looking for more effective ways to enhance efforts to assist underrepresented individuals because the relationship between these communities and law enforcement has historically been strained, a circumstance highlighted by recent social justice activism and political attention paid to policing. In addition to a campus climate survey, UF is conducting focus groups to see how underrepresented communities on campus view the program. Preliminary feedback points to possible changes in police uniforms, where officers would wear a pin or patch to identify themselves as Crisis Intervention Team trained, which means they have received mental health instruction to guide interactions. Individuals surveyed also showed interest in making the clinician the lead responder instead of an officer. This model was used successfully a couple of months ago, Sixbey says. A faculty member of color called regarding a Black student who made a concerning statement about suicide and left the classroom abruptly. The caller didn’t want police to go to the student’s home because they were aware he had experienced past interactions with law enforcement, but the caller still felt a wellness check was warranted. Based on the information provided, the clinician was able to strategize and lead the interaction. They found that the fears the instructor had regarding the student’s mental health were not present and that he was thankful for the tailored response. “Why a program like this is so beneficial, especially to underrepresented populations, is simply because it provides an additional resource which is an alternative to law enforcement response,” Sixbey says. “Even the best law enforcement officer with an abundance of mental health and crisis intervention team training is still an officer. When you can bring a mental health worker to the scene, it can shift the dynamic and allow for a noncriminal approach to a noncriminal matter.”](https://www.insightintodiversity.com/wp-content/uploads/2023/03/Crisis-Response-1-218x150.png "Counselor-Police Response Partnerships Benefit Students in Crisis")
