A dangerous wait: Colleges can’t meet soaring student needs for mental health care
February 6, 2017 | By Megan Thielking
Colleges across the country are failing to keep up with a troubling spike in demand for mental health care — leaving students stuck on waiting lists for weeks, unable to get help.
STAT surveyed dozens of universities about their mental health services. From major public institutions to small elite colleges, a striking pattern emerged: Students often have to wait weeks just for an initial intake exam to review their symptoms. The wait to see a psychiatrist who can prescribe or adjust medication — often a part-time employee — may be longer still.
Students on many campuses are so frustrated that they launched a petition last month demanding expanded services. They plan to send it to 20 top universities, including Harvard, Princeton, Yale, MIT, and Columbia, where seven students have died this school year from suicide and suspected drug overdose.
“Students are turned away every day from receiving the treatment they need, and multiple suicide attempts and deaths go virtually ignored each semester,” the petition reads. More than 700 people have signed; many have left comments about their personal experiences trying to get counseling at college. “I’m signing because if a kid in crisis needs help they should not have to wait,” one wrote.
STAT requested information from 98 campuses across the country and received answers from 50 of those schools. Among the findings:
At Northwestern University, it can take up to three weeks to get a counseling appointment. At Washington University in St. Louis, the wait time runs nearly 13 days, on average, in the fall semester.
At the University of Washington in Seattle, delays in getting care are so routine, the wait time is posted online; it’s consistently hovered between two and three weeks in recent months. In Florida, where educators are pressing the state legislature for millions in new funding to hire counselors, the wait times at University of Florida campuses can stretch two weeks.
Smaller schools aren’t exempt, either: At Carleton College, a liberal arts campus in Northfield, Minn., the wait list can stretch up to 10 days.
A few weeks’ wait may not seem like much. After all, it often takes that long, or longer, for adults to land a medical appointment with a specialist. But such wait times can be brutal for college students — who may be away from home for the first time, without a support network, and up against more academic and peer pressure than ever before. Every class, every meal, every party can become a hurdle for students struggling with eating disorders, depression, and other issues.
Many counseling centers say that they are often overwhelmed during the most stressful times for students, such as midterms and finals. Creighton University in Omaha, Neb., for example, reports a wait time of up to a month during busy periods.
In most instances, STAT’s examination found, students who say that they are suicidal are seen at once, and suicide hotlines are available for after-hours emergencies. But some students are uncomfortable acknowledging an impulse to harm themselves, and thus get pushed to the end of the line, along with undergrads struggling with concerns ranging from acute anxiety to gender identity issues.
Campus counselors are acutely aware that they’re leaving students stranded but say they don’t have the resources to do better.
“You’re making sure people are safe in the moment,” said Ben Locke, who runs a national college counseling network and directs counseling services at Pennsylvania State University. “But you’re not treating the depression or the panic attacks or the eating disorders.”
‘I needed to see someone’
Constance Rodenbarger, now in her third year at Indiana University, first sought help at the counseling center in her second semester, as she struggled to deal with an abusive relationship on top of long-term depression. The next appointment was at least two weeks away.
“I was just looking at that date on the calendar and thinking, ‘If I can just make it one more day,’ but then it became just one more hour, and then one more minute,” she said.
“I just couldn’t hang on.”
The day before her appointment, on Nov. 17, 2014, she tried to kill herself.
Her roommate found her, and Rodenbarger was rushed to the hospital. She called the counseling center from the hospital to say she wouldn’t be able to make it in the next day.
“When I called that day and said, ‘I need to see someone,’ I needed to see someone,” she said.
Indiana University now says it connects with all students who seek counseling within two days. But that connection can involve simply setting up an appointment — for up to three weeks away.
“We, like centers across the country, are working on expanding our staff,” said Nancy Stockton, the director of Indiana University’s counseling center. “We certainly need more clinicians.”
Indiana University and several other large schools said they employ one counselor for roughly every 1,500 undergraduates. That’s at the high end of the range recommended by national experts. The numbers reported in an annual national survey are even more stark: In 2015, large campuses reported an average of one licensed mental health provider per 3,500 students.
When students do get in to campus counseling centers, most see therapists, social workers, or perhaps psychologists.
Just 6 in 10 college counseling centers have a psychiatrist available, even part-time, to prescribe or adjust medications, according to the annual survey, conducted by the Association for University and College Counseling Center Directors. That’s a serious mismatch, given that about one-quarter of college students who seek mental health services take psychotropic medications.
There are other hurdles, too. While many schools tout free counseling, they often cap that benefit. Students at Brown University, for instance, get seven free sessions a year. At Indiana University, students get just two free sessions and then pay $30 per visit.
And it can be hard for students to develop a consistent relationship with a therapist when so many college mental health providers work limited hours. At Wellesley College, for example, four of the school’s nine mental health providers are currently part-time.
While dozens of colleges provided STAT with detailed information about their mental health resources, the public relations staff at others, including Georgetown University, Dartmouth College, and Grinnell College, refused to provide information after repeated requests.
Others, such as Harvard and Yale, declined to provide specific staffing information. In some cases, such as with the US Merchant Marine Academy, media relations staff expressed discomfort about being compared to other colleges.
Columbia University told STAT it employs the equivalent of 41 full-time counselors for just over 6,000 students, which would be an enviable staffing level, far better than most other schools its size. Columbia said its wait time varies, but did not provide a specific range. All enrollment numbers come from U.S. News and World Report.
A spike in crisis cases
Demand for counseling on college campuses has been rising steadily for several years.
And the latest data, released in January, show a recent spike in cases of students in acute crisis.
One in three students who sought counseling last year said they’d seriously considered suicide at some point in their lives, according to a report out last month from the Center for Collegiate Mental Health. That’s up from fewer than 1 in 4 students in 2010.
And those are just the students who admit they’re in crisis. Untold others don’t know how to respond when an employee at the counseling center asks if it’s an emergency. They may downplay their situation, telling themselves others are in more dire condition or it must not be a true crisis if they have the presence of mind to ask for help.
That’s what happened to Adrienne Baer during the fall of 2015, in her junior year at the University of Maryland. Both her grandparents had recently died. So had a high school friend.
“It was a lot to wrap my head around,” she said. With a push from friends, she decided to call the counseling center. “I didn’t exactly have an education on what their resources were, but I got one,” Baer said.
Baer said she was asked on the phone whether she was experiencing an emergency. She didn’t know how to answer that: No one gave her a definition. So she said no and was shunted to the end of the waiting list. It would be two weeks before she could see a counselor.
She dashed off an angry email to the counseling center the minute she hung up the phone:
“I am currently struggling with the issues I wanted to discuss with a therapist or counselor, but even I don’t know how I’ll be in 24 hours, let alone 2 weeks.…
I don’t know if all that constitutes an emergency or if I need to have a mental breakdown to be seen prior to a two week wait but I am seriously disappointed in the lack of availability in mental health resources.”
That got their attention. She was given a quick appointment for an initial assessment. But for continuing care, Baer was put back on the waiting list. It would be five weeks before she could see a psychiatrist who could prescribe medication.
“I had to wait. There was nothing I could do,” said Baer, now a senior. “It was just a roller coaster that I couldn’t control.”
Sharon Kirkland-Gordon, director of the University of Maryland’s counseling center, said she knows her staff can’t keep up with demand, though she said they’re “working overtime to meet the needs of students.”
Requests for appointments shot up 16 percent last year alone, she said.
Nationally, about six in 10 undergrads seeking counseling are women, and 5 percent are international students. There are roughly an equal number of freshman, sophomores, juniors, and seniors.
Kirkland-Gordon has started to bring on part-time seasonal staff to help handle the workload. Many campuses also use therapists who are still in training work one-on-one with students, as long as they report to licensed counselors.
“If we had a magic wand, I think you’d probably hear the same thing from all of us counseling directors,” said Kirkland-Gordon. Their wish list is simple: more resources.
No one is entirely sure why student demand for mental health services is rising; factors may include increased pressure from parents or peers on social media, or a difficult job market. Another possible reason: increased awareness about the risk of mental health conditions.
In the past decade, the federal government has given out tens of millions in grants to suicide prevention programs that raised awareness of risk factors. A generation of students trained by such programs is now in college — and seeking help when they feel warning signs. But not every college got a bump in funding to meet the surge in demand.
“If you want a perfect recipe to generate reduced availability of treatment, that would be it,” said Locke, of Penn State, who also serves as director of the Center for Collegiate Mental Health, a national network.
Locke notes that college health centers would never require a student with strep throat to wait two weeks for an appointment. Yet that’s what’s happening to many students with anxiety, depression, and other serious mental health concerns. “It puts the student’s academic career, and potentially their life, at risk,” he said.
As for Baer, she said she made it through that stressful semester by leaning on friends at school and family back in Pennsylvania. She wonders what would’ve happened to an international student or to a freshman without a reliable support network.
“I do feel like I fell through the cracks,” she said, “but I feel like I fell onto a safety net that other people might not have.”
A college president sounds the alarm
In an era when colleges are ranked by the number of their professors and the quality of their food — or whether their gyms house rock-climbing walls — it can be tough for the counseling centers to make a case for more resources.
Some turn to quick fixes, touting “stress-busting” programs like bringing in puppies for students to pet during midterms or handing out free cookies in the library during finals.
Others are making a concerted effort to respond to the surging demand.
The wait times at Ohio State University were so alarming to Dr. Michael Drake — a physician who stepped into the president’s office in 2014 — that he hired more than a dozen new counselors. That pushed the school’s ratio down to one provider for roughly every 1,100 undergraduates.
“We were doing it to really smooth the pathway of success for students,” Drake said. National data suggest the additional providers will help; 7 in 10 students who seek counseling say the mental health care improved their academic performance.
The University of California system moved to update counseling services in 2014, as wait lists grew and students with acute needs sought care. It took another year to get a dedicated funding stream to hire more counselors, in the form of increased student fees.
“Things start to back up like a traffic jam,” said Gary Dunn, director of counseling and psychological services for the University of California, Santa Cruz. “A lot can happen in four or five weeks during a quarter in college. It really wasn’t OK to have that delay in place.”
Students who have lived through mental health crises welcome more staff. But they also urge better training so that everyone on campus knows to treat mental health concerns as seriously, and with as much empathy, as a physical injury.
Nick, who asked that his last name not be used, was diagnosed with depression before college and had a difficult transition to his freshman year at Ithaca College in upstate New York. “I had no idea how to cope with all of it and I floundered a bit,” he said in an interview.
He sought help early on — during orientation — because he knew he’d likely need it. But he said he was bounced between two counselors and had difficulty getting appointments that fit into his schedule. In the end, he had to pay for a private mental health specialist off campus.
Ithaca did not respond to requests for information on its mental health services, saying its counseling center staff was busy. At the time he sought care, Nick said there were just two counselors for the school’s 7,000 students.
“I was so badly handled. Not by any fault of their own, they were just woefully underprepared,” he said.
This year, by contrast, he had to take time off for a surgery. Getting help with a physical injury was a breeze, he said.
“The administration and professors have been much more understanding and willing to help when it’s something tangible and physical,” he said, “when the doctors can say, ‘Here’s what’s wrong with you and here’s how you can fix it.’”
Drawing lessons from trauma
Rodenbarger, the Indiana University student, is still feeling the echoes of her struggles to get mental health help on campus. Her suicide attempt cost her both her job and her off-campus apartment. The medication she was put on cost her a pilot’s license.
But she is recovering — with the help of a mental health provider off campus. She’s easing off the medication. She’s on track to graduate in the summer of 2018 with two degrees, a fine arts degree in printmaking and another in astronautics.
She’s also excited to have seen the school expand its walk-in services for students in need of urgent mental health care. It’s a step forward — and she wants to see more like it.
“Had I gotten help when I reached out for it,” she said, “it would never have gotten to the level that it did.”