Welcome to our new section, Thrive on Campus. Alarming new data is making it increasingly clear that college students are struggling with mental well-being. In this multi-part series, Thrive brings you in-depth reporting into the reasons behind the college mental health crisis, unvarnished truths from students, faculty and experts about what needs to change, and science-backed strategies to boost students’ well-being. We will be adding new pieces on an ongoing basis, and if you are a college student, grad, or expert with a perspective to share, we invite you to contribute (please tag your pieces ThriveOnCampus.) Read more here.
By the time Kelly Davis arrived at American University in Washington, D.C. in 2011, she’d already been diagnosed with depression, post-traumatic stress disorder and body dysmorphia, and had survived three suicide attempts. “I came with a laundry list of different diagnoses,” says the 25-year-old director of peer advocacy, supports, and services at Mental Health America in D.C., a national nonprofit dedicated to helping those living with mental illness. But like many freshman, she saw college as an opportunity to shed her former self and emerge anew. “‘That’s all in the past. I’m a new person now. It’ll be great,’” she remembers thinking. But it was nowhere near great.
Davis stopped taking her meds, skipped classes, drank every day, and replaced quality relationships with unhealthy ones. At the peak of her devolution, she couldn’t get off her bedroom floor, strewn with dirty clothes, for three days straight because she was so depressed. Her grades plummeted and she was on the brink of losing her financial aid and failing out of school.
When she visited American University’s Counseling Center, she received yet another diagnosis -- bipolar disorder -- and was given a referral for therapy outside the institution. “The message I took from it was: ‘You’re too sick and we can’t help you,’” she says. “But if I can’t get out of bed and I can’t get off the floor,” she stresses, “how am I going to make a doctor’s appointment, show up for that appointment, fill out the paperwork for the Americans with Disabilities Act, inform my professors of what’s going on, and all the other things that need to be done to get help?” She bristled at the urging of administrators for her to take a leave of absence. To Davis, the institution’s reaction seemed to be, “This person is struggling, and we should get them out of this environment,” she says. “But what they should be saying is: This person is struggling, so how do we make this environment better?”
Davis ran up against a problem that a growing number of students with mental health issues are experiencing: overtaxed, understaffed, and underprepared mental health facilities on college campuses across the country. As rates of depression and anxiety continue to soar among college kids, counseling facilities are struggling to keep up.
Headlines from student newspapers around the country have been megaphoning for help: “NU Is Grossly Underfunding Students’ Mental Health Services,” fumed The Daily Northwestern in April. “‘Duke Would Rather Sweep the Issues Under the Rug,’” students raged to Duke University’s The Chronicle last year. “Students Criticize Mental Health Services,” blared Yale Daily News this past spring.
The damning headlines have hit national media outlets as well. This August, the New York Times reported on a class action lawsuit brought against Stanford University by students who claim the institution discriminated against them on the basis of their mental health status by forcing them to take medical leaves of absence. (Thrive Global editorial intern Abe Thompson, a junior at Stanford, reported on how mental health is handled on that campus in this story.)
Earlier this year, the Times reported on the grievances of the parents of Graham Burton, a student who hanged himself at Hamilton College, after they learned that faculty and high level administrators knew their son was in dire straits but failed to inform them. This month, a former -- and sole -- staff counselor at Florida Polytechnic University decided to sue the institution for allegedly dismissing her after she was critical of their limited mental health resources. Tragically, a month after her departure, a student died by suicide there.
Ben Locke, Ph.D., senior director at Penn State’s Counseling & Psychological Services (CAPS), says the “huge and increasing demand for services” can no longer be ignored. “The lack of planning ahead for growing service capacity is producing a supply and demand problem.”
Students’ complaints include long wait times for initial and follow-up appointments (up to 5 weeks in some cases), a short-term model of service that can’t accommodate those with more serious, ongoing mental health issues, caps on the number of therapy sessions students are allotted (anywhere from 6 to 12), and forced medical leave for students with more severe mental illnesses.
As the crisis continues to surge and colleges scramble to address the intensifying needs of Gen Z, Thrive Global spoke with current and former students, professors, counseling directors, and mental health advocates to identity the steps colleges are taking -- and need to be taking -- to improve the quality of care for students.
Changing Their Rules
A growing number of college mental health facilities are racing to meet the rising mental health needs of students. Some are expanding or eliminating caps on sessions, extending hours of operation, hiring case managers to help students navigate things like insurance and making appointments with off-site therapists, employing more clinicians (most centers have gained, rather than lost staff last year, per the Association for University and College Counseling Center Directors’ report with the Center for the Collegiate Mental Health, which shows that resources dedicated to “rapid access” increased by 28 percent on average over a six-year period), and providing alternative forms of counseling like group therapy.
Brown University in Providence, RI, is a standout example of a college attempting to implement positive changes. Stefanie Lyn Kaufman, a former student who rallied for change after she was encouraged to take a leave of absence in 2013 over concerns about her mental health, attributes the improvements to student-led mental health advocacy on campus and Will Meek, Ph.D., the newest director of Counseling and Psychological Services (CAPS) at Brown. Kaufman calls him “one of the most incredible practitioners I’ve ever met,” noting that she doesn’t hand out such compliments lightly. (Read Meek’s essay for the Thrive Global series on campus mental health, which outlines how he has been overhauling Brown's system, here.) Here’s a quick snapshot: In 2016, just before Meek’s arrival, Brown did away with limits on sessions and wait times to see clinicians have dramatically decreased. CAPS no longer triages students or requires in-depth, hour-long intakes. “We offer actual clinical service straight away with a quick followup with the same counselor for consistency,” says Meek. They’ve also hired an urgent care clinician who’s available for crisis walk-in appointments, as well as less urgent ones, throughout the day -- and they’ve expanded their staff over the last five years so there are more resources.
These types of changes are positive and necessary, but according to Laura Horne, director of programs at Active Minds, a student-led non-profit mental health advocacy organization, they’re not enough. “Yes, we need more counseling staff on campuses and we need more funding,” she says, “but we are never going to be able to keep up with this kind of demand through CAPS alone.” Kelly Davis adds that she doesn’t envision a future where colleges are going to shoulder the costs to meet every student’s needs and wants. “And,” she stresses, “I think it’s misguided to think that's the answer.” Horne, like Davis, thinks what we need, alternatively, is a “public health approach” that’s focused on prevention and equips everyone on campus with the ability to help students in crisis.
Many of the administrators and faculty Thrive spoke with agreed, and are taking innovative, multi-pronged approaches to meeting students’ mental health needs.
Creating a Community of First Responders
Sometimes members of the campus community -- faculty, staff, RAs, peer counselors, fellow students -- are the first to encounter students in crisis. To help them navigate exigent situations or spot the warning signs of students in emotional distress, many schools have designed emergency response directives to help guide non-clinicians through mental health challenges.
Brown has the B.E.A.R. Project -- the acronym stands for Be Present, Engaged, Ask Questions, and Refer -- which Meek says is “a crash course training” in helping students across the urgency spectrum, from those in difficult situations to those in crisis. UCLA has adopted what Robert M. Bilder, Ph.D., a professor in the department of psychiatry and biobehavioral sciences there, calls a “Red Folder,” which he describes as a “rapid resource guide” that includes relevant numbers and literature on how to identify a student with a mental health problem. They also started the Mindwell Lexicon Project, which aims to increase everyone’s mental health literacy by familiarizing them with appropriate terminology and symptoms of different diagnoses to help them identify troubled students.
At the University of Pennsylvania, Anthony L. Rostain, M.D., a professor of psychiatry and pediatrics at the University’s Perelman School of Medicine, says a three-hour training session called I CARE is designed to help the college community recognize students in distress and educate them on how to approach difficult conversations with people in fragile psychological states. I CARE’s website includes an array of resources, including worksheets on self-care and literature on how to identify stress, distress and crisis. Barry Schreier, Ph.D., the director of the University Counseling Service at the University of Iowa, points out that training on how to effectively steer students in crisis toward resources and support has become standard practice. But expecting students to provide care beyond what their training equips them to do puts an undue burden on them, critics say. Many RAs experience the unique stressor of being students who are facing their own issues while being asked to tend to the mental well-being of other students in the absence of adequate campus care.
Building Well-being into Life on Campus
What’s less standard, but intensely needed, are attempts to weave well-being through all areas of life on campus so students can better manage their emotions before they become overwhelmed. For UCLA, that means creating courses, initiatives and awards designed to encourage students to take their well-being seriously and give them the tools they need to do so. Bilder, for example, teaches a summer course called Personal Brain Management, which tackles topics like stress, time and sleep hygiene. UCLA also launched the Mindwell Program, a health initiative that supports campaigns like Sleep Well, which educates students about the health benefits of eight hours of sleep, and provides sleep tips and “nap maps,” which show students where they can catch a nap on campus.
In the interest of encouraging students to cultivate sustained forms of happiness, the university created the Eudaimonia Award last year to honor faculty, staff, students and alumni who embody the Greek term eudaimonia, which loosely means “a life built on the pursuit of purpose and meaning.” Aristotle used the word to distinguish it from hedonia (brief and fleeting types of satisfaction that come from satiating immediate desires). Bilder says it’s a great message to instill in college students to help them differentiate between ephemeral kinds of gratification, like the number of followers or Likes they’ve amassed, and more long-term, sustaining values. “As we focus our curriculum and extracurriculars more and more on enduring reward systems,” Bilder says, students may be able to break habits that aren’t in the interest of their long-term well-being and purpose.
George Mason University in Fairfax, Virginia is pursuing similar goals. In 2009, the university established the Center for the Advancement of Well-Being to promote, “the science and practices that lead to a life of vitality, purpose, and resilience,” its website reads. Nance Lucas, Ph.D., the executive director, describes the center as a “laboratory” on campus, where they test out various enterprises that take a holistic approach to educating “the whole student,” she says. “We give them the tools to cope on a daily basis,” she says, “so they can engage differently when they’re faced with problems and challenges that encompass the full spectrum of emotions they experience everyday.” Lucas describes a range of opportunities for students to think in terms of healthier, saner living, including a residence hall called Mindful Living that’s meant to foster meaningful connections and help students learn to manage their stress and health with various techniques each week; a “Well-being Team,” which comprises a posse of peer educators who sponsor different events tethered to wellness like Gratitude Day; a “Resilience Badging Challenge”, which is a five-week course where students learn to grapple with “stress, change, uncertainty and adversity”; and a recreation center that offers mindfulness classes like yoga and meditation.
While all of these efforts are noble and important, they all have the same shortcoming: they’re all elective, meaning only students who are aware of and interested in them will seek them out and receive their benefits. When asked if there were any plans to making courses like Bilder’s mandatory, Nicole Presley Green, Ph.D., the executive director of UCLA’s Counseling Center, says despite discussions around doing so, “we haven’t been able to implement yet.” About his course, Bilder says: “It could be a core course in a curriculum we’ve considered that would focus on Positive Applied Neuroscience, or a master’s program, but there’s not enough bandwidth to organize that, on top of other stuff.”
Turning to Technology
Sarah Ketchen Lipson, Ph.D, an assistant professor in the Department of Health, Law, Policy and Management at the Boston University School of Public Health, researches mental health services for adolescents and young adults, particularly college students. She thinks innovations in the mental health system, particularly through mobile technology, are crucial for meeting students’ needs in real time.
Lipson recently attended a talk by the former director of the National Institute of Mental Health, Thomas Insel, M.D., who noted that our mental health delivery system is behind the times, especially when compared to how we are accustomed to accessing other services, and pointed to digitally-based companies like Airbnb and Uber that provide rapid service. “Immediate access” to mental health support is key because today’s college students are “so strapped for time,” Lipson says.” She cited Talkspace, which recently teamed up with 120 chapters of sorority Sigma Kappa, as one example of a program connecting people through smartphones to trained mental health professionals.
Mary Phillips, the director of educational programs for the sorority, is enthusiastic about the ways the mobile therapy company will help busy students easily carve out time for therapy via text, audio or video messaging. Noting that the average mental health counselor to student ratio is 1 to 1,737, she says, “it’s a convenient and flexible solution that removes the barrier of long wait times or perceived stigma of being seen going into a university counseling center.” Once a student activates their account, they can pick from a list of three counselors, who are available five days a week.
Kelly Davis’s Collegiate Mental Health Council recently rolled out a bunch of new tech-centric solutions: BetterMynd is a platform that contracts with universities to help students connect to counselors in their area for tele-counseling; Runaway App connects students to trained volunteers; and the Buddy Project, a suicide prevention non-profit that connects teens based on age and mutual interest to buddies via Twitter. Davis, who founded the Council last year to highlight and promote student-led organizations, says sitting in a room with a counselor for an hour is not sufficient, even if you can get a regular appointment. “We need something more comprehensive,” she says, that includes “a menu of ideas that students can pick from.”
Lipson is enthusiastic about these tech innovations as a means of offering “a wide range of services to meet students’ preferences,” she says, but notes that they are “a compliment rather than a substitute for traditional counseling services.” Penn State’s Ben Locke emphatically agrees: “These kinds of services can not and should not replace traditional brick and mortar, in-person mental health providers,” he says, stressing that “so much of what we do is tied to being with a person, face to face, where we see their nonverbal behavior and can better assess crisis and risk evaluation.”
Healing Through Storytelling
Davis went from nearly dropping out of American University to making the dean’s list every semester after she got the help she needed. She attributes her success to a lot of healthy incremental and holistic life changes -- regularly seeing an off-campus therapist, learning to reshape dark thoughts, practicing yoga, going to the gym -- but nothing improved her life like hooking up with Active Minds, she says: “I eventually started finding out that there were all these people around who felt the way that I felt and we could support one another,” she says.
Active Minds, which boasts more than 450 chapters nationwide, was formed in 2003 after its founder Alison Malmon, lost her brother Brian to suicide. On National Suicide Prevention Day in 2016, Malmon outlined the fundamental reason she started the organization: “What I thought Brian needed from the very beginning,” she told Today, “[was] a student-to-student conversation about these issues. As a freshman, he needed to hear from a senior, ‘Hey, I’ve been through that, too, and I’m doing OK.’” Fifteen years later, that mission remains at the heart of what Active Minds does, says Horne, spotlighting programs like the Speakers Bureau, which trains young adults on how to share their mental health stories, and a traveling exhibit of backpacks that bear the personal narratives of those who previously owned them and died by suicide.
Stefanie Lyn Kaufman, who’s the founder and executive director of Project LETS, an organization that builds peer-led communities for students with mental illness, just received a $30,000 grant from the Rhode Island Foundation and will add eight more chapters -- it currently has 19 -- this fall. She had a similar impetus for starting her organization: “We wanted to build a system of care led by students who look like [those struggling] -- share their race, gender, sexuality and diagnosis,” so they can forge bonds through a common set of experiences.
Kaufman recalls a pivotal experience of sharing her personal narrative with a group of Girl Scouts about the years she spent in high school self-harming: “I felt like they actually listened and really connected with me at a level much different than if I’d been an expert,” she says. “My story told them, “‘I’m right here in this with you.’”
Studies have demonstrated the healing powers of storytelling. Some might even say we survive by the stories we hear and tell. For Maya Angelou, who suffered a tumultuous childhood, there’s nothing as painful as not being able to give voice to what you’ve lived: “There is no greater agony,” she once wrote, “than bearing an untold story inside you.” Says Davis: “People don't want you to ‘fix’ their challenges...they just want to be heard.”
Locke lauds all the efforts to create a larger network of support for college students. Peer support groups, like Active Minds, works to raise awareness and reduce stigma, he says, which are good preventative measures. “But the idea that college students or peer-based technology is going to meet the needs of students in mental distress is not responsible,” he says. “Just replace ‘mental health’ with ‘cancer.’ If we'd done 15 years of cancer prevention advocacy, the cancer screening unit would be flooded with people seeking screening, right? We wouldn't then refer them to their cousin or a neighbor,” he says of the hundreds of millions of dollars poured into mental health awareness and suicide prevention over the last decade and a half in grades K-12 and college.
“All of these efforts are part of a larger solution,” Locke says, “but the first step is recognizing that we spent 15 years trying to convince college students to utilize mental health resources, and now we have to live up to our side of the bargain.”
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