Fighting the Mental-Health Crisis Narrative 

This article is excerpted from a new Chronicle special report, “Overcoming Student Loneliness: Strategies for Connection,” available in the Chronicle Store.

“Notre Dame Makes $68-Million Commitment to Fighting Mental-Health Crisis; Scalable Solutions Could Become National Model,” reads the headline of a February news release. “University of Iowa Working to Combat Mental-Health Crisis Among Students Over Summer Break,” headlines a June 2023 article about the university’s embedding therapists in various schools, departments, and dorms. A March alert about a mental-health survey from the publishing company Wiley quotes the author of a psychology book: “The student mental-health crisis is real, and evident every single day in my classroom.”

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Crisis. Crisis. Crisis. Even before the pandemic, college counseling centers described being overwhelmed, not nearly able to meet students’ need for help handling mental-health challenges. Amid rising overall rates of anxiety and depression, researchers report an increase in social anxiety, among late adolescents and college students in particular. That’s contributed to what has been described as an epidemic of loneliness.

But an intriguing news release this past February from Richard Shadick, chair of the communications committee at AUCCCD, the Association for University and College Counseling Center Directors, takes a different tack.

“Changing the Crisis Narrative,” the release is titled. “In an era where mental-health concerns among college students are at the front of public discussion,” it opens, “AUCCCD is urging the media, the public, and educational institutions to adopt a more responsible approach to discussing the mental well-being of students.”

The crisis narrative, writes Shadick, director of Pace University’s counseling center, “points to increased clinical resources as the primary answer to addressing that perceived crisis.” Sensationalistic depictions can contribute to misinformation, panic, and the perpetuation of “harmful stereotypes,” he writes.

AUCCCD, the release says, emphasizes that the crisis narrative discourages help-seeking because a fear-based approach “may contribute to judgment and discrimination” against those experiencing mental-health challenges. The narrative “overlooks college-student resilience,” and by underlining insufficient resources it makes students who need those resources “less likely to seek them.” The association urges the news media and colleges to “avoid headlines that catastrophize,” “highlight stories of resilience,” “focus on positive coping mechanisms,” describe students’ struggles “in a more nuanced manner,” and “emphasize the availability of a wide variety of support services.”

In other words, although statistics may be alarming, please don’t call it a crisis.

Conversations with counseling directors, student-affairs administrators, and psychology professors shine some light on what’s happening here.

Destigmatizing discussion of mental-health problems has been largely successful over the last couple decades, so much so that students now sometimes pathologize routine stress and hastily self-diagnose various normal human conditions as maladies about which they’ve heard or read.

It’s important to understand that colleges would far rather have this problem than have the pendulum back too far the other way. No one wants to return to the bad old days when students’ psychological distress was the stuff of hushed, shamed conversations in the hallway.

Still, because normal problems like low mood and mild worrying are now confounded with clinical depression and anxiety disorders, young people who say they have mental-health problems are met with skepticism. “When I am interviewed about this topic,” the University of Oxford psychologist Lucy Foulkes wrote in an article this past January, “the subtext is sometimes obvious: Why are young people lying, and how can we get them to stop?”

On college campuses, when students seek help, the help they seek is too often an appointment at the counseling center even when that’s not necessarily the best remedy, or a remedy at all. That, as AUCCCD’s news release suggests, pulls resources away from students who need them most. It also contributes to already-significant counselor burnout and staffing problems.

Even if counseling centers were sufficiently staffed to meet the oversize demand, students’ stress often has to do with academic issues, student-life conundrums, or financial and basic needs like food, housing, laptops, and textbooks. Those needs are better tackled with the help of academic advisers, resident advisers, the financial-aid office, or student-life and peer-support groups through recreational, social, and wellness programs. Maybe a student is simply becoming more mature, knowledgeable, and appropriately dismayed by current events. The antidote for that kind of stress, which is really more of an awakening to broader realities, might be a new academic major and career focus or volunteering through some civic-action or service program.

The counseling center is not, alas, a one-stop solution to all things anxiety-producing. In an interview, Shadick gives a sense of how this plays out at Pace’s campus for students struggling socially. Before the pandemic, he says, the counseling center would encourage those students to attend drop-in workshops about mindfulness, managing strong feelings, assertiveness, as well as some traditional psychotherapy groups, like one on understanding the self and others. Post-pandemic, counselors are seeing a lot more student interest and enthusiasm toward those offerings. “A real appetite,” Shadick says, and that’s good.

Beyond those resources, however, Pace, like many institutions, increasingly tries to imbue wellness priorities throughout the university, he says. It strives to promote health in a more comprehensive way — psychological, spiritual, physical, occupational, environmental, and with diverse students feeling that they belong. Shadick’s vision echoes that of Katy Redd, executive director of the University of Texas at Austin’s Longhorn Wellness Center. The center trains students to be resources for their peers and to communicate that everyone has ups and downs on a spectrum of mental wellness.

The diffusion of such ideas is no coincidence. You’ll hear them on more than 250 other campuses that have, over the last decade, signed on to the Okanagan Charter: An International Charter for Health Promoting Universities and Colleges. The charter, which dates back to a conference in 2015, is multifaceted, but consider one particular call to action: to “generate thriving communities and a culture of well-being.”

“Be proactive and intentional,” the charter urges, “in creating empowered, connected, and resilient campus communities that foster an ethic of care, compassion, collaboration, and community action.” Support and collaboration as an integral part of campus culture is a tonic against crisis thinking, counselors and student-affairs administrators explain. Drawing strength from one another, developing simple skills to better meet each day’s difficulties and opportunities, gives students a sense of agency, capability.

The crisis narrative, says Jennifer I. DeBurro, dean of students at the University of New England, implies obstacles thrown in the way of what too many students expect to be steady progress in their personal and academic worlds. Like a storm-downed tree blocking the road.

“Young people have been sold a false narrative about life,” she says — that if they just do it right, it comes together, like a test passed or the thumbs-up of a liked social-media post. But, says DeBurro, life is largely mundane, punctuated by great joy or sadness, “a series of ups and downs and a lot of flat,” as she puts it. A crisis mentality, in addition to driving too many students to the counseling center, messes with their minds.

“We’ve sort of engaged in this use of language that is really disempowering for our young people,” she says. “We have pathologized normal, everyday emotions.” Better, she says, to give students the often-unglamorous but effective practices to manage their responsibilities more confidently. Spend 20 minutes in the sunshine before studying. Visit the gym. Find friends with common interests among your campus’s clubs. Maybe skip the deep-fried chicken tenders. “It sounds so simple and easy, but we’ve eliminated all these things about well-being,” DeBurro says, “and shoved them toward the counseling center.”

The inadvertent side effect of well-intentioned focus on mental health from kindergarten on, says Sarah Rose Cavanagh, senior associate director of teaching and learning at Simmons University, is that it sends to young people “the message that we should be on the alert for negative emotions,” that they are a sign of something wrong “rather than negative emotions being part of the human experience and a signal that this is something that you are a little uncomfortable with.” Social engagement, Cavanagh says, “has always been uncomfortable. … Being in this world together as co-human beings is fraught, and it doesn’t mean there’s something wrong with you.”

“Mental health,” says Barbara Lewis, a psychiatrist and senior director of student mental health at Harvard University, has “become a generic term” among students. It can mean “‘I lost my grandmother.’ It’s normal to go through a grieving process, but it’s made into a disorder. … You have a spectrum, but everything is getting lumped into ‘mental health.’”

Like “crisis,” the word “epidemic,” as applied to loneliness, also gets mixed reviews. Kimberly Quinn, a psychology professor at Champlain College, thinks the word is appropriate. She points to Merriam-Webster, which defines epidemic as “an outbreak of disease that spreads quickly and affects many individuals at the same time,” or more loosely, “an outbreak or product of sudden rapid spread, growth, or development.” The term fits, she says. And in addition to the problem’s scope, “epidemic” helpfully suggests a whole-campus public-health-type response to it that’s in step with the Okanagan Charter.

On the other hand, “epidemic” somewhat confusingly treats as a medical concern a serious but not utterly mysterious deficit in skills. Measles or meningitis poses an immediate, grave threat to a college campus. Loneliness, left unaddressed, can too, but it is, more immediately, a question of education and practice, says Gary Glass, director of counseling and career services at Emory University’s Oxford College. In a relationship workshop series, for instance, students might explore how much their fear of being judged is constraining them from making friends, or how vulnerability is a prerequisite to intimacy.

Rachel L. Koch, assistant director of training at the University of Richmond’s counseling center, has been a college counselor for almost a dozen years. For students, making friends in their first year is always an adjustment, she says. But post-pandemic, they’ve demonstrated a particular dearth of social skills. “Everybody has AirPods in, hats on, not making eye contact. They’re really trying to hide themselves. And then they come into my office and wonder why they feel so lonely and haven’t made connections.”

If students’ social skills are lacking and their anxiety substantial, what’s the most helpful response when they ask for special accommodations, like not being called on in class or being allowed alternatives to classroom presentations?

It’s hard to get a clear quantitative sense of how often such accommodations are granted for anxiety because of privacy laws and the fact that unless students explain their accommodations to professors, the professors don’t know what the accommodations are for and aren’t supposed to ask.

But college administrators and clinicians say accommodations for anxiety are on the rise. At one private liberal-arts college, about 60 percent of classroom accommodations are for mental-health issues, which include anxiety but also attention-deficit and hyperactivity disorder (ADHD) and other neurodiverse diagnoses. At another, anxiety in the 2023-24 academic year was the No. 1 diagnosis reported to the disability office, supplanting the longtime leading condition: ADHD.

Champlain College’s Quinn, who in addition to being a psychology professor there is part of the wellness team, specializes in positive psychology and is an upbeat, empathetic presence on campus and in her Mindcraft podcasts and videos. Her vibe is fun — she has been known to parade around campus in wizard and gorilla costumes — but she’s also known for straight talk on difficult matters. (She has spoken publicly about overcoming her own childhood traumas.)

On the subject of accommodations for anxiety disorders, she is an absolutist. “There should not be accommodations for anxiety, period,” she says. Disability offices are well-intentioned in approving such accommodations, but in doing so, says Quinn, they are doing students a disservice. The situation isn’t like a time extension on a test for a student with dyslexia or limiting sensory stimulation for a student with autism.

When it comes to managing anxiety, says Quinn, “from a cognitive neuropsychological standpoint, the only way out is through because the worry loop is self-reinforcing.” If students are allowed to miss or leave class or skip a presentation, they experience relief through the limbic system’s reward center, which releases little dollops of pleasure-priming dopamine that reinforce the avoidance behavior. The accommodations, Quinn says, also disrupt and diminish the classroom experience for fellow students.

When encouraged to go to class and be present in the moment, “they become more confident, and it’s less scary.”

Although anxiety accommodations for students are well-meaning, says Quinn, “we’re actually harming them. We’re trying hopefully to produce happy, successful young adults.” How, she asks, will they become schoolteachers or Wall Street bankers with all this enabling?

Felix Pizzi, senior director of the Wellness Center and student-support services at Southern New Hampshire University, offers a different view. “My sense is that accommodations are appropriate when there is an identified disability, and I would not lean toward dismissing the need for reasonable accommodations, which are protected by the Americans With Disabilities Act,” he writes in an email.

“At the same time, I think it’s important to identify opportunities to help students build skills that can help them manage their needs outside of an accommodation. These two efforts are not mutually exclusive. If the student can develop skills, the need for accommodations may decrease, yet that does not invalidate the need for accommodations in the first place.”

How to do that? Or, as Cavanagh asks in her 2023 book Mind Over Monsters: Supporting Youth Mental Health With Compassionate Challenge, “How do we help young people shed their armor, read their physiological arousal as challenge rather than threat, embrace their vulnerability, and leap into not-knowing in order to learn?” She explains: “It isn’t going to be either by shock-and-awe thrusting them into situations they fear or by helping them avoid experiences. Rather, it will be by engaging them and drawing them into learning environments that help them understand their own power.”

In the book, a therapist tells Cavanagh that “he worries when he sees clients ‘fuse’ their identity with their symptoms — ‘I am my anxiety, therefore I can’t do this’ — where ‘this’ might be get this shot, go into that classroom, or tackle that assignment.” Getting over the anxiety speed bump is crucial, Cavanagh explains, because “many people follow a common trajectory where they first begin experiencing anxiety symptoms … and then over time, depressive symptoms emerge.” What connects the anxiety to the depression is avoidance. “You begin in your withdrawal to feel less and less effective, less and less able to act on the world and have it respond meaningfully.”

Colleges increasingly understand that keeping students from falling into that cycle, helping them become more socially engaged, is part of higher education’s mission. If it’s successful, the impact will be felt not only on campuses but, as students graduate, far beyond.