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More students are coming to college counseling centers asking urgently for help. They often have multiple diagnoses or previous suicide attempts. For the counselors who try to help them, the student mental-health crisis is taking a toll.
“While all of us have chosen this profession because we have a passion for helping others, avoiding the risk of vicarious trauma and burnout is not easy,” said Melissa Boston, associate dean of student health and counseling at Manhattanville College, in Purchase, N.Y.
In the past four years, she wrote in response to Chronicle questions, her counseling staff has seen roughly a 35-percent rise in the number of students using its services. While the staff of three full-time psychologists has grown by one part-time social worker and two part-time interns in that period, the number of counseling sessions has increased 60 percent.
Stress is on counselors’ minds after the suicide last week of one of their own: Gregory T. Eells, executive director of Counseling and Psychological Services at the University of Pennsylvania, and a respected figure in the profession.
“The pressures that counseling-center clinicians face are at an all-time high,” wrote David Onestak, director of the Counseling Center at James Madison University, in Harrisonburg, Va. “The daily experience of working at a college counseling center today bears only a faint resemblance to the field that I entered in the 1990s.” At his center, time to assess and treat students has shrunk while cases have grown more complex. The number of crisis clients, those with immediate safety issues at stake, has grown 900 percent since 2004. Rising rates of depression and burnout are, according to Onestak, “the lived experience of most counseling-center clinicians.”
How high are those rates? No one knows. There are no studies solely of college mental-health caregivers, experts say.
But Joshua Altman, associate director of the Student Counseling Center at Adelphi University, in Garden City, N.Y., points to a 2018 meta-analysis that draws from 40 articles over 30 years of research and includes almost 9,000 psychotherapists. It describes more than half of those as reporting “moderate to high burnout,” which revealed itself most often in emotional exhaustion, “feeling physical and emotional fatigue while at work,” and sometimes in “depersonalization and a reduced sense of personal accomplishment.”
College mental-health counselors are likely to be among those experiencing such effects. “We’re seeing students who sometimes have multiple diagnoses when they come to counseling, have been treated in inpatient facilities, have made previous suicide attempts, and come into the center on more than one type of psychotropic medication,” said Altman in a phone interview. That severity of issues “absolutely impacts the staff.”
About 15 clinicians at Adelphi saw 1,000 students for a total of 4,000 visits last year, Altman said, and those numbers climb annually. And it’s not only the number but the nature of those visits that is shifting. Like Onestak, Altman said that a rapidly increasing percentage of those sessions are crisis visits, including students who say, “I know I have an appointment with my counselor in two days; I need to speak to someone right now.”
Since 1999, the national suicide rate has risen about 30 percent and the JED Foundation, which works to prevent teen and young-adult suicide, estimates that roughly 1,300 to 1,400 college students die by suicide yearly.
“These statistics are not lost on us and cause us a significant amount of stress,” wrote Manhattanville’s Boston. “We care deeply for our students and for their well-being, and at the same time, we can only do so much. … The fear of losing a student to suicide is intensely scary and compounded by the fear of litigation for not having done enough.”
“When does it end?” she asked. “How long can those who work in college counseling centers maintain these high levels of stress?”
A Shock to the Profession
Gregory Eells, 52, was about half a year into his new job at Penn, as director of Counseling and Psychological Services, when, officials say, on a Monday morning at about 6:40 he jumped from the 17th floor of his building in the heart of Philadelphia.
Before coming to Penn, Eells had directed counseling centers at Cornell University and the University of Southern Mississippi. His executive positions in professional organizations included the presidency of the Association for University and College Counseling Center Directors and the chairmanship of the Mental Health Section of the American College Health Association. He wrote scholarly papers and taught undergraduate and graduate courses on counseling, social psychology, and developmental psychology.
Eells had a knack for tackling tough topics in an approachable, accessible way, and spoke to Ted X and other live, video, and webinar audiences, as well as to the news media, about resilience, mental health, and best “postvention” practices following a suicide to avoid contagion.
Colleagues speak of him with great fondness and respect.
“He was exceptionally cordial,” said the University of Southern Mississippi’s Eddie Holloway, a recently retired assistant vice president and dean of students, who has also taught psychology there. He and Eells worked together at the university’s counseling center.
Eells would go for daily midday swims and inspired colleagues to do the same, Holloway said. “He was a gentleman by every standard, extremely conscientious, an ideal coworker and administrator.” He was never the guy you worried about, said Holloway, but rather the guy you’d consult about a difficult case.
Counseling centers are often effectively serving as walk-in clinics, crisis centers, social-service agencies, and emergency rooms in addition to the standard therapy and care provided.
Victor Schwartz is a clinical associate professor of psychiatry at New York University, the Jed Foundation’s chief medical officer, and former medical director of NYU’s Counseling Services. Over 15 years or so, he worked with Eells on a book project, consulting visits, and presentations. “He was very involved in the national efforts around mental health,” Schwartz wrote in an email, “but not in a self-serving or ego-driven way. He was always ready to help and support his colleagues.”
In short, Eells was considered something of a rock, and his death has shaken the profession to the core.
“There is something destabilizing about it on a very deep level,” said Adelphi’s Altman.
Eells’s mother told The Philadelphia Inquirer that he found the new job tougher than he expected and missed his wife and children in Ithaca, N.Y. But in an interview in her office, just down the street from the counseling center Eells ran, Maria Oquendo, chair of Penn’s department of psychiatry, cautioned that the news media and the public focus too much on possible triggering incidents.
Suicide is a “profoundly biological process,” she said, and can be associated with a variety of mental-health conditions. It can also emerge in those with no documented previous history of psychiatric illness, although sometimes problems are uncovered in a psychological autopsy.
Unrealistic Expectations
Whatever the circumstances of Eells’s death, and however much his job may or may not have factored into it, his loss has counselors thinking about the pressures of their daunting, perhaps impossible, responsibilities.
“Counseling centers,” wrote NYU’s Schwartz, “are often effectively serving as walk-in clinics, crisis centers, social-service agencies, and emergency rooms in addition to the standard therapy and care provided.”
On top of all the other pressures they face, he explained, the centers and their staff members have the added burden of the “public nature of their work.” Suicides on a large campus become national news, whereas the same number of suicides in a town of comparable size, with tens of thousands of people, would be unlikely to attract similar attention — or blame. And as awful as the college suicide rate is, Schwartz said, it is believed to be significantly lower than that for 18- to 25-year-olds not attending college.
Expectations of counseling services, on the part of universities, students, parents, courts, and the public, are unrealistic, said Richard Shadick, director of Pace University’s Counseling Center. The centers are expected to shoulder the wave of illness, trauma, and unfortunate circumstances that come to their doors when it should be the shared responsibility of faculty, administration, families, and — most of all — the students themselves. “College is a place,” he said by phone, “where young adults should face challenges and learn from these challenges. A university can be helpful in supporting that education, but it’s a partnership.”
Eric Wood, director of Counseling and Mental Health at Texas Christian University, calls the death of Eells, who was one of his mentors, “very shocking and sad” but also a spur to focus on care for the caregivers. Most colleges don’t have formal self-care protocols in place for counselors — such as opportunities to talk about their reactions to tough cases and connect with the larger mental-health community — but he imagines that now many counseling directors will make that a priority.
Onestak, of James Madison University, puts it this way: “The instructions given by flight attendants regarding placing the mask on yourself before your child ring true here. If the healers are not well, who will do the healing?”
Alexander C. Kafka is a Chronicle senior editor. Follow him on Twitter @AlexanderKafka, or email him at alexander.kafka@chronicle.com.
