Margie L. Madison likes to think of herself as one of the lucky ones. Things could have been much worse, much more destructive.
She knew what it was like to be gripped by anxiety. But she was lucky, she says, because she also knew she needed a counselor. Psychotherapy had worked before, in high school.
So Ms. Madison, then a 22-year-old accounting major at the University of Florida, went to the university’s counseling center with a simple question: Will somebody please talk to me?
The university’s response: Take a number.
Ms. Madison’s experience of being frustrated by a campus counseling center’s wait list is nothing unique. A third of colleges that responded to a recent survey by the Association for University and College Counseling Center Directors reported having a wait list at some point during the 2012-13 academic year.
And the lists are getting longer: The same study found that, from 2010 to 2012, the maximum number of students on counseling centers’ wait lists at universities with more than 25,000 students nearly doubled, from 35 to 62. During peak times—October to November—students can wait up to four weeks at some institutions.
Many counseling centers have reported increased budgets and hiring efforts, but more students are showing up, and counseling-center officials say their staffs struggle to meet the booming demand. Some of them have also raised concerns that long wait times can only compound students’ anxieties, making their troubles worse.
Ms. Madison made an initial triage appointment—a common type of visit many college counseling centers use to sort students with mental-health emergencies from those who can wait. But the university put her case in the latter category and told her, she says, to come back in two weeks.
So she waited, anxiety still roaring. She tried to eat right. She exercised. She took deep breaths.
During that waiting period, she says, “if I was somebody who was living on my own for first the time and had no idea how to handle it, that would have been a lot worse and a lot more destructive.”
When Ms. Madison returned after two weeks, a counselor handed her a piece of paper with the names of several mental-health providers in the community. The center’s wait list was still long, the counselor said, and she had health insurance the providers accepted. Or she could wait two more weeks for a full appointment at the college.
“I just wish that, before waiting those two weeks, they had been upfront with me,” Ms. Madison says. “I could have been treated during the two weeks if I had just Googled those doctors in the beginning.”
Rising Demand
Shari A. Robinson, interim director of Florida’s counseling center, says the center’s wait list has peaked earlier in each of the last three years. This year, Ms. Robinson says, the center had to start a wait list in late September, and it’s so busy that it’s “unusual” for the center to have a same-day triage appointment available.
Instead, she says, students who come to the counseling center or call for an appointment usually wait three to five days even for their initial triage appointment. The counseling center does offer two hours each day for walk-in triage appointments, but that doesn’t guarantee a student will be seen that day. Then, during peak times, a student may wait for another two or three weeks for an appointment.
“Things start to feel uncomfortable for both the students and the staff when the students have to wait for more than two weeks,” Ms. Robinson says.
Ben D. Locke, clinical director at Pennsylvania State University’s counseling center, shares Ms. Robinson’s worries. If a student waits until November to seek help, he says, continuing treatment probably isn’t possible.
“The problem is that a lot of times when students seek out help in distress, they often need problem-solving help right now. And if that help isn’t available right now, there could be serious consequences,” Mr. Locke says. “The students I worry about with the delays in care are the ones who the day they reach out is the day they need treatment. And they need a very direct and immediate support to succeed that semester. And if they don’t succeed that semester, they fail out of their major, they fail out of school. That lack of ability to intervene means they have lasting consequences.”
Combating Long Waits
Many colleges have tried a variety of tactics in recent years to reduce wait times, but delays can persist.
Group-therapy sessions, for instance, allow the counseling centers to devote a block of time to multiple students rather than just one.
Florida offers a biofeedback lab, which includes six computer stations that teach students how to lessen anxiety on their own, using stress-reducing exercises.
Additionally, many counseling centers set limits on how many sessions students can book—usually seven to 10—to free up time for new patients.
And one major public university has eliminated wait lists altogether by focusing on staying flexible to meet students’ needs.
“We either say, ‘We can see you today, but we might have a little more time to see you tomorrow. What do you think about that?’” says Aaron D. Krasnow, Arizona State University’s director of counseling services. “It’s the opposite of a wait time. You tell me how much of a service you want.”
If a student’s counselor isn’t available, Mr. Krasnow says, the student can choose to see someone different. If all of the staff members working in triage appointments are busy with patients and the counseling center needs someone else, the staff looks to see who can be made available. And, he says, perhaps there’s an immediate outside referral the counseling center can offer a student.
“There’s never a conversation saying, ‘I want to see you, but I can’t,’” Mr. Krasnow says. “We’re here for them. They’re not here to wait around for us.”
But to many, that’s easier said than done. Kirk Dougher, Florida Atlantic University’s executive director of health and wellness, says he has hired staff members in 36 out of the 38 months he’s been in charge. But, he says, he’s “hired himself out of space,” and the wait at the Boca Raton institution at peak time is still two and a half weeks.
Mr. Krasnow, for his part, recognizes the challenges of counseling centers that are understaffed, but says that hiring alone will not clear the backlog.
“Everyone is under-resourced because the need is so great. But no one is going to staff their way out of this problem. There is no staff number that will make this go away,” Mr. Krasnow says. “We own that reality. It’s a perspective that we’re not going to put our eggs in that staff-number basket.”
Mr. Krasnow still worries about how long wait times hurt students.
“You don’t have to be a psychologist to know the potential impact of being told, ‘We would, but we can’t,’” he says. “Not only are they not getting help, but now they’re losing time and they’re losing momentum and all the energy they took in reaching out for help, which is not a small thing. It’s a massive act.”
