As demand for campus counseling skyrockets and therapists are forced to manage increasingly larger caseloads, students are less likely to see improvement in their mental-health symptoms.
That’s according to a report from the Center for Collegiate Mental Health, at Pennsylvania State University, which examined the impact of students’ increasing demand for mental-health services on the effectiveness of the treatment that colleges can provide. The report includes data from 163 campus counseling centers, covering more than 200,000 students who have sought treatment.
Over the past decade, rates of anxiety, depression, and suicidal thoughts among college students have risen significantly, and more students have sought help at counseling centers. But staffing and funding for the centers, which typically don’t charge students for treatment, have not kept pace with the demand. That has led to student complaints about long wait times for therapy and unsatisfactory interactions with campus counselors.
“It’s expensive to grow mental-health services,” said Ben Locke, executive director of the Center for Collegiate Mental Health and senior director of counseling and psychological services at Penn State. “Even though we’ve been asking students to seek services, we’re now in a place where institutions are failing to respond in terms of growing those services.”
Most counseling centers have been forced to do more with less. Therapists have had to add more students to their caseloads, even if they don’t have time to see those students very often. According to the center’s research, Locke said, some students who need regular therapy are getting only one session every three to four weeks, or no continuing care at all.
Such a low level of treatment, he said, won’t help many students get better. The study found that when campus therapists had higher caseloads, students showed significantly less improvement in their symptoms of general distress, depression, and anxiety.
The findings, the report says, “confirm the critical relationship between effective treatment and positive outcomes, which have been largely ignored as institutions have sought to respond to growing demand by emphasizing access at the expense of providing sufficient treatment dosages.”
The report is a cautionary tale about the changes that many colleges are putting in place to manage demand at counseling centers — for instance, serving many students through same-day drop-in appointments, Locke said. “This idea that you can provide treatments in a 30-minute, one-time appointment that’s going to meet the needs of people with mental-health concerns is not accurate.”
For some students who don’t need therapy but have a short-term problem, like a bad test grade, one short session might be enough, he said. Some colleges are stepping up programming on resilience skills, hoping to help students cope with life stressors on their own and not reach a point where they need the counseling center.
But that won’t be enough for many students. According to the Healthy Minds Study, which surveys thousands of students each year, about one-third of students screen positively for a mental illness. Nationally, on average, counseling centers see just 11.8 percent of the student population, according to the Association of University and College Counseling Center Directors. That means colleges are probably serving fewer than half of the students who actually need mental-health services, Locke said.
Colleges with large enrollments — in particular, public universities and community colleges — appear to be the most overburdened, as their counselors tend to have the highest caseloads. What’s more, the study found that those counseling centers, which see only small percentages of students, Locke said, are serving those with higher levels of distress.
The report uses a tool called the Clinical Load Index, available on the Penn State center’s website, that is designed to help colleges compare their counseling centers’ staffing levels with those of other institutions and understand what kinds of services they are actually capable of providing, given how many therapists they have and how many students seek counseling.
About 20 percent of colleges score above 150 — meaning that each campus therapist has an average caseload of 150 students — which is the point at which, Locke said, “your ability to provide treatment is really starting to get pinched.”
If colleges don’t have the resources to hire more therapists and provide intense treatment, Locke said, counselors and administrators must be transparent with students about that.
The report also shows that the number of students having experienced trauma who go to counseling centers is rising, as is the number of those who have previously been in treatment.
It’s also notable, Locke added, that on the basis of campus counselors’ evaluations, the number of cases of anxiety and depression has begun to plateau during the past three years.
Sarah Brown writes about a range of higher-education topics, including sexual assault, race on campus, and Greek life. Follow her on Twitter @Brown_e_Points, or email her at sarah.brown@chronicle.com.
