Counseling and psychiatric services at Midwest universities are buckling under the increased demand from students – many of whom are entering schools with more serious illnesses than ever seen before.
Indeed, many counseling programs are failing to meet the nationally accepted standards for counselor-to-student ratios, leading to longer waits for assistance and a limited number of sessions, an investigation by a consortium of Midwest journalism faculty and students has found.
The five-month examination of programs was conducted by the Investigative Journalism Education Consortium, a network of journalism faculty and students at Midwest universities and colleges. The project is funded by the Robert R. McCormick Foundation based in Chicago.
The consortium also found that many campuses have not implemented key recommendations made to improve campus safety and mental health services in the wake of the fatal shootings at Virginia Tech in 2007 and at Northern Illinois University in 2008.
In addition, the consortium discovered that counseling centers are juggling limited staff and cutting programs because of shrinking budgets.
All this comes at a time when counselors are seeing more students entering college with histories of mental illness.
In the past, “if someone had a mental illness, college was not a feasible option,” Christy Hutton, programming and communications coordinator for the University of Missouri's counseling center, said. “They either received long-term treatment for their illness or they were placed in a closet and hidden from the rest of society.”
Now, she said, it is possible for most students to balance outpatient care and college coursework because of the treatment and medication they received before they entered college.
The consortium reviewed services at more than two dozen campuses in Wisconsin, Illinois, Indiana and Missouri. In its ongoing review, the consortium found that centers often fell far short of the number of mental health providers recommended by the International Association of Counseling Services.
The association’s recommendation for staffing levels calls for college counseling centers requires a minimum of one mental health provider for every 1,500 students. Yet most campuses have ratios of one provider for more than 2,000 students, with some having ratios as high as one mental health provider for more than 16,000 students.
As a result, students in need wait weeks for appointments and get only a few sessions. In some cases, outreach programs and preventative services have been cut, reduced or turned over to trained students to run.
“It means making tough choices,” said Carla McCowan, director of the counseling center at University of Illinois Urbana-Champaign. “It’s a nick here and a nick there because I can’t cut people, really. I can’t cut clinicians.”
This proves to be a frustration for many students.
For example, when University of Wisconsin senior Rachel Steidl sought counseling services this year, she was assessed the same day under a new process at her Madison campus. But because her immediate needs weren’t deemed urgent, she was asked to wait three weeks for her next appointment.
“If my depression gets worse, it could escalate,” Steidl said. “I want to avoid getting to the point where I have to call the crisis hot line.”
As part of its review, the consortium culled through data and documents and conducted numerous interviews with mental health providers, experts, university administrators and students.
Among the consortium’s findings:
- Four years ago, a University of Wisconsin System subcommittee recommended that, in the short term, its four-year institutions try to meet 75 percent of the association’s staffing standard or one mental health provider for every 2,000 students. The average is now is about one mental health provider for every 2,027 students across its 13 campuses. But when students at the Wisconsin Center for Investigative Journalism used the subcommittee's methods to re-calculate ratios for 2010-2011, it found that five of the 13 campuses failed to meet that standard.
- In Missouri, the University of Missouri-Kansas City has seen a 175 percent increase in the number of students seeking services over the past decade, while the University of Missouri-Columbia saw 80 percent more students seeking services over the past five years. At the Columbia campus, there were 602 students seen for individual, couple or group therapy in the 2006-2007 school year. For the 2010-2011 school year, there were 1,091 students seen.
At the Kansas City campus, there were about 830 students seen for therapy in the 2010-2011, up from 300 students during the 2000-2001 school year.
On average, University of Missouri says it has one mental health provider for every 1,900 students.
- In Indiana’s public universities, counseling centers have been consistently understaffed. As a result, trainees are heavily used to provide clinical services. Ratios range from one mental health provider for every 2,208 student to one mental health provider for more than 16,000 students.
- Southern Illinois University Carbondale has one mental health provider for every 3,000 students, while the ratio at the University of Illinois at Urbana-Champaign is one counselor for every 2,100 students.
“We start to get a wait list and what that means is that a student comes in this week but we won’t have any ongoing openings for three more weeks,” said Rosemary Simmons, director of counseling at Southern Illinois University Carbondale.
Simmons added, “For the past 10 years, we have had a built-in triage system and so we really make an effort to meet every student when they come in to make an initial assessment.”
The consortium also looked into other issues related to mental health on campus, including psychiatric treatment and the creation of behavioral or threat assessment teams.
In some instances, it was difficult to assess problems because campuses did not provide information despite repeated requests.
National experts say the challenges at Midwest universities reflect national trends.
A 2011 National Survey of Counseling Center Directors found an influx of students with serious psychological problems including large increases in crisis issues that require an immediate response and an increase in students arriving on campus already on psychiatric medication.
“Sometimes counseling centers have to decide which is the least worse because there’s no money,” Dan Jones, president of the Association for University and College Counseling Center Directors. “There are some things you just can’t address because of the budgets.”
Hutton said there are three major reasons why the number of college students seeking treatment has gone up.
The most important factor is improved treatments for mental health disorders. As more teenagers receive professional care for mental illness, an increasing percentage of them are able to pursue secondary education. In the past, this was not often possible for most students with mental disorders.
“If someone had a mental illness, college was not a feasible option,” she said. “They either received long-term treatment for their illness or they were placed in a closet and hidden from the rest of society.” Now, it is possible for most students to juggle outpatient care and college coursework.
Threat assessment teams
The Virginia Tech and Northern Illinois University shootings that left 39 people dead spurred the creation of threat assessment or behavior assessment teams on college campuses nationwide and led to wide-ranging recommendations on improvements in mental health care on campuses.
These teams are comprised of mental health providers, campus security officials and college administrators who work to identify and help students at risk for harming themselves or others.
This adds yet another responsibility to already overworked counseling centers.
“But one side effect is identifying all these students that might have gone unnoticed and may not have had intervention in the past ... More people are connecting the dots,” Jones said, and “people are more attentive to troubled students than before these kinds of tragedies. “
These teams are comprised of mental health mental health providers, campus security officials and college administrators who work to identify and help students at risk for harming themselves or others.
At the University of Illinois, a Behavioral Intervention Team meets weekly to discuss students whose behavior can be considered disruptive and concerning to the rest of the campus community.
This behavior oftentimes does not require disciplinary action, but it has reached a level of concern and needs to be addressed before it escalates, said Ken Ballom,University of Illinois Urbana-Champaign’s dean of students.
“Becoming more aware of the student and offering support services could prevent future escalation and crisis,” Ballom said. “The role of the Behavioral Intervention Team is to review student behavior on campus that appears disruptive or destructive and intervene for safety and support.”
Yet this new process adds another responsibility to the already overworked and often underfunded college counseling center.
“It’s one of these things that are a two-edged sword,” Jones said. “These committees are helping us identify students that need help. It is sad and unfortunate that we’re not always able to provide comprehensive and timely treatment given the limits of budgets and limits and staffing of counseling centers.”
Medication
The low or free cost of counseling center services coupled with the lack of health insurance for off-campus services prompt many to seek help at campus counseling centers.
More students are on psychiatric medication and more students are diagnosed with severe issues such as depression and anxiety.
For most college campuses across the nation, this is now considered the norm rather than atypical, McCowan said.
“Typically, many years ago, you would see students that would come in saying things like ‘I’m having difficulty with a roommate’ or having difficulty with academics or feeling homesick,” she said.
“We still see students that complain of academic difficulty of roommate problems but it is simply that it is rarely their only issue and so many more students have severe presenting issues,” McCowan said. “Almost everyone comes in talking about severe symptoms of depression, severe problems of anxiety, suicide, suicidal thinking or thoughts.”
Some students taking psychiatric medication when they arrive on campus stop taking their medications so they can drink or party with their friends, Jones said.
For others, the high cost of prescriptions prompt them to stop taking needed medication and self-medicate with alcohol and illegal drugs.
“The self-medication issue is complex,” said Danielle Oakley, director of mental health services at University of Wisconsin - Madison. “For example, students who use substances such as alcohol to treat anxiety can end up with substance abuse problems in addition to their anxiety.”
Campus safety
State and federal representatives have recognized the growing need for mental health services on campus and improved campus security.
In the aftermath of the April 2007 shooting at Virginia Tech, Missouri’s Department of Homeland Security compiled a list of recommendations for universities to follow in order to decrease the likelihood of a similar attack occurring on a Missouri college campus.
Among the most important recommendations were calls for a higher percentage of counselors per student and for mental health counseling to be provided for students 24 hours a day, seven days a week.
Additionally, one federal bill - the Campus Safety Act of 2011 - establishes a national center for campus public safety. That bill remains in committee.
State legislation in recent years include moves to establish emergency plans on college and universities, that in some areas, many colleges still lack.
But some universities have attempted to go further.
More than two years ago, the University of Illinois at Urbana-Champaign took the initiative to establish building emergency action plans.
Without these Building Emergency Action Plans, which require buildings to plan emergency responses for situations ranging from natural disasters and fires to bomb threats and shooters, building staff are not prepared to respond to an emergency like the presence of a gunman in a classroom.
Of the approximately 450 buildings on the University of Illinois campus, only 75 have Building Emergency Action Plans completed or in progress. While these buildings include all residence halls, both public and private, they do not include many buildings that host countless classes throughout the day, some with rosters of more than 700 students. And it could take another decade for every building on campus to have one.
“I don’t care if the plans are required,” said Todd Short, director of the Office of Emergency Planning. “Having these plans is the right thing to do, and every building should have one.”
Though campus shootings have been documented as far back as the 1800s, there’s been an increase in the past 20 years because campus populations are growing, said Anne Glavin, chief of police and director of police services at California State University NorthRidge and president-elect of the International Association of Campus Law Enforcement Administrators.
“So it’s been an evolving problem and as we look at it and as it’s been studied, a lot has come out on the issues of mental health, violence and the need for better risk assessment,” Glavin said.
Campus law enforcement, like mental health provider, are challenged with identifying and helping a person of concern before something violent actually happens, she said.
To that end, campus law enforcement agencies are taking a closer look at commonalities with campus mental health and how departments can better work together.
Mental health is “one of the biggest topics and priorities that most of us have, that we really have to focus on because I think it touches probably virtually every university in the country,” Glavin said.
