Just over four years ago, when Alyshia Hull arrived on campus at Cayuga Community College in Auburn, New York, she found herself surrounded by hundreds of other wide-eyed new students. But beneath her eagerness to start her first semester at college, Hull was battling something that made her feel entirely alone: anxiety.
She had dealt with anxiety her whole life, but the pressures of being in a completely new environment only made things worse. “I was so scared of not being good enough,” she tells Health. She felt uneasy in campus social situations, her grades started to slip, and she even opted to take a two-hour bus ride to class every morning because she didn’t feel confident driving. Some days, she would stay home all together, feeling like she “just couldn’t do it.”
A surge in students needing help
To make things even more complicated, Cayuga didn’t offer any mental health services for students. Like most community colleges, the school didn’t have the resources to help students like Hull, of which there are thousands, suggests recent data: A 2018 World Health Organization survey of 14,000 students across the globe found that one in three college freshmen reported dealing with mental health disorders in the years leading up to college.
It can be nearly impossible to manage anxiety like Hull’s without treatment, and that can lead to poor grades, time management struggles, even the possibility of dropping out of college. In a 2017 survey by the American College Health Association (ACHA), students reported that anxiety and depression are among the biggest factors that negatively affect their academic performance. Forty-two percent of participants said they had felt so depressed in the past year, it was difficult for them to function.
Hull stuck it out, and two years after she started at Cayuga, she transferred to a school that did have mental health services: the State University of New York College in Oswego County, New York. She began to see a therapist, and she slowly felt herself taking control of the anxiety that had plagued her first two years.
She described the change she saw in herself as a release. “Imagine your greatest fear, that feeling of being so scared, but experiencing that every day,” she explains, “and then that being fear being lifted.”
Hull is part of a rising number of college students seeking out mental health treatment on campus. Between 2009 and 2015, the number of students visiting counseling centers surged by about 30% on average, while academic enrollment grew by less than 5%, states a 2015 report by the Center for Collegiate Mental Health (CCMH). The report also found students seeking help are increasingly likely to have previously engaged in self-harm or attempted suicide.
News outlets have described the rise as a “crisis,” and it’s easy to see why. A significant number of college students grapple with mental health disorders and there’s been a dramatic increase in the demand for mental health services on campus. But the question is, what’s really going on?
A generation that sees no stigma
Gregg Henriques, PhD, director of the combined clinical and school psychology doctoral program at James Madison University in Virginia, posed this question in a 2018 Psychology Today article: “Are we seeing an ‘epidemic’ of mental illness racing through the country? Or are we seeing a shift in attitudes, definitions, and the expectation of, availability of, and willingness to seek mental health treatment?”
Henriques went on to argue that a cultural shift toward normalizing mental illness is the primary reason for the rising numbers, though an actual increase in mental distress is an “important secondary cause.”
Ben Locke, counseling director at Penn State University and head of CCMH, also believes that cultural shift to be the force behind the numbers. “It’s my perspective that the way people are interpreting this increase in utilization is fundamentally wrong,” Locke tells Health. He believes that more students visiting campus counseling centers isn’t a crisis—rather, it’s a sign that the efforts put in place to make students more comfortable seeking help are working.
Locke references the Garrett Lee Smith Act, a federally-funded suicide prevention program that’s funneled hundreds of millions of dollars into counseling centers across the country since 2005. (It was put into place after Garrett Lee Smith, son of Gordon Smith, a U.S. senator from 1997 to 2009, took his own life.) Now, 14 years later, the effects of that infusion of funding is manifesting in the high number of college students accessing counseling centers on or near campuses that have benefited from the extra funds.
Other sources of mental health funding are also operating nationwide, Locke explains. But most of them, including the Garrett Lee Smith Act, focus on three goals: reducing the stigma of mental illness treatment, increasing “help-seeking behaviors” (in other words, empowering people to recognize when they need help and to ask for it), and gatekeeper training (educating people so they can identify warning signs and refer others for treatment).
“All three of those mechanisms, stigma reduction, increasing help-seeking behavior, and gatekeeper training, accomplish the same end goal, which is they increase the rate of identification and referral of people at risk,” Locke says. “What we’re seeing in counseling centers is what I believe to be the signs of a successful intervention.”
Locke says it’s unfair to assume that the rise in mental health treatment reflects a lack of resilience in today’s college students. To prove his point, he compares mental-health treatment to national breast cancer screening programs. “If you spent 15 years trying to convince women to come get their breast cancer screening, you wouldn’t turn around and say, ‘Why are all of these people coming in for services? Don’t they have any resilience?’”
He believes the stigma of mental illness is down, awareness is up, and people who need mental health services—especially those who have already engaged in self-harm or have attempted suicide—are finding treatment.
Mental disorders are also on the upswing
It’s impossible to ignore the sudden cultural shift in the way we talk about mental health. Young celebrities like Selena Gomez and Lady Gaga have opened up about their struggles with anxiety and depression, influencing millions of young adults to see mental disorders as threatening to health as physical conditions. The shift is also reflected in many workplaces. These days, it’s completely normal to use a personal day as a “mental-health day,” with no judgment from managers or coworkers.
As Henriques pointed out in Psychology Today, however, there is evidence of an actual increase in mental distress in college students as well. While the 2018 ACHA survey determined that 42% of students had felt so depressed in the past year that it was difficult for them to function, the same survey given in 2009 found 31% of students felt that level of depression. The number of students who had seriously considered suicide within the past year has doubled, with 6% in 2009 and 12% in 2018, according to both surveys.
The jump in mental health issues can be attributed to many cultural and economic changes between 2009 and 2018: the increased reliance on social media, which can be isolating and trigger self-esteem issues; frequent school shootings and the gun control debate fostering fear and panic; and the soaring price of education and worries about loan debt, to name a few. While it’s difficult to pinpoint one overriding reason more students have mental health issues, these all likely play a role.
How colleges can help struggling students
No matter the cause, universities across the country are experiencing the same problem: They haven’t been able to expand their counseling centers rapidly enough to keep up with the growing demand for services. But that doesn’t mean they haven’t tried.
Penn State allocated around $700,000 in additional funding for counseling and psychological services in 2017. During the 2016-17 school year, Ohio State added a dozen mental health clinicians and also launched an app that lets students schedule appointments, access breathing exercising, contact the clinic in case of an emergency, and more. A bus driver at James Madison University even started something called the “Struggle Bus,” where he talks to riders over the loudspeaker about their everyday challenges as he drives.
Still, as of 2016, the Association for University and College Counseling Center Directors found the average university had only one professional counselor for every 1,737 students, which is lower than the International Association of Counseling Services’ recommended minimum of one therapist for every 1,000 to 1,500 students. What could alleviate this and make mental health treatment more accessible to students who need it? More. Funding.
As we wait for lawmakers and administrators to secure the money needed to help college students with diagnosis and treatment, there’s one more thing to consider. Henriques mentioned in Psychology Today that he spoke with David Onestak, PhD, director of the counseling center at James Madison University, who said it’s senseless to call this a “crisis” because the numbers have been on the rise for years, and there’s no reason to believe they’re going to slow down anytime soon. In his opinion, there’s really only one way to describe the situation: “the new normal.”
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