How university counseling centers help (and hurt) students seeking mental health care

* Some names have been changed.

Sara Perfin applied for counseling not long into her first year at Virginia Commonwealth University in Richmond, Virginia, hoping to finally find relief after years of dealing with severe depression.

While her intake appointment at University Counseling Services (UCS) occurred not long thereafter, Perfin, like 35.9 percent of students at universities nationwide, according to the 2016 Association for University and College Counseling Center Directors (AUCCCD) Annual Survey, was placed on a waitlist.

As she eventually learned that being on the waitlist meant that she might not even be seen by a counselor that semester, and as the pressures of being a freshman intensified, Perfin attempted suicide.

A campus of 31,000 students in Richmond, Virginia, VCU suffers from an overabundance of students and an underabundance of student resources, a common problem on large college campuses. According to the American Psychological Association, the more students that attend a university, the more demand a university counseling center will experience. With more students than ever attending college, university counseling centers across the United States are having trouble keeping up with this demand. Failing to meet this demand means more students than ever are dealing with mental illness alone, without the chance of being helped.

“When it came to dealing with greater issues, like prolonged mental illness, severe anxiety and even suicidal ideation, I felt very failed,” Perfin, who graduated in spring 2017, said. “They were equipped to deal with day to day problems, but not long-term illnesses.”

Among universities with between 30,000 and 35,000 students, like VCU, about 12 students per university were reported as being involuntarily hospitalized for psychological reasons, including suicidal ideation, otherwise known as suicidal thoughts. Perfin was one of these students, and she said UCS was the authority governing which students required these hospitalizations.

When compared by campus size, the differences in university counseling centers range from how many students are served to whether or not the counseling center is accredited. / Graphic by Christine M. Hopkins

“Myself, and several people I know, were shipped off to the hospital instead of given a chance at outpatient treatment,” Perfin said. “Even when we expressed that we did not want to go to the hospital, miss class [or] get behind.”

Perfin’s experience is not uncommon. The AUCCCD survey says more than half of college counseling centers reported that student mental health concerns had increased over the 2015–16 academic year. Fifty-two percent of these students reported anxiety as their primary concern, while 41 percent reported depression as theirs.

Edward*, a recent graduate of Iowa State University in Ames, Iowa, was dealing with newly-diagnosed depression when he first arrived on campus as a freshman. Iowa State enrolls more than 36,000 students, and, like Perfin, Edward faced the uncertainty of the waitlist when he first tried to sign up at Student Counseling Services (SCS).

“I was at my worst when I called them,” Edward said. “[Being waitlisted] was incredibly frustrating.”

When Edward finally got in to see a counselor, he was disappointed with the care he received. While his singular experience does not necessarily speak to a larger problem among large college campuses, the sheer number of students seeking counseling — as evidenced by the waitlist — could mean the scope of care available is compromised.

“It just didn’t feel individualized,” Edward said. “It felt like [my counselor] was feeding me a bunch of stuff she got from a self-help book. Everything she asked me or told me to do was very, very generic.”

Luckily, Edward was able to take advantage of a service vastly more common at larger universities, according to the AUCCCD survey: group therapy. While students who attend group therapy sessions come from a wide variety of backgrounds, their mental health concerns are generally similar. At Iowa State, groups include grief counseling, men’s and women’s issues and one for students dealing with trauma.

“I guess [group counseling] felt more authentic,” Edward said. He added he wished his individual sessions at Iowa State had been more successful, as the ease of scheduling at SCS did initially appeal to him. Eventually, he had to seek help from a therapist elsewhere in Ames.

Not being able to attend to this growing need for individual mental health care means students like Perfin and Edward with serious needs are not only left unsure of their options moving forward, but might also watch as other students’ more minor concerns are prioritized.

“[UCS] seemed equipped to handle general life issues, but not the greater, heavier ones,” Perfin said. “With school anxiety or boy troubles, they were there to lend an ear.”

For Otis*, a graduate student at Iowa State, these kinds of “troubles” were exactly what he hoped counseling would be able to address at his previous university, which was around VCU’s size. After a breakup that left him miserable for longer than he felt was normal, he decided to stop by the counseling center for a session.

As a teaching assistant, he realized this was a prime opportunity to take the advice he’d been taught to give others.

“I was like, well, I would probably tell a student to talk to a counselor,” Otis said. “I felt like I’d talked out my friends and family by that point.”

At his appointment, Otis found a sympathetic counselor who let him tell his story, allowing him talk for as long as he needed without challenging his views. Most importantly, and unlike Otis’ friends, the counselor was willing to listen to his concerns without judgment.

“It felt more objective [talking to someone I didn’t know],” he said. “I was surprised at how much going and talking to a stranger for an hour helped.”

While smaller colleges are not immune to the issues suggested by the AUCCCD survey, Jen, an alum of Mills College in Oakland, California, feels their experience at the Counseling and Psychological Services (CAPS) Center was mainly positive.

“I feel like my college was very open about addressing mental health issues,” said Jen, who asked only to be identified by their first name. “[CAPS] was always mentioned to us in hall meetings in our dorm and by our professors and by [the Office of] Student Life.”

Even among larger colleges, the number of staff available to help students can fluctuate vastly, some even almost as low as the number of staff at smaller colleges. / Graphic by Christine M. Hopkins

Mills, which enrolls 1,400 students, is unique in that it is an all-women’s college, but it is also deeply committed to accepting and affirming LGBTQ+ students, staff and faculty. They offer information for these students including on- and off-campus resources for specially-tailored health care, group therapy and safe, welcoming events. The kind of open communication that Mills provides in terms of LGBTQ+ health means mental health issues are also given a high priority.

“I think the campus culture, including being open about mental health, was extremely important,” Jen said. “I don’t think I would’ve been as comfortable if the community wasn’t supportive.”

Even though Jen ended up needing mental health services beyond what Mills could offer, adding that they considered the limited number of sessions offered due to the college’s small size a drawback of their experience, they reiterated that Mills’ supportive atmosphere still helped them a great deal.

“They were always accommodating depending on a student’s needs,” Jen said. “My general experience was actually extremely positive.”

Jen, like others who attend smaller colleges, benefited from the fact that counseling centers like CAPS serve a greater percentage of their student bodies, according to the AUCCCD survey. The atmosphere they describe is overall more welcoming and personal than the atmosphere at larger colleges.

This overall lack of personable treatment leads to students like Perfin expressing frustration over the perceived shortcomings of VCU’s counseling center.

“If I had the choice to do it all over again, I wouldn’t,” Perfin said. “I would go to some outside counseling resource, not provided by the school.”

But others, like Edward, are willing to give their school other chance, in spite of their personal shortcomings.

“I think they do the best they can,” Edward said.