Years ago, college counseling centers were pleasant little side
channels of the mental health system, helping students cope with roommate
conflict and adjustment to college. No more.
Today they are the newest front line in the war against mental
illness, struggling to manage swarms of students with serious depression
and anxiety disorders. And generally facing a growing demand for their
services in a world of shrinking resources.
The middle of the night may find a SWAT team of counselors calming
down a dorm wing after having crisis-managed an acute manic episode or
yet another incident of self-mutilation. Morning will certainly find the
staff administering psychotherapy to students struggling to overcome
histories of trauma such as childhood sexual abuse, relationship problems
including date violence, and that dormitory staple, eating
disorders.
Did we mention substance abuse? Attention deficit disorders and
learning disabilities? At one elite institution, 10% of students report
problems with binge drinking.
Rare is the college that has not experienced a student suicide. A
10,000-student campus can expect one student suicide a year. That doesn't
count all the highly disturbing attempts.
Hospitalization, a court of last resort, is commonplace.
Eighty-nine percent of counseling centers hospitalized at least one
student in 2001; one hospitalized 80. On one 5,000-student campus where
most students are commuters, three to six students are typically
hospitalized a semester, primarily for suicidal gestures and first
psychotic breaks.
In 2001, 85% of North America's student counseling centers reported
an increase in "students with severe psychological problems" over the
past five years. Thirty percent of them had a student suicide; 60% of
them dealt with obsessive pursuit cases (50 persons injured, five
killed).
"Every director of every college counseling center is reporting
more hospitalizations, more serious problems, and taking care of sicker
students," says Richard Kadison, M.D., a psychiatrist who heads Harvard
University Health Services and its counseling center. The severity of
students' mental health problems has been rising since 1988, reports
psychologist Robert Gallagher, Ph.D., of the University of Pittsburgh,
who each year surveys directors of college counseling centers.
"The world isn't getting crazier," observes Pamela L. Graesser,
M.Ed., director of counseling at Rivier College, a small Catholic college
in New Hampshire whose students are primarily from blue-collar families.
"College is just getting more like the real world around it." College is
simply available to more people than it used to be. The problems Graesser
saw 12 years ago when she worked in a psychiatric hospital "are the same
ones I now see on campus."
"We are probably seeing the true prevalence of mental disorders,"
observes psychiatrist Morton Silverman, M.D., head of counseling services
at the University of Chicago. "There is not as much surveillance in the
outside world."
Then too, he says, "we are the beneficiaries of our own
successes."
Call it the Prozac payoff. Colleges are reeling from the number of
students arriving already on antidepressant and other medication and
requiring psychiatric monitoring. A decade of improved drugs has
encouraged earlier diagnosis.
Early treatment of depression—along with institutional
accommodation of disability—has enabled students to stay in the
academic system who in other eras might not have made it to college, or
would have dropped out after a semester or drifted into community
colleges. Today they are attending the nation's elite institutions, where
academic, living and developmental demands sometimes overwhelm the coping
skills they have yet to acquire.
"Many who wouldn't have gotten to an elite college before are
getting here because they were treated when younger," observes Harvard's
Dr. Kadison. "They need ongoing, intensive care," which not every school
has the resources to supply. Many students fall apart given the looser
environment, erratic sleeping patterns and added stresses of
college.
Many others experience their first onset of disorder. There is the
indisputable fact that age 18 to 25 is prime time for eruption of mental
illness, making college, with its concentration of 18- to 25-year-olds,
the prime place. Increasingly, mental health professionals recognize that
depression, anxiety disorders, bipolar illness, personality disorders and
schizophrenia are conditions that first arise in young adulthood.
Catching them quickly is critical, as early management strongly
influences how they play out over adulthood.
And so it is that increasingly, colleges are the first best hope
for rescuing the minds of America's future. But what no one ever imagined
is that colleges would also find themselves the last best hope of mental
health care in America.
April is the cruelest month. College counseling centers really feel
the crunch.
Students who put off counseling suddenly realize they're going home
soon. "They're going back to the situation that made them crazy in the
first place, or back to the abuser," reports Rivier's Graesser. Seniors
flock in with anxieties about confronting the real world.
Tags:
anxiety disorders,
attention deficit disorders,
childhood sexual abuse,
college,
commuters,
counseling,
depression,
disorder,
dormitory,
learning disabilities,
psychological problems,
relationship problems,
self mutilation,
treatment
