The hottest place on college campuses these days is not the local
pub, the athletics center or the famous-architect-designed student union.
It's the campus-counseling center. Through its doors are likely to
march at least 10 percent of the student body in any given year.
The vast majority of the nation's college counseling centers
report they are under siege, trying to meet the demands of unprecedented
numbers of students with a range of serious psychological problems. From
major and manic depression to eating disorders to self-harm to substance
abuse, campus mental health centers are increasingly dealing with
conditions that have life and death consequences. Shedding their
reputation as the Rodney Dangerfield of college services, counseling
centers are now seen as critical to the core mission of the
university—relieving the mental burdens that impede students from
learning and creating a civil society.
As a result, the issues that campus counseling centers face reach
into the highest offices of higher education. There isn't a meeting
of college presidents where the subject of student mental health
doesn't come up, observes Steven Hyman, as provost the second
highest officer of Harvard University and a psychiatrist who was formerly
director of the National Institute of Mental Health. "It's an
important, nationwide problem in higher education," he says. Adds Kevin
Kruger, assistant executive director of the National Association of
Student Personnel Administrators: "It's one of the top five
critical issues on campuses."
The rising demand for clinical services by a new "psychologically
diverse" student body is hitting a wall of finite, if not shrinking,
resources. "By the eleventh week of a semester," says Russ Federman, the
University of Virginia's head of counseling, "all appointments are
filled. But students don't stop coming."
Their services overtaxed, schools are responding by triaging cases,
rationing counseling and, some say, over-relying on medications to get
kids through what may, in the end, prove to be an unusually difficult
(but not necessarily permanent) transition to adulthood. "Counseling
centers are struggling with brief crisis stabilization versus addressing
fundamental issues to effect change," says Federman.
Schools literally can't afford to have anyone fall through
the cracks; student suicide presents huge liability issues and is highly
disruptive to a campus. At the same time, parents are pressing colleges
to take on even more responsibility for student safety, well-being and
success.
No one's sure when the demand for counseling and more
intensive psychiatric services will level off—or where, or how, to
draw a line between academic and therapeutic community. But lots of
students today have needs beyond traditional adjustment and developmental
issues.
"Through 1996," reports Kansas State's Sherry Benton, Ph.D.
assistant director of counseling, "the most common problem students came
in for were relationship issues. That is developmentally appropriate."
But in 1996 anxiety overtook it and has remained the top problem.
Relationship problems may have leveled off but their severity has
escalated. Colleges report ever more cases of obsessive pursuit,
otherwise known as stalking, leading to violence, even death.
Fact: 14 percent of college students filling out prematriculation
health forms indicate they are actively being treated for clinical
depression. That's before they get to campus. Many more are
diagnosed on campus. A depression-screening day at 134 colleges processed
12,999 students; 5,199 were referred for treatment.
Fact: Campus counseling center directors report that 41 percent of
their clients have severe psychological problems; 12.2 percent receive a
psychiatric evaluation and 20 percent take psychiatric medication.
Fact: Anorexia and bulimia in florid or subclinical form afflict 40
percent of women at some time during their college career.
Fact: Hospitalization for psychological reasons is increasingly
common on campus; 333 counseling centers hospitalized a total of 2,136
students in 2003.
Fact: With suicide the third leading cause of death among those
aged 15 to 24 and second among college-age students, schools can expect
1,100 student suicides this year. Two thirds of the students do not seek
help beforehand.
Medication issues are huge. Even those students who come to college
already diagnosed and well-treated can get into trouble. "The hottest
cases for me," says Bruce Nelson, director of Elon University (N.C)
counseling center, are bipolar disorder. "It's so hard to manage.
They don't want help when they're manic." Under the best of
conditions bipolar disorder is a challenge; on campus it's
daunting.
Students are a long distance from their doctors and put in a
disorganizing environment of more drinking, less structure, more stress
and many reasons to forego sleep. Sleeplessness alone can precipitate
mania, which has its appeal when there's always studying to be done
or distractions to enjoy. The illness impairs insight and encourages
denial. "No one is managing the medication, " says Nelson.
Then there are the students who think everything is going to be OK
now that they're out of their home environment. "We always see a
number of bipolar patients in crisis who've stopped their
medication," reports Bradford King, Ph.D., head of counseling at the
University of Southern California.
Add in the enterprising students who go off their meds but still
fill their prescriptions—so they can peddle the pills to others.
Many colleges unwittingly host an informal black market in
medications.
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