Universities are hiring more social workers, psychologists and psychiatrists as demand for campus mental-health services rises. But persistent budget gaps mean that students in some cases foot much of the cost of the positions.
Students at George Washington University will be charged an additional $1,667 in tuition next year, a jump of 3.4%. More than $830,000 of the resulting new revenue will pay for mental-health services.
Regents at the University of California system are weighing a plan to hire 70 additional psychologists—a 40% increase—and 20 more psychiatrists—a 60% jump—to keep up with the demand at counseling centers across its 10 campuses. Administrators estimate the annual cost of the hires would top $17.4 million, and they plan to raise a mandatory annual student services fee to $1,242 from $972 by the 2019-2020 academic year to cover some of the expense.
“The demand [by students] so outpaces the supply of appointments that it’s very hard to get a weekly appointment, even for students having pretty serious symptoms that interfere with their academic function,” said Elizabeth Gong-Guy, executive director of counseling and psychological services at UCLA and president of the Association for University and College Counseling Center Directors.
The increase in students seeking mental-health care mirrors society at large, where more people are taking drugs for depression, anxiety and related concerns. The stigma surrounding psychiatric issues also has faded among younger generations, experts say.
Nearly 59% of college counseling center directors reported that their operating budgets rose in 2013, up from 23% in 2012 and 15% in 2009, according to a survey by the Association for University and College Counseling Center Directors. Yet many schools fall far short of recommendations regarding the number of mental-health professionals they should have for the size of their student populations—and about one-third don’t have a psychiatrist on campus at all.
With more students arriving already taking medication or having seen therapists, colleges are struggling to navigate their roles in this highly sensitive area, balancing student safety with financial, privacy and liability concerns.
Schools including Massachusetts Institute of Technology and the University of Pennsylvania are re-evaluating their mental-health programs—and students’ drive for perfection—in the wake of recent campus suicides. And some colleges face controversy about complex rules covering how students may take medical leave for psychiatric issues.
MIT, which had six suicides in the past year, recently launched a pilot study on student workloads in electrical engineering and computer science, its largest academic department. “We will identify ways to adjust curricular expectations, such as possibly spreading work more evenly over the semester,” said MIT Chancellor Cynthia Barnhart.
Karen Hao, an MIT senior, said students can put too much pressure on themselves. “We are so caught up in our pride that we don’t realize the toll” an MIT workload can take, she wrote in the school newspaper.
In her own struggles with depression, Ms. Hao gave up seeking treatment because navigating the school’s system of phone interviews and screenings was too exhausting, she said in an interview. “Like many students I knew that mental health services existed, but I think it’s a flaw in the system to give the responsibility to go to mental health to the student who is actually mentally ill,” she said.
Nearly 10% of current freshmen nationally said they “frequently” felt depressed, compared with 6.1% in 2009, according to a survey of first-year students by the University of California, Los Angeles’s Higher Education Research Institute.
Meanwhile, college counseling centers reported in 2013 that 26% of their clients are on psychiatric medications, up from 9% in 1994, according to a survey by the American College Counseling Association and International Association of Counseling Services.
“More and more students are coming in that are beyond the scope of our services,” saidCharles Beale, director of the University of Delaware’s center for counseling and student development.
Nine percent of Delaware’s 22,000 students find their way to the counseling center each year, receiving services from the equivalent of 1.75 full-time psychiatrists, four interns, three post-docs and 15 psychologists. Though the school has hired the equivalent of two full-time psychologists in recent years, Mr. Beale said, “I could probably hire four new psychologists and they’d all have a full case load in six months.”
Sometimes schools are prodded to action by tragedy. Three students from the same George Washington dormitory committed suicide in spring 2014, a decade after a similar pattern of deaths.
In January, GW opened a new “wellness hub” at the center of campus, combining its medical, mental health and health promotion services with the aim of minimizing the stigma of seeking professional help, said Peter Konwerski, vice provost and dean of student affairs. It also has been assessing peer-counseling programs.
Similarly, The College of William & Mary in Virginia has set aside funds to hire a full-time psychiatrist and expand its emergency call center. The school has had several student suicides this year.
At Yale University, sophomore Luchang Wang committed suicide in January while home in California during winter break. She had a history of depression and took a leave of absence once before. She wrote in a Facebook post shortly before her death that she feared she wouldn’t be able to return if she withdrew again to wait for a new medication to take effect.
The current leave policy “imposes massive hardships on students,” said Geoffrey Smith, a Yale senior and friend of Ms. Wang’s.
Yale’s readmission policy usually requires, among other things, that students spend their time away “constructively” and take courses, and submit a new application when they want to return. Mr. Smith said that can be difficult to do if a student is recovering or in treatment.
Yale spokeswoman Karen Peart said few such students actually withdraw from school, and the majority of them are readmitted. A university committee is reviewing the current policies.
Meanwhile, the University of Pennsylvania last month issued a report calling for a greater commitment to student mental health after a spate of suicides in recent years.
The school already had added four new clinicians last year, helping to cut wait times for routine appointments to 8.5 days from 21.6 days since December 2013. The counseling center moved to a new location with additional rooms for group therapy, and the school has been training faculty, staff and students on how to spot others in distress.
“We need to identify unhealthy attitudes, like destructive perfectionism, this relentless need to succeed at the cost of one’s physical and mental health,” said Dr. Anthony Rostain, professor of psychiatry and pediatrics at Penn’s medical school and co-chair of the university’s task force on student psychological health and welfare.
Once they identify those attitudes, though, schools are still uncertain about what comes next.
While 83% of campus counseling centers say they maintain the right to refuse treatment to a student whose problems are beyond the staff’s capabilities, only 68% have written policies covering such situations and 43% of those with policies said the documents have been approved by legal counsel, according to a survey by the American College Counseling Association.
Karen Bower, a Washington, D.C., lawyer specializing in higher-education discrimination cases, said concerns about legal liabilities are likely overblown because no university has ever been found liable for wrongful death related to suicide.
“Technically, schools have no obligation to provide services,” said Dr. Victor Schwartz,medical director of the Jed Foundation, a nonprofit focused on college-student suicide prevention. “They just have an obligation not to do things that are negligent and stupid,” such as ignoring a spate of suicides or penalizing students for seeking help.
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