Written by Hannah Geller, JD.
If you are a college student, chances are you or someone you know has visited your college counseling center. Over the last decade, college students’ use of mental health services has risen dramatically. Between 2009 and 2015, the number of students seeking services at counseling centers increased by 30 percent, while overall enrollment grew by only 5 percent, according to the annual report of Center for Collegiate Mental Health. This means that utilization of college counseling services is at an all-time high.
The Role of Policy in College Mental Health Care
Federal policy is one reason for increased utilization of college counseling services. In 2003, the President’s New Freedom Commission Report Achieving the Promise: Transforming Mental Health Care in America (2003) identified suicide as a public health crisis that lacked appropriate attention.
In response, Congress passed the Garrett Lee Smith Memorial Act in 2004, which created a national suicide prevention program with goals including:
- Increased awareness
- Stigma reduction
- An expansion of programs that address suicide prevention, substance abuse, and related issues.
Since implementation, the program has since spent tens of millions of dollars on college mental health care.
With this push for improved and increased services, supply is lagging behind demand. According to a recent report by the Association for University and College Counseling Center Directors, students must wait to receive treatment at 32 percent of centers. This number has grown over recent years; the average maximum number of students on waiting lists at large institutions nearly doubled between 2010 and 2012.
Why are schools struggling to keep pace with student needs?
Simply put, counseling is expensive: according to one university, sessions averaged $85 each. Funding for college counseling comes from a combination of government and private sources, and schools cite budgetary concerns as the fundamental reason for inadequate mental health care coverage. Last year, Congress introduced but failed to enact the Mental Health on Campus Improvement Act, which would have increased federal funding for college counseling.
Without an influx of funds, some schools have taken creative measures to increase mental health care. Colleges have experimented with peer counseling, prevention, and tele-counseling to reduce costs and improve access. But student needs for traditional, in-person therapy remain high.
The Healthy Minds Study
In order to determine the best way to spend limited resources and to strengthen the case for budgetary allocations, psychologist Daniel Eisenberg launched the Healthy Minds Network in 2007. In the past decade, this national survey has asked over 200,000 students at more than 150 colleges and universities to provide detailed data on their mental health, lifestyle behaviors, service utilization, environment, and awareness. Findings have been published on eating disorders, anxiety, depression, suicide, and substance use in college students.
Consistent with national statistics, the percentage of students with apparent mental health problems has increased over the last ten years. Less than 50 percent of these students have received treatment. Even among those who have, the treatment received may be lacking. For example, in one study of students receiving treatment for depression symptoms, roughly half received less than minimally adequate care, defined as at least four psychotherapy visits or two months of medication.
Why might this be?
Contrary to common hypotheses, Eisenberg found that stigma was not to blame: most students with untreated mental health issues reported positive beliefs and low stigma associated with mental health care.
A different psychological phenomenon called present orientation may instead be the culprit. Present orientation refers to our tendency when making a decision, to overemphasize short-term effects and underemphasize long-term effects. In this case, the costs of therapy (time, money, and effort) occur in the short term, while the benefits do not occur until the future.
For this reason, Eisenberg has suggested schools increase nudge interventions, which encourage students to overcome inertia and seek care today. Creative approaches are being explored to help college students appreciate tomorrow’s benefits for today’s mental health care including:
- Training peers and adults on campus, like sports coaches, as influencers towards treatment
- Developing an online resource connection
- Enhancing the appeal of marketing efforts to increase awareness of mental health services (for example, video interviews with student athletes)
Can this research inform policy going forward?
The Healthy Minds study is helping to support not just the emotional but also the economic argument in favor devoting resources to amp up the supply side of college mental health services. The study has collected information about GPA, student retention, and alumni spending to argue that increasing mental health spending will benefit schools financially in the long run.
For example, Eisenberg’s team has found that depression correlates with lower GPA and higher dropout rates. For some schools, dropouts directly affect budgets: If a school cannot easily fill the student’s slot, it misses out on the tuition money. The economic argument for these schools to increase mental health funding becomes clear and direct.
For schools that can easily fill a newly opened student slot, the economic argument lies in the future: happier students make for enhanced school reputation and improved alumni giving down the line. More broadly speaking, a better-educated population translates into a better economy for the country at large.
Interested in learning more?
The Healthy Minds Study is currently recruiting schools for the 2017-2018 academic year to participate in data collection. As the school year begins, students, parents, and faculty may visit http://healthymindsnetwork.org/ to learn how to enroll their institution, and play a part in the important cause of improving quality and quantity of mental health care as efficiently as possible.
Additional information on mental health care and eating disorders for college students:
- What you need to know when seeking mental health care.
- Returning to school after eating disorders treatment.
- Five ways to tackle your eating disorder freshman year.
