Ben Locke, a psychologist who founded the Center for Collegiate Mental Health, sees this exposure of campus counseling to many older students as the unintended consequence of widespread efforts to prevent suicide and neglect therapy.
For the past two decades, colleges, with millions of dollars from the federal government and foundations, have been asking students for help, saying “it’s okay not to be okay,” he said. They have trained faculty and colleagues to identify distressed students and refer them to counseling, and urge students not to bother silently.
Now, as a result of that deliberate and often helpful push, students are even looking for therapy for routine challenges, Locke says, who is now Together, the chief clinical officer of an online mental health community.
Smith, who has been a counselor for a decade, says he has seen a change in cultural attitudes toward mental health, with schools now teaching children coping skills before preschool. “My 2 year old son will come home from school and say: ‘I’m sorry. I have a great feeling. I need a break, “he said.
Schmidt said he was attracted to counseling work because he enjoyed “being with people”, supporting them with highs and lows.
“I see my role as a helper. They are all working hard, ”he said. “I love being there to see that growth.”
But being present in his own life is not always easy. She tries to practice self-care, goes for a walk with her young child, or hits the elliptical trainer while she and her baby brother are in bed. But sometimes a thought or thought about a client crawls into his head while he is at home.
“The most challenging thing is to be able to sit down and be present and be as kind and sympathetic to ourselves as we are to everyone else,” he said.
At 1:15 a.m., she left her office at the University Capital Center, a shopping mall on the edge of Smith University’s sprawling downtown campus, to attend her mindfulness session. The counseling center opens a second location here in 2017, after passing another office in an old brick building across the Iowa River, from a tanning salon and in the corner next door to Candy Nails.
He hurried through the midday darkness to the Campus Recreation and Wellness Center and climbed three flights of stairs to a yoga studio, where he landed on a mat in front.
“Do you ever feel like your thoughts are running out or all over the place?” He asked the students.
“All the time,” replied one.
Smith instructed the students to sit quietly, breathing slowly as they imagined their negative thoughts settling under the snowy earth, a practice he called “emotional blizzard.”
Such wellness workshops, known as “Mindfulness Matters” have become commonplace on college campuses, as part of an effort to help students cope with stress before it becomes serious. According to Kelly Klogger, another interim co-director of the University of Iowa University Counseling Service, the number of hours spent reaching out to students increased by 123 percent between fiscal years 2013 and 2021.
However, it is not clear if the programs are reducing the pressure on counseling centers. For some students, the handful of coping strategies need to be managed on their own. But for students with more serious concerns, outreach programs can serve as a soft entry to the counseling center, increasing demand.
Although the stigma surrounding mental health has diminished in recent years, some community therapists are skeptical, or even dismissive, and students of color are less likely to be treated than their white peers, research shows.
To reach out to students who may not be able to ask for help on their own, many colleges have begun “embedding” mentors in dormitories and academic buildings, where they can build their confidence with students.
At the University of Iowa, five counselors meet with students eight hours a day in the dormitory and professional school office. The effort has been so successful that some embedded counselors are struggling to meet demand.
“We’re in a place where it feels sustainable,” Klogger said.
After Mindfulness Matters, Smith ran to the Iowa Memorial Union, where a group of students were organizing a suicide awareness event called “Sand Silence Packing.” Backpacks with photos and heartbreaking stories of students lost in suicides across the country lined the stairs and filled the ballroom, where We Kings’ song “Just Keep Breathing” was played over loudspeakers, reminding listeners that they were not alone.
Anamaria Yerrapino, president of the Iowa chapter of Active Minds, a national student organization that sponsors travel exhibitions, said the group was “trying to change the conversation about mental health, reducing stigma.”
Yerrapino says his group is not pushing for big policy changes on campus, as some students at other schools have. But he wants to see colleges dedicate more resources to mental health.
“More mental health professionals need to be, because a lot of students need help,” he said.
In fact, many colleges have increased their enrollment in recent years. The University of Iowa roughly doubled the size of its counseling center staff between 2016 and 2019, to dozens of individuals.
But they still could not meet the demand.
“We’ve seen more students, but no one has waited less,” said Barry Schreier, a former director of the University Counseling Service who led the expansion. “We realized we couldn’t get ourselves out of trouble.”
According to recent figures from the Center for Collegiate Mental Health, counselor caseloads vary widely across universities, with between 12 and 314 clients per year, an average of 90. The caseload per University of Iowa counselor is 120.
Physicians at centers with larger caseloads need to take new cases even though they do not have the time – which is known as an exploitation model. To accommodate everyone, they often set session limits and place appointments, scheduling students on a fortnightly basis.
Centers with smaller caseloads are more apt to use a “treatment” model, employing a student counselor when a spot is open. While this may mean waiting for treatment, staff members get a more predictable schedule, and students are more likely to attend weekly therapy to get better results.
The University of Iowa tends towards an exploitation model with its embedded counselors but uses a treatment model at its main counseling center.
To reduce waiting time, the center uses a “step-by-step” approach, directing students to low-level service-support groups and workshops with less serious concerns.
However, during busy periods, the waiting time for individual therapy can be extended up to six weeks – especially if a student has a special need, such as an eating disorder or limited availability.
Although Iowa does not have a strict session cap, it does tell students that therapy will be short-lived and focused on specific goals.
“It’s not ‘let’s work on everything in your life,’ but ‘let’s prioritize,'” Davis said.
Students who want or need long-term therapy are usually referred to community-based providers, although students without private insurance are sometimes allowed to stay longer. Staff will also help students sign up for Medicaid and connect them to free clinics in the city.
This does not mean, however, that poorer students will have the same access to long-term treatment as their wealthy peers, including personal insurance, Davis said. As co-director of counseling, her job is not only to help students, but also to protect her staff – and that means maintaining boundaries.
“Access to health care is not fair in this country. That’s not right, “he said. “We’re always in conversation about how far we can go and make sure our doctors are well.”
At the University of Iowa, students without funding or transportation to attend off-campus counseling can join the Schmidt-led therapy group after the Sand Silence Packing event.
The university offered more than 5,500 hours of group therapy in FY 2019, the full year before the epidemic, four times the amount offered in FY 2009. This Thursday, in small groups of students gathered through Zoom, the focus was on managing and dealing with emotions. Smith talks about how people choose to respond to situations, reminding students of a skill he calls “my friend CARL”, an acronym for “change it”; Accept; Reframe it; Give it up. “
Next, Schmidt will lead a support group for students to find a healthy relationship with drugs and alcohol, followed by a workshop on endurance. His workday will not end until 8pm, more than 12 hours after it starts.
College counseling was never a chore, but it was less expensive than it is today. Applicant pools were large, and employers tended to stay year after year, says Schreier, who has been on the field for 30 years.
Today, some counselors are applying for jobs, and some who plan to stay forever are fleeing for personal practice, where they can work fewer hours and earn more money, he said. The University of Iowa currently has three vacancies, including a director’s job.
“It’s an underlying demand, and limited resources, and it’s starting to erode people’s sense of efficiency,” said Schreier, who quit his job in February to join the university’s newly formed Iowa Center for School Mental Health, where he focuses on staff and faculty. Mars
Schmidt, who came to the university from a community mental health center in 2019, said she has learned that it is “okay not to say certain things” in order to refuse some requests to serve on the committee or to present to the student group for hours on end. He has no plans to leave; Some days were tiring, but he didn’t burn, he said.
And so, this Thursday, she got in her car shortly after 8pm and drove for 45 minutes to her home in rural Iowa to say good night to her 2 year old baby, to give the baby the last bottle and to spread out everyone’s clothes. For the next day, she spent the night quietly and purposefully with her husband, watching the food network and sipping her last cup of tea.
If you or someone you know has suicidal thoughts, call the National Suicide Prevention Lifeline and Crisis text line at 1-800-273-talk (8255) – home text to 741741 – a free, 24-hour service that can help. Information and resources.