Students Struggle but Don’t Seek Colleges’ Help

For many students, spending the year with COVID has felt like being on a sinking ship, desperately searching for a lifeboat and perhaps choosing one that falters when lowered.

Campus counseling centers and their staffs, meanwhile, have been like the band on the Titanic’s deck, continuing to comfort others even as their own lives are at stake. That’s how a friend of Barry Schreier, the communications chair for the Association for University and College Counseling Center Directors (AUCCCD), describes their pandemic position. “All the things students are going through, staff is going through,” says Schreier, who is also director of the University Counseling Service at the University of Iowa. “It’s been a harder lift for a lot of folks this year.”

As students struggle, they may hear about counseling center supports but not take further action.

Campus efforts were strong. Even counseling centers with tight budgets quickly pivoted to virtual operations last spring. Many created student guides to mental wellness while at home, asynchronous content such as video series and workshops, and support groups, says Schreier.

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However, the latest Student Voice survey, conducted by Inside Higher Ed and College Pulse and presented by Kaplan, indicates that a year into the pandemic:

• 65 percent of students report having fair or poor mental health.
• 63 percent of those who say it’s poor would grade their college’s response to student mental health and wellness services a C or lower (compared to 43 percent of all students).
• 47 percent say they could have used some (28 percent) or a lot (19 percent) more support from their college during this time.
• Only 15 percent engaged in college-offered counseling in the past year.

“This should be a wake-up call. Even if it feels like we are starting to move back into a normal phase, students are still suffering,” says Lisa Sontag-Padilla, a behavioral and social scientist at the nonprofit RAND Corporation who has written on helping college students manage COVID’s mental health impacts.

The Student Voice survey, fielded from March 15 to March 25, collected responses from 2,002 students at 116 higher ed institutions (250 from two-year colleges, the rest at four-year colleges and universities) and asked about frequency of feeling anxious, worried or scared about life in the past six months. More than half of respondents reported worrying “constantly” (18 percent) or “often” (35 percent), with nonbinary and female-identifying students most likely to feel constant worries (35 percent and 23 percent, respectively).

Other research has explored sources of stress. For example, in interviews conducted for the Applied Cognitive Ergonomics Laboratory at Texas A&M University, “academic was the top anxiety,” says postdoctoral researcher Xiaomei Wang.

Three out of four students recently surveyed by student telehealth provider TimelyMD said COVID’s impact on the quality of their education has worsened their mental health.

One Student Voice survey respondent says the focus on mental health is all talk. “No one actively reaches out and makes sure students are doing OK, and no one takes action to address the root causes of the issues. No matter how anxious or depressed you are, that paper’s still due on Friday.”

Respondents, 46 percent of whom are currently taking all online courses from home, report greater mental health needs if they fall into certain at-risk groups. Forty-three percent of those identifying as nonbinary in gender, for example, say their mental health has decreased a lot since COVID (versus 32 percent of all respondents). The good news? These students were three times more likely than the full sample to have recently used college counseling.

LGBTQ+ students have felt particularly isolated during COVID, says Josh Altman, associate director of the Student Counseling Center at Adelphi University in New York. “Many had found community on campus, a source of nurturing. Some had to go back into homes where family may not accept their identity and where they had to, so to speak, go back into the closet.”

Other groups seeking campus counseling more than other students are the one in four who had accessed mental health counseling and the one in five who had been prescribed medications for mental or emotional health before college. These students were about twice as likely to use services.

Lingering stigmas may contribute to the small percentages of students who took advantage of mental health counseling this year.

“We’ve spent the last 20 years trying to reduce stigma, increase help seeking and train communities of people about mental health and to not be fearful about admitting you may be having a mental health problem,” says Ben Locke, founder and executive director of the Center for Collegiate Mental Health (CCMH), a network of over 650 counseling centers.

To Laura Horne, chief program officer at Active Minds -- which supports mental health awareness and education for young adults and has a presence on more than 800 college campuses -- stigma has eased significantly. “Students are sharing that they’ve called a telehealth number or started seeing a therapist. We’ve had tremendous progress toward [students realizing they] can’t just muscle through it on their own.”

Students in Wang’s interviews “know they’re depressed and know counseling might help, but they just don’t want to get it. Or they’re suspicious about whether it would be helpful,” she says. Back when she was a stressed student and friends suggested she connect with the counseling center, Wang was offered one 15-minute session monthly. She turned to a support group instead.

Locke, also senior director of Counseling and Psychological Services at Pennsylvania State University, says colleges have “extended themselves to pretty incredible lengths to provide support,” but that services must continue to be refined and improved.

Of the small number (8 percent) of Student Voice survey respondents identifying their mental health as excellent, men were three times more likely to use that rating than women (of note, twice as many women as men took the survey).

TimelyMD research found that women are four times more likely to seek mental health support than men. “We could use some better understanding toward marketing services to males,” says Dr. Alan Dennington, the company’s chief medical officer. Men may be more willing to engage in self-care in other ways, such as through health coaching.

Haiden Smith, who heads up the Student Government Association’s mental health committee at Indiana-based Rose-Hulman Institute of Technology, says, “No one wants to admit they’re doing poorly. We’re approaching that era where people can speak up, but we’re not quite there yet.”

Smith, a junior electrical engineering major, wants to help his institution with mental health to limit peers’ negative experiences with finding and using supports. “Mental health is personally something I’ve struggled with myself -- where I am, who I want to be, where I’m going,” he says.

Greater awareness around why students struggle may help in planning effective outreach and programming. An Active Minds student focus group revealed that students may see counseling as only for those in crisis. “They think, ‘Everybody is struggling. Life is terrible right now. What makes my problem big enough?’” explains Horne. Counseling centers could communicate about how no problem is too small to seek help.

Dennington thinks it’s time for colleges to “double down” in making sure students feel connected. That can mean increasing clinic hours, adding more telecounseling and ensuring emergency care is in place. “When do you have a mental health crisis? It’s not Tuesdays at 2 p.m.,” he says, adding that 45 percent of TimelyMD telecounseling sessions are “after-hour visits.”

Following are 12 ideas for improving mental health services and supports now and post-pandemic.

1. Critique how assistance information is shared.

Only 14 percent of Student Voice survey respondents who had made a college counseling appointment during COVID-19 found it somewhat or very difficult to find out how to do so. But among those rating their college a D or an F on mental health, more than one-third found it difficult. Could the process be explained more clearly or concisely?

One survey respondent got conflicting advice from faculty members about “who to talk to, sending me in a circle.” Also, a friend in crisis couldn’t reach the counseling department because its website did not make it clear they were only responding to emails. Another respondent expressed frustration that counseling request forms could only be submitted between 8 a.m. and 4 p.m.

2. Offer private counseling spaces.

Students with no privacy at home or within a residence hall may avoid telecounseling, so some institutions have set up private spaces. At Adelphi University, which has about 8,000 full- and part-time undergraduate and graduate students, rooms within the counseling center serve this need, says Altman. The University of Iowa, with nearly 32,000 total enrollment, meanwhile, built an inventory of about 150 rooms across campus that can be reserved for virtual counseling or other private meetings. Users are asked to clean surfaces upon entry.

3. Provide immediate help options.

About one-quarter of survey respondents experienced no wait for a counseling appointment, but 10 percent waited between two weeks and a month. Nearly all centers advertise a crisis hotline, and telehealth providers may offer on-demand support. The important thing, says Sontag-Padilla from RAND, is that “you don’t just say there’s a wait list. You give them an alternative.”

Erik Hayes, vice president for student affairs and dean of students at Rose-Hulman, says limited resources prevent more proactive outreach. “We provide top-notch education, but here we are with mental health, not meeting those needs,” he says, noting that a three-week wait for care with a broken finger would never be acceptable. Smith and his peers have been talking with officials about getting a night shift counselor. And newly awarded grant funds will expand services.

4. Examine prioritization processes.

The rate of students receiving mental health treatment before college has increased annually for the past decade, says Locke. This question is being asked widely: “If more people are accessing mental health care through health benefits, should it become the college’s responsibility once they land there?” Where demand outweighs supply, center leaders must prioritize access. Should appointments go to those with precollege needs or to newly struggling students?

CCMH’s Clinical Load Index comparing counseling center staffing levels can be used to help optimize resource distribution.

5. Be transparent about care models.

Most campuses post a scope of services statement online, explaining a center’s mission for supporting mental health, but students may not know or understand its impact, says Schreier of AUCCCD. “Some centers want lots of individual client care; others want [to offer] quick access with immediate response.”

Messaging must match the model, says Locke. An institution with funding only for crisis care and referral services shouldn’t be telling incoming students, “Welcome to University of Unlimited Counseling Any Time You Want It!” he adds. Better would be something along the lines of “Welcome to the University of Limited Resources. We’re able to provide most students with short-term counseling.”

At Adelphi, a care coordinator uses a "step-care model," meeting with each student in need to determine treatment interventions, such as a stress management session, a workshop or individual counseling. “We had adopted this model before COVID so students could have an expedited experience,” Altman says.

6. Consider screening tools.

Horne, who has seen colleges mandating mental health screenings for college freshmen, says success relies on resources being available to those who screen positive.

One tool is the American Foundation for Suicide Prevention’s Interactive Screening Program, involving a stress and depression questionnaire. Even when a campus counselor responds with suggestions and encouragement, students can remain anonymous.

Colleges could ask students if they want to connect with particular services, provided any information disclosed is utilized in a HIPAA-compliant way, says Dennington. Or students could be asked about medical needs the college should be aware of, Hayes suggests.

Some institutions encourage students to use an app for wellness self-checks. Wang’s lab is developing one to monitor mental health plus direct students to counseling or resources.

7. Engage with all, not just the help seekers.

Multiple surveys have revealed how stressed college students are these days. “Students have different struggles, but everyone is definitely struggling,” says Smith.

Assuming all students need support could help prevent challenges from escalating. “Even before the pandemic, experts had really been pushing for colleges to think about mental health proactively,” Horne says.

“Convey the idea that human stress is normal, rather than pathological,” advises Locke. Or, Dennington says, remind students that “mental health is not just about therapy, it’s about wellness.”

Schreier has observed some campuses implementing public health-level responses during COVID -- such as via mental health webinars suitable for students and their families.

Counseling centers can also train groups in grit. Altman created a “Road to Resilience” workshop that has been offered via classes and to athletic teams. “Challenge is inevitable, curveballs are going to happen in life and there are evidence-based skills that can be developed to help in difficult situations,” he says.

8. Incorporate peer training and support groups.

Peer-to-peer programming, such as through Active Minds chapters, is another way to help students, who turn to each other when they’re stressed. But students need training on having more productive conversations with peers, says Smith. “Best buddies don’t always give the best advice.”

Support groups also help counseling centers increase reach. West Virginia University, for example, started a group for students isolated due to COVID-19. “When I had COVID back in January, I received at least three emails saying, ‘We’re hosting these group therapy sessions if you want to talk or listen,’” says Amaya Jernigan, the Student Government Association president-elect. She ultimately did not join the group. But the approach was proactive, adds Jernigan, who begins her term on April 18 and plans to prioritize mental health.

9. Get student input.

Even colleges with the best intentions and solid mental health investments often misstep here, says Horne. “We don’t see students as whole people who are adults, with skills and strengths. As stakeholders we often think of them as children. We’re acting on them rather than acting with them as partners.”

Jernigan believes “a lot of marks are missed because students are left out of conversations.” Students may be eating, sleeping, studying and working out from their rooms on campus, so they are eager to participate in the right wellness activities. “Everything we do is in one box,” she says.

One Student Voice survey respondent urges administrators to imagine the monotonous life of students right now. “Improving student mental health is done through so much more than canceling a lecture, extending a deadline and emailing us about yoga. It’s done through making us excited to wake up and do it all again.”

Jernigan appreciates that West Virginia’s counselors leave their offices to meet students. Chatting with a therapist during an event “takes away the awkwardness,” she says.

The Rose-Hulman SGA mental health committee has helped advertise counseling services by distributing Silly Putty with the center’s logo, says Hayes. Students have also been working with officials on finding space for a campus dog park for emotional support animals living with students. Having the formal connection with administration, Smith says, has “tied together communication lines really well.”

Presidents, says Sontag-Padilla, must go beyond using a mental health catchphrase in an email once a semester, but rather provide opportunities for students to constructively voice concerns and experiences.

Horne advocates for presidents reporting back to students on strategy and actions.

10. Diversify the counseling workforce.

One popular conversation in mental health circles, on and off campuses, is counselor diversity. A lack of it could account for why some students avoid pursuing support or don’t connect with counselors. “Students want somebody who looks like them and understands them to be there to support them in their hardest times,” says Sontag-Padilla.

Jernigan wrote legislation at WVU that resulted in the hiring of a Black, Indigenous and people of color counseling specialist and should increase team diversity further. “If I wanted to go seek help, no one would understand the experience of being a Black woman on the campus. That’s unacceptable,” Jernigan says. She hopes to see other new staff who specialize in supporting groups such as international students and transfers.

One survey respondent says, “The best thing my college has done in response to the pandemic was to bring an Asian American counselor to the wellness center team.”

Diversity efforts can also extend to private providers. At the University of Iowa, case managers can connect students with a good-fit therapist rather than just provide any name, says Schreier. “We know the mental health practitioners around town. We are conscious about who of color is available, and who is within walking distance.”

11. Partner for more resources.

Besides telehealth providers, counseling centers can partner with local therapists or even centers at other colleges.

Rose-Hulman is sharing $8 million in Lilly Endowment funding with DePauw University and Saint Mary-of-the-Woods College to expand student mental health services via the MINDful College Connections nonprofit consortium. Shared services offer opportunities for colleges with limited resources to provide what they could not afford individually, says Hayes.

Within six months, the collaboration should have a DePauw-based director to hire staff who will eventually split their time between campuses. Hayes looks forward to having a full-time psychiatrist available to students. In the past, the wait to see an outside psychiatrist with a referral might be two months.

 Along with enhancing treatment effectiveness, the grant will allow the three institutions to focus more on prevention. Within five years, the effort could expand, with other colleges paying to join the consortium, says Hayes.

12. Don’t ease up post-pandemic.

As most professionals recognize, pandemic-related trauma won’t disappear by fall, even if the virus is no longer a major threat.

During Horne’s college years in New Orleans, Hurricane Katrina forced a temporary transfer. She recalls two hard transitions -- first, when she realized she couldn’t go back to campus, and second, when she finally could. “I looked forward to getting back, but it was still an adjustment, and it was hard. It remains to be seen what [today’s] students are going to need when things go back to ‘normal.’”

Some will prefer virtual counseling -- and one COVID silver lining is that centers have determined how to execute it, says Locke. He cautions, however, that using rule-out criteria, telecounseling may only be inappropriate for 30 to 60 percent of students.

This year has taught mental health professionals that a little flexibility, such as meeting a client outside, goes a long way, says Altman. He expects to see radical flexibility from institutions and students, including a “spirit of open-mindedness about how things should be and could be.”

Sontag-Padilla anticipates anxiety remaining. Administrators need to ask themselves, “What has the pandemic shown us about our mental health needs and how can we be more creative in providing support?” she says. “There’s no easy fix. This is not a problem that’s going away when the pandemic subsides.”