Not long after Nelly Spigner arrived at the University of Richmond (USA) in 2014 as a Division 1 football player and aspiring surgeon, college began to feel like a pressure cooker. Overwhelmed by her busy football schedule and heavy course load, she also found herself suffering from anxiety over how each grade would bring her closer to medical school.
At first, Spigner hesitated to seek help at the university’s counselling centre, which was conspicuously located in the psychology building, separate from the health centre. “No one wanted to be seen going up to that office,” she says.
But she began to experience intense mood swings. At times, she found herself crying uncontrollably, unable to leave her room, only to feel normal again in 30 minutes. She started skipping classes and meals, avoiding friends and professors, and holing up in her dorm.
In the spring of her freshman year, she saw a psychiatrist on campus, who diagnosed her with bipolar disorder, and her symptoms worsened. The football team wouldn’t allow her to play after she missed too many practices, so she left the team. In October of her sophomore year, she withdrew from school on medical leave, feeling defeated.
Spigner is one of a rapidly growing number of college students seeking mental health treatment on campuses facing an unprecedented demand for counselling services.
Between 2009 and 2015, the number of students visiting counselling centres in American colleges increased by about 30% on average, while enrolment grew by less than 6%, the Centre for Collegiate Mental Health found in a 2015 report.
Students seeking help are increasingly likely to have attempted suicide or engaged in self-harm, the centre found. In spring 2017, nearly 40% of college students said they had felt so depressed in the prior year that it was difficult for them to function, and 61% of students said they had “felt overwhelming anxiety” in the same time period, according to an American College Health Association survey of more than 63,000 students at 92 schools.
As midterms begin in March, students’ workload intensifies, the wait time for treatment at counselling centres grows longer, and students who are still struggling to adjust to college consider not returning after the spring or summer breaks. To prevent students from burning out and dropping out, colleges across the country are experimenting with new measures.
For the first time last fall, UCLA offered all incoming students a free online screening for depression. More than 2,700 students have opted in, and counsellors have followed up with more than 250 who were identified as being at risk for severe depression, exhibiting manic behaviour or having suicidal thoughts.
Virginia Tech University has opened several satellite counselling clinics to reach students where they already spend time, stationing one above a local Starbucks and embedding others in the athletic department and graduate student centre.
Ohio State University added a dozen mental health clinicians during the 2016-17 academic year and has also launched a counselling mobile app that allows students to make an appointment, access breathing exercises, listen to a playlist designed to cheer them up, and contact the clinic in case of an emergency.
Pennsylvania State University allocated roughly $700,000 in additional funding for counselling and psychological services in 2017, citing a “dramatic increase” in the demand for care over the past 10 years. And student government leaders at several schools have enacted new student fees that direct more funding to counselling centres.
But most counselling centres are working with limited resources. The average university has one professional counsellor for every 1,737 students — fewer than the minimum of one therapist for every 1,000 to 1,500 students recommended by the International Association of Counselling Services.
Some counsellors say they are experiencing “battle fatigue” and are overwhelmed by the increase in students asking for help. “It’s a very different job than it was 10 years ago,” says Lisa Adams Somerlot, president of the American College Counselling Association and director of counselling at the University of West Georgia.
As colleges scramble to meet this demand, off-campus clinics are developing innovative, if expensive, treatment programs that offer a personalised support system and teach students to prioritise mental wellbeing in high-pressure academic settings.
Dozens of programs now specialise in preparing high school students for college and college students for adulthood, pairing mental health treatment with life skills classes — offering a hint at the treatments that could be used on campus in the future.
When Spigner took a medical leave from the University of Richmond, she enrolled in College Re-Entry, a 14-week program in New York that costs $10,000 and aims to provide a bridge back to college for students who have withdrawn due to mental health issues. She learned note-taking and time management skills in between classes on healthy cooking and fitness, as well as sessions of yoga and meditation.
Back at the University of Richmond for her senior year, Spigner says the attitude toward mental health on campus seems to have changed dramatically since she was a freshman. Back then, she knew no one else in therapy, but most of her friends now regularly visit the counselling centre. “It’s not weird to hear someone say, ‘I’m going to a counselling appointment,’ anymore,” she says.
She attended an open mic event on Richmond’s campus earlier this semester, where students publicly shared stories and advice about their struggles with mental health. Spigner, who meets weekly with a counselor on campus, has become a resource to many of her friends because she openly discusses her own mental health, encouraging others not to be ashamed to get help.