“I’m literally fighting for my life but staying safe,” 22-year-old Christopher Biehn emailed a professor in late September. “I won’t be in class today (or perhaps for a bit) & just pray I won’t be hospitalized long-term.”
As Biehn prepared to check into a psychiatric ward four hours from campus, a crisis team from the private liberal arts college in central New York swung into action. Shortly after Biehn wrote to his professor, a campus safety officer went to his apartment to make sure he was OK. A social worker from the college reached out to discuss academic options as he worked to manage his bipolar disorder.
Two weeks later, after returning to his home in Medford, New Jersey, for treatment, he applied for a medical leave of absence from the college — his sixth leave in four years.
In extensive interviews, Biehn recounted his experiences. He has also written about them in a blog and in Ithaca College’s student paper. He started a grassroots social media campaign to promote acceptance for mood disorders, inspired to share his story in hopes of helping others.
His journey illustrates the intense struggles students can face and the increasing steps colleges are taking to manage what some experts are calling a mental health crisis on campus. (Ithaca officials said they could not discuss a student’s health records, citing federal privacy laws.)
Students and institutions are grappling with issues like the surge in school shootings and trauma from suicides and sexual assault. But it’s not just the crises that have shaken this generation — it’s the grinding, everyday stresses, from social media pressures to relationship problems to increased academic expectations.
More than 60 percent of college students said they had experienced “overwhelming anxiety” in the past year, according to a 2018 report from the American College Health Association. Over 40 percent said they felt so depressed they had difficulty functioning.
Money problems are exacerbating their worries. Mental health professionals say college students have experienced financial burdens on a different scale than many of their predecessors. They grew up during the Great Recession and have seen family members lose jobs and homes. They have great uncertainty about their career prospects and feel pressure to excel academically or risk losing job opportunities.
“There’s a much more radical feeling that you’re either a winner or a loser,” said Victor Schwartz, a psychiatrist and medical director of the Jed Foundation, which helps colleges improve their mental health programming. “That’s put tremendous pressure on college students and is feeding a lot of the anxiety we’re seeing.”
As students have encountered more mental health problems, they have sought help in record numbers. Between the fall of 2009 and spring of 2015, the number of students who visited campus counseling centers increased by more than 30 percent, while college enrollment climbed just 5 percent, according to a 2015 report by the Center for Collegiate Mental Health.
People of all ages, but young adults in particular, are increasingly comfortable sharing intimate details of their mental health conditions, right down to their dose of antidepressant. Many expect their colleges to help them cope.
“You want a college that treats you for the person you are and gives you the help you deserve,” said Katia Seitz, a 19-year-old high school senior from Houston, who has received treatment for an eating disorder. “You don’t want a college that shuts you off or feels like it’s not their responsibility to take care of you.”
Several admissions officials say they have seen a rise in inquiries regarding counseling and mental health services and accommodations from parents and prospective students.
Colleges have helped drive demand for mental health services, pouring money into education and training to help students identify problems and learn where to turn for help. But critics say many colleges have not adequately prepared for the increasing demand, leaving some students frustrated.
Nationwide, students typically have to wait almost seven business days for their first appointment with a college counselor, according to a 2017 report from the Association for University and College Counseling Center Directors. But at some colleges, it can be more than two months.
Three years ago, the counseling center at Queens College had 60 students on its waiting list (it does not require anyone experiencing a crisis to wait). Like many institutions, it began restricting the number of times students could see a counselor, from unlimited visits to 12. At the start of this semester, its waiting list was down to 30 students. But wait times can grow during peak periods.
“As we approach midterms, it feels like we’re running a crisis clinic rather than a counseling center,” said Barbara Moore, director of counseling, health and wellness. She would like to add more counselors but doesn’t have the space.
Many colleges, however, are increasing their ranks. At least 155 counseling centers added new clinical positions from July 1, 2016, to June 30, 2017, according to the report by the association for counseling center directors.
Studies show that hiring additional therapists helps keep students healthy and enrolled, which can be a good return on investment for an institution.
“If your tuition is $50,000 a year and your counseling budget is $1 million, your counseling center doesn’t have to retain that many students to make up that cost,” said Greg Eells, director of counseling and psychological services at Cornell University.
A recent independent review of Ithaca College’s student health and psychological services center, which found gaps in senior leadership and access to care, prompted the college to create a senior-level position responsible for student wellness and to make other improvements. Since 2017, the college has added two positions to both its counseling and case-management staffs.
The 2007 mass shooting at Virginia Tech, which prompted universities to change how they deal with mental health issues, led many institutions to hire case managers, or “ICare” teams, like Ithaca’s, whose jobs include helping students in distress. Just 25 people attended the inaugural meeting of the Higher Education Case Managers Association, in 2008, the group said. The association expects to have more than 900 members by the end of this year.
And although colleges have increased the size of their counseling staffs, many campuses are still straining to keep up, forcing some institutions to rethink their treatment strategies.
Daniel Eisenberg, a University of Michigan professor, said many colleges were also intrigued with the idea of online treatment but were skeptical of its merits.
“One of the best parts of campuses is that we have this in-person community where we can support students, so why start doing things online? It’s a debate or question that’s hanging over higher education,” said Eisenberg, who is helping to lead a large study to better understand the effectiveness of online treatment.
Traumatic incidents have helped other institutions revamp their intake processes. A 2010 shooting at the University of Texas led its counseling center to develop a crisis-response system now used to assess all students seeking mental health treatment. The university’s “brief assessment and referral team,” or BART, aims to identify students’ problems quickly and direct them to the right service.
UT refers many students to one of the 30 to 40 counseling groups it administers each semester. Among other things, the groups have helped survivors of sexual assault and students exploring different identities. The forums show students they are not alone, which can be a powerful message. They also help reduce the load on university counselors.
“We would love to provide all the resources to all the students,” said Christopher Brownson, associate vice president for student affairs and director of the university’s counseling and mental health center. “But the answer to all social and emotional problems in the world cannot be to go see your therapist.”
Other institutions have found success with modified counseling sessions. Penn State University has set up a half-dozen drop-in clinics at places like residence halls and student unions where students can consult a licensed therapist without having to make an appointment.
“You drop in, get your answer and go on your way,” said Ben Locke, senior director for counseling and psychological services. “It fundamentally changes the interaction.”
Dozens of universities have placed therapists around their campuses, making it easier for students to find help in a convenient location. The University of Michigan has 12 “embedded” counselors, including psychologists and social workers, in its schools of engineering, dentistry and pharmacy. Other schools have placed full-time counselors in the athletic department, where they help players recover from head injuries or overcome mental performance blocks.
The University of South Florida has gathered data on the students who seek mental health counseling at its main campus, in Tampa. It has found that about a quarter of them don’t need a therapist. They often just need better time-management or anxiety-reducing skills, said Rita DeBate, associate vice president for health and wellness.
To help address those issues, the university created “relaxation stations” that include massage chairs, bean bags and nap pods — chairs that cost more than $10,000 each and have quickly become the most sought-after seats on campus.
“We’d love it if we had a lazy river,” DeBate says, referring to the ultimate student amenity. But once students sink into one of those chairs, letting the white noise settle over them, it’s almost as nice, she says.
Biehn, the Ithaca College student, has not found many relaxing moments since applying for his sixth medical leave last fall. The former high school class president, who was on a full academic scholarship at Ithaca, has tried dozens of medicines, but nothing seems to work. He hopes to finish his degree someday, but he has no plans to return to the college.
Late last month, after sounding hopeful on a phone call with a reporter, he slipped into a dark place, returning to the psychiatric ward for another week. At his lowest moments, he said, he lies in bed, feeling numb.
“I’m basically dead to the world,” he said, “even though there’s just enough breathing going on to call me alive.”
This article originally appeared in The New York Times.