In a university counseling center grappling with students’ mental health crisis

Ben Locke, a psychologist who founded the Center for Collegiate Mental Health, sees this opening up of campus counseling to a much wider group of students as an unintended consequence of widespread efforts to prevent suicide and destigmatize therapy.

For the past two decades, colleges, helped by millions of dollars from the federal government and foundations, have told students to seek help that it’s “OK not to be okay,” he said. They trained teachers and colleagues to identify and refer students in need to counseling, and urged students not to suffer in silence.

Now, as a result of that well-intentioned and often helpful push, students are seeking therapy for even routine challenges, said Locke, who is now the chief clinical officer of Togetherall, an online mental health community.

Schmitt, who has been a counselor for a decade, said she’s seen a shift in cultural attitudes toward emotional well-being, with schools now teaching kids to cope with it as early as kindergarten. “My 2-year-old son comes home from school and says, ‘I’m sad. I have a great feeling. I need a break,” she said.

Schmitt said she was drawn to counseling work because she likes to “be present with people,” supporting them through highs and lows.

“I see my role as a supervisor. They do all the hard work,” she says. “I’m thrilled to be there to see that growth.”

Instructor leading mindfulness practices
Heidi Schmitt, a staff therapist at the University of Iowa, leads a weekly mindfulness workshop on campus. (Mike Rundle for the Hechinger report)

But it is not always easy to be present in her own life. She’s trying to practice self-care, going for a walk with her toddler, or hitting the elliptical after he and his little brother are in bed. But sometimes a thought or concern about a client creeps into her mind when she’s at home.

“The most challenging thing is being able to sit and be present and be as kind and compassionate to ourselves as we are to everyone else,” she said.

At 1:15 PM, Schmitt left her office at the University Capitol Center, a shopping mall on the edge of the university’s sprawling campus, on her way to her mindfulness session. The counseling center opened a second location here, around the corner from a tanning salon and next to Candy Nails, in 2017 after it outgrew its other office, an outdated brick building on the other side of the Iowa River.

She rushed through the afternoon twilight to the Campus Recreation and Wellness Center and climbed three flights of stairs to a yoga studio, where she sat on a mat in the front.

“Do you ever feel like your thoughts are speeding up or going in all directions?” she asked the students.

“Always,” replied one.

Schmitt instructed the students to sit still and breathe slowly as they visualized their negative thoughts descending on the bottom of a snow globe, an exercise she called “emotional blizzard.”

Wellness workshops like this one, called “Mindfulness Matters,” have become common on college campuses, as part of an effort to cope with student stress before it gets serious. According to Kelly Clougher, the other interim co-director of Iowa’s University Counseling Service, the University of Iowa increased the number of hours it spends outreaching to students between fiscal 2013 and fiscal 2021 by 123 percent.

However, it is not clear whether the programs will ease the pressure on counseling centers. For some students, a handful of coping strategies may be all they need on their own. But for students with more serious concerns, outreach programs can serve as soft access to the counseling center, increasing demand.

While the stigma surrounding mental health has declined in recent years, some communities remain skeptical or even dismissive of therapy, and students of color are less likely to seek treatment than their white peers, research shows.

To reach students who may not seek help on their own, many colleges have begun “embedding” counselors in dormitories and academic buildings, where they can build student confidence in their premises.

At the University of Iowa, five counselors spend eight hours a day meeting students in offices in dormitories and professional schools. The effort has been so successful that some of the embedded counselors are struggling to keep up with demand.

“We’re in a place where it feels untenable,” Clougher said.

Kelly Clougher
Kelly Clougher, one of the University of Iowa’s interim co-directors of counseling, in her office. (Mike Rundle for the Hechinger report)

After Mindfulness Matters, Schmitt rushed to the Iowa Memorial Union, where a group of college students organized a suicide awareness event called “Send Silence Packing.” Backpacks filled with photos and heartbreaking stories of students who have died by suicide across the country lined the stairs and filled the ballroom, where We the Kings’ song “Just Keep Breathing” was played through a loudspeaker, reminding listeners that they were not alone.

Annamaria Iarrapino, the chair of Iowa’s branch of Active Minds, a national student organization that sponsors the traveling exhibit, said the group “tried to change the conversation about mental health and reduce stigma.”

Iarrapino said her group is not pushing for major policy changes on campus, as some students at other schools have done. But she would like to see colleges devote more resources to mental health.

“There should be more mental health professionals because so many students need help,” she said.

In fact, many colleges have ramped up their hiring in recent years. The University of Iowa doubled the size of the counseling center’s staff, to a few dozen individuals, between about 2016 and 2019.

But they still couldn’t keep up with demand.

“We saw more students, but no one waited less,” said Barry Schreier, former director of the University Advisory Service who led the expansion. “We found out that we couldn’t rent ourselves out of the problem.”

Counselor caseloads vary widely between universities, ranging from 12 to 314 clients per year, with an average of 90, according to the latest figures from the Center for Collegiate Mental Health. The University of Iowa caseload per counselor is 120.

Centers with larger caseloads often require clinicians to take on new cases even if they don’t have time available – what’s known as an absorption model. To accommodate everyone, they often set session limits and room for appointments, scheduling students fortnightly.

Centers with smaller caseloads are more likely to use a “treatment model,” where students assign a counselor when a spot becomes available. While this may mean waiting for treatment, employees are given more predictable schedules and students are more likely to go to therapy on a weekly basis, leading to better outcomes.

The University of Iowa tends to adopt an absorption model with its embedded counselors, but uses a treatment model in its main counseling center.

To reduce wait times, the center uses a “stepped care” approach, directing students with less serious concerns to lower service levels – including support groups and workshops.

However, during busy periods, wait times for individual therapy can be up to six weeks, especially if a student has a specialized need, such as an eating disorder, or limited availability.

While Iowa does not have a strict session limit, it informs students that the therapy will be short and focused on specific goals.

“It’s not ‘Let’s work on everything in your life,’ but ‘Let’s prioritize,'” Davis said.

Holly Davis
Holly Davis, one of the University of Iowa’s interim co-directors of counseling, in her office. (Mike Rundle for the Hechinger report)

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. The staff also helps students sign up for Medicaid and connects them with free clinics in the city.

But that doesn’t mean poorer students will have the same access to long-term treatment as their wealthier peers with private insurance, Davis said. As co-director of counseling, her job is not only to help students, but also to protect her staff — and that may mean guarding boundaries.

“Access to healthcare is not fair in this country. It just isn’t,” she said. “We’re always talking about how far we can stretch and make sure our clinicians stay healthy.”

At the University of Iowa, students who do not have the financial means or transportation to attend off-campus counseling can join a therapy group like Schmitt’s after the Send Silence Packing event.

The university offered more than 5,500 hours of group therapy in fiscal 2019, the last full year before the pandemic, more than quadrupling the amount it offered in fiscal 2009. In the small group of students gathered through Zoom this Thursday, the focus was on about dealing with and dealing with emotions. Talking about how people choose to react to situations, Schmitt reminded the students of a skill she calls “My Friend CARL,” an acronym for “Change It; Accept it; reframe it; Leave it.”

Later, Schmitt would lead a support group for students seeking healthier relationships with drugs and alcohol, followed by a workshop on enduring suffering. Her workday wouldn’t end until 8pm, more than 12 hours after it started.

College counseling was never an easy job, but it used to be less time consuming than it is today. The pools of applicants were large, and the hires usually stayed in place for years, said Schreier, who has worked in the field for 30 years.

Today, few counselors apply for the jobs, and some who planned to stay forever flee to private practice, where they can work fewer hours and earn more money, he said. The University of Iowa currently has three vacancies, including that of director.

“It’s a bottomless demand and finite resources, and that’s starting to crumble on people’s sense of efficacy,” said Schreier, who left the job in February to join the newly formed Iowa Center for School Mental Health. the university, where he focuses on staff and faculty well-being.

Schmitt, who came to college from a community mental health center in 2019, said she’s learned it’s “OK to say no to some things,” some requests to serve on committees, or after-hours for student groups. present, reject. She has no plans to leave; some days are exhausting, but she didn’t burn out, she said.

And so on this Thursday, a little after 8:00 p.m., she got in her car and drove 45 minutes to her home in rural Iowa to say goodnight to her 2-year-old, give the baby one last bottle, and get all the clothes ready for the next day. She ended the evening quietly and purposefully with her husband, watching the Food Network and sipping one last cup of tea.

If you or someone you know has suicidal thoughts, the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Crisis Text Line – text HOME to 741741 – toll-free 24 hour services that can provide support, information, and resources .

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