Look around a waiting room at a university counseling center and you'll see students wrestling with all sorts of issues: The one who's failing because of binge drinking. Another who's struggling with a roommate conflict, or a recent break-up. Yet another who's stressed out and suicidal.
Many centers are more swamped than ever, college therapists say, particularly at this time of year, in the frenzy of final exams and job searches.
Though there's debate about why there are more students seeking services, there is agreement on this: The increase in demand, those therapists say, has made it even more crucial to zero in on the students who are in the most distress.
"We used to worry about there being a stigma about coming in for counseling," says Ian Birky, director of counseling and psychological services at Lehigh University in Pennsylvania. Now, he says, they're "overwhelmed" with students seeking help.
To help deal with the demand, more campus counseling centers are using computerized questionnaires, some that generate color-coded charts, to help them flag a serious problem more quickly than traditional paper-and-pencil evaluations.
Though they stress that these evaluations are not a replacement for in-depth questioning or counseling, many counselors say high-tech methods like these appeal to students, who are often more comfortable communicating with smart phones, iPads and laptops.
These therapists say these screenings also help them do their jobs better, and fine-tune therapy.
One of them is Paul Toth, a staff psychologist at Indiana University, where therapists began using a computerized evaluation called the Behavioral Health Measure, or BHM, in November. He recalls one student whose depression scores were improving but whose overall well-being scores were not. Staffers then determined that, to truly get better, the student needed to deal with academic issues that had been caused by the depression.
Evaluations like these also shed light on topics that students may not verbalize in therapy, such as a lack of trust, or bonding, with their therapist. In some cases, Toth says he's found out that a few students haven't liked it when he's suggested trying antidepressants with therapy.
"So then I can back off on that," he says.
Perhaps most importantly, therapists say these instant evaluations show them more quickly when a student is seriously considering suicide.
"I can look at that on my computer before the student even walks into my office," says Birky, whose new clients sit at private computer kiosks in the counseling center waiting room to take a different evaluation called the Counseling Center Assessment of Psychological Symptoms, or CCAPS.
CCAPS, which has versions with 34 and 62 questions, is used on dozens of campuses across the country, including Penn State, where researchers used national CCAPS data to generate an annual study on the mental health of students on campuses across the nation.
Among other things, the research found that about a quarter of U.S. college students sought mental health services last year.
"So as demand increases, you have to be more objective about deciding who's in the greatest need," says Ben Locke, the study's lead author and the associate director of research and technology at Penn State's Center for Counseling and Psychological.
Technology makes for better evaluations
The newer BHM was developed by Mark Kopta, a psychology professor at the University of Evansville in Indiana. So far, it is used on just 15 campuses, from the University of Minnesota and Johns Hopkins to tiny Fairmont State University in West Virginia.
But those who use it say it has some advantages over more established evaluations.
For one, it has a 20-question version that takes two minutes or less to complete, so it can be used more easily at every counseling session.
"It doesn't take the place of an interview, but it makes the interview much more efficient," says Kopta, head of CelestHealth Systems, which markets the BHM questionnaires with a package other tools that evaluate such things as the bond between counselor and client.
Factors students are asked to rate in the BHM include:
- "Alcohol or drug use interfering with your performance at school or work."
- "Thoughts of ending your life."
- "Powerful, intense mood swings or highs and lows."
Results from that evaluation also are divided by categories, including suicide risk, depression, anxiety and drug and alcohol abuse. Each category is color-coded — green for normal, yellow for mild distress, orange for moderate distress and red for severe distress.
Glenn Hirsch, head of counseling services at the University of Minnesota, recalls one student whose suicide chart was flagged with red, but who initially denied she was severely suicidal.
Her scores also indicated that she was mistrustful of Hirsch and the counseling process, so he used those scores — and showed her her charts at each session — to get her to open up and deal with her suicidal thoughts.
"Showing that visually can really make a difference," he says.
After initially dropping out of school, he says the student client returned to the university and passed all her classes. She also has regularly taken her medication, something she hadn't done before.
There are other ways mental health professionals are using technology to help them evaluate clients, on and off college campuses.
A psychiatrist at Johns Hopkins has developed a free service called Mood 24/7 that sends a daily text message to its users, asking them to rate their mood on a scale of 1 to 10. The data can then be accessed by the user, their mental health counselor and even family and friends.
Dr. Adam Kaplin, who came up with the idea, says that typically clients are unlikely to remember how they were feeling between visits, or to use paper and pencil charts to keep track.
"It's very simple. But there is power in simplicity," Kaplin says of the system, which now has about 3,000 users, from college students to older clients. Among other things, he says the system helps psychiatrists do a better job of monitoring and adjusting psychotropic medications.
Outreach to depressed students still needed
All of these methods are fine for those who seek help. But there's also concern that the large majority of suicidal and depressed students still don't seek counseling and, therefore never are evaluated.
"I've talked to graduating seniors who literally didn't know that the mental health counseling center existed," says 23-year-old Jeff Brozena, president and founder of Penn State's chapter of Active Minds, an organization aimed at raising students' awareness about mental health.
His chapter is one of a few that hosted a traveling exhibit called "Send Silence Packing," made up of 1,100 backpacks representing the estimated number of college students who take their own lives each year.
Counseling centers also have expanded outreach.
At Pace University in New York, counseling director Richard Shadick and his staff give a presentation at each "University 101" class for freshman and give them a survey to help them get a read on substance abuse and mental health problems they may be having. The mental health staff also spends time on campus giving mini screenings called "checkups from the neck up" and refers students who need help to the counseling center.
Elsewhere, the National College Depression Partnership has been working with campus health centers across the country to do their own quick mental health screenings when students come in for regular visits with the doctor.
Within the counseling field, there is no consensus about whether there really are more college students with mental health issues or whether they are simply increasingly willing to ask for help.
Some say that antidepressants and more support has made it more possible than ever for a student who is mentally ill to attend college. Others have noted that this generation of students seems less able to cope with stress, for whatever reason.
"Maybe, in some ways, these kids are a little bit less resilient," says Birky, at Lehigh.
Whatever the reason, it's an issue that's being taken seriously.
A recent analysis of BHM questionnaires from 13,300 students who were treated at campus counseling centers found that those students were, indeed, having significant psychological problems. Just over two-thirds were clinically depressed at some level. Seventeen percent had drug and alcohol problems. About 20 percent were suicidal.
And those figures do not include the students who have yet to seek help.