Since many American college students today are experiencing mental illness, and especially of considerable severity (see story above), what kind of help is available to them?

Most colleges have counseling services. Some are freestanding, while others are located within colleges’ medical departments.

Colleges are also increasingly recognizing that sustaining good mental health is critical to students’ academic success and thus are improving their counseling centers.

For example, as Richard Kadison, M.D., chief of the Mental Health Service at Harvard University’s Health Services, told Psychiatric News: "The provost at Harvard increased our staffing a year ago pretty dramatically. We now have a staff of 14."

Staff in college counseling centers are likewise working hard to help those students with mental health problems. "We are making huge efforts to educate students about symptoms of depression," Kadison pointed out. "You know, the lifetime incidence of depression is 20 percent, and the peak age of onset is around college age. So many students have their first incidence of depression while in college, and they are completely surprised by it. They think that it is just that they have become lazy or that they have a sleep problem."

College mental health professionals are also looking for new ways to do the job better. And one of the ways is through outreach efforts.

Five or six years ago, for instance, Dartmouth College’s counseling center was primarily a clinical service with some outreach on the side. Today it is doing much more outreach.

"We have staff liaisons with each residence hall and do a number of programs each week for students, staff, and faculty groups," said Mark Reed, M.D., director of counseling and human development at Dartmouth’s College Health Service. "We also invite representatives from different groups on campus to come to our staff meetings, or we visit them to discuss the quality of service we are providing and how we can do a better job and be more welcoming."

Another college where mental health outreach is being heavily extended is Colgate University. The counseling staff has formed a group called "Men Advocating Change," which goes into fraternities and residence halls to address male-only audiences in hopes of reducing rape on campus. The staff has also connected with certain student groups—say, one providing emotional support for victims of rape—as a means of reaching students in need of help.

In 2001 Colgate’s counseling center treated 13 percent of the student population—the largest ever in its history. One of the reasons, Mark Thompson, Ph.D., director of the center, told Psychiatric News, is undoubtedly because of its outreach efforts. "I think students are more aware of our service than has been the case previously," he said.

Another college stepping up its outreach efforts is Boston University. Incoming freshmen view an attention-grabbing multimedia show about mental health issues that they may encounter in college. It was designed by some of the more creative members of Boston University’s counseling staff, Leah Fygetakis, Ph.D., director of counseling at the university, said in an interview.

Yet even with college mental health professionals’ vigorous efforts and creativity, there is still a great need for more mental health services on campuses.

"We are very fortunate that Colgate has been very supportive of our counseling service," Thompson said. "We have five full-time professionals on a campus of 2,800. So that ratio is incredibly good. . . .But even with that wonderful ratio, we certainly do find ourselves under the gun with demands."

"It is a challenge to find a balance between clinical work and outreach; it is a bit of a Catch-22," Reed said. "Most college counseling centers are very busy clinically, so any time for outreach takes away from possible clinical work, and if you do outreach, it usually creates more clinical work. On the other hand, if you don’t do outreach, you see only those people who are comfortable with your services or those who have drawn attention to themselves in a public way."

Also, there is a pressing need for more psychiatrists on campuses, especially in view of the increase in the severity of mental illness on campuses during the past three to five years.

"Many colleges don’t have any psychiatric coverage," Reed explained, "and when they do, they may contract out for a few hours a week, which can make it difficult to get ongoing care for their students with significant needs."

"A big problem with many schools," Kadison said, "is that they don’t want to get into the business of psychiatry and medication management."

Still another obstacle to college students getting the mental health help that they need is, not surprisingly, money. At some colleges, such as Dartmouth, short-term counseling, medication consultations, on-call coverage, and infirmary services are available to students at no additional cost since the college’s health service is supported through a health fee included in tuition. At other colleges, however, such as the University of Minnesota, students must either have health insurance that covers mental health or pay for mental health visits themselves. In fact, in the opinion of Morton Silverman, M.D., director of student mental health at the University of Chicago, one of the most pressing needs regarding college students’ mental health care is "to ensure that health insurance coverage has adequate mental health benefits so that students can seek long-term treatment if needed."

So all in all, it looks as if college students’ need for mental health services far outstrips available resources. Or as Reed put it, "College mental health is one area that is really underserved." ▪