As more students seek mental health care, Boise State and other colleges try to keep up
There are seven counselors at Boise State University. With help from trainees and part-time clinicians, those counselors give mental health care to hundreds of people a year.
The demand for their services has grown — from 3,861 appointments in fiscal year 2015 to 5,321 in fiscal 2019.
Why? A few reasons, says Matt Niece, the director of counseling services at Boise State.
“More students are making their way onto campus with serious and persistent mental illness,” he said. “So they’ve learned coping skills earlier on, been put on medication earlier. ... But a student may come to campus and maybe not adhere to that treatment plan or regimen.”
Students might be removed from their support network for the first time, “trying to go it alone,” Niece said.
But a major factor, both in Boise and elsewhere, is the increased openness to getting treatment.
More college students are turning to their schools for help with anxiety, depression and other mental health problems, an Associated Press review of more than three dozen public universities found. And many must wait weeks for treatment or find help elsewhere as campus clinics struggle to meet demand.
Boise State’s wait time for counseling is two to five weeks, depending on the time of year. Patients in crisis are seen immediately, Niece said.
On some campuses, the number of students seeking treatment has nearly doubled over the past five years, while overall enrollment has remained relatively flat. The increase has been tied to reduced stigma around mental health, along with rising rates of depression and other disorders. Universities have expanded their mental health clinics, but the growth is often slow, and demand keeps surging.
‘It’s an incredible struggle’
Long waits have provoked protests at schools from Maryland to California, in some cases following student suicides. Meanwhile, campus counseling centers grapple with low morale and high burnout as staff members face increasingly heavy workloads.
“It’s an incredible struggle, to be honest,” said Jamie Davidson, associate vice president for student wellness at UNLV, which has 11 licensed counselors for 30,000 students. “It’s stressful on our staff and our resources. We’ve increased it, but you’re never going to talk to anyone in the mental health field who tells you we have sufficient resources.”
The Associated Press requested five years of data from the largest public university in each state. A total of 39 provided annual statistics from their counseling clinics or health centers. The remaining 11 said they did not have complete records or had not provided records five months after they were requested.
The data show that most universities are working to scale up their services, but many are far outpaced by demand.
Since 2014, the number of students receiving mental health treatment — at the 39 schools whose data the AP analyzed — has grown by 35%, while total enrollment grew just 5%.
Boise State’s counseling center is unique, from its broad client base to its funding source. The counseling center is part of what Niece calls “kind of a one-stop shop for health care” that includes medical, psychiatry and wellness clinics.
About 40% of the medical visits involve mental health issues, Niece said.
“It’s not just counseling that’s doing the lift when it comes to mental health concerns,” he said.
Unlike at other schools, Boise State’s counseling center sees not only students, but also faculty, staff and family members of all those groups. And its funding model is different, Niece said. The health center receives appropriations from the Legislature and payments from health insurance.
“We rely on billing (insurance) in order to keep our doors open, where other counseling centers are funded by student fees,” he said. “But we never turn anybody away based on their ability to pay.”
Not enough counselors ‘by a long shot’
An industry accrediting group suggests a minimum of one counselor per 1,500 students, but few of the 39 universities the AP reviewed met that benchmark.
“We’re not at that” ratio, Niece said. “Not by a long shot.”
Boise State had one counselor for roughly every 3,400 students last year. That doesn’t count the staff, faculty and dependents served by the university’s counseling center.
The center recently got approval to add an eighth counselor, funded by the university, Niece said.
It couldn’t have come at a better time. Last month, crisis counseling was up 89%, scheduled appointments were up 57% and group counseling was up 60% from last October.
One patient interviewed by the Statesman said he sought mental health care on campus about a year ago. A graduate international student who asked not to be named, he noticed that he was struggling to cope with the demands of a rigorous academic program. He couldn’t focus on his studies. He couldn’t manage his stress. He wasn’t sleeping normally.
“I was getting more and more frustrated ... and that sort of put me in a position where seeking counseling would help me understand how to manage my stresses better,” said the student.
He still goes to the center for individual counseling and group therapy, he said, learning skills to manage stress.
What happens in a crisis?
When Ashtyn Aure checked in at the mental health clinic at Utah Valley University last year, she was suffering anxiety attacks and had not slept for days. Her mind kept returning to past traumas. When she asked to see a counselor, a staff member told her the wait list stretched for months. She left without getting help.
“I was so obviously distressed, and that was the place I was supposed to go. What do you do after that? Do you go to the hospital? Do you phone a friend?” said Aure, 25, who graduated this year.
Ultimately, she turned to her church, which helped her find therapy at an outside clinic. “If it wasn’t for that,” she said, “I don’t know.”
Officials at Utah Valley said they are working to avoid such cases. If staff know a student is in crisis, they said, a counselor can see that person in a matter of minutes. But staff members have only a few moments to make an assessment.
“Unfortunately, stories like this are not that uncommon,” said Dr. William Erb, senior director of student health services at Utah Valley. “We train, review and revise these procedures so that situations like this can be avoided as much as possible.”
At most universities, students contemplating suicide or otherwise in crisis are offered help right away. Others are asked to schedule an appointment. Many schools that provided data to the AP said it takes weeks to get an initial appointment.
Students at Brigham Young University drew attention to delays last year after a student took her own life on campus. Days after the suicide, an anonymous letter was posted at the counseling center describing the dilemma some students face.
“I have a therapist on campus, and he is wonderful and well qualified. But I only see him once a month. Because he has too many clients to see in one week,” the letter said. “It is the story of many of us barely getting by here at BYU. If I died would anything change?”
The shifting landscape has spurred many universities to rethink how they provide help. Some say changes will help little if clinics remain understaffed, but some schools are offering more treatment options and telehealth. More students are being steered to group therapy or anxiety workshops. Counseling centers offer yoga, and many train students to counsel one another.
“We’re reframing what mental health looks like at a school. It’s not necessarily 10 therapists sitting in offices,” said Erb, the student health director at Utah Valley.
Niece said his center ramped up its training program, effectively doubling its staff.
But there’s still a struggle to keep up. The center is now “doing more transports to the ER than we have done in my time here,” he said, because more students are coming to the center in crisis or suicidal.
