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Campus Counseling Conundrum

Campus
  Counseling
Conundrum

As mental health issues mount among undergraduates, Macalester and other colleges expand their efforts to keep up.

By Laura Billings

ILLUSTRATION BY JULIE DELTON

Shelly Lear came to Macalester to study psychology in a department with a strong reputation. One thing she didn't learn during her four years as a psych major was whether mental health services were available on campus for students like her. "I'm embarrassed to say that I didn't even know that we had a counseling center," says Lear '80. "I just don't remember anyone talking about it."

How times have changed. These days, the mental health needs of college students are discussed almost everywhere--from freshman orientation every fall to the floor of the U.S. Senate last spring, in the wake of the Virginia Tech shooting. Lear herself is now the associate director of counseling services at Colgate University in Hamilton, N.Y., where she sees firsthand what college parents, alumni, and the public may have learned only in the wake of that tragedy--that the mental health needs of students are on the rise. [Editor's note: A Virginia state panel found in late August that Virginia Tech University officials misunderstood federal privacy laws as forbidding any exchange of a student's mental health information, thus causing them to miss numerous indications of the gunman's mental health problems.]

According to Active Minds on Campus, a national effort to support student-run mental health awareness on 68 U.S. campuses, young adults ages 18 to 24 actually have the highest prevalence of diagnosable forms of mental illness, at 27 percent. Researchers estimate that as many as 30 percent of college-age women may display bulimic behavior, the kind of disordered eating patterns that are often linked to depression, substance abuse, and anxiety disorders. And last year, an estimated 44 percent of college students reported feeling so depressed that they found it difficult to function.

The good news: Today's college students are also more likely to seek out counseling help when they need it than any previous college cohort. "I often joke that these are the children of the generation that made psychology the number one major, so their parents have a high level of sophistication about what the field can do, and what can be done for their children," says Linda Schmid, staff psychologist at Macalester.

But she doesn't joke about the variety of issues that will compel an estimated one-third of all Macalester students to come through the counseling services at Winton Health Services before graduation day. One recent nationwide survey of college students found that more than 90 percent admit to feeling overwhelmed by all they have to do, and 9 percent have seriously contemplated suicide. Between those extremes lie a host of mental health issues--everything from homesickness to more serious problems such as schizophrenia and bipolar disorder, psychiatric illnesses with symptoms that often don't emerge until late adolescence.

It may be no surprise that in a 2005 national survey of the directors of college counseling centers, 95 percent reported an increase in the number of students already taking medication for psychiatric problems before they came in for help. New medications for things like ADHD and bipolar disorder now make it possible for students who might not have entered college 20 years ago to succeed there today. "Our semesters are only 15 weeks long, so you've got to keep up, and these medications have made it possible for them to do that, which is a positive thing," says Schmid. "At the same time, these students may need more support while they're here."

Like many campuses across the country, Macalester has increased its counseling offerings in recent years, nearly doubling its staff to three full-time and one half-time counselor, an advanced doctoral student, and a consulting psychiatrist, who can also offer referrals to students who need more specialized care. "We have a lot invested in the students who come here, and we want to take their issues seriously and provide as much support to them as we can," says Schmid.

While many Macalester alumni and parents may look back on their own college years as a time of fun and freedom, counselors would remind them that they may be remembering only half the story. In fact, the years between orientation and commencement are often a tug of war between adolescence and the new demands of adulthood: You don't live on campus, but you don't live at home either. You're making your own decisions, but your parents may still be paying the bills. You may fall in love for the first time and find a vocation, but you may also have to survive your first breakup (with your girlfriend still living down the hall) or come up with a new major. You're under pressure to find yourself and try new things, but you're also cautioned about how it all might reflect someday on your permanent record. You want to change the world, but at the same time, you'll have to pay back those student loans.

"The main anxiety is that you're never doing enough--that there's always something more you should be doing," says Sven, a recent Mac graduate (who, like other students interviewed for this story, asked for a pseudonym). Sven describes the pressure he felt to make the most of his college time, while the demands of his coursework and academic competition made him feel "unconnected" to other students.

When he began to have trouble sleeping, Sven investigated the Winton Health Services web site and made an appointment with a counselor. "It wasn't like there was a sign that said, 'Need help?' but I figured they could point me in the right direction," he says.

In fact, Macalester directs most of the information about its counseling services not to students, but to their parents during a one-hour session that explores the challenges likely to be encountered by first-year students and their families. "There's always a parent who will say, 'This is great--now what have you told students?' And we'll tell them, 'The students aren't ready to hear this now,'" says Schmid. "They're so overwhelmed with new information, and adjusting to campus, and making 15 trips to Target to set up their rooms that they can't imagine the possibility that they may have a hard time."

Although parents are told where to refer a troubled student, they are also reminded that federal privacy laws forbid health care providers to pass on to parents and others information shared by a student who is 18 or older. Antidiscrimination laws further restrict how a college can deal with students with mental health problems. These laws create a kind of catch-22 for colleges, which can't inform authorities unless students pose an imminent and lethal risk to themselves or others, but also can't prevent a troubled student from staying on campus. For instance, the parents of Elizabeth Shin, a student at MIT who killed herself in 2000, sued the university for not informing them of their daughter's deterioration. (The case was settled for an undisclosed amount.) Last year, the City University of New York agreed to pay $65,000 to a student who had been prevented from returning to her dormitory room after being hospitalized for a suicide attempt.

"It's a balancing act that is going on at all universities, where we are trying to strike a balance between the freedom of the individual student and the responsibility of the college to protect the learning environment," says Ted Rueff, associate director of counseling services at Macalester.

The tragedy at Virginia Tech last spring, after student Cho Seung-Hui rebuffed the repeated efforts of faculty and roommates who reached out to him, has prompted a whole new level of soul-searching about what colleges can do to get help for their most troubled students. "These are the cases that keep us up at night," says Barbara Blazick '72, a psychologist in Carnegie Mellon University's counseling department. "Every mental health provider struggles with that."

In the wake of the Elizabeth Shin case, Laurie Hamre, Macalester's vice president for student affairs, conceived of a plan to make sure that troubled students know where to get help. Known as "case management," it calls together staff members from residential life and health services, as well as international student advisers and dean of students office staff, who meet regularly to identify students who might need help. For instance, a professor might notice that a particular student hasn't come to class in a week, while a member of the residential life team may be aware that the student has recently lost a family member.

"It calls to staff attention a student who may be having academic problems or difficult personal or family issues," says Hamre. "It's still up to the student to use the services and take advantage of all that a college like this has to offer."

The program is "a little delicate," Hamre says, "because we don't want students to think we're talking about them all the time." But she also notes that there were no complaints from students when the program was mentioned in a local newspaper article. In fact, several students interviewed for this story were pleased to find out that the program exists.

"It's good to know that the adults on campus are looking out for us," says Katya, a junior. "I think people come to a place like Macalester because they want to be part of a community where people have a sense of responsibility toward each other."

This willingness to receive help, and to seek it out, seems to be part of a trend among the latest crop of college students, referred to by demographers as "millennials." "They're used to reaching out for services, having their parents assist them--sometimes a little too much--so their coping skills are not as well-defined as those of other groups who have come through campus," says Hamre.

In fact, Rueff notes that last year was the first time that Macalester first-years sought more help in counseling offices than the members of any other class. Of those who came for help, 57 percent had received counseling before they came to campus.

Some of their issues are common to all college campuses--sleep disorders, drug and alcohol problems, learning self-motivation, coping with stress, getting along with roommates. Other concerns seem more typical of Macalester students and the mix of values and expectations they bring to campus. "Social anxiety is an issue here," says Sven, who got help for anxiety at Winton. "The students here are intelligent and awkward--and that doesn't lend itself to feeling really comfortable all the time."

"With Mac students there is also this pressure of feeling privileged," says Rueff, "and feeling the responsibility that comes with that, to make the most of their college experience, and that can lead to overcommitment." Hamre echoes this observation: "These students often come with a well-defined sense of what the world needs. There aren't many schools where students who are still teenagers are worrying about how they're going to save the world."

This was among the questions that weighed heavily on Sarah, a recent Mac graduate who wondered if she had come to the right school when she "expected a kind of transformative experience I just wasn't having." She talked to a counselor at Winton, but simply her experience at Macalester--making connections with professors, finding a path that excited her, volunteering with a nonprofit in St. Paul--brought her struggles into perspective. "I've had the privilege of being friends with a lot of older people and seeing their journeys," says Sarah. "That's taught me that things are not linear, and you don't get everything figured out by the time you're 25."

Insights like Sarah's make working with Macalester students rewarding, Rueff says. They're at once so confident and so vulnerable, and more capable than they often realize of solving their own problems. "They are all on their own path toward wisdom," he says, "and every once in awhile you get to be a part of that glimmer of discovery."

Laura Billings, a freelance writer who lives just three blocks from the Macalester campus, is a former St. Paul Pioneer Press columnist.