Can We Do Better?

Today, prevalent cases on the desks of college counselors involve serious concerns including depression, anxiety, and eating disorders, a relatively recent phenomenon in the long history of higher education. For the last several years, Harvard has seen a corresponding increase in the frequency and intensity of conversations regarding mental health. Punctuated by viral articles in The Crimson such as “I Am Fine” and the more recent “In Sight, Out of Mind,” this period of intensified attention towards mental health issues is reflective of a nationwide trend over the past few decades.
The Harvard Political Review is seeking to examine this trend by speaking with adolescent psychologists and counseling service administrators at institutions around the country. Universities should be acutely conscious that creating a mentally healthier campus is not an effort that should stem solely from the counseling center or the administrative offices; only the concerted awareness of an entire campus community—including faculty and staff—can translate into action and resources.
Seeking Help
In their conversations with the HPR, the seven directors unanimously expressed that there has been a gradual yet conspicuous increase in the severity and the number of mental health cases that are being brought to counseling offices at colleges across the country. This does not necessarily indicate that a higher percentage of students carry mental disorders today than several decades past. Rather, as Monica Osburn, the president of the American College Counselors Association and the director of counseling at North Carolina State University, told the HPR, “There is now better medication for folks with more extreme forms of mental illnesses. Increases in terms of access to medication have increased the number of these students on campuses.”
Some counseling directors attributed the rise in the number of cases to the prevalence of technology. Ronald Albucher of Stanford emphasized how “Facebook and Twitter” are allowing students to “reveal things about themselves online that they may not have otherwise” in face-to-face conversations. On the other hand, Gregory Eells of Cornell pointed to the possibility of technology acting as a stressor. In an interview with the HPR, he explained that “massive technology use can have a negative effect on sleep … since it allows you to play games and internet poker, watch porn, and check Facebook constantly.”
The Resource Strain
Interestingly, one of the positive side effects of the increased number of students coming in with mental disorders has been a decline in the stigma associated with seeking help. Despite this positive trend, problems have surfaced in the area of resource allocation. Michael Young, a vice chancellor at the University of California at Santa Barbara who has observed and researched the collegiate mental health scene for over a decade, told the HPR that he saw “the perfect storm: an increase in the number and severity of the mental illness while there was a decrease in the resources and budgets to respond to these issues.” According to Young, the scarcity was only exacerbated by budget cuts that were put in place at most universities in response to the 2008 financial crisis.
In many colleges, counseling centers have also not been able to adapt their skill set to the changing severity of the problems being brought before them. Darcy Gruttadaro, Director of the Child and Adolescent Action Center at the National Alliance on Mental Illness, shared the results of her recent survey of college students with the HPR: “A number of the respondents indicated that they felt like the disability resource center on their campus didn’t understand mental health issues nearly as well as they understood developmental issues.” According to Osburn, schools might face problems especially with more chronic disorders that require treatment beyond a couple of appointments.
Yet the main problem with a strained resource bucket is undoubtedly that college counseling centers can never accommodate everyone who needs their help, leaving less time for non-counseling activities that are critical to shaping the campus’ mood on mental health issues. Kathy Miles of Centre College explained, “We’re less able to do educational programs since we don’t have separate education people on campus.” That most of these shortages are the result of inadequate funding raises important questions about the ways in which activists can engage the campus to influence the politics of resource allocation in favor of mental health support.
Falling through the Cracks
Despite a decrease in stigma, some students still fall through the cracks, as counseling centers only have the time and staffing to treat those who actively seek them out. Eisenberg told the HPR that he views help-seeking behavior in parallel to diet and exercise. “Most Americans are not healthy, but there isn’t a stigma issue or knowledge issue that’s holding people back from diet and exercise. There’s going to have to be some new approaches that make [mental] health a concrete priority alongside classes.”
Meanwhile, many directors saw another crack created by financial concerns, an issue that recently became a controversy on Harvard’s own campus through the op-ed, “In Sight, Out of Mind.” Sherry Benton of the University of Florida told the HPR, “We have all kinds of things to get people to the level of treatment they require. But if you don’t have insurance, we’re out of options.” While most other directors and former directors, like Thomas Kramer of the University of Chicago, agreed with this sentiment, Gruttadaro saw hope in legislation like the Affordable Care Act to bring more health opportunities to students who need it. Despite this cause for optimism, some students cannot afford insurance co-payments or have conditions that require a longer-lasting series of therapy visits.
A Shortage of Staff 
Adequate staffing has also long been a concern at institutions across the country. In response to difficulties with staffing, many counseling centers have turned to more creative solutions. Benton told the HPR about the University of Florida’s new online initiative. “Therapist-assisted online treatment,” a solution used in Australia, New Zealand, the UK, and Germany, consists of “online modules, a corresponding progress monitor, and a video conference with a counselor every week.” This decreases the time each counselor spends with each student, while essentially providing face-to-face treatment. For the University of Florida, “it is a way to increase capacity without having to increase the budget,” Benton remarked.
Building support for increased funding and staff is still crucial, however. The directors of counseling services that spoke to the HPR actively advocated for better and more frequent training of professors and staff. On a campus where mental health campaigns have mostly stemmed from the students with the support of just a few especially vocal professors, this discussion is largely absent within the Harvard community.
Maintaining Perspective
Despite the many complaints about the shortcomings of mental health resources on campuses nationwide, it is important to put things back in perspective. Eells told the HPR, “Colleges and universities are some of the few places in the United States where there is a comprehensive health care system.” Although the ratio is still astoundingly small given the weight of the mental health concerns, Harvard has kept itself in a comparatively solid place in terms of mental health resources. Compared to the 1:937 ratio of private universities of its size, Harvard’s University Health Services provides a staff of one per 750 students, not including the resources at the Bureau of Study Counsel.
But the larger community outside university hospitals and counseling centers also has an obligation to protect and build upon this unique privilege. Nothing will come to fruition without a genuine, campus-wide shift in the attitude towards mental health. As an institution dedicated to learning and the “life of the mind,” mental health is really a responsibility of the whole institution, according to Eells. Indeed, mental health encompasses something much larger than simply a medical concern for the select portion of the student body that seeks out counseling; it is about creating a healthy and supportive environment in which to be we can be seekers of knowledge, intrigue and of course, ‘veritas.’ Whether student, faculty, or staff, it is our duty to illuminate and facilitate the path to knowledge for each other as best we can.