In the past few years, college mental health issues have received increasing attention by the mental health community, the public, administrators, and legislators. Events such as the death of MIT student Elizabeth Shin and the subsequent legal battle, and the series of suicides at NYU a few years ago received prominent media coverage.1,2 In the aftermath of the tragic murders/suicides at Virginia Tech and Northern Illinois University, college student mental health issues and campus safety have become pressing public health and policy concerns.3,4
Psychiatrists have historically played a peripheral role in most college mental health services and, thus, have not been well informed about the mental health challenges encountered on campus.
The scope of the problem
While the tragedies at Virginia Tech and Northern Illinois University riveted the nation’s attention, professionals within the college mental health world had been discussing the mental health crisis for years before these horrific events. Research in college mental health issues has not been well funded, and epidemiological information is scarce. The American College Health Association undertakes a yearly self-report survey of college students (nearly 95,000 respondents last year), which gathers general information about students’ health and mental health.5 Dr Robert Gallagher of the University of Pittsburgh surveys college counseling center directors yearly.6 The University of Michigan is also in the early stages of a multiyear study of the mental health of university students.7
What have these reports shown? There are currently approximately 17.5 million university students in the United States.8 Gallagher reported that in 2006, 8.5% of students sought counseling through their school service; another 29% were seen by college-based counselors in other settings. Voelker9 noted that visits to university counseling centers rose 42% between 1992 and 2002 at 11 large Midwestern universities.
For the past 10 years, Gallagher has consistently reported that about 90% of counseling center directors believe they are treating increasing numbers of students with severe pathology. In 1994, 9% of students seen at counseling centers were taking psychiatric medications. By 2006, this number had risen to 23.3%, and 7.5% of students had such serious impairments that they could not function in college settings or without extensive psychiatric/psychological support.6
Students’ self-reports seem no more reassuring. According to the most recent American College Health Association survey, about 13% of students reported having symptoms of anxiety, and more than 18% reported depression symptoms.5 Almost 15% had received a diagnosis of depression sometime in their lives; 25% reported problems with their studies as a result of sleep problems; 33% acknowledged stress-related problems; 43% said they felt so depressed at some point in the academic year that it was difficult to function; 10% had seriously considered suicide; and 1.9% had attempted suicide.
The National Institute on Alcohol(Drug information on alcohol) Abuse and Alcoholism (NIAAA) has gathered data on alcohol use in colleges. The news is dire on this front as well: 31% of the surveyed students met criteria for alcohol abuse.10 Moreover, there were 1.3 million yearly alcohol-related injuries or assaults among college students. While there are estimated to be about 1100 suicides each year on college campuses, 1700 deaths are attributed to alcohol-related accidents and unintentional injuries.11
Large numbers of students acknowledged that they had unsafe sex while intoxicated or did something they later regretted. Rates of assault and sexual assault related to alcohol and drug use are also alarmingly high. In 2005, 83% of campus arrests were alcohol-related.12
Students who abused painkillers during the previous month increased from under 1% in 1993 to 3.1% in 2005.12 During the same period, daily marijuana use more than doubled from 1.9% to 4%; the use of illegal drugs other than marijuana, such as heroin and cocaine, increased from 5.4% to 8.2%.
The clinical crisis
When most college clinicians discuss the crisis in college mental health, they emphasize that the demands on services have dramatically outpaced the capacity and rate of growth of available mental health care systems. Most college counseling services provide free, short-term care for students and are usually funded by student services fees. Historically, the counseling centers were conceptualized as settings where students could be helped through a specific developmental challenge or adjustment problem (eg, homesickness, failure to establish a social network). The centers are frequently staffed by psychologists (more often counseling psychologists rather than clinical psychologists) and, until recently, often had little if any psychiatric staff.6
Because many students have limited or no insurance coverage and many communities have limited options for low-fee care, colleges find themselves providing services for larger numbers of seriously ill students for longer periods. With the availability of effective treatment options, students with serious mental illness are now able to attend college. The need for clinicians equipped to care for these students has grown simultaneously. Colleges must decide whether to spend money hiring lower-salaried therapists (social workers and nurse practitioners) or psychiatrists.
