Editor’s note: The Focus on Research column highlights different research projects and topics being explored at Penn State. Each column will feature the work of a different researcher from across all disciplines.
Beginning in 1949, a week in May was promoted as Mental Health Awareness Week — which eventually became Mental Health Awareness Month. The goal was — and still is — to educate the public about the signs, symptoms and treatments as well as the positive lifestyle choices that lead to mental health.
An estimated 1 in 5 Americans will be affected by a mental health condition in their lifetime, according to the National Alliance of Mental Illness. And the Institute of Health Metrics and Evaluation shows that when compared to other health risks, mental illness is responsible for approximately 30 percent of all lost life and productivity for Americans aged 15 to 24, an age range that includes the majority of U.S. college students.
The Center for Collegiate Mental Health at Penn State — http://ccmh.psu.edu — is an international multidisciplinary research center focused on understanding and describing college student mental health by pooling standardized data about college students seeking mental health treatment at hundreds of colleges and universities in the United States and internationally. CCMH’s 2015 annual report was recently released and describes 476,388 students who sought mental health services on campus between 2010 and 2015, providing five-year trends that help to describe how college students’ mental health characteristics are evolving.
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This year’s report also examined how the demand for mental health services is changing in comparison to institutional enrollment levels. Consistent with other anecdotal and survey results, the 2015 CCMH report found that the demand for mental health services in higher education grew at more than five times the rate of institutional enrollment during the past five years. This explosion in demand for mental health services, in comparison to relatively flat student body growth, helps to explain the frequent report that college and university counseling centers simply cannot keep up with demand — often resorting to the use of triage (an emergency medicine technique for sorting based on medical urgency), treatment limits and waiting lists.
To explore the nature of this rapid growth in demand, CCMH examined a range of student mental health characteristics during the past five years. Surprisingly, some key characteristics such as lifetime prevalence rates of prior counseling, prior psychiatric medications and prior hospitalization have remained high but flat. This finding contradicts frequent reports that college students’ mental health has reached a crisis state or that college students are coming to college with more mental illness than ever before.
On the other hand, this year’s report did find consistent year-over-year increases in students’ self-reported levels of depression and anxiety, suggesting that the growth in demand does include students who are more distressed than in past years. Further, significant increases were also noted in the lifetime prevalence rates for “threat-to-self characteristics” such as nonsuicidal self-injury, serious suicidal ideation and suicide attempts. Particularly concerning is a 38 percent relative increase in the lifetime prevalence rate for serious consideration of suicide during the past five years.
Some in the media have labeled the growth in demand for mental health services as a “crisis,” while others have pointed to factors such as helicopter parenting, academic pressures, overscheduling, social media and the ubiquity of instant communications as potential contributors to trends in college student mental health.
While each of these explanations is worth exploring, it is important to situate these national trends in the appropriate context. Passed in 2004 and funded in 2005, the Garrett Lee Smith Memorial Act released millions of dollars of funding to help prevent suicide among youth and college students. During the past decade, this federal funding mechanism has injected more than $60 million into college and university communities for the explicit purpose of decreasing mental health stigma, increasing help-seeking behaviors, preventing suicide and training collegiate communities to identify and refer at-risk students to treatment.
In addition, more than $275 million has been distributed to states to support youth suicide prevention efforts. When these intervention efforts are factored in, the concerning trends of increasing demand and increasing rates of threat-to-self characteristics are actually consistent with the desired outcomes of such national intervention efforts: increase the early identification of students-at-risk in order to refer them for treatment.
Interest in the mental health of U.S. college students has grown consistently since the development of university and college counseling centers in the beginning of the 20th century. After an initial focus on academic concerns and advising, university and college counseling centers pivoted rapidly toward mental health treatment with the influx of World War II veterans via the GI Bill. Counseling centers grew slowly but consistently from the 1950s through the 1980s, providing a wide variety of psychological services.
From the 1980s onward, and especially following a series of campus tragedies in the late ’90s and 2000s (for example, the shootings at Virginia Tech in 2007), institutions of higher education actively developed their counseling centers into large multidisciplinary mental health agencies with the full range of psychological services including triage, crisis stabilization, psychiatry, counseling, specialized treatment teams (for example, for eating disorders), psychological testing, training of future practitioners and participation in institutional teams such as those focused on managing potential behavioral threats. The trends identified in the 2015 CCMH annual report represent the most recent evolution of the field — rapidly growing demand for service by students who may be a risk to self.
Many well-intended efforts have unintended consequences. In the case of college student mental health, we know that the United States has invested hundreds of millions during the past decade to prevent suicide, promote mental health treatment and increase the early identification/referral/treatment of at-risk youth. At the close of this time period, CCMH detected a dramatic increase in demand for service and a specific increase in “threat-to-self” characteristics among students referred to university and college counseling centers.
On one hand, these findings suggest that national intervention efforts have been successful. On the other hand, the rapid growth in high-risk demand paired with relatively flat funding for counseling centers means that it is now increasingly difficult for students to access mental health services in general, and especially formal treatment, which requires more resources. As a result, colleges and universities must now focus their attention on addressing the unintended consequences of well-intended national intervention efforts by growing mental health services on campus to meet new levels of demand so that students in need can be responsively and effectively treated in order to be successful in their academic pursuits.
Ben Locke is associate director of clinical services with Penn State’s Counseling and Psychological Services.