College Students and Mental Health: What Parents and Students Should Know

Maybe you’re a student about to go away to college. Maybe you’re a parent about to send your kid to college. Congratulations!! Going away to college can bring up a lot of emotions, ranging from excitement and pride to anxiety or some sadness. While I hope that you or your child love(s) college, it doesn’t hurt to think about a few things in advance. This is especially important if the person attending college has a history of mental health concerns. Here are a few things to know:

1.) Most college counseling centers operate on a short-term model. What this means is that therapists generally cannot see students for long-term, open-ended, ongoing treatment. Some centers even have session limits, like 6-10 sessions. Some are more flexible. It’s not that therapists don’t want to offer more, they do, but they simply cannot due to demand. This brings me to my next point.

2.) Demand for services at counseling centers is HIGH. So high. At one of the schools I’ve worked at, over 20% of the student body sought counseling services during the year. When you break that down, even a school with a LOT of counselors ends up with something like an over 500:1 student to therapist ratio. On the one hand, it’s great that stigma is decreasing and that more students want help. On the other hand, it can be tough for counseling centers to keep up with demand.

3.) If you go to your college counseling center, you may only be seen once every few weeks. Again, this is not because therapists don’t want to offer more. It’s because counseling centers have an obligation to balance treatment and access. Unlike private practice, they can’t shut their doors when their caseloads fill up. Therefore, they have to space out sessions to accommodate more students.

4.) Acuity has increased over the years. College counseling used to be thought of as sort of a cushy job where you talk with students about homesickness and relationships and existential questions. While these things do come up, many college counseling centers operate in some sense as little crisis centers. A huge number of students suffer with severe depression, crippling anxiety, etc. Therapists have to be available to manage crises and make sure the students who are seriously struggling and/or are unsafe are getting adequate support. This means that in addition to “regular” therapy, counselors are juggling walk-in hours, managing crises, etc. I say this to emphasize that counselors are busy and working very hard. I also want to note that, due to the issues I mentioned above, oftentimes therapists cannot see these clients long-term and will see them until they are more stable and then refer them locally so that they can get weekly, ongoing therapy.

5.) If a student makes an appointment later in the semester, it may take a while to be seen, especially if the student is not in crisis (meaning the student isn’t a danger to themselves or someone else). This can be really tough when a student is suffering and wants/needs to be seen sooner. These are my suggestions: If you as a student are starting to struggle with mental health concerns, do not wait until things are really bad to seek care. If you (as the student) have a history of mental health concerns, contact the counseling center right when you get to school to set up care, or find a therapist near the school that you can see in an ongoing way. If you are a parent, encourage your kid to do this or help them do it. If you aren’t sure how, see my article “How to Find a Therapist.” You can also call the counseling center and ask for some referrals. Many counseling centers have lists of local therapists that they refer to, although usually it is a list of local providers (the counseling center hasn’t vetted everyone on the list).

6.) Know that you may get referred by the counseling center to a local provider. This can be frustrating for students, but there are good reasons for this. You may have figured some of them out already from reading the above list. Sometimes the student needs a higher level of care (more frequent, regular therapy). Maybe a student could benefit from a certain type of care or specialty that isn’t offered at the counseling center. If the student has a long history of being in therapy, it makes sense to refer them because it is likely they will want ongoing services. If the student is older, or is familiar with going to therapy, it can make sense to refer them because they will be capable of getting to those appointments and following through. Again, therapists are constantly trying to balance access and treatment, as well as consider what is in the best interest of the student.

7.) Consider group therapy!! Many counseling centers offer groups, especially toward the beginning of the semester. Many students worry that they will not benefit as much from a group for a variety of reasons (e.g., worry they won’t feel comfortable sharing, worry that they need the one-on-one treatment, etc.). The truth is though, groups can be SO POWERFUL and sometimes even more healing that individual therapy. It’s powerful to sit with peers who “get it.” We generally get really positive feedback from group members when they finish a group.

8.) If you are a parent and you call the health center about your child, know that we can listen to whatever information you share but we CANNOT confirm or deny that we know your child without a release of information. This is true even if your child tells you all about their therapy. We simply CANNOT DO IT. It is ILLEGAL. Even if a child is suicidal, we can’t just call the parents about it if the child doesn’t want us to and they are over 18. Our job is to work with the student about how to stay safe and then send them to the hospital if we are worried they are in imminent danger. I know as a parent that is probably terrifying, but it is the law when it comes to health care. For what it’s worth, I frequently encourage clients to talk with their families, reach out for support, and not worry about burdening others with their issues. Sometimes I will ask a client to sign a release, but if they refuse, there isn’t usually a lot I can do. So, check in with your kids and if you think it would be helpful, ask your child to sign a release of information.

9.) All this probably makes it sound like it’s impossible to actually get decent therapy at a counseling center. That’s not true though. I’ve worked with SO MANY students in therapy, some for longer periods of time than others, and we’ve done good work. Clients have told me, not infrequently, that they have referred their friends to the counseling center, so that’s saying something. If your child does get seen at the counseling center, chances are that they are working with a competent and talented professional.

So, to sum this up in a nutshell:

  • Counseling centers are struggling to balance access and treatment and there is a high demand for services.
  • As a result, students may not be seen as often as they would like and may not be able to be seen in a long-term, ongoing way. There may also be a significant wait time to be seen during the busiest times in the semester.
  • If you anticipate needing mental health services, work this out at the start of the semester. Don’t wait until things get bad.
  • Don’t rule out group therapy.
  • Therapists are bound by HIPPA (confidentiality) laws just like others in the health profession (doctors, nurses, etc.).
  • Many students only need short-term therapy and find it to be quite helpful. In addition, some counseling centers are more flexible than others when it comes to length of treatment.
  • Therapists at counseling centers are, in my experience, pretty awesome people.

I hope this is helpful! I’d love for this to make a difference in helping someone to have a more enjoyable college experience!

Photo Credit: Tim Gouw via Unsplash

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