Early in his first quarter at the University of California-Davis, Ryan Manriquez realized he needed help. A combination of pressures — avoiding covid-19, enduring a breakup, dealing with a disability, trying to keep up with a tough slate of classes — hit him hard.
"I felt the impact right away," said Manriquez, 21.
After learning of UC-Davis' free counseling services, Manriquez showed up at the student health center and lined up an emergency Zoom session the same day. He was referred to other resources within days and eventually settled into weekly group therapy.
That was September 2020. Manriquez, now president of the student union, considers himself lucky. It can take up to a month to get a counseling appointment, he said, and that's "at a school that's trying really hard to make services available."
Across the country, college students are seeking mental health therapy on campus in droves, part of a 15-year upswing that has spiked during the pandemic. U.S. Surgeon General Vivek Murthy in December issued a rare public health advisory noting the increasing number of suicide attempts by young people.
Colleges and universities are struggling to keep up with the demand for mental health services. Amid a nationwide shortage of mental health professionals, they are competing with hospital systems, private practices, and the burgeoning telehealth industry to recruit and retain counselors. Too often, campus officials say, they lose.
At UC-Davis, Dr. Cory Vu, an associate vice chancellor, said the campus is competing with eight other UC system universities, 23 California State universities, and multiple other health systems and practices as it tries to add 10 counselors to its roster of 34.
"Every college campus is looking for counselors, but so is every other health entity, public and private," he said.
According to data compiled by KFF, more than 129 million Americans live in areas with a documented shortage of mental health care professionals. Roughly 25,000 psychiatrists were working in the U.S. in 2020, according to the Bureau of Labor Statistics. The KFF data indicates that more than 6,500 additional psychiatrists are needed to eliminate the shortfall.
On campuses, years of public awareness campaigns have led to more students examining their mental health and trying to access school services. "That's a very good thing," said Jamie Davidson, associate vice president for student wellness at the University of Nevada-Las Vegas. The problem is "we don't have enough staff to deal with everyone who needs help."
About three years ago, administrators at the University of Southern California decided to respond aggressively to the skyrocketing demand for student mental health services. Since then, "we've gone from 30 mental health counselors to 65," said Dr. Sarah Van Orman, the university's chief medical officer for student health.
The result? "We're still overwhelmed," Van Orman said.
Van Orman, past president of the American College Health Association, said the severity of college students' distress is rising. More and more students come in with "active suicidal ideation, who are in crisis, with such severe distress that they are not functioning," Van Orman said. For counselors, "this is like working in a psychiatric ER."
As a result, wait times routinely stretch into weeks for students with nonemergency needs like help dealing with class-related stress or the transition to college. Professionals at campus counseling centers, meanwhile, have seen both their workloads and the serious nature of individual cases rise dramatically, prompting some to seek employment elsewhere.
"This is an epidemic in its own right," Van Orman said, "and it has exploded over the last two years to the point that it is not manageable for many of our campuses — and, ultimately, our students."
The pandemic has exacerbated the challenges students face, said UNLV's Davidson. Lockdown measures leave them feeling isolated and disconnected, unable to establish crucial relationships and develop the sense of self that normally comes with campus life. They also lose out on professional opportunities like internships and fall behind on self-care like going to the gym.
A study by the Center for Collegiate Mental Health at Pennsylvania State University found that among 43,000 students who sought help last fall at 137 campus counseling centers, 72% said the pandemic had negatively affected their mental health. An online survey of 33,000 students last fall found that half of them "screened positive for depression and/or anxiety," according to Boston University researcher Sarah Ketchen Lipson.
Even before the pandemic, university counseling center staff members were overwhelmed, Northwestern University staff psychiatrist Bettina Bohle-Frankel wrote in a recent letter to The New York Times. "Now, overburdened, underpaid and burned out, many therapists are leaving college counseling centers for less stressful work and better pay. Many are doing so to protect their own mental health."
On average, a counselor position at UC-Davis requiring a master's or doctorate degree pays $150,000 a year in salary and benefits, but compensation can vary widely based on experience, Vu said. Even at that rate, Vu said, "we sometimes cannot compete with Kaiser [Permanente], other hospital settings, or private practice."
Tatyana Foltz, a licensed clinical social worker in San Jose, California, spent three years as a mental health services case manager at Santa Clara University. "I absolutely enjoyed working with the college students — they're intelligent, dynamic, and complex, and they are working things out," Foltz said. But she left the university a few years ago, lured by the flexibility of private practice and frustrated by a campus system that Foltz felt did not reflect the diverse needs of its students.
Foltz returned to campus in December to support Santa Clara students as they protested what they said were inadequate services on campus, including insufficient numbers of diverse counselors representing Black, Indigenous, and LGBTQ+ communities and other people of color. The protests followed the deaths of three students during the fall quarter, two by suicide.
"It should not be taking student deaths to get us better mental health resources," said junior Megan Wu, one of the rally's organizers. After the rally, the chair of Santa Clara's board of trustees pledged several million dollars in new funding for campus counseling.
Replacing therapists who leave universities is difficult, Davidson said. UNLV currently has funding for eight new counselors, but the salaries it can offer are limiting in a competitive hiring market.
Universities are getting creative in their attempts to spread mental health resources around on their campuses, however. UC-Davis embeds counselors in student-utilized groups like the Cross-Cultural Center and the LGBTQIA Resource Center. Stanford University's Bridge Peer Counseling Center offers anonymous counseling 24/7 to students who are more comfortable speaking with a trained fellow student.
Mental health services that can be accessed online or by phone, which many schools did not offer before the pandemic, may become a lifeline for colleges and universities. Students often prefer remote to on-site counseling, Davidson said, and campuses likely will begin offering their counselors the option to work remotely as well — something that private practices and some medical systems have done for years.
"You have to work hard and also smart," Foltz said. "You need numbers, but you also need the right mix of counselors. There is a constant need to have culturally competent staff members on a university campus."