Crisis on the Campus

Years ago, college counseling centers were pleasant little side channels of the mental health system, helping students cope with roommate conflict and adjustment to college. No more.

Today they are the newest front line in the war against mental illness, struggling to manage swarms of students with serious depression and anxiety disorders. And generally facing a growing demand for their services in a world of shrinking resources.

The middle of the night may find a SWAT team of counselors calming down a dorm wing after having crisis-managed an acute manic episode or yet another incident of self-mutilation. Morning will certainly find the staff administering psychotherapy to students struggling to overcome histories of trauma such as childhood sexual abuse, relationship problems including date violence, and that dormitory staple, eating disorders.

Did we mention substance abuse? Attention deficit disorders and learning disabilities? At one elite institution, 10% of students report problems with binge drinking.

Rare is the college that has not experienced a student suicide. A 10,000-student campus can expect one student suicide a year. That doesn't count all the highly disturbing attempts.

Hospitalization, a court of last resort, is commonplace. Eighty-nine percent of counseling centers hospitalized at least one student in 2001; one hospitalized 80. On one 5,000-student campus where most students are commuters, three to six students are typically hospitalized a semester, primarily for suicidal gestures and first psychotic breaks.

In 2001, 85% of North America's student counseling centers reported an increase in "students with severe psychological problems" over the past five years. Thirty percent of them had a student suicide; 60% of them dealt with obsessive pursuit cases (50 persons injured, five killed).

"Every director of every college counseling center is reporting more hospitalizations, more serious problems, and taking care of sicker students," says Richard Kadison, M.D., a psychiatrist who heads Harvard University Health Services and its counseling center. The severity of students' mental health problems has been rising since 1988, reports psychologist Robert Gallagher, Ph.D., of the University of Pittsburgh, who each year surveys directors of college counseling centers.

"The world isn't getting crazier," observes Pamela L. Graesser, M.Ed., director of counseling at Rivier College, a small Catholic college in New Hampshire whose students are primarily from blue-collar families. "College is just getting more like the real world around it." College is simply available to more people than it used to be. The problems Graesser saw 12 years ago when she worked in a psychiatric hospital "are the same ones I now see on campus."

"We are probably seeing the true prevalence of mental disorders," observes psychiatrist Morton Silverman, M.D., head of counseling services at the University of Chicago. "There is not as much surveillance in the outside world."