SALT LAKE CITY — College campuses are juggling a lot more than providing students with a robust education. They’re being flooded with requests for mental health services from students dealing with anxiety, depression and suicide ideation.

The good news is university administrators are increasingly prioritizing mental health. The bad news is they struggle to meet all the needs, according to Michael L. Sulkowski, psychologist and associate professor at the University of Arizona.

But as universities scramble to keep up with demand for mental health services, students sometimes wait weeks for treatment and some of them give up, which may lead to greater mental health problems.

Last year, the World Health Organization reported that at least one-third of freshmen it surveyed in eight countries — including among America’s 19.9 million college students as of fall 2019 — said they need mental health services.

The Deseret News reported on the crisis last year, noting that colleges nationwide are hiring more counselors, teaching students mindfulness practices and training instructors and staff to spot signs of serious stress among their students. Some schools, like the University of Utah, now devote a few dollars from each student’s fees to providing treatment services, while the University of Michigan and the University of Illinois have scattered mental health providers in offices throughout campus to make them more accessible.

The Center for Collegiate Mental Health 2018 annual report says nearly one-fourth of students listed anxiety as their primary concern, while 1 in 5 listed depression. The rest of the top 10 concerns were a specific relationship problem, stress, family, grief or loss, trouble navigating interpersonal relationships, adjustment to a new environment, academic performance and trauma.

When The Associated Press released a review of more than three dozen public universities this week, it found campus clinics struggling to keep up. Some report the number seeking treatment has nearly doubled over the last five years while enrollment was relatively flat.

Meanwhile, campus counseling centers grapple with low morale and high burnout.

Associated Press survey

The Associated Press requested five years of data from a public university in each state. Thirty-nine provided annual statistics from their mental health providers; the remaining 11 didn’t respond or didn’t have complete records.

The data shows the number of students receiving mental health treatment at those schools has grown by 35% since 2014, while enrollment grew 5%. By last year, nearly 1 in 10 students were seeking help, but the number of licensed counselors barely changed, from an average of 16 to 19 over those five years.

On some campuses, that means one counselor for 4,000 students, including at Utah Valley University. An industry accrediting group suggests at least one counselor per 1,500 students, but few of the 39 universities met that benchmark.

When Ashtyn Aure checked in at the mental health clinic at Utah Valley University in Orem last year, she was suffering anxiety attacks and had not slept for days. Her mind kept returning to past traumas. When she asked to see a counselor, she learned the wait list stretched for months. She left without getting help.

“I was so obviously distressed, and that was the place I was supposed to go. What do you do after that? Do you go to the hospital? Do you phone a friend?” said Aure, 25, a 2019 graduate.

Her church helped her find therapy at an outside clinic. “If it wasn’t for that,” she said, “I don’t know.”

Officials at Utah Valley said a counselor can see a student who is in crisis in a matter of minutes. But staff members have only a few moments to make an assessment.

“Unfortunately, stories like this are not that uncommon,” Dr. William Erb, senior director of student health services at Utah Valley, told The Associated Press. “We train, review and revise these procedures so that situations like this can be avoided as much as possible.”

Waiting lists

To understand the issues with which students grapple, the Deseret News sat down with students in social work professor David Derezotes’ class at the University of Utah last year. For two hours, students outlined their stressors, which filled a gigantic whiteboard. They described fear of being invisible, but also fear of their flaws being noticed. Issues from political discord to environmental degradation made them feel both helpless and uncertain. They were afraid of missing out, of failing, of not landing a job that would propel them forward. They were terrified of being judged and excluded. Some were depressed. The price tag on living — from tuition to housing — created massive stress. Personal safety on campus was very real as they frequently saw reports of sexual assaults and shooting rampages. And the background music for many was parental expectation, social media comparisons and peer pressure.

“The reduction in stigma, which is great, may account for some of the increase in help seeking. Other factors may be the instability of the current state of affairs in our country/world divisiveness, terrorism, school shootings, random acts of violence, economic instability, student loan debt — the list goes on. No wonder young people are anxious!” said Nance Roy, assistant clinical professor of psychiatry at Yale School of Medicine and chief clinical officer of The Jed Foundation.

The sheer volume of mental health problems isn’t the only challenge. Symptoms appear to be growing more severe, Daniel Eisenberg, professor of health management and policy at the University of Michigan and director of the Healthy Minds Network, told the Deseret News. He said nearly half of students with serious need weren’t being treated as waiting lists that sometimes stretched months and too few resources thwarted efforts to provide help. Colleges were not designed with mental health crises in mind and many students underestimate the severity of their symptoms.

Many schools that provided data to the AP said it takes weeks to get an initial appointment. At Utah Valley, students waited on average more than four weeks last year. At the University of Washington at Seattle, it was three weeks. During busy times at Louisiana State, wait times stretched up to five weeks.

“It’s an incredible struggle, to be honest,” said Jamie Davidson, associate vice president for student wellness at the University of Nevada, Las Vegas, which has 11 licensed counselors for 30,000 students. “It’s stressful on our staff and our resources. We’ve increased it, but you’re never going to talk to anyone in the mental health field who tells you we have sufficient resources.”

Some schools see students the same day, but it can take weeks to get further treatment. So some forego treatment completely and problems can snowball.

Students at the University of Maryland called for change last year after some on campus waited 30 days or more for an initial appointment.

Officials at the University of Maryland said the “30 Days Too Late” campaign revealed a need to raise awareness about same-day crisis services on campus. The school also hired more counselors.

Other schools, including Michigan State, Louisiana State, Columbia and Cornell have received student petitions to improve counseling.

Does waiting matter?

A recent study found greater reductions in anxiety and depression at clinics that focus on providing students counseling at regular intervals, a system that might mean waiting for a therapist’s caseload to open. That practice was compared with clinics that offer quick initial help but cannot always provide routine follow-up treatment.

The study by Pennsylvania State University’s Center for Collegiate Mental Health said prioritizing access over treatment “may have significant negative consequences for students in need.”

The shifting landscape has spurred many universities to rethink how they provide help, including offering different options, like group therapy or anxiety workshops. Counseling centers offer yoga. Mindfulness is taught in groups. Students may help each other through peer networks like the Wolverine Support Network at the University of Michigan, a student-led effort where students form small groups that can bond. Peer leaders can help group members find services and provide support, while peers often help each other work though issues.

Rising demand has also opened doors for business solutions. Some schools have signed on with companies that provide therapy by phone or video chat. Others urge students to try smartphone apps.

But some say changes will help little if clinics remain understaffed. And schools struggle to pay for more counselors. Many campus clinics don’t charge students for services and generate little or no revenue. A 2016 bill in Congress proposed new grants for university counseling, but it never advanced to a vote.

Some schools are adding new campus fees to hire counselors or are subsidizing clinics through athletics revenue, as the University of Texas recently did.

Help yourself

Sulkowski said it’s easy to focus on mental health challenges of students and miss their other important traits and that’s a mistake.

“The current discussion of problems afflicting college students needs to be counterbalanced by the strengths these students possess. Essentially, we need to focus on resilience in addition to risk,” he said. “We also need to stop using dismissive terms like ‘snowflake’ to describe individuals going through a significant life transition that is marked by growth, exposure to new people and ideas, greater degrees of freedom, and inherent uncertainty about the future. The ‘when I was in college’ or ‘back in my day’ arguments really are based in ignorance and a profound failure to grasp how each generation has its own advantages yet also faces its own set of unique challenges.”

Sulkowski noted that thousands of college students have “successfully learned to manage anxiety through counseling, therapy, exercise and other healthy lifestyle adjustments.”

Experts Luke Henke, a University of Michigan staff psychologist, Jed Foundation’s Roy and independent college consultant Eva McGregor Dodds told the Deseret News parents and college students can take steps to improve their mental health at college.

While trying to excel, students should forgive themselves for not being perfect. Parents should focus on encouraging students to do their best, not be the best.

Students already diagnosed with mental illness should line up mental health services in advance. That means considering the available services nearby, on campus or off when choosing a school. A therapist who’s already providing treatment might even be willing to Skype.

Students should know who to contact at college in a mental health crisis. Plan, rather than cobbling care together on campus.

If a college has a program like Michigan’s Wolverine Support Network, students should join or find a friendly, caring academic advisor.

Pre-book the first trip home. It’s important to have something familiar and happy already planned.

Contributing: Collin Binkley and Larry Fenn, Associated Press