Bettina Bohle-Frankel

Opinion contributor

The freshman in my office had finally summoned the courage to seek help. He was depressed and not eating or sleeping well. Because he had fallen behind in his classes, he was in danger of failing. He acknowledged cutting himself and had contemplated suicide.

An accomplished student from a close-knit family, he sailed through high school and had been excited to attend Northwestern University, his father’s alma mater. Now, he was reluctant to tell his family about his problems for fear of disappointing and burdening them.

He is not alone: Colleges and universities are facing a mental health crisis. In the 20 years that I have worked as a psychiatrist at Northwestern’s Counseling and Psychological Services, the number of students seeking services and the severity of their concerns has increased, not only at our school, but across the nation.

College students' growing mental health crisis

This student’s situation created a dilemma familiar to everyone working in a college counseling center. In order to improve quickly, he needed intensive treatment, which college centers do not offer. Also, the best programs near campus were not covered by his insurance. Despite his reluctance, we needed to involve his parents, not just to support him, but also to figure out finances. Many health insurers cover quality mental health care at affordable cost only near the student’s home, not in other locations.

Read more commentary:

I know college admissions offices from the inside — schools basically sign off on scandal

I'm a poor kid at an elite college. Bribes are not the reason my wealthy peers are here.

Flashback: Our flawed college system takes toll on families years before tuition is due

Data shows that from the 2009-10 school year to 2014-15, counseling center utilization grew five times faster than institutional enrollment growth in the United States. The Center for Collegiate Mental Health (CCMH), an organization of more than 550 college and university counseling centers, reports in its 2016 Annual Report a 28% rise in "rapid-access" hours per client since 2010. These are visits by students who come to counseling centers in crisis and cannot wait for an appointment.

About 1,100 college students die by suicide every year and suicides are even the second-leading cause of death for people 10 to 34 years old. According to the 2018 CCMH report, 35.8 percent of the students who present to counseling centers report that they seriously considered suicide before. And their 2017 report showed that depression and anxiety have steadily increased since 2013 among students seen at counseling centers.

These trends of increasing numbers, urgency and severity are likely to continue for the foreseeable future: The rate of adolescents reporting a major depressive episode in the last 12 months grew from 8.7% in 2005 to 11.3% in 2014. The rate of suicide for 10- to 19-year-olds increased by 56% between 2007 and 2016.

This trend is not confined to the United States: More than a dozen Canadian universities’ counseling centers have also experienced a surge of 35% on average in the demand for their services.

College counselors stretched thin

What's driving the demand? Some research suggests that the surge in use of electronic devices and social media is connected with an increase in depression and suicidality in adolescents.

Parenting styles, overscheduling children and the lack of free, unstructured play are also being blamed. Education and outreach trying to destigmatize mental health concerns and encouraging young people to get help might also have had an effect and thus led to an increased utilization of counseling services.

Counseling centers everywhere are trying to meet the demand — but can only stretch so far. Many universities have increased the number of counselors. At our center, for example, staff almost doubled since 2005.

Usually counseling centers can only offer certain services, including assessment, referral and brief counseling. However, as the academic year progresses, there might be a wait for non-urgent appointments and services. Students who need specialized or more intensive treatment will be referred off campus using their health insurance.

Many psychiatric disorders emerge for the first time in young adulthood, even in individuals who had no prior problems. The pressures of college life test the student’s resilience and ability to cope on his or her own. Yet many are reluctant to seek help, often because of concerns about stigma or cost.

How families can protect vulnerable students

So, what can a family do to prepare?

►Talk to your children before they leave. Like most parents, I talked to my children about health and safety before they left for school, including topics such as sleep and substance use. Parents must also talk about maintaining good mental health and getting care when needed. Young people feel more confident about seeking help when they know their families support them.

►Check your insurance coverage. Before waiving the college health insurance plan, families should make sure that their own plan has good coverage for mental health care near the school. Some plans look very good on paper, while the actual coverage is sorely lacking. Sometimes it might be best to purchase the school insurance, if it offers better coverage.

►Make a plan for more vulnerable students. Some students already struggled with mental health issues in high school or recently had a traumatic event, such as the death of a parent or a friend. A new environment in college will not make it easier to cope. Alone, adjusting to college life, these students falter unless they have support. In my experience, continuing with a therapist or psychiatrist from home via phone or Skype is usually not a good choice. Set up care in advance with local providers.

►Choose the right college. For some students, a college close to home might be a good choice because they can continue with their familiar providers and have more family support.

For my freshman patient, it ultimately became too difficult to attend to his studies and treatment while feeling so poorly. He chose to take a medical leave and go back to his home in a different state, where his family’s health insurance provided better coverage.

Six months later, he returned to Northwestern feeling much better, ready to succeed as a student. Enrolling in the university’s insurance plan allowed him more affordable access to local health care. He continued outpatient therapy and medication treatment through his graduation from Northwestern.

More college students are facing mental health struggles than ever before. However, we are fortunate to live in a time when effective mental health treatment is possible for many disorders. Families need to make sure that students feel comfortable seeking help and have the means to access it.

Bettina Bohle-Frankel has been a psychiatrist at Northwestern University's Counseling and Psychological Service for more than 20 years and is on the faculty of Northwestern's Feinberg School of Medicine. She is a fellow of the American Psychiatric Association.