“Are you actually going to kill yourself?”
Sociology Professor Kristen Hourigan stared intently at Beth Yuan, an academic advisor at Cal State Los Angeles, waiting for a response.
To both women, the question felt uncomfortably frank. But blunt talk — asking a student directly about his or her suicidal intent — was the key point. They were role playing in a two-day training seminar about Mental Health First Aid, and mincing words wasn’t really an option.
Hourigan and Yuan were two of some 20 faculty, staff and university-employed students attending the recent session. Such on-campus training is increasingly common, as colleges seek to raise awareness about student mental health woes that, at many schools, is approaching a crisis level.
To some degree, anxiety and depression have always been part of the college experience. But over the past five years, the number of students seeking help for mental health symptoms has outpaced overall enrollment growth by 25 percent, according to a 2016 report by the Center of Collegiate Mental Health at Penn State University.
Southern California hasn’t been spared, as over the past five years the number of students seeking help has jumped at virtually every campus, from a 17.5 percent at the Claremont Colleges to 168 percent at USC.
The crisis has caught most schools off guard. And with limited resources, schools increasingly are looking at the kinds of tactics employed by public clinics — directing group therapy sessions, hosting workshops on time management and stress relief, partnering with outside organizations — to fill gaps in mental health care.
As part of that, at many schools, such as Cal State Los Angeles, teachers and dorm assistants are being trained on how to be first responders; to spot students in crisis.
“How many people in this room have had a student come to you and say they’re really anxious or depressed?” Jonna Fries, the school’s director of counseling and psychological services, asked the class that included Hourigan and Yuan.
Almost everyone in the room put up their hand.
“You guys are the front line,” she told them.
Struggling with demand
In California, public schools are scrambling. Increased mental health spending at the University of California system has helped reduce average wait times for a first appointment to 12 days from 19 days three years ago, according to UC budget documents.
But demand is incessant. System officials say they have seen the number of students seeking mental health services increase 100 percent over the past decade.
A scathing 2016 report by the UC Student Association graded all nine undergraduate university counseling centers with a “C” or below on measures of accessibility, diversity of providers and outreach to students. Three local schools, UCLA, UC Irvine and UC Riverside, all scored “C” grades.
In response, UC regents, with the support of student leaders, approved an increase in annual students fees to hire an additional 85 mental health clinicians with the goals of increasing diversity while reducing wait times even further.
The help can’t arrive too soon, said some student leaders.
“There is no consistency for students in terms of (mental health) visits,” said Judith Gutierrez, a student at UC Santa Cruz and president of the UC Student Association, which represents students system wide.
“(Students) know that they’re going to be asked to wait, or they’re not going to feel like there’s immediate help.”
Though Gutierrez said she’s aware of the new counseling hires, she said it’s unclear if that’s translated yet into actual improvements.
Schools in the California State University system appear to lag behind their UC counterparts, at least when it comes to the capacity to help students with mental health issues.
While UC Irvine has one mental health professional for every 1,159 students — fairly typical in the UC system — the ratio at Cal State Los Angeles is one for 4,637 students, and at Cal State Long Beach it is only slightly better, with one for every 3,191 students.
A recent report compiled by the California Faculty Association, a union representing professors and others in the Cal State system, concluded that only three of the 23 Cal State campuses meet the International Association of Counseling Services recommended ratio of one mental health counselor for every 1,500 students. The report estimated that the average ratio, system wide, is one counselor to 2,355 students.
The disparity between demand and what universities can supply means at least some students “fall between the cracks,” said Ashley Salazar, a Cal State Fullerton senior who works part-time at the counseling center and is president of the Fullerton chapter of the mental health advocacy organization Active Minds.
“Some students don’t see counselors when they need to because of the wait times,” Salazar said.
Students also criticized what they believe is a common practice of referring students to off-campus mental health providers. Going to an outside provider, said Gutierrez of UC Santa Cruz, can cost students out of pocket, require off-campus travel and make it difficult to follow up on care.
Officials from several universities countered that campus counseling centers are designed to address short-term needs and don’t have the resources to provide long-term mental healthcare.
But they also noted that the need for such care does exist.
Beth Jaworski, director of counseling at Cal State San Bernardino, pointed to a relationship recently struck between her school and San Bernardino County. The county pays for a case worker on campus to help students get into mental health programs outside of the university.
“We’re the first in the state to have this,” Jaworski said. “The program has been invaluable.”
Other mental health counselors say the gap between the need on campus, and a school’s ability (and mandate) to help those students, remains vast.
Sarah Van Orman, associate vice provost for student health at USC, said “it really is a resource issue… To provide for all the mental health needs of their students, meaning long-term care…. many of our campuses would need to double or triple our staff.”
Changing the system
One way to relieve the pressure, and provide at least some help for students in need of mental health care, is to trade one-on-one counseling for group therapy. Increasingly, when appropriate, schools in Southern California are doing just that.
Kevin Thomas, a licensed psychologist at Cal State Fullerton, said group therapy previously was dismissed because students tend to shun group projects and fear opening up to peers. While Thomas said those factors are still true, he added that students who get into group therapy tend to see results. “They learn there are other people like them. They aren’t alone.”
Cal State San Bernardino, among others, offers group sessions tailored to specific campus communities, including the lesbian, gay, bisexual, transgender community; veterans, women and men.
Some schools have come up with other intervention programs intended to catch mental health issues before they escalate.
This fall, for the first time, UCLA invited all freshman and new transfer students to fill out an online survey that screens for anxiety and depression disorders. Students identified as at-risk were encouraged to use an online program to treat and prevent these disorders, and students with more serious depression were offered counseling.
The initiative, called the “Depression Grand Challenge,” is part of a wider research study examining genetic links to depression.
At the UCLA student counseling center, a team of therapists tries to manage demand with triage. Students with serious concerns, such as suicidal thoughts, substance abuse or post-traumatic stress, are seen right away. Others with less acute symptoms might wait two to five weeks.
The center has expanded group therapy. It also teaches more workshops on mental health wellness skills, such as mindfulness and self-compassion; the idea being to offer students some genuine help even while they wait for an individual appointment.
Similarly, USC is stepping up mental health wellness programs. The school’s counseling center also is setting up an “Office of Campus Wellness and Crisis Intervention” to tackle mental health related issues as they occur. The goal is to prevent students from becoming overwhelmed.
A decade ago, university officials and experts said, professors and other faculty at most schools wouldn’t have given a second thought to a student who suddenly started failing tests or missing class.
Today, faculty are told or trained to recognize when a student is in crisis. Missing classes, for example, can be a sign that a student is too depressed to get out of bed. An unexpected drop in test scores can mean a student is suffering from anxiety.
And, critically, faculty are encouraged to talk more with students and refer them to counseling when appropriate. Universities work to get students back on track, offering extra credit or make-up assignments if a mental health crisis interferes with studies.
But counselors said there is another question to consider, even as they push to help students with legitimate mental health problems: What is the balance between support and indulgence?
What if a student fails a test not because of anxiety, but because of bad study habits? Poor study habits can lead to test-anxiety, which can lead to further trouble on exams; but are universities obligated to help those students?
“We sometimes need to let students fail. That can be part of the learning process,” said Jaworski of Cal State San Bernardino. “But if a student needs help, we should offer it.”
Many universities rely on students themselves to address mental health issues.
UC Riverside employs five students, and recruits close to 30 volunteers, to assist with mental health promotion, said Mental Health Outreach Coordinator Jessica Bowes. Students make presentations to fraternities and sororities on issues such as sleep hygiene, self-care and stress management. They also staff tables at fairs and student orientations, offering information about mental health resources on campus, she said.
Then there is Active Minds, the national student-led advocacy group that focuses on mental health challenges that has chapters on many Southern California campuses.
At a recent Active Minds meeting at Cal State Long Beach, the executive board taught each other relaxation tips. One student demonstrated stress-reducing stretches. Another talked about the mental health benefits of exercise. The centerpiece of the presentation was a Buzzfeed video about finding your own stress relief.
“We advocate for students’ mental health,” said Salazar, of Cal State Fullerton. “We host different workshops and let students know about their resources.”
Related: At some schools, mental health battle includes the Bible
At UC Irvine, the student government organizes an annual “Reclaim Mental Health” conference. Academics are invited to talk about their research on specific aspects of mental health, and to host panels where students discuss mental health experiences. The event draws students from across the state.
Caroline Nguyen, 26, a social ecology major at UC Irvine, worked to launch the conference in 2015. Topics, she said, sometimes touch on community mental health issues, such as homelessness and the psychological impacts of climate change. Others focus on individual student mental-health concerns, such as surviving graduate school depression.
The conference is one of several now held at UC campuses, Nguyen said.
“Student advocacy on mental health has exploded,” she said.
Chris Haire is an Orange County Register staff writer and Claudia Boyd-Barrett writes for the Center for Health Reporting at the USC Schaeffer Center for Health Policy & Economics. Reporting for this project was supported by a grant from the California Mental Health Services Oversight and Accountability Commission.
