University Times

College counseling centers nationwide report a significant increase in the number of students with severe mental health problems, and Pitt is no exception.

The trend is documented in an annual survey of counseling center directors conducted by Robert P. Gallagher, associate clinical professor in administrative and policy studies at Pitt's School of Education.

The rate of counseling centers reporting an increase of clients with severe problems has been growing steadily since he first asked the question on the 1990 survey, Gallagher said. "The rate in 1990 of 50 percent has grown to 85 percent this past year of counselors reporting an increase over the prior five years of clients with severe problems. This puts a lot of pressure on counseling center staffs."

Among the severe psychological problems suffered by counseling centers' clientele are on-campus sexual assault concerns, problems related to prior sexual abuse, learning disabilities, alcohol and drug abuse, self-injury and eating disorders.

Since 1981, Gallagher has authored the annual "National Survey of Counseling Center Directors," a publication of the International Association of Counseling Services, Inc. The survey, which measures trends in counseling centers, polled 274 counseling center directors, including 91 from colleges such as Pitt with more than 15,000 students.

Gallagher headed Students Affairs from 1996 to 2000. Prior to that, he headed Pitt's Counseling Center for more than 25 years. He now works in the University Counseling Center one day a week as an adviser to counseling interns.

"I think the increase in severe problems is due to a combination of a number of factors," Gallagher said. "One, colleges are much more open now with respect to enrollment. Two, students are accepted who are already on medication or have been in counseling and expect that to be continued. Three, colleges really are becoming a referral place; mental health professionals want to put clients in a university setting where they can get support, maybe to get them out of a bad family situation. We pick up a lot that way."

Penny Crary, who succeeded Gallagher as director of Pitt's Counseling Center, said the increase in severe problems is a concern for her as well. "I would say lack of the proper parental attention that children need is a big factor in the increase of mental health problems of all kinds, particularly severe ones. There is also a lack of referral services, and, certainly, the diminished community mental health resources are factors that put pressure on college counseling centers.

"I would describe our caseload at present as manageable," she said. "But one of the problems with the increase in clients generally is that it limits our other programs. The Counseling Center is responsible for outreach to the University community, for making presentations and workshops. And, unfortunately, we just don't get to do as much preventive work of that kind as we would like."

Staffing shortages also are a concern, Crary said. "Even though we were able to increase our staff by one, two years ago, the demand for services has increased at a rate greater than the number of staff we've been able to hire."

Currently, Pitt's center has 12 full-time counseling staff, one part-time consulting psychiatrist and four full-time predoctoral interns, Crary said. The student to counselor ratio is 1 to every 2,180 students, which, according to the survey, is slightly better than the average school of 15,000 or more students (1 for every 2,239 students).

"On the other hand, I know we can't just be expecting to increase staff all the time," Crary said. She said that to cope with increased caseloads the center has adopted some strategies. One is to have a 12-session per student annual limit, with some flexibility depending on the case.

According to Gallagher's survey, 44 percent of centers limit client sessions per student and an additional 38 percent encourage such limits. The average number of sessions per client is 5.2 nationwide.

Another strategy at Pitt, Crary said, is to spread out the time between sessions for less severe problems.

A third strategy is to urge clients to join group therapy sessions focused on common problems, such as relationships, bereavement and family issues.

"Although it is not popular, we really try to promote a group therapy culture, where it is appropriate," Crary said. "Who better to talk with about relationship problems than men and women who have similar problems? You know, people often have the wrong idea about group therapy, that it's people screaming at each other, or it's like the 'Bob Newhart Show' with crazies everywhere. Usually, after a few individual counseling sessions, we can break down those stereotypes and clients see the benefit in trying group therapy."

Both Gallagher and Crary stressed that a high percentage of clients at Pitt and nationwide — as many as 80 percent, Gallagher estimated — are normal people with normal problems, such as self-identity issues, homesickness, roommate disagreements, relationship break-ups, test anxiety, stress.

"The top three reasons clients come in [at Pitt] are depression, anxiety and relationships," Crary said, all of which can be severe, but most of which are not.

"At Pitt, counseling started with services that were primarily career development services, which is typical," Gallagher said. "Now the situation is reversed: 75 percent of work at counseling centers nationwide deals with psychological problems, only 25 percent career problems. Career services are moving over into specialized placement services. And while, for example here at Pitt [admissions] standards are increasing, psychological problems are really not related to intellectual capacity.

"There's also more acceptance generally to counseling," Gallagher continued. "Over the last several years there is a growing awareness of the importance of these services. There is less of a stigma to talking with a counselor. If you go back 25 years you rarely heard about sexual abuse, for example. And at one time, you would never share that — anywhere with anyone. Now there are TV shows and psychology classes."

According to the survey, students with severe psychological problems are a concern for 84 percent of counseling centers. Indicators of the severe problems facing counseling centers include:

* 89 percent of counseling centers had to hospitalize at least one student for psychological reasons (1,135 students in all);

* 30 percent of schools reported an enrolled student suicide in the past year (80 in all);

* 60 percent of centers had at least one case of an obsessive pursuer (347 cases in all; 50 persons were injured and 5 were killed).

Other major concerns of counseling center directors include the growing demand for services with no increase in resources or reduced resources (62.7 percent), and the need to find better referral sources for students who need long-term help (59 percent).

"At one time it was easier for counseling centers to refer students needing long-term intervention to community mental health centers, but these programs are bursting at the seams," Gallagher said. "If a student comes in from out-of-state or from another country and doesn't have the insurance to cover mental health care, it is very hard to find external help for them."

Colleges take different tacks in dealing with severe mental health problems, depending mostly on their resources, Gallagher said. The survey indicates that 90 percent of centers, including Pitt's, reserve the right to deny service to a student whose problems are beyond the center's treatment capabilities.

Pitt's consulting psychiatrist, who treats the most severe problems, is "booked solid," Gallagher said. "We try to establish early on with a client that the problems are long term, to avoid a client's forming a bond with a particular counselor. We try to refer to outside services, including private practice, where the student is covered by insurance. Sometimes, we even have to suggest to an out-of-state student to go home, to go to school there where insurance will cover services. And, occasionally, we have had to hospitalize students against their will."

–Peter Hart