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March 17, 2016

MENTAL HEALTH: Counseling Center plans changes to cope with increased caseload

Handsome student in pain having a headache in school

The University Counseling Center plans to expand its counseling staff by nearly 50 percent this summer, due to a student usage rate that is significantly outpacing the national average.

Growing use of counseling centers has been a nationwide trend, according to the annual survey of the Association for University and College Counseling Center Directors. The latest results, from 2014, show that campuses with 25,000-30,000 students provide services to a median 1,466 students per year. The trend peaked in the previous year, at 1,616, rising from 1,591 in 2012 and 1,474 in 2011.

But on the University’s Pittsburgh campus, which has 25,464 full-time undergraduates and graduates, according to the most recent Pitt Fact Book, about 2,500 students use Counseling Center services annually, reports Kenyon Bonner, vice provost and dean of students. Pitt’s Counseling Center has 89 percent more client sessions per year than the national average (16,361, compared to 8,652).

But this higher rate can be seen, at least in part, as a positive sign, according Bonner and Counseling Center head Ed Michaels. In 2008, the Office of Student Affairs began the “Talk about it” campaign, an effort aimed at reducing the stigma of mental health issues and promoting awareness of Counseling Center services.

“In a large part, on our campus, because we’re so open about it, more students are utilizing our services,” Bonner says.

The Counseling Center’s move to Nordenberg Hall, when the residence facility opened in fall 2013, also spurred an increase in counseling clients, since the center became both more visible and more convenient for students.

The Counseling Center offers individual counseling every other week and group counseling weekly, focusing on goals students might achieve in five-eight sessions. These sessions are covered by the wellness fee that students pay each semester, without the need for additional insurance coverage. For more intensive problems and issues that require hospitalization, students are connected with other community resources. To direct students to the right source of help, the Counseling Center holds workshops on topics that are common college stressors. Last month the center presented “How to tell if a friend is struggling and how to help” and “Suicide: The myths, the facts and the resources,” while earlier this month it held “Self-care: The importance and strategies.” The workshop “Cracked not broken: A suicide attempt survivor’s unforgettable story of hope” is set for 3-5 p.m. on April 10 in the O’Hara Student Center ballroom. The speaker is Kevin Hines, who attempted suicide by jumping off San Francisco’s Golden Gate Bridge and now is a suicide-prevention lecturer.

Pitt plans to add six more staff positions — social workers, counselors and psychologists — to bring the clinical staff up from 14.5 full-time equivalent (FTE) employees to 20.5 FTE. Advertisements for two psychologists and a counselor currently appear on Pitt’s Human Resources website.

Michaels acknowledges that clinicians may make more money in private practice, but he says the University hopes to attract new Counseling Center hires who understand the satisfaction of working at a university and the particular gratification of helping students.

To further optimize counseling resources, Michaels adds, Pitt is contracting with Protocol, which will provide after-hours telephone support to those who contact the Counseling Center. Protocol staffers work with other major university counseling centers in the U.S.; their staff members are able to speak with students to offer both immediate help and to identify follow-up steps. The move will free up Pitt’s counselors, who currently are on call for overnight problems, to better handle issues during regular Counseling Center hours.

Pitt counselors still will be on call to assist Protocol if the need arises, Bonner says.

“How do we maximize the level of service to students?” Bonner adds. “It’s really difficult to do it when counselors are up all night dealing with emergency services.”

He recalled his days as a resident director in his college dormitory, when overnight student difficulties made it tough to handle his duties the next day.

For release this summer, the Counseling Center also is preparing a new scope of practice. It will, according to Michael, “put into writing our priorities and in particular our determination that Job One [is] the identification of what student needs are” — and then pinpointing how best to serve those needs by using Counseling Center or other community resources.

“Our philosophy is: We connect them to those resources,” says Bonner. “We don’t just give them a sheet of paper: ‘Find these resources, good luck.’” Counseling Center case managers then follow up with students to direct them to the most appropriate help and aid in the progress of their treatment.

Is Pitt’s Counseling Center used so heavily because more students are asking for help on more minor issues, or because more students are asking for greater amounts of help with more severe problems?

“It’s all of the above,” says Bonner. According to the Association for University and College Counseling Center Directors’ 2014 survey of 497 counseling center directors: “Anxiety continues to be the most predominant and increasing concern among college students (47.4 percent), followed by depression (39.7 percent), relationship problems (33.7 percent), suicidal ideation (18.2 percent), self-injury (12.1 percent) and alcohol abuse (8.5 percent).”

A quarter of students seeking counseling services had been prescribed psychotropic medications, the survey found.

Statistics compiled by the Center for Collegiate Mental Health at Penn State show that, 2012-14 rates for problems and experiences among those seeking help at 350 college counseling centers remained steady:
• 48 percent had received prior counseling;
• 33 percent had received prior psychiatric medication;
• 10 percent had previously been inpatients at a psychiatric facility;
• 35 percent reported “I have thoughts of ending my life” in the previous two weeks;
• 13 percent reported “I have thoughts of hurting others” in the previous two weeks;
• 33 percent had experienced harassing, controlling and/or abusive behavior(s);
• 27 percent had felt the need to reduce alcohol or drug use in the past;
• 17 percent had reported others expressing concern about the student’s alcohol or drug use in the
• 4 percent had received prior treatment for alcohol or drug use;
• 24 percent reported self-injurious behavior(s) in the past;
• 31 percent reported they seriously considered attempting suicide in the past;
• 9 percent had made a suicide attempt in the past;
• 11 percent had considered causing serious physical injury to another person in the past;
• 3 percent had intentionally caused serious physical injury to another person in the past;
• 19 percent had experienced unwanted sexual contact(s) in the past.

In addition, says Michaels, “There is a trend line nationally … the last three-five years especially: a gradual increase in student demand for counseling that is reflective of the fact that they are finding life in college more stressful.”

However, he adds, there has been no research to pinpoint whether life at Pitt in particular has become more stressful as it becomes harder to gain admittance, or that Pitt students’ stress level is higher or lower than levels for students at other schools.

But it’s also true that in 2016 it is easier for those with a history of mental health issues to gain admission to a college and live independently than it was in years past, Michaels says.

Pitt’s Counseling Center is making greater effort to speak with freshmen about connecting to resources, making new friends and managing their time, he says. Some new students need to have more realistic expectations for college life, he adds: how they will handle their new independence, the increased schoolwork load and the likelihood that they may not earn as many A grades as they did in high school.

“College in and of itself is stressful,” Bonner allows. “When students have higher expectations they tend to put more pressure on themselves.”

Students who grew up with social media, he adds, also may have an unrealistic notion of what life is like for others. When they see the positive version of life that others post as pictures and emoticons on Facebook, they may not realize that others are experiencing struggles just as they are.

“We fell away from the power of human interaction,” he says. “If you grow up thinking that everyone’s life is a highlight reel, then reality hits you. That creates additional stress and, quite frankly, increasing stress.”

Neither Bonner nor Michaels believes that helicopter parents coddling students is a cause for concern. Although such over-involvement could present problems, overall “we want parents to be involved at the appropriate level,” Bonner says. “We welcome parents. If parents reach out and say, ‘I’m concerned about my student,’ that’s helpful. It’s another set of eyes and ears … if the student is okay with that.”

Bonner recalls his own days as a college undergraduate: “Thinking about it, there were times when my friends should have gone” to the college counseling center, he said. “But we just talked it out. There were even times when I should have gone. We didn’t even know about the counseling center.

“Our job now is to see that we have the resources to respond to increased demand.”

—Marty Levine

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