[deck]Overwhelmed campus counseling centers make changes to meet the increased need for mental health services.[/deck]
[cap]H[/cap]er eyes jolt open. She feels glued to the bed – a mass too heavy to move. She’s confused by this half dream, half reality. Her heart is trying to escape her chest, and sweat beads up on every inch of her immovable body.
Thinking about this stuck feeling makes her throat cinch up; now she can’t breathe. All she needs is one breath, anything to make it through this.
Alicia Lynn Walcher, a twenty-two year old University of Oregon student, has awakened to these anxiety attacks more than once. Although she was diagnosed with an anxiety disorder at age thirteen, Walcher still battles moments of trepidation.
In middle school, Walcher knew it was time for a doctor’s visit when she started suffering from bouts of dizziness and fading consciousness during class.
“I just started crying because I was so happy I wasn’t gonna have a heart attack and die at fifteen,” says Walcher, of being diagnosed with an anxiety disorder. Being diagnosed at a young age helped, Walcher explains, because she was able to learn how to manage her anxiety before going to college.
Walcher is part of a growing majority of people with mental health issues attending college. And because many students are away from home and their regular doctors, campus counseling centers become their main support system.
Many students arrive at school predisposed to mental health problems. The normal stress of classes, relationships, finances, and family can cause panic attacks to develop at any moment.
“It can be random,” says Walcher. “I could wake up one day and feel incredibly anxious, like you’re about to go skydiving.”
In a phase of severe stress, Walcher discovered the University of Oregon’s counseling center during her second year of school. After waiting over a week to get an appointment and eventually going through the maximum ten appointments, it’s now been ten months since her last panic attack.
Since the sudden surge in demand for mental healthcare, students often get scheduled weeks out, put on waiting lists, or given contacts for counseling off campus. Campus counseling centers across the nation have been adapting to the increased demand from students with extended hours, same-day appointments, and outside referrals—adapting with little increase in funding or staffing to cope with the changes.
The University of Oregon and Oregon State University’s counseling centers completely shifted appointment policies, hours, and staffing to accommodate the influx of students. In a 2008 survey of 284 counseling centers throughout the country, almost 60 percent reported a growing demand for services with no increase in resources.
Ron Miyaguchi, a senior staff psychologist at UO’s University Counseling and Testing Center (UCTC), said it became evident midway through fall term of 2010 that the increase in students wasn’t going to stop.
“The number of students coming in is through the roof,” says Miyaguchi.
“We’re turning away more students and racking our brains on how to see more students without over-stressing ourselves.”
Staff members at the UCTC have added an hour of drop-in time to their load. The trade-off for seeing more students for shorter periods, Miyaguchi says, is that they have to cut back on long-term counseling appointments.
At the same time counseling centers were beginning to notice leaps in demand around 2009, Walcher’s anxiety disorder developed a new symptom—hyperventilation.
During Christmas break, Walcher found herself in the hospital with pneumonia; something she didn’t think would affect her mental health. However the stress on her lungs, coupled with the exhaustion of being sick, brought up anxious feelings about breathing. Her first episode of hyperventilation—rapid breathing, which causes faintness and sometimes lack of consciousness—struck her when she was driving down Highway 99.
“I swerved across two lanes of traffic; I was just so dizzy,” says Walcher.
It was a miracle the oncoming cars stopped, she says, but a new fear of driving kept her out of the driver’s seat for more than a month.
“The stress level was just so high, I was becoming my sorority’s president, and I still couldn’t breathe 100 percent,” she says. “So I knew I needed to figure out how to deal with it or it was all just gonna come crashing down.”
Although she was aware of the university’s counseling center, Walcher says she assumed they wouldn’t be able to help with her specific needs. Then, a graduate student who taught one of Walcher’s courses came to her with Ron Miyaguchi’s contact information, knowing he specialized in anxiety cases.
“I thought…I’ll give it a shot. I was at a point where I didn’t know where to go; I was really struggling.”
Walcher decided to take a chance for the same reason counseling centers across the nation decided to make changes—necessity.
Oregon State University’s Counseling and Psychological Services (CAPS) also struggled to keep up with the rise in demand. The staff’s caseload exploded fall term with a 44 percent jump in the number of students coming in compared to fall 2009.
“Essentially, we’ve overhauled how we’re doing our caseloads,” says Jackie Alvarez, CAPS’s director. “We expected some increase because our enrollment increased, but we didn’t expect 44 percent. That was just like ‘surprise!’”
Caught off guard by the increase, CAPS took in two new staff members in March 2010, and hired two more part-time professionals in December. This brought the number of staff to sixteen plus three pre-doctoral interns.
“It’s hard to know whether this is a blip or if this is a trend,” says Alvarez. “It could be the stigma has decreased or it could also be there’s just an increase in the level of concern and pathology among college students.”
Another reason counselors stipulate for the incursion is the ever-growing enrollment, which is also a nationwide trend.
Between 2000 and 2008, undergraduate enrollment exploded by 24 percent. Furthermore, enrollment at degree-granting institutions jumped from 18 million in 2007 to 21 million in 2009, according to the National Center for Education Statistics.
At the University of Oregon, UCTC’s assistant director Joseph DeWitz hasn’t nailed down one specific reason for the change, but he does consider the increased enrollment to be one contributing factor.
The university saw a 6 percent increase in enrollment between 2004 and 2009. However, the number of drop-in students being seen at the counseling center during these same years jumped 17 percent, almost triple the percentage increase in general enrollment.
Whatever the reason for the new trend, DeWitz says it has forced them to look more closely at how they manage their resources.
Off-campus counselors and psychologists are resources the UCTC must utilize. DeWitz says turning away students takes the biggest toll on staff – something they have to deal with now more than ever. DeWitz adds that when you have an extremely caring staff, not being able to help every student in need just adds to the daily stress level.
Staff psychologist Miyaguchi agrees that outside referrals are a major downside to having maxed-out caseloads.
“If there’s a waiting list, it can be intimidating for students,” he says.
For Walcher, the wait was worth it. After working up the nerve to call Miyaguchi, there wasn’t an open block of time for more than a week. The first session was like a get-to-know-you appointment, Walcher says.
Then he asked her to do something she didn’t think she would ever do.
“I said hyperventilation scares me,” Walcher recalls. “He goes, ‘Okay I want you to make yourself hyperventilate,’ and I looked at him like he was actually insane.”
Although she was in disbelief at the time, Miyaguchi pushed her boundaries over the following nine weeks. Not only did Walcher trigger her own hyperventilation, she learned how to pull herself out of it. She even got behind the wheel of a car.
By the time Walcher reached the ten-week treatment limit, that was the end, she says. With no off-campus references or follow-up calls, Walcher felt severed from the counseling center.
“It would’ve felt like more of a support system that I could go to again, whereas now I feel like I have to look elsewhere if I need a support system.”
Heavy caseloads aren’t just forcing more outside referrals; they’re cutting into appointment lengths, on-going counseling, and drop-in hours.
“We’re in the process of looking at changes we can make both short and long term,” says DeWitz. “We’ll probably even look at staying open later.”
The UCTC also brought in a temporary counselor to help stave off extra stress and pressure on staff members.
Back at Oregon State, Alvarez dreads sending students off campus for problems they can address there, therefore hiring four new staff members helped balance out the caseloads. The crisis hours, or drop-in time, also changed when appointments were getting booked three to four weeks in advance. Instead, the staff is scheduling students on the day they call in—a policy CAPS switched to winter term.
“If we can get them in the same day, maybe they won’t get worse over four weeks,” says Alvarez. “I think students love it, faculty love it. I can’t imagine going back.”
She explains the same-day appointment system is most effective for both students and staff, as it cuts no-shows down to almost zero.
UO’s counseling center picked up on the same idea. Also, by recently switching to same-day scheduling for individual counseling, the UCTC has seen similar positive results, but still suffers from a backed-up waiting list. The new temporary staff has only begun to help relieve the issue.
Currently, staff and students must find understanding as they adjust to the imbalanced ratio of counselors to students. According to the latest 2009 survey of counselor directors, that ratio is 1 counselor to 1,527 students.
Walcher is thankful for Miyaguchi’s persistence and patience in coaching her through one of the most stressful periods of her life.
“Looking back, I overcame these things,” says Walcher. “I have skills now from therapy about how to deal with certain situations, like driving.”
Now, Walcher prepares to present her senior project – a video presentation for her family and human services program. She has to stand up and speak in front of a hundred people. While thinking about walking to the front of the room, with all eyes on her every move, Walcher feels her nerves tingling. But she takes a calming breath, contains her thoughts, and remembers she can do it.