Continuum

Midway through fall semester of her junior year, MacKenzie Bray was tired—bone-shatteringly tired—of feeling like she was going to die. Her heart was racing, and she was sweating and shaking uncontrollably. It felt like a heart attack. And it wasn’t the first time. In fact, it was happening daily, and medical doctors couldn’t find a physical cause. Symptoms would hit her on buses, in classrooms, or while driving. “I would get this feeling of impending doom, like something’s wrong and I have to get out of here right now,” she says, so she would rush off the bus or leave abruptly in the middle of class. “It was interfering with so much every day.” Afraid the attacks might make her pass out while she was driving, she stopped driving home to her parents, who lived only an hour away. “It got to the point where I thought, I just can’t do this anymore.”

So on that October day, she typed “University of Utah therapy” into her computer… and found the University of Utah Counseling Center and a pathway out of her personal torment.

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MacKenzie’s story is far from isolated. In fact, the growing number of college students being seen for mental health concerns, such as anxiety, depression, or self-harm issues, is sounding alarms nationwide. In 2014, the annual National Survey of College Counseling Centers, in which the University of Utah participates, revealed that 94 percent of college counseling center directors are seeing a steady increase in students with severe psycho-logical problems. A spring 2014 survey by the American College Health Association showed that 14.3 percent of college students were diagnosed with or treated for anxiety problems (up from 10.4 percent in fall 2008), and 12 percent were seen for depression (up from 10.2 percent in 2008). Still another 2014 report, from the Higher Education Research Institute, found that 59 percent of college seniors had felt depressed, and 35 percent had sought personal counseling in their senior year.

This growth is evident at the University of Utah. According to Lauren Weitzman BS’84, director of the University of Utah’s Counseling Center (UCC), the number of students seen in initial “intake” sessions last year (2014-15) rose 13 percent over the previous year. And the total number of students they saw in sessions of direct service rose 14.6 percent, from 1,240 clients to 1,421, continuing a decade-long trend for growing demand at the UCC. More worrying is that the numbers show increasing severity in the mental health issues students struggle with. Last year, 26 percent of their clients reported self-harming behaviors, and more than one third indicated they had thoughts of suicide, with almost half of those serious enough to require intervention. Meanwhile, UCC staff logged 70.8 percent more hours in direct crisis intervention services than in the previous year. As for referring students for hospitalization due to significant mental health reasons, Weitzman says, “It only used to be one or two people for a whole year.” But in the first six weeks of Fall Semester 2015 alone, the UCC referred four students for hospitalization. “These trends are sobering.”

They are so sobering, in fact, that in October 2014, University of Utah President David Pershing emailed the entire university faculty and staff, reminding them to be alert for signs of distress in their students and to “be prepared to refer them to campus resources designed to provide expert help.”

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MacKenzie picked up the phone and was soon sitting in a UCC therapist’s office. By the end of that first appointment, the therapist had identified MacKenzie’s attacks as a panic disorder. She was confident she could help MacKenzie understand what was happening to her and learn to manage it. “I was bawling in that first intake meeting,” says MacKenzie. “I had a feeling of great relief. I remember that bus ride home—I thought, this is the first time I’ve felt okay in four years.”

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What the numbers don’t show is why more college students are being seen by mental health professionals than ever before. Are today’s students really in worse shape, mental-health-wise? Or are they simply more willing to seek help, so that they are finally being tallied?

Lauren Weitzman

Recently, the stigma surrounding common mental health issues such as depression and anxiety—while certainly not lifted—has been lessening. Psychologists, talk show hosts, and celebrities are slowly chipping away at barriers that discourage people from getting assistance. Our society is finally, albeit in baby steps, making it easier to ask for help. “I feel that with more and more people seeking mental health support, we’ve normalized that help-seeking behavior,” says Katie Stiel MEd’10, program manager for the Center for Student Wellness. Tony Kemmochi MS’05, prevention and outreach coordinator for the UCC, agrees: “One reason why [we’re seeing an increase in mental health issues] comes from a positive change. Mental health care is more accessible.” Many students are getting help earlier, too, so more are finding it possible to enter college in the first place, and more are entering college already on medication. In fact, 86 percent of counseling center directors in the 2014 National Survey of College Counseling Centers reported a steady increase in the number of students arriving on their campus already on psychiatric medication. At the UCC last year, says Weitzman, “Fifty-six percent of our clients had utilized mental health services previously, and 40 percent had taken medication.”

So today’s students may not necessarily be more distressed than students in the past, those on the ground say. We may just finally be seeing a truer picture of how widespread mental health concerns actually are among students.

Either way, President Pershing views the numbers as a call for action, saying, “We consider it a good sign that more students are utilizing valuable resources when they struggle with depression, anxiety, unexpected loss, or trauma.” Battling mental health concerns can greatly affect a student’s ability to study, learn, and even remain in college, he and others acknowledge.

According to Christine Contestable PhD’10, a Student Success Advocate acting under the U’s Student Success and Empowerment Initiative, the U’s goal isn’t just to help students graduate with the required credentials, but also to help them “have a more meaningful, transformative experience while they’re here.” Letting students fall through the cracks because of anxiety, depression, or the emotional ramifications of a family tragedy runs counter to both goals. That’s why the U is reaching out, normalizing help-seeking behavior, and helping students navigate through their issues to success.

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Over the course of eight counseling sessions, MacKenzie learned why her body reacted physically to stressful situations. “I realized what would work best for me, and what my triggers are.” Her counselor soon had her riding buses, for short distances at first, building up a sense of control. Then they tackled driving on the freeway—at slow times first, then gradually working up to rush hour. Relatively quickly, MacKenzie was able to recognize “this is what it is, and this is how you can control it and not have it control you.”

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The UCC, located within the Student Services Building, is the primary hub for clinical mental health resources at the U. Its permanent clinical staff consists of 12 professionals—psychologists and clinical social workers—and, for limited hours each week, a psychiatrist. Together with about two dozen clinical trainees, they provide developmental, preventive, and therapeutic services to the University’s 31,000 students.

Katie Stiel

“Our top three reasons why students say they are coming here are always anxiety, depression, and stress,” Weitzman explains. “The big question is, why are people more anxious and depressed?” Weitzman says theories include a modern parenting style that doesn’t encourage resiliency, increasing feelings of isolation, too much interaction with technology instead of the outside world, and even a societal shift from internal values (such as altruism or volunteering) to external values (bigger houses and nicer cars). “We’re still trying to sort that through, but the reality is, for whatever reason, the severity seems to be increasing.”

The UCC’s services include counseling sessions, anxiety-reducing workshops at the Mindfulness Center, and couples counseling. If a student requires more intensive treatment, counselors help the student access off-campus resources.

Across campus in the Eccles Student Life Center, the three staff members of the Center for Student Wellness (CSW), plus one full-time victim advocate, focus on educating the student population on health and wellness issues. “We are the outreach and education arm of the Counseling Center and Student Health Center,” says program manager Stiel. The CSW partners with university departments and student leaders to provide skill-building workshops or programs for their members. Armed with data identifying stressors that impact students’ academic abilities, Stiel says, “We could go to the Personal Money Management Center and say, ‘Hey, finances was No. 9 [on our list]. Can we partner with you on an event?’ ” Or she might offer, “Let’s do a stress reduction workshop” or “What does your community need?”

The CSW doesn’t provide clinical help themselves, but they act as a clearinghouse, connecting students, faculty, and staff to health and wellness resources on and off campus. “In our office, we just want to encourage students to reach out,” says Stiel. “Reach out now, before you’re freaked out and panicked and so overwhelmed that you can’t function.”

Another resource for U students isn’t found in an office at all. Instead, the eight Student Success Advocates carry their offices in their backpacks while they walk around campus meeting students. Their objective? To connect students with resources that can “help them get the most out of their time at the U by making use of the amazing opportunities here,” says Contestable. The Student Success Advocates make themselves available at different places on campus every day, introducing themselves to students and discussing what they need to be successful. While that can mean help landing an internship or advice on applying for a scholarship, Contestable says they may, at times, encounter students struggling with mental health issues. Like the CSW, the advocates are plugged into the U’s web of resources. “That may include making contact with the Counseling Center, the Women’s Resource Center, the LGBT Resource Center, or the Center for Ethnic Student Affairs,” says Contestable. “We are reaching toward them instead of hoping they find resources on their own.”

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Now a senior, MacKenzie says her panic attacks occur only once or twice a month these days, and they’re less severe. “Knowing that I’m not dying and I’m not going to pass out, it’s much easier to deal with,” she says. “Now I’m not scared of getting them anymore.”

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The UCC, the CSW, the Student Success Advocates—all three echo the importance of outreach. “Traditionally, we sat back and waited for students to come in,” says Kemmochi. “Now we’re doing outreach to proactively find those students.” Whether it’s walking up to students in the library, sponsoring a Wellness Fair, speaking at New Student Orientation, blasting out stress-reduction advice on social media, adding resources to mobile apps, or handing out bookmarks printed with tips on getting a good night’s sleep, the organizations tasked with helping students are finding new ways to present a visible face on campus, making it easier for students to find support.

Christine Contestable talks with a student in the Olpin Student Union.

Still, they can’t make individual contact with every student. That’s why the U’s faculty and staff are an essential link in the support chain. They are often the first to notice signs of a student in distress, whether it’s out-of-character behavior in class, disturbing topics in a homework assignment, or a student suddenly opening up during a discussion. “Those are like our inside people,” says Stiel. “To get their buy-in is really important, because they’re seeing students in their own environment.” Weitzman and Stiel, in collaboration with the Dean of Students office, produced a presentation that guides faculty and staff in recognizing distress, listening and communicating, and referring students to campus resources. In addition, the UCC provides liaisons to every academic department, so that faculty and staff have a personal contact they can approach for advice. President Pershing also encourages faculty and staff to be willing to step in, saying, “Those of us who interact daily with students must stay attuned to warning signs they may exhibit when experiencing severe distress.”

Says Stiel, “We tend to think it’s none of our business to ask these kinds of questions, but we’re here to develop students and be resources to them in their quest for academia. Our sole purpose is to help students graduate, and that sometimes requires us to be uncomfortable, especially with health and wellness topics.”

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Because of her UCC counseling, MacKenzie says, “There are a lot of things I’ve done that I would not have done before.” She ran in the Ogden Marathon last spring, just months after finishing therapy. At mile 15, she had a panic attack but talked herself through what she was feeling. Deciding the attack was just her body assuming she was running because something was wrong (the “fight or flight” reaction), she told herself, “I’m just going to try to get to mile 20. If I get to mile 20, then I’ll be fine.” She made it all the way to the finish line.

The next day, she left for a study abroad course in Austria. Flying alone and leaving the country for her first time, she wasn’t surprised when another attack happened. “Before, it would have been, ‘Turn the plane around, I need to go home! Something’s terribly wrong with me!’” she says. “But it’s that whole thing of ‘get comfortable with being uncomfortable.’ ” Once MacKenzie accepted that she would be uncomfortable until she settled into her new routine abroad, she was able to manage her body’s response and keep moving forward. “That was kind of life-changing.”

Learning to manage her panic disorder has given MacKenzie new confidence in her own strength, even in situations that are stressful for anyone. “I don’t mind giving presentations in class anymore, because my heart will be pounding, but I’m like, ‘I’m used to this, I can deal with this.’ I won’t say I like the panic attacks, but they made me realize something good can come from this.”

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MacKenzie Bray

While some of the recent statistics from the UCC are alarming, others show promise. According to Weitzman, 47 percent of the UCC’s clients say counseling has helped them increase their academic performance, and 70 percent say counseling has enhanced their U experience. And of the 29 percent of clients who indicated they were thinking of leaving the U before they entered counseling, 70 percent said counseling helped them stay.

“I think we should step into the reality that mental health and wellness are a big factor of our college students’ success,” says Stiel. “We know if they’re feeling well, they’re going to do well, and don’t we want them to do well? That’s the whole point of college, right?”

—Kelley J. P. Lindberg BS’84 is a freelance writer based in Layton, Utah.

Read the bonus sidebar “Social Media—Hurting or Helping?” here.

Links to resources: http://counselingcenter.utah.edu/, http://wellness.utah.edu/