America’s College Mental Health Crisis

By MARISA COHEN

Randi*, a 20-year-old basketball player from Nashville, had struggled with depression for a few years before she left for college in 2019, but the abrupt switch to remote classes at the onset of the COVID pandemic in March 2020 – and then the return to a completely different college experience later that fall – threw off any semblance of stability.

“The implementation of confusing hybrid classes and isolation from most of the student body really made my mental state tank,” Randi recalls. “I found that I couldn’t get out of bed, I wasn’t eating, and I was starting to slip into a really jarring pattern of self-destructive thoughts and behaviors.”

Randi started to consider what her life would be like back on campus for the spring semester, with COVID rules still in place, the pressure of her pre-med track accelerating, and, most importantly, what she knew would be limited access to mental health services at her school, which was seeing an unprecedented demand during the pandemic for the few therapists available on campus. She made the difficult decision to take a medical leave and spent the following year at home focusing on her mental health.

As the COVID-19 pandemic stretches into its third year, it’s no secret that the social distancing, fear of illness, and constant disruptions to our daily routines have taken a major toll on our collective mental health (the CDC reported that rates of anxiety and depression had nearly doubled 1 year into the pandemic). But there is one group the pandemic has hit with a particularly vicious wallop: college students. As Sam*, a junior who has spent the majority of his collegiate experience masked, getting biweekly nose swabs, and worrying about getting sick said, “Things that I took for granted – living independently, in-person friendships, and a moderately predictable future – were taken from me in the blink of an eye.”

A review by Yale University researchers published last month confirmed that over the course of the pandemic, there was a steep rise in the percentage of college students who experienced moderate to severe depression, anxiety, stress, and posttraumatic stress disorder (PTSD).

This follows the findings last year by the University of Michigan’s Healthy Minds Study, which surveyed more than 32,000 college students across the country and reported that 39% reported some level of depression, and 34% had an anxiety disorder. According to the same report, almost a quarter of the students were taking medication for mental health issues, including antidepressants and anti-anxiety meds. And even those who did not fit the clinical definition of depression were not feeling great – 60% agreed that in the past year they needed some help for emotional or mental health problems.

Life, Interrupted

Imagine jumping into a new life – one filled with parties, sports, fascinating classes, and new friends, but also the hurdles and challenges of a major life transition – and then having everything come to a screeching halt. Imagine working hard for years to get accepted to college only to have the experience look completely different from what you had expected, right at the moment you’re supposed to become more independent and chart a path for your future.

“I had struggled with depression in my early high school years, but I was able to mostly overcome it by the time I graduated,” says Sam, who is from a lower-income family in the South and spent the fall of 2019 adjusting to the culture of his elite Massachusetts college. Yet when the entire student body was abruptly sent home in March 2020, that cloud of depression descended again. “I felt like I had lost any sense of connection that I tried so hard to create. Coming back to school the following fall certainly helped, but the depression has remained, ebbing and flowing throughout the pandemic,” he says. “As someone who seeks control of my future, the pandemic has left me feeling utterly helpless.”

Stories like that – a feeling of hopelessness, an increase in anxiety, complete uncertainty about the future – have been heard across college campuses throughout the pandemic. “Our college students are facing a challenge that could not have been imagined just a few short years ago,” says Molly Ansari, PhD, an assistant professor of counseling at Bradley University in Peoria, Il. “The combination of remote learning, restricted social gatherings, mourning the loss of the college experience that was expected, plus depression and anxiety can be a recipe for disaster.”

The Center for Collegiate Mental Health at Penn State (CCMH) surveyed 43,000 students who sought counseling and asked them how COVID had negatively affected their life: 72% cited issues with mental health, 68% said it decreased motivation, 67% talked about loneliness, and 60% mourned their missed experiences or opportunities.

A Challenging Age Even in the Best of Times

This is not to say that the COVID-19 pandemic is solely responsible for the staggering rates of depression and anxiety among college students: Even before anyone ever heard of social distancing or Zoom, the college years have been a fraught time for mental health. “The transition to college can bring a lot of new stressors, such as living independently from family, forming new friendships and relationships, and facing greater academic challenges,” points out Daniel Eisenberg, PhD, professor of health management and policy at UCLA and co-author of the Healthy Minds Report, who reports that the rates of depression and anxiety symptoms among college students has been rising substantially since 2011, doubling by 2019, and rising again during the pandemic.

“The most significant concerns we’ve seen from students related to the pandemic are experiencing the loss of loved ones and financial difficulties,” he adds. In addition, changes in the brain during adolescence make the teen years a peak moment for the onset of mental illness, including depression, anxiety, and substance abuse.

Looking for Help, but Not Finding It

Adding to the pandemic mental health crisis is the inability of many colleges to keep up with the increasing demand for counseling services. From small, private colleges to large state schools, student newspapers are reporting that students are finding many barriers to accessing mental health care. A new report the CCMH released in January found, not surprisingly, that counseling centers with the highest number of students seeking care were able to provide fewer sessions for students in need–even those with critical concerns such as suicidal thoughts and survivors of sexual assault–than colleges that had lower caseloads. It’s possible, says the report, that those students received help through counseling outside of their college settling.

Sam reports that he started seeing a school-provided therapist during the fall of 2020, when he returned to campus. “They were certainly helpful, but there was such a demand for them from other students that the appointments were short and infrequent.” According to the CCMH report, the average number of counseling sessions for students at college centers last year was 5.22, showing that they are set up for short-term crisis support, but not the long-term, continuous care students with more chronic concerns might need. “Over the past 2 decades college counseling services have experienced a well-documented soaring demand for services, while the capacity to treat the growing number of students seeking care has not been equivalently increased,” the CCMH report said. “This trend has caused distress for nearly all stakeholders and generalized assertions that institutions are experiencing a mental health ‘crisis.’”

Adding to the complication is that when a student lives in one state and goes to college in another, they often need to switch between two therapists (who may not be licensed in both states) and toggle between providers to write prescriptions for antidepressants or other meds.

Grace*, a student from South Dakota who attends college in the northeast, says, “Accessing mental health services has been really difficult during the pandemic, especially when we were away from campus. I had weekly therapy appointments at my college when I was a freshman, but I was not able to continue those appointments remotely when we were sent home, and I have not been able to get into a regular therapy regimen since, despite my best efforts.”

The pandemic has ultimately brought to light a problem that has been growing over the past decade, Eisenberg says. “I think the pandemic has accentuated what has been a major public health challenge for many years: a large portion of students, and young people in general, are experiencing significant emotional distress, and our support systems are struggling to keep up.”

Hope for the Future

The good news is that, like everyone who has learned to go to the gym in a mask or attend a birthday party over Zoom, the college mental health community is learning to adjust, too. “After a difficult initial adjustment period, many of the centers were able to offer teletherapy by videoconferencing or phone,” Eisenberg says. Many centers have also offered more options, such as self-guided digital programs or have contracted with outside teletherapy providers to make additional counselors available to students.

In another positive shift, the stigma against seeking therapy or taking psychiatric medications has vastly diminished in today’s cohort of college students. “Over time, we’ve seen a decrease in negative attitudes regarding mental health treatment, to the point where now the vast majority of students report very favorable attitudes,” Eisenberg says. “This is a strength of today’s generation of students – many of them are very knowledgeable and comfortable with the idea of mental health treatment.”

This is clearly a crisis that started before the COVID-19 pandemic and will likely continue even when weekly nasal swabs and face masks in college colors become a relic of the past. Hopefully, the lessons that we’ve learned will lead to better options for students in crisis in the future.

A year later, Randi finally felt well enough to return to campus. Though she is still taking it day by day, she is hopeful things will get better. “What has really helped was the medication, therapy, emotional support from my family and dogs, and immersing myself in things I used to love to do, like reading and baking,” she says. “I spent a lot of time at home building good habits. So far, my workload combined with my focus on mindfulness appears to be sustainable.”

*Last names have been withheld to protect the privacy of students.