Colorado universities strain to keep up with students’ ever-increasing demand for mental health resources

Kori Heidelberg’s bulimia worsened during her freshman year at Colorado State University.

The first-year college student was assured her student fees paid for a wide range of mental health supports on campus, so she called the CSU Health Network and explained she was struggling with an eating disorder.

“I was excited that I didn’t have to go through my parents. I could just do it myself,” Heidelberg said. “But when I called, they said they didn’t really have the resources for helping me with an eating disorder, and they recommended me to an off-campus treatment center. But that didn’t end up taking my student insurance.”

Heidelberg emailed the CSU president’s office, explaining she didn’t get the help she had needed for her eating disorder on campus. She never heard back.

Two years later, during her junior year, Heidelberg was hospitalized for her mental health twice. She checked herself into a local hospital in October, and again in November after a suicide attempt. Heidelberg said the hospital alerted CSU about her stay there, but said the college didn’t reach out for a counseling appointment until weeks later.

“I felt really hopeful coming out of the hospital,” Heidelberg said. “I was told they had talked to CSU and I was going to get the help I needed, but I feel like CSU failed me a little bit.”

Universities across the nation are trying to figure out how to keep up with an ever-increasing demand for student mental health services, said Brett Scofield, executive director of the Center for Collegiate Mental Health. The center is a research network at Pennsylvania State University that collects de-identified data from nearly 700 college and university counseling centers, including multiple Colorado institutions.

The average demand for college counseling center services across the country grew at least five times faster than average institutional enrollment from 2009 to 2015, according to the center’s 2015 annual report. Colleges have experienced year-over-year increases in demand for college mental health support services for decades, Scofield said, including leading into the pandemic.

Around 25% of people 18 to 24 surveyed by the Centers for Disease Control and Prevention in 2020 experienced thoughts of suicide. And Colorado has among the higher prevalences of mental health issues and lower rates of access to care in the nation, according to the 2021 State of Mental Health in America report.

During the pandemic, the Center for Collegiate Mental Health said those climbing demands for support services saw a dip nationally, likely due to COVID-related obstacles such as remote learning and barriers to telehealth.

With students flooding back to Colorado campuses as COVID-19 cases have fallen, local college counseling centers report they’re back to seeing an influx of students.

“If everybody who needed or sought services was going to be treated, it would take huge numbers of therapists and counselors and things, so most places don’t have the resources to build a center that can accommodate everybody’s needs at all times,” said Lori Lynn, executive director of Colorado State University’s health network.

In response to Heidelberg’s story, the CSU president’s office said in a statement that it “regularly monitors email and other forms of communication for issues that arise within the CSU community. When appropriate, the Office of the President will refer the email to the proper CSU office for review and action as deemed appropriate.” It wasn’t clear whether that happened in Heidelberg’s case.

Heidelberg ended up dropping most of her classes this semester to focus on getting better, but that also meant losing her student insurance.

She’s now searching for a therapist outside the university she can afford.

Staffing shortages

Colorado universities are feeling a strain on their resources as hiring constraints and a generational shift toward mental health acceptance means counseling centers are busier than ever while sometimes understaffed. Wait times for one-on-one counseling appointments can be weeks out, experts said.

These local institutions have been forced to innovate by using group therapy, student-therapists in training, risk assessment that prioritizes who requires attention first, and partnering with outside mental health providers.

“With the uptick of people requesting services, it has put a strain on our system,” said Michael LaFarr, executive director of University of Denver’s Health & Counseling Center. “There is no question.”

The private Denver university serves about 12,000 students and employs seven full-time counselors and has three unfilled positions.

LaFarr named a number of ways DU has adapted to better meet students’ mental health needs.

When the pandemic hit, LaFarr said DU trained all of its therapists to use telehealth technology. They partnered with LifeWorks, a third-party platform offering students 24-hour phone access to a licensed therapist they can text. The university is also utilizing its fleet of about 50 master’s or doctoral-level student-therapists-in-training, LaFarr said.

However, the position to oversee those student therapists, who require expert supervision as they practice their skills, has been open for more than two years, he said.

“We have not been able to identify a qualified candidate for that,” LaFarr said. “Clinicians are feeling burned out. We have a number of positions we’ve had open for months. We’ve had to pull some of our full-time senior staff to fill that role in order to ensure excellent supervision, but that means those people I’m pulling away can see fewer students, and I’m taking them out of direct clinical care.”

CSU’s Lynn said there is a lot of talk in the profession about how university counseling centers are never going to be able to hire their way out of the predicament they find themselves in.

“It’s really trying to figure out how do you most effectively use the services you have and move beyond just counseling. It’s making it a much broader campus-wide initiative, and I think we’re moving in that direction,” Lynn said.

Scofield, of the Center for Collegiate Mental Health, said he hears the argument that centers can’t hire their way out of this situation often.

“You might not be able to hire your way out of it, but you need to hire,” Scofield said.

When searching for counseling information on CSU’s website, readers are met with warnings that the demand for counseling on campus has increased each year and the university is typically unable to offer weekly individualized appointments. At the top of the counseling webpage in red, the university warns staffing shortages may affect appointment availability and encourages students to consider seeking individual therapy outside of the university.

Lynn acknowledged staffing as one of the biggest challenges the public Fort Collins university faces in serving student mental health.

The nearly 30,000-student campus employs around 47 counselors, the university said.

“At one point earlier this year, we had 14 vacancies in our counseling department,” Lynn said. “Right now, we have five. There is just difficulty attracting and hiring right now.”

Gen Z more accepting of mental health help

To help reach more students, Lynn said CSU partnered with a company called Grit Digital Health to create You@CSU, an online tool providing students with articles and tips about mental and physical health. Additionally, students can access SilverCloud, a free online, self-guided program offering articles and information about mental health education.

Lynn said to have a successful mental health culture on campus, universities must take a multi-pronged approach including educating staff and faculty about how to recognize issues among students and train them to connect students to the right resources.

Throughout the past two decades, college counseling services across the country experienced skyrocketing demand for services, but the capacity to treat that demand has not been equivalently increased, according to the Center for Collegiate Mental Health’s 2021 report.

As a result, data collected by the center showed counseling facilities shifting from traditional treatment to short-term crisis support and rising clinician caseloads — both associated with less treatment for students and less effective care, the report said.

“This trend has caused distress for nearly all stakeholders and generalized assertions that institutions are experiencing a mental health ‘crisis,’” the report read. “Responses have ranged from claims that the demand for mental health services will never be met (and ergo we should not try) to attempts at providing professional services to every student who seeks care.”

Generation Z, people born after 1996, are significantly more likely than other generations to report their mental health as fair or poor, according to the American Psychological Association’s 2020 report on stress in America. They are also more likely to report receiving mental health treatment or therapy with 37% of people surveyed from Gen Z reporting such interventions compared to 26% of Gen Xers and 22% of baby boomers, the report found.

Mental health treatment has increasingly normalized, Lynn said, but college students are also a more diverse population than ever before. Because of that, some students face challenges — poverty, housing and food insecurity, racism, health issues — that college students of the past may not have encountered as often.

“We need to identify some of the things from a societal standpoint causing these issues and deal with them upstream so hopefully we don’t have this growing population of people needing services,” Lynn said.

Students seeking connection

Mia Rivero, 20, struggles with anxiety, depression and attention deficit hyperactivity disorder.

The 20-year-old CSU junior said she went to the campus’s counseling services when she was a freshman for a consultation, and they told her they were at capacity as far as one-on-one counseling, but that she could try group therapy or look for external counseling services.

“I think what they say they offer is reasonable, it’s just that it doesn’t seem like they have the resources to back it up and that’s where their downfall is,” Rivero said. “What they advertise to be able to do seems kind of misleading and could be detrimental if you’re counting on that when you choose the school.”