David, a sophomore pre-med student at the University of Washington, was used to juggling a busy schedule: He was a wrestler, swimmer, and runner in high school and works 20 hours a week on top of a full course load.
Still, when he finally made it to campus this school year — attending labs in person for the first time after two years of online work — the stress was bubbling. Being on campus was challenging and exciting, but he felt higher expectations came with in-person learning.
“I felt like I had to have my foot pressed all the way down on the pedal 100% of the time, or else everything’s just gonna fall apart,” said David, who asked that only his middle name be used out of concern that speaking about mental health struggles could disqualify him from future professional opportunities.
“It just got to this point where I couldn’t keep putting my foot down,” he said.
In January, David had a manic episode — a period of extremely elated, irritable or energized behavior — and his fraternity brothers took him to UW Medical Center on campus, where he was monitored overnight. He now sees a therapist weekly at the UW Counseling Center.
David and many other students now back on college campuses are experiencing not only the stress that comes from entering young adulthood, but also the added burden of the COVID-19 pandemic as a backdrop. And while David was lucky to get mental health care, many college students experience long wait times to see a counselor as UW and other universities across Washington state struggle to keep up with demand.
Even before the pandemic, college and university counseling systems couldn’t provide enough services for students. COVID-19 exacerbated the problem, and it worsened as students returned to classes in person.
In an average school year, the UW Counseling Center sees about 4,000 students — mostly undergraduates — out of a population of 46,000 at the Seattle campus. At the start of the pandemic in 2020, demand for services dropped as students quarantined at home, according to staff at the center. Students out of state were not eligible for the university’s teletherapy, and some new students didn’t even know counseling services were available to them.
In 2021, as in-person classes returned, the demand for services grew again. Especially as finals approach, students reach out for help dealing with stress.
According to a 2020 report on student mental health at the UW, about 28% of students coming in for services reported depression, followed by anxiety and eating disorders. More than a quarter have been diagnosed with a mental disorder at some point, and 1 in 5 have reported nonsuicidal self-harm. Both young women and men use the center in equal numbers, though clients are mostly white and Asian.
Despite being home to one of the best psychiatric teaching hospitals in the region, the university doesn’t have the staff to help all the students who want or need services. Currently, the UW Counseling Center has 34 staff members, including licensed psychologists, social workers and therapists.
“If we were able to serve all of [our students], and we were able to serve them for as many sessions as they needed, we would need more than 200 counselors, which honestly is not possible,” said Natacha Foo Kune, a psychologist and the director of the counseling center.
And that was before the pandemic stressed out students and their families, as people worried about health, finances and political issues. With the virus, there were also moments of recalibration for mental health providers who contemplated their futures. The university lost several of its staffers, though it has since hired more.
Some realized they could set up a private practice from home and be fully booked with private practice clients within weeks — they didn’t need to deal with insurers and could work out of their living rooms.
“They make more money working less hours. I can’t fault people for that,” said Foo Kune, noting that especially for families with children and caretaking responsibilities, the flexible option was a better fit.
To compensate, the center prioritizes students who need the highest levels of care immediately — students like David.
Other students, like Rachael McDonald, don’t get care. She waited two months before giving up.
A junior studying political science, McDonald was diagnosed with anxiety and reached out to the UW Counseling Center in January to get set up with a therapist and psychiatrist. She was seen once for a consultation and told she might be able to see someone in March. She called a few more times to check for cancellations but ultimately looked elsewhere for a private practitioner.
“I really was hoping to get [care at UW] because when you have a team like that in school, they can communicate with a disability team,” said McDonald. “[A team] that can say, ‘She deals with really severe anxiety so we can give her extra time on the test or let her take it in a quiet environment.’ It makes it that much harder to advocate for yourself because the resources aren’t as accessible.”
It’s not just the University of Washington that is facing this dilemma.
Central Washington University is down 2 1/2 staff positions (some people work part-time) on a team of 11 people. Together they see around 1,000 students a year, or 10% of the student population.
Cindy Bruns, the director of student counseling services at the university in Ellensburg, said students don’t have many options outside the school. “CWU exists really in a medical desert, in terms of outside resources,” she said.
The city has one mental health agency in town; Bruns says some people wait up to about six months to see a practitioner. Though there are some private therapists, many don’t take insurance. According to the American Medical Association’s Workforce Mapper, there were two psychiatrists in the county at the 2010 census count; Bruns says she doesn’t know of any now.
Washington State University likewise faced staffing shortages, leading to longer wait times for students.
“Ideally, a student would be able to be seen within two to three weeks,” said Jennifer Ellsworth, the director of counseling and psychological services on the Pullman campus.
“Last semester, [the wait time] was as long as six weeks, which is so discouraging to see. We know that six weeks later is a huge portion of the semester.”
A broader shortage of mental health workers is well documented in Washington state and around the country, but for counselors who work with college students, the issue precedes the pandemic.
University Counseling Jobs, an online job board, has recorded a steady increase in demand for providers over the last five years. Though COVID-19 caused many colleges and universities to implement hiring freezes in 2020, that changed in 2021 and job posts increased by 60% on the site.
According to a separate 2021 report from the Association for University and College Counseling Center Directors, more than half of counseling centers reported turnover in one or more positions, and 70% reported difficulty recruiting.
“The request for care at college counseling centers has far surpassed the rate of enrollment,” said Meghann Gerber, a former director of the UW Counseling Center who is now in private practice. “There’s just a much larger proportion of people needing support.”
The college experience is a time of transition; a place for young people to learn, plan the start of their professional careers and explore their identities. But college also overlaps with a time when the adolescent brain is still developing. Three quarters of mental illnesses begin by age 24, and stress itself is a known factor in the development of mental health conditions such as depression and anxiety.
From scholarship applications to competitive classes, campuses are taxing environments. Add in student loans and part-time jobs, and it can add up to devastating stress. A 2012 report by the National Alliance on Mental Illness found that among students who dropped out of college, 64% said it was related to their mental health.
As McDonald put it, “You can’t write a paper if you’re too depressed or too anxious. You can try but that’s not going to be as successful as your normal baseline.”
That’s why early intervention is vital, experts emphasize. Students can learn healthy coping mechanisms and start treatment, which can positively affect the rest of their lives.
So how can colleges do that?
Foo Kune points to two key changes: more funding and an overall cultural shift on college campuses.
Federal money from the 2020 CARES Act meant an additional $1 million arrived to fund mental health at UW. The counseling center used it to contract with a service to provide counseling across the U.S., and even internationally, for students who don’t live in Washington. Still, more is needed, Foo Kune said.
She also hopes that, rather than having a counseling center as a primary safety net for students’ mental health needs, UW and other campuses will ask professors, students and staff to prioritize mental health.
That can mean accommodations for students like flexible deadlines, and more prevention services like peer support groups and wellness programs for stress management. Students like David and McDonald agree those changes could help students like them cope with the challenges of school in a world rebounding from a pandemic.
“The mental health of students is not just resting on the shoulders of the mental health professionals,” said Foo Kune. “It actually rests on the shoulders of the entire campus.”