A recently released survey of 150,000 college freshmen found that 9.5% had frequently felt depressed in the last year, up from 6.1% in 2009. As such numbers rise, some colleges balk at the idea of being "caretakers" for their psychologically fragile students. But ignoring the mental health of freshmen has serious consequences, as I know firsthand.
I started out strong my first year at Sarah Lawrence College almost four decades ago. I landed the lead in a play and signed up for a heavy course load. Within weeks, I was sitting in my room without the energy to return a book to the library. Soon, I could not imagine going to class.
Back then, the college had few resources for troubled students. When I downed a bottle of prescription pills one night, I was hoping someone would get me to a doctor or let me go in peace. I woke up in a daze, and a kind teacher took me to a psychiatrist who urged me to go home.
Soon after, I found myself in the now-closed Renard Hospital in St. Louis, where a doctor shot me up with Thorazine and four male psych techs stripped me down and put me in a padded cell that smelled like urine. I could not go to college, the psychiatrist informed me, and I should get used to "being mediocre." Four weeks later, I sneaked past a guard and bolted through the hospital door.
Thirty years later, when I was an assistant professor of journalism at Loyola University Chicago, I kept that history under wraps. But when my student Kathryn told me about her depression, I urged her to go to the school's Wellness Center.
I later learned that a part-time psychiatrist said he could not help her and gave her the name of a website listing local doctors who might or might not take her insurance. Too distraught to navigate the list and feeling desperate, Kathryn gathered all the pills in her house and swallowed them with alcohol. By the time I heard from her, she was in the psych ward of a local hospital.
"We could have lost her," I told the Wellness Center psychiatrist, who said he had done everything by the book.
Not until they reach college do many students have their first, and often frightening, bouts with mental illness, such as depression, bipolar disorder and schizophrenia. Others will contend with anxiety, eating disorders, addiction, PTSD, relationship problems and issues of sexual identity. Still others will confront the aftermath of sexual violence. The National Survey of College Counseling Centers reported that in 2014, 94% of directors surveyed said they are seeing more students with severe psychological problems.
Some universities resist becoming "residential treatment centers" for troubled students, said Richard Kadison, the former head of Harvard University's mental health services and an author of "College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It." To avoid a small chance of liability — especially for a suicide — these schools provide limited on-campus mental health treatment and are quick to send troubled students home.
A growing number of school officials believe they have a moral imperative to provide good care on campus — and an economic incentive because strong mental health programs have been shown to increase retention and graduation rates. Johns Hopkins, for instance, has psychiatrists, psychologists and social workers and allows students to come in for treatment as often as they like at no cost.
Still, at most colleges, counseling centers are stretched thin. A 2013 survey by the Assn. for University and College Counseling Center Directors reported an average of one mental health staff member for every 1,772 students. Employees complain of unreasonable caseloads. Students facing a crisis end up on wait lists for psychological services.
It's past time for mental health to be a priority for colleges. They can start by hiring a diverse staff of psychiatrists who can prescribe medication, as well as psychologists, nurses and social workers knowledgeable about the most effective types of therapy.
Campus wellness centers should provide outreach and basic training for faculty and staff to identify ill students, and offer classes on coping skills. Students should have immediate access to group and peer-counseling sessions. And a university-based counselor should be on call 24 hours a day.
College insurance plans should cover care on- and off-campus. No one should be handed a list of psychiatrists and be expected to fend for herself. Harvard tries to vet in person every doctor it recommends so it can point students to the ones who meet their needs. The University of North Carolina at Charlotte even has a case manager who helps students find doctors covered by their insurance plans and follows up to see whether more care is needed.
College applicants and their parents would be well advised to check out the mental health centers on campus as carefully as the dorms and gyms. Particularly if a student has experienced psychological problems, parents should delve beyond schools' idle promises to care for the total person. What is staffing like? What is the cost? A little pressure from parents could help ensure that no one in crisis is told to take a number or handed a list of doctors they will never call.
Julia Lieblich is an author of "Wounded I Am More Awake: Finding Meaning After Terror" and "Sisters: Lives of Devotion and Defiance."