Depression: What it means for higher education

Last year, a troubled Kenyon student threatened to hurt herself and told a friend she had taken pills to do it. Paramedics were called, and she was taken to the hospital.

"We felt she needed to return home and be assessed, because it was important for the student to get some help we couldn't provide here," says Associate Dean of Students Cheryl Steele. "We called her parents and they never offered to come. Their attitude was that they'd dealt with this sort of thing before, and they didn't want to deal with it again. It was tragic."

So the College paid for the student to fly home and gave the parents their daughter's flight information. "I finally had to tell the parents, 'Look, you need to be there to pick her up,'" Steele says. "That was an extreme case, but we shouldn't have to be telling parents what to do."

That's just one example of what Kenyon and colleges across the country are dealing with as the number of students diagnosed with depression and other mental illnesses continues to rise at an alarming rate. In a 2001 survey of college counseling centers, University of Pittsburgh psychologist Robert Gallagher found that 85 percent of colleges reported an upswing in the previous five years in numbers of students with severe psychological problems. And approximately 30 percent had at least one suicide attempt in the previous year.

"Mental illness is absolutely going off the charts on college campuses," says Hara Marano, who recently published a study of college students in Blues Buster, a newsletter about depression. "College counseling centers used to be the backwaters of the mental healthcare system. Now they are the front line."

Director of Counseling Services Patrick Gilligan and his staff know this firsthand as they work with increasing numbers of students on a daily basis. The fall 2002 semester saw a record number of students come in for counseling.

"It does get difficult to manage all the students sometimes," Gilligan says. "We work hard and put in a lot of hours. We end up deferring our lunch hours and our time after work so we can make sure the students get seen. We keep thinking we've hit our saturation point, but then we figure out ways to kind of extend our saturation point."

But Gilligan clearly loves his job and sees his work load as a sign things are working. "The number of students we see in my office isn't alarming to me," he says. "If we were seeing fewer students, it wouldn't mean that there are less students with problems on our campus. It would mean that we aren't doing our jobs as counselors, and that would alarm me."

The spiraling numbers have repercussions across campus. Faculty, staff, and administrators are often involved when students suffer from mental illness. And helping students is a time-consuming process with high stakes.

"We are really looking at a whole new job in some ways," explains Dean of Academic Advising Jane Martindell. "We are less and less academic advisors and more and more crisis managers, crisis intervention, social work-type people."

As colleges and universities in the United States strive to help students combat mental illness, colleges like Kenyon may need to reevaluate the role of the counseling center.

"I kid sometimes and call us Cleveland Clinic South because sometimes I feel like we're running an outpatient clinic," Steele says. "We're a college. We're an educational institution. Part of that is providing support, but the lines sure have moved."

The most obvious reason that depression and other disorders are rising among college students is that more and more people, regardless of age, are suffering from these conditions.

"It's clear that countries around the world are experiencing increases in depression, particularly in comparison to fifty or one hundred years ago," says Professor of Psychology Michael Levine. "So what you may be seeing in colleges is at the very least a more general phenomenon."

Quite simply, college kids are just like everybody else. "College is no longer an elite place," says Marano, whose report on depression was recently published in association with Psychology Today. "College populations are more like real life."

Plus, young adults ages eighteen to twenty-five are particularly vulnerable to mental illnesses, ranging from depression to anxiety disorders. And while many students develop emotional problems during their undergraduate years, a significant number arrive at first-year orientation with full-blown mental disorders.

"In talking to other counselors around the country, it's agreed upon that we're seeing more students with a long history of severe mental problems," says Diane Tinsman '85, a licensed social worker with the Bowling Green State University counseling center. "It used to be problems with homesickness and adjustment to college; now we're seeing people with bipolar disorder, significant depression, eating disorders, and self-mutilation."

In fact, improvement in the care for mentally-ill children and adolescents has increased the need for care at the college level. "We're seeing a greater need for psychological support because kids who might not have made it into college years ago are now able to cope," says Ruth Woehr, a counselor at Kenyon. "They can succeed in high school, score well on the SATs, and get into a good school."

But once they settle into their dorm rooms, the freedom and pressure of college life can quickly undermine the progress students might have made back home.

"In theory, they can be productive college students," says Rebecca Hamilton '92, who works with students at the counseling center at the Barat Campus of DePaul University. "Unfortunately, a lot of them come and they're not in the protected, structured environment of the family. Mom isn't there to remind them to go to counseling or take their medication. They don't get that in the residence halls, and a lot of students stop taking their medication or don't pursue services on campus. They kind of fall apart after that. It's common."

Alcohol and drugs, both of which can be associated with depression, can play havoc with students already on antidepressant medication such as Prozac. Students may also attribute their problems to a troubled home life and choose to go off medication once they arrive on campus.

"Students are very intelligent, but you have to remember how young they are," cautions Tracy Schermer, Kenyon's full-time physician and the director of the health and counseling center. "We have a lot of issues with drug and alcohol interaction."

Students are also dealing with greater pressure to succeed in an increasingly competitive world.

"When I think back to my work with students in the early nineties, there wasn't as great a pressure put on them to know what they're going to become, what they're going to do with their lives," Woehr says. "Now there's a much greater expectation to define yourself, to organize, to specialize. There's information coming at them from all angles and things are changing rapidly. I think this hurried, organized life has something to do with it."

Levine adds, "Think of how great the pressures are to get into a top school. Then imagine the pressures once you get there."

Patrick Gilligan lives "literally ten seconds" from the Health and Counseling Center. It's almost like a second home for him, and the counseling offices upstairs have a welcoming feel to them. Ruth Woehr often brings Rosie, her friendly, cuddly Portuguese Water Dog, to work with her when she counsels students. "After she greets everybody and gets a hug, then this is what she does," Woehr says, motioning to Rosie, who is sprawled out on her office floor sleeping. "Some of the kids see her and say, 'Oh, I miss my dog so much.'"

Woehr finds her work particularly fulfilling because college students are at such a vital point in their lives. "It's nice because you can seem them over a four year period of time during a period where there is great potential for growth and change and maturity," she says.

While some students are still reluctant to see counselors or admit they have problems, a visit to the counseling center on North Acland Street is far more acceptable among students than it was in the past.

"Some of the students are remarkably comfortable in coming here," Gilligan says. "They can be a half-mile off campus and see you, and they'll be screaming, 'There's my counselor!' Kenyon students are pretty sophisticated people who understand that by thinking out loud and articulating their issues, that there's an opportunity to work things out and bring about change. And a lot of them come from families where their parents recommend that they go see a counselor."

Woehr adds, "I hope this doesn't sound boastful, but I think over the years students have come to recognize this as a helpful place, and they tell their friends."

Schermer, who has treated Kenyon students for the past twenty-two years, remembers when the stigma of mental illness was much stronger. The counseling offices at that time were one of the few college services on Wiggin Street, and students were reluctant to be seen heading in that direction. "They thought if you went down Wiggin, then you were crazy," he says.

When the Health and Counseling Center first moved to its current location, students used the main entrance rather than the side door that led directly upstairs to counseling. "They didn't want to be seen going to counseling then," says Schermer. "Now they're beating the side door down because they don't care."

Anna Hargrave, who graduated last year with a double major in Spanish and drama, says going to the counseling center was so common that she started taking a poll her senior year to see how many of her friends were going to the same therapist. Two of her roommates in the Taft Cottages were regularly attending sessions, and she can succinctly sum up her reasons for going: "senior year."

In the midst of completing an intense acting project for her comps in drama, Hargrave discovered she was losing her love of the theater.

"It's funny how comps will make you hate your major," she says. "I suddenly realized, 'Oh, I hate this. I don't want to do this for a living.' I was trying to re-examine what I wanted to do with my life, and senior year kind of throws that in your face. Every ten minutes, people are asking you, 'What are you doing?'"

Hargrave, who now works for the office the county executive in Montgomery County, Maryland, says she couldn't necessarily turn to friends or family for help.

"It's the type of thing where it really helps to have a third party who doesn't see you every day, who you don't brush your teeth with," she says. "I can't tell my dad these things because I'll get a time-management lecture. I just want someone to listen. Too many people are quick to give advice and not just listen and be supportive."

Hargrave confirms that the sessions helped her get a handle on her situation immediately. She saw Gilligan weekly, before her visits began to taper off after the fall semester.

"I was fine with everything, but I just liked going after a while," she says. "It was nice."

Patrick Gilligan works with another full-time counselor, a substance-abuse specialist, two part-time counselors, and two interns to meet student needs. For a school with approximately fifteen hundred students, this is a relatively large staff. Having a full-time physician is even more rare. Bowling Green State University, for example, has seven full-time and five part-time counselors to treat nearly twenty thousand students. That's about one staff counselor for every two thousand students, compared to one for every three hundred and seventy-five students at Kenyon.

In addition to the one-on-one sessions, there are group sessions for students with eating disorders, substance abuse problems, bi-polar disorders, and those who have suffered sexual abuse.

"Students want relationships with adults on campus," Gilligan points out. "So they come here and we become friends, and this is a place where they really hope to keep some structure in their lives."

But the support network for students extends well beyond the counseling center. Some students already have a therapist back home, and some arrive at Kenyon on medication for depression and other conditions. That means the counselors and Schermer often have to coordinate treatment with therapists and doctors in other states.

Faculty members are often the first to notice a problem with a student. Michael Levine, who teaches abnormal psychology courses and also periodically suffers from depression, regularly meets with students who are experiencing various mental illnesses. He doesn't see depression as the most serious issue confronting students, but depression mixed with other conditions such as substance abuse or obsessive-compulsive disorders.

"I see myself and my colleagues sometimes doing a lot of hand-holding and reaching out and being there for students as friends and teachers," he says. "I feel that part of my job is to support students as they try to understand and cope with these problems. So I don't see it as a burden, but I don't want to make it sound like it doesn't affect me. Of course it does."

When a student is obviously struggling in a course or confides to a professor about a problem, the faculty member often contacts academic advising in the Student Affairs Center. Professors have even been known to walk a student over to the offices, where staff members work to create a plan for students to make up assignments, drop courses, or, in extreme cases, leave school. The counseling center participates when the issue involves mental illness. (The process can also work in reverse; a student might visit the counseling center first and be referred to academic advising.) Ultimately, any accommodation made for students - such as getting an extension on a paper - must be approved by the faculty member.

Legal issues make the decisions more complicated. If a student is diagnosed with a condition that is considered a disability, the Americans with Disabilities Act (ADA) requires certain legal steps. "With depression and other mental illnesses, it's often hard to say when it moves into the category of a disability," says Martindell. "There are a lot of gray areas where we're trying to do the right thing."

The process involves a lot of coordination and often some difficult decisions. "There's a lot of back and forth where we all try to problem-solve," Martindell says. "It's really tough to make these calls."

And getting parents involved in decisions can make a very complicated situation even more complex. "There are parents who think we're crazy and it's our problem, and they don't even want to talk about it," Martindell says. "Other parents drop the phone, get on a plane, and come help you try and solve the problem. It's a very wide spectrum."

Although no two cases are exactly alike, in many ways Patty Esposito is typical of the students who visit the counseling center. The twenty-two-year-old graduated last May with a degree in history and a concentration in Southeast Asia. She spent a semester in Vietnam her junior year and had trouble re-adjusting to life at Kenyon when she returned.

"I encountered a lot of turbulence when I got back," she remembers. "I had a lot of depression. It was very abstract and things just didn't feel right. I was just kind of uncomfortable about how my relationships were going."

She started seeing Gilligan once a week. "I just needed another opinion in my life, someone who was objective and could see things from outside my life," she says. "I did a lot of talking, and he would ask good questions that would make me think. It was more like a partnership, and we were working together to figure things out."

Gilligan, in consultation with Schermer, suggested Esposito try a mild dosage of Zoloft, and she took the medication from April through October of last year in conjunction with counseling.

"The entire process was a big help emotionally," she says. "It was very nice to have a safe space to talk about things and not worry about how people are going to react."

While individual cases like Esposito's do not present unusual challenges for the counseling office, resources are being strained as more and more students seek similar care. "We've done a good job, but we know how far we're stretched," says Schermer. "We're at a pretty vulnerable stage, and we might reach a point where we can't do the kind of work that we'd like to do."

Students who reach a crisis stage, such as a suicide attempt, put an even greater strain on College resources.

"Once the incident occurs, that only begins the process of trying to help," Martindell says. "It might involve hospitalization, working with the family, sending the student home. Then there's the follow- up and trying to determine when the student is ready to come back. A lot of people have to get involved to try and make that determination. When you put several students like that together, it's overwhelming because it's not in anybody's job description to oversee that process."

How to meet the challenges of overseeing this process is an issue at schools across the country. Steele says there are plans to evaluate how Kenyon deals with students suffering from mental illness sometime this year and to determine if changes need to be made. "In the current economic situation, we are not going to get more staff," she says. "We've got to make what we've got work, because the number of students coming to us with problems isn't going to change."

More fundamentally, Kenyon may be deciding what role it wants to play in the lives of students outside the classroom.

"There seem to be a lot of students who have serious psychological disorders," Levine says. The school is caught between accepting them and nurturing them, or sending them home where parents often don't know what to do with them or think they're better off at school."

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