Student visits to Counseling Services on the rise

As the nationwide demand for campus mental health services continues to rise, McCosh Health Center is working to cope with the increasing number of students who arrive at the University on medication or with counseling needs.

The demand for counseling has risen nationwide since the early 1990s, when universities began collecting empirical data about mental health on campuses. McCosh has also witnessed this trend, having received 8,000 mental health appointments last year, compared to 7,000 the year before — an almost 15 percent increase.

The number of students on medication has also increased over the years, though the University declined to release exact statistics due to patient confidentiality.

"We probably have a generation of people, not just young people ... who are on medications of all types, so medications management is another issue that brings students to psychological services," Vice President for Campus Life Janet Dickerson said.

This year, Counseling Services added a second full-time psychiatrist to its staff due to the increasing demand for psychiatric services. The position is being filled by interim psychiatrist Kate Salvatore while the University looks for a permanent employee.

Until recently, psychiatrists worked as part-time consultants for Counseling Services, but the University now employs a full-time psychiatrist, Deanna Nobleza, in addition to Salvatore.

Counseling and Psychological Services Director John Kolligian said Counseling Services sees students with a wide variety of depressive spectrum problems and anxiety spectrum problems, from panic attacks to suicidal tendencies to just feeling down.

Nationally, the percentage of college students who have been diagnosed with depression at any point in their lives has increased from 10 percent in the spring of 2000 to 14 percent in the fall of 2006, according to data from the National College Health Assessment. Among those diagnosed, 34.1 percent were on medication in 2000, while 37.1 percent were on medication in fall 2006.

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At Princeton, the number of self-admitted students with substance abuse problems has grown in the past couple of years, as has the number of students who are admitted after a dangerous incident, Kolligian said.

A stressed generation

Kolligian cited recent improvements in mental health medications as one reason more students come to the University on psychoactive and psychotropic drugs. Lately, he said, there has been greater "familiarity and utilization of these new classes of medications such as SSRIs, a class of antidepressants, that have dramatically fewer side effects than the previous class of medications and antidepressants."

But, Kolligian said, students' increasingly hectic lives also may be to blame for the rising number who are turning to Counseling Services. "There's a lot of discussion about [whether] students at this moment in our history [are] more stressed and at times more fragile than they've been at previous generations," he said, "and the science is not clear. We don't have definitive studies in that area."

"If you ask most counseling center directors or maybe vice presidents of campus life," he added, "they'd probably say that it certainly does seem like it's an intense time for this generation of students."

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Dickerson echoed his sentiments. "Even though some of us believe that students in this generation have many privileges, many students also feel very stressed, perhaps because of those privileges or the pressures they have to be successful," she said.

Kolligian also cited financial burdens and the quickness of modern communications as possible causes for students' increased counseling needs.

Students today may be less able to deal with multiple stressors in their lives, Kolligian said, leading them to seek outside help, though he noted that this theory has not been confirmed by any studies. Dickerson, meanwhile, cited family problems, community problems and dorm issues as possible factors.

To address such issues, the University has hosted activities with faculty members, staff and administrators to heighten awareness of depression, stress, self-injury and other problems, Dickerson said. Counseling Services has also focused on building a stress management team to help students deal with the mounting pressures of campus life.

In a recent report, the Priorities Committee, which deliberates on the University's operating budget, supported the creation of the new psychiatric position currently filled by Salvatore. It suggested, however, that the money come from resources that University Health Services (UHS) is already receiving rather than newly allocated money, since the University has given UHS $664,000 in supplemental funding over the past four fiscal years.

The stress of the modern world may not be the only factor in the rising demand for counseling services on college campuses. The spike in students who enter college with mental health needs may also reflect increased efforts to assimilate children with mental health disorders into their broader peer group. In recent years, Dickerson said, elementary schools have tried harder to place these students in mainstream classes — and, consequently, on track to seek postsecondary education at places including the University.

"We probably have more students in university and college in this generation who have physical or mental or other challenges, who in much more distant generations might not have gotten to college," she said.

Breaking the 'code of silence'

Several factors set Princeton's Counseling Services apart from other universities', such as students' unlimited access to counseling. By contrast, other schools limit students to five or seven appointments and then refer them to off-site centers.

But because the Americans with Disabilities Act prevents the University from seeking information about applicants' mental health during the admissions process, certain cases may come as a surprise to UHS once students arrive on campus.

"Now, because of the federal government, we can't ask about the kinds of situations that might be of concern," Dickerson said, "so in some cases we have students who come to college with a need for psychological or psychiatric support" that may not have been anticipated.

She added, however, that "we are as responsive as we can be to those students."

Kolligian said the increased use of Counseling Services is generally viewed as "a positive event, indicating that students are feeling somewhat less stigmatized around mental health issues and that campus communities are more ready to be mobilized and to refer students who may seem distressed or having a difficult time."

Dickerson agreed that the rising demand for mental health services may signal greater openness about psychiatric issues. "I think that whereas in some previous generations there was a code of silence around some problems, I'm hoping that code is being broken and students who really want to discuss matters in a confidential way with a therapist have an opportunity to do so here at Princeton," she said.