Roommate issues, relationship problems, classroom woes?-- they're the main reasons college students are stressed, right? Wrong. Those stereotypical college problems may have been why students sought counseling in the past. But serious mental health issues among college students have increased dramatically in the past decade, causing strain not only on students but also on the facilities created to assist them.
"Baylor has followed the national trend," says Marsh, who in 1998 received his PhD in counseling psychology from the University of Tennessee, came to Baylor as a staff psychologist in 1999 and has served in his current position for two years. "More students are seeking our services and coming for counseling." During the 2003-04 school year, there were nearly 3,500 counseling appointments and more than 880 psychiatric appointments, and those numbers continue to climb, he says.
Marsh cites a study at Kansas State University, which found that between 1989 and 2001, the number of students diagnosed with depression had doubled. It also found that the number of suicidal students had tripled and the number of students taking psychiatric medications had increased from 9 percent to 22 percent.
Nationwide, Marsh says, students entering college today have a 50-50 chance of becoming depressed or experiencing some other serious mental health problem during their college years.
The numbers are troubling. According to the American College Health Association, of the college students they surveyed:
"I think people have a misguided perception that college students are coming to counseling only for relationship problems," Marsh says. "But what we see are problems that have a wide range of severity."
At Baylor, more than 50 percent of students who seek counseling services do so because of mood disturbances, such as depression, or anxiety disorders. But others are looking for help with things like substance abuse, eating disorders, sleep disturbances and problems stemming from a sexual assault, Marsh says.
A very small percentage of Baylor students have a history of psychosis -- or thought disturbances -- such as schizophrenia, he says. "We'll have one or two students each year who need to be hospitalized for mental health reasons," he says. "It is a very small number, but it is beginning to inch up."
Byron Weathersbee, interim University chaplain, has seen similar increases. "Anyone who works directly with students on a weekly basis can tell you that the seriousness of problems is increasing," he says. "My observation at Baylor, and in my past 15 years in church work, is that the issues have really shifted."
When he started his career in ministry, mental health issues often were talked about in a light-hearted manner, Weathersbee says. But in recent years, the mood has changed because the concerns students have seem greater than before.
"Some of these young people are carrying tremendous baggage," he says. Although Weathersbee's staff does not include any licensed counselors, he says students sometimes seek pastoral care before calling the counseling center. "We try to assess the situation and give them a place to start," he says. "We oftentimes direct them, almost immediately, to counseling services." And Weathersbee is grateful to have a comprehensive center on the Baylor campus.
"As a minister, I appreciate the spirit and manner in which Dr. Marsh and his staff handle things," he says. "They're great to have on our team."
Stress remains the No. 1 reason students make the initial call to counseling services, and that's one of the reasons Kelly (not her real name) sought help during her sophomore year at Baylor.
"I was feeling very depressed," says Kelly, who recently earned her graduate degree from Baylor. "I was feeling overwhelmed, like my life wasn't my own and I wasn't in control."
Struggling with family relationship issues stemming from her parents' unwillingness to recognize her independence, Kelly found herself sleeping too much and becoming reckless with her schoolwork.
"I just didn't care about my work, and that's not like me," she says. "I used to love doing well in school. But I wasn't finding joy in any of the things I used to." A friend finally convinced Kelly that she needed to seek help, sharing that she had received counseling for an eating disorder.
"She told me very clearly, 'If you had a broken leg, you'd go to a doctor. You wouldn't wait for people to beg you to go, you'd just go. If you're broken mentally or emotionally, you need to go to a doctor and get help,'" Kelly recalls. Kelly was terrified to make the first call, but once she did, she says her life got better.
"I went for help with family relationship problems, but Dr. Marsh was able to dig a little deeper and get to the heart of it," she says. "I began to learn about myself and the choices I was making. I recognized the person I was dating wasn't a good fit for me. I learned why I was having problems with my father and how to deal with it."
Initially, Kelly -- like many college students -- did not tell her family about seeking counseling.
"I was worried about what they would think," she says. "I was pretty sure they wouldn't understand or would think I was weak." After much internal debate, she finally told her sister and then her mother.
"They were very curious, and my mom worried that she was doing something wrong," Kelly says. "But they were supportive." Although she didn't immediately tell her father about the counseling, he began to notice that her reactions to him were changing. "It opened the lines of communication and helped me to be able to articulate what I wanted and needed from my parents," she says. And when she finally did tell her father about going to counseling, she was surprised by his response. "He was impressed that I took the initiative and got help for myself. He had a newfound respect for me," she says. Kelly says she now has a great relationship with her parents.
"Without counseling, it never could have been this good," she says. "It helped all of us. Once I started to get healthy, my family started to get healthy."
Most parents are aware that college life can be stressful. But not all realize the severity of the mental health issues that students can face when their stress levels exceed their limits.
In their book, College of the Overwhelmed, authors Richard Kadison and Theresa Foy DiGeronimo outline the main issues faced by college students and offer suggestions for parents.
The first step is to be aware and communicate with students.The authors also recommend knowing the symptoms and warning signs (see sidebar) of depression, substance abuse, anxiety disorders, eating disorders and suicidal thinking. It is also important, they write, to understand what facilities are in place for students on- and off- campus.
Baylor's counseling center is staffed by four full-time psychologists, including Marsh, one full-time and two part-time professional counselors, one part-time psychiatrist and four doctoral students who are closely supervised by the staff.
Because of the increased demand for their services, there is almost always a waiting list for appointments, Marsh says. But he hopes that will not deter students from seeking help.
"We know how hard it is for a student to call," he says. "We will find a way to see every student who needs help." Although students needing routine assistance may have to wait for an appointment, emergencies or a crisis situation will always be dealt with immediately. "Those are always exceptions and we will always make a way to see someone in crisis right away," he says.
New policies are making it easier for the center to serve more people: guidelines for missing or canceling consecutive appointments have been instituted and students are limited to 12 sessions per year. The initial intake and first six counseling sessions are free, but the remaining sessions cost $10 each. The center also offers psychiatric evaluations and pharmacotherapy for additional fees.
The staff recognizes that some needs will take longer to address, Marsh says. "For some things, like eating disorders, the therapy is going to be too intensive for just 12 sessions here," he says. "For things that are going to be more long term, we help students to find mental health facilities in the community. We also refer out most substance abuse, including alcohol problems, because we know people can be better helped by residential or more intensive treatment. Those are beyond the scope of what we can do with limited time here."
Students on the center's waiting list also are offered community referrals.
In addition to individual psychotherapy sessions, the center also offers group therapy and a class in resilience. The class, which is designed to help students cope with daily adversities, is eight weeks long and counts as one elective credit. Other tools include online mental health screenings, accessible through the counseling center's Web site, where students can assess their use of alcohol and look for warning signs of depression, bipolar disorder and other mental health problems Staff members of the counseling center are also available to make presentations to groups that want to learn more about mental health issues.
There are several theories surrounding the increase in more serious and complex mental health problems on college campuses, Marsh says.
"More people today have access to higher education," he says. "The thought is that it's not as much a change in students, but that we're seeing a larger segment of the population."
Another theory is that the advances in psychotropic medication make it possible for people to attend college who would never have the opportunity without the medication, he says. There is also a belief that more students are seeking help because there is no longer such an overwhelming social stigma attached to psychotherapy and mental illness.
Marsh believes there is some truth in all of those theories, but places emphasis on the changing dynamic of the new generation of college students. Millennials, those born between 1982 and 2002, are the largest cohort in history and are estimated to be 33 percent larger than the baby boom generation. They also are the most diverse group ever to go to college (African American enrollment has doubled since 1980, and Hispanic students are the fastest growing group to enroll) and are very ambitious, with 75 percent expecting to earn a graduate degree.
As a group, Millennials are thought to be confident, team-oriented and high achievers. But they are also generally sheltered by their parents and other adults, and are under a great deal of -- sometimes self-imposed -- pressure, Marsh says.
"They tend to think they need more than they really need in order to be successful," he says. "But they're also facing a tougher job market when they graduate. It creates a bit of a pressure cooker, academically."
He also believes that the "Ivy League factor" applies at Baylor. Researchers have noted that students in an academically stressful environment utilize campus mental health services three times as much as at other schools.
Weathersbee, too, has varying theories about the changing atmosphere.
"I don't know if we can attribute it to the fact that we are becoming more educated about mental health problems and understanding it more, or if it's just the chaos and confusion of society. But my gut is that the breakdown of family and community life has created isolation and, therefore, depression." He also believes that when students' expectations are high and the reality falls short, it creates trauma.
"As a University, we need to be about the reality of [students'] identity," Weathersbee says. "They need to know who they are in Christ and accept that we are made in the likeness of God and are fully accepted by God ... no matter what goals they have met or not met."
No matter the reason for the increased need for mental health services on campus, Marsh and his staff are dedicated to helping students face their current challenges and frustrations, and to learn to cope with what comes next.
For Kelly, what came next was impossible for her to imagine. After completing therapy as an undergraduate, she felt ready to face the challenges of seeking a graduate degree. Her relationship with her parents was healthy, and she had even convinced other family members to seek treatment for mental health issues.
"I was starting school, tackling my dream, and it felt great," Kelly says. "It was incredibly stressful, but I was dealing with it. I knew how." Then, an old boyfriend began stalking Kelly, harassing and even physically confronting her in a dark parking lot. The pressure and stress began to consume her again.
"I started to lose weight," she says. "I felt physically sick, like I wanted to throw up just to get it out. I was having anxiety attacks -- sometimes three times a day -- so I would stay in bed."
But this time Kelly didn't wait for someone else to tell her to get help. "I had already been trained to know the signs of when I'm not able to handle things on my own," she said. "I got on the phone and called for help right away." She stayed in therapy through the legal battles that followed her stalker's attacks. The Baylor counseling center, she says, became her safe haven. "If something popped up midweek, I knew that come Thursday afternoon [at her therapy session], I could unload," she said. "Someone would take it over for me. It was like someone was finally on my side."
Without counseling, Kelly is convinced she would have dropped out of school after the stalking incident.
"Counseling gave me my life back; it gave me control," she said. "And I know Dr. Marsh would say that he didn't give me my life back, that I took it back. But he was right there beside me, helping me. His support made all the difference."
Instead of retreating into her depression and anxiety or dropping out of school, Kelly was able to take what she calls the most traumatic experience of her life and make something positive out of it.
The following summer, Kelly went to work at a family crisis center, where she compiled a handbook for people dealing with abusive relationships. "It's the most rewarding feeling to get a call from my old boss saying she gave the book to a high school student or a judge," she says. "It's my way to pay it forward, to pay back Dr. Marsh and his staff."
Kelly is also a vocal proponent of counseling. (She wanted readers to know that if not for the nature of the stalking incident, she would have gladly used her real name for this article.)
"I'm always telling people, 'If you don't go for yourself, do it for your family.' That's one of the reasons I did," she says. And Kelly has noticed that people's reactions to her story are changing.
"The stigma is going away," she said. "Television shows like "Dr. Phil" are letting people know that there are mental health issues out there. And it doesn't mean you're crazy if you get help. Ordinary people are having problems and getting them resolved."
Kelly knows that reminders of the stress and traumatic experiences she had during her college years will stay with her for her entire life. But that's OK because the things she learned about herself and how she deals with others will stay with her, as well.
"When you start off with counseling, you walk into that room and you think you're weak," she says. "But when you walk out, you're as strong as you've ever been, and life is so much better."