Hidden among the record numbers of students on college campuses is one secret in plain sight: Nearly one in every 10 students is getting mental health counseling on campus.
Counselors say the demand for their services — often offered free or at a nominal price — is at a record high this year and the illnesses they are treating are more serious, often including prescriptions.
"The mental health common cold for this generation of students is anxiety disorder, whereas for previous generations it was depression," said Kip Alishio, director of student counseling at Miami University.
Students visiting Xavier University's Counseling Center have increased about 20 percent this year, compared to a year ago, and XU spends about $300,000 a year on counseling.
The onslaught of mental health issues threatens to engulf a generation: Nearly half of college students say they have felt so depressed in the past year it was difficult to function, and two-thirds of those who need help don't get any, the national student organization Active Minds reports.
That can lead not only to suicides — 1,100 by college students last year, Active Minds says — but a flood of other issues. In this region, colleges such as Northern Kentucky University and Miami University report serious incidents, such as attempted suicides or threats of violence against others, more than once a week.
Kaela Allton, president of the Active Minds chapter at Xavier, was diagnosed with clinical depression before arriving at XU and has participated in counseling there, although she currently is not in counseling.
"I had no idea what (depression) meant, other than I felt terrible," said Allton, a junior from Ashland.
For colleges across Greater Cincinnati and the nation, mental health counseling is just one more service that students and families are demanding. And those services increase the cost of college tuition, which has more than doubled in the last 30 years and has many families struggling to be able to afford college.
But colleges are also responding to a new group of highly stressed students arriving on campus every fall, accustomed to therapy and pharmaceuticals.
Counselors say that in previous generations, those students probably would have struggled through high school, perhaps without counseling or drugs, and would never have been able to handle the academics or other stressors associated with going to college.
The expansion of special education programs as early as elementary school has made it easier for those students to go on to college. But once they are there, it can be a strain on both the student and the college.
"In some ways they do good things. We help students get through school," said Josh Gunn, director of counseling and psychological services at Kennesaw State University in Georgia and president of the American College Counseling Association. "But then they get to college and it's a very different system. You have to go to the counseling center yourself."
If you have a broken arm, you're going to go to the doctor. If you're feeling sick, you're going to go to the doctor. If it's an internal illness, a mental illness, people just have a difficult time, thinking that there's something weak about going to get help.
Kaela Allton, president of the Active Minds chapter at Xavier University
Gunn said as more students enter college, more resources are needed.
"The only people this is a surprise to are people who don't work in counseling centers," he said. "There are just more kids coming to school now."
Counselors say a combination of factors has driven record numbers of students to counseling offices, including job stress in a slowly recovering economy and a record-cold winter.
"The second semester has been unrelenting," Miami's Alishio said. "We've had lots of crises. I've been doing this for 22 years, and I don't think any (terms) have been any worse than this one."
Stigma keeps many students from going to counseling
One of those crises was the case of Andrew Salsman, a sophomore who committed suicide in December.
Salsman had been in and out of Miami, suffering from obsessive-compulsive disorder and other conditions, and had been under the care of a Cincinnati Children's Hospital Medical Center psychiatrist for several years, said his mother, Lynn Dalton Anderson.
He had "an amazing term" in fall 2012, earning a physics scholarship, but withdrew last year, hoping to return in 2014, she said.
Anderson said Salsman didn't get on-campus counseling at Miami and says students still need to conquer the fear of seeking treatment.
"He was reluctant to go. This is part of the problem," said Anderson, who lives in Springdale but is moving outside of the region. "It's not as simple as offering counseling services. There's a reason students don't seek it out as much as they should. You can see why students would not want to admit having a mental health issue."
Often, students with mental health issues are embarrassed to seek counseling on campus, students say.
"It does seem very hard for people because of the way it's portrayed in the media — that if you're depressed, you're crazy," said Colleen Gerding, a University of Cincinnati sophomore and vice president of the Active Minds chapter there. "(But) even just bringing it up (the subject of mental health) helps to reduce the stigma."
Xavier's Allton said Active Minds tries to assure students that mental illness is something to be treated, not avoided.
"If you have a broken arm, you're going to go to the doctor," she said. "If you're feeling sick, you're going to go to the doctor. If it's an internal illness, a mental illness, people just have a difficult time, thinking that there's something weak about going to get help."
Generally, parents or guardians aren't informed if a student seeks out counseling or a prescription. The students are legal adults, and counseling centers guard privacy carefully in accordance with state laws.
But if a student's safety is in question or that student is a risk to others, counselors can send the student to the hospital or seek permission from the student to call parents or guardians.
Without permission, the only way counselors will contact a parent is as a last resort to protect that student's safety, they say.
To raise awareness of mental health issues on campus, Anderson is working toward creating a group and website, www.2LiveOn.org.
She said two changes need to be made on college campuses: talking about stress and mental illness during orientation, encouraging students to seek help; plus beefed-up insurance coverage for drugs and counseling.
Salsman was put on Miami-provided health insurance last year, she said. But the benefit was nowhere near enough to cover the $700 a month cost of Salsman's antidepressant.
"It's minimal coverage," Anderson said. "It's to cover emergencies. You get strep, and you get antibiotics. Anyone who has a mental health issue, most of them are on regular medication. I think Andrew felt like he was a burden because of the cost."
Families, students expect colleges to offer counseling
Some colleges charge a fee for counseling services. Students usually are either on their family's insurance plan or buy one from the university.
Both Xavier and the College of Mount St. Joseph, however, offer counseling sessions for free. The Mount does not prescribe drugs on campus but often refers students to area doctors.
Last semester, counselors at the Mount saw 193 students for an average of seven to 10 sessions, said Patsy Schwaiger Willig, director of the Wellness Center and a professional clinical counselor.
"If you have a genetic predisposition toward mental health issues, it often shows up between the ages of 18 and 22," Willig said. "Students will often have their first panic attack, or their first depressive issue. This is another first for a lot of students."
Alishio said some families actually ask about mental health services during admissions tours and then choose a college based on those services.
"That just didn't happen 15 or 20 years ago," he said.
Xavier's Allton said colleges have a responsibility to care for students, especially students who live on campus and can't easily access counselors elsewhere.
"I think it's kind of a privilege that we have free services," she said. "But I do think it's something schools should provide."