More college students are seeking help for mental health, but what happens when there aren't enough counselors?

Counselors in North Dakota are booked out for two weeks, and when school counselors are forced to refer students off campus, the wait can be even longer, especially in rural areas, officials said.


FARGO — More college students are asking for help from mental health counselors at public institutions in North Dakota, and they often have to wait weeks before they can get an appointment.

The demand for counseling services at public universities and colleges in the state increased between 20% and 50% since 2014, according to data presented last month to a State Board of Higher Education committee.

North Dakota State University booked 6,206 counseling appointments for 1,139 students during the 2018-19 school year through the school's counselors, up from the 865 appointments for 104 students in the 2008-09 academic year, said Katie Fitzsimmons, student affairs director for the North Dakota University System.

“This is a huge concern as it plays into the direct health and wellness of our students,” she said. “Not addressing these needs can have tragic consequences from the destruction of personal relationships to suicide to threats of violence on our campuses.”


The rise in North Dakota is not unique. The utilization of counseling centers by students rose between 30% and 40% from the fall of 2009 to the spring of 2015 at 139 higher education institutions in the U.S., according to a 2018 report from the Center for Collegiate Mental Health at Penn State. But the population at those schools rose only 5% in that time frame, the study said.

Counselors in North Dakota are booked out for two weeks, according to NDUS. When school counselors are forced to refer students off campus, the wait can be even longer, especially in rural areas, Fitzsimmons said.

Higher education staff are coming up with creative ways to handle the climb in demand — some offer telemental health services or come up with preventative care — while finding ways to convince those who don’t seek the help they need it’s OK to make an appointment.

Rising numbers

NDUS doesn’t have comparable data for all universities dating back five and 10 years, so it’s hard to know if schools are seeing the same increases across the board, Fitzsimmons said.

Among eight campuses that reported to NDUS, total enrollment has dropped 6.5% since the 2016-17 school year, while mental health needs dropped 4.5%.

Over a longer period of time, the rise in demand is apparent. Last year, twice the amount of students than in the 2014-15 school year at Williston State College sought help through WSC services.

One counselor served the campus, even with the increase, Fitzsimmons said. The provider left in January, and the position wasn't filled until August. Since there was no counselor on campus in the spring semester, the number of appointments dropped significantly during that time, Fitzsimmons said.

WSC is one of seven higher education schools in North Dakota that have only one counselor. Minot State University and Valley City State University each have two, and the University of North Dakota and NDSU have more than three.


Despite NDSU seeing only a 4.2% increase in enrollment over the last decade, appointments requested multiplied by eight, and the number of students seeking help increased tenfold, Fitzsimmons said.

There are a number of factors that contribute to the upward trend, said William Burns, Director of the NDSU Counseling Center.

Students face additional stress when they begin their higher education careers, said Jennifer Rothman, senior manager of youth and young adult initiatives at the National Alliance on Mental Illness. They are pressured to do well in class, join extracurricular activities and find new friends, all while being away from family.

“It’s a big transition,” she said.

Anxiety from social media and news around the world may also contribute to the increase in mental health counseling demands at colleges, Rothman said.

“Just look at politics that you are hearing about left and right,” she said. “You’re seeing shootings happening almost on the daily.”

The Minnesota Office of Higher Education did not have numbers on mental health appointments sought by students in the state, but the issue is a rising concern, according to media reports.


In November 2018, the Star Tribune reported more than 42% of University of Minnesota students had diagnosed mental health conditions, a jump of 29% from 2015.

Minnesota State University Moorhead closed its clinic, pharmacy and medical lab in July, rebranding its offerings as MSUM Counseling Services to shift its focus to providing emotional and mental health services as demand increases.

A lessening stigma surrounding mental health helped convince students that seeking help is a good thing, Burns said.

Some may chalk up the rise to a generational thing, Fitzsimmons said, but addressing mental health does more than help individuals be the best person they can — it also affects workforce needs and society as a whole.

“People’s mental health is health,” she said, noting schools would do everything to treat a flu outbreak. “Why do we want to put up any barriers for someone who is struggling with a mental illness or anything that might be beyond that spectrum?”


Access to help

Budget constraints restrict the number of counselors a school can hire, which means longer wait times for students or referrals to services off campus, Fitzsimmons said. But sometimes there is no place to send students, especially in rural areas.

Minot recently lost four off-campus mental health providers, she said.


“All of the sudden, that two- to four-week waiting period for an outside referral has just jumped to two to three months,” she said.

A student in crisis at NDSU can get an appointment right away, Burns said, and non-crisis students have their first appointment within three or four days.

“After that, it might take longer to get an ongoing appointment because we’re full,” he said.

North Dakota schools are doing the best they can with the resources they have to help students, but services could be better if more funding was available, Burns said.

Funding, or lack thereof, plays a role in limited access to counseling for students across the nation, Rothman said.

Some institutions, including in North Dakota, have presented creative ways to prevent moments of crisis and help students with mental health-related issues. NDSU offers stress-relief programs like equine therapy and gardening. VCSU holds counseling sessions in residence halls after normal hours, and WSC hosts group therapy.

“(Bismarck State College) has offered yoga classes, and they had more turnout than they ever imagined,” Fitzsimmons said. “They see the students really craving alternatives … just for some other type of way to be connected with other students.”

Coming up with ways that don’t “scream mental health help” can be more appealing to students, Rothman said. Schools should communicate with students to find out how to help them, she added.


“Ask your students what they need,” she said.

The Legislature has taken on concerns regarding mental health in recent years, and there is great leadership at state agencies when it comes to implementing programs in rural areas, Fitzsimmons said. Ultimately, having a support system, whether it is just one or two friends, can make a difference.

“Whatever we can do to get the message out there that this stuff isn’t easy, and you have to be talking to someone,” she said. “You don’t need to tough it out. You don’t need to do it on your own.”

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