For many students, stress is simply part of college life — as unavoidable as tuition, fees and final exams. And the number of students flooding university counseling centers suggest stress levels on campuses may be rising.
Izzy Gerard, a sophomore at the University of Puget Sound, a small liberal arts college in Tacoma, Washington, has observed this firsthand. She's in charge of outreach at her campus counseling center and has noticed more and more students visiting the center since she started her job last August. Although walk-in appointments are available for several hours each weekday, not everyone can be seen during those times, so for some, the wait to see a counselor can be over a month.
"We always have a backlog, and people aren't always able to get the help they need. We have to turn people away sometimes, which is really frustrating for us because we want to help people," Gerard said.
Gerard's experience is not unique. The number of students seeking campus counseling services is growing over five times faster than enrollment, according to the Center for Collegiate Mental Health (CCMH) 2015 annual report, the most recent data available.
College administrators insist understaffed counseling centers desperately need more funding. But in its absence, universities and students are increasingly turning to another resource to expand mental health support — the internet.
From mental health apps to school-sponsored software to social media, these digital resources are helping students bypass counseling center waiting lists and offering new options for those too afraid to see a therapist in the first place.
Many mental health professionals say the future of mental health care must involve embracing digital tools.
According to April Foreman, a psychologist studying technologically assisted therapy, our current mental health system can't possibly meet today's demand. Most therapy resources still resemble "Victorian spa treatments," where you "see Freud" and "lay on a couch" at expensive weekly appointments, she said. "But once we become aware of the scope of mental health need, we realize the traditional ways we have of providing will never scale up." So Foreman argues we have to look to digital portals.
Others are less optimistic about mental health's technological turn. Some experts say digital communication can never replace in-person therapy. Even Foreman noted most tech tools aren't yet supported by clinical research because they spring up by the hundreds "like mushrooms in the night."
Yet even though they aren't a perfect fit for everyone, college students across the nation are improving their mental health by looking to the internet.
Reasons for rising demand
Whether or not college students are actually becoming more mentally ill remains a topic of debate. Some argue increased social media usage and a new culture of overachievement create more mental strain and that today's college students are too coddled and lack coping skills.
Others insist these rising numbers actually represent remarkable progress, demonstrating students are more comfortable seeking treatment instead of suffering in silence.
Ben Locke, president of CCMH, believes there's data to support the latter theory.
Locke pointed to the center's 2015 report and forthcoming 2016 figures, which both indicate the number of students reporting "threat to self" (meaning suicidality or non-suicidal self-injury) has increased dramatically while rates of anxiety and depression reflect much slower growth.
Locke explained these numbers are "very consistent with the goals of suicide prevention in the last decade." If these initiatives were successful, including the Garrett Lee Smith Act, which allocated over $90 million a year to suicide prevention programs in schools, we should see an increase in people seeking treatment who represent a threat to self. And that's exactly what the data show.
"If you imagine us 20 years ago trying to intervene with breast cancer, and women start showing up in treatment centers for screenings, we wouldn't say, 'Don't you have any resilience? Where are your coping skills?' We would celebrate the fact that these women are seeking treatment," Locke said. "In the mental health world, we find the seeking of mental health services is often judged morally rather than medically. Where the challenge comes is meeting the demand rather than judging it."
Regardless of what's causing this rapid increase, school counseling centers are struggling to meet the growing demand for mental health care, and digital tools are proving imperfect yet still promising means of expanding these resources.
Text therapy
At the beginning of this school year, Alpha Tau Omega, or ATO, a nationwide fraternity, partnered with Talkspace therapy app, offering its 10,000 members free 24/7 access to licensed therapists through text messaging.
Talkspace is prominent among hundreds of mental health apps, some of which connect users to professionals and others that provide tools users navigate alone. The app boasts a network of over 1,000 therapists and 500,000 clients (and its site saw a seven-fold spike in traffic immediately after November's election.)
Communicating with a remote therapist is not a new idea. Telepsychiatry, or therapy conducted through phone call or video conference, has existed for decades. But text-based therapy offers a newer, more convenient version, especially for tech-savvy millennials.
Wynn Smiley, ATO's CEO, said the fraternity reached out to Talkspace hoping to support students who need professional help but aren't willing see a counselor because "campus counseling centers are pretty backed up right now" or they fear "the stigma of doing that."
Katherine Glick, a Talkspace therapist, said the app provides students the same benefits traditional counseling offers and perhaps even more.
When you first sign up, a "matching agent" assigns you a therapist based on your particular concerns, unlike a campus counseling center where "you don't know what you're going to get and your options are so limited," Glick explained.
Even for non-ATO members, the service is relatively inexpensive at $128 a month, Glick said. That's less costly than traditional therapy, which can cost anywhere from $75 to $200 per hour, more expensive than university counseling, which is typically free for students. Talkspace doesn't accept insurance, though Glick noted they hope to soon.
The biggest benefits for students, according to Glick, are accessibility and convenience. Accessing a therapist from home at any time means they can "build therapy into their life in a way that's convenient, as opposed to having to push things aside and put therapy in its place," Glick explained.
Broc Christensen, a junior and ATO president at the University of Nevada, Las Vegas, found the app very helpful when trying it for the first time last fall.
"It was really nice to be able to vent and get good advice from actual therapists on the other side," he said. "If I'm feeling super stressed or if I'm worried about a test or something, and I feel a lot of anxiety, I just text them."
For Christensen, responses almost always came immediately — the longest he ever waited was 20 minutes. Glick said response times vary from therapist to therapist, but they typically answer clients' messages within the same day.
Christensen also likes the confidentiality the app offers. He said he will sometimes talk about anxiety with several fraternity brothers, but mental health isn't widely discussed among his peers. He tried one in-person session at his university counseling center but said he felt uncomfortable with a person walking around campus knowing all his personal thoughts. Texting his concerns to someone far away from UNLV feels much easier.
But texting therapy isn't for everyone, nor is Talkspace without controversy.
Glick acknowledged that people with serious mental illness, like those who are actively suicidal, can't benefit.
And if you only communicate through text messaging, your therapist can't read visual cues. Miscommunications happen, and it may be harder to connect with clients.
Moreover, Talkspace recently came under fire for ethical issues regarding client information and safety. An investigative report indicated Talkspace's policy of user anonymity — users aren't required to share identifying information or contact info — means therapists can't always intervene if clients pose danger to themselves or others.
Yet many experts agree text-based therapy has the potential to democratize therapy by reaching those who don't have the means or courage to see a therapist in person.
"I have a lot of clients who identify as introverted and would never see someone face to face," Glick said. "But they will write me paragraphs and paragraphs. So I can get to know them in a really deep way, in a way I never would have been able to if this platform didn't exist."
Campus computer programs
Other recent efforts to expand mental health care through technology are happening in college counseling centers.
A handful of universities now supplement their counseling services with online cognitive behavioral therapy (CBT) programs, which offer mostly self-guided exercises, like journaling about stressful events or prioritizing activities in a daily schedule, to help students change beliefs and behaviors causing mental distress.
This school year, Texas A&M, the University of North Texas and Baylor University adopted a CBT program called Therapy Assisted Online. Brigham Young University recently added a similar service called SilverCloud.
Tyler Pederson, associate director of BYU's counseling center, explained the center first purchased SilverCloud in October 2015 to meet student demand, which has grown 10 to 15 percent a year for the past five years.
Pederson hoped it would allow the center to assist more students by reducing the amount of time staff spent with them in person.
By the end of 2016, 12,000 students signed up to use the free eight-week program, which Pederson noted is one in every 30 students on campus. Some use it to supplement traditional therapy and others without seeing a therapist at all.
Pederson said student feedback is "all over the map." Some really like SilverCloud and consistently complete each exercise, but others are less diligent. Keeping students engaged is the biggest challenge.
Even though many studies show online CBT can be as effective as face-to-face treatment, these studies don't reflect a real-life setting where users are much less inclined to follow through with programs, Pederson explained.
As difficult as it is to engage students, persuading therapists to monitor students consistently is even more challenging.
"Therapists are very used to a specific model of how systems work, and we're asking them to do something completely different. Most of us went into this profession because we like to talk to people, and talking to people online does not feel the same at all," Pederson said.
And like text-based therapy, online CBT can't help everyone. BYU has versions geared toward stress, anxiety and depression, and it plans to add additional tools for social anxiety and eating disorders later this year. But students with more severe issues need to be seen in person.
According to Locke, online CBT can provide solid information but will likely only help a very specific segment of students: those interested in mental health services, highly motivated and experiencing only mild or moderate symptoms. Students who report a threat to self, the largest area of increase nationwide, probably won't be helped by these tools.
Even with the program's limitations and the increased demand BYU's counseling center faces, Pederson remains optimistic.
He is confident SilverCloud reaches a group of students who wouldn't otherwise participate in therapy, either because their schedules don't allow time or because they are "frightened to death of meeting with someone face to face."
While this expanded reach hasn't yet reduced the center's waiting list, he hopes it will in the future as more students and therapists adjust to the process.
Social media support
While some students find adequate mental health resources through university programs, many also turn to online communities.
Gerard, at Puget Sound, said students on her campus often look to social media for mental health support because "it's accessible and honest and provides space for students to have unfettered access to people who think like them, want what's best for them and share similar experiences."
She explained that different platforms offer different types of communities. Personally, she likes Tumblr, a microblogging website, because it "isn't a space that creates a huge divide between creator and consumer. It initiates conversation and allows anyone to be a resource (through posting their own content) rather than only seeing what other people create."
Kathleen Porcello, also a sophomore at UPS, turns to Facebook for mental health information. "I have moderate anxiety and depression, and I have a wonderful counselor at UPS. However, the school only lets students see a counselor for 50 minutes a week," she said. So Porcello pursues what she calls "self-therapy" in her spare time by following Facebook friends who frequently discuss and post articles about mental health.
Kelly Aschbrenner and John Naslund, a professor and a Ph.D candidate at Dartmouth researching how digital technologies extend mental health care, confirm that social media is increasingly used as a mental health tool, particularly by young adults.
Surveys show that more and more people are turning to the internet for health information and support, "so we can definitely say the same thing is happening for mental health," Naslund said.
Because mental illness is so isolating and stigmatizing, social media can help those suffering connect with people who have similar symptoms, helping them discover coping skills and feel less alone, Aschbrenner explained.
Kati Morton, a 33-year-old therapist in Los Angeles, discovered these benefits when she started a mental health YouTube channel in December of 2011.
Her husband, a film producer, had recently attended a conference on YouTube, a new platform at the time. He insisted Morton, who worked at an eating disorder clinic, should share mental health information on YouTube. "You always talk about how people don't understand eating disorders and how there aren't good therapists to refer to. This would be a great way to educate people."
Morton initially refused to be on camera, but her husband eventually wore her down.
Her videos never went viral, but she immediately had at least 10 or 15 active viewers who discussed and shared her content.
Five years later, Morton manages a community of over 157,000 subscribers. She posts two videos a week on viewer-requested topics from social anxiety to self harm, hosts weekly livestreams and runs dozens of forums where viewers share tips and personal experiences.
Morton admitted having such a large audience — many of whom struggle with mental illness — can be overwhelming, but "the saving grace of the channel is having a community."
She once joked that she didn't have minions in her basement helping her answer questions; she's only one person. So now her viewers call themselves "Kinions" (a portmanteau of "Kati's minions") and actively listen and respond to each other's concerns on her behalf.
Some might find getting mental health advice from peers risky, but Morton sees no danger in sharing personal experiences and coping strategies. She always reminds her viewers to see a professional before making decisions about medication or other treatments.
Aschbrenner also said peer guidance can be safe and useful, even advice on which medications helped and which ones produced negative side effects, as long as individuals check in with both themselves and a professional when determining which treatment plan fits their needs.
Morton doesn't view her channel as a replacement for professional care — it's more of a supplement. She also hopes it serves as a point of entry for teenagers and young adults who've never sought out mental health support.
Aschbrenner explained that discussing mental health on social media, technology young adults are already comfortable with, can normalize these conversations and help-seeking behaviors.
Ultimately, Morton hopes her channel shows viewers they aren't alone.
"A lot of times people feel like they're at the end of their rope and nobody's there to help them. But you're not alone. How you're feeling isn't weird. There's at least 157,000 people out there who have questions just like you and concerns just like you."
