Students in Crisis: Climbing Out

Depression and anxiety on college campuses have risen to epidemic proportions. There are a variety of suspected causes for the alarming trend, which is supported by numerous studies, including a February 2010 Healthy Minds Study finding that 20 percent of BU students surveyed fit the criteria for anxiety or depression.

Monday we began a three-part series examining depression and anxiety among BU students. Part one offered an overview and a look at what’s behind the increase and who is most at risk. In part two, we showed the faces of depression and anxiety through a series of candid interviews with students. The series concludes with information on how to get help, what that help involves, and how some students suffering from depression and anxiety—treatable conditions—have found hope, and a way out.

It was fall semester of junior year and Becky Gordon was in a dark hole. The once–straight A student barely got out of bed anymore. The last time she’d shown up for class she’d run out in tears. She still didn’t know why. The sadness was suffocating, heavy as lead, pierced only by wrenching questions she couldn’t answer: am I the only one? Why me?

“It was extremely isolating,” says Gordon (CAS’10). “When I would talk to my friends, they understood what it meant to be sad, but they didn’t know what I was going through. I went on the internet and tried to find people who were going through this, just so I didn’t feel I was the only person.”

Online was also where Gordon finally typed into a search engine the words “depression+BU+counselor.” Scrolling through the results, she found Behavioral Medicine at BU’s Student Health Services. She screwed up her courage and dialed the number. When she swiped in at 881 Comm Ave the next day, she was nervous and intimidated. But those were the steps that would change her life, she says.

Over the last 10 years, Behavioral Medicine has seen a 250 percent increase in appointments, an unsettling spike, and one that mirrors a national trend of distressed students on campus. The numbers are driven largely by a growing awareness and acceptance of mental illness, an increase in the number of students arriving at school already in therapy and medicated, and to a lesser extent by the isolation of technologies like texting and Facebook.

“We know that we’re being used more heavily, which is great,” says Margaret Ross, director of Behavioral Medicine. “Students are not shying away from coming in. Our on-call service is busier than ever. Students are calling after hours.”

Ross knows also that there is plenty of iceberg below the surface. According to the 2010 Healthy Minds Study, an annual national online survey of college students conducted by the University of Michigan, 36 percent of the 1,400 BU student respondents thought they needed mental health help during the previous year, but less than two thirds sought treatment. Google shouldn’t be where students turn for comfort, Ross says.

“The internet is a wonderful informational tool, but it is not a substitute for a relationship with a trained mental health professional,” she says.

Student Health Services has a full- and part-time staff of 15—psychiatrists, psychologists, a nurse clinical specialist, and social workers, along with a handful of trainees. Emergency clinicians work the phones around the clock. SHS also offers support groups for depression, substance abuse, grief, chronic illness, stress and anxiety, family issues, and for the particular challenges faced by international students. All communications and visits are free and confidential unless the student poses a danger to himself or herself or to others.

Ross says the first contact typically starts with a phone call. On the other end, a trained SHS receptionist determines the urgency of the situation and whether the student needs medication or only wants someone to speak with. Little time is wasted. “We don’t maintain a waiting list,” Ross says. “We try to get people in as quickly as possible, including that very day.”

Once a distressed student walks through the doors at SHS, they fill out a medical questionnaire, which also explains confidentiality issues. This is followed by a one-on-one meeting with a counselor, where medical, psychiatric, family, demographic, and lifestyle backgrounds are discussed, as well as the exploration of symptoms of depression, anxiety, attention deficit hyperactivity disorder (ADHD), and bipolar disorder, among other ailments. By the end of that first meeting, the therapist will recommend a treatment plan and help determine whether medication and/or an off-campus therapist should be pursued. Behavioral Medicine clinicians may see a BU student over the course of his or her academic career, but they don’t offer long-term regular care.

“We’re in a particularly blessed situation that we work a 10-minute walk from Beacon Street, which I call therapy central,” Ross says. “There are tons of therapists available who take many insurances, and we have arrangements with them. We meet the outside therapists at an open house every year and make sure that we’re sending our students to good people.”

Gordon says that the feelings of distress may be acute, but she urges patience with the process. She tried several therapists before finding one she was comfortable with and found helpful.

“The most important thing is you shouldn’t give up,” she says. “I thought within the first session I’d be feeling better, and to some extent I did, because I talked about things I never talked about before and there was someone sitting across from me who not only cared, but had the tools to help. But it wasn’t like I saw him once and I was fixed.”

One BU senior we’ll call Sarah found the adjustment from high school to college overwhelming. Feeling lost and unable to fit in, she began drinking and developing dangerous eating habits. After months of isolating herself, Sarah finally confided in her parents, who set up an appointment at the Center of Psychiatric Rehabilitation, a research, training, and service organization affiliated with Sargent College of Health and Rehabilitation Sciences. There she was hooked up with an outside therapist. She also met with a counselor at Behavioral Medicine to work on the drinking habit she’d developed. Sarah’s only regret is she didn’t reach out earlier.

“I was intimidated about seeking help through BU services, which I realize now is nothing to be embarrassed about,” she says. “I’m only embarrassed that I was too proud to seek help sooner. Because of that, I missed out on a lot my first year at BU. A good way to look at emotional health is that you go to the doctor when you physically don’t feel well, so why would you not seek the same type of help when you’re emotionally not well?”

Gordon, who was diagnosed with depression and anxiety, admits she ignored her symptoms for too long as well; eventually she began cutting herself, a physical expression of her inner turmoil.

“I really saw college as the best four years of my life, the time of my life,” she says. “I was very involved in a lot of different things, extremely interested in my academics. I had papers, friends to see, things do all the time, and I was in this great big city. Working on my issues didn’t factor into that. There wasn’t time for it. I didn’t allow myself to say, I don’t have to participate in this or to feel that I could be sad or talk to someone about it.”

Spread thin
With 29,000 students on two campuses, to say Behavioral Medicine is stretched thin is an understatement, Ross says. The American College Health Association, an organization of 900 member institutions dedicated to the health of college students, recommends a ratio of one counselor per 1,500 students. With 11 full-time clinicians, Ross says the figure at BU is closer to one per 2,500. Other campus resources, such as the Center for Psychiatric Rehabilitation and the Danielsen Institute, cater to mental health issues, too, but Ross says they provide different services and many times have waiting lists, which her staff members often have to cover.

“Our staff really has been dealing with a tremendous crush of sicker students, more students,” Ross says. “The numbers don’t lie. The kinds of things we’re dealing with are so much more intense than in the past.”

Joseph Mercurio, BU’s executive vice president, says the resources allocated for SHS have grown exponentially, and he points out that Boston is also a city bursting with medical clinics and hospitals.

“We sit down at least once a year and review the number of providers that we have and the number of cases,” he says. “We review in terms of number of employees and budget. But we also review them in the context of other resources available on campus for mental health and therapeutic treatment. There are also other resources in Boston covered under the health insurance plans of all these kids.”

In 2009, the University landed a three-year, $300,000 grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), which Congress established in 1992 to bolster substance abuse and mental health services. The grant’s focus is to chip away at the stigma of mental illness on campus through, for example, the BU Secret campaign and depression screenings. According to the Healthy Minds study, 67 percent of BU students said they would turn to one another before an adult, so a component of the grant is training students in empathetic listening and directing troubled peers to the right resources. So far, more than 100 BU students have participated and some 300 resident assistants have received similar training.

“We’re broadening the safety net,” says Dori Hutchinson, director of services at the Center for Psychiatric Rehabilitation. “The idea of the grant is to create a culture of caring on campus and to really strengthen the network of people, not just adults. If you get it off your chest when it’s on your chest, we’re going to listen without judgment and you’re going to feel better. Keep it in for a long time and it’s going to cause distress. That’s when kids pull the covers up and don’t go to class and drink themselves into oblivion.”

Digging out
Gordon ended up taking a medical leave—a process with which BU was extremely helpful, she says—and pursued medication so she could work on her issues in a concentrated way. When she returned to campus a year after that initial phone call to SHS, she chose not to live at her previous residence hall, where she’d languished under a black cloud. No longer taking medication, she worried about the memories, so she took a room at a dorm nearby.

“When I was there, I was so deep down in my hole that I was thinking about ending things, and to walk by the place where you had those thoughts and see the sights where you were at the bottom of the bottom…” Gordon says, trailing off. “But I knew I was better because I sympathized with that person. I really felt for that person, but I wasn’t that person any more. It was a good thing. If I’d run away from it, or not gone back to those places, I wouldn’t have known how much I had recovered.”

Gordon went on to to become president of the student mental health advocacy group Active Minds at BU. Today, she is a national chapter leader, helping develop programs that educate students on mental illness in an accessible, nonclinical way. Stigma still exists on college campuses, she says, and many students, males in particular, have been socialized to equate asking for help with weakness, but that mentality is slowly changing.

So what would Gordon say to her younger, once-suffering self?

“First, you’re not the only person,” she says. “People have been at the lowest of the low and have gotten out of it and are now leading beautiful, wonderful lives. I would say, look around, because you can really live in your own head when you’re going through something like this. It helps to look at your environment and see that other people are there, beautiful things are there, and people are there who are available to help. Don’t be afraid to get help and don’t be discouraged if you have to try more than one thing.”

Those interested in seeking free, confidential mental health counseling can contact Student Health Services Behavioral Medicine, the Center for Psychiatric Rehabilitation, and the Samaritans of Boston suicide hotline.

Caleb Daniloff can be reached at cdanilof@bu.edu.