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Mental Health on Campus: University Counselors Seeing Fewer Clients, But More Often

Pondering the Pandemic’s Toll

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Above image credit: The COVID-19 pandemic has had a mixed impact on mental health services on college campuses. Fewer students are reaching out for help, but those who do are seeing counselors more frequently. (File photo)

Diana Restrepo knew what she needed to do in her last year of graduate school. She needed to wrap up her Ph.D research, write and just get through to the end of 2020, somehow.

But prior to the COVID-19 pandemic, Restrepo was diagnosed with severe endometriosis, lost an ovary as a result and ended a years-long abusive relationship. 

The pandemic left her even more isolated, with nothing but her cat to keep her company. She plunged into a dark place.  

“You know how your mental state, and your physical state, are connected in so many different ways?” she said. “I think that my emotional state was so damaged that my body just kind of sent me a really big red signal.”

She decided it unwise to remain alone during the pandemic and moved in with her family, who live in the Kansas City area. 

“I was just like, ‘I cannot do this. Oh my god, I cannot.’ So I took my cat, I took some leggings and I went to their house that day.”

A once vivacious and happy person, her family said they could hardly recognize her. 

Diana Restrepo sought mental health counseling at the University of Kansas during the pandemic.
“There’s so much other stuff that is happening that you’re always on fight or flight mode. You don’t really have enough time, typically, to feel the feeling.” – Diana Restrepo, who sought sought mental health counseling at the University of Kansas during the pandemic. (Contributed | Jessica Fernández Vega)

“I was left like a zombie,” Restrepo said.

So, she went to the health center on the University of Kansas campus. She was diagnosed with anxiety and depression, which would explain her cycles of panic attacks followed by days where she’d shut herself in at home, in the dark. 

She also felt isolated as she navigated the new diagnosis.

Restrepo, a Colombian immigrant who escaped threats by moving to the Midwest when she was 16 years old, said she felt obligated to keep powering through. 

“There’s so much other stuff that is happening that you’re always on fight or flight mode,” she explained. “You don’t really have enough time, typically, to feel the feeling.”

Restrepo is not alone. College students across the country experienced isolation, anxiety and depression as the pandemic changed the social scenes of school.

At Missouri and Kansas schools, there was a decrease in the number of students seeking counseling. But those students seeking help scheduled more appointments, several university counseling centers said.

The University of Missouri’s counseling center saw 34% fewer unique clients in fall 2020 compared to fall 2019, but only 8% fewer appointments. 

“So what that means is that the students that were coming in were having potentially more significant issues, or their symptoms were worse that were requiring a longer course of therapy than maybe they did in the fall of 2019,” said Dr. Christine Even, director of the counseling center at the University of Missouri.

Demand for appointments steadily increased as the pandemic wore on. At the start of the pandemic in spring 2020, there were about 1,700 fewer appointments at MU compared to fall 2019. But over the entirety of the 2020-2021 school year, there were 11,584 appointments, compared to 9,471 in the 2019-2020 school year — a 22.3% increase.

Even said that when the pandemic first hit, counseling wasn’t a priority for a lot of students as they were struggling with more pressing issues like staying healthy, finding work or paying bills. But as the pressure built, students felt like they needed more help, she said.

“As the year went on, the stress and the burden just kind of added up to the point where I think for a lot of students, it was time for them to seek help,” Even said. “That they had been dealing with it on their own for long enough and it was time to seek support.”


Students who sought treatment because of COVID-19 reported higher rates of negative life impacts across all areas when compared to students who initiated treatment for other reasons.
Students who sought treatment because of COVID-19 reported higher rates of negative life impacts across all areas when compared to students who initiated treatment for other reasons. (Graphic | The Center for Collegiate Mental Health)

The numbers are consistent with counseling centers nationally. According to the Center for Collegiate Mental Health (CCMH), college counseling centers nationally saw a 32% decrease in the number of students seeking counseling services in fall 2020 compared to fall 2019. 

But again, those who were seeking counseling attended more appointments than they had in the past, meaning their need was higher. 

The University of Missouri-Kansas City counseling center also had fewer unique clients, but more appointments in the 2020-2021 school year, with 567 students and 5,878 sessions through July 7. 

In 2019-2020, there were 699 students and 5,310 sessions and in 2018-2019, there were 801 students and 5,391 sessions.

The University of Kansas also saw fewer unique clients but an increase in the number of visits from those clients. However, they did not provide their exact numbers.

Dr. Arnold Abels, the director and clinical coordinator of UMKC’s counseling center, said this decrease in clients is partially due to limitations on who they provided services to. While the center can help students in Kansas and Missouri, they cannot help students in other states or countries because they are not licensed in those areas. 

“We only have staff that are currently licensed in Missouri and Kansas, and if somebody lived in Texas or California or Washington state, etc., legally we can’t provide services to them,” Abels said. “Those students need to seek services in those communities.”

This is a challenge both MU and KU experienced as well.

Exacerbated by Pandemic

Deegan Poores, a recent graduate of KU, started going to therapy at KU’s counseling center as a freshman. He was planning on starting antidepressants right before the pandemic began.

“There was just a point where it was really difficult for me to get through a lot of struggles,” he said.

He scheduled a consultation appointment to discuss medication options. But because of the shutdown, his appointment was canceled. More than a year later, Poores still has not been able to get on medication.

CCMH’s data show that while 33% of students indicated that their reasons for seeking counseling were related to the pandemic, 67% did not. Many students had preexisting reasons, like Restrepo.

The compounding trauma of a physical illness and the depression-anxiety combination just made things worse, she said. Her experience tracks with CCMH’s data

On a more granular level, when respondents were asked what aspects of their lives were negatively impacted by COVID-19:

  • 65% said mental health
  • 61% said motivation or focus
  • 60% said loneliness or isolation
  • 59% said academics
  • 54% said missed opportunities or experiences

Poores started law school during the pandemic, but encountered challenges when it came to navigating a partially online learning environment.

In addition, he wasn’t able to fully embrace the social life that comes with being a college student as he was living off campus with his grandparents.

“It made the fulfilling aspects of being at a university much more challenging and practically nonexistent,” Poores said.

Laurie Wesely at KU’s counseling center said stress, anxiety, academic difficulties and depression were the most common reasons students sought counseling. But in addition to the pandemic, she said students were also struggling with the social and political divisiveness of the country, racism and fear.

Abels said that when students at UMKC’s center were asked what their primary presenting concerns were, 77.5% said anxiety, 75.4% said stress and 64.1% said depression.

Previously, 70% identified depression, 65% said anxiety and 60% percent said relationship issues.

“I think there’s been an element of uncertainty for a lot of the students we’ve worked with in terms of ‘What does this mean moving forward for me in terms of my education and career? Are there going to be jobs available?’” Abels said.

Transition to Teletherapy

Prior to the pandemic, Poores only saw his counselor in person. Then he had to switch to phone calls and eventually Zoom calls.

While this made it easier to talk to his counselor on short notice, he said the transition wasn’t completely comfortable to him.

“It just felt awkward to talk to my counselor on the phone,” he said. “So that just made me want to meet with him less … It got to the point where I’d only meet with him when I really, really needed to.”

But he said these were personal issues, such as feeling uncomfortable talking in his family home, or being self aware of how he looked on the screen.

“I don’t think the quality of the care I was getting was diminished,” Poores said. “It just, on a personal level, wasn’t as accessible for what I needed out of it.”

Although Poores favored seeing his counselor in person, many students actually preferred virtual counseling and hope it continues past the pandemic. Even said 87% of clients at MU’s counseling center would like telehealth services as an option in the future.

“I will be the first to say I was surprised,” Even said. “It was something that was new to us. We’ve actually found that students have really enjoyed it and said it’s been convenient for them to not have to leave their homes.”

She added that some students felt safer and said they were more willing to attend therapy from their homes rather than going in person.

Abels said he was also skeptical of the virtual platform at first. And while he prefers in-person counseling, the virtual sessions went much better than he anticipated.

“Students have been very adaptive and responsive to it,” he said. “And it’s actually something we’ll never give up.”

Virtual counseling can also be more accessible to those who are especially having a difficult time, Even said.

“For some individuals that are severely depressed … they may be able to get out of bed to do a virtual appointment,” Even said. “But getting out of bed and showering and getting dressed and getting in a car and driving across town to an in-person appointment, that may be too much for them to feel like they can do.” 

That was the case for Restrepo. During the pandemic, she went through one of her darkest depressive episodes. So, she asked for her sister’s help, asking her to take her on a walk or grab some coffee. But she couldn’t muster up the energy to move. That scared her sister. They planned on going on a road trip this summer, helping her sister get settled in her new home in Portland. That changed. 

“After this last episode she told me, ‘I don’t want you to ruin my first experience, moving away and living on my own,’ ” she said, her voice breaking.

Tears rolled out of Restrepo’s eyes. The thought of her sister, who’s one of her best friends, being unable to help was heartbreaking. 

Since then she’s begun what she calls her mental health journey. She realized the pressures of academia, of being the eldest child in an immigrant family and making the choice to get help is a lot. 

“I have learned to be very tough and resilient. And when we’re like that, we can get up so many times … from so many different situations,” Restrepo said. “But it requires the hardest of situations. The ones that destroy you, for you to be able to wake up.”

Marissa Plescia is a Dow Jones summer intern at Kansas City PBS. Vicky Diaz-Camacho covers community affairs for Kansas City PBS.

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