members provide from 43 to 1,333 sessions, with the vast
majority providing under 500 sessions. Individual clients
attend an average of 5. 5 sessions. The average number of
sessions does not vary strongly by institution size, but private
institutions report a higher average number of sessions than
public institutions ( 6. 1 versus 4. 9 percent).
Session Limits
Forty-eight percent of centers do not limit the number of
sessions provided to clients. Only 18 percent reported defined
limits, while 34 percent of centers reported flexible limits that
ranged from 4 to 45 sessions over a student’s college career.
These results raise the question: Do limits decrease the average
number of sessions per client? Past analyses have not shown a
significant reduction in sessions due to limits and have occasionally shown an increase in utilization. Current data suggest
that for those centers with session limits, the average number
of sessions is 4.93; for those having session limits with some
degree of flexibility, the average number of sessions is 5. 16;
and for those centers with no limits, the average number of
sessions is 5.85. The current pattern is consistent for public
and private universities with slightly more sessions provided at
private universities.
Formal Diagnoses
For those institutions that offer psychiatric services, the
majority are provided in the counseling center (46.3 percent),
with 24 percent offered at other locations on campus, most
typically in student health services. Psychiatric services are not
provided at 26. 2 percent of campuses. Only 21 percent of
directors report that students have access to sufficient psychiatric services, indicating a growth area that will need additional support in the future.
Historically, most counseling centers do not make formal
diagnoses as part of their treatment protocols. With both the
rise in serious mental health issues and the increasing utilization of psychiatry services on campuses, it is not surprising
that 40 percent of counseling centers are increasingly
providing formal diagnoses. As institution size increases,
centers are more likely to provide formal diagnoses.
Medical Leaves
The increase in serious mental health issues has led to a corresponding focus on related issues, such as student medical
leaves from school for psychological reasons. More than 200
directors reported at least one student on medical leave. A
total of 2,305 students had taken medical leaves at surveyed
institutions, yielding an average of 12. 4 leaves per school.
Directors also report a total of 2,059 students hospitalized for
psychological reasons, averaging 9. 8 hospitalizations per
school. Fifty-eight percent of schools report at least one hospitalization. Directors also report 1,474 suicide attempts,
yielding an average of 7. 7 suicides per school. Ninety-one
student deaths by suicide were reported, down from 111 in
the 2006 survey.
Transportation
Directors also noted the method of transportation typically
used to take students to psychiatric hospitalizations. The
most frequent means is campus police (63 percent), followed
by local emergency medical services (54 percent), friends
(40.5 percent), family members ( 33 percent), campus administrators ( 17 percent), and counseling center staff ( 12 percent).
Confidentiality
Another key issue raised in the survey data is student confidentiality and when and how to involve student affairs
colleagues and families of struggling students. Under the law,
most college students are legal adults and are entitled to the
confidentiality that is codified in state and federal law for all
adults. These laws exist because confidentiality in treatment
saves lives. However, when a threat to safety occurs, these laws
have provisions that place the value of safety over confidentiality. Seventy percent of directors surveyed do not believe it
is legally permissible to notify an institution’s most senior
student affairs officer without client consent when a student is
hospitalized for psychological reasons.
The legal reality is that without a student’s consent, a counseling center staff member is almost always unable to discuss
information learned as part of a therapeutic relationship with
campus administrators. Sixty percent of directors report that
they do not believe it is legally permissible to notify parents or
other significant relatives without client consent in that same
situation. However, 79 percent of directors report that they
would seek student consent to inform family members or
important others. Most significantly, 67.5 percent of directors
said they are successful most of the time in obtaining client
consent; another 32. 2 percent report obtaining permission
some of the time.
An Evolving Landscape
The face of college student mental health continues to evolve
rapidly. The results of the AUCCCD survey illustrate the
considerable variability that exists in the practices and issues at
college counseling centers. The survey also provides a clear
picture of the actual work of the centers and promotes a
better understanding of services provided. The staff at university and college counseling centers are resources for their
institutions, providing expertise in college student mental
health and offering critical services that improve student wellness and academic success and embrace the overall missions of
higher education institutions. LE
Victor Barr, AUCCCD governing board member, is the director of the
University of Tennessee at Knoxville Counseling Center.
Robert Rando, AUCCCD survey coordinator, is the director of
Counseling and Wellness Services and associate professor in the School of
Professional Psychology at Wright State University in Dayton, Ohio.
