Jason Reed / REUTERS Students attend commencement at Ohio State University, May 2013.

Generation Stress

The Mental Health Crisis on Campus

It is supposed to be the time of their life—the halcyon days of college, when young adults grow, acquire knowledge, and learn new skills. But according to the 2016–17 Healthy Minds Study, an annual survey of mental health on American college campuses, while 44 percent of students said that they were flourishing, 39 percent reported experiencing symptoms of depression or anxiety. The proportion of students experiencing suicidal ideation has grown from six percent in 2007 to 11 percent in 2017. The percentage of students receiving psychotherapy has jumped from 13 percent to 24 percent over the same period. Even though more students are getting help, only a little more than half of those with symptoms of depression and anxiety had received treatment in the previous year.

The rise in mental health challenges is not limited to college students. One in every four adults in the United States will suffer from an anxiety disorder in the course of his or her lifetime, and suicide rates for men and women have risen since 2000. Whether these figures are a passing trend, the new normal, or a harbinger of greater challenges to come, one cannot fully know. But no matter what, universities need to deal with this uptick in psychological distress. No longer can they consider students’ mental health to be outside their area of responsibility.

Nowadays, that responsibility has broadened to include increasing students’ resiliency—that is, helping them not just avoid stress but also develop the tools to work through it. Resiliency is about decreasing students’ sense of overwhelming stress while fostering their growing autonomy to tackle difficult life challenges. It’s also about treating their very real depression and anxiety.

Taking responsibility for students’ mental health needs is particularly complex at a time when universities are rightfully under pressure about cost and access. And it is all the more complex given that part of the core mission of higher education is to challenge students. To put it succinctly, college is supposed to be hard. How to balance the natural challenges and stress that university life presents while supporting students’ mental health is an increasingly difficult tightrope to walk. Yet it needs to be walked, since students’ mental health is a growing concern, and when that health is poor, it can inhibit the core mission of learning. To address the issue, universities must raise awareness of the problem through education inside and outside the academy; focus on prevention, detection, and treatment; and acknowledge the importance of community—all while recognizing that stress is a part of life.

Following World War II, the United States built a thriving middle class and became the engine of the global economy thanks to the foundation of a thriving higher education system. Now, that same system must be a part of resolving today’s mental health crisis, which presents a broad challenge to American competitiveness and productivity.

STRESSED OUT

In my first year as president of American University, I met with students from a variety of backgrounds and quickly learned that they have a great deal of insight into why they experience more stress and anxiety than previous generations. The answer boils down to three factors: safety, economics, and technology. 

Students’ concerns about safety stem from different sources. Most undergraduates have no memory of a world before 9/11. They have grown up with bag searches on subways, SWAT teams at stadiums, and body scanners at airports—constant visual reminders that the United States was attacked and could be again. Students of an older generation would note that those are no different from Cold War–era “duck and cover” drills. Yet today’s students point out that Americans never experienced nuclear war, only the threat of it. 

They have also grown up with increasingly deadly mass shootings. This fall, students arrived on campus with the 2018 attack at Marjory Stoneman Douglas High School, in Parkland, Florida, fresh in their minds, but they also remember the attacks in 2017 at a concert in Las Vegas, in 2016 at the Pulse nightclub in Orlando, in 2012 at Sandy Hook Elementary School, and in 2007 at Virginia Tech. For some students on campus, incidents that have involved racially motivated acts of violence—such as the events in Charlottesville, Virginia, in 2017—add to their fear, stress, and anxiety. Female students have additional cause for worry. While the increasing transparency about how often sexual assault occurs on campus has helped advance the conversation about the issue, it has also added to safety concerns.

Other fears are rooted in economics. A college education is essential to social mobility, but tuition at both public and private universities continues to rise. Many students, especially first-generation college students, come from families with already stretched budgets and little experience in the nuances of financing higher education, making the prospect of student debt particularly daunting. 

Students also worry about the economy they are graduating into—they are old enough to remember the Great Recession—and fear that they will end up jobless, unable to pay off their debt, and forced to live with their parents. Although unemployment is now low in the United States, wage growth has stayed relatively flat throughout the recovery, and early career salaries, in particular, dropped during the recession. 

As a result, many students worry that they will do no better than their parents, and with good reason: in the United States, the likelihood that a child will earn more than his or her parents has dropped from 90 percent to 50 percent over the past half century. Students also see an economy that offers them not a single career choice but an ever-changing panoply of career steps. Such a path may be exciting, but it is nowhere as conducive to stable health insurance and a secure retirement as the one their parents and grandparents followed. 

Then there is the anxiety that results from social media. Part of the stress has to do with the pressure on young people to constantly present a curated version of their lives on Instagram, Snapchat, and other platforms. The way I translate this concern to older generations is by asking, “What would it be like if you had to update your resumé every day?” The obvious answer: incredibly stressful. Another part of the stress comes from the observing side of social media. Because people tend to heavily curate what they present, it can sometimes seem as if everyone else has better internships, earns higher grades, and attends more exclusive parties. 

A memorial to the victims of the mass shooting at Marjory Stoneman Douglas High School, Parkland, Florida, February 2018.

A memorial to the victims of the mass shooting at Marjory Stoneman Douglas High School, Parkland, Florida, February 2018.

THINGS REALLY ARE DIFFERENT

Some argue that all this is nothing new, that school has always been anxiety inducing. But regardless of whether today’s students really do face a greater number of stressors than generations past, there is little doubt that the impact of those stressors is felt more than before. Today’s young adults seem to arrive at college with less resiliency and a lower appetite for risk and failure. 

In raising their children, parents have focused more on protecting them from stress and anxiety and less on teaching them how to cope. Today’s incoming classes are of a generation that received athletic trophies merely for participating. Becoming so used to winning makes it all the harder to deal with losing. It makes it harder to learn resiliency. On top of this, parents have created a culture of risk aversion. Today’s students were warned as children not to walk home alone, and they grew up playing on playgrounds designed to break their falls. In many ways, children have been taught both explicitly and implicitly to avoid risk, and for many of them, the resulting safety has made them less capable of coping with failure and disappointment. 

When students have a panic attack because they received a B minus on a test, it becomes clear that parents have probably not done enough to prepare them for the fact that life involves both success and failure. Today, high school graduates arrive on American University’s campus with higher SAT scores, more Advanced Placement credits, and more International Baccalaureate degrees than ever before. They are book smart but perhaps less life ready. This problem can be seen not only in how they deal with bad news but also in what they know about basic life skills, from managing their finances to doing their laundry. There are exceptions, of course, but American University’s faculty and staff are probably not unique in observing that students increasingly come to college with less mastery of such skills.

Today’s young adults seem to arrive at college with less resiliency and a lower appetite for risk and failure.

Another way that today’s students differ from their predecessors is in their relationships with their parents and other adults in their lives. Gone are the days when a five-minute phone call every Sunday was the extent of communication with family. For many students, thanks in part to advances in technology, there is nearly constant communication with parents through texting and calls. In the interactions I see with faculty and staff on campus, students seem to seek more adult guidance and assistance with problem solving than previous generations did.

Stress can play out in different ways. One common type of student is the overachiever: a first-year student who was at the top of his class in high school and never needed to exert much effort to get there. In his first semester at college, he fails a couple of midterm exams and finds himself too embarrassed to lean on his support network from home. At night, when his friends have gone to bed, he heads to the library and immerses himself in his studies. Eventually, he’s sleeping less than four hours a night. And only when he reaches a breaking point does he seek out counseling that can help him work through his own expectations and time management.

Another common type is the overcommitted student. She comes to college with a strong sense of what she wants to do afterward—say, work on a political campaign—and loads up on extracurricular activities in pursuit of that goal. In her first semester, she joins several political clubs, runs for student government, and takes on a part-time internship on Capitol Hill. She even adds an extra class to get ahead. Without this level of commitment, she fears, she won’t be competitive for the best campaigns. The result is long days of meetings, work, and classes, along with late nights trying to catch up. Only after she breaks down emotionally does she confide in her dorm’s resident assistant, who refers her to the counseling center.

CHALLENGE AND RESPONSE

According to a 2015 report from the Center for Collegiate Mental Health, the number of students visiting counseling centers increased by 30 percent between 2009 and 2015 (enrollment grew by only six percent). Across the country, colleges and universities are adding extra professional staff to help students, in part because the types of counseling needs have also expanded. Some students arrive with complex medication regimes, whereas others are part of the growing number of students experiencing thoughts of suicide, a trend that requires more emergency services, such as 24-hour rapid-response counseling. As student bodies become more diverse, schools need support staff who can reach across cultural divides. Adding all these resources is not easy, especially for schools in rural areas, where mental health providers are in short supply.

Universities are struggling to keep up with rising numbers of students seeking support: according to the Association for University and College Counseling Center Directors, in 2016–17, 34 percent of college counseling centers had to put some students on a waitlist. And it’s important to note that many students remain reluctant to talk to a professional: while stigma concerning mental health today is less than what it was in the past, it still impedes students from recognizing their challenges, seeking out help, and committing to treatment. 

Universities are putting more effort into prevention. Harvard University has started the Success-Failure Project, a program that hosts discussions aimed at redefining success and dealing with rejection. Duke University offers a mindfulness program designed to help students manage stress. At American University, we introduced a mandatory, two-semester course aimed at helping students adjust to their first year in college. Of course, it’s important to make sure such programs don’t end up adding to the problem: when I asked students if stress-reduction seminars might be helpful, one responded, “Please don’t add anything to my already packed schedule that will further stress me out!”

Campuses that focus on creating a sense of community and belonging find that students who have support networks to turn to are better able to work through their challenges and stress. This sense of belonging can act as a preventive tool, countering students’ feelings of loneliness and depression and providing a way for them to alert others to the problems they are facing. Increasing a campus’ sense of community can often mean running into long-standing questions—for instance, about the value of fraternities and sororities and about whether to increase student engagement by offering more activities and clubs. Universities must face these old questions in the new context of growing mental health issues.

PRODUCING HAPPIER GRADUATES

Universities are in the early stages of grappling with the increase in stress and anxiety. Although there is no agreed-on formula at this time, there are some approaches that show promise. 

There is general agreement that the solution lies in more education about the issue, inside and outside the academy. Creating awareness of the problem and teaching faculty, staff, and students how to prevent, recognize, and respond to it can help. Just as many campuses have made progress on educating students about sexual assault, they can do the same when it comes to mental health. 

Moreover, as odd as it may sound, universities should draw on some of the lessons learned during the 2014 Ebola outbreak—a global health threat that emerged during my tenure as U.S. secretary of health and human services—and adopt a public health approach to the problem. With Ebola, the priorities were prevention, detection, and treatment. These core elements can also guide universities in framing their approach to mental health. Prevention can mean introducing courses that help students adjust to college life. Detection might mean developing ways to quickly notice when a student doesn’t download an assignment or show up for classes. 

As for treatment, universities need to secure adequate resources for counseling so that students seeking help receive timely and effective care. On many campuses, triage systems prioritize the most acute cases, determine which students can be treated in a limited number of sessions, and refer to other providers those who require long-term care. No university is capable of offering unlimited sessions and all kinds of care, so administrators need to determine which cases to refer and which to keep in house. They must also have the capacity to meet demand without long waitlists for treatment. To inform their investments, universities should use data about their campus’ particular needs—especially at a time when the economics of higher education are under both scrutiny and pressure. 

Universities also need to acknowledge the power of communities. Communities can not only act as a knowledge base and a source of referrals; at a more basic level, they can also stem the problem to begin with. Study after study has found that social connectedness is correlated with well-being and resiliency, so universities should strive to build inclusive communities. Encouraging in-person (not Instagram) connections can help. Administrators should make sure that students are aware of the clubs and groups on campus, offer a sense of belonging, and invest in first-year residence halls and other communities for living and learning. Faculty and staff should recognize the value of engaging with students. 

Finally, students, parents, and universities should embrace the healthy idea that stress is a part of what makes college great. College students develop intellectually, socially, and morally through a combination of challenge and support. Their time on campus should be not so overwhelming that they retreat, yet not so comfortable that there is no incentive to grow. Thus, the college experience should teach students not to avoid challenges—life is full of them, after all—but how to handle the stress that results. Recognizing this is the first step to producing more resilient students, as well as happier, better-adjusted graduates.

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