Why Should Schools Be Mental Health Care Providers?

A capacious national health system should provide systemic solutions for young people

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Should colleges and universities be the primary point of care when it comes to the mental well-being of students? I suspect my point of view will be controversial: no.

Let me explain.

Since the pandemic began, addressing the mental health of students has evolved from an ongoing buzz to an urgent, insistent appeal that is drowning out almost every other issue in higher education except for the cost of attending college at all. Some of the reasons for this escalation are external to campus life. The general need for mental health care has risen dramatically in the last two years, and there aren’t enough therapists to meet the demand. Then there’s the expense. Seeing a licensed psychotherapist in New York City, where I teach, can cost upwards of $350 for a 50-minute hour; in some of the less glitzy places I have lived it is more affordable, at $125 an hour.

Yes, there are clinics where you can get help on a sliding scale keyed to income, but people who are poor—many students, as well as many working people, are poor—still can’t afford it. A student who is working their way through school and taking out loans may not have even $10 or $20 left over every week after paying for rent, food, transportation, and internet service.

And yes, there are limited psychological support services on every campus, but let’s stress the word “limited.” While a student who is in danger of self-harm can usually get crisis intervention, that student also risks being sent home if their condition becomes known to the college. So not infrequently, even though students know they are in danger, they try to cope by themselves. Those who want help, despite being in terrible pain, often can’t see someone and they go on waitlists. Should a student come off the waitlist, they generally get a set number of sessions, after which they are expected to transition to a private provider. And counseling centers are often staffed by unlicensed graduate students who see clients under supervision as part of their clinical training.

Now, the Surgeon General of the United States, Vivek H. Murthy, has weighed in w on two startling new studies suggesting that the failure to provide adequate mental health services should be at the top of every university’s agenda. “Mental health is now one of the top reasons many college students are considering dropping out of college,” reports Oyin Oledeyin at The Chronicle of Higher Education.

What Murthy doesn’t say is that campus mental health is not unlike climate change: the conditions have been ripe for a system collapse for years. COVID-19 appears to have accelerated that collapse, as has the shortage in therapists, a problem common to many healthcare fields.

Murthy also noted that the front line for student mental health is usually professors, coaches, and administrative assistants. In other words, a college’s most capacious resource in dealing with students in distress is people who are completely untrained in helping students in distress, except by instinct and the dozens of memos we get every year asking us, in effect, to be kind to our students and cut them a break. In my undergraduate classes, I always have students fill out a survey so that I know a few things going in, and one question asks: “Is there anything you want me to know about you?” Four-fifths of the class had some kind of diagnosis, and many are in some kind of treatment. That treatment often includes medication.

Caring for students’ emotional needs is now an unspoken part of the contract you sign as a university professor. Since the pandemic began, those memos we get have highlighted strategies for relieving student stress that often make teaching more cumbersome and time-consuming, and do nothing to address the root causes of the anxiety and depression with which students are coping. We are asked to take attendance, but not visit penalties on students who don’t attend class; make deadlines flexible; and warn students about anything on the syllabus that might upset them, providing alternatives if the assignment triggers stress or trauma.