At Moravian College in Bethlehem, Pa., Allison Blechschmidt has noticed a yearly uptick in the number of students seeking psychiatric services, such as diagnoses of mental-health issues and prescriptions for antidepressants and antianxiety medication.
As the director of Moravian’s counseling center, Blechschmidt has tried a number of solutions to deal with the growing demand, such as having a psychiatrist on campus on certain days of the week or referring students to providers in the community. But neither was particularly efficient — paying for a psychiatrist is expensive, especially for smaller colleges, and the shortage of psychiatrists in the Lehigh Valley meant long waits for students looking for off-campus services.
“If I can’t find someone in the community that a student can see in the next six weeks, that’s a long time for someone to be waiting,” Blechschmidt said. “All this time, the student can’t get out of bed.”
This is a common dilemma for colleges in more rural parts of the United States. A 2009 study found that 96% of U.S. counties have an unmet need for mental-health care professionals, and the problem is most prevalent in rural or suburban areas. In Pennsylvania, more than 1.7 million people live in areas with a shortage of mental-health care providers, according to KFF, a health-policy nonprofit. And the problem is expected to worsen: The Association of American Medical Colleges estimates that the United States may be facing a shortage of up to 15,600 psychiatrists by 2025.
While the coronavirus pandemic has increased the prevalence of telemedicine, making it easier for patients to seek care from psychiatrists, demand for services has increased, as well.
“There was definitely a shortage before COVID,” said Taliba Foster, a psychiatrist practicing in Ardmore and at the Children’s Hospital of Philadelphia. “With COVID, the shortage became more prevalent and visible. It was already bad, and then it got worse. It’s affected all age groups.”
What’s more, experts believe the shortage of mental-health care providers, which forces people to wait weeks or months for appointments, is likely contributing to the rising rate of suicides in the country.
At the same time, the demand for mental-health services on college campuses has increased across the country over the last decade. A 2018 report by the Collegiate Center for Mental Health found that the use of counseling centers on campuses increased by 30% to 40% on average between 2009 and 2015.
To meet that demand, Lafayette College retains a psychiatrist from the community as an “independent contractor” to see students about four to five hours a week said Jeffrey Goldstein, the college’s director of health services. Making psychiatric services available to students on the Easton campus is high on the college’s list of priorities, he said.
“It’s definitely always worth the expense because the students who are coming to see the psychiatrist are high-risk students,” he said. “So we’ll bear that cost, whatever that cost might be.”
Muhlenberg College takes a similar approach, said Timothy Silvestri, director of the Allentown college’s counseling center. On average, students wait for two to three weeks before they see the psychiatrist, which is “astronomically better than three to six months in the community,” he said.
“It’s incumbent on us to try to fill that gap of not being able to get access in the community,” Silvestri said. “When talking about mental health, psychiatry is crossing into specialized care, which you typically wouldn’t expect from colleges. But we’ve had to meet that need.”
The counseling center also prioritizes follow-up care after a student has met with the psychiatrist. Silvestri said that after their first appointment, he encourages students to start looking for someone they can see at home over winter or summer break.
Many students could be facing a long wait list once they get back to their hometowns, he said. “So we want them to be as proactive as possible.”
At Haverford College on the Main Line, students can see a psychiatrist after meeting with a therapist in the college’s counseling and psychological services (CAPS). But CAPS does not usually diagnose students, said Hunter Logan, a 20-year-old junior who sought psychiatric care last year for symptoms of anxiety and depression. Logan said that more than a month passed between first bringing up the possibility of psychiatric care to his therapist and his scheduled appointment. Due to the pandemic, his appointment was canceled and he instead sought care from a psychiatrist in his hometown in Ohio.
“When I brought up that I wanted to meet with a psychiatrist at Haverford, my therapist said, ‘Let’s wait a few weeks and keep talking,’” Logan said. “The sense I got from them that was that, ‘If it’s still serious in a few weeks, we’ll go through with you.’”
Haverford employs a psychiatrist who works for about nine hours a week, said Philip Rosenbaum, the college’s director of CAPS. The college has also employed additional independent contractors when needed to “ensure that the wait time does not get too long,” he said. Last year, CAPS psychiatrists saw 52 students for a total of 240 sessions.
Moravian has taken a different approach this semester, choosing to partner with Mantra Health, a digital mental-health care provider focused on higher education. Blechschmidt said that Mantra appealed to her because the company was used to partnering with college counseling centers.
Through Mantra, students first take an assessment before they are paired with a psychiatric care provider or a therapist, whom they can message 24/7 or see via video appointments. The cost of the service is fully covered by the college. Blechschmidt said the transition has been seamless, and students are getting appointments within one week of making a request.
“We were looking for a solution that students would find more effective,” Blechschmidt said. “Mantra offers hours in the evening and flexibility. It’s efficient.”
Foster said that because colleges are mostly focused on preventing COVID-19 right now, there “hasn’t been as much of a focus as I would like on mental health.” Many of the college students she’s seeing are struggling with anxiety and depression.
“The students are away from home, generally for the first time, and without a lot of resources,” Foster said. “Their classes are virtual. They’re stuck in their dorm room. There’s just a lot of loneliness and anxiousness. College health centers are overwhelmed and their medical services are geared toward COVID, not the secondary effects of all of this.”