Mental-health counselors at La Salle University were feeling overwhelmed, their appointment books packed with students in need of help, seemingly more so than ever.
Counseling director Suzanne Boyll ran numbers last week and confirmed her suspicion. They were busier.
As of Oct. 16, the number of counseling sessions had spiked 48 percent to 204, up from 137 the same time last year, a jump not solely explained by the school's record freshman enrollment.
"There are trauma-related problems, death of a family member, bad news about a class, other family stresses, boyfriend/girlfriend issues, conflict with a roommate," said Boyll, a 30-year veteran and one of four psychologists on staff.
Counseling centers at many schools in the region and nationally note the same trend: more students seeking help for routine and severe problems.
Still shaken from the Virginia Tech shootings in 2007, campuses are responding to the demand by adding counselors, reorganizing how they assess students to get to the most acute cases quickly, and training workers to deal with newly emerging problems.
Rutgers University's main campus in New Brunswick, N.J., opened a new $5 million, 35-room counseling center this fall with all mental-health services consolidated there. It also has overhauled how it responds to students.
"If a student calls for help and they need urgent help, they're seen the same day or same moment," said Jill Richards, counseling director.
At Rowan University in Glassboro, an increased number of students are "coming in with heightened symptoms of depression, anxiety, and suicidality, as well as students with developmental disorders, specifically Asperger's disorder, as well as attention-deficit disorder," said David Rubenstein, counseling and psychological director.
Gwynedd-Mercy College in Gwynedd Valley has treated students with deeper problems, too. Counselors in 1999-2000 saw 133 students for 227 sessions; last year, the numbers were 126 students for 610 sessions.
Increasingly, students are requiring hospitalization, some schools say. Temple University last year had 37 students hospitalized, up from 16 in 2007-08.
"We don't know if that's a trend, but we're going to monitor it," said John DiMino, Temple's counseling director.
And more students are coming to campus already with a mental diagnosis.
Nationally, nearly 15 percent of college students in spring 2008 said they had been diagnosed with depression, up from 10 percent in 2000, the American College Health Association says.
A report by Pennsylvania State University's Center for the Study of Collegiate Mental Health found that one in four students who showed up at a sampling of college counseling centers last fall had seriously considered suicide. One-third had previously taken psychiatric drugs.
The influx comes as advances in psychiatric drugs allow more students with serious mental problems to attend college.
Students also find less stigma in seeking help; they routinely see commercials for psychiatric drugs on TV and billboards, experts say.
"These kids want to be in therapy today," said Ian Birky, counseling and psychological director at Lehigh University in Bethlehem, where the number of students seeking individual or group counseling has crept up in the last decade to 841. "They're growing up in a little bit of a different culture."
Add to that the stresses of a bad economy, uncertain environmental conditions, and more "hyper parents" who haven't allowed their children to develop their own coping skills, counselors say.
"If you have a parent who is so hyper-concerned that they 'rescue' them, you don't allow them the time that they need to sort of struggle," said La Salle's Boyll. "They're really cheating their child out of their ability to learn to manage their own stress."
Consequently, Boyll said, her center is getting more calls from parents asking about their children. By law, counseling centers can't reveal information or acknowledge that a student is a patient without written consent from the student, she said.
"We tell them to have their child sign a release," she said.
Also contributing to the rise in demand is the better job that counseling centers are doing of advertising their services and making students feel welcome, no matter the severity of their problem.
"We say you don't have to be sick to come. If you broke up with your boyfriend or have a roommate problem, you can come," said William Alexander, counseling and psychological director at the University of Pennsylvania, where the percentage of students seeking service has risen from about 9.5 to more than 11 in the last decade.
To respond to the increased demand, schools are adding staff. Temple hired three more counselors over the last five years, at a cost of about $250,000.
Lehigh University got two doctoral interns.
Ursinus College grew from one counselor four years ago to three. About 8 percent of the 1,676 students sought counseling in spring 2009.
Some schools have taken the unusual step of adding specific fees to help cover burgeoning costs.
Emory University in Atlanta a year ago tacked onto bills for all students a $50 fee for mental health and counseling. The reason wasn't only to bring in more revenue for counseling. The university also wanted to reduce the stigma, said Mark McLeod, director of student counseling for the 12,000-student school.
"Our board of trustees wanted to say . . . it's OK to talk about this," he said.
Penn State charges a fee for some services. Psychiatric sessions cost $30; the first 10 sessions with a psychologist are free, and there is a $30 fee for each additional one.
Other schools embed costs in health or general fees.
To improve service, Temple several years ago converted to a "walk-in clinic format" allowing students to come without an appointment during a four-hour daily window, DiMino said.
In the past, students would have to wait several weeks for an appointment, and some were found to have acute issues.
Rutgers made a similar shift in spring 2008 that has resulted in more students going in for counseling, said Richards, the counseling director.
About 2,800 of the campus' 35,000 students went for counseling last year.
"If you make a person wait, anxiety builds," she said. "If they have to wait two weeks, they may not go for the help."
The center employs 17 psychologists and social workers, five psychiatrists, three substance-abuse specialists, six doctoral students, and several graduate trainees. Staff has not increased but has been consolidated at the new center.
The center also is training its staff in how to deal with students who have increasingly common "pervasive personality disorders," Richards said. The students fail at relationships, struggle with authority figures, and have poor self-concept.
The counseling center also prepared and sent out 18,000 flyers to faculty and staff on how to direct a student in crisis, she added.
"Students will write things in an English assignment or say things on e-mail and instant messages that they can't say in face-to-face contact," she said.
Some schools are creating committees with liaisons from academics, mental-health, campus security, and other areas to coordinate help for those with severe problems.
In its third year, La Salle's group, called Threads, meets once a week.
"We really try to identify students at risk and intervene," Boyll said.
Gywnedd-Mercy added a similar team this fall.
St. Joseph's University, where up to 13 percent of undergrads seek counseling, is hiring a case manager to coordinate care for an increasing number of severe cases.
Mark Salzer, an associate professor in psychiatry at Penn, has found that some college counseling centers still don't know what students with psychiatric disorders need to be successful.
"Pills and therapy are great things, but those aren't the only . . . things," he said. "They need contacts who will help them with academic accommodations, check to see if they're going to class and doing homework, and encourage them to stay in treatment."
Students themselves are getting involved.
Alison Malmon, a 2003 Penn graduate, was moved to action when her brother killed himself after dropping out of Columbia University, having struggled with mental problems largely in silence for three years.
She started a nonprofit, Active Minds, to help reduce the stigma and increase discussion on campuses about students who need mental-health help. There are more than 200 chapters at campuses nationwide, including Cabrini, Bryn Mawr, Immaculata, Temple, Ursinus, and West Chester University.
"I looked at the lack of dialogue that was going on on my campus," said Malmon, 28. "Students need to be brought into it more. They are the ones who can make an impact with their friends."
Pennsylvania State University's Center for the Study of Collegiate Mental Health collected data on 28,000 students who went to counseling centers at 66 colleges across the country last fall.
Participating schools included Penn State, Franklin and Marshall, Lafayette, Lehigh, Susquehanna, and the University of the Sciences in Philadelphia.
Here are the findings:
51 percent of surveyed students had mental-health treatment before going to the college counseling center.
34 percent had used psychiatric medication.
9 percent had prior psychiatric hospitalization.
5 percent had previous drug or alcohol treatment.
Students reported that, before going to counseling:
21 percent had injured themselves without intending suicide.
25 percent had seriously considered suicide.
8 percent had attempted suicide.