It was deep into the fall semester, a time of mounting stress with finals looming and the holiday break not far off, an anxiety all its own.
On a Thursday afternoon, a freshman who had been scraping bottom academically posted thoughts about suicide on Facebook. If I were gone, he wrote, would anybody notice? An alarmed student told staff members in the dorm, who called Dr. Hwang after hours, who contacted the campus police. Officers escorted the student to the county psychiatric hospital.
There were two more runs over that weekend, including one late Saturday night when a student grew concerned that a friend with a prescription for Xanax, the anti-anxiety drug, had swallowed a fistful.
On Sunday, a supervisor of residence halls, Gina Vanacore, sent a BlackBerry update to Dr. Hwang, who has championed programs to train students and staff members to intervene to prevent suicide.
"If you weren't so good at getting this bystander stuff out there," Ms. Vanacore wrote in mock exasperation, "we could sleep on the weekends."
Stony Brook is typical of American colleges and universities these days, where national surveys show that nearly half of the students who visit counseling centers are coping with serious mental illness, more than double the rate a decade ago. More students take psychiatric medication, and there are more emergencies requiring immediate action.
"It's so different from how people might stereotype the concept of college counseling, or back in the '70s students coming in with existential crises: who am I?" said Dr. Hwang, whose staff of 29 includes psychiatrists, clinicalpsychologists and social workers. "Now they're bringing in life stories involving extensive trauma, a history of serious mental illness, eating disorders, self-injury, alcohol and other drug use."
Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting.
There is also greater awareness of traumas scarcely recognized a generation ago and a willingness to seek help for those problems, including bulimia, self-cutting and childhood sexual abuse.
The need to help this troubled population has forced campus mental health centers — whose staffs, on average, have not grown in proportion to student enrollment in 15 years — to take extraordinary measures to make do. Some have hospital-style triage units to rank the acuity of students who cross their thresholds. Others have waiting lists for treatment — sometimes weeks long — and limit the number of therapy sessions.
Some centers have time only to "treat students for a crisis, bandaging them up and sending them out," said Denise Hayes, the president of the Association for University and College Counseling Center Directors and the director of counseling at the Claremont Colleges in California.
"It's very stressful for the counselors," she said. "It doesn't feel like why you got into college counseling."
A recent survey by the American College Counseling Association found that a majority of students seek help for normal post-adolescent trouble like romantic heartbreak and identity crises. But 44 percent in counseling have severe psychological disorders, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent a decade ago.
The most common disorders today: depression, anxiety, suicidal thoughts, alcohol abuse, attention disorders, self-injury and eating disorders.
Stony Brook, an academically demanding branch of the State University of New York (its admission rate is 40 percent), faces the mental health challenges typical of a big public university. It has 9,500 resident students and 15,000 who commute from off-campus. The highly diverse student body includes many who are the first in their families to attend college and carry intense pressure to succeed, often in engineering or the sciences. A Black Women and Trauma therapy group last semester included participants from Africa, suffering post-traumatic stress disorder from violence in their youth.
Stony Brook has seen a sharp increase in demand for counseling — 1,311 students began treatment during the past academic year, a rise of 21 percent from a year earlier. At the same time, budget pressures from New York State have forced a 15 percent cut in mental health services over three years.
Dr. Hwang, a clinical psychologist who became director in July 2009, has dealt with the squeeze by limiting counseling sessions to 10 per student and referring some, especially those needing long-term treatment for eating disorders or schizophrenia, to off-campus providers.
But she has resisted the pressure to offer only referrals. By managing counselors' workloads, the center can accept as many as 60 new clients a week in peak demand between October and the winter break.
"By this point in the semester to not lose hope or get jaded about the work, it can be a challenge," Dr. Hwang said. "By the end of the day, I go home so adrenalized that even though I'm exhausted it will take me hours to fall asleep."
For relief, she plays with her 2-year-old daughter, and she has taken up the guitar again.
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http://www.nytimes.com/2010/12/20/health/20campus.html?_r=1&ref=general&src=me&pagewanted=all
