Christopher Newport University. (CNU)
The kids are not all right, and they aren’t afraid to tell you that.
On college campuses in Virginia and nationwide, students are increasingly reporting struggles with mental health. Study after study has shown rising cases of anxiety, depression and other forms of psychological distress among students aged 18 to 25 — trends that predate but were exacerbated by the isolation and disruptions of the COVID-19 pandemic.
“The complexity of the mental health challenges that students are facing and when they come for the first time in the clinic are growing,” said Kevin Hughes, vice president of student affairs and dean of students at Christopher Newport University in Newport News. “It’s not just the volume, but it’s how complex the issue is that they’re dealing with.”
Another thing the kids aren’t afraid to do? Ask for help.
“None of us have it together by the time we’re 25,” said Courtney Hairston, a counselor-in-residence at Christopher Newport’s Office of Counseling Services. But today, she said, “the stigma, I think, is gone.”
“This generation is like, ‘Hey, we need help. Help us,’” she said.
Compared to a decade ago, the number of students seeking mental health services on college campuses has skyrocketed. An annual report from Penn State University’s Center for Collegiate Mental Health found that during the 2021-22 school year, almost 191,000 students at roughly 180 higher education institutions in the U.S. sought mental health treatment at campus counseling centers. In 2011-12, by comparison, that figure was just over 97,000.
The same trend can be seen on Virginia campuses, say numerous people working in education and health in the state.
At Radford University, roughly 45 minutes southwest of Roanoke, enrollment is dropping. But despite that, “we’re seeing an uptick in the percentage of students we’re seeing in the counseling center,” said Brian Lusk, the school’s director of student counseling services.
“The younger generation of students are coming in more in tune with their mental health needs and more willing to seek out treatment,” said Lusk. And while he said it’s encouraging to see students being proactive about their needs, “it really puts a strain on our counseling centers.”
“Most of our counseling centers are staffed reasonably well, but they’re not staffed well enough to handle the kind of need we’re seeing now,” he said.
Now, Virginia is trying to harness campuses’ soaring demand for mental health services to meet another goal: get more young professionals in the pipeline to provide them. In 2022, lawmakers added $1 million to the state’s two-year budget for a pilot program that would pay salaries and benefits for counseling and social work graduates pursuing state licensure to work at campus student health and counseling centers.
A May 30 report from the State Council of Higher Education for Virginia (SCHEV), as well as interviews with participating universities and other people involved in the effort, indicate that nearly a year after the General Assembly signed off on the initiative, it’s showing promising results.
Most of our counseling centers are staffed reasonably well, but they’re not staffed well enough to handle the kind of need we’re seeing now.
– Brian Lusk, Radford University director of student counseling services
“Participating institutions are already seeing tangible impacts,” SCHEV wrote in the May report. Among the takeaways: Five residents employed through the program have provided over 740 hours of direct clinical services to 220 students on Virginia campuses while racking up over 1,000 hours of supervised practice needed for their licensure.
“Adding this professional colleague has bolstered morale and bandwidth and prevented burnout and turnover of clinicians,” wrote one supervisor in anonymous comments on the pilot included in the report. “In sum, this hire has stabilized the counseling center and our services to the university.”
At Christopher Newport, “they have hit the ground running,” said Bill Ritchey, executive director of counseling and health services. “My most pressing question is: How do we keep it going?”
Rising demand, looming provider shortages
Among nearly all age groups, there’s a rising demand for mental health services nationwide. In Virginia, policy discussions have mainly centered on the state’s troubled behavioral health system, the network of community services boards and state-run facilities that provide treatment to people who are in crisis or experiencing the most severe mental health challenges.
But while the overburdened public system deserves attention, said Deborah Oswalt, executive director of the Virginia Health Care Foundation (VHCF), the majority of Virginians who seek mental health treatment are in search of more “basic” services. Those include treatment for conditions such as depression, anxiety and panic disorder, as well as help dealing with difficult circumstances like a death or traumas linked to situations like abuse.
“There’s really not been much of a state focus on that end of the continuum,” said Oswalt.
Even as demand has risen, the number of professionals available to meet that demand has fallen in Virginia, with data showing it could shrink ever further as a wave of behavioral health providers prepare to retire.
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“The need and demand for behavioral health services far exceeds the available capacity to meet them,” found a 2022 report from the Virginia Health Care Foundation. “[Behavioral health] professionals throughout the Commonwealth are overwhelmed and Virginians are waiting months for help.”
VHCF’s data paint a stark portrait. Of Virginia’s 133 localities, the organization found, 93 are considered by federal standards to have a shortage of mental health professionals. At the time the report was issued, two localities — Craig County near the West Virginia border and Surry County just west of Newport News — had no licensed behavioral health professionals of any kind. Forty-eight localities had one or fewer full-time clinical psychologists, while 11 had one or fewer full-time social workers and 16 had one or fewer licensed professional counselors.
The workforce was also nearing what the VHCF called a “provider cliff”: Among psychiatrists, 61% of providers were aged 55 and older, as were 36% of licensed clinical psychologists, 37% of licensed clinical social workers and 32% of licensed professional counselors. Furthermore, the majority of providers were white, even as Virginia becomes more diverse.
“As more people get comfortable with seeking out mental health treatment there’s not going to be enough providers,” said Lusk. “In reality, pretty much all of us could use someone to talk to at some point in our lives.”
“Life is full of challenges,” he continued. “And trying to suck it up and rub some dirt on it or whatever you want to say, those southern sayings, and push through it, it doesn’t work well for everyone.”
A long road to licensure
Despite the aging workforce, getting new professionals into the field has been difficult because of the steep requirements many graduates face to achieve licensure in Virginia.
The largest sectors of Virginia’s behavioral health professions are clinical social workers and professional counselors, who in 2021 made up almost three-quarters of the workforce, according to VHCF data. While roughly 4,000 of the 12,000 current professionals in those fields are nearing retirement age, colleges and universities in the commonwealth are only producing approximately 400 graduates per year — not enough to offset the exits.
More crucially, those graduates still lack licensure. While both professional counseling and clinical social work require graduate-level degrees, licensure requires graduates to undergo thousands of hours of clinical and supervised practice. Professional counselors must undergo 3,400 hours of clinical work experience, of which 2,000 must be direct client contact and 200 must be supervised. For clinical social workers, the requirement is 3,000 hours of experience, including 1,380 clinical hours and 100 supervised hours.
“That’s one of the big hurdles a lot of [licensed professional counselors] have,” said Ritchey. “I think there’s a lot of people who want to be in higher education who are LPCs that the doors need to be opened to.”
Supervised hours are particularly tricky for graduates, as most are forced to pay experienced practitioners an average rate of $100 per hour for the supervision.
“That’s a lot of money,” said Lusk. “If someone’s charging you $100, $150 an hour, that adds up fast.”
Hairston, the counselor-in-residence at Christopher Newport, said supervision posed a barrier for many of her fellow students.
“You have some private practice members who are willing to work with you, some who are not,” she said.
The state’s steep licensure requirements, in the absence of other mechanisms to offset the burdens, may also be weeding out candidates with graduate degrees in their field but without the resources to navigate a prolonged and expensive process.
“Given the low salaries available to these pre-licensees ($42,000 – $47,000/year) and the high student debt load they carry, many cannot run the financial gauntlet of paying for the required supervision hours,” the VHCF report found.
Virginia has “some of the strictest and highest standards to get licensure,” said Lusk. “We have to be gatekeepers of our profession, right? But sometimes we have such high standards in Virginia, it really puts a barrier up.”
‘Exactly what we’ve been trying to do for such a long time’
Over the past few years, Virginia has become increasingly interested in putting state support toward licensure of counseling and clinical social work graduates. VHCF’s Boost 200 program, which aims to speed up the licensure of 200 behavioral health professionals by paying for their required supervision hours, has received funding from the General Assembly and Virginia Department of Behavioral Health and Developmental Services.
Then, in 2022, conversations between the foundation and SCHEV led to a new idea: Why not marry the need for licensure with growing college campus needs for mental health services?
“Obviously the pandemic really brought to light a lot of issues related to student mental health,” said Emily Salmon, a senior associate with the state council.
Colleges and universities were immediately enthusiastic. With the General Assembly allocating $500,000 in each of the fiscal years 2023 and 2024 to the pilot, the schools scrambled to apply.
“This is literally something I’ve been looking for for honestly almost my whole career,” said Ritchey. “This is exactly what we’ve been trying to do for such a long time.”
Of the 10 colleges and universities that applied for funding, six were chosen. Their awards ranged from $66,810 for Longwood to $100,000 for Christopher Newport, which chose to cover resident benefits with university funds in order to add two graduates to its counseling center.
“The interest and submission of proposals exceeded the amount of funding that was available,” said Salmon.
For Oswalt, the rush of interest from schools made it clear the pilot was filling an urgent need.
“This isn’t a problem that somebody made up or something,” she said. “Universities can be pretty slow sometimes in the way they do things, but I think it’s telling that a good chunk of grantees really made an effort to advertise and get someone on board quickly so they could get the whole thing started.”
Five months in, Lusk at Radford and Ritchey and Hughes, the dean of students, at Christopher Newport said the benefits of the initiative were already clear — not just among the residents offering care, but among the students receiving it.”
“It’s a real critical juncture in life,” said Ritchey. “It’s the first time in life when a person is out of the parents’ home but they’re not set so much that they have the encumbrances that a lot of us adults have, so it’s a real prime time for some heavy lifting in terms of self-exploration and personal development.”
“My hope is that we lose the word ‘pilot,’ and then it just becomes a program,” said Hughes.
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