UNIVERSITY PARK, Pa. — The 2021 Center for Collegiate Mental Health (CCMH) annual report released this week summarizes the state of college student mental health from U.S. and international college counseling centers during the 2020-21 academic year. Additionally, this year’s report advances the understanding of how annual counselor caseloads are associated with center practices and outcomes.
Housed at Penn State, the CCMH is an international practice-research network of more than 650 colleges and universities focused on understanding and describing college student mental health. This CCMH report annually summarizes the findings from the data collection.
In 2019, CCMH introduced the Clinical Load Index (CLI), a metric that describes the relationship between the demand for and supply of mental health services in college and university counseling centers. The CLI can be thought of as the average annual caseload of a typical full-time counselor at a center. Previous CCMH findings discovered that higher counselor caseloads are associated with reduced treatment and less improvement in symptoms when students receive care. For the 2021 report, researchers specifically examined the relationship between counselor caseloads (CLI scores) and the amount of treatment received by students with critical and key needs (e.g., students with suicidality, recent self-harm, sexual assault survivors, and students with a registered disability).
Findings demonstrated students with all presenting concerns, on average, received less treatment at high CLI centers, including clients with recent serious suicidal ideation and self-injury, histories of sexual assault and trauma, transgender identity, registered disability, first-generation identity, and various racial/ethnic identities.
“When clinicians have smaller caseloads, they are able to provide more treatment to all students seeking care, including those with safety concerns and critical needs,” said Brett Scofield, executive director of CCMH and interim co-senior director of Penn State Counseling and Psychological Services. “Colleges and universities must understand the potential consequences of operating a counseling center with high counselor caseloads, which may be incongruent with the expressed mission of the institution that prioritizes support for students with these critical needs.”
The Clinical Load Index is a tool that can assist institutions with staffing counseling centers in order to meet their goals.
“The CLI can help institutions create alignment between what students want, what parents are requesting, and what the institution is able to fund,” Scofield said.
The report concludes that the increasing demand for services in college counseling centers over the last two decades, coupled with the lack of equivalent funding to increase treatment capacity, has led to negative consequences for counseling centers, including pending questions about the effect on the counselors providing services.
“There are growing concerns about the impact on the clinicians providing care,” said Scofield. “When counselors repeatedly face scenarios where they deliver reduced care to students with critical needs, this can have a negative psychological effect on those providers, including burnout, compassion fatigue, and moral injury. CCMH is hopeful to evaluate these impacts on counselors in future studies.”
This year’s report also captured ongoing mental health trends among college and university counseling centers. The report notes that several mental health trends shifted during 2020-21, likely a consequence of the impacts from the COVID-19 pandemic.
Below is a summary of some of the other key findings in the 2021 CCMH annual report:
- While anxiety and depression continue to be two of the most common concerns identified by clinicians, both leveled off in the 2020-21 academic year. Anxiety continues to be the most common presenting concern assessed by clinicians; however, stress increased to become the second most common followed by depression.
- Student self-reported eating and family concerns increased slightly, while academic distress displayed a sharp increase from the prior year, possibly a reaction to the widespread remote learning experience for students.
- After years of steady increase with recent stability, the lifetime prevalence rates of threat-to-self characteristics (nonsuicidal self-injury, serious suicidal ideation, and suicide attempts) and prior treatment (counseling, medication, hospitalization) decreased. These declines might be explained by the following reasons: (1) students with prior treatment and threat-to-self histories may have been more likely to return to a prior therapist at home during remote instruction periods; (2) a greater portion of students without a treatment history may have sought care due to stressors related to the onset the pandemic; and (3) students who otherwise would have not sought in-person services might have received care due to the accessibility of remote services.
- The average length of individual treatment increased from 4.35 appointments in 2019-20 to 5.22 in 2020-21, an increase of 20%.
- 31.9% of students reported seeking services for reasons related to the COVID-19 pandemic, and 72.4% of students indicated their mental health was negatively impacted due to COVID-19.
CCMH collects and analyzes de-identified data as part of the routine practice of seeking mental health treatment from colleges and universities in the U.S. and internationally. The CCMH 2021 Annual Report describes 153,233 unique college students, nationally and internationally, seeking mental health treatment; 4,043 clinicians; and more than 1.1 million appointments from the 2020-21 academic year. This is the 13th year the report has been produced. The full report can be found online here.