Student Mental Health Report

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More information:
Benson Canfield,
Counseling Services
Intern
STUDENT
MENTAL HEALTH
REPORT
SPRING SEMESTER 2012
Health and Wellness Center
Juniata College
(814) 641-3353
[email protected]
BACKGROUND
In recent years, there has been growing concern about the rise in psychological distress among
college students across America. Scholars and administrators have more and more been recognizing
the rather alarming trend that has taken a more pronounced shape in the past decade as a problem
bigger than their institution (Kizrow, 2003; Rudd, 2004).
Juniata College has not been exempt to this trend. Within the period of this past decade, the
counseling staff has doubled, and has seen an exponential rise in counseling sessions. At this time, the
two counselors on staff are more often than not booked for weeks ahead of time, and measures are
being taken to address this tremendous surge in demand for services. As part of this effort, it has been
necessary to consolidate accessible data concerning Juniata student’s needs, history, and status in the
area of counseling services with hopes that this data might better inform action taken to relieve these
stresses on our staff and students. This report is the result of this consolidation.
METHOD
The data in this report has been gathered from a few different sources. The data regarding
Juniata students has been taken from the Counseling Services Evaluations and from the Counseling
Center Cumulative Statistics. The data regarding college students across the nation has been taken
from the National College Health Assessment (ACHA, 2008-11).
The Counseling Services Evaluations are forms which clients are encouraged to complete
(usually delivered via campus mailbox) following their final appointment. These evaluations inquire into
reasons for termination, quality of services received, and basic client data (gender, class, etc.). The
forms referenced in this report include the totality of evaluations throughout the 2011 fall semester as
well as all evaluations received in the spring semester up to 2/15/2012. These evaluations reflect
counseling experienced during 2010/2011 school year. There were a total of 30 students who
submitted evaluations.
The Counseling Center Cumulative Statistics are data sets, consolidated by the Health and
Wellness Center staff, of the total diagnoses of various conditions and numbers of clients admitted into
various areas of service. This data is divided by class standing.
The American College Health Association’s (ACHA) National College Health Assessment
(NCHA) is a bi-annual report released each semester of the school year. The data contained in the
report is collected from an extensive survey administered (in the thousands) to college students across
the nation. This survey probes not only the psychological well-being of the subject, but covers the
breadth of a student’s overall health. There are many inconsistencies between NCHA data collection
methods/ resources and our own, making cross-comparison somewhat difficult. These flaws will be
detailed later in the report.
CLIENT PROFILE
At 55.17%, most clients had previous experience with counseling. The vast majority (77.33%) of
students who sought services were female, and there were especially high concentrations of 20 and
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22-year-old clients. The following table displays which demographics, according to the evaluations, are
significantly more likely to seek counseling services.
Students More Likely:
Students Less Likely:
Percentage of Sample
20 years old
22 years old
Female
Senior
26.67%
26.67%
73.33%
36.67%
Percentage of Sample
18 years old
21 years old
Male
Junior
10%
13.33%
26.67%
13.33%
COMMON DIAGNOSES
The following chart displays the diagnoses/reasons for which students last semester (fall ’11)
came into counseling. Currently, depression and anxiety have been the two leading diagnoses for JC
counseling clients, followed by adjustment/transition and relationship issues. This data is historically
reflective of diagnoses’ frequency. The data is from the Counseling Center’s cumulative statistics.
40
Number of Clients
35
30
25
20
15
10
5
0
Diagnosis / Reason for Counseling
LEVELS OF DISTRESS & FUNCTIONALITY
In an attempt to quantify the severity of the issue of psychological distress among Juniata
students, a new intake assessment has been designed (see appendix item). The assessment was
designed to briefly determine some measure of differentiation of source of distress as well as functional
impact. This form is to be filled out by each new client before scheduling an appointment, and will serve
two primary purposes. Firstly, the assessments will serve the purpose to some extent of determining
priority of appointments. Since currently our demand of services is so high in comparison to our supply
of available counselor hours, it would be wise to prioritize to make the best out of our resources.
2
Secondly, the assessments will provide the first ever basis for establishing actual numbers/hard data
for measuring the trends of severity among Juniata Counseling center clients.
The design of the assessment is based loosely upon the PHQ-9, a diagnostic tool for measuring
severity of depression (Kroenke and Spitzer, 2002). The setup of the PHQ-9 is appealing for this
context due to its brevity and proven accuracy compared to forms twice its length. Also, depression,
being usually the largest diagnosis of our center’s clientele, is the PHQ-9’s object. Of course, since
depression is not the only condition for which our clients seek services, many questions were
added/changed to reflect the breadth of cases we typically see in our center (anxiety, relationship
distress, eating disorders, etc). The final feature of the form which made it an appealing template is that
it includes a single item rating functional impairment, which as a college center, we are particularly
interested in.
COMPARING JUNIATA TRENDS WITH NATIONAL DATA
Statistics Comparison Flaws
There are more than a few difficulties presented in accurate cross-examination of Juniata and
NCHA stats. Some of these concerns have been taken into account in the design of the counseling
services’ new intake assessment, but several of these difficulties are somewhat inevitable in light of our
center’s size and how we handle our clients; our foremost priority is providing care to our clients to the
best of our ability, and that need will unavoidably take precedence over the (albeit necessary) ability to
cross-examine with NHCA data.



Perhaps the most difficult difference between NCHA’s collection methods and ours is the time
frame they use in the phrasing of the survey questions. Although samples (surveys) are
collected, like ours, on a semester-basis, NCHA uses twelve-month periods to assess the
frequency of a diagnosis in most given survey questions (ex: “In the last twelve months, have
you been diagnosed or treated by a professional for any of the following?”). In contrast, Juniata
Counseling Services statistics are collected and processed exclusively in the context of
individual semesters, because the semester schedule is the structure around which we operate
and admit clients. This difference results in an apparent inflation of NCHA numbers compared to
ours, since the data covers the time span of a half-year, and ours a semester. This also results
in NCHA trends appearing to be more gradual than ours, since the time span of the data is more
spread out.
Because the NCHA survey underwent a major reconstruction in between the spring and fall
semesters of 2008, it is only acceptably accurate to use data from Fall 2008 on due to the
change in baselines. In effect, comparisons between Juniata and NCHA numbers can only
(accurately) go back to fall 2008. That said, it is fairly common knowledge in the field that this
trend of growth in psychological distress among college students dates as far back as the 90’s.
The NCHA surveys are phrased such that students report being “diagnosed or treated by a
professional,” whereas JC data reflects only students who were diagnosed or treated by
counselors in our center, leaving out students outside our center that are diagnosed or have
been treated elsewhere. Again, our numbers in comparison are apparently lower than NCHA’s
because of this.
3

Many sources of distress by which many students find themselves at our center, such as
relationship issues, are not mental conditions per se, and thus are not included in the NCHA
survey/statistics regarding being “diagnosed or treated by a professional.”
The Comparisons
The following chart displays the total number of clients who sought counseling services within
the three-year period from fall ’08 to spring ’11, weighed against the Juniata total student population for
each semester. A linear regression line has been included in the chart to more clearly illustrate the
overall trend that is being displayed.
Percentage of JC total Population
Counseling Services Clients
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
08 Fall
09 Spring
09 Fall
10 Spring
10 Fall
11 Spring
In comparison, the chart below displays the total students reporting being diagnosed or treated
for a mental health condition within a year prior to being administered the NCHA survey. The general
shape of the line is similar to the JC graph, with peaks in ’10 Spring and ’11 Spring, troughs in ’09 Fall
and ’10 Fall, and maintains a similar level from ’08 Fall to ’09 Spring.
Percentage of total students surveyed
NCHA total students diagnosed/treated for
mental health condition
21.00%
20.00%
19.00%
18.00%
17.00%
16.00%
15.00%
08 Fall
09 Spring
09 Fall
10 Spring
10 Fall
11 Spring
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As predicted, the average trend of diagnosis for NCHA is more gradual, owing in no small part to the
earlier mentioned difference in data collection. The regression lines of each chart can safely suggest
that the frequency of student psychological distress at Juniata is rising at a similar rate as students on
the national level. However, it is not possible to accurately compare baselines between the two,
because there are far too many inconsistencies in data collection to have even remotely comparable
baselines. Regardless of exact quantification, it is clear that the frequency of psychological distress in
both Juniata and NCHA students is currently at an alarming high point within this decade, if not all time
(Gallagher, 2011).
CLIENT EVALUATIONS OF SERVICES
Client Responses (Averaged)
5
4.5
4
3.5
3
2.5
2
1.5
1
I would not hesitate to return
for counseling if I felt the
need
Overall, I was satisfied with
the quality of counseling
Counseling has helped me
to be more successful in
school
I regard the Center as a
necessary part of the
College
I would refer my friends to
the Counseling Center
My counselor and I prepared
for termination of counseling
Counseling helped me
broaden my insight and skills
for a more effective future
My counselor seemed
knowledgeable about my
issue
I was encouraged by my
counselor to make my own
decisions
I felt accepted and respected
by my counselor
My counselor worked with
me to set goals for
counseling
Disagree.........................................Agree
In the Counseling Services Evaluations, students were presented with a series of statements
regarding the quality of counseling service provided by our center. These statements were rated on a
scale of 1 (strongly disagree) to 5 (strongly agree). The chart below is a consolidation of all 30 students’
responses to this section. The most agreeable two statements overall were “I felt accepted and
respected by my counselor” and “I regard the [counseling] center as a necessary part of the college.”
The least agreeable two statements overall were “My counselor and I prepared for termination of
counseling” and “counseling has helped me to be more successful in school.” No statement, on
average, fell on or below the neutral score of 3.
Students were also asked in the evaluations about the reason for termination of services. The
clients were given four options to choose from. The results are shown below.
5
I am not continuing with counseling
because...
I feel better/have met my
goals
21%
36%
I am dissatisfied with the
services
I am no longer a student at
Juniata College
21%
22%
My life situation has
improved and, therefore, I
do not need counseling at
this time
It is important to make a note regarding the 22% of evaluators who reported dissatisfaction, as
this is quite a high percentage. During the time which these evaluations reflect (2010/2011 school
year), the counseling center was composed of two full-time counselors, who are still with the center,
and three part-time graduate students, making us a learning center. Although our full-time staff
counselors were not without their critics, much of the negative feedback received from the evaluations
was regarding the grad-student counselors. For example, the third-lowest score in the statement ratings
(“My counselor seemed knowledgeable about issue”) was weighed down primarily by evaluators who
had had counseling with a student-counselor. Although there are currently no graduate student
counselors at our center, there is always the possibility for utilizing them in the future.
UNMET NEED
At this time, we do not have the data necessary to accurately calculate the level of unmet need
of counseling services at Juniata College. Suffice to say, the best one could do with assessing an exact
level of “unmet need” in a matter of such subjectivity is an approximation. However, some projection is
possible with the use of NCHA data; and given that the comparable data we do have between the two
is reasonably similar, it would seem that this could give us a better idea of the unmet need of
counseling services on Juniata’s campus.
In NCHA’s latest available data report (spring 2011), students were surveyed regarding the
occurrence over “the last 12 months” of various mental health conditions, as well as distress in the area
of personal life which would warrant counseling. 20.6% of all students surveyed reported diagnosis or
treatment for some mental health condition (anorexia, anxiety, ADHD, bipolar disorder, bulimia,
depression, insomnia/other sleep disorder, OCD, panic attacks, phobia, schizophrenia, substance
abuse/other addiction, other mental health condition). 74.6% of those surveyed reported an area of
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personal life being “traumatic or very difficult to handle” (academics, career-related issue, death of a
family member or friend, family problems, intimate relationships, other social relationships, finances,
health problem of a family member or partner, personal appearance, personal health issue, sleep
difficulties, other).
During the spring ’11 semester, 8.7% of Juniata’s student body received (not sought) counseling
services. If the NHCA data is at all reflective of Juniata students, then it would mean that probably a
bare minimum of 29% of all Juniata students were coping with significant psychological distress but did
not receive counseling. This number is very probably quite greater, but that is most likely the very least.
CONCLUSIONS
The data presented in this report certainly supports the notion that Juniata’s campus has not
been exempt to the nationwide surge in the psychological distress of college students. Our center
seems to be experiencing symptoms of this pressure quite similarly to other college health centers
across the country: at a shortage of resources and with demand at an all-time high (Gallagher, 2011).
In the culmination of this report and our new intake assessment, we have taken strides in terms of
quantifying the problem; in fact, what can be done in this area seems to be now somewhat exhausted.
As one may gather from the data above, it is a risky endeavor to attempt to quantify this subject,
especially at an institution as small as ours, where operations tend towards the integral rather than the
systematic.
What we know from these numbers is fairly straightforward: the center is has its hands more
than full, yet there remains an abundance of students on our campus who would benefit from
counseling but are not in contact with the center. In this knowledge we can see four general groups of
students who might benefit from counseling services at Juniata College. The first is the group of
students receiving services. The second group seeks services, but because the services are stretched
so thin, the prospect of counseling is either abandoned or forgotten. The third group does not seek
services, although is aware of the availability of services in some capacity. This is an ambiguous group
who may not be seeking services for various reasons; perhaps they are not aware that we can provide
services that would benefit them, or perhaps are frightened by the some aspect of our services (e.g.
counseling in general or the gender/race of counselors). The fourth group consists of students to which
the thought of counseling has not occurred, and thus does not seek services. Our current task is to use
the knowledge we have now to reach students of every perspective through outreach, improvement of
our resources, and other means to serve the psychological needs of the Juniata student community to
the very best of our ability.
References
American College Health Association. American College Health Association-National College Health Assessment II: Reference Group Reports
Fall 2008 – Spring 2011. Hanover, MD: American College Health Association; 2008 - 2011.
Gallagher, R.P., American College Counseling Association. National Survey of Counseling Center Directors 2011. Alexandria, VA:
International Association of Counseling Services, Inc.; 2011.
Kitzrow, M. (2003). The mental health needs of today’s college students: Challenges and recommendations. NASPA Journal, 41, 167-181.
Kroenke and Spitzer (2002). The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals, 32, 9.
Rudd, D.M. (2004). University counseling centers: Looking more and more like community clinics. Professional Psychology: Research and
Practice, 35, 316-317.
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(APPENDIX: INTAKE ASSESSMENT)
Please take a moment to complete the following form. The following information is used by your
counselor to best prepare for the appointment by providing background information. Please answer
honestly and to the best of your ability.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Not at all
Less than half
the days
Around half
the days
More than half
the days
Nearly
every day
1.
Feeling down, depressed or hopeless...
0
1
2
3
4
2.
Trouble falling asleep/staying asleep
or sleeping too much…………………
0
1
2
3
4
Experienced violence or assault
(physical, sexual, mental, financial)….
0
1
2
3
4
Preoccupation with food, exercise, or
other routines that interrupt your life...
0
1
2
3
4
Significant anxiety or mental unrest
attributed to a major life/lifestyle
change or adjustment…………..……..
0
1
2
3
4
Trouble concentrating on normally
engaging things, such as reading the
newspaper or watching TV…………..
0
1
2
3
4
Symptoms of grief due to loss of
someone close to you (including a
pet)…………………………….……...
0
1
2
3
4
Thoughts that you would be better off
dead or of hurting yourself in some
way…………………………………...
0
1
2
3
4
Intrusive or distressing
thoughts/compulsions with some
negative effect on mood or behavior…
0
1
2
3
4
10. Difficulty controlling strong impulses,
resulting in outbursts on roommates,
classmates, faculty members, etc…….
0
1
2
3
4
3.
4.
5.
6.
7.
8.
9.
If you checked off any problems, how difficult have these problems made it for you to keep up with your
academic work, take care of personal concerns, or get along with other people?
Not difficult at all
A bit difficult
Moderately difficult
Quite difficult
Extremely difficult





Counselor’s Signature: ______________________________________ Date: ______________
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