Colleges See Rise In Mental Health Issues



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They may not tell their roommates or even close friends, but on college campuses all across the United States, more students than ever before are seeking psychiatric help, according to recent national surveys of campus therapists.

And it's not just for homesickness and relationship problems, says the University of Michigan's Daniel Eisenberg. He directs the Healthy Minds Study, a multicenter study that queries primarily students, but also a sampling of college counselors, about mental health issues, including the prevalence of clinical depression, anxiety and eating disorders on campus. Eisenberg says his findings dovetail with those of a large national survey of counseling center directors, led by the University of Pittsburgh's Robert Gallagher.

"One of the questions is whether they're seeing an increase in the number and severity of students with mental health problems," Eisenberg says. "And over 90 percent [of college counseling services] are saying yes to that question." Just one example: In 2007, around 15 percent of students reported having been diagnosed with depression at some point in their lives; that's up from 10 percent in 2000.

Better Diagnosis And Treatment

Eisenberg and other experts say they haven't yet teased out all the reasons behind the surge of mental health issues on campus, but think it doubtful that today's teenagers are more psychologically disturbed than past generations. Other explanations seem more likely.

Better screening and earlier diagnosis of mental illness in high school and even before may be one factor, Eisenberg says.

"Especially when Prozac and other antidepressant drugs like that came onto the scene in the late '80s and in the '90s, the likelihood of teenagers getting treatment went way up," he says. Now, many of those teens getting treatment are in college and are accustomed to turning to therapists for help.

Researchers suspect the increased severity of mental illness that counselors are seeing may be partly the consequence of a good thing: better treatment. Twenty years ago, many high school students with an illness as difficult as bipolar disorder or deep, persistent depression might never have made it to college or been able to stay there. Now such students are on every campus. Many are thriving, but in need of significant support to make it through.

Knowing When To Ask For Help

Some are first hit with the illness in college. Stanford University senior Amanda Gelender found herself battling a deep depression for the first time her freshman year. After weeks of going it alone, exhausted and "crying under the covers for hours" in the dorm, she says, she finally called her doctor. She was eventually diagnosed with bipolar disorder and found significant relief, she says, with the right medication and other support that enabled her to stay on campus and even keep up her near 4.0 grade average.

Still, for years, she never told friends, professors or dorm-mates of her diagnosis or ongoing struggle. "I felt like the most isolated person in the world," she says of that time. "I didn't feel like anybody would understand what I was going through."

Last January, Gelender broke her silence. She's the co-founder of a student theater group called Stanford Theatre Activist Mobilization Project (STAMP), and for a project last winter, STAMP solicited anonymous true-life letters from classmates living with depression, panic attacks, obsessive-compulsive disorder and other mental health problems. In January, Gelender and the group dramatized the accounts as monologues in their theater production, Out of Sight, Out of Mind.

Educating Others

The student actors performed the monologues in various venues around campus — including 13 student dorms. After each performance, Gelender and several other students acknowledged their own diagnoses and took questions.

The campus response to Out of Sight, Out of Mind, was overwhelmingly positive, Gelender says. One student residence adviser told her it was "probably the best thing that has been done for mental health on campus in a long time. He could really sense a change in his dorm."

"Just giving voice to these thoughts can open a floodgate," says Alex Holtzman, one of the student actors. Holtzman performed the anonymous monologue about a student with obsessive-compulsive disorder. "There were many people at these performances in the dorms who had never talked about their mental illness to anybody else.

"I used to hide all these things," Gelender says. "But I don't want to do that anymore. It's a big part of my life, and I'm trying to be more upfront about it." Her classmates and professors know about all her accomplishments — her academic scholarships and public service awards. Why not, when appropriate, let them in on her struggles, too?

"I think that some people definitely look at you differently when they find out," she says. But she's also convinced that the only way to change that is if more people are willing to be open and show classmates just how many people on college campuses — roughly 18 million by some estimates — are dealing with mental health issues today.

Radio story and Web audio produced by Cindy Carpien

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It's MORNING EDITION from NPR News. I'm Renee Montagne.

They may not even tell their roommates but according to recent surveys, the number of college students seeking help for serious psychological problems has soared in recent years.

All across the U.S., campus counseling centers are straining to keep up. And in the first of two stories, we'll hear the perspective from the students. NPR's Deborah Franklin has this report, which involves a group of students in California who created a theater production that got their campus talking.

DEBORAH FRANKLIN: Amanda Gelender is a senior at Stanford University - confident, with a big laugh. As she recalls, she was having coffee off campus last winter with a new friend, a freshman, when it struck her that he might not be as happy as he seemed.

Ms. AMANDA GELENDER (Senior, Stanford University): He starts talking about his friend in the dorm who's really, really depressed. And like, he feels really bad for this kid. And I just had an instinct. I don't know why I did it, but I just told him, I'm bipolar and I know how hard that is.

FRANKLIN: Amanda had spent her freshman year depressed, too, crying under the covers for hours and exhausted, trying to hold everything together.

Ms. GELENDER: And I would cry on my way to class. And every day when I got home from class, I told my roommate that I had to take naps. And it wasn't about anything in particular, it was just sadness - a sadness that I couldn't shake. And I didn't care about anything. I didn't care about my friends. I didn't want to socialize with anyone in my dorm. And this was very uncharacteristic of me. I'm someone who dives into activities and academics. I didn't want to get help. I thought I could do it on my own. So it was just a very lonely time.

FRANKLIN: The young man listened to her story and confessed that the depressed friend was really him. It was a relief to them both to come clean. But Amanda and her friend wondered how many others were suffering. And that's when they got their big idea. Both are members of a student theater group that shines a spotlight on social issues: homelessness and AIDS, farm workers and pesticides.

Ms. GELENDER: We decided that it would be great if we could get stories to show that there is such life happening under the surface, about mental illness -that there is so much struggle and triumph going on.

FRANKLIN: So they sent out an email to everyone they knew on campus, asking for anonymous, true-life stories. And within half an hour, Amanda got the first response. She brings it up on her laptop.

Ms. GELENDER: (Reading) Am I the only person who never feels good? I've always felt this way from as long as I can remember. And all I've wanted is for somebody to say: I know how you feel. I am the same. We are all the same.

FRANKLIN: Dozens more letters poured in - what it's like to be hauled off to the psych ward for observation, or to stand at the edge of a high balcony and fight with yourself to keep from jumping.

Before we tell you what Amanda Gelender and her friends did with all that email, you first need to know these kids' struggles are not unusual. A Stanford task force on student mental health last year reported what it called an unprecedented demand for psychological services on campus - roughly twice as many students seeking help as a decade ago. To try to keep up, Stanford increased its staff from 10 therapists to 16 in just the last year. Other schools are even more swamped.

Dr. DANIEL EISENBERG (University of Michigan): We're not seeing that it's specific to elite schools, by any means.

FRANKLIN: Daniel Eisenberg is a mental health researcher at the University of Michigan in Ann Arbor. He cites surveys of college counseling directors published over the last decade - schools ranging from small community colleges to the largest universities.

Dr. EISENBERG: And one of questions is whether they're seeing an increase in the number and severity of students with mental health problems. And over 90 percent are saying yes to that question.

FRANKLIN: Here are some more stats from colleges nationwide. More than twice as many students are on psychiatric medications as a decade ago. And there's been a 50 percent increase in the diagnosis of depression.

Last January, Amanda Gelender, the Stanford student you heard earlier, was determined to go deeper, to give all those numbers a human face. So she and her troupe of actors turned some of the letters they'd collected into 25 monologues. One even came in from a student resident adviser in the dorms.

Student Actor #1: (Reading) One night, I sobbed in bed until 5 a.m. I imagine depression feels different for different people. For me, it felt like an elephant was sitting on my chest, constricting my heart and I could barely breathe. I'm not supposed to be like this, I kept telling myself. I need to be strong. Other people come to me for help. I started to panic. What if I can't graduate? What if I have to drop out of medical school? What if I can't take care of a family?

FRANKLIN: The actors took their show to various places around campus, making sure faculty and the counseling center had a chance to hear the stories. But Amanda Gelender says there were two audiences that were most important.

Ms. GELENDER: First and foremost, people who were struggling with mental illness and thought, there's no one else out there like me. Secondly, we're trying to reach people in dorms who are complicit in creating an environment that is hostile to people with mental illness, even if they don't know it.

FRANKLIN: And so they performed in 13 student dorms, too, stories of severe anxiety problems, obsessive-compulsive disorder and eating disorders.

Student Actor #2: (Reading): It doesn't help my self-esteem that people think of bulimia as a joke problem, gross and unrespectable. It's an issue of control. Who overeats like a dumb animal and then has to vomit because they have no self-restraint? Me, apparently. It's embarrassing but beyond that, it was also that I was on a varsity team and knew that if news got to my coach or the sports medicine, I would risk my spot on the team.

Student Actor #3: (Reading)When you hear OCD, you probably think of some Jack Nicholson type: neat freak, really uptight. But that's not me at all. Hell, in terms of neat, I live in a frat.

Student Actor #4: (Reading) My junior year of high school, I couldn't even listen to the radio during a traffic report because I would just know that my family had been in an accident. I started thinking that every furtive-looking man on the street was a terrorist, that every plane flying overhead was going to crash into my house. Twenty milligrams of Prozac a day changed my life. So I went to Stanford relatively healthy, happy and excited. In December, my young grandmother died of a sudden aneurysm. That winter quarter, I had a panic attack in the middle of a math exam. It was time to seek help again.

FRANKLIN: The stories inspired lots of Facebook discussion about mental illness. Some students found the production too disturbing, but Amanda Gelender got a lot of positive feedback, especially from resident advisers, the RAs.

Ms. GELENDER: I spoke with an RA who said that this was probably the best thing that has been done for mental health on campus in a long time. He could really sense a change in his dorm.

FRANKLIN: So, the Stanford student actors got what they most wanted, to dispel some of the stigma of mental illness. It's a good start, but is there really some new epidemic of psychological problems on campus? Researchers say it's doubtful that today's teens are actually sicker than past generations. Instead, they suspect what we're seeing is partly the unintended consequence of a good thing. Twenty years ago, many high school kids with an illness as difficult as bipolar disorder or major depression might not have gotten treatment or even made it to college. Again, the University of Michigan's Daniel Eisenberg.

Prof. EISENBERG: When Prozac and other antidepressant drugs came onto the scene in the late '80s and in the '90s, the likelihood of teenagers getting mental health treatment went way up.

FRANKLIN: Now, with earlier diagnosis and better treatment, they're on every campus. And when they have problems, many more are turning to therapists for help.

Deborah Franklin, NPR News.

MONTAGNE: And we have more of the Stanford monologues at

Ms. GELENDER (Reading): Why did I let myself sleep all day, stay up all night, stop eating, stop caring, and a few times almost stop breathing?

MONTAGNE: Next Monday, we'll hear how colleges are reacting to this big increase in demand for mental health services, especially at a time of tight budgets.

(Soundbite of music)

MONTAGNE: You're listening to MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.