"I’m really stressed about college because I’m worried it'll trigger my depression," one of my close friends wrote on Koko, a social media network that helps users in emotional distress.
She soon received a response from an anonymous user: “I know exactly what you’re feeling, because I’ve been there too. I know that kind of fear — you don’t want it to get worse because it’s awful… Try to pace yourself while in college. Everything will be OK!”
As she received more words of support and encouragement from strangers, my friend also responded to others on Koko about their problems.
“You might feel like you’re putting a burden on others, but you might really need them for help and that’s OK,” she wrote to one user. “Reaching out makes the people around you feel trusted and closer to you. Everyone makes their own choices, and they all chose to let you into their lives.”
She got a rapid and gratifying response: “Thank you so much!”
I had introduced my friend to Koko after she came to me about her concerns. Even though I also try to check in and help her over the phone, I sometimes feel unsure of what to say, or worry that I might have said something wrong.
That feeling is all too familiar: As a college student, I often feel surrounded by people who are stressed and struggling with their mental health. I’ve seen and helped with multiple breakdowns and crises when on-campus counseling services were not available, not sure how much I can really help but still glad that my friends reached out for support.
And it’s not just my group of friends. In 2016, 38 percent of undergraduate students reported that within the last 12 months, they have at some point “felt so depressed that it was difficult to function,” while 59 percent of students said they have at some point “felt overwhelming anxiety.” So it's not surprising that 14 percent of incoming freshmen anticipate a “very good chance” of seeking help and counseling in college, up from 3.5 percent in 1991.
The growing number of students who need help with mental illnesses creates challenges for counseling centers on college campuses: They are simply not equipped or designed to help everyone who needs help. Many students end up on long wait lists and must look elsewhere for support.
“Many of these centers operate on a short-term treatment model,” said Dr. Micky Sharma, president of the Association for University and College Counseling Center Directors. “But there can be health care conditions that can exceed what we can provide on campus or students who may need a longer term treatment.”
Aiming to fill this gap, a broad array of resources like Koko — many new and innovative, often founded by students or recent grads — offer mental health support for students. They do not, of course, replace professional help, and are meant only to supplement traditional counseling services and treatment. Most resources have not gathered data to document how effective they are. But they offer added options as students — including me — head to school at summer's end.
I spoke to a handful of psychiatrists and mental health professionals, including Dr. Sharma, about resources they thought could help students, and here is a selection of some they mentioned. After some reporting, I came away thinking I would suggest these resources to friends and family — and consider myself, if needed.
E-Connect With A Therapist
Zencare is a free online platform to help users in Boston and Rhode Island find an off-campus therapist. It helps students and others match themselves with a therapist through video profiles, a free initial phone call and an online booking system.
The therapists must go through an interview and review process before they can be listed on the website. About half of Zencare users are college students, according to founder Yuri Tomikawa, and it is working on making therapy more affordable by including therapists who accept school insurance. It also aims for a highly diverse corps of therapists.
Brianna Pastro, a senior studying psychology at Tufts University, has had depression and anxiety since freshman year. After working as an intern at Zencare, Pastro decided to try the service out for herself when she had to find a new therapist, a process she describes as “anxiety-inducing.” But because she used Zencare, she knew what to expect when she got to her new therapist’s office.
“I knew what the building and waiting room were like, and I knew what she looked like because I saw it on Zencare,” Pastro said. “So when she walked out of the door, I thought to myself, ‘Yes, that’s her. I’m here to meet you.’ ”
“The unfortunate reality is, there are millions of people on these networks every day reaching out for help.”Koko CEO Rob Morris
Tomikawa was inspired to start Zencare after going through a frustrating and time-consuming process of finding a therapist herself: dozens of phone calls, voice messages and notifications that they weren’t taking new clients.
“That's why I wanted to start a network of really outstanding clinicians who I felt I could recommend to friends or family members,” she said.
“Talkspace is inexpensive, starting at $32 per week, and it’s digital, which is how college students already communicate,” co-founder Oren Frank said. “If you’re used to texting your friends, parents, even grandparents, it’s natural that you’d want to text you therapist as well."
That $32-a-week plan allows unlimited text messages to the therapist, with answers to be expected a couple of times a day. After being assessed and choosing a plan, a student can be matched with a therapist and start messaging. This can be especially useful for students in rural areas, where it might be more difficult to find an off-campus therapist.
“Students can text their therapist whenever they want — before a first date or an internship interview — and don’t have to wait two to three weeks until their next appointment,” Frank said.
On-Campus Education And Advocacy
Active Minds is perhaps the best-established student organization that aims to improve mental health on college campuses through education and advocacy.
"One of our key messages is that if you're a student on your campus struggling with a mental illness, you're not alone," said Laura Horne, director of programs at Active Minds.
In each of the over 400 Active Minds chapters across the country, students form a community on their respective campuses and meet weekly to help raise awareness and reduce stigma around mental illnesses.
Active Minds also equips students to advocate for changes in policy on mental illness at their schools. On a more national scale, Active Minds collects key findings and trends on what makes for a healthy campus, and uses that data to commend schools that are doing a particularly good job.
"[Students] know better than anyone what the barriers are,” Horne said. “And so any time decisions are being made about mental health on campuses, students should have a seat at the table, because they are often the ones who know what's going to work best to support those diverse needs."
Peers Helping Peers
Koko was started in 2012 as a research project at MIT, where CEO Rob Morris was a graduate student. After a clinical trial and published paper, Morris started working to make Koko more widely available. Though it started as an app, it now works through various social media sites like Tumblr, Twitter and Facebook Messenger.
“We tend to individuals in emotional distress online, particularly in large social communities and networks,” Morris said. “The unfortunate reality is, there are millions of people on these networks every day reaching out for help.”
Koko will triage your needs based on what you write: If it’s a “high risk” case, it will direct you to resources like emergency lifelines or specialized eating disorder chat lines. If not, your post will go to other users in the network, who tend to respond to your message in a few minutes. The vast majority of users on Koko are experiencing more moderate or mild levels of distress, Morris said, like academic pressure or a breakup.
But according to Morris, what users like most about Koko is having the opportunity to help others. As soon as you post something to the Koko network, you will be asked and guided to support and respond to other users.
Those interactions are structured and filtered to encourage you to help others: The more you do, the more “Karma” points you will earn. The amount of points you accumulate will determine your “spirit animal,” and you can even receive a Twitter shout-out, blog interview, Koko stickers or a prize pack if you reach a certain number of points.
“Our studies suggest that the most benefits come from the act of helping others,” Morris said. “This is when you’re strengthening the skills we hope you’ll depart with, you’re experiencing self-efficacy, and there are a whole host of mechanisms which makes this really therapeutic.”
If you’d rather interact with another student face-to-face, Project LETS, a nonprofit, has a Peer Mental Health Advocate Program (PMHA) that trains students on certain campuses who have experience with mental illness to be peer counselors.
After applying and being interviewed, a select group of students go through a six-week training program to learn relationship-building and crisis skills. Then, they are matched with students they will form long-term partnerships with, providing emotional support and helping manage academics.
“Our primary goals are to create a network and an inclusive community for people with lived experience of mental illness,” founder and executive director Stefanie Kaufman said.
While the program was started at Brown University, it will be expanding to 12 universities this fall, including Yale, Columbia, Michigan State and the University of Pennsylvania.
“One of the most important things for us is making sure that people are in relationships that they feel are relatable, and that they’re not being judged or trying to be fixed,” Kaufman said. “It can be terrifying in our current society to be bold and proud and out loud about being mentally ill, especially if treatment is inaccessible.”
Project LETS also has chapters that meet weekly to help members share their stories and work on various activities including panels, workshops and student organizing.
To address self-harm and campus suicides, Project LETS started the Self-Harm Initiative — you can send letters and self-harm tools in the mail in a symbolic act of releasing negative thoughts and intentions, and a peer counselor will respond with a handwritten note and resources to help cope and take care of self-harm wounds. This can then lead to a one-on-one relationship with a peer counselor for further support.
"On college campuses, there are a number of students who engage in self-destructive behaviors, and there’s a fear of seeking help from the university because you don’t know if you’re going to be in trouble," Kaufman said. "So we work with students who are dealing with self-harm or suicidal thoughts who don’t want to seek university support but would rather go through a peer."
Lean On Me
Lean On Me is another peer support system that uses anonymous text messages. When you’re struggling with a problem, you can text the hotline and receive a response from a trained supporter from your school, with your number encrypted to ensure anonymity. You can then continue the conversation for as long as you want.
“Students are really busy,” CEO Daniel Mirny said. “We wanted to find some way to lower that barrier to seeking support.”
It was started at MIT a bit later than Koko — in the spring of 2015, following a difficult year of campus suicides.
Suicide hotlines are available 24/7 by phone, but Lean On Me was founded to help students who are not in a crisis-level situation but still want someone to talk to.
“If you failed an exam, you probably wouldn’t call a suicide hotline,” Mirny said. “The idea we had was to create a service that was easily accessible and easy to use.”
After going through an application and interview process, supporters go through an online and in-person training before they start texting. Lean On Me is currently focused on university students, with chapters at MIT, Chicago, Penn and Northeastern.
The service has plans to expand and is in conversation with over a dozen other universities. If Lean On Me is not available at your school, you can start a chapter with a team of just three or four students, Mirny added.
“It’s kind of cliché, but it’s like Uber in the sense that there’s a web of supporters,” he said.
For LGBTQ Students
The Trevor Project
The Trevor Project, a national organization founded by the creators of the short film "Trevor," aims to help LGBTQ students with their mental health.
"The Trevor Project is the leading and only accredited national organization providing crisis intervention and suicide prevention services to LGBTQ young people under the age of 25," said vice president Sheri Lunn.
Its programs include “TrevorLifeline,” “TrevorText” and “TrevorChat,” as well as “TrevorSpace,” a peer-to-peer social networking site. You can find resources for specific cases and situations -- like coming out, homelessness and HIV/AIDS — in the Trevor Support Center on its website, and it also offers an education program for adults and organizations involved with LGBTQ youth.
"[We also] conduct research to discover the most effective means to help young LGBTQ people in crisis and end suicide," Lunn said.
Immediate Help In A Crisis
If you’re in a crisis or considering suicide, you should use these hotlines:
National Suicide Prevention Lifeline — 1-800-273-TALK (8255)
Crisis Text Line — 741741 (text HOME)
Both resources are free and confidential. When you contact these hotlines, a trained volunteer will respond. They can help with thoughts about suicide, concerns about family and friends, and emotional support.
Readers, have you tried any of these, or other resources? What would you recommend?
Eojin Choi was CommonHealth's 2017 summer intern.