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Compared to how long colleges have been around (which has been a really long time–the University of Al-Karaouine was found 859 A.D.) counseling services on campuses are relatively new. While Princeton University is credited with starting the first on-campus mental health service, which focused on performance and personality development, the trend of providing psychological support to students took several more decades to fully take hold.
The next phase in college counseling services took the form of vocational and career counseling following World War II. These programs were set up to help transition GIs back into society as productive workers.
It wasn't until the 1960s and 1970s that college counseling services became part of the normal student support system. As colleges sought to delineate counseling from other health services, more programs began using the acronym CAPS which stands for Counseling and Psychological Services. It's the blanket term used by colleges and universities to describe short term mental and behavioral health services which often include skill-building and wellness workshops, individual counseling, psychiatric support, and group counseling. While most colleges don't have formal, accredited CAPS programs, almost all provide some type of counseling service with an onsite clinician.
For example, Grinnell College in Iowa has a comprehensive list of mental health services for 'Grinnellians' (yes, that's what they call themselves) yet refers to their program simply as Counseling Services. It's not called CAPS yet based off the list of licensed professionals, I know they have at least a minimum amount of oversight from each of their individual licensing boards (eg. LMHC).
Most CAPS programs and campus counseling centers are accredited by IACS which provides a framework and standards for programs to understand, implement and be held accountable to the best practices for mental health services on college campuses. For example, IACS standards indicate that CAPS programs should provide one professional staff member (counselor) for every 1,000-1,500 students. Want to know if your son or daughter's university has an accredited CAPS program? Check out their list here. CAPs staff often have a graduate degree and may be licensed though it's not necessary for accreditation.
I've worked with dozens of college counseling services and CAPS programs over the years and across the country and consider them an essential resource for today's students. In 2018, The American College Health Association's 2018 Annual Survey found that 60% of students experienced debilitating anxiety, 40% of students were too depressed to go to class or hang with friends and 55% felt hopeless in the last year. Nearly 20% considered suicide and about 1,100 commit suicide each year. Only 10–15% of these students seek help at campus counseling services.
Even though a small percentage of students end up seeking help, CAPS programs should be one of the first places students go when they're struggling. The ways students actually reach out for help are typically to their parents first (who end up frantically calling the school, friends and local professionals). Next, students will often feel compelled to talk with professors because of slipping grades. RAs and RDs are often tipped off by roommates and student advisors in the course of setting up classes for the next semester may discover just how much the student is struggling.
Once a student gets into the counseling center, a clinician will often conduct an intake assessment to determine safety risks and what type of intervention is needed. If a student has a more chronic issue like Major Depressive Disorder or an eating disorder, they are often referred to a professional in the community. Since time is limited, clinicians at counseling programs will often be very goal-oriented with a focus on reducing symptoms.
What I really like about most CAPS programs:
- On-Campus/Virtual Support: What kid wants to walk to the parking lot, drive, pay the meter, go to counseling and then drive back to the dorm? Most CAPS are intentionally located in or close to campus health centers and super accessible to most students. The University of Notre Dame uses Therapist Assisted Online (TAO) for how-to videos and actual counseling sessions.
- Understanding of Student Life: Staff at CAPS often live within the same community as the university and have at least a basic idea of what's happening around campus.
- Payment/Insurance Convenience: Most CAPS are either included in student fees or are offered at a reduced fee after the first few sessions. Almost all CAPS that do charge also accept insurance.
- Not Financially Driven: Though CAPS programs are almost always underfunded (my opinion here, not a fact) I've never had a conversation with any dean, director or CAPS clinician who has talked about 'more billable hours' the same way I here community-based clinicians talk. There's no profit motive since their funding is often a big chunk of money from a large university pot.
What I'd like to Change about CAPS programs:
- Stronger ties with Local Community: Why doesn't EVERY CAPS program and counseling center connect with local providers the way the University of Florida does? It's mind-boggling that CAPS often operates as if they are in competition with community clinicians.
- Yearly Training on College Student Mental Health Issues: Every student at nearly every university and college is required to have insurance. They are required to participate in orientation. They are required to live in dorms the first year. Why not mandate ONE class (for credit of course) on self-care/mental health/healthy relationships? Retention rates would go up, costs of running CAPS would decrease, professors wouldn't call people like me asking for advice on how to handle a suicidal student.
- More Visible Presence on Campus: Think about the college you went to–were you ever confused as to when a home football game was happening? Why does CAPS not market and promote themselves more and the good work they do? Come on, folks. Get out of the office, hand out some t-shirts. Get some face paint rockin. Every student should know how to access help BEFORE it's an emergency
- Greater Engagement with Faculty: Most of our friends are faculty members and every social event is the same - talking with them about how to handle student mental health in the classroom (or in their office). I wish academic departments provided mandatory training on how to respond to student issues. Faculty are not clinicians yet are often acting as the first line of support
- No EMR: Ughh. This is my frustration with the whole field of mental health. It seems like so few individuals or large counseling centers use Electronic Medical Records (EMR) for conducting intakes, writing session notes or session scheduling. EMRs help coordinate with outside providers, make it easy for parents to get important health updates, and is more secure than paper files.
- No Long Term Care Option: If a student has a more chronic issue like Major Depressive Disorder or an eating disorder, they are often referred to a professional in the community. More and more schools are expanding their services since attrition rates due to substance use and mental health obstacles are strongly correlated.
Ok, so you know the history of college counseling services. You know my opinion of how they
could be better. So now, let's talk about how to actually access them if your college kid is in need of support.
- Non-Negotiable Assessment: I recommend that if a parent's spidey-sense is tingling that something is wrong (or you have a freshman heading into the first week of classes and they have a history of depression/anxiety), go ahead and MANDATE your college kiddo go for an intake assessment within the next 24 hrs. While this seems too intense and maybe even counterintuitive, your son or daughter may secretly appreciate not having to make a decision about whether to ask for help or not.
- Setup the First Session: Some schools now offer to schedule through an online student portal while others are super old school and you have to call or just walk-in. Either way, I recommend parents don't leave this step up to the student since setting up the first appointment can be confusing. To start, go to the school's webpage and in the page's search bar look for 'counseling services' or 'CAPS.' They typically are associated with Student Life or Campus Health Center.
- Non-Negotiable Release of Information: Ughh - another thing that drives me nuts about counseling services is that all colleges treat students like they are medical patients. I get it that a student's private academic and healthcare information should be kept private but when it comes to the parents paying tens of thousands of dollars, parents should by default have access to at least a regular update on the medical and mental health of their child. As soon as your kiddo gets into the initial session, make sure they sign a release of information so that you and the counseling center can exchange information.
- Follow-Up: Make sure that your kiddo follows-up with you and lets you know the results of the intake and what recommendations they had. It's not a bad idea to get the clinician's name that saw your son or daughter and call them first thing in the morning or on a Friday. It's essential that parents hear exactly what the outcome and recommendations were so that the student can be held accountable and supported. When you talk with your kiddo and the clinician, make sure to also understand what the next steps are and how to implement them. If they are recommending weekly individual counseling sessions, make sure your son or daughter has an appointment scheduled already that doesn't interfere with classes. Some CAPS programs are so slammed with students that they will eject students from future appointments if they miss a certain number.
College is stressful but with early intervention and the support of caring college professionals like those found on any campus, your son or daughter can thrive.
