Less than two years ago, the Baylor Counseling Center (BUCC) had one staff person for every 1,775 students, which is at the national average for all colleges, according to the Association for University and College Counseling Center Directors. Today, that ratio is roughly one for every 750 students, a figure that puts the school ahead of many other private universities, where the average is roughly one per 1,000 students.
But while BUCC Executive Director of Counseling Services Dr. Jim Marsh concedes that recent events have played a role in both the rapid growth and the nature of the staffing, he says that hiring additional staff and making new resources available to the counseling center have been priorities all along. He also points with pride to the BUCC partnerships with many on-campus programs for internships. The center has 22 full-time clinicians and a strong training program with graduate students from psychology, social work, and higher education.
Additionally, this past June the American Psychological Association accredited BUCC’s doctoral internship program, which attracts Ph.D and Psy.D candidates from across the country who are required to complete a one-year formalized training experience once their coursework has been completed and before graduation. Baylor has had two doctoral interns in recent years and will have four this year.
“There were many years that the counseling center would be the only place in the Division of Student Life that got the position for a new person or initiative,” Dr. Marsh says. “But I do think we’ve also recognized the importance of being able to respond quickly in an efficient manner to anyone coming through the door.”
Across the nation, institutional enrollment grew by 5.6 percent between 2009 and 2015, while the number of students seeking services increased by 29.6 percent, according to a report from the Center for Collegiate Mental Health. At Baylor, enrollment increased by 10.4 percent between the 2012-13 and
2016-17 school years while the number of students seeking counseling services doubled. The BUCC served 65 percent more students during the 2016-17 school year than it did in 2015-16, with counseling appointments increasing 50 percent to 13,513 during that same timeframe.
Baylor’s ability to handle that increased demand and expand its services was enhanced by the opening in January 2017 of its Dutton Avenue location.
Baylor’s two locations — the other is in the Student Life Center — offer a variety of services including workshops, group and individual therapy, couples’ therapy, along with specialty services focused on trauma recovery, addictive behavior, and medical nutrition therapy, substance abuse, and eating disorders. The Counseling Center offered 25 groups that met on a regular basis during the past school year, and it’s put a big focus on alleviating anxiety.
Nationwide, the rates of mental health issues on college campuses have been increasing. Seventeen percent of college students were diagnosed with or treated for anxiety problems and 13.9 percent were diagnosed with or treated for depression, according to a Spring 2016 survey of 95,761 students by the American College Health Association. The figures are higher at Baylor, where 18% of students reported anxiety as their primary concern for the 2015-16 school year. That was up 20 percent from 2014-15, but down from 23 percent in the 2011-12 school year.
Dr. Marsh says he’s not surprised by the increased demand, given the recent nationwide shift in how mental health treatment is perceived.
“There’s greater access to higher education, which means the college student population is just starting to look a little more like what you might say the general population as a whole. I think the other thing is that there’s less stigma. This is a generation that is much more comfortable with mental health and counseling.”
Where many schools focus on differentiating between appointments provided on short notice for emergencies and non-urgent individual appointments, Baylor focuses on access to services and the speed with which someone who’s having a problem will meet with a staff member.
“We [strive to] see students immediately,” Marsh says. “Right when they want to be seen. So we have walk-in hours, nine to four, Monday through Friday, including the lunch hour. You can just walk in without an appointment and once you finish your paperwork, you see somebody within an average of 15 minutes.”
The Counseling Center starts with an initial assessment.
“We find out what’s going on, and then we can talk to them about all these different services, Marsh says. “We call it our program of care. When you walk out the door, you’ve seen someone and you’ve got your next appointment.”
There’s no cost for the Counseling Center’s services, which likely removes one source of concern for students who don’t want their parents to find out about their visit through their insurance companies. By comparison, Marsh says as many as 25 percent of other schools charge for some or all of their services.
Experts say that most mental illnesses begin to manifest between ages 18 and 24, forcing many students to juggle the onset of complex conditions in addition to the many other stresses of college life. The three most common diagnoses both at Baylor and nationally are anxiety, depression, and relationship problems. Marsh says the order has changed a bit over his 18 years at Baylor, with anxiety taking over the top spot because of the number of different diagnoses, including panic disorder, social anxiety, and Obsessive Compulsive disorder.
Marsh says Baylor’s decision to reduce its staffing ratios is driven in part because of the university’s academic rigor. He points to “this generation’s incredibly high expectations for performance, success. It’s the participation-trophy generation. Now, 75 percent expect to go to grad school. Twenty percent expect to go to medical school, and less than 1 percent do. I think they have unrealistic expectations sometimes. You have a lot of students with really high GPAs who are incredibly anxious, even when they’re doing well academically. There’s this worry about, ‘How are things going to go when I graduate, get a job, be able to have the things that I want?’ So I think that’s a big factor.”
Baylor takes a number of different approaches to treating that anxiety.
“Obviously, we do individual therapy,” says Marsh. “Dr. Yoshiko Hall [specializes in] mindfulness, and she’ll actually go out across campus and do workshops. I lead groups for students who get highly anxious in social situations [and we work through fears concerning small talk, making friends, talking to professors, raising their hand in class, all sorts of things.”
The BUCC recently introduced an anxiety-focused program created by the University of Florida called “Therapists Assisted Online (TAO).”
“We’re really excited about TAO because it is designed for students with mild-to-moderate anxiety,” Marsh says. “It offers online modules that you combine with a 20-minute video counseling session. You don’t have to come into the office. You can be at home at your laptop, desktop, iPad, or iPhone, and connect with somebody in the office for your appointment. We’re really hoping this program will grow, because it’s just as effective as coming in one-on-one, sitting down with somebody, with this kind of mild-to-moderate anxiety you’ve got a busy schedule, you have to be off-campus, those sorts of things. It’s really great for that.”
Another exciting new feature in the center allows students to test new techniques and technology created to help manage stress.
“We’ve created what we call a mind-body lab,” Marsh says. “With anxiety being the number one problem, we’re teaching students relaxation skills. They can come here and try out all these different devices or programs, and see what works for them. Each of these things costs about $20 on Amazon. So if they find something that works, they’re not dependent on the space, and the room.”
The university is adamant about finding new, interesting ways to help and support students.
“We do a lot of other programs around stress. We’ve had puppy play days. We participate in the green dot training, which is the sexual assault prevention training. We have a big outreach full-day program we do every year. Part of the reason we do that is education. But it’s also stress-relieving; it’s preventative. We want the students to know who we are, and to take away that mystery. And say, ‘I see Dr. Hall. I think I can connect with Dr. Hall.’ That type of thing. So that’s the other function it serves.”
Dr. Marsh says his staff does “somewhere in the area of 100 to 125 outreach programs a year. We will do suicide prevention. I speak every year in chapel. It’ll be my ninth year this fall. So every student that’s come through Baylor in the last eight years has heard about mental health and suicide prevention.
Recent events have affected some of the Counseling Center’s staffing and training decisions.
“There are only three places on campus that you can go where your information is confidential,” Marsh says. “It’s us. It’s the health center. And it’s the university chaplain. Let’s say a student has experienced some form of interpersonal violence. We want them to be able to meet with somebody immediately, to talk about that, and then give them some time, really, to think about, to process a little bit, get some support. And then they can decide what they want to do from there. That gives them time to think, ‘Do I want to move forward with Title IX,’ or whatever it might be. So we’re a very important role in that. And so we often see students who this is there first time talking to someone about interpersonal violence.”
This emphasis on responding to interpersonal violence has influenced some recent staffing decisions and led to further departmental growth.
“Two of the additional staff that we hired were staff members with experience in what we call ‘the treatment of trauma,’ which is often associated with interpersonal violence,” Marsh says. “It’s impacted our training. Last year, we invited Dr. Edna Foa, who is one of the leading experts in the world on the treatment of [post-traumatic stress] trauma, to provide training for all our staff and we invited the greater Waco community. We (had) training on cognitive processing therapy for two days this past June. We are hiring a Crisis Care Counsel position whose primary job will be to meet with students who have experienced some type of interpersonal violence or other trauma for initial assessment, follow-up, and connection to other resources on campus.”
Marsh says the Crisis Care Counselors will be a student’s initial contact if they’ve experienced interpersonal violence and will stay with them throughout the follow-up process, even if they have to come back in for another reason. The counselors will help those students get connected to the right service, and help them with access to other campus resources.
Marsh says the university also has three case managers in Vice President Kevin Jackson’s office, including one whose primary job is helping students who are considering or going through the Title IX process.
As schools across the country struggle with the increased need, Dr. Marsh says there are a number of components that go into creating a strong program.
“I think the ideal campus mental health system includes staff and resources, which we have at Baylor,” he says. “When you have more staff, you can do a lot of things. We need a very diverse staff so we can connect with a very diverse student body. The second thing is access, and in addition to the walk-in appointments, we’re available 24/7 to students through our staffed crisis line.”
Marsh says external referrals were very rare this past year, recognizing that there are still some things that the BUCC is not able to offer due to limitations as a university counseling center and not a hospital,] partial hospital, or intensive outpatient program.
And the counseling center uses students for both outreach and support.
“Students are more likely to listen to other students,” Marsh says. “If you can have students help you carry your message it’s just going to work better. We do that in two ways. We serve as an advisor to the Active Minds Group and the 20-student fall Peer Leadership class focuses on college-student mental health. We have students who help us create public service announcements, because they’re way more creative at videos and YouTube.”
With such substantial growth, challenges are always to be expected.
“When most people think about counseling, they think they’re going to go in, it’s going to be one-on-one, and they’re going to sit down with ‘my psychologist, my counselor, my clinical social worker,’ and we’re going to meet for an hour,” Marsh says. “That’s the traditional model. We have all of these great services, all these different groups that we offer. All of these different ways to be helpful to students. And they’re just as effective as what I’m going to call Individual Therapy, which can be a more-intense, higher-investment type of service that some students are ready for and some are not. The problem is [communicating] everything we have to offer. I would say the biggest challenge is getting them plugged into that right service.”
Some experts, including Dr. Richard Kadison, author of College of the Overwhelmed, says parents and students should consider the type and scope of a school’s mental-health services, just as you evaluate things like class size and academic support services. But Dr. Marsh says he really hasn’t seen much of that.
“I really just haven’t been asked a lot of questions,” he says. “We do a lot of things on the front end. We send a letter to all incoming students [in the spring] and say, ‘If you have some questions about our services, feel free to meet with us during orientation.’ We point them toward our website. And on the first day of orientation, I do the parents’ talk with Dr. Martha Lou Scott and we’ll get two or three questions.”
Marsh laughs when asked what constitutes a “good day” for him.
“I’m a person who likes to check off the boxes, and get a lot of things done. But I think a good day, for me, and a good day for us, is we were able to see all the students who wanted to be seen. The students who came in, they were able to be seen quickly. They felt cared for. They felt like they were provided excellent service. Any crises that walked in the door that we were able to manage well, and handle, and those students are doing well. That would be it. Students felt cared for.”
