The Post-College Therapy Void

Mental-health resources are proliferating on campuses, but after graduation, students who relied on counseling face a trying transition.

A sign on the Georgetown University campus reads "The Spirit of Georgetown: Education the whole person"
Georgetown University recently lowered its per-session counseling fee from $85 to $10. (Joshua Roberts / Reuters)

Before he arrived at Wichita State University, Steve Paniagua had never seen a therapist. He’d struggled with depression and suicidal tendencies for years, but his family could never afford treatment. As soon as he got to the Kansas school, Paniagua called the school’s counseling center. He learned that he could meet with a licensed therapist as often as he needed to, free of charge.

“For two years, I would go maybe once a week to the counseling center,” Paniagua said. “It was that extra support that I needed. If something bad happened, I always knew I could go there and be a little bit safer than I was before.”

Paniagua graduated last month. He has no job and no health insurance.

“When you have something for a really long time, you don’t know what you’re going to do when you lose it. What happens if my depression gets really bad again? It’s one of those things I haven’t really thought about,” Paniagua said.

While student enrollment at U.S. colleges and universities only grew by 5.6 percent between 2009 and 2015, the number of attended counseling appointments grew by 38.4 percent. At mid-size schools (those that educate between 5,000 and 10,000 students), an average of 10 percent of the student body uses the counseling center.

In 2016, over half of all college counseling centers experienced an increase in funding from their universities. As more and more schools expand their mental-health services, students are becoming increasingly accustomed to free or low-cost, easily accessible therapy. That can make it hard to leave college behind.

Despite the fact that the Affordable Care Act allows recent graduates to stay on their parents’ insurance until age 26, many still struggle to find therapists covered by their insurance or afford copays and high deductibles. Now that a Republican plan to replace the law is poised to allow states to opt out of “essential health benefits” like mental-health care, many recent graduates could be in for a major shock.

When I asked Paniagua where he’d go if he needed mental-health care after graduation, he said he’d most likely return to WSU’s counseling center.

“If I really needed help, I think I’d enroll in one of the half-semester classes at Wichita State,” he said. “I feel like that would cost as much as a couple sessions of counseling.”

Not all students have such a positive experience with mental-health care at their universities. Eight percent of schools with counseling centers charge for one-on-one counseling sessions, and another 7 percent charge after a certain number of appointments. Some schools have no counseling centers at all. Recently, however, as the media has taken a greater interest in the issue, colleges have been investing in mental health more heavily than ever before. Georgetown University in Washington, D.C., for instance, used to charge $85 per counseling session. In the fall of 2016, that price dropped to $10.

Evidence suggests these are necessary changes. Studies show college students benefit immensely—both personally and academically—from having access to a licensed therapist. But as colleges bolster their mental-health resources, they should also consider how to prepare their students to lose them.

For many students, the transition from college to adult life is the most drastic one they have ever experienced. They often have to figure out how to exist outside of the communities that education has provided for them since kindergarten. Particularly for students who suffer from mental illness, that transition can easily become debilitating.

“If you’re here, you’re receiving the great, free resources that the university provides—basically, that’s all you know. So if you struggle with mental health, I imagine it would be very difficult for you to move out of the university,” said Shelby Steverson, the Co-Director of CAPS In Action, a mental-health advocacy student group at the University of Michigan.

Today, the vast majority of college counseling centers only serve current students. That makes sense: At most schools, student fees provide the majority  of their funding. Especially at public institutions, where shifting state budgets mean funding can vary wildly from one year to the next, college counseling centers struggle to keep up with rising demand. That doesn’t leave much room for new programs or extra sessions dedicated to the post-college transition.

“When you have tighter resources and a smaller staff, you have to spend the bulk of your time on one-on-one counseling and clinical services. Starting new programs is much more of a challenge,” said Micky Sharma, who oversees counseling at Ohio State University.

Community colleges, in particular, have very few resources dedicated to counseling services. Counselors often wear multiple hats, simultaneously providing students with psychological, career, and academic counseling. Close to 18 percent of community colleges provide no mental-health counseling at all.

Community colleges serve high numbers of part-time and nontraditional students, many of whom have outside jobs and families. “They may need more support than the typical student,” said Jennifer Ruark, who edited a recent Chronicle of Higher Education series on college mental-health services, “but it’s harder for them to get it.”

So what can counseling centers that are already strapped for cash do to help students make a smooth transition from college to real life?

A few universities offer students insurance plans that extend a few months beyond graduation. At New York University, for example, students can purchase continued coverage for up to 90 days after they’ve gotten their diplomas.

But the solution might be simpler than that. Students like Paniagua would likely benefit from just starting to think about these issues, and planning for their future care, before they’re out on their own. School counselors could work with graduating seniors to find therapists in their new cities, develop plans for how to pay for treatment, and advise them on managing the stress that comes with leaving college.

Many universities already help students transition from one mental-health-care provider to another. Those students just typically aren’t seniors getting ready to graduate. At the University of Michigan, each student is typically allotted five free sessions with a school counselor before the school refers him out to a provider in the community. The school employs two full-time consultants to help students connect with therapists in the Ann Arbor area and figure out how to pay for their care. On its website, UM Counseling and Psychological Services features detailed video explanations of how to find providers—both with and without health insurance.

It wouldn’t take much for colleges to adapt these kinds of resources to the needs of graduating seniors. Sharma suggested that college counseling centers also hold workshops on the post-graduation transition.

“In the final year of college, you have the added pressure of, ‘where do I go?’ ‘what is this next step going to be like?’ We need to make sure students have the right skill set,” Sharma said.

At Ohio State, Sharma oversees one of the largest college counseling centers in the country. The school’s counseling services include 43 full-time staff members and more than 20 graduate-student trainees. When I asked Sharma how he responds to the growing contingent calling college-educated millennials “snowflakes,” and dismissing programs like his as unnecessary, he said he argues that the world has changed.

“There are added stressors and pressures on college students. The more we’re helping students to manage stress, the better,” he said. “These are the future world leaders—why not give them these tools they need in college?”

Even better: Why not give them the tools they need when they leave?