Discussions of mental health diagnoses and treatment have increased in recent years, particularly on college campuses. At the University of Massachusetts, this upward trend has increased scrutiny of the campus’ Center for Counseling and Psychological Health.

In a press release from the American Psychiatric Association, more than one-third of students reported a diagnosed condition in 2016-17.

Emily Dykstra, the president of student mental health promotion group Active Minds, became concerned about CCPH services after a student reported that the Center had stopped accepting patients for one-on-one therapy.

“When Active Minds found about this, we were kind of like, ‘What? Why is this happening?’ So, we kind of just wanted, from the source, to see what was up,” Dykstra said. “Why is this lack of services happening?”

Dykstra met with the interim co-director of CCPH Melissa Rotkiewicz, Psy.D., who explained CCPH was looking to fill staffing vacancies to meet increasing student demand for counseling. However, workshops, consultations, crisis intervention and community referrals and other services offered on the CCPH website would continue to be offered.

“They said that they hope to resume individual counseling services, like accepting new patients for that at the beginning of next semester,” Dykstra said.

However, the increasing pressure placed on CCPH to supply services to the community reflects national trends in mental health care according to Rotkiewicz. In the entering class of 2021, approximately 19 percent of students indicated previous experience with psychotherapy or medication, which she said was consistent with anecdotal experience.

“There’s increase [in] acuity, higher rates of suicidality,” Rotkiewicz said. “There’s lots of reasons to speculate why, but it seems to be national.”

In Rotkiewicz’s 15 years at the University, the number of students utilizing CCPH services has increased to approximately 13 percent, or 3,900 students. The vast majority of students who take advantage of CCPH resources are seen three to four times.

“In general, the U.S. population is looking more into mental health,” Rotkiewicz said. However, she continued, the demand for services is greater than the traditional system of therapy can provide.

At the University, approximately 22 clinicians, 10 to 12 trainees and eight or nine administrative staff work to serve the student body. With a large staff, “some turnover is expected,” Rotkiewicz said, leading to the current openings.

Rotkiewicz said CCPH looks for a qualified, diverse staff “who look like the students they’re serving,” but finds the lengthy hiring process and relocation to western Massachusetts presents unique difficulties at the University.

“Historically, college counseling has been a desirable job. As student stress levels have gone up, the job has become less desirable to some,” Rotkiewicz explained.

However, Rotkiewicz emphasized that this isn’t an issue the University can “hire our way out of.” Given the limited supply of therapists, one-on-one treatment levels are “difficult to attain not just here but across the country.”

In recent years, CCPH has sought to re-conceptualize people’s expectations of therapy and mental health treatment. While students are offered up to four sessions per academic year through student fees, this isn’t necessarily in the form of one-on-one therapy.

“There isn’t enough capacity to have everyone go to individualized therapy,” Rotkiewicz said.

Likening mental heath treatment to “packing a toolbox,” Rotkiewicz explained different individuals respond to different treatments and that it’s important to stay open to other paths besides individualized therapy.

“Therapy can be great, medication can be great, but there are things that can be better,” Rotkiewicz continued, referencing exercise, yoga and self-treatment.

Students best served through long-term one-on-one treatment tend to be sent off-campus.

“We can manage the stabilization and setting up a plan,” Rotkievicz said. “For the long-term care, a referral may be the best solution.” She added, however, that area therapists are also undergoing increased demand consistent with the national trend.

“It’s also extremely hard to find [treatment] in the community since we’re a big college town and there’s a lot of people who need therapy, and there’s only so many therapists,” Dykstra said, adding that she had a friend currently looking for therapy in the area.

“He’s called so many, and most of them either don’t get back to him, or are completely full,” Dykstra said.

Niamh Smithers, a psychology senior and Active Minds member, said mental health matters “just as much as flu shots and check-ups.”

“If freshman me finally mustered up the courage to go to CCPH for help and I got immediately referred to an off-campus site when I had no car, I would not have gotten help and who knows where I would have ended up,” Smithers said.

“Also, for a lot of people, reaching out for therapy is very hard for them, so if they take that first step, and then they’re turned away from a counseling center to go look in the community, that might be where it ends for someone, because finding someone in the community can be so, so, so difficult,” Dykstra added.

On campus, group therapy has played a large role in CCPH initiatives to diversify mental health treatment. Group therapy has people “meet regularly in small groups to discuss and explore their problems with each other and the group leader(s),” according to the CCPH page on the subject.

In the Fall 2018 semester, groups addressed ADHD/ADD, grief and loss, LGBTQ+ support, social anxiety and understanding self and others. For female graduate students, a group addressing issues with balancing roles and completing theses was held.

“As a group, Active Minds was thinking how we could help de-stigmatize group therapy, to move this forward,” Dykstra said. “But it’s really understandable to not want to go to group therapy on your own college campus. Like seeing someone from your calc class while you’re talking about your eating disorder might be something that you might not want to do. So, we’re trying to figure out more about what action can be taken.”

In order to protect student privacy in a group setting, groups set ground rules including no sharing outside of the group and how to handle in-person interactions outside of therapy.

“Each group makes their own decisions on what to do if they meet on campus,” Rotkiewicz said, referencing some groups’ choices to simply acknowledge each other or to meet outside of the designated time.

Rotkiewicz looks forward to the expansion of services, noting developments in Therapy Assisted Online. Additionally, CCPH is looking to adopt the CCAPS assessment, a quantitative and qualitative system of evaluating campus mental health services currently used by universities like Pennsylvania State University.

From budget documents obtained by The Massachusetts Daily Collegian through a records request, the annual budget for CCPH has increased in previous financial years, from $3,439,834 in FY14 to $4,187,014 in FY18.

In FY18, gifts/donations and insurance claims made up 12.04 percent of the total budget. The remaining 87.96 percent of funds is drawn from state and tuition support.

Rotkiewicz explained that in previous years, CCPH was supported by a specific student health fee which is now included in tuition fees.

The building renovation of CCPH’s new location Middlesex Hall, a $3.8 million project, was not drawn from the CCPH budget.

In FY18, CCPH used $4,138,373 of its budget. With most CCPH positions requiring a higher degree — masters, doctorate and/or medical — and offering good benefits, the bulk of the budget, 87.85 percent, is spent on personnel.

The remainder of budgetary use, designated as “non-personnel,” was spent on office supplies, license renewals, trainings and conferences, among other things.

The budgetary gap between funding and uses — $48,641 in FY18 — is rolled over to the next financial year. In a labor intensive organization like the University, these funds support filling vacancies and retirement processes.

Ed Blaguszewski, executive director of strategic communications at UMass, said the University is planning an education campaign to increase awareness of CCPH services.

“Given the curve in demand, we need to offer people a variety of options they can take advantage of,” Blaguszweski said.

Michael Connors contributed to this article.

Kathrine Esten can be reached at [email protected] and followed on Twitter at @KathrineEsten.