It was LSA sophomore Lauren Matson’s first night on campus freshman year when she felt it.
“I was walking back with my friend that night through the streets of Ann Arbor, and I just felt this pang of loneliness — this pang of sadness,” Matson said.
It must be homesickness, she thought. Sure, she missed her friends from home, but didn’t everyone, especially on their first night?
The sadness, however, stayed. Matson began having difficulty eating and keeping food down. Some days, she would only eat a granola bar or two because of nausea. Within weeks, her bodily sickness began to negatively impact other aspects of her life too. Worried she would feel sudden bouts of queasiness, she didn’t want to leave her dorm and felt anxious about going out with new friends.
“That anxiety was what was leading me to not want to leave my dorm, or go out with my friends to do things in Ann Arbor Welcome Week,” she said.
Transitioning to college
Matson’s experience is one that has familiar echoes for a lot of University students — last year 4,197 students sought help from CAPS — and for college students nationwide, with a range of different outcomes, choices and paths for each as they move forward in their college careers and lives.
For Matson, the choice was to go to Counseling and Psychological Services three weeks later, on the advice of a friend. It wasn’t until November, however, when she would find answers.
She spent months bouncing back and forth between CAPS and University Health Service. A CAPS counselor referred her to UHS, determining the medical staff would be more suited to address her stomach problems. The lines between physical illness and mental illness blurred.
Matson was put on medication to correct the nausea, but the medication soon stopped working. As time went on, she began to have suicidal thoughts — she said she always knew the problem was with her mind, not her stomach.
When she returned to UHS with the same symptoms of nausea, she was told she had depressive disorder. She was back to seeing counselors at CAPS, and her parents started visiting every week — or she would go home every weekend. But nothing was working.
CAPS currently does not have the resources to support long-term care, and eventually, Matson said, her counselor felt it was time to refer her to an outside counselor, who would become essential to her health improvement in the coming years.
Students seeking mental health help can also go to the University Health Service, but according to Dr. Robert Winfield, chief health officer and director of UHS, the psychiatry department only offers prescription and drug treatments.
“We don’t offer any counseling at Health Services, so there are a variety of situations where somebody wants to be evaluated for the continuation of medications,” he said. “And some of those situations are situations where somebody might choose to not get counseling or may want to focus on medications.”
There is no one cure-all for patients concerned about their mental health, though many people choose to turn to medications over counseling after talking with a doctor. According to the Centers for Disease Control, across the United States approximately one in 10 Americans ages 12 or older take antidepressants. At colleges, these numbers are typically higher.
“Sometimes people just feel terrible with anxiety or depression but they haven’t been able to put a word on it — they just don’t feel well,” Winfield said. “And so they may think ‘Maybe there’s something wrong with me physically,’ so they may come in not knowing what’s wrong.”
LSA junior Raivynn Smith had a similar experience with a physical sickness accompanying mental health concerns. Before transferring to the University this year, Smith took a two-year gap following a painful and difficult freshman year experience at a small private college in Illinois. She said though it probably wasn’t when she first started experiencing her social and generalized anxiety, coming to college is when she first noticed it. Like Matson, the transition to college was difficult and her anxiety began to affect her diet.
“I had really bad panic attacks,” Smith said. “I stopped eating. I was really, really, really sick, and I ended up leaving school.”
The gap was cathartic for her, she said, though she noted that she still deals with her anxiety, especially on a larger campus like the University of Michigan where day-to-day things like going to the dining hall can be challenging.
Even for students who have already noticed and begun acting on the signs of mental health issues before college, the transition can still be significantly difficult, on top of what is an already challenging process. LSA sophomore Jarrett Reichel dealt with depression throughout high school, but had a support system then — leaving home, he said, meant leaving that comfort and support.
“I had a really good support group in high school, with my friends and my family, and coming here since none of my friends came here, the transition was really difficult because I didn’t have that support group I normally had,” Reichel said. “Then, of course, the added stress of changing your entire life.”
Reichel lived in Bursley Residence Hall his freshman year and said he found the experience to be isolating. Like many students, he didn’t make friends immediately during Welcome Week and felt alone. Everyone in his hall became tight-knit and he said he felt as though he was missing out on the college experience.
“It was a pretty rough transition — especially because everyone around me seemed as though they were having a good time, and it was kind of hard to recover from that,” Reichel said. “It was irrational, but I felt like after the first couple of months it was almost too late (to make friends). So, that was rough, especially in regard to the future.”
Like Reichel, LSA junior Morgan Rondenelli said she found the new surroundings in college made it easier for her to avoid addressing her obsessive compulsive disorder.
“When you’re away from home — and taking exams — it’s a huge transition,” Rondenelli said. “Plus, it’s such an opportunity to just isolate yourself and just let things get out of control.”
A balancing act
The services the University provides for students struggling with mental health issues span several arenas.
CAPS, the main University resource for mental health, spans three prongs: clinical, outreach and training. Within clinical aspects of CAPS, resources are divided between providing ongoing services and the demands of new requests and crisis appointments.
According to CAPS director Todd Sevig, the distribution of counselors currently heavily prioritizes short-term care. Sevig said one of the largest challenges for CAPS is how their counselors — to whom the largest portion of the program’s funding goes toward paying — are distributed within CAPS.
Reichel said he sought help from CAPS near the end of September of his freshman year and found the experience to be beneficial in helping him adjust to campus and learn to deal with his depression.
“It was definitely very, very helpful,” Reichel said. “Normally they don’t do (long-term) therapy there that much. Normally they just figure out what’s going on and help you find somewhere out in the community to send you to. They kept me around.”
Reichel noted, however, that there are some issues with the current system that he believes could be resolved through increasing resources and funding to the center.
“In regard to CAPS, they have really great stuff and they have really great people and they’re doing a lot of good things to help out — there just isn’t enough,” Reichel said.
For many, that sense of not having enough is frequent with CAPS — especially with long-term care like the kind Reichel received, for which funding is noticeably limited.
Since 2011, CAPS’ budget has increased by more than 30 percent. In 2016, CAPS received $3.0 million in funding from the University’s General Fund — the vast majority of which goes to counselor salaries, according to Sevig. Other funding for projects come from donations: The Gatof Foundation funded the creation of CAPS’ After Hours hotline and the CAPS Stress Busters app, and funding from the Logan Family Foundation created a QPR (Question Persuade and Refer) training video for new faculty and students aiming to prevent suicide.
But this increase in funding has been accompanied by significant increases in demand. Last year CAPS had more than 25,000 appointments — about 1,300 of which were crisis appointments. The numbers break down to 4,197 individual patients seen for clinical services in the last year alone.
Every year for the past five years, CAPS has experienced an average increase in appointments of 7 to 9 percent. This year, the average increase for the Fall semester in comparison to that of last year was 20 to 25 percent. During one of the first few weeks of the semester, CAPS experienced a 43 percent increase in new appointments. CAPS staff, in contrast, has not increased at nearly that pace, according to Christine Adiado, CAPS’ associate director of community engagement and outreach.
“There is a 43 percent increase from 2010 to now — our staff has not increased 43 percent,” Adiado said
Sevig said the increases have prompted CAPS personnel to start looking for new answers in how they do things, a conversation he added that the program can’t have on its own.
“What we’re all trying to figure out is sort of new answers to new questions: What if next year we have a 40 percent increase? And then the year after that? What is the best way to meet that level of student needs on mental health?” Sevig said. “That’s where we can’t figure this out on our own, we need to answer those questions together with students — including faculty, staff and administration. We can adapt, we can add, but if that level of increases continues then we have to rethink some new ways.”
For CAPS, the patient increases are a double-edged sword: While on one hand the counseling center is happy to see new clients and more students on campus seeking help, the increase in demand leads to resources stretched thin. CAPS staff said they largely credit the recent increase in students seeking help in the past five years to an increased de-stigmatization of seeking help for mental health issues.
“I don’t know if anyone’s figured out the answer (to the increase in demand) but what people are seeing and what we’ve experienced both anecdotally and looking at our data, there are a few multiple reasons,” Sevig said. “The first is stigma has decreased over this time period.”
Sevig pointed to several University outreach mechanisms as potential reasons for that decrease, such as the “Do Something” campaign, which promotes a positive campus environment. He estimated that at least 15,000 students are influenced by outreach initiatives such as those annually.
“When we wake up in the morning we are devoted to the people who walk in our doors — our clinical work,” Sevig said. “But when we wake up we are also trying to think of literally every student and also the culture of this place, the campus climate around mental health. And that’s where I think both of these things — when I think of the last five to 10 years this is a big part of the increase.”
The wait
The limited resources of CAPS is manifested most readily for students in appointment wait time — it’s one of the most talked about complaints students have about CAPS, and one that has seen a renewed push of attention this semester.
Kinesiology freshman Shanze Noorani, who is not affiliated with any mental health advocacy groups on campus, is currently petitioning to increase funding for CAPS. To date, the petition, which emphasizes the need for shorter appointment wait times, has garnered 1,836 signatures.
“I think it’s something everyone does feel really passionately about,” Noorani said. “It’s one of those things. I think I actually got a lot of support because it’s not like a debatable thing; I think it’s pretty much across the board that everyone feels that this is an important issue — especially here at Michigan.”
Noorani said when the petition reaches 5,000 signatures she intends to present it to University administration.
“Currently, wait times to make appointments here are approximately 3 weeks long, which is not very beneficial to those that are suffering NOW,” Noorani’s petition reads. “If funding for CAPS is increased, more staff members can be hired so more students can make appointments and work through their hardships. In order to make our campus a more conducive environment to preventing tragedies like this from occurring, mental health services should be made a priority so that those suffering from depression, anxiety, and other mental health disorders can get the help that they need.”
Noorani said in her own experience, CAPS wait times have been problematic.
“I’ve tried to make appointments there multiple times and I always end up having to cancel it because you have to make it three weeks in advance, and, like, who knows what they’re doing in three weeks? Or if they’re even going to need it in three weeks?” Noorani said. “I think the main thing they could improve is hiring more people that are available to talk to. I’m not saying CAPS is the worst thing because I know it has helped so many people, which is great, but there are also so many more people that it could be helping.”
In response to the petition, Sevig said the three-week wait periods aren’t true.
“It’s never been three weeks; it’s a myth and a misunderstanding.”
Business junior Kelly Lewis said her first time making an appointment at CAPS was difficult. She was told she would have to wait two weeks to get an appointment, but when she asked if there were any other options she was pointed to see the on-call counselor, which she said worked out fine for her.
Lewis discovered last semester she had a physical disability causing her eyes to not see at the same time. Soon, her disability began to have a negative effect on her mental health as well. Lewis said she lost trust in her body — everything she thought she perceived, her mind doubted.
Lewis didn’t not need long-term counseling, but said even the short period she dealt with CAPS scheduling was a hassle.
“I really enjoy my counselor, and have a lot of good experiences with him, but it is frustrating — even as someone using the resource — trying to set up an appointment,” Lewis said. “Even though I’m in the system, and set up to see him, we have a very hard time scheduling.”
Adiado said she thought perceptions of long wait time may stem from scheduling issues.
“I think it is more of the student not being able to make an earlier time so the thing that maybe works with their schedule is a couple of weeks later, but it’s not because we have a waitlist or a wait time of two weeks or three weeks,” Adiado said. “It’s really essentially eight days.”
The wait period for appointments is updated daily on the CAPS website.
A focus on North Campus
Reichel, who noted feelings of isolation as a freshman in Bursley, isn’t alone in his sentiments on the necessity of increasing services to North Campus as part of increasing CAPS service.
In recent weeks, multiple organizations across campus have called for reform to North Campus options. LSA senior Marlee Beckering and five other students recently started the Help CAPS Catch Up Campaign, a group advocating for better mental health resources on campus. The campaign, which began as a project for the course Organizational Studies 203, aims to find ways to better increase CAPS’ resources. On April 6th, the Campaign launched its survey of students on what they would like to see done to address mental health on campus. The survey is still open and collecting data but thus far the top two responses were increasing funding overall and increasing resources for students on North Campus.
Engineering freshman A.J. Ashman president of Bursley Hall, said he believes the University needs to do a better job at broadcasting the mental health resources available. In particular, he said he felt there was a need for a CAPS clinic on North Campus given that the majority of students there are freshmen and may be having trouble adjusting to college.
Though there is no branch of CAPS on North Campus, there are counselors available for students in colleges based on North Campus, such as the College of Engineering and College of Music, Theatre & Dance. CAPS launched the program of “embedded counselors” two years ago as part of a restructuring of the system to reduce wait times, and has since expanded to professional schools on Central Campus as well, hiring seven new counselors for the initiative. Each school on North Campus has one embedded counselor whom students in need can e-mail for an appointment. This past year CAPS expanded the initiative into professional schools such as Law, Business, Rackham and Dentistry, and are working on a study to see the benefits of the program — hoping to ultimately expand it into other colleges.
In recent months, Central Student Government and LSA Student Government have each proposed several resolutions to broaden mental health services onto North Campus. CSG party newMICH, who recently won the CSG presidential election, ran partially on the platform of creating a CAPS center on North Campus, along with hiring 11 new counselors to decrease the ratio of counselors to students from the current 1:1,300 to 1:1,000.
At a recent LSA Student Government meeting, LSA sophomore Nicholas Meier, who proposed a resolution for a campus-wide “Mental Health Day,” highlighted the importance of increasing mental health resources in “isolated” areas of campus like North Campus.
“People should not be prevented from having access to the same resources as other students just because of where they were randomly assigned to live,” he said. “We need to get something there now, so they can get the help they need now. Not in a month or five years, but now.”
Students who live on North note that it often has a worse reputation of isolation or lack of community than the reality. Ashman said Bursley Hall Council works hard to promote activities to build a sense of community.
Baits II residents Sabrina Wong and Elan Johnson, both LSA freshman, echoed Ashman’s sentiments, saying while logistic issues like buses to Central Campus are not ideal, there is a sense of community. That given, Wong said she “didn’t know how isolating North Campus would be” until she got on campus, and while there are benefits of the community setting, she said there are noticeable drawbacks.
“It’s kind of nice to have your own community to escape to” Wong said. “I think that the social aspect of it, I think it’s a lot harder. I live in Baits so your own house is like your own community and there’s like maybe 200 people that live in a house. It’s really quiet and unsocial. If I lived in Markley or East Quad or South Quad, I feel like I’d have a lot more people to talk to and hang out with.”
Johnson said Baits Residence Hall does a good job of promoting social activities and creating a community.
“It’s a little bit isolating but if you make the most of it then it’s not as bad as everybody says,” Johnson said. “I think if anyone gets on North Campus, while it is sometimes disappointing, if you make the most of it then I think it’s not as bad as everyone says it is.”
Reichel said overall, expanding resources would have helped students like him.
“Being on North Campus, coming down to the Union can be hard at times, too,” she said “If they had a satellite clinic or something up on North that would be cool, too.”
Moving forward
The increase in demand, though it’s prompted student outcry and concerns, has also been accompanied by University and student efforts to provide more services and shift campus culture.
Initiatives such as the embedded counselor program have already seen progress in reducing wait time. When the program was implemented two years ago, wait times were cut 60 percent to an average wait time of four days, according to CAPS.
One of the main pillars of the Help CAPS Catch Up Campaign is ensuring funding is at a satisfactory ratio based on the research of Daniel Eisenberg, an associate professor in the Department of Health Management and Policy at the University, who found that college counseling centers should have $1 million per every 15,000 students. Under the increase in the 2016 budget, CAPS is now receiving what Eisenberg deems is the proper amount — prior to this year, though, it was below.
Lewis said another initiative the campaign supports is one Central Student Government has mentioned implementing: a mental health liaison for student organizations. This would be a person who is trained in the resources on campus, though not necessarily a counselor themselves.
“I’m in a 300-person organization,” Lewis said. “If somebody is having a moment where they just need to figure out who to go and talk to, they can go to this person and say, ‘Hey, who do I go see? What’s the wait time like at these different places? What are my options?’ ”
Beckering was interested in working to improve mental health resources after dealing with her own issues and experiencing others’ firsthand — noting countless instances of the impact of mental health issues in her sorority. She said she believes the widespread nature of mental health issues is a result of counselor’s limited resources.
“Unfortunately, one of my (sorority) sisters committed suicide as a sophomore. As a 19-year-old I had to plan her memorial service and support other 19-year-olds who were going through a period of loss, and that was really, really hard,” Beckering said. “Then when I was a junior, I intervened in a situation where someone was trying to commit suicide. There have been so many other situations throughout my college career where I’ve seen people who aren’t able to gain access to what they need — and that’s including myself.”
The group has also found lack of long-term care in the form of follow ups after CAP appointments is an area students feel CAPS is less effective in due to underfunding.
Beckering said several suggestions have been made to alleviate this, such as having CAPS call patients who skip their appointments, or check in on them after they are referred to an alternative private practice to see how it’s going.
“CAPS doesn’t have the resources to call and check in and say, ‘Hey, how are things going with the person we referred you to?’ ” Beckering said. “They’re amazing people and they have the capacity to make amazing change in the people that they do help.”
Smith, who utilized CAPS when struggling with mental health after coming to the University, said she stopped going after a few sessions. She said she felt her counselor wasn’t a good fit for her and she started to have anxiety about it, but a follow up visit might have helped encourage her to come back.
“Part of me is like, ‘You should probably just try again,’ ” Smith said. “But it’s also hard because my schedule is really packed. It’s kind of hard because CAPS is only open during the day when we have classes, but I should probably just try again.”
Overall, students interviewed for this article echoed the same sentiment over and over again — any increase in campus mental health resources will be a positive.
Across the board, the primary solution presented by students was increasing the number of counselors, whether at CAPS’ current location, a new North Campus clinic, or more embedded counselors.
Sevig said he was interested in hearing student input on what steps should be taken moving forward to improve CAPS. Improvement models CAPS is currently considering, he said, include whether to expand the embedded counselor program or change the current model’s focus away from prioritizing crisis work, as well as more attention to ongoing follow up appointments.
“Yes, we’re all aware of what’s going on right now,” Sevig said in regard to student concerns. “There’s a lot of student cries and demands: ‘We love CAPS, we need more CAPS.’ We’re all hearing it. What we’re all trying to figure out quickly is what is the best way to meet student needs, but don’t forget the president, the provost, the vice president of student life have decided to add seven new staff members in the last two years. That’s not a small thing.”
In an interview, E. Royster Harper, vice president of student life, echoed Sevig’s sentiments, saying the administration wants to hear students voices on the subject.
“We are open to hearing what students are saying and we are open to making changes based on what students are saying.”