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College can be stressful for students, especially during this time of the year as students are completing final examinations and graduating. Considering the challenging academic workload, it is normal for students to feel worried, anxious, restless, or sad from time to time. If these feelings or other mental health symptoms persist and start to interfere with daily living and academic performance, it may be indicative of a mental health issue. Without treatment for mental health issues, college students are more likely to drop out, abuse substances, and even commit suicide.

According to the 2018 Center for Collegiate Mental Health Annual Report, college students across the country are increasingly experiencing and reporting mental health issues. Anxiety and depression were identified as the most common concern — as assessed by clinicians that provide mental health services to students. Some students may be at a higher risk for mental health challenges, including undocumented students, veteran students, and LGBTQ students. Having a low socioeconomic background and low social support may also put some students at a higher risk, especially considering the increasing cost of attendance (tuition, housing, books) and related food insecurity issues.

Years of rising demand in mental health services among California college students have contributed to longer wait times and growing pressure to improve access to these services. California higher education leaders and policymakers are taking steps to reduce the gap between students’ need for mental health services and their use of these services.

In light of Mental Health Awareness Month, and as budget deliberations are underway in the state legislature, this piece describes mental health trends and examines current state proposals to maintain, improve, and/or expand access to mental health supports in college campuses across California.

The 2018 National College Health Assessment reports that in the past year, 63% of college students surveyed felt overwhelming anxiety, 42% felt so depressed that it was difficult to function, 62% felt very lonely, and 12% seriously considered suicide. Researchers at UC Berkeley found that nationally, the percentage of students who reported being diagnosed or treated for anxiety disorder in the past year doubled from 2008 to 2016 from 10% to 20%.

Students in California’s public colleges report similar experiences. At the California State University (CSU), students reported an increase in hopelessness, loneliness, sadness, depression, anxiety, and suicidal thoughts in the past two years and 16% of students received some psychological counseling or treatment on campuses last year. At the University of California (UC), the percentage of students seeking mental health services in the past 10 years rose 78%, nearly three times higher than enrollment growth during the same period. While the demand for mental health services has increased significantly, it may actually understate the need, as many students may choose not to seek support due to the stigma attached to counseling.

At California Community Colleges (CCC), students experience similar rates of psychological distress as UC and CSU students — uncomfortable feelings or emotions that affect daily living — according to a recent study. However, students from CCC reported higher rates of impaired academic performance due to mental health issues than students at CSU and UC campuses. CCC students were half as likely to receive referrals for counseling or mental health services by a faculty member and were also less likely to receive services on campuses than their UC and CSU counterparts.

Availability of Mental Health Services and Resources for College Students Varies Across the State

The UC, CSU, and CCC have long recognized the need to provide mental health resources on campus, but have differed in their responses to meet increasing demand due to budget constraints and other factors. For that reason, students’ access to mental health services varies depending on the sector and campus.

At the UC, each campus has a Student Counseling Center that provides direct services, outreach and prevention services, and campus consultation services. In response to the increasing demand for mental health services at these centers, the UC Board of Regents approved a 5% annual increase in the Student Services Fee (SSF) for five consecutive years (2014 – 2019), with half of revenues earmarked for Student Mental Health. In 2018-19, the UC received $4.8 million in State General Fund in lieu of another SSF increase. As a result of this funding, UC was able to hire 70 Full Time Equivalent (FTE) counseling providers, reduce the average wait times for intakes from 12-18 days to 9-11 days, increase the use of case managers and launch integrated care efforts, and more.

The CSU campuses also provide myriad services to support students, focusing on efforts around education outreach, training, and acute crisis care. All campuses provide baseline mental health services: counseling, suicide and violence prevention, emergency crisis interventions, outreach, consultation, and referral resources.

Several CSU campuses have attempted to address the increased demand for mental health in a variety of innovative ways. Some campuses offer wellness workshops, a series of emotional well-being workshops led by counselors. At CSU Fresno, the Let’s Talk Program has allowed counselors to meet with students anonymously for 20-minute sessions in locations around campus, during which the counselor assesses the student’s need. Campuses have also invested in peer mentoring programs, which have “increased academic and social integration” as well as “improved student outcomes for all students, particularly those from historically underserved communities,” according to the CSU Office of the Chancellor.

CSU is also working to strengthen community partnerships in order to increase mental health services. Earlier this year, the Office of the Chancellor hosted a systemwide convening to connect campuses with their local county behavioral health offices. The goal of this convening was to develop partnerships that will bring additional mental health services to CSU students.

Compared to the UC and CSU systems, mental health services at the CCC appear to be less consistent, partly because community colleges typically do not offer their own health insurance plans. Currently, 90 of the 115 community colleges offer mental health services, with students averaging one to three counseling sessions per semester. Establishing health services is optional for community college districts, and districts that provide health services cannot charge a student health fee that exceeds $21 per semester, which means student health services are typically more scarce on campuses with relatively small student populations.

In 2011, CCC implemented the California Community Colleges Student Mental Health Program (CCC SMHP), a statewide effort focusing on prevention and early intervention. The CCC SMHP promotes faculty and staff training, peer counseling, and suicide prevention. According to a recent CCC SMHP report, nearly 168,000 students, faculty, and community members have been reached through prevention and early intervention trainings.

Barriers to Accessing Mental Health Support

One of the greatest challenges on California college campuses is that mental health funding has not kept pace with demand. This disinvestment in crucial services results in understaffed counseling offices, long wait times, and inadequate facilities — all of which negatively affect students seeking help.

The International Association of Counseling Services advises there to be one professional for every 1,000 to 1,500 students — an effort pushed for by legislators and vetoed by Governor Brown in 2018. Recent reports suggest that staffing ratios at the UC and CSU are close to that ratio (about 1,100 students per counselor at UC and 2,000 students per counselor at CSU); however, ratios at the CCC exceed more than 7,000 students per counselor. While the rates of both perceived and personal stigma have decreased in recent years, it is particularly salient for black students, Latinx students, and others who may already suffer from discrimination. Ensuring diversity among counseling staff may help with stigmatization and is a priority advocated for by students.

Before students can receive counseling, many must wait up to a few weeks for an available appointment. Additionally, many campuses have inadequate counseling infrastructure, with appointments taking place in non-discrete locations.

Current Budget and Policy Proposals to Improve Access to Mental Health Services

Improving access to mental health services for college students is a widely shared goal among policymakers, students, and institutional leaders. Several budget and policy proposals have been introduced this year from the legislature, Governor, and educational institutions.

In the legislature, AB1689 (McCarty) would create the College Mental Health Services Program, a matching grant program to enhance the provision of mental health services at CSU, UC, and CCC. Additionally, the Assembly’s budget provides $2 million ongoing and $3 million one-time of Proposition 63 state administration fund to support student mental health services at UC and CSU, and $10 million ongoing and $12 million one-time Proposition 63 state administration fund for the community colleges. The Senate’s budget allocates $550 million for “Mental Health Partnerships” between local behavioral health departments and K-12 schools, county offices of education, and public colleges within a county region.

For the UC, Governor Newsom’s proposed 2019-20 budget includes $5.3 million ongoing General Fund to improve mental health programs on campuses, which UC proposes using to hire more counselors and stabilize funding for existing counselors. Ultimately, UC notes that this funding would help to improve capacity for direct services, further enhance provider diversity, and bolster targeted prevention efforts for vulnerable students. In 2018-19, UC received $4.8 million in State General Funds to support expanding mental health services. This year, UC asked to make this funding permanent and ongoing and warned that without it, there is a potential for counseling staff layoffs, worsening accessibility, longer wait times, and decreased provider diversity.

For the CSU, the Governor’s budget proposal includes $15 million in one-time funding for the Basic Needs Initiative, which helps to support a variety of students’ basic needs, including mental health. It is not clear how much, if any, of the Basic Needs funding would be allocated for mental health and counseling services.

For the CCC, there are no funds included in the Governor’s budget for the mental health needs of students. However, last year the legislature approved $10 million dollars of one-time funding in the 2018-19 state budget for California Community Colleges to support mental health services and training.

Mental Health Services Are Critical to Student Success

Given the increased rate of mental health issues among college students, California colleges must work to improve access to mental health services and treatment. Increased mental health funding should be directed to prevention and early intervention as well as direct services for students, considering that the demand for these services already exceeds the availability at many campuses across the state. Adequately funding these services can help mitigate the negative toll that mental health conditions can take and help students succeed academically.

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