With a 48 percent increase in the number of students seeking counseling, Florida universities are asking for an additional $14.5 million in the coming budget year to hire more mental health professionals, including psychologists, counselors, psychiatric nurses and prevention specialists.
At least eight out of the 12 universities don't meet staffing standards recommended by experts, because they have more than 1,500 students for each mental health professional on the campus. The inadequate staffing has led to waiting lists, fewer counseling sessions and the need to rely on off-campus services, which are not covered by student health fees.
There is also an increase in more severe cases, with campus counseling centers reporting 4,200 visits in the 2013-14 academic year that were classified as emergency or crisis visits, involving issues like severe depression, acute anxiety and suicidal thoughts.
The counseling centers also reported 300 students had to be involuntarily hospitalized under the state's Baker Act during that academic year.
"The (state university system) counseling centers provide services that are critical to student retention and success and the need to address the mental and behavioral health of SUS university students has never been more critical," according to a report from Christy England, associate vice chancellor for academic research and policy.
The state Board of Governors, which oversees the universities and is meeting Wednesday and Thursday in Sarasota, will review the report and consider the mental health funding as part its 2017-18 budget request to the Florida Legislature.
The data shows that since the fall of 2008, the number of students seeking counseling services rose 48 percent, to 20,495 clients, in the 2013-14 academic year. There were also 163,000 counseling sessions, a 67 percent increase.
The directors of counseling services at Florida State University and the University of Florida, two of the state's largest and oldest institutions, confirmed the staffing challenges.
"Every year our utilization rates go up," said Carlos Gomez, a licensed psychologist and director of FSU's counseling center.
Between the 2014 and 2015 academic years, Gomez said his center saw an increase of 19 percent in student visits, rising to about 3,800, or about 9 percent of the campus' 41,000 students.
Gomez estimated that FSU has roughly one mental health professional for every 1,900 students, well above the 1,000 to 1,500 students per counselor ratio set by the International Association of Counseling Services.
When he arrived on campus two years ago, Gomez said students faced a five-week waiting period for services. He said his center changed its clinical model, allowing immediate evaluations. But he said the staffing problems make it difficult to provide extended counseling services.
"What we can't do is see every student who walks in our door for psychotherapy," Gomez said. "We are referring in record numbers out into the community."
The FSU counseling center has created a "treatment coordinator" position to help students, who get free health care on campus, find and pay for off-campus services.
"Sometimes they (the off-campus providers) give us a break, sometimes they don't," Gomez said. "But that's certainly a challenge."
As for students who can be accommodated on campus, Gomez said the staffing shortages means students are receiving counseling sessions every two or three weeks, rather than the once-every-week standard.
Ernesto Escoto, the licensed psychologist who directs the University of Florida's counseling center, said his school has one mental health professional for every 1,546 students. It means that by roughly mid-October each new academic year, the counseling center is putting students on waiting lists for services, he said.
"The demand for mental health services has increased at counseling centers, not only in Florida, but across the United States," Escoto said.
Escoto said the UF counseling center uses a "triage" system to identify students in the greatest need of services, but like FSU and other universities is also having to refer more students to off-campus services.
In Gainesville, Escoto said students can use an off-campus counseling service provided by Alachua County that only requires a modest co-payment.
"But that is not the case for all the counties in the state," he said.
The counseling directors cited several trends that may be adding to the increased demand for mental health services.
Escoto said effective psychiatric drugs have allowed more students with mental health challenges to attend state universities than did so in the past.
"Now with the care, more and more students are able to enroll and succeed. But at the same time, it's like moving to the major leagues from the minor leagues," Escoto said.
Some of those students find their coping skills "become taxed" by the more intense atmosphere and "they relapse and struggle," Escoto said.
Both Escoto and Gomez cited a "lack of resiliency" among students, as compared to previous generations, when it comes to coping with normal setbacks like a low grade, a relationship breakup or roommate problems.
"A number of the students we see lack the resiliency skills necessary to bounce back from setbacks," Escoto said, saying the situation can be heightened in a competitive university atmosphere. "They have not failed much in life and now they get a 'B' or a 'C' in class and all hell breaks loose."
Under the budget proposal, the $14.5 million would fund 137 positions spread across all 12 state universities. It would allow the schools to hire more psychologists, mental health counselors, psychiatric nurse practitioners, case managers, prevention specialists and office staff.
FSU would receive $1.9 million for 19 counseling positions, with UF receiving $2.2 million for 23 positions.
Gomez and Escoto said the funding would have a dramatic impact on their staffing challenges.
"My hope is then that we won't have a wait list anymore," Escoto said. "We will be able to provide care immediately to students and help them be successful in their studies and complete their education in a timely manner."