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UT is Working to End the Stigma Surrounding Mental Health and Offer Support – The Alcalde

By in Features, Jan | Feb 2022 on January 1, 2022 at 9:25 am | No Comments
When the last slice of pizza had disappeared, the 30 students at the NAMI on Campus meeting quieted and turned their attention to their vice president, psychology junior Alexis McDonald. The agenda for this meeting in October 2018 included a talk about depressive disorders, followed by a National Alliance on Mental Illness tradition: McDonald would share her own story.  
“In high school, I experienced a lot of depression and anxiety, but I had never seen a therapist or had a diagnosis,” she began. “I thought things would improve in college, but my freshman year was the most lonely, isolating experience of my life. I was so anxious I couldn’t go into social spaces and introduce myself. When I walked around, I felt no connection to anyone.”  
Her sophomore year, McDonald dove into campus activities until she became overwhelmed by depression and stopped going to class. Eventually she reached out to the Counseling and Mental Health Center at UT and connected with a therapist who helped her begin to manage her condition. The path to recovery wasn’t linear, she emphasized, but with her counselor’s support, she was doing better and even had told her parents about her depression.  
Mackenzie Ulam, BA ’21, then a freshman, listened, her chin cradled in her hand. As a psychology major, she had an academic interest in mental health. But lately, the subject had become more personal. Like McDonald, she’d struggled a bit in high school, and the transition to college had intensified her anxiety. In stressful situations, her heart and mind would race, her body would tremble, and she’d find it hard to catch her breath. At NAMI meetings she heard other students call these feelings panic attacks.   
As she listened to McDonald, Ulam considered seeing a counselor. Within a few months, she had visited a therapist, been diagnosed with a panic disorder, and told her parents.  
Knowing another student had sought help was gratifying, McDonald, BA ’20, says. “I’ve seen the conversation shift in NAMI, and on campus as a whole, about belonging, depression, loneliness, and suicide. Mental health challenges and conditions are very common, so it makes me hopeful that more people are talking about it and supporting one another.”  
The conversational shift McDonald describes is happening across the country. Today’s college students are experiencing an unprecedented level of mental health challenges, with marked increases in anxiety, depression, loneliness, and sleep disturbances. In a 2019 national survey by the American College Health Association, the majority of students reported feeling overwhelmed by their responsibilities within the past two weeks, and the majority also said they had felt exhausted. In the same timeframe a third of students had felt very lonely, and a third had felt very sad. Students today are far more likely than past generations to have the vocabulary to name their experience, speak about it publicly, and seek help. As a result, campus counseling centers are overwhelmed by demand. 
Experts agree that students today have more to worry about, including debt, the cost of living, employment instability, and the state of the world—and, compounding their distress, carry in their back pockets the perfect devices for comparing themselves unfavorably to their classmates. While this is true across the country, the pressure is intensified at UT Austin, a campus populated by overachievers. Add a pandemic, the social injustice and ensuing protests of 2020, and Winter Storm Uri, and many Texas students would roll their eyes at the notion that college today constitutes the best years of one’s life. In response, UT has developed innovative programs to foster well-being among its students. While it scrambles to keep up with the demand for individual counseling, the university is doing its best to help students in an era of anxiety.  

The best data on UT students’ mental health comes from the National Collegiate Health Assessment, administered by UT to a random sample of about 8,000 undergraduate and graduate students roughly every two years since 2006. Because it’s sent to a subset of all students, not just those who seek help from the Counseling and Mental Health Center, it provides a comprehensive picture of how Longhorns are feeling about their lives.  
The results are staggering. In response to a question about whether students have felt overwhelming anxiety at some point over the past year, more than 55 percent of UT students answered “yes” on each survey from 2013 to 2017. During the same years, more than a third said that at some point they had felt so depressed it was difficult to function. (These questions have been changed on more recent surveys.) In 2010, 56 percent of respondents said they didn’t get enough sleep to feel rested on four or more days of the last week. In 2019, the number was 71 percent.  
Only a fraction of students who report feeling depressed or anxious have been clinically diagnosed with those conditions, but the number of diagnoses is rising, too. In 2010, 11 percent of UT students had been diagnosed with anxiety over the past year. In 2019, it was 14 percent. For depression, the number increased from 8 percent in 2010 to 11 percent in 2019. 
UT students report feelings of anxiety and depression at rates similar to the national average. And they, like students across the country, are feeling stressed. Nationally, the number of students who said they experienced “tremendous”—as compared with “average” or “above average”—stress rose from about 9 percent in 2008 to almost 13 percent a decade later. In 2019, nearly a quarter of the U.S. college population reported ever being diagnosed with an anxiety disorder.  
What’s behind the disturbing upward trend? “It’s really hard to be a young person now,” says Mandy Colbert, MSSW ’14, a former peer health education coordinator at UT. “It’s harder than it was 10 or 20 years ago.”  
The reasons begin with financial stress. College is more expensive than it used to be, and the state of Texas has asked students at public universities to pay an ever-larger share of the cost. For many, this means taking on hefty student loans. Measures like the Texas Advance Commitment, which offers free tuition for students from families making less than $65,000 and tuition support to those making up to $125,000, and the expansion of relatively affordable university housing have helped but have not solved the problem. Today’s students were children during the Great Recession of 2007-09 and grew up amid economic uncertainty. They watch older friends and relatives struggle with the rising costs of housing, health care, and child care. And they’re aware that a college degree isn’t the ticket to a well-paying job that it might have been decades ago.  
“Because of those expenses, a lot of students have existential fears about getting a job after college,” says Morgan Kretschmer, BA ’21, who was active in NAMI on Campus. “It seems like you have to go above and beyond to get decent jobs now. There’s a lot of stress, and I think those crushing expectations cause much more anxiety.”  
The anxiety is compounded by a student’s sense, fostered by social media, that everyone else is doing better and achieving more. While young people use Instagram and Twitter to post supportive messages about mental health or to share their own struggles, they also meticulously curate what they post about personal accomplishments and their social life. “Seeing those idealized versions of people’s lives takes a toll on people’s mental health and sets unrealistic expectations for oneself,” says government senior Kelly Choi, who has helped lead Student Government’s Mental Health Agency
Today’s college sophomore has never known life without the internet—but, more importantly, was a preteen when smartphones became widely available in 2011-12. And more screen time, whether dedicated to social media, texting, gaming, video chatting, or internet surfing, contributes to poorer mental health, according to the 2017 book iGen: Why Today’s Super-Connected Kids are Growing Up Less Rebellious, More Tolerant, Less Happy—And Completely Unprepared for Adulthood (And What That Means for the Rest of Us). Author Jean Twenge, a psychology professor at San Diego State University, crunches the numbers from national surveys that pose the same questions, year after year, to people in their teens and early 20s. The data show how today’s adolescents differ from the adolescents of previous generations.  
In one survey after another, Twenge found that teens’ responses changed dramatically after the smartphone became ubiquitous. In aggregate, teens’ self-reported life satisfaction steadily increased from 1980 until 2012, when it plummeted. Loneliness in eighth and 10th graders increased by 31 percent between 2011 and 2015. The number of teens who experienced a major depressive episode grew by 56 percent between 2010 and 2015. The number of college students who seriously considered suicide climbed by 60 percent between 2011 and 2016. The culprits, Twenge writes, include not just social media-facilitated comparison, but the fact that when teens spend more time online, they’re spending less time exercising, working, volunteering, and building relationships and support systems in real life.  
These challenges are set against the backdrop of the things that keep us all up at night: climate change, political polarization, income inequality. “With many students I interact with, there is a sense of hopelessness about the future of the country and the state of the environment,” says electrical and computer engineering alumna Flannery Thompson, BS ’21. “It’s like, OK, no matter what we do at this point, our government or economy or environment is going to fail us, and that’s not because of what we’ve done, it’s because of what generations before us have done or not done.”  
At UT Austin, these factors are exacerbated by a hypercompetitive atmosphere born of the university’s automatic admissions threshold and an achievement-focused student culture. As more Texas students compete for spots at the university, the threshold has narrowed, from the top 10 percent in 1997 to the top 6 percent today. Surrounded by accomplished classmates vying for slots in graduate programs and good jobs that seem more scarce, UT students feel pressure to outperform their peers by taking on harder classes, more leadership positions, and more prestigious internships.   
Emily Roth, BS ’20, interned with NASA after high school and worked at a Department of Defense contractor her freshman year at UT—while taking more than 15 hours a semester and joining a club. She spent subsequent summers interning with Facebook and Google. Roth often spent 17 hours a day in the engineering building and drank protein shakes when she didn’t have time for a meal. Now a software engineer at Google, she wonders if it was worth it. “It felt like if you weren’t sacrificing your health, your entire social life, everything for engineering, you were never going to make it,” she says. “I still can’t figure out if there was ever truly a way to balance it all.”  
Located on the fifth floor of the Student Services Building, the Counseling and Mental Health Center is UT’s headquarters in the campaign for better mental health. The CMHC’s services include crisis counseling, individual therapy, psychiatric services, and group counseling focused on issues including stress and anxiety, depression management, trauma, grief, and loss. Associate Vice President for Student Affairs and CMHC Director Chris Brownson, BA ’92, MA ’97, PhD ’01, Life Member, who started at the CMHC in the early 2000s, says anxiety began to outpace depression as the most common presenting concern around 2008. By 2019-20, more than 80 percent of CMHC clients were dealing with anxiety.  
The raw number of students seeking help is increasing, too. The CMHC served 4,039 students in 2009-10 and 7,286 in 2018-19. The numbers dropped slightly the next year, during the pandemic, but for most of the last decade, the CMHC has been contacted by about 10 percent more students each year.  
“One of the hottest topics in our field is how to make the most of the resources you have to take care of the students that are coming in to see you, knowing that each year it’s increasing,” Brownson says. “In 10 years, we would predict, at this pre-pandemic growth rate, that we would have about half of the UT student body coming to us, and in 20 years it would be every single student. Now, we know that’s not going to happen, but when, in the next 20 years, will this growth rate start to level?”  
Most students want to meet with a therapist on campus for individual counseling, but because of the enormous demand, the CMHC must refer many to off-campus counselors. Those who connect with an on-campus counselor may wait two weeks for an opening. For students who’ve finally mustered the courage to seek counseling, the wait can be a tremendous letdown. Students interviewed for this article all said they or their peers had been disappointed by limited access to on-campus individual therapy. “There’s just a lack of resources, overall, for how humungous this university is,” Choi says. “Even as more people are open and honest about their mental health, they’ve been deterred from getting help because of the lack of resources.”  
The good news is that in 2020 the CMHC’s budget allowed it to hire 10 additional staff, including six counselors and four case managers. The latter position is critical to helping students who are referred to off-campus therapists. Mental health care is in high demand everywhere, not just at UT, and even in a large city like Austin, new patients can wait weeks or months to see a provider. CMHC’s case managers step in to help students find providers who have openings and take their insurance, and they follow up to make sure the counselor was a good match—and work with students to find another option, if necessary.  
Brownson and his colleagues also recognize that mental health can’t just be addressed on the fifth floor of the Student Services Building; it is a campuswide pursuit. In 2014, the CMHC decided to embed counselors in each college and school. The Counselors in Academic Residence (CARE) staff help students who are struggling academically for mental health reasons. A student might, for example, meet with an academic adviser or professor and share a school-related concern: My grade is so low that I’m thinking of dropping this class. It’s just been so hard this semester with my mom’s cancer diagnosis. I can’t focus or finish projects. Realizing the larger context for the student’s struggle, the adviser can suggest a quick check-in with the CARE counselor and walk the student down the hall to the counselor’s office. Because students aren’t necessarily seeking counseling when referred to CARE, they typically have their first counseling session earlier in their struggle than if they’d waited to make an appointment at the CMHC. CARE counselors become experts on the issues that are more common in particular schools; perfectionism and test anxiety might be prevalent in, say, pre-med students, while social work students might need to process stress from working with populations who have experienced trauma.   
If the staff on the fifth floor of the SSB is the equivalent of a major hospital, CARE counselors are small-town doctors. “We think about small-town doctors as people who are part of the community, people that you know and trust,” says Laura Dupuis, the CMHC assistant director for CARE and the CARE counselor for the College of Pharmacy. “They know us, they can come and talk to us, and we can help them get connected to other resources.”  
In 2017, with support from the Hogg Foundation, the university launched a program to help faculty embed wellness within their classes. Texas Well-being helps professors make small adjustments to their classes that promote good mental health. The program is led by Thea Woodruff, a lecturer in the College of Education, whose expertise is in teaching effectiveness. Professors invite Woodruff to observe their classes and suggest a few tweaks; as Woodruff explains, “The strategies that are good for supporting student mental health are just good teaching strategies.” Some faculty now begin class with a three-minute mindfulness meditation. Others pause during lectures and ask students to spend 10 minutes discussing a question with the person next to them or working on a problem in a group. Still others have restructured their courses to remove the pain points without reducing rigor.  
“The idea is to reduce the unnecessary stress and anxiety that I cause by making certain choices in the way the class proceeds,” says Brian Evans, a professor of electrical and computer engineering and a past chair of the faculty council. With Woodruff’s help, he successfully adapted his classes to support his students’ mental health. 
For many years, Evans taught 50-minute classes. On exam day, students always struggled to finish their tests. When his teaching schedule changed to semiweekly 75-minute classes, Evans decided to continue writing exams to fit a 50-minute class but give the students 75 minutes to complete them. Students were able to finish the exams, their grades went up, and their stress decreased. Evans also reorganized his classes to have only one major assignment due each week. He reordered the lessons in one sophomore engineering class where about 20 percent of students dropped the course or earned grades of D or below. Evans realized the hardest topic was taught too early in the semester, so he moved it later. Less than 7 percent of his students earned low grades or dropped the class.  
His efforts have made a difference for students like electrical and computer engineering alumna Roth, who calls him one of the best and most supportive professors she had at UT. “The classes he teaches are really difficult, but for some reason they’re still some of my favorites,” she says. “He really cares about students.”  

Students’ openness to sharing their mental health struggles makes them ideal partners—and leaders—in the university’s quest to support Longhorns’ well-being. NAMI on Campus formed in 2016 and hosts guest speakers from the mental health field, along with chances for students to share their personal story. Students who have completed facilitation training, including McDonald, Kretschmer, and Ulam, lead NAMI Connections support groups for their peers. 
In the 2018-19 school year, Student Government launched its Mental Health Agency, one of 18 areas of focus within the executive branch. The group has hosted events during Suicide Prevention Week and an open mic night designed to reduce stigma around mental health challenges.  
Because students are more likely to express mental health concerns first with friends, rather than college staff, UT trains students to share accurate information with their peers through programs housed in the Longhorn Wellness Center, the health promotion arm of both University Health Services and the CMHC. Mental Health Ambassadors are members of student organizations who volunteer to help build a culture that supports well-being within their group and facilitate conversations about mental health. The LWC also trains 30 students each year to become peer educators who lead workshops about stress management and resilience for student orgs, Greek chapters, and First-Year Interest Groups, further disseminating constructive messages about mental health.  
On a cold, rainy Saturday morning in February 2020, Ulam walked through the empty halls of an engineering building to the classroom where she would lead her first workshop. A Latinx engineering club had invited peer educators to present about building resilience and recovering from failure, and Ulam was nervous but excited. When the dozen students had arrived, Ulam and two fellow presenters introduced themselves, then drew the “resilience tree,” complete with roots and leaves, on the whiteboard. She asked the group to share examples of their past successes and wrote them in the canopy of the tree: I got into UT. I got an A on my test. I got the internship I wanted.   
Now for the roots. “What made those successes possible?” she asked. Hard work. Determination. Social support. The marker squeaked as she wrote the words as the roots. Then she turned to the group. “No one said ‘failure’ or ‘challenge,’” she pointed out. “But failure can be a valuable teacher. How can failure help us?” As the students offered their ideas, she labeled the trunk that connected the leaves and roots “resilience.”  
By the end of the workshop, Ulam’s nervous jitters were replaced with a newfound confidence and feelings of warmth toward her student audience. She couldn’t wait to lead more workshops.  
A month later, the pandemic lockdown began.   
When she left Austin in March 2020, Ulam felt like she’d finally hit her stride at UT. She was excelling in her classes, had made some good friends, and was involved in several clubs. The isolation of lockdown was an echo of the loneliness she’d felt as a freshman, when leaving her dorm room felt overwhelming and the threat of panic attacks was constant. “It felt like I had regressed all the way back to where I was at the beginning of college,” she says.  
As the pandemic dragged on, students struggled with flagging motivation and deep disappointment as study abroad programs and internships were canceled. The social unrest of summer 2020 gave way to election anxieties that fall and the Jan. 6 insurrection. Some students lost jobs. Others lost relatives to COVID.  
“There’s just a lot of uncertainty, and that creates huge amounts of stress and anxiety and depression,” says Woodruff, the leader of Texas Well-being. “This is basically trauma for a lot of people—and in some cases trauma upon trauma upon trauma, when you’re talking about a lot of social justice issues, and then the ice storm that knocked everybody’s power out.” 
Through the 2020-21 school year, Woodruff continued to present, virtually, to classes about self-care and the importance of sleep. Professors were quicker to encourage students to tend to their mental and physical health, she says. Some said they’d understand if a student needed to take a mental health day.  
As a peer educator, Ulam, too, led virtual workshops about stress management and resilience. As president of NAMI on Campus in the 2020-21 year, she was encouraged to see twice as many people attend virtual meetings as had come to pre-pandemic meetings in person. One night, Ulam shared her own mental health story at a chapter meeting, just as McDonald had done two years earlier.  
By fall 2021, students were back in the classroom (sometimes sitting 6 feet apart), and DKR-Texas Memorial Stadium roared back to life on gamedays. With the new school year, the university added more resources to support students’ mental health. During the pandemic, the CMHC, whose staff are licensed in Texas, had contracted with a virtual counseling provider that could connect students outside Texas with licensed mental health professionals. In the fall, the service opened to all students, who can use the free My Student Support Program app to chat or talk with a professional any time of day or night. The CMHC also hired a campus mindfulness coordinator to help students cultivate their ability to remain focused in the present moment and sit with difficult emotions. It hired a peer support coordinator to equip students with knowledge and skills to handle conversations with friends about mental health concerns.  
Additionally, the university launched Mental Health Conversations, an avatar-based software that helps students, faculty, and staff practice having difficult conversations about mental health and suicide. And because the UT Police Department often responds to mental-health crisis calls, UT is piloting the Mental Health Assistance and Response Team. Through MHART, a licensed mental health professional accompanies the officer to those calls and helps students in distress connect with the proper resources.   
No one program will reverse the negative trends of the past decade. Instead, the university is offering students as many options as possible, particularly as the pandemic has intensified awareness and concern for mental health. For Brownson, gratitude for that greater awareness is tempered by the knowledge that the road ahead is long.  
“I think we’re going to be dealing with a lot of grief from loss during this period, and the ramifications of increased loneliness, anxiety, and depression, and students will be grappling with their modified plans and goals because of this pandemic,” he says. “Sometimes it’s not until the crisis subsides that the symptoms that take the toll on you begin to emerge. I think we are going to be seeing a lot of fallout from this in the years to come.”   
Life isn’t back to normal, and for many people with mental health challenges, “normal” has been out of reach for a long time. As UT moves forward in a world forever altered by COVID, it will continue to support students with all the resources it can offer, including the one most elusive in a season of darkness: hope. 
THE ADDED STRESS OF BEING UNDERREPRESENTED   
For UT students from underrepresented backgrounds, college can be even more stressful. They have to work harder to find friends who have had similar life experiences, and they may be the only person from their identity group in the classroom. McDonald, who is Black, says that happened often at UT, where just over 5 percent of students are Black. “The struggle is feeling like, ‘Oh, here I go again, being the only Black person in the room, who’s kind of being this representative of my race,’” she says. 
Students from all backgrounds wrestle with impostor syndrome: a feeling of inadequacy compared to one’s peers, often manifesting in a sense they were admitted to UT by mistake. This feeling is even more complicated for underrepresented students. Engineering alumna Emily Roth says one reason she constantly overperformed during college was to prove classmates wrong when they implied that she’d gotten an opportunity because she was a woman or because she was Hispanic. 
These struggles add another layer of challenges. “Just trying to be a normal student, and then also having to face this sense of not belonging—that takes a toll and a lot of energy, and it’s very stressful,” says Stephanie Dodoo, associate director for diversity counseling and outreach services. 
Dodoo is one of seven diversity counseling and outreach specialists, clinicians in the CMHC who focus on the needs of students with nondominant identities. Each counselor is a liaison to a specific community, such as Latinx students or LGBTQA+ students, and offers individual counseling as well as identity-based support groups. 
The events of 2020 and beyond—anti-Asian violence; police killings of Black people, especially George Floyd; and racial justice protests and counterprotests—exacerbated students’ anxiety. Social media contributed, as reshared footage of distant events made them feel more immediate. Young people also used social media to speak out against racism, an act that Dodoo says encouraged some students, who felt supported by new allies, but left others feeling skeptical. 
“Black students last year and this year—and maybe the past five years, maybe the past 400 years—they are feeling really exhausted,” Dodoo says. “The conversations around racial justice are in some ways really good, but I think some of the Black students are feeling like, ‘We’ve been having these conversations in our circles and our families and our communities forever.’” Some students, she says, are wondering if some of it is just performative: “‘Let’s say the things that we need to say and then go back to life as usual.’ So, there’s also the sense of not knowing if folks are in it for the long haul.” 
CREDIT: Hokyoung Kim
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