Samuel Cotthoff has always tried to be as independent as possible. He filled out his college applications himself, and his scholarship forms, too.
But in October of his first year at Centre College, he was alone in his dorm room, struggling with what he later realized were undiagnosed body image issues he had never fully confronted. Cotthoff completed a screening on Centre’s counseling website, and he learned he likely had an eating disorder.
He called a friend who was a resident assistant and asked for the number for the crisis line for Centre’s counseling services.
“I needed someone else in that moment, and it probably should be a professional,” he said. “I was really scared because I was admitting to myself that I had a problem, and (it was) something I needed to talk with someone else about. It wasn’t something I could fix myself.”
Counselors helped Cotthoff calm down and make it through the moment. Then, the next morning, they sent him an email to follow up and schedule an appointment with a counselor.
Cotthoff was — and is — thankful for the help.
“Since it is a free resource for students, I think it’s pretty invaluable,” he said. “Especially, in my case, the crisis moments, but I know a lot of people who went for multiple years, built really close relationships with their therapists and felt they could really talk to someone about anything.”
Nationally, instances of depression, anxiety and suicidality have steadily increased among college students over the past decade. The percentage of students reporting depression and anxiety has doubled since 2013, according to the Healthy Minds Survey, which examines the mental health and well-being of college students across the country.
And though more students are seeking help, the number of students reporting mental health concerns continues to grow, said Sarah Lipson, an associate professor in the Department of Health Law Policy and Management at Boston University and a principal investigator of the Healthy Minds Network.
“Those increases have far outpaced things that we see in help-seeking. There are even greater unmet needs now than there were 10 years ago, and even more students are seeking help,” she said.
The good news, Lipson said, is that colleges and students alike better understand how to identify and treat mental health needs. And the stigma around seeking help continues to recede.
“Levels of stigma are low and going down, and levels of knowledge are quite high,” she said.
“So the majority of students say, ‘I know what resources are available, I have a sense of the signs and symptoms to look out for, I think treatment is effective, and I don’t think less of someone who’s received mental health treatment.’”
The same is true in Kentucky. The Herald-Leader contacted 16 colleges and universities across the state to discuss what resources are offered to students, and campus leaders largely agreed that needs were increasing.
But so, too, are the resources available. And those college administrators insist the job is not yet done.
“I think we still have this weird way of separating mental health from other aspects of our life, and so oftentimes students don’t make this connection between a negative experience — maybe I was discriminated against, or I had some trauma — and now I can’t concentrate in class,” said Tina Bryant, acting executive director at the University of Kentucky’s counseling center.
“Sometimes that’s what we’re doing in therapy, is helping connect the dots and helping people understand how all the aspects of their life are connected.
Integrating mindfulness and well-being at Centre
During the 2013-14 school year, 16% of students at Centre College used counseling services offered by the university, according to school data. A decade later, that number has jumped to 25%.
Ann Goodwin, associate dean for student well-being and director of Centre Counseling, attributed the increase, in part, to the availability of resources.
In 2015, Centre had three full-time counselors, including the director. Today, the counseling center has four full-time therapists, plus a director, with each counselor seeing 25 to 27 appointments per week.
A big push for student resources came in 2022, when Centre was awarded the Garrett Lee Smith Suicide Prevention Grant and a nationwide program through the JED Foundation to help schools improve their mental health support launched the Office of Health Promotion.
JED Campuses work with the JED foundation to take a comprehensive look at their mental health support for students and build on existing systems to meet a higher level of care for mental health, substance abuse and suicide prevention.
“(JED) is the national expert on suicide prevention on college campuses and they came in and worked with us to develop a plan with our college about how to do things better,” Goodwin said. “Always we’re trying to decrease barriers to accessing services.”
The department looks to take a student-centered approach to support holistic well-being on campus, focusing on alcohol and drug prevention, suicide prevention, sexual assault and interpersonal violence prevention and holistic well-being.
The goal is to ensure that Centre students make physical, emotional, social and spiritual health a priority during their time in school, including offering courses that focus on well-being.
“One of our goals is to integrate wellness across the campus everywhere,” Goodwin said.
In addition to offering classes like “Mindful Living,” Centre professors are encouraged to include well-being into their curriculum each semester, no matter the subject. Aaron Godlaski, associate professor of psychology and behavioral neuroscience, teaches the mindful living course.
“It’s a course on meditation (and) I also talk about nature and wellness,” he said.
“They do a little yoga here and there, they keep a daily journal of their practice. It focuses a lot on trying to get them to slow down a bit, focus more on their immediate experience, become more self-aware, more intentional in the way they approach their day-to-day lives instead of just rushing from class to class like they do.”
Godlaski said almost all his classes have some components that try to build motivation for health and well-being.
“In my health psychology course, students do a ‘behavior change plan,’” Godlaski said.
“They basically do a single, individual experiment on themselves where they try to incorporate some practice that’s going to promote their health and wellness. Some will start meditating every day, some will start a creative project, some will work their way through a self-help book.”
Kentucky State University tackling perceived stigmas
As the only historically Black public university in Kentucky, Director of Student Wellness and Experience Kelly Ruff said Kentucky State University’s approach to mental health services has to be focused and intentional for its students.
“There’s still a great deal of stigma as it relates to Black people getting behavioral healthcare,” Ruff said. “We’re hoping to move away from that. We see some movement away from that. This is a community having more conversations, creating more opportunities, but there is still a barrier when it comes to men, Black men in particular, seeking clinicians (and) seeing it as a weakness.”
With three full-time counselors in its department seeing around 80 students a month each, almost a third of Kentucky State’s student population sought mental health counseling through the university during the 2023-24 school year.
School leaders see that as a success attributable to the department’s plan.
Kentucky State’s most recent graduating class did not have a prom, a graduation or a senior week in high school. School officials say the increase in the number of students affected by the COVID-19 pandemic asking for help to work through the issues that came from that period of their lives.
“That traumatized every single student that came in that freshman class,” KSU Mental Health Counselor William Mynk said. “Their entire world was turned upside down. I’m a believer that COVID didn’t necessarily cause mental health issues, but it exposed a lot of things that were not at the surface.”
“Cultivating a culture of care” is a cornerstone of the counseling department’s philosophy, ensuring that students are familiar and comfortable with their staff, even if they never set foot in the door, Ruff said. Engaging with organizations allows for an expectation for at least one program each year to cover behavioral health, substance use and interpersonal violence.
“We’re present in our campus community, so they see us, that we’re visible, but also so they feel comfortable knowing who we are, coming to us when they’re in need,” Ruff said.
“I eat in the cafeteria to be visible. We don’t just hide in our offices. When there’s time and space, we move around campus, we engage our student organizations.”
Finding a fit at Northern Kentucky University
During the 2023-24 academic year, 3,087 of the nearly 16,000 total students at Northern Kentucky University received counseling services through the school’s counseling center, which is made up of 12 staff members available to meet with students for free through both scheduled in-person and telehealth meetings and crisis walk-in appointments.
Staff members at NKU’s counseling center include a full-time director, a full-time associate director, six full-time clinicians specializing in disciplines including clinical mental health counseling, clinical psychology and social work and four part-time interns who are graduate students in the NKU clinical mental health counseling and social work programs.
Amy Clark, director of counseling services at the university, said a diverse staff has been intentionally curated to make students more comfortable with receiving counseling. She said students and counselors are often matched based on similarities in demographics and personalities.
“We try to match the student with what’s going to be the best fit for them,” Clark said.
Students are first told about counseling services during new student orientation, in the classroom, with promotions through social media and campus televisions during months such as Domestic Violence Awareness Month and Men’s Mental Health Awareness Month.
Staffers also chat with students and give out informational items at tables around campus.
Clark said there is a wide array of reasons students seek services including anxiety, depression, the struggle with transitioning into college life, family and relationship issues and trauma. She said most students who seek counseling are “in crisis mode.”
“Students are dealing with pretty significant issues, most of the time, when they come in,” Clark said.
And Clark said there has been a steady increase in students seeking counseling services since COVID-19. She said she thinks that is due to a lessened stigma surrounding mental health that both NKU and general society have contributed to through an increase in information and awareness.
“I think we have done a good job doing the work to break down the stigma about mental health as well as offer an extension of how important mental health, wellness and taking care of yourself is,” Clark said.
Mental health challenges at Berea College
Berea College has a different element to consider when supporting its students: It is one of 10 federally recognized work colleges in the United States, and the only one that provides its students with a paycheck.
Each student works at least 10 hours per week at a campus job in one of the school’s 130 departments, and tuition is free.
This past school year, almost 40% of Berea’s first-year students were from counties that ranked among the top 25% for most economically distressed in the U.S.
During the 2023-24 school year, Berea College saw 420 students at its counseling center — around 28% of its student body — according to Jodi Whitaker, media relations manager for the school.
“We have a counseling services website in addition to going to new student orientations and a variety of first-year classes to talk about services that we offer,” Whitaker said via email. “Additionally, we train faculty and staff on how to refer students to our office given the sometimes delicate nature of complex mental health situations.”
The counseling center’s staff of seven includes four counselors, a case manager, a director and an administrative assistant, all of whom work full time. On average, Whitaker said each counselor sees 24 to 26 students each week.
Like other schools, Berea has seen an increase in the number of students seeking mental health services in recent years.
During the 2024 school year, the counseling center provided 2,181 sessions, 46 of which were crisis appointments. Sessions at Berea can range from individual sessions to couples, group and crisis counseling.
The two biggest issues seen in Berea students coming to the counseling center are depression and anxiety, said Brad Stepp, the school’s director of counseling. He joined Berea about a year ago after leaving a job at Indiana University.
“A lot of students are coming to not only our college campus but campuses across the country with mental health issues, longstanding mental health issues,” Stepp said.
In addition to major depressive disorder and generalized anxiety disorder, Stepp said, Berea sees a lot of students with trauma and PTSD.
Additionally, Stepp said, the jump from high school to college can be a key factor in college student’s struggles.
“Students who may have struggled with depression or anxiety in their background and maybe they become stable toward the end of their high school careers, anytime they experience a new transition, like moving across the state or across the country and starting college, being on their own for the first time, that can often trigger some mental health concerns,” Stepp said.
EKU uses counseling center to address trauma
Eastern Kentucky University, home to nearly 17,000 students, offers two primary programs — a counseling center and psychology clinic — to help students seeking mental health resources.
“We do a lot of individual counseling, which is probably what most people think of,” said Kevin Stanley, director of the counseling center. “We also do group counseling, and we have therapy groups where people are really processing their issues.”
EKU also offers support groups, and the counseling center has a relaxation room equipped with a massage chair for students.
The counseling center keeps track of the main concerns presented by students, including several subcategories for anxiety such as: generalized anxiety, social anxiety, panic attacks, specific phobias, test taking and unspecified anxiety, according to Stanley.
“Our top five (concerns) would be generalized anxiety, depression, stress, social anxiety and trauma,” Stanley said.
Some students, Stanley said, have dealt with an issue for a while. They “have kept it together until they can get out of mom and dad’s house, then come to us and say, ‘My family doesn’t believe in mental health but I’ve been struggling.’”
Over the past 10 years, EKU has seen a steady increase in the number of clients they see. In the 2012-2013 academic year, they saw 493 students; Last year, that number jumped to 741 students, with 79 seeking services over the summer, too.
In the 2022-2023 academic year, nearly 40% of EKU Counseling Center clients reported finances as a source of stress, and about 35% reported their finances had caused them stress in the past, Stanley said.
There will be 11 full-time counselors in the EKU counseling center starting in August, two of whom will be on an internship to complete their doctorate degree in psychology.
A staff of 11 counselors is the largest that EKU has had, and Stanley said he is hopeful that the large number of counselors aids in the workload of each counselor. There is no waiting list for appointments at EKU, meaning that every student who comes for services is matched with a counselor and is typically seen within two days.
There are three significant times during the fall semester when counselors find their caseloads increase: the beginning of the semester, midterms and finals. Stanley said the spring semester follows a similar pattern.
“Mental health has become something that is more okay to talk about. People will be open about having a therapist in a way that you never used to see,” Stanley said. “There’s more people hurting, and it’s less looked down upon to get help.”
Louisville faces unique challenges
For students attending the University of Louisville, unique challenges from 2020 still linger.
Along with the COVID-19 pandemic, which upended higher education as students knew it, the killing of 26-year-old Breonna Taylor by Louisville police officers and the resulting community fallout brought new challenges for students.
Geetanjali Gulati, the director of the Counseling Center, said Taylor’s death was felt throughout the city, and made an impact on UofL’s student body. Protests broke out in Louisville as the community railed against the police department’s handling of a warrant that led to her death and the investigation of her death.
“We had rioting downtown and protests and such, and students were involved,” Gulati said.
The counseling center offered telehealth appointments to create a “safe space” for students. Gulati said the center encouraged students to seek individual services, and added a Black male therapist to their staff who ran a group for men.
Last school year, 1,266 students received services from two different locations of the counseling center. The number of students requesting services has been on the rise in recent years with a gradual 1-2 percentage point increase per year.
Gulati said the severity of issues students have brought to the center has also increased, and most students struggle with anxiety stemming from a wide range of issues: financial instability, academics, relationships, family issues and depression.
“You would not believe how many students are actually taking care of their families as well. … They’re taking loans, they’re making stipends, but they’re also supporting families through their own education and any additional work that they do,” Gulati said.
“This generation, they’re not coming in fancy, free and footloose, they’re not. They’re coming in burdened, presenting burden to us on multiple levels.”
Following the pandemic, Gulati noted that most students’ social networks dwindled. While most students recovered, recouped and relearned, she said a significant subsection didn’t have the ability or means “to learn how to renegotiate that developmental state and overcome the deficiencies that they have to suffer.”
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