Annual collegiate mental health report examines trends and policy implications

January 16, 2019

UNIVERSITY PARK, Pa. — Mental health treatment in higher education is a complex practice that has been rapidly evolving in response to a growing demand for services. For example, between fall 2009 and spring 2015, student utilization of university and college counseling centers increased by an average of 30-40 percent (CCMH 2015 Annual Report). While treatment provided by counseling centers has been found to be effective in decreasing student distress (CCMH 2017 Annual Report), many years of escalating demand have led to treatment limits and prioritization of rapid-access services, which may be impacting the ability of centers to provide ongoing treatment (CCMH 2016 Annual Report).

The 2018 Center for Collegiate Mental Health (CCMH) Annual Report, found that college students seeking treatment (and the professionals who treat them) continue to identify anxiety and depression as the most common concerns for seeking treatment, among dozens of other concerns. For the first time in five years, anxiety did not increase in prevalence whereas depression increased slightly again. Most other areas of self-reported distress remain flat or are even decreasing. 

“As institutions confront the cumulative impact from years of rising demand for mental health services, it is critical to remember that we have spent more than 15 years actively working to prevent suicide, increase help-seeking, and train our communities by identifying and referring students at risk to treatment. As a result, institutions must be creative and wholistic in their response to a new level of demand that will not go away; but must not forget that we actively worked to create the very demand we are seeing, and our first job is to grow service capacity quickly in order to effectively support, and treat, students who are identified and referred,” said Ben Locke, senior director of Penn State Counseling and Psychological Services, and executive director of CCMH, on increased demand and importance of an array of services.

As with past years, the 2018 report found that self-reported lifetime prevalence rates of “threat-to-self” characteristics (self-injury, suicidal ideation, suicide attempts) increased for the eighth year in a row, highlighting the important service that counseling centers serve in supporting students at risk and our broader national success in identifying and referring students who need help. Students reporting life-time threat-to-self characteristics, when seeking treatment, use an average of 20 to 30 percent more services than students who do not (CCMH 2015), which further increases the strain on counseling centers as they seek to balance being responsive to new students in distress while also providing effective treatment for those who need it. 

The 2018 report specifically examined the impact of two high-level center policies on treatment outcomes for the purpose of informing higher education policy-makers: (1) how counseling center’s systems for handling new clients impact treatment outcomes, and (2) whether access to counseling center electronic medical records, by health care staff, impact treatment outcomes. Regarding systems for handling new clients, also known as “clinical models,” the report found that counseling centers that assign new clients to counselors with a dedicated appointment time demonstrated significantly greater symptom reduction, significantly more appointments per student, and significantly shorter wait times between appointments than counseling centers that require counselors to absorb new clients regardless of their existing caseload. In addition, the 2018 report found that policies governing access to electronic medical records, by health center staff, were not associated with significant differences in treatment outcomes, suggesting that treatment outcomes are determined by other aspects of counseling center operations.  

“In addition to eight-year trends and a national population-level perspective on college students seeking mental health care, the 2018 CCMH report provides specific and actionable findings that should be used by administrators to inform policy decisions related to mental health care in higher education. In particular, the take-home message from the last four reports is that counseling centers are doing everything they can to accommodate the growing demand for service, such as prioritizing rapid access to care. However, this report highlights the negative impact associated with enacting these adjustments to services, such as providing a decreased dosage of treatment, and consequently less effective services. While it is critically important that counseling centers are responsive to the growing number of students who are identified and referred, it is equally important for institutions to recognize the value of policies that support effective treatment of students in distress,” said Locke.

These are some of the findings in the 2018 CCMH Annual Report:

  • Anxiety and depression (as reported by students and their counselors) continue to be the most common presenting concerns for college students, as identified by counseling center staff. Anxiety did not increase in prevalence for the first time in four years, whereas depression continued to increase in 2017-18. 
  • Student’s average rates of self-reported anxiety and depression continue to increase while other areas of self-reported distress remain flat or decreasing.
  • The average rate of self-reported “threat-to-self ” characteristics increased for the eighth year in a row among students seeking treatment. Nearly 36 percent of students seeking treatment endorsed having experienced serious suicidal ideation in their lifetime but only 8.2 percent of students seeking treatment report serious suicidality in the last month. Clinicians identified suicidality as a current concern for just under 10 percent of students. 
  • The prevalence rate of students who have received prior mental health treatment continue to remain largely flat over eight years. However, the rate of students who have received prior counseling has trended up over the last three years, with 54.4 percent of students seeking treatment indicating they have been in counseling before. 

The 2018 Annual Report describes 179,964 unique college students seeking mental health treatment; 3,723 clinicians; and more than 1,384,712 appointments from the 2017-18 academic year. This is the 10th year the report has been produced.

The Center for Collegiate Mental Health at Penn State is an international practice-research network of nearly 550 colleges and universities focused on understanding and describing college student mental health. CCMH collects and analyses de-identified data on college students seeking mental health treatment at colleges and universities in the U.S. and internationally.

The full report can be found online at

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Last Updated September 23, 2020