Center for Collegiate Mental Health releases 2020 annual report

January 12, 2021

UNIVERSITY PARK, Pa. — This week, the Center for Collegiate Mental Health (CCMH) released its 2020 annual report, which summarizes the state of college student mental health from U.S. and international college counseling centers during the 2019-20 academic year. In addition, this year’s report describes a revised Clinical Load Index, which was introduced in the 2019 annual report to better measure and compare staff levels and related impacts across counseling centers nationally.

Housed at Penn State, the Center for Collegiate Mental Health is an international practice-research network of more than 600 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. De-identification prevents someone's personal identity from being revealed. 

One of the highlights of the 2020 report is the further development of the Clinical Load Index (CLI), a metric that describes the relationship between the demand for and supply of mental health services in college and university counseling centers.

The 2020 report expanded the CLI distribution to represent more colleges and universities and evaluated the differences in counseling center practices between centers at the low and high ends of the Clinical Load Distribution.

“The key takeaway from the new CLI distribution is that clinician caseloads matter,” said Ben Locke, senior director of Counseling and Psychological Services at Penn State and executive director of CCMH. “When clinicians have a smaller caseload, students have better access to treatment. The Clinical Load Index is a tool to help institutions determine how to staff their centers in order to meet their goals. It can fundamentally shift how colleges and universities understand and plan for mental health services by finding alignment between what students want, what parents want, and what the university is able to provide.”

Findings demonstrated that counseling centers with low CLI scores are more likely to be smaller institutions. Students at these institutions are more likely to receive more appointments that are scheduled closer together and experience more symptom reduction during treatment.

Centers on the high end of the distribution are much more likely to focus on rapid access or crisis services and, in general, centers in this zone are managing very high demand that consistently exceeds supply and are more likely to provide a range of services, other than counseling, for students. These centers often implement a variety of practices, such as requiring clinicians to offer a specific number of rapid access service hours per week, charging missed appointment fees, and holding workshops as an alternative to individual counseling.

The CLI was developed with support from the Association for University and College Counseling Center Directors and the International Accreditation of Counseling Services. It provides counseling centers with a standardized score that can be thought of as the standardized caseload for a center. The score, which essentially describes the relationship between the demand for and supply of mental health services in college and university counseling centers, can be used to inform decisions around the resourcing of mental health services. CCMH was recently awarded the Association for University and College Counseling Center Directors (AUCCCD) President’s Award for its work on the CLI.

This year’s report also captured ongoing mental health trends among college and university counseling centers. Anxiety and depression continued to be the most common concerns experienced by students during the 2018-19 academic year. Last year’s report indicated that the growth of these concerns had slowed, and that trend carried into the 2020 report. Anxiety again had a slight decrease as a top concern and depression demonstrated a slight increase over the last two years. 

Notably, trauma as a primary presenting concern increased each year during the past six years and had a significant increase from 2016-17 to 2018-19. The 2020 report shows only a slight increase from 2018-19 to 2019-20.

Below is a summary of the some of the key findings in the 2020 CCMH Annual Report:

  • Anxiety and depression continued to be the most common presenting concerns assessed by clinicians, but their rate of growth appears to be slowing
  • Depression showed a mild decrease as a “check all” and a “top concern,” whereas anxiety revealed a slight increase as a “top concern.” Trauma has increased annually over the last seven years as “check all” and a “top concern,” but it is still a less common concern.
  • The rate of students who report having prior counseling continued to increase. Approximately 60% of students seeking services at counseling centers are now reporting they have had prior mental health treatment.
  • The self-reported lifetime prevalence rates of “threat-to-self” characteristics (nonsuicidal self-injury, serious suicidal ideation, and suicide attempts) were relatively stable, unlike many prior years where this number continually increased.
  • Lifetime experience of traumatic events has continued to show mild increases for the past six to eight years.

The CCMH 2020 Annual Report describes 185,440 unique college students, nationally and internationally, seeking mental health treatment; 3,890 clinicians; and more than 1,395,685 appointments from the 2019-20 academic year. This is the 12th year the report has been produced. The full report can be found online at

Last Updated January 27, 2021