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Shifting from the Mental Health Crisis Narrative

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Title: Shifting from the Mental Health Crisis Narrative
Language: English
Authors: Gary D. Glass
Source: Journal of College Student Mental Health. 2024 38(4):788-800.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 13
Publication Date: 2024
Document Type: Journal Articles
Reports - Descriptive
Education Level: Higher Education
Postsecondary Education
Descriptors: Mental Health, College Students, Higher Education, Guidance Centers, Access to Health Care, Health Needs, Student Needs, Mental Disorders
DOI: 10.1080/28367138.2024.2401958
ISSN: 8756-8225
1540-4730
Abstract: There is a great deal of attention, in professional communities and the lay public, to a college mental health crisis. This article will review the dominant narrative of this situation, identifying and challenging the common elements of the narrative. The author will locate this college mental health crisis narrative in historical context, introducing considerations that facilitate an alternative narrative, one located in broader systemic issues across Higher Education, in general.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1443452
Database: ERIC
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  Value: <anid>AN0180231313;[nm80]01oct.24;2024Oct15.04:47;v2.2.500</anid> <title id="AN0180231313-1">Shifting from the Mental Health Crisis Narrative </title> <p>There is a great deal of attention, in professional communities and the lay public, to a college mental health crisis. This article will review the dominant narrative of this situation, identifying and challenging the common elements of the narrative. The author will locate this college mental health crisis narrative in historical context, introducing considerations that facilitate an alternative narrative, one located in broader systemic issues across Higher Education, in general.</p> <p>Keywords: College mental health; counseling center; crisis narrative; higher education; mental health crisis</p> <hd id="AN0180231313-2">INTRODUCTION</hd> <p>Higher Education settings remain persistently entrenched in a well-documented "college mental health crisis" that continues to pose challenges for university administrators and, in particular, college counseling center professionals (Abrams, [<reflink idref="bib1" id="ref1">1</reflink>]; Brown, [<reflink idref="bib8" id="ref2">8</reflink>]; V. Schwartz & Kay, [<reflink idref="bib24" id="ref3">24</reflink>]). While this is understandable, given the very real impact on campus communities, the narrative includes an almost inevitably reactive stance to address the impact of widespread distress or impairment among students. In addition to the actual situation reflecting the state of students' mental health, there is a neglected and, arguably, more important issue warranting attention: the narrative of this "college mental health crisis," one that may be maintaining or exacerbating the problem at hand (Bantjes et al., [<reflink idref="bib5" id="ref4">5</reflink>]). In other words, the impact of the widespread and perpetual narrative that continues to reference a crisis in college mental health, delivered through headlines and book titles, as well as various sources of media and professional arenas, may be having an impact beyond the real and actual challenges facing the field of college mental health. Furthermore, the language carrying this narrative requires some scrutiny, including an acknowledgment of how little curiosity has been applied to the terms "mental health" and "crisis" (not to mention various other terms that maintain the crisis-reactivity permeating higher education, such as <emph>depression</emph>, <emph>anxiety</emph>, and <emph>trauma</emph>).</p> <p>A foundational aspect of the current relentless narrative is the persistent demand that more therapists are made available to meet the students' needs. Whether this involves hiring more staff at the campus counseling center or investing in 3rd party vendors that promise increased accessibility to providers, this mental health crisis narrative is, primarily, rooted in a problem of too-few resources for individual therapy. To the degree that we succeed in meeting this demand, we face the risk of exacerbating the problem because we continue to advance the assumptions feeding this spiral. Additionally, we are failing to actually address what this crisis is really about: a higher education system that is in crisis as its ideals are eclipsed by social and economic realities from which our students (and their mental conditions) emerge, leading to existential threats to particular colleges and to the construct of a college education, itself.</p> <hd id="AN0180231313-3">DECONSTRUCTING THE MENTAL HEALTH CRISIS NARRATIVE</hd> <p></p> <hd id="AN0180231313-4">Examining the Data</hd> <p>To be clear, there is no denial of the real distress and impairment students experience, in increasing numbers, with increasing intensity and with problematic consequences. There is data to validate this assertion that more students arrive at college with a history of receiving mental health treatment. From 2012 to 2020, the percentage of students seeking counseling on campus that had never received counseling services before dropped from 52.4% to 40.5% (CCMH, [<reflink idref="bib9" id="ref5">9</reflink>], [<reflink idref="bib10" id="ref6">10</reflink>]). CCMH trend data, whether at 8-year or 11-year spans, also show steady increase in depression, generalized and social anxiety (CCMH, [<reflink idref="bib10" id="ref7">10</reflink>], [<reflink idref="bib11" id="ref8">11</reflink>]). Additionally, counseling center directors across the country continue reporting increase in demands and severity (AUCCCD National Survey, [<reflink idref="bib4" id="ref9">4</reflink>]). The paraprofessional community also maintains awareness of these trends, with alarming statistics delivered in persuasive info-graphic layouts. Reports are published from entities such as the Active Minds ([<reflink idref="bib2" id="ref10">2</reflink>]), the Student Voice survey by Inside Higher Ed and College Pulse (Flaherty, [<reflink idref="bib16" id="ref11">16</reflink>]) the Healthy Minds Study annual survey, the National Alliance for Mental Illness (NAMI) and ACHA. Additionally, there is a growing number of surveys or reports centering companies providing mental health services (Donadel, [<reflink idref="bib13" id="ref12">13</reflink>]; Edelman, [<reflink idref="bib14" id="ref13">14</reflink>]). Not incidentally, many of these companies stand to profit on the intensity of this mental health crisis narrative which includes, at its core, the inability of campus resources to keep up with the demand for services that <emph>they</emph> can provide. Additionally, there is a widespread sharing of mental health anecdotes and confessionals in social media, not to mention the occasional high-profile lawsuit against another university that failed to meet the needs of students – or worse, neglected to.</p> <p>Regardless of the source of the narrative, there is a wide range in the quality of the data used to support the narrative. For example, there is a big gap between the data from the Center for Collegiate Mental Health (which is clinically derived, standardized, and developed by college mental health professionals) and data from the lay public. Among the more impactful lay public data sources are the numerous "mental health" surveys that are published in various platforms, employing a whimsical adherence to reliance and validity standards, along with the alarming infographics highlighting specific findings. The narrative has come to include some predictable elements: a reminder that the 2nd leading cause of death among college aged students is suicide (which functions to activate an alarm-level response). This is usually followed by various statistics whose quantitative elements (usually some high percentage of respondents) so effectively convey a need for alarm that they eclipse any curiosity about the actual information being presented. A common presentation includes some diagnostic implications of anxiety and/or depression in the same survey that asks about normal, expected, human experiences of "stressed" or "overwhelmed" or "worried" or "lonely" or "sad." The juxtaposition of these clinical and normal experiences all but requires an association (and amplification) of the clinical phenomena carrying the credibility of an assumed diagnosis. At the end of the day, there is this ignored dilemma that clinical constructs of depression and anxiety (which are, technically, diagnosed according to objective criteria) are also very much part of the everyday vernacular and represent subjective meaning. For example, the following data, presented among the "key findings" introduction from the Healthy Minds Survey (2021) launched by Active Minds, contains these elements – in this instance contextualized in the pandemic to illustrate how severe this crisis must be.</p> <p>High percentages of respondents have experienced stress or anxiety (87.03%), disappointment or sadness (78.06%), or felt lonely or isolated (77.47%) during the pandemic. For many respondents, stress (84.25%), anxiety (82.35%), sadness (73.23%), and depression (60.7%) have all increased since the beginning of the pandemic.</p> <p>(Active Minds, [<reflink idref="bib2" id="ref14">2</reflink>], p. 1)</p> <hd id="AN0180231313-5">The Semantics of the Crisis Narrative</hd> <p>The immediacy of descriptive statistics presented in a crisis context seems to keep the public from employing some reasonable, if not obvious, caution before accepting the alarms being sounded. For example, during a pandemic that involved a once-in-a-generation level of social distancing for the sake of public health, feeling lonely and isolated, stressed, sad, and disappointed would seem to reflect an expected normal response to an unusually difficult time. However, presented in this manner, along with the many other surveys, news reports and town halls about campus mental health, it is not difficult to see this only as a "mental health crisis" because there is little, if any, consideration of how mental health is being defined, much less understood. Additionally, the juxtaposition of normal emotional experiences (sad, lonely, disappointed) with more clinical language blurs the boundary between what this language actually refers to. This is particularly curious given that "depression" and "anxiety" are not actual diagnoses of specific conditions as much as they are diagnostic categories. The DSM classification system refers to a variety of Major Depressive Episodes, adjustment disorders with either depressed and/or anxious moods, or elements of perinatal, seasonal affective or psychotic conditions that include "depression" and "anxiety." Some of these are inherently temporary and some may be chronic, all of which can occur on a range of severity levels. Therefore, even if this college mental health crisis narrative relied completely on clinical frameworks, there is far more nuance in our clinical frameworks than are present in the current dominant narratives of "college mental health."</p> <p>Another predictable element in this crisis narrative, presumably associated with attempts at stigma-reduction, is the message to those struggling that they are not alone. While the kindness and, potentially, encouraging (sometimes life-saving) messaging is laudable, the pervasiveness of this should prompt some consideration (if not careful research) of whether cultural or environmental effects are operating (Wilson, [<reflink idref="bib26" id="ref15">26</reflink>]). Rather than enjoy the invitation to connect with others who are struggling or are caring enough to want to be a supportive friend or mentor, the collective conclusion being reached seems to be less of solidarity and more of epidemic: everyone has mental health problems, and they all need help that is not available (and the lack of available therapists increases the distress, representing another element of the crisis spiral).</p> <p>An inherent risk in confronting this crisis narrative is that critiquing the narrative and the elements that maintain it can be experienced as minimizing the very real experience of struggling students and overwhelmed professionals trying to help them. Therefore, it is imperative to distinguish between challenging a narrative that questions the validity of the data and interrogating a narrative that inhibits a more nuanced exploration of what the data is telling us. The aim of this discussion is not to question the data but, rather, prompt discussion on how crisis-based approaches to reporting the data tends to create alarm rather than an informative curiosity about how to address the real challenges facing Higher Education. Such a distinction will, likely, not only validate the data (not to mention the experience of the human beings reflected in the data), but it will also highlight the systemic nature of this, increasingly, self-perpetuating challenge. A concerning aspect of this machinery is that the basic <emph>not-enough-resources</emph> and <emph>increasing-severity-and-demand-of-struggling-students</emph> situation will continue to spiral as the number of professionals needed to serve these students decreases. Data is emerging that reflects the unprecedented attrition of counseling center staff, coupled with the 70% of centers reporting difficulty filling those positions or failing those searches (Gorman et al., [<reflink idref="bib17" id="ref16">17</reflink>]). The quantitative and qualitative data reflecting this trend, perhaps, lends the most credence to the validity of the data and the importance of approaching it with more complexity than crisis-response usually permits. Therefore, while it can be acknowledged that the data employed in the crisis narrative is reported from a range of empirical standards (and a range of motives), it still remains useful, if not necessary. However, a shift from the crisis-tone can more effectively make use of the data, given that it does provide material for conceptualization of the "collective presenting problem," reported on the landscape of college mental health. Such a shift is not unlike the conceptualization of the clinical data that emerges in therapy sessions, including those of students in acute crises for whom the alarming intensity of what they present does not always align with the severity of distress that the crisis-tone might suggest or capture the nuances needed to intervene effectively. Such a conceptualization employs the skills and wisdom of counseling center clinicians and administrators with expertise in the unique context of colleges and universities, leading to thoughtful and caring interventions.</p> <hd id="AN0180231313-6">Historical Context of the Narrative</hd> <p>Significant improvement in college students' mental health may depend on how much longer this narrative is allowed to continue unchallenged. To some extent, the definition of a crisis would seem to suggest a temporary and situational phenomenon, a disruption of equilibrium. However, this narrative crisis is far from recent. A. J. Schwartz ([<reflink idref="bib23" id="ref17">23</reflink>]) noted, nearly 20 years ago, that the alarms regarding students being in greater mental distress, endorsed by an alarming "more than 80% of directors from many hundreds of counseling centers endorsing this view" (A. J. Schwartz, [<reflink idref="bib23" id="ref18">23</reflink>], p. 327) had been sounding since the late 1990s. Yet, his meta-analysis indicated that the narrative that students became more acutely distressed from the early 1990's to the early 2000s was not supported by the data. Further, he cited earlier equivalent research questioning a widely reported increase in student distress "that extends the period of stability in student pathology from the mid-1980s through the early 2000s" (Pledge et al., [<reflink idref="bib21" id="ref19">21</reflink>], Cornish et al, 2000 as cited in A. J. Schwartz, [<reflink idref="bib23" id="ref20">23</reflink>], p. 335). Similarly, Erickson Cornish et al. ([<reflink idref="bib15" id="ref21">15</reflink>]) found that students' perceived distress in the 1990's did not align with the sense of urgency reported in the literature documenting the perception of counseling center professionals about increased student distress and impairment. Sharkin ([<reflink idref="bib25" id="ref22">25</reflink>]) also reported little direct evidence that aligned with observed trends of increased psychopathology perceived among counseling center practitioners. Given that the longitudinal span during which this narrative has been operating is not acknowledged in the current version of this crisis narrative, it is reasonable to consider whether this long-standing narrative may reflect a self-perpetuating problem.</p> <p>Because perceptions can and do impact experience, it is insufficient to simply critique the narrative in a manner that invalidates the very real challenges facing college counseling centers and their colleagues throughout higher education settings. Regardless of how quantitative analyses fail to confirm the broad impact of this crisis, students are struggling as the demand for services shows. Furthermore, burnout, turnover, and difficulty hiring are real manifestations of the current reality (including this narrative) that informs the landscape of higher education (Gorman et al., [<reflink idref="bib17" id="ref23">17</reflink>]; Mitchell, [<reflink idref="bib18" id="ref24">18</reflink>]). These more recent personnel impacts related to staff availability provide a vivid illustration that the challenge is real, quite likely a systemic challenge, warranting a systemic analysis that is not introduced in the current crisis narrative.</p> <p>To be sure, there have been systemic efforts at ensuring an understanding that socio-ecological models are needed, including approaches that clarify that the college counseling center, alone, cannot be responsible for addressing the mental health needs of students (Biglan et al., [<reflink idref="bib7" id="ref25">7</reflink>]; Reupert, [<reflink idref="bib22" id="ref26">22</reflink>]). The philosophy of the JED Foundation that is establishing JED Campuses across the country to promote mental health is an encouraging example of this. However, the future of college mental health calls for building on such efforts to include systemic elements beyond the construct of "mental health." To address this, the future of college mental health will depend on two primary revisions to the dominant narrative: <emph>increase the nuance</emph> in our discussions about college mental health (including the terminology employed in those discussions) and <emph>relocate the narrative</emph> in a context that allows us to address the neglected and broader arenas of this crisis.</p> <hd id="AN0180231313-7">Increasing the Nuance of the Mental Health Narrative</hd> <p>The current narrative has come to rely so heavily on the more convenient vernacular use of the terms "depression" and "anxiety," which top lists of mental health concerns, year after year. However, there is little discourse about how many students are included in that narrative that <emph>do not actually meet diagnostic criteria</emph> for the various depressive and anxiety disorders so widely reported. When students, in large numbers, arrive for an intake informed by the vernacular understanding of depression and anxiety, their use of these terms is then included in the clinical documentation by clinicians who, with the validity of a provider, add to the number of "students with anxiety or depression." It is worth examining how, rather than simply being the most prevalent problems, the "top two concerns" of depression and anxiety function as containers for a variety of experiences. However, because of the clinical validity they carry, they function to validate urgent calls for clinical intervention via resources that are inadequate—-thereby extending the college mental health crisis narrative. In this way, we continue in a systemic reality that characterizes too many things as "mental health" issues, overwhelming resources and leaving insufficient remedy for those who do have mental illness or suffer from a condition that warrants the expertise and experience of clinical intervention.</p> <p>While it is beyond the scope of this article to provide more elaborate or detailed suggestions on how to remedy the linguistic elements of this challenge, more actionable ways to define the psychological experiences of students are warranted. Practices and standards that aim, specifically, to ignite conversation and discourse on these clinical constructs would be a helpful starting place. Ideally these could be developed in ways that apply to clinical services and can also be translated into outreach and consultations offered by the counseling centers and, gradually, permeate through campus communities. As a starting place, simply launching conversations about what "mental health" refers to and how it is defined can be productive. Conventional practice has emphasized advocating for mental health resources or reducing stigma related to seeking services or experiencing mental illness. The current state calls for <emph>a broadening of psychoeducation to include attention to the semantics of these issues</emph>. One form this might take is programming to student leaders and campus partners that launches discussion on how nomenclature regarding mental illness has evolved. This discussion is happening, already, in academic and professional arenas, to some extent. Neimeyer ([<reflink idref="bib19" id="ref27">19</reflink>]) observes a major epistemological shift in the DSM-5 toward "biological reductionism" and the "primacy of neuroscience." The process by which this has taken place, juxtaposed by the unprecedented exposure to resources from the pharmaceutical industry is worthy of inquiry, not simply in academia but in the arenas of university life where clinicians of various disciplines have avenues of input. Such discourse need not promote a particular agenda or perspective, beyond naming that a deeper exploration of how "mental health" and "mental illness" are understood may yield creative approaches to addressing the suffering or distress these terms refer to. At the very least, reflection and dialogue can be introduced and facilitated to help students recognize and acknowledge that their mental wellbeing is not independent of forces and trends beyond their individual psyches. Similar to how cognitive interventions in individual therapy routinely emphasize that how something is construed can have an impact on lived experience, campuses can be empowered to reflect on how the manner in which their mental health is narrated can impact the mental health of the community. Additionally, introducing clinical and outreach interventions that provide more nuance to the diagnostic criteria for depression or anxiety can play a role in prompting a re-assessment of these clinical concepts. For example, juxtaposing the lists of symptoms for major depressive episode with a descriptive typology that lists various contexts in which these symptoms emerge, can prompt discussion in RA training, student mental health advocacy groups, and presentations to faculty and staff on referral toward potential (hopeful) gradual culture-shifting about the experience and needs of those with these struggles are about. The aim of such efforts would be to prompt curiosity about how much of the mental health challenges emerge from broader contexts on college campuses by examining them contextually. Among the contexts in which the symptoms do emerge, associated with depression, anxiety, or other clinical terms, it is almost inevitable that the <emph>stressful academic experience</emph> and <emph>the costly college endeavor</emph> will emerge. This could, potentially, advance dialogs on the revisions needed in the higher education landscape, well beyond mental health arenas.</p> <hd id="AN0180231313-8">Relocating the Narrative</hd> <p>Greater curiosity and responsible inquiry are needed about what is <emph>not</emph> being addressed while we remain in the crisis-response mode of the status quo. A closer look at the top concerns of the annual report of the Center for Collegiate Mental Health reveals that, just below the emphatically higher prevalence of Depression and Anxiety on the list, is <emph>Academic Performance</emph>. Given the actual location of "college mental health," there is a profound irony that Academic Performance is not explored with more nuance in our discourse of this crisis. Those who explore the salience of academic performance <emph>in therapy sessions</emph> routinely see how it links to the way students experience disappointing grades, undermined or surrendered career aspirations, fears about future financial security, and panic about failing to achieve the wealth and status that higher education tends to promise in its marketing practices. Yet, while "mental health" is referenced countless times in this current crisis narrative, including in refereed journals focusing on college mental health, the words <emph>academic</emph>, <emph>learning</emph>, education or even <emph>grades</emph> occur so seldom that it is reasonable to consider them as functionally absent. Is it worth considering that the urgency associated with clinicals connotation of "depression" and "anxiety" center the mental health narrative and function to eclipse a broader Higher Education crisis? And, what if the mental health crisis is merely the symptom of a what is seldom discussed in this problem: an utter misalignment between the motivations, efforts and investments of <emph>students</emph> pursuing a college degree and the structures and practices of the <emph>institutions</emph> they eventually attend?</p> <p>As promising as it is that senior administration, including more college Presidents, are identifying "mental health" on their campuses as a high priority (Chessman & Taylor, [<reflink idref="bib12" id="ref28">12</reflink>]), simply prioritizing mental health in the context of the current crisis narrative risks amplifying the problematic dimensions of this narrative. The future of college mental health may require articulating the actual issue as a higher education crisis, exposing parallels between the mental state of students and the mental state of higher education. Regardless of the efforts of the campus counseling services, getting out of this crisis may rely more on senior higher education leadership to address the complex challenges they face. In some ways, this involves the moral courage to explore and address how the strategies of operating in the current competitive market of higher education are guided by many of the same toxic expectations and pressures to achieve poorly-defined success that our students are facing – doing so in increasing distress and impairment at crisis levels. The current enterprise of higher education is dependent on well-marketed (but poorly articulated) notions of excellence, promised preparation for vaguely-defined success, and narratives of an enriching college experience that provides access (and promises) to structures of security, if not empowering wealth. Much of this, however, is grounded in a mentality of superiority that requires a comparison point representing inferiority. This generates a pervasive fear of inferiority and a need to create a narrative of being "the best" and "outstanding" and "excellent" that is reflected in the widespread student distress in the college admissions process, the undergraduate experience, and the graduate and professional schools that make up the landscape of the so-called college mental health crisis. While the narrative of this crisis may be decades old, it is not as old as the theoretical framework that associates striving for superiority with psychological distress (Adler, [<reflink idref="bib3" id="ref29">3</reflink>]).</p> <p>Students (and families) begin a long (and increasingly intimidating) task-list, years before even applying to college as they execute a presumed contract that promises that completion of increasingly demanding tasks (excellent grades, AP credits, and impressive co-curricular activities) will lead to success via to college, often articulated as "a top" college. The spiraling cost of a college education makes this an overwhelmingly transactional endeavor-one which impacts stress about financial stability for the institution and stress about crippling loan debt for the students. Consequently, the mentality of students becomes a rigidly linear, fear-driven approach to college that expects success if they complete the task-list. Meanwhile, faculty and Deans engage in efforts to provide learning through ideals of reflection, discovery, experiential learning, and maintaining as much academic integrity as possible through some measure of feedback via grading. Consequently, however, when a student's unwavering belief that they must achieve a particular grade to include on an eventual transcript to submit to a graduate school or job application collides with professors' or Deans' aims to teach a subject matter and provide what thoughtful pedagogy can offer, the collision is likely to emerge as a mental health issue. Genuine attempts at safeguarding the future of college mental health and the future of higher education will need to involve confronting the inevitable and intense dissonance resulting from institutions selling an outcome of promised success when they are actually delivering a process, inherent in a curriculum.</p> <p>A common symptom of student mental health struggles, particularly in more rigorous and competitive settings, is the persistent and disruptive compulsion among students to compare themselves to each other in presumed competition. It is unlikely coincidence that higher education senior administrators closely monitor what their "peer institutions" are doing, with brochures, website, and highway billboards that manage to find a way to demonstrate some quantitative element of superiority over other institutions. The persistence of this circular dynamic requires interruption, one that involves leaders in Higher Education articulating a paradigm shift toward restoration of the ideals of higher education with benefits that include a responsibility to society, a commitment to collaboration as a cultural value, and pragmatic advantages to qualitative personal development over an over-reliance on quantitative outcomes like GPA, rankings, and lists of the top 5% of the graduating class—-measures that seldom, if ever, have much construct validity.</p> <p>Another dimension of this problematic misalignment between the pursuits of Higher Education and the students who attend them is the seldom challenged scarcity mentality that helps to maintain the hyper-competitive superiority mind-set. Increasingly, college admissions departments boast about the number of applications they have received and, increasingly, the number of students admitted under Early Decision or Early Action agreements. The point of pride, via published yield rates, is that so many students have such strong preference for the college that they are able commit at Early Decision I or Early Decision 2 deadlines. Meanwhile, counseling center therapists helping students likely hear a different story. College mental health would benefit greatly from research investigating how much of the pervasive imposter syndromes, lack of belonging and loneliness, and drop-out rates represent some aspect of the admissions process. For example, how much of the decision-making processes in Early Decision are made out of fear? Whether or not getting into a higher-ranked or preferred school or painful decision-making about certain generous financial aid packages that may not be available during the regular admission process, the intersections of admissions experiences and presenting concerns students bring to counseling centers may prove to be an informative area of inquiry in efforts to address the challenges associated with college student wellbeing. Such a shift in the narrative can also lead to potentially encouraging approaches, involving correcting distortions that lead students to engage in their college experience in a state of perpetual self-doubt or decreased self-worth. Another point of inquiry can focus on the psychological impact on students who feel the pain of rejection from colleges they apply to. The pain of that rejection is often not informed by a full appreciation of why admission decisions are competitive; it is not due, merely, to the quality of students applying but by the sheer number of students applying. Nietzel ([<reflink idref="bib20" id="ref30">20</reflink>]) reported that, in 2023 there was a 30% increase in applications to schools using the Common App process. Bierer ([<reflink idref="bib6" id="ref31">6</reflink>]) paints the crisis even more vividly by pointing out that "in 1975, only 3.2% of students applied to seven or more colleges. However, in 2006, that number rose to 17.4%." All of this creates, at the beginning of the college experience, a foundation of fear based on widespread perceptions about the world of Higher Education. Unfortunately, perhaps much like the distortions inherent in the mental health crisis narrative, the competitive higher education narrative omits that, according to Bierer ([<reflink idref="bib6" id="ref32">6</reflink>]), more than 70% of students receive multiple college offers, including their 1st choice.</p> <hd id="AN0180231313-9">CONCLUSION</hd> <p>Most evidenced based clinical practices involve some dimension of helping clients recognize and replace distortions in perception toward behaviors that are less compulsive and disruptive and more rooted in values. Many of these involve some aspect of helping clients recognize how much their distress or impairment is rooted in fear, resulting in loneliness, and perpetuating weariness in the face of relentless demands to push forward. The nuances of both the skill and art of therapy are difficult to see and inefficient to celebrate in the face of a crisis, especially those with alarms blaring that lives are at stake. Similarly, the challenges of higher education are more difficult to promote in terms of the curiosity, learning and growth that makes a college education so valuable when the economic landscape includes many institutions facing existential threats. With this in mind, it is important to maintain compassion for those remaining in crisis mode – not to maintain the crisis-narrative but to illuminate how much we have to gain by trusting our ideals enough to shift the conversation to something more conducive to effective (and therapeutic) interventions. Doing so will, necessarily, involve a strategic shift away from the college counseling center being defined, simply, as a mental health clinic on campus. The college counseling center can and should play a role in providing clinical services. Perhaps more importantly, however, it must be recognized as providing expertise to the campus community, informed by more strategically collected data. However, this requires clinical wisdom and systemic thinking to identify data points that are unique to the college and university setting, to inform clinical service delivery for individual students while also informing various constituents and stakeholders invested in the future of higher education about how the machinery of higher education is impacting the students' mental health and the institution's value to the public. The future of college mental health, therefore, must be envisioned in the broader future of higher education, and the college counseling centers will have much more to offer as they focus, not only on their expertise as clinicians but also in their nuanced perspective as Educators.</p> <hd id="AN0180231313-10">DISCLOSURE STATEMENT</hd> <p>No potential conflict of interest was reported by the author(s).</p> <ref id="AN0180231313-11"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Abrams, Z. (2022). 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  Data: There is a great deal of attention, in professional communities and the lay public, to a college mental health crisis. This article will review the dominant narrative of this situation, identifying and challenging the common elements of the narrative. The author will locate this college mental health crisis narrative in historical context, introducing considerations that facilitate an alternative narrative, one located in broader systemic issues across Higher Education, in general.
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