ITHACA, N.Y. – “You look at yourself and you look at everyone else who needs it and you say, ‘Okay, someone probably needs it more than me. I can probably go one more day or one more week,’ and eventually it just piles up.”
After noticing signs of isolation her freshman year, a friend recommended that Annie Uhle seek help at Ithaca College’s Center for Counseling and Psychological Services, or CAPS. Uhle, now a senior journalism major, refused and recounted not feeling deserving enough to use CAPS’ services. “There’s such an emphasis on save it for someone who needs it,” she said.
A year later, Uhle had an anxiety attack while in class and a public safety officer escorted her to Cayuga Medical Center. It wasn’t until then that she utilized counseling services, when CAPS arranged a mandatory post-hospitalization session.
The office canceled her appointment, and Uhle waited a week for the next opening.
The Service and the Stigma
Although collegiate health services have been in place since the 1860s, Princeton offered the first mental health service in 1910. Interest in counseling departments rose slowly until the passage of the G.I. Bill in 1944, where veterans had greater access to college education and therefore more counseling of a post-war economy.
As the country moved toward a more diverse college population in 1958, Congress passed the National Defense Education Act. The NDEA provided funds for and expanded guidance and counseling institutes. Nationwide, faculty realized that outside factors played a role in students’ academic performance.
As for the Ithaca College CAPS department, formal counseling services began in the late 1980s. A 24-hour infirmary allowed students to spend the night if needed, where the physician resided in apartment above the center. Lack of demand and difficulty staffing forced the infirmary to close. When Deborah Harper, director of the Office of Counseling and Wellness, joined the staff in 1993, there were four psychologists.
Today the department has expanded to include nine staff members, including psychologists and social workers. The Office of Counseling and Wellness comprises the Center for LGBT Education, Outreach and Services and the Center for Health Promotions as well as CAPS.
Ithaca College CAPS is one of 135 college counseling centers accredited by the International Association for Counseling Services, or IACS. CAPS receives no outside funding from IACS, as the department functions under student life and all matters go through the provost’s office.
Harper says that having the accreditation adds professionalism and an outside voice, both to which the administration responds favorably. Experienced IACS counseling center directors come on-site to review CAPS’ service and efficiency every 5-8 years, although Harper can request a review at any time. A fall 2015 review resulted in the addition of a second front desk staff member. A separate external review in July 2015 encouraged CAPS to use an initial phone intake.
The brief phone assessment, which is still used today, assesses how urgent a student’s situation is and why he or she is seeking help. Students answer preset questions during a 15-30 minute phoned timeslot, which Harper says allows students rapid access without a lot of paperwork.
“If a student has an eating or alcohol-related problem, we can get them to an appropriate therapist directly without having to transfer the case after an initial visit because we know ahead of time what the issues are,” said Phil Meilman, director or Cornell CAPS. Cornell has used the phone intake since 2003.
In contrast, freshman Sarah Horbacewicz noted feeling judged by the predetermined questions via phone interview. When reaching out to CAPS after a sexual assault, she said the questions were focused on her alcoholic intake, and that she would be better able to explain her situation in person.
The number of students seeking counseling and psychological services continues to increase with each year. In 2015-16, 862 students sought out some form of help from CAPS, according to Harper. That number surged to 1,129 students in the 2016-17 year, a 31 percent increase.*
*Number of students per year cut off at April 5
Why this change? Harper attributes it to greater awareness in the media, stressors of college life and new resources to diagnose. Changes in the social media climate have opened a discourse on the importance of mental health.
Chris Biehn, an IC student, has worked as a mental health advocate after doctors diagnosed him with type one bipolar disorder. In April, he hosted a city-wide event called Believe in Love, inspired by the Love Button Global Movement. People from around Ithaca gathered to do service and discuss social justice causes in efforts to destigmatize mental health.
“I think that with the political climate, there are so many divisive aspects of the nation going on right now. Especially on a really liberal campus like Ithaca, people are feeling the weight of this more than they have in the past,” Biehn stated.
Biehn also noted that with the stressors of college campus life comes a need for a call to action. Student activists and members of Active Minds promote the positive aspects of seeking help, as Biehn emphasized mental health’s impact on each member of the community. “People recognize that they have an issue and recognize that it will be beneficial for them to get help, and that’s a beautiful thing.”
Even with a surge in counseling usage, some students remain wary to publicly disclose their mental health challenges.
Dean*, a recent graduate, noted several times the stigma surrounding mental illness. Although Dean was a Speak Your Mind co-chair for Active Minds, he did not want his name being used.
*Pseudonym used for privacy purposes
“The stigma is so strong that even though I am so willing to speak to you and I was looking forward to it, that I don’t want my name out there,” Dean said. “And that says a lot.”
The Wait
“CAPS was always pushed at us at summer orientation and was raved about by all students and faculty,” noted Suzannah Van Gelder, a freshman culture and communications major who briefly used CAPS’ service. “They wanted to emphasize that it was available and accessible to students.”
And Harper attempts to make it as accessible as possible. Information about group sessions are hung around campus. At the start of each semester, CAPS sends professors a pre-written statement about how students can contact counseling services if needed. The statement urges students to seek help from CAPS rather than their professors. A majority of professors include it in their syllabi, along with statements on academic honesty and Student Disability Services.
However, time is a concern. Consider one student’s schedule:
• Class on Monday, Wednesday, Friday 8 a.m. to 1 p.m. and 3-5 p.m.,
• Class on Tuesdays and Thursdays 9:25 a.m. to noon and 1-4 p.m.
• Involvement in the Catholic Community, Project Sunshine, Hands of Praise.
• Working as a Teacher’s Assistant and Residential Life Office Assistant for a combined 10 hours per week.
The schedule of junior physical therapy major Nicole Kuzdzal did not include her mental health. She managed to squeeze the time in for a quick CAPS session on Tuesday mornings. “For me it made it difficult because I was running there in between two classes. Going in there I felt very stressed and leaving I felt very stressed,” Kuzdzal said.
CAPS, located on the lower level of the Hammond Health Center, operates Monday through Friday, 8:30 a.m. to 5 p.m. The center is solely open during business hours, making it difficult for students with busy schedules to find time for counseling.
Among expectations for CAPS was the ability to accommodate all those who require support. For Van Gelder, the stressors of college life are present at all times, and counselors should be available when needed.
“This is a major college. We pay so much money to be here,” said Uhle, when commenting on a lack of counseling resources.
Other students disagree. Biehn and Dean say that CAPS is not meant to offer long-term treatment and that students should seek local professional help.
There are 88 private practice mental health professionals in Tompkins County, according to a self-selected list from The Mental Health Association in Tompkins County. Harper notes that there is not a shortage of professionals in town, but the demand continues to rise as upwards of 30,000 college students compete with residents for availability.
Kuzdzal now sees a therapist off-campus, but for some students, it is not as easy. Whether it be privacy, transportation, or health insurance, a number of reasons exist as to why students are hesitant to venture past CAPS.
Compared to institutions of similar size, IC CAPS served 62 percent more students in the 2015-16 school year. Similarly, IC ranked above the national average for students having been diagnosed or treated with a variety of mental health concerns by the National College Health Assessment in Feb. 2015. The highest needs nationally are for anxiety and depression-related situations. Nearly 20 percent of IC students seeking services have been diagnosed with or treated for anxiety, compared to the 12.9 percent average.
IC’s disposition as a residential and rural campus plays a key role in greater diagnoses, Harper notes. Students are more likely to seek help within the school community, and the department cannot outsource as easily as urban campuses.
The counselor-to-student ratio at IC currently sits at 1 to 820, not including students served by non-licensed interns and post-doctorate workers. IACS suggests one therapist for every 1,000 to 1,500 students, while the average for medium sized college of 5,000-7,500 students is a 1-1,702 ratio.
Even though IC performs better than the national, many students have expressed concerns that CAPS does not possess the resources to match the growing needs. Students have recounted tales of waiting weeks to see a counselor or to switch counselors.
Rebecca Szlajen, freshman CMD major, says if she wants services more frequently than biweekly, CAPS requires her to go off-campus. Sometimes she went to the same-day crisis hours because it was the only time she could get an appointment, emergency or not. “It made me feel uncomfortable because I didn’t know if my situation called for the crisis hours. … Not every incident is a crisis, but it’s still nice to talk to someone,” Szlajen said.
Van Gelder noted at least six other people waiting with her at the beginning of coveted walk-in hours. Dean went to the same-day crisis service and waited two hours to see a counselor. Both Szlajen and Kuzdzal waited three weeks before being assigned a new counselor.
In spring 2017, students spent an average of 19 days on the waitlist, up from seven days last semester. Before the office performed outreach in mid-March, which includes an email followed by a phone call of potential openings, 66 individuals were actively waiting for services. Now, between four and five are voluntarily waiting.
The Money
When listing hypothetical questions for the staff, Uhle mentioned: “I would ask about funding and what students could do to help. Students care so much about CAPS.”
Since 2012, there has been an increase in health care practitioner salaries at 4-year private institutions. The Chronicle for Higher Education reports a $23,000 jump between 2012 and 2015, compared to a $16,000 jump nationally. Additionally, the average IC salary is $97,793, around $26,500 above the national average, the Chronicle details. An increase in salary may be effect of the growing demand for therapists at the college level.
Harper herself constructs a non-salary operating budget every October to be approved for the following year. Included in these costs are material goods, IACS accreditation fees, the software system and professional development. When Harper sees the need for a new position, she creates a proposal that then reaches senior administration. It is the rare year that Harper does not propose for more staff.
Competition for budget money exists across campus. “There’s a whole lot of positions on campus that either are standing vacant or there is a lot of demand in offices,” Harper stated. “There’s quite a process across the institution where they look at all the proposals and needs in the various offices and then they decide who gets the position and who doesn’t.” She listed other offices in need of more financial support, including Case Management Services and Student Accessibility Services.
Other departments also feel the effects of CAPS’ underfunding. The Department of Residential Life and Judicial Affairs works in conjunction with CAPS, as Resident Assistants commonly direct their residents to seek counseling. Jacob Morton-Black, a senior RA in Clarke Hall, stated, “We can refer them to CAPS and it’s recommended that they go to CAPS, but it could be weeks before they are seen.” And while RAs make themselves available to help their residents, Morton-Black says the overflow often falls onto the RAs.
The Ithaca College Budget Office and Department of Analytics and Institutional Research declined requests to release a line-item budget.
The Activists and the Counselors
“We love CAPS, we support CAPS, but they don’t have enough support from the administration,” said Molly Robbins, co-president of Active Minds.
Ithaca College’s Active Minds, a mental health awareness and stigma reduction organization, is one of 400+ national chapters. Although the student-run organization, with the help of adviser and CAPS counselor Sasha Lerner, is not a support group, often they will refer students to seek help at CAPS. The relationship is symbiotic. Counselors will recommend Active Minds to students who may be struggling to find a group of peers.
Not everyone clicks with his or her counselor right away, and for some, it may take two or three counselors before finding the right one. Of the nine students interviewed who have used CAPS, seven recall a time where the counselor-student dynamic was not helpful to the specific situation.
A weak connection with a counselor carries the potential of breaking student ties with CAPS. After a traumatic car accident, Van Gelder went in to CAPS hoping to learn of coping resources, but instead felt as though the counselor lacked constructive feedback. She has not returned since.
Robbins attributes this to contrasting therapeutic approaches, such as behavioral therapy and talk therapy, to name a few. Robbins laughed as she recalled being placed with an art therapist in high school. “At different points in my life I’ve needed different things, and I had to figure out what I needed in a therapist. It’s really important to communicate that.”
“There’s a lot of variety of counselors at CAPS, and I think they’re all really great for different people, but that doesn’t mean that they’ll work for everybody,” Robbins said. Each counselor in the department has his or her personal therapy style and mission, as listed in the clinical staff biographies on the CAPS webpage.
The National
At Wells College, creative writing professor Rebecca Myers often spends time before and after classes conversing with students. As a young teacher workshopping sensitive material, Myers must make it clear at the start of the term that she is not a trained counselor, but can refer her students to qualified professionals. Although Wells has taken steps this past year to prioritize mental health by arranging a support group for survivors of sexual assault and violence, that does not stop students from talking to Myers rather than a counselor.
The college across the hill, Cornell University, offers a CAPS program similar to that of Ithaca College. Cornell CAPS offers one-on-one and group counseling for students, serving approximately 20 percent of the student population each year, according to the Cornell Health Department website.
Unlike IC, Cornell CAPS provides a 24/7 crisis aversion telephone line, which allows students to call at any time for a mental or physical health concern. After the office has closed, the telephone line will connect the caller with an on-call health care provider.
Cornell also offers an Empathy, Assistance and Referral Service. EARS provides anonymous and free counseling services staffed by undergraduate and graduate students who undergo a three-semester comprehensive training. As an alternative to the CAPS department, EARS gives students an opportunity to discuss any issue with an unbiased peer. Students can call or drop in from 3-10:30 p.m. most days, whereas Cornell Health Center closes at 7 p.m.
While IC CAPS does not charge for its services, it is not the same for all colleges around the country. According to the Association for University and College Counseling Center Directors (AUCCCD), 7.9 percent of centers charge for the use of the counseling department. This includes Cornell, which requires a $10 co-pay upon each visit. An additional 7 percent charge after a determined number of visits, such as Indiana University. Their health center charges students $25 after two visits.
In order to meet demands, other colleges and universities limit the number of times students can access counseling. At Fordham University, students are given the option of 10 individual counseling sessions or unlimited group sessions.
However, other factors including school size and environment make it difficult to compare counseling services. For example, the influx of Cornell student suicides from 2000-2010 put the university on high mental health alert. Therapists held open-door hours at 10 locations, and custodians and professors were trained to look for signs of emotional distress.
In contrast, Christian schools see less students utilizing counseling services as a result of religious influence. Chris Stockwell, director of counseling services at Lancaster Bible College, stated in 2009 that 10 percent of the population sought counseling, a mere 2 percent increase in the past five years.
The Campaign
At SUNY Geneseo, a New York public college with a student population of 5,400, the counseling services department hired three new counselors this year, bringing them to eight total with four interns. That number is up from 2 counselors in Fall 2010, when Jared Wolf was a freshman.
SUNY Geneseo asked Wolf to transfer schools when the counseling department told him they did not possess the resources to accommodate his mental health needs. Many other institutions have told students to do the same, either take a leave of absence or be voluntarily withdrawn — Yale, Brown, George Washington University, Hunter College and Northwestern to name a few.
“When I transferred, I wanted to do what I could to prevent that experience from happening to other students,” Wolf said. In his first week as an Ithaca College student, Wolf joined Active Minds and eventually became co-president in 2013.
Wolf’s senior year saw the advent of a new challenge — acting as lead organizer for the Get CAPS Ready campaign. When the administration denied the CAPS’ faculty council budget request for a new counselor to meet the growing need, students took action. In March 2015, students collectively formed the Get CAPS Ready campaign in efforts to bring attention to the administration on the department’s lack of funding.
A group of marketing majors, including Wolf, took to social media in hopes of raising awareness and rallying community support. Students, faculty and alumni posted why they felt mental health needed to be prioritized at IC using the hashtag #getCAPSready. The Facebook page has 903 likes, and organizers sent a petition with 1,369 signatures to the Board of Trustees. Within a few weeks, the campaign’s organizers were collaborating directly with President Tom Rochon and CAPS, bringing the concerned voices from social media to the front lines of administrative power.
On April 8, President Tom Rochon and Provost for Vice President for Educational Affairs Linda Petrosino responded with a commentary article in The Ithacan, stating, “Adding staff members means increasing costs to students, so it should never be a measure of first resort.” Rochon and Petrosino noted the number of additional resources on campus in lieu of CAPS, including the Center for Health Promotion, Center for LGBT Education, Outreach and Service, Pathways, Assisting Students at Risk, the Mental Health Response Team and the Behavior Intervention Team.
That summer, external reviews and the Office of the Provost declared CAPS required more staff, specifically two positions. The college announced the introduction of more staff on Aug. 20, 2015. Harper received the funding for a temporary post-doctorate position that has since turned permanent, as well as for new social worker later in the year. Get CAPS Ready rejoiced.
The news of the Get CAPS Ready’s success spread, as other universities reached out to IC for tips of how to improve their counseling departments. IC Active Minds sent Ball State University in Indiana their petition layout so Ball State could replicate the campaign.
Ithaca College is among many institutions seeking additional resources to match the changing social climate surrounding mental health. According to AUCCCD, 42 percent of college counseling center directors reported gaining a new staff hire within the past year.
The Representation
“One of the biggest barriers to getting help for a lot of students is feeling like they aren’t represented by the counselors there,” said Wolf, who now works as the media manager for Crisis Text Line. He noted the flaw of the campaign- not demanding greater diversity within the staff.
Harper says that while the staff may not look visibly diverse, the counselors represent several sexual orientations, genders, faith practices and physical ability levels. Races represented include African American, Hispanic and Middle Eastern.
The initial phone intake matches students with appropriate counselors concerning areas of expertise. However, CAPS does not invite a preference when gathering student information. Harper knows that if there is a preference for a counselor of specific race, gender, sexuality or ability, a student will state it explicitly. “Sometimes it’s a good idea and sometimes it doesn’t pan out,” Deborah responded when asked if students could request a counselor. “If we have one African American female to choose from and it’s not a good fit, what is there to do?”
The most common requests the office receives are gender-related — a greater desire for female counselors — followed by requests for Jacque Tara Washington, CAPS’ only African American clinical staff member.
While Zahra Wardrick clicked well with her counselor of different race and gender, she noted not stating a preference because she was unaware CAPS offered an option. “It did not process that Ithaca College would have a person of color as a counselor, considering it is a PWI (Predominately White Institution) and most of the counselors are white.” According to Ithaca College’s fall 2016 diversity statistics, 20.3 percent of the student body identified as being of color, according to Ithaca College’s fall 2016 diversity statistics.
Sean Eversley Bradwell, Director of Programs and Outreach at IC, knows that Wardrick’s projections are not in isolation. After forming close working relationships with students as a mentor, Bradwell found that students of color, LGBT students, first-generation college students and working-class students were less likely to make the initial phone call to CAPS. Bradwell said, “They may not know there is someone at CAPS who shares their identity, but their assumption is that there is no one.”
Bradwell noted that CAPS has taken proactive steps in becoming more culturally inclusive, like a spring 2017 support group dedicated to students from the African Diaspora. Nationally, AUCCCD reports 96 college counseling centers have constructed greater outreach for students of color through various multicultural campus partnerships.
The Future
“It’s an interesting thing to get ready for the next person coming in because it’s an opportunity to rethink who you are and introduce yourself in that way,” said Harper. With the advent of Shirley Collado as the college’s next president effective in July, Harper and her staff are working on recreating their mission statement.
Harper and her staff understand Collado will be tackling a stretch of issues upon, and Harper believes Collado is the right person to take the college in the right direction for the future. The department is hopeful she will prioritize student services based on her background in psychology and campus life, but acknowledges she may not begin her IC career by immediately revamping CAPS programs.
As for connecting further with the campus, Harper finds it challenging to gage the needs of students, as well as their complaints. She has brought up the idea of a student advisory board to act as a liaison between CAPS and the community. And one student is making that a reality.
When Horbacewicz went to her first counseling appointment in fall 2016, she came upon a locked front door and never received follow-up as to why. “If it’s happening to me, something similar is happening to other people,” she said.
As Student Governance Council Class of 2020 Senator, Horbacewicz introduced the CAPS Initiative bill April 10. The bill passed unanimously, the first to do so all year. An Ad-Hoc Committee will bring student requests to the CAPS staff, in a joint effort to make CAPS more efficient.
The new plan in a massive for those looking to strengthen the relationship with CAPS while improving the program, according to students. Jordyn Steinheiser, SCG Senator for the school of Health Science and Human Performance, is excited to make CAPS more accessible. “What CAPS is meant to be is a great organization, but with the lack of funding and therapists, it is difficult for the students to get the amount of appointments they need or follow-up,” Steinheiser said.
Anticipated members of the committee include Harper, therapists, CAPS staff members and students. Before adjourning for spring semester, Horbacewicz met with the clinical management team, a subdivision of the CAPS department. They solidified goals for the committee next semester: meeting once a week to address outcomes of a survey Horbacewicz conducted in February; performing more outreach for freshmen who think their needs aren’t severe enough, much like Uhle; working to make clinical systems like the phone interview and paperwork more organized; and meeting with local therapists to strengthen the relationship between CAPS’ counselors and off-campus counselors.
Many students have reached out to Horbacewicz asking to be involved or suggesting ideas. Harper values the interest in the process, saying, “It’s really satisfying to see how many students, faculty and staff are in support of our services.”
Horbacewicz realizes she must address the small issues first before tackling funding, but is excited to start committee work next semester. “I know it’s such a big issue, but it’s important to not just look at is as a big issue. It’s important to try and take it one step at a time and to make change as you can.”