Fresno State students often wait weeks for mental health therapy. Advocates want change

The Fresno Bee |

--Advocates at Fresno State are asking for more resources to hire additional mental health counselors in order to reduce long wait times and high staff-to-student ratios that they say pose a danger to students in crisis.

The university has eight licensed counselors for its 24,000-strong student body, or one counselor for every 3,000 students. That's the second-highest ratio in the California State University system, and double the 1-to-1,500 ratio recommended by the International Association of Counseling Services.

The counseling staff at the university is supported by a team of interns who see patients under the supervision of a licensed counselor, as well as a case manager, groups, classes and a crisis service that can see students within one hour during business hours.

Still, the staffing ratios mean that students may wait 2-3 weeks for a non-emergency appointment during the busy times of the year, something Cecilia Ruesta, who's pursuing a masters in social work at the university, says she experienced firsthand as an undergraduate.

"When I was first seeking out services, I was in crisis. And to have to wait another three weeks to be seen was not good for me. It's not consistent," she said. "Seeing my own patients now, I know it's critical that students in need be taken care of as quickly as possible, and that those services be accessible."

More staff would also reduce the time in between repeat visits, which Ruesta said she believes is crucial to effective therapy.

"Therapy is a very slow process," she said. "If there is a two, three week wait, it's almost like starting over."

National, state and university trends

Not all 24,000 students on the Fresno State campus will seek out counseling, but each counselor does process one new patient every day, according to the university's director of counseling and psychological services, Malia Sherman. The Student Health and Counseling Center sees about 5,000-6,000 appointments every academic year, she said, with the longest wait times at the end of the semester.

Sherman said the university does a good job with the resources that it has, but that there is a need for additional mental health staffers on college campuses nationwide.

"We have a lot of opportunities for one-time money, but we can't hire people with one-time funding," Sherman said. "We can always find something for another counselor to do."

Instead, Sherman said she believes that the way forward is through innovative programs like text message-based crisis hotlines, as well as Fresno State's own Let's Talk program, which seeks to capture students who may not have experience with traditional therapy.

Licensed counselors staff the Let's Talk program, and students may be referred to further therapy in the clinic, but wait times and sessions are shorter: students can walk in and expect to be seen the same day for a 20- or 30-minute appointment.

Fresno State does not have a dedicated suicide hotline because there hasn't been much student demand for one, Sherman said. Instead, students experiencing a crisis during off-hours are encouraged to call the National Suicide Prevention Lifeline (800-273-8255), where, if they identify themselves as Fresno State students, they can be referred to university resources in addition to getting immediate help.

The university also has a partnership with the Community Behavioral Health Center, where students can go during off-hours. There is no cost to students at the center, and Fresno State's services are covered by a student health fee.

Ruesta said that expanding on-campus services would help students who are wary of outside services, particularly those who have had negative experiences with police or who fear the stigma of a psychiatric clinic.

Mental health and student experience

In a survey of student health conducted in 2018, over one-third of Fresno State students reported feeling too depressed to function, while over half felt overwhelming anxiety or sadness in the preceding 12 months.

Additionally, approximately 10 percent of students surveyed said they'd seriously considered suicide, while 5 percent reported they had intentionally harmed themselves.

Sherman said that her office has seen more students seek out counseling as a result of lessened stigma around mental health issues, a trend that's reflected across the country.

Academic and financial issues are at the forefront of all students' concerns according to the National College Health Assessment Survey, with career, relationships and other pressures following. At Fresno State, there is also a large population of first-generation students who may not have anyone to turn to for help, Sherman said.

"It's never been more expensive to attend college," Sherman said.

A recent push to improve four-year graduation rates may be having an effect, too: Diane Blair, incoming secretary of the California Faculty Association, says it foists extra stress on students, and creates a narrow definition of success that sacrifices true learning and student well-being.

"There are other ways in supporting student success that isn't just about moving them faster to their degrees," Blair said. "It's not that it isn't a good goal, but a lot of our students are not just going to school. They have jobs and families. They have a lot of stresses and pressures."

At a school with a large population of low-income students, the toll of balancing one or more jobs with classes can be a part of that pressure, Blair said.

Data from the California Faculty Association shows that Fresno State has one of the highest ratios of students to mental health counselors in the CSU system, second only to CSU Los Angeles. Just six campuses meet the IACS' recommended ratio, though the agency describes the number as "aspirational."

The San Joaquin Valley as a whole also faces a shortage of mental health professionals, as well as programs for training them.

Blair said the California Faculty Association is lobbying for $20 million in the state budget for the California State University system to hire additional counselors. The proposal is being made in conjunction with a piece of legislation, Senate Bill 660, which would bring counselor-to-student ratios down.

The ask is part of a larger effort to hire more full-time faculty, which Blair says is key to supporting students on campus.

"Part of our job is supporting students no matter what they have going on," Blair said.

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