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As the number of students seeking help from BYUH’s Counseling Services rises, expert Steve Smith says building a strong community can help overall mental health issues

Two arms, both with black long-sleeved shirts on, reaching out to each other. Behind the hands is a blue sky and there are green trees in the right corner.
BYUH Counseling Services described what they do to accommodate students.


Sierra Allred, a junior from Oregon majoring in peacebuilding, said she was going through a difficult period in her mental health in September of 2021, and she felt the need to turn to BYU–Hawaii’s Counseling Services for help.

She said when she went into the counseling center, an employee handed her a form to fill out that would determine her levels of needs. “Everyone is worthy and deserving of the resources it takes and the time it takes to heal their heart and help resolve their mental health issues,” said Allred.

Sister Carol Skinner, a counselor at BYUH Counseling Services, who worked as a licensed psychologist for 20 years before serving her mission here, said she helped develop this new system for the counseling center intake form to ensure the students with the most urgent care are prioritized.

She said the first layer is anyone in an emergency, who will be seen within 24 hours. She said an emergency is defined as “current suicidality with intent.” The next layer is for students with urgent needs and is defined as people who have had a past history of suicidality but nothing current, Skinner explained. They are seen within seven days. The third layer is general problems, and she said, the fourth layer is a peer mentor to help with generic issues if the students are willing to see them.

Allred said when she went into the counseling center, she was not in crisis, so they could not get her an appointment for two months. “I have experienced depression in the past, and when you’re in that space and you feel like you can’t get help, it’s a very hopeless feeling.” She said although in her situation she found ways to cope without the counselors, “it was definitely discouraging because if you want to talk to someone, you should have that.”

She said if she were contemplating suicide or dealing with depression and still had to wait one to two months, “It would be scary.”

Skinner explained, “It is important for the students to understand that if they are in crisis, we will see them. ... We will make space for all the students.” She encouraged students to just walk into the counseling center if they are in crisis because they will make sure they get you in.

An increasing demand


In mid-November 2021, Counseling and Disability Services at BYUH had an evaluation, in which they brought an outside reviewer named Steve Smith. Smith was part of the BYU in Provo counseling center for 30 years as a training director in the counseling psychology department and served in administration for the counseling center and as director of the counseling center.

When asked if the wait time Allred had experienced was common among other universities, Smith said it was not uncommon to have a waiting period of six weeks. He said the wait time to get in the counseling center at BYU in Provo for those who with non-crisis cases is five and a half to six weeks as well.“

The demand has risen everywhere in the country. ...Without enrollment increasing, the number of students asking for help is going up. And that is happening in every counseling center I know of in the country.”

He said this trend is not new to post COVID-19 university life. In the first year of his directing the counseling center at BYU in 2011, Smith said, the counseling center served about 3,500 individuals in a calendar year, and in his last year as director in 2021, he said they helped 6,000 in a calendar year.

At BYUH, the numbers have also increased between 2020 and 2021 according to Skinner. She said Dr. Eric Orr, an assistant professor in the Faculty of Sciences and a member of BYUH’s Counseling Services, told her they had 10 hospitalizations in the Fall 2021 Semester. Normally they only have one or two hospitalizations in an entire academic year, Orr said.

Skinner said the intake form system they created is working to combat these increasing numbers, even with their lack of counselors available for the students. “The four-tier system really helps us identify people with the greatest need, and so far, fingers crossed, it’s working. I still fear that we could miss somebody. I pray every day, let there be space for people who need it. Our students are really, really suffering.”

Smith said no one really knows why the numbers have increased, but he believes it is partly due to the decrease of stigma for those who seek counseling. Gen Z especially, “are more willing to seek help,” said Smith. Allred said although many of this new generation of students are willing to seek help, the shortage of space available for students has opened the door for guilt. She said when she did go in after two months of making the appointment, she felt guilty because, “I know there’s a lot of other students who need help a lot more than I do.”

She said her friends have also expressed this concern where they make an appointment when they feel they need it, but when they finally get in, they feel guilty because they have worked through what they were struggling with, Allred shared. “I don’t think [a student] will seek out help if they feel like their situation is not as bad as someone else’s,” explained Allred.

Emotional drain


Smith, along with Student Life Vice President Jonathan Kau, acknowledge BYUH’s Counseling Services employees hard work to help as many people as they are able. Allred expressed her gratitude for how mental health services have helped her in the past. She said she didn’t have access to mental health services when she was struggling in high school, but she was able to receive help during her mission.

She said the changes she saw after getting help were “like night and day. Because if you feel like you don’t have a place to turn or people to listen, and it feels like no one cares and you are very alone and very hopeless. ... After you get the help and the resources that you need, ... it’s like a weight has been lifted.”

Due to the lack of counselors, Skinner said, her job can be very draining and she often works longer than she is supposed to because she wants to reach as many students as possible. “The emotional drain affects me physically.”

She said not only would more counselors allow more students to be helped, but also it would increase the quality of the help students receive because the counselors would not be as mentally, physically and emotionally stretched.

She said there is a gear shift that has to take place in the counselors’ heads as they go from one client to the next, and that becomes more difficult the busier they are. Smith said, “This University... [is] working hard to get people in as quickly as possible...Right now they are keeping their heads above water, but they are having to swim pretty quickly to do that.”

Kau said, “I commend the Counseling Services team for all they are doing to meet the needs of students.” While Kau and Smith acknowledged the hard work the counselors do and the struggles with a lack of counselors, Kau said, “There are limits to what the university can provide.” It is not a simple matter of just hiring more counselors to keep up with such an unprecedented increase ... we need to look at this and see what is reasonable and what is needed.”

Responsibility


Kau said while he wants to help keep students in the classroom and help them as much as possible, it is not the sole role of the university to provide all counseling and medical services students may need. “We cannot provide all [the] resources. We will do what we can to help students succeed, but students may also have to find their own additional support. They have a medical benefit. They have access to Counseling Services. But there are limits, unfortunately.”

Smith agreed with Kau. “You can’t add enough counselors ultimately to stem the tide and meet the demand.” As director of the BYU in Provo counseling center, Smith was also part of the Association of University and College Counseling Center Directors, with more than 600 college counseling center directors who agreed with that same conclusion, said Smith.

Skinner agreed that at most universities this is the case: students should not rely solely on the university to provide mental health care. However, she added, “There’s not enough mental health services in this area that our students can easily access.”

Skinner said due to BYUH’s large number of international students, students without cars and the lack of mental health resources nearby, the situation at BYUH is more difficult than other universities where students can more easily turn to mental health care outside of the university. Because of this, she said, the responsibility of the students’ mental health care falls back on the university.

Smith explained part of the responsibility of this problem may be to add a counselor, but another aspect is trying to address what the particular mental health issues are on a certain campus. This is done through effective outreach called primary prevention, he said, which includes QPR training, suicide prevention, stress management, etc.

According to the Suicide Prevention Research Center, QPR training stands for “question, persuade, and refer” and is a suicide prevention training designed to teach the warning signs of a suicide crisis and how to respond.

Smith said, “Does the university have a responsibility to provide for the comprehensive mental health of every student that comes? I don’t think so. I think their responsibility is to provide for dealing with those issues that get in the way [of their studies] and helping an individual deal with them. And if a person’s struggles are so great, then they may need to take some time away from the university."

Smith said he admires his colleagues at BYUH who are trying to find that balance. Allred said the amount of time it took to resolve her situation would not have changed meeting with a counselor because, “For me, I feel empowered with a lot of tools to help get myself out of dark places because I have been there in the past and I have gone through counseling and therapy so I have been given the tools.”

However, she said, she felt that it would’ve been more helpful if she could have talked to someone closer to the moment that was causing her distress. “I think the role of the counselors is: if you don’t have those tools, they’re going to give you those tools. But they’re also going to keep you accountable and help you practice them so you are more prepared in the long term.”

Building community


Smith’s advice to students on how they can individually help is to get the QPR training and to have an “awareness of persons who struggle, a willingness to sit and talk, a willingness to engage ...“Building community is one of the most important things you can do,” continued Smith.

BYU campuses have a big advantage because of built-in communities, he said. Participation in church events helps build that community where they can then invite others to come, said Smith.

Allred said during those two months she was waiting for help from Counseling Services, she found other resources on campus that helped her cope with her struggles. One of the places that she said she found a community was the yoga classes held several times a week on campus. “I think the yoga class is great. It’s very grounding. ... Everyone in that space is very welcoming.”

She said there are many places around campus or clubs students can join that can help them through hard times. Smith said, “If someone is struggling or is suicidal, is it your job to make sure they are okay? It absolutely is not. But can you be part of the solution by building a strong community."