The Gift of a Student’s Trust

Monica Osburn in NC State's Counseling Center

As difficult as the pandemic has been, Monica Osburn has seen some upsides.

The executive director of the Counseling Center says switching to telehealth proved popular with students, attracting those who otherwise would not have used its services. Students could open up to counselors in their own comfortable, familiar environments, and it’s easier to talk when you don’t have to wear a mask.

There have been some challenges as well. More students means a bigger workload. The Counseling Center offers on-call and crisis support 24 hours a day, seven days a week, even when the university itself is closed. Burnout is real, and staff have to balance taking care of students with taking care of themselves. But knowing they are helping students keeps them going.

“When you meet with a student and they trust you enough to share their lowest lows, their scariest woes, their most painful experiences, there’s something precious about that,” Osburn says. “Things don’t get perfect overnight, but that relationship with them knowing they have you as a support becomes motivation for them to keep going and try new things. And when they start building success? There’s no better feeling.”

Finding the Right Care

Amid all the changes the pandemic wrought over the past couple of years, there was one constant: the reasons why students come to the Counseling Center.

“Depression, anxiety and relationship issues,” Osburn says. “Depression and anxiety flip-flop some years with which is first and which is second, but they’re usually all right there year after year. We run this data every year, and every year it tells us the same thing.”

Students who come to the Counseling Center fill out paperwork that includes describing how they are feeling. Stress is a common theme, but that doesn’t tell the complete story. Loss of motivation, oversleeping, racing thoughts and difficulty breathing indicate deeper problems.

The center conducts virtual triage once students complete their paperwork, prioritizing those who need the most help soonest. While some students can schedule an appointment, others need immediate care.

“There is a big difference between distress and risk, and we look at both,” Osburn says. “If they are in high distress, we might still see them soon. But if they’re high risk, we’re definitely going to. A student who is actively having suicidal thoughts, they’re high risk. If the triage counselor deems they need a safety plan or an immediate assessment to mitigate the risk, they immediately hand them off to another clinician who will sit with them all afternoon if they need to.”

The Counseling Center factors urgent and same-day appointments into its schedule, and there is always someone on duty to manage them. But those slots run out.

“There have been days where we’ve had 30, 40, 50 unique students — brand new, never come to the Counseling Center — initiate services,” says Osburn, who jumps in to provide counseling when needed. “If you’ve got 50 new people coming in a day, you’re going to get really full really fast.”

Over 5,000 unique students came to the center in the 2021-22 academic year, on par with the year before. With only 50 or so people available to provide clinical services, it’s impossible for every student to receive individual counseling. The center uses a “stepped care model” to guide students toward resources that can help them faster, such as online self-help guides; workshops on handling anxiety, building positive relationships and other issues; and group therapy on specific topics such as binge eating and perfectionism.

Ideally, Osburn says, students would come to college already armed with skills to help them cope with challenges they’ll face on campus.

“What I think needs to happen is we look at the interventions that can happen more upstream,” she says. “What can we teach students related to coping skills for anxiety or pressure when it comes to academics? How can we promote wellness, self-care and environments that are supportive and collaborative for the student as opposed to, by the time they get to us, them feeling isolated and not having the tools to even know where to start to tackle what they’re feeling?”

Partners in Wellness

NC State is not the only university to see such a demand for mental health services. The Center for Collegiate Mental Health (CCMH) noted in its 2021 annual report that demand for college counseling services has soared over the past two decades. Depression and generalized anxiety leveled off in 2020-21, but academic distress went up. The average length of individual treatment increased from 4.35 appointments in 2019-20 to 5.22 appointments in 2020-21.

The Counseling Center would benefit from more clinicians, Osburn says, but “upstream interventions” that help students before they need the center make a difference — even if that’s just talking to students who seem troubled or stressed. Encouragement from a faculty member can give a student a much-needed confidence boost. Students experiencing food or housing insecurity can find help through Feed the Pack food pantry or University Housing.

“How can we all be stronger partners in supporting student wellness?” Osburn asks. “I would love for us as a community — and not just NC State as a community but the greater world — to open up those conversations and not be afraid to check in on another person and say, ‘Hey, I noticed you’re not yourself. What’s going on? What do you need? How can I help? You’re worth it.’ It goes a long way.”

Mental Health Resources

For students:

For faculty and staff:

This post was originally published in NC State News.