Texas colleges and universities are struggling to keep up with the demand for mental health services amid a statewide shortage of care providers.

This isn’t just a public health crisis in Texas but across the United States, according to Zachary Zoet, the assistant director of Midwestern State University’s Counseling Center in Wichita Falls.

“There’s a lot of different factors that are going into the staffing issues, the salary issues, these retention and recruitment issues, because this is a serial theme that administrators in counseling centers are discussing at the state and national level,” Zoet said.

The need for mental health support is urgent. During the 2020-2021 academic year, the majority of college students across the country met the criteria for at least one mental health diagnosis — a nearly 50% increase from 2013. It’s an alarming finding from a recent Healthy Minds Study, which surveyed more than 90,000 students on 133 U.S. campuses.

But the study did reveal a silver lining: more college students than ever before report receiving therapy or counseling.

The increase in cases is partly due to more awareness and less stigma associated with mental health care, said Hillary Jones, associate director of clinical services at the Texas State University Counseling Center. She said students with less serious concerns, who in the past might not have considered counseling, are seeking help.

Rising demand for mental health services on Texas college and university campuses hasn’t been matched by a corresponding increase in funding. This has led to higher caseloads per campus clinician – the number of sessions each counselor is expected to handle.

“There’s a lot of students here at Texas State, so it’s a lot of resources to be able to meet the mental health needs of all those students,” said Jones. “I think it's just been an ongoing conversation, both within the counseling center and upper administration of ‘How do we meet those needs? How do we do this in creative and innovative ways?’”

Annual caseloads for a typical full-time college counselor in Texas range from 95 to 200 students per counselor, according to data obtained through public records requests filed by Texas Community Health News.

This data comes from records obtained from Texas public universities with at least 2,000 students for the 2022 fiscal year. Twenty-three universities responded to the request, representing two-thirds of the universities contacted.

For centers with larger caseloads, like Texas State University, staff often set session limits and space out appointments, scheduling students on a biweekly basis.

College counseling has never been an easy or lucrative career path, but it was a profession that many staff members were passionate about, and it used to be less demanding on staff’s time.

“I think why most of us continue to work here, despite not getting paid as much as we would elsewhere, is because we really do feel called to help students and love this work deeply,” said Jones, who counsels students on a daily basis.

Lynn Reeder, director of the Texas State University Counseling Center, said pre-pandemic, applicant pools for counselors were large and hires used to stay for years.

“Just in the last five years, we have lost so many talented counseling center professionals to private practice because the sense of reward isn’t there, and the actual reward isn’t there. I mean, we can live for a long time on the joy of what we do, and certainly that’s what has sustained me a lot over the years that I’ve done this, but it just saddens me,” Reeder said.

Today, few people are applying for jobs at Texas college and university counseling centers, and some who planned to stay until retirement have left for private practice, she added.

At Texas Southern University, during the 2021-2022 academic year, three out of four full-time, non-trainee staff members at the university’s counseling center resigned from a team that has one of the highest rates of student use among responding universities.

Texas Southern University didn’t respond to numerous requests for comment.

Campuses across the state are struggling. Of the schools that provided student use numbers, the University of North Texas saw about 3,600 students last year, more than any other school.  That same fiscal year, almost 40% of UNT’s counseling staff resigned.

Stephen F. Austin State University, which is about a quarter of the size of UNT, had the highest student utilization of any school that provided data. The rate was almost double that of UNT, with nearly 16% of the students enrolled at the university seeking counseling.

The University of North Texas didn’t respond to requests for comment, and Stephen F. Austin State University declined to comment on the findings.

All of the colleges and universities referenced in this article were given an opportunity to respond to our reporting and either didn’t respond to requests for comment or declined to comment.

The International Association of Counseling Services, an organization that sets accrediting standards for university and college counseling centers, recommends campuses maintain minimum staffing ratios in the range of one full-time professional staff member to every 1,000 to 1,500 students, depending on services offered and other campus mental health agencies.

Ann Patterson, the association’s executive director, said there are six accredited colleges and universities in Texas that meet the staffing standards, but there’s no way to know how many other counseling centers meet the association’s standards but choose not to apply for accreditation.

“The lack of staffing isn't so clear cut,” said Patterson. “The open positions aren’t being met, and so students are having to suffer. How they’re having to suffer kind of all ends up having this cascading effect: long wait times, and then if the long run wait times happen, and then perhaps a problem that could have been more addressed had the student not had to wait for a month or two maybe the problem would be less severe than it is now, in terms of the kind of counseling they might need.”

Of the 23 responding Texas universities that provided staffing data, six met the recommended ratio. The counseling center at The University of Texas at Arlington is farthest from this mark, missing 16 of the recommended 27 full-time mental health professionals that would be needed to meet the counseling association’s standards.

At this rate, The University of Texas at Arlington would need to budget about $1 million to hire the needed professionals at $63,000 a year, the average salary for a psychologist at the university.

Zoet said the problem is even worse on campuses in rural communities with low density and fewer people, where there may be a lack of local amenities and the salary is typically lower than in urban areas.

“Students will go and get these health care provider degrees, and a lot of times they don’t go back to the rural areas that they come from,” said Zoet. “They will follow the money, the ability to get a job, the opportunities involved in city life, which leads to these rural, underserved areas not keeping pace and being able to provide healthcare to those areas.”

Zoet said efforts have been made to increase the number of mental health professionals on Texas college and university campuses, including student loan repayment plans for employees, along with increased state and federal funding to recruit and retain staff.

“There’s a lot of different factors that are going into the staffing issues because this is a serial theme that administrators in counseling centers are discussing,” he said. “It’s hard for me to crystal ball where I think it's going, but there are shifts that are changing how students access and receive services.” 

In addition to programs intended to recruit and retain staff, some academic institutions in the state and across the country have partnered with tech companies to provide virtual mental health services to supplement a counseling center’s typical 9-to-5 schedule. The Texas State University and University of Texas systems are among the more than 300 schools throughout the country that have partnered with the company TimelyCare on a mental health and wellness app for students. The app, which was adopted at Texas State University this academic year, is designed to broaden access to student mental health services.  

The telehealth service isn’t replacing the entire counseling center but, instead, allows students non-stop, 24/7 service access to a diverse range of licensed counselors throughout the country. The service is free to students.

Teletherapy became more popular during the pandemic, especially on college and university campuses that moved classes online while mental health disorders like anxiety and depression skyrocketed.

Christopher Albert, director of the Counseling Center at The University of Texas Rio Grande Valley, said apps like TimelyCare bridge the gap in college students’ mental health treatment.  

“They learn how to recognize when a student is struggling. They know how to talk with that student and help persuade them to get the help they need, and then they'll know about our counseling center,” said Albert. “We can't do all the work just sitting in our offices.” 

Jordan Gass-Poore’ is a New York-based freelance journalist who works with Texas Community Health News, a collaboration between the School of Journalism and Mass Communication and the university's Translational Health Research Center. TCHN stories, reports and data visualizations are provided free to Texas newsrooms.