How Providers Can Support Students With Eating Disorders and Mental Health Concerns

For generations, college students have faced many stresses related to this major life transition, maneuvering through the challenges of a new location, new roommates and new academic demands. 

“When I first started working in college counseling in 2005, the acuity of the mental health issues we saw was not nearly as severe as it is now. It has continued to increase year by year.” says Casey Tallent, PhD (she/her/hers), Director of Collegiate & Telehealth Partnerships at Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight).

Increased student mental health concerns

So why does the number of students seeking mental health services continue to rise? Experts cite some of the reasons:

#1: Social anxiety

Getting back into a normal classroom environment can be a big adjustment for students who have been learning virtually during the pandemic, especially for those who suffer from social anxiety.

#2: Financial stress

“Many students are really pushing hard to get and keep scholarships; others are working to help cover their expenses,” says Tricia Besett- Alesch, PhD (she/her/hers), Director of Counseling and Psychological Services at the University of Nebraska-Lincoln (UNL).

#3: Online distractions

“Students are finding it hard to put their phones down, and for Generation Z it’s especially difficult,” Dr. Besett-Alesch says. “The algorithms on social media platforms keep people scrolling on and on. There’s gaming, streaming services and apps at the palm of their hands. The hours go by and then they realize they’ve lost a significant amount of time, leading to more stress and anxiety.”

#4: Preexisting mental health issues

“About a third of the students we see have already been on mental health medication,” Dr. Besett-Alesch says. “The medication has enabled them to attend college—which wouldn’t have been the case 10 or 15 years ago—but that doesn’t mean their struggles have gone away.”

How providers and campus mental health centers can adapt

This increased demand by students comes at a time when campus mental health services are finding themselves stretched thin, as many colleges and universities may have cut counseling budgets during the pandemic. 

So, college campus counseling centers have devised a number of strategies to adapt:

Tip 1. Try creative scheduling

“We will never tell students, ‘That’s it, we’re full,’ so we’ve had to become more innovative in scheduling,” says Dr. Besett-Alesch. At UNL, students new to Counseling and Psychological Services are encouraged to call for an initial appointment on the same day they want it instead of scheduling weeks in advance. This has reduced the late cancellations and no-shows significantly at the center. “In a very busy period, the student still may have to call in the next day or two to get the first appointment, but they no longer have to wait weeks for that first visit like they did when we scheduled those appointments out,” says Dr. Besett-Alesch. Counselors at UNL also vary the frequency with which they see patients, seeing them once a week if possible, but switching to every other week at times of peak demand.

Tip 2. Get help from case management/team extenders

“Case managers are worth their weight in gold,” says Karen Anderson, MD, CEDS (she/her/hers), a physician with University Health Services at Penn State in University Park, whose campus eating disorders team has seen a 100% increase in students over the course of the pandemic. “They can help a student get medicine and connect with outside resources as needed.” Dr. Anderson also hired a nurse to do regular vital signs checks and weigh-ins, freeing up her own time to see more patients.

Tip 3. Make a list of free resources

Free resources for students are widely available. In-person and virtual support groups are offered by colleges, nonprofits and other organizations, including ERC Pathlight. Mental health awareness programs like ERC Pathlight’s “Say It Brave on Campus” series help reduce stigma and provide education to students, resident advisors, athletic departments and other campus organizations.

View ERC's ongoing free weekly eating disorder support groups.

Tip 4. Get familiar with virtual treatment

Mental health treatment, including telebehavioral therapy, is widely covered by most commercial insurance, but it takes effort to identify partners who are knowledgeable about the needs of college students and who can help with more acute cases. Available across the nation, Eating Recovery At Home and Pathlight At Home are proven virtual intensive outpatient programs.

For all the challenges of increased demand, the fact that students are seeking help is a good thing. “Increased utilization of our services is telling us that students are recognizing that they need help and taking steps to get the support they need,” says Dr. Besett-Alesch.

Why virtual treatment suits college students

In a 2020 survey, more than 70% of students said they would utilize telebehavioral health services if they had access to them, and now, more than ever, they have options. [1]

“Virtual services have been a game changer for college providers, especially now that it’s covered by most major insurances,” says Casey Tallent, PhD (she/her/hers), Director at Eating Recovery and Pathlight At Home. “Not only has it opened up outpatient care, but virtual intensive outpatient programming (IOP) is helping students stay in college and student athletes continue in their sport while getting the care they need.”

Virtual IOP also offers anonymity for students who don’t want to be seen walking into a counseling center. That’s especially true for college athletes, on-campus counselors have found, because they’re dealing with a culture of perfectionism, and they can often be local celebrities.

That was the case for former NFL player Patrick Devenny, who developed bulimia when he was a star college football player. “There’s so much pressure to do well—you’ll try any crazy diet hack to make weight,” he says. “Did I want my coach to get a report that I went to a counseling center? No way—that would affect my playing time. Virtual IOP would have been an incredible opportunity for me at that time.” 

Now in recovery, Devenny has become a mental health advocate and is a member of the ERC Pathlight Say It Brave Collective to use his lived experience to help others and end mental health stigma.

Find more eating disorder resources for college professionals and those who work with college students here.

Citations

1. The JED Foundation. (2020). Survey of college student mental health in 2020: Summary of findings. October 22, 2020