By Sophie Bolich, The Cap Times

As a teaching assistant at the University of Wisconsin-Madison, India Archer worked closely with her students. She watched them grow, learn, succeed and fail throughout each semester.

This past spring as the coronavirus pandemic swept across the United States, she saw those students’ worlds fall apart.

“I watched people’s mental health take a downturn,” Archer said. “People were shipped back home away from their friends and family and possibly any support unit that they had.”

 Archer graduated from the University of Wisconsin-Madison in May with a computer science degree and now works in Chicago. As the pandemic progressed, she was shocked to see students who had previously performed well become withdrawn.

“These were students that I talked to and saw every day,” she said. “All of a sudden, they just disappeared, completely disappeared halfway through the semester.”

As students return to campus for the fall semester, colleges are taking measures to protect students, physically as well as mentally, from the pandemic and its effects. Most schools have transitioned large courses online, freeing up bigger classrooms to allow proper distancing for smaller, in-person classes. Students are being asked to wear masks and limit gatherings to limited 10 or fewer people indoors and 25 or fewer outdoors, in accordance with guidelines from the university, Public Health Madison & Dane County and the Centers for Disease Control and Prevention.

UW-Madison reopens this week for in-person instruction. Dane County allows colleges to open given they provide a written plan to manage the spread of the virus by monitoring symptoms. Among other things, they must ensure students maintain at least six feet of physical distancing and wear face coverings.

Demand for mental health services among college students was already trending up before the pandemic. A UW System report in April 2019 showed a 55% increase in demand for behavioral health support since 2010. But for some students, the pandemic worsened pre-existing illnesses or caused new ones.

The pandemic’s effects are multifaceted. Illnesses like obsessive-compulsive disorder and anxiety thrive on the uncertainty and fear of the virus itself, while social isolation, financial insecurity, disrupted routines and the mental toll of attempts to contain the virus can lead to depression and other mental health issues.

For example, Nicholas Jenkins, a mental health advocacy coordinator at Marquette University in Milwaukee, noted the pandemic’s negative impact on those with obsessive-compulsive disorder. About 25% of people with OCD have a subset of the illness called contamination OCD, which makes sufferers terrified of germs and getting sick.

COVID-19 “took something that was an irrational thought, then suddenly made it feel a lot more rational,” Jenkins said.

Shawnna Hunter studies early childhood education at Madison College. She said her OCD made it difficult to leave the house when the pandemic hit.

“Especially before it was mandated that we wear masks, I felt so uncomfortable being in those settings,” she said in reference to public places like the grocery store. “It gave me a real sense of fear just going to the one place that I needed.”

In a recent survey of 18,000 students on 14 college campuses across the U.S., 60% of students responded that the pandemic has made it more difficult to access mental health care. The Healthy Minds Network and the American College Health Association conducted the survey, which showed that negative effects from depression and anxiety have also increased from fall 2019 to spring 2020.

UW-Madison advised instructors to be understanding of students’ struggles, Archer said.

“It’s really hard to be a college student right now,” she said. “It’s crazy, and that cannot not be hard on people’s mental health.”

Touchy transitions

At first, the events and classes canceled in the wake of the pandemic felt like a much needed break from the world for Hunter, who is also a mother to three young children.

“At first I was delighted to be away,” Hunter said. Then “it became really real to me.”

Throughout the past months, Hunter has had to balance her roles as a parent, employee and student, in addition to caring for her mental health. She started watching the news to be prepared with answers to her kids’ questions about the pandemic. She arranged Facetime meetings with the kids’ friends and strived to establish a stable work-life balance.

One thing that helped Hunter’s family maintain a sense of normalcy was sticking to a schedule and having regular family dinners. During these dinners, everyone disconnected from their devices and took an hour to talk through questions and concerns about the pandemic, school, work and life.

For herself, Hunter transitioned to virtual therapy, a change that she said wasn’t as jarring as many would expect. Several sources who spoke to the Cap Times for this story shared that physically going to therapy and being able to leave the space afterward is an important part of the emotional process, but Hunter said her situation was different because she’s working on generational and emotional trauma.

“I never really had the choice to walk out of the place to reset,” Hunter said, adding that it was important for her to take a few minutes after each session to sit quietly at the computer to process and decompress.

In early March, Ben Weinstein was preparing for a spring break training trip with the UW-Madison sailing team when he received an email saying he had 48 hours to move out of his dorm and travel home, with no set date to return.

After booking a last-minute flight and packing whatever he could fit in a suitcase, Weinstein, a sophomore studying mechanical engineering, arrived home in Rhode Island. Half of his possessions were still in his Wisconsin dorm room as he faced the final weeks of a challenging curriculum in an unfamiliar, virtual format.

“There’s a loss of community in a sense,” Weinstein said. “When you’re at school, the mentality is very school focused. So it’s easy to deal with the grind because everyone else is also dealing with the grind.”

Weinstein struggled with anxiety before college but school exacerbated his symptoms, and the pandemic made things worse. Though his final grades didn’t show it, the transition to online classes was fine in some instances and brutal in others.

“Test anxiety sucks as it is,” Weinstein said. “Add an internal voice screaming at you that you’re a failure and you’re too stupid to graduate…you’re basically both trying to study for the material and fight your entire subconscious at the same time.”

Weinstein sees a private therapist. The support helped him a lot during the spring semester, but his test anxiety still made focusing difficult. He often found himself procrastinating or spending upwards of five hours on a single test.

Moving into the fall semester, Weinstein said he expects mental health among his peers to deteriorate because students won’t “have the outlets they’re used to.”

“Sailing was an escape for me where I could just go on the water for two, three hours and not have to think about the obscene amounts of homework I had to do,” Weinstein said. “For a lot of people, they’re going to lose their version of that.”

Loss of control 

Students as individuals have unique perceptions of the current situation. What many have in common is a lack of control over living situations, finances, relationships and education as the fall semester approaches. Despite universities’ best-laid plans, there is still an element of uncertainty inherent to the situation.

Add to this that months spent in fear and isolation can be detrimental to physical health as well as mental health. Karen Smith, a postdoctoral fellow in the Child Emotion Lab at UW-Madison, has studied the effects of loneliness and stress during the pandemic.

Smith said loneliness is found to be a stronger predictor of mortality than smoking or obesity. In the short term, these emotions are helpful in activating physiological systems that aim to resolve or react to a perceived threat.

However, a “chronic activation of the systems,” such as extended time spent in social isolation, “can lead to dysregulation, which has been associated with longer negative health outcomes,” Smith said. (Emotion dysregulation is the inability to manage the intensity and duration of negative emotions such as fear, sadness or anger.)

Smith noted that while stress has been a constant for many throughout the pandemic, research suggests that loneliness has decreased. In fact, many report feeling less lonely than even before the pandemic.

“Stress and loneliness aren’t necessarily negative things,” Smith said. “They represent adaptive processes aimed at dealing with a perceived threat in the environment. So with loneliness, it acts as a signal that you’re lacking social relationships.”

That loneliness, according to Smith, motivates people to seek social engagement.

“It may be that we’ve gotten more prone to reaching out to others and making sure we’re engaging in other ways socially as we move through this stressful period,” she said.

A problem arises when mental illness poses a barrier to reaching out and maintaining those connections. Stress, loneliness and fear affect everyone differently, and the perception of control plays a major role in that difference.

“It’s not going to be the case that everyone demonstrates the same long term health outcomes. It’s going to be very dependent on how they’re perceiving the environment we’re in right now,” Smith said. People who feel more in control of their life will likely not be as affected as severely, she added.

The concept is similar to teaching someone to drive, Smith explained. While both the passenger and the new driver are in the same situation, the passenger/teacher may experience an elevated stress response because they lack control. This phenomenon has also been studied in animal behavior.

With the fall semester, and the tentative hybrid of face-to-face and virtual instruction planned for many colleges, Smith said it’s important to reassure students that feeling fearful or lonely is normal. She added that schools should work to socially engage students either virtually or via distanced, outdoor gatherings.

Students’ ability to connect through clubs, sports and other extracurricular activities are also affected by COVID-19. Jenkins, the mental health advocacy coordinator at Marquette University, said that can influence a student’s decision to transfer or drop out. A recent study by SimpsonScarborough suggests that as many as 40% of incoming freshmen are likely to either change the school they plan to attend or not attend at all.

 “When you think about how most people engage when they’re first coming to college, you join clubs, you hang out with people on your floor, you do all these things to acclimate to this experience,” Jenkins said. “That’s going to be a big challenge with a lot of universities.

“How do we get incoming students to feel as connected when a lot of the socialization things that we typically do … (require) physical proximity with other people?”

Counseling centers adjust

When campuses closed in March, many counseling centers moved to virtual therapy sessions, which brought new challenges. As centers worked to set up platforms and training for virtual therapy, one major barrier was state-by-state licensure, which prohibits licensed therapists from practicing across state lines.  That meant students who attended college in a different state could not legally access the therapist they saw as a student. 

To combat this obstruction, U.S. Senator Chris Murphy (D-Conn.) and U.S. Senator Roy Blunt (R-Mo.) introduced legislation on Aug. 4 that allows any health care practitioner or professional in good standing with a valid practitioners’ license to render services — including telehealth — anywhere. The Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act S.4421 would last for the duration of the COVID-19 pandemic with a 180 day phase-out.

In March, Gov. Tony Evers signed an emergency order allowing licensed doctors from other states to legally provide telehealth services in Wisconsin. However, that didn’t change the situation for counselors at Wisconsin colleges.

“If someone calls from California, sometimes the best thing I can do is help them get set up and situated with a therapist in California for the rest of summer,” said Jenkins. Some of his colleagues are considering getting licensed in multiple states, waiting to see what happens in the coming months.

Another barrier to telehealth is confidentiality. After counselors at Marquette underwent tele-behavioral health training, the process still took a while to get up and running because the center had to find a platform that could ensure confidentiality.

Alex Schmidt, a junior at Marquette, is president of Active Minds, a student-run mental health advocacy organization. She said virtual therapy is beneficial, but the dynamic is different.

“Any opportunity to work with a professional is great and should be taken advantage of, but it’s also not quite the same,” Schmidt said. Not being in an office can be difficult, and some people aren’t comfortable sharing information over the phone to the extent that they would in person, she added.

In partnership with the Marquette Counseling Center, Active Minds conducted a survey of high school and college students in April about the pandemic’s effect on their mental health. The results showed that 55% of students do not know where to go to get mental health help. Students’ number one priority was academic support, including leniency, accommodations and flexibility throughout the fall semester.

In addition to other stressors, “many students are also balancing multiple roles such as family member and student,” said Sarah Nolan, the recently appointed director of UHS Mental Health Services at UW-Madison. Students are “navigating the changes in those dynamics, including moving back home with parents or family after living independently.”

Nolan noted that people of color are disproportionately affected by COVID-19, exacerbated by ongoing health disparities and inequitable access to health care.

“Systemic racism and social injustice negatively impact the health and academic success of students,” she said. “In addition, physical distancing, working remotely, event cancellations, and the suspension of in-person classes can pose additional challenges for individuals in unsafe living environments.”

Nolan added that “safer at home” doesn’t apply to everyone.

“The very things that help to reduce the spread of COVID-19 may also increase isolation and danger for individuals staying with or living with abusers and/or dysfunctional family members.”

Understaffed, overbooked

Many colleges anticipate an increase in students seeking mental health counseling this fall. For schools whose counseling centers were already understaffed and under-resourced before the pandemic, handling the increased demand will be a balancing act.

According to several students, this has been an ongoing problem at UW-Madison. Students who tried to make appointments for mental health treatment through University Health Services (UHS) during fall 2019 said that the center was overbooked, forcing them to wait from two weeks to indefinitely for an initial appointment. (UHS did not release data or respond to direct questions about access to care by press time.)

Helen Walz, a fifth-year senior at UW-Madison, said she was able to be seen right away during the fall 2016 semester, but had more difficulty in recent years.

“Even before 2019, I think it was hard to find an appointment, and I know that availability has been a challenge for a while,” Walz said.

Walz, who studies civil engineering, was advised to schedule an initial appointment “pretty far out” in the future. She was told to seek immediate help via the crisis line if necessary.

Similarly, Archer, the computer science TA, had received treatment through the university in previous years with no problem. She said when she tried to return during the fall 2019 semester, she was turned away.

“It was crazy because the very first time I went to UW to ask for a therapist, it was like, ‘Yes, no problem, totally, we’ll get you in tomorrow,’” she said. “And then the next time I went, maybe two semesters later, it was just like, ‘We don’t have enough people to deal with the number of people who want this service now.’

“The mental health resources need to be available and ready,” she added, “because the world is in a dark place right now and we need it.”

Looking ahead

While counseling services work to meet demand at the start of the semester, administrators also want to connect students with self-guided or group resources regardless of student location, which may alleviate some pressure from counseling center staff.

UW-Madison’s UHS hosts a virtual Coping with COVID processing space every other Friday for students struggling with feelings of isolation and hopelessness. Healthy Minds Innovations, the external nonprofit affiliated with UW–Madison’s Center for Healthy Minds, launched a well-being app called the Healthy Minds Program.

Social media, in addition to keeping students connected with friends and family, can provide a platform for mental health resources. The Marquette Counseling Center Instagram account shares helpful videos and infographics (like the calendar at left) related to mental health and self-care, specifically tips for dealing with the pandemic. In one video post, psychologist Debbie Contreras-Tadych discusses ways to address grief and loss during the pandemic.

The University of Wisconsin System is providing free access to SilverCloud, an online behavioral health tool, for students, faculty and staff. The self-guided program utilizes cognitive behavioral therapy techniques to help people address depression, anxiety, stress and body image.

SilverCloud offers several learning modules which include informational quizzes, facts about mental health and online journaling. The service is not meant to replace in-person treatment for more severe mental health concerns.

In some cases, schools may arrange for students most in need of face-to-face counseling to get priority while others continue with virtual counseling. The Higher Education Mental Health Alliance released a guide for colleges considering moving counseling services online for the long term. Another option is outsourcing mental health care to a contracted counseling service.

Watching the reopening of universities across the country has caused Walz, the civil engineering senior, to worry about Madison’s own reopening. She’s specifically worried about students who don’t adhere to guidelines.

Students have been gathering for parties on and near UW-Madison’s campus throughout the summer and don’t show signs of stopping, according to Walz.  She’s concerned that in other states where classes have already resumed, “they’re not tracing outbreaks back to classrooms, but they’re tracing them back to large, out of school gatherings.”

“It’s going to be different for everyone, and it’s just going to be really, really challenging,” said Weinstein at UW-Madison. “There’s no perfect solution. We all just have to deal with it and try and make the best of it.”