The Kids Are Not Alright

Executive Summary

The current Counseling and Psychological Services (CAPS) at the University of California (UC) are not enough to address the worsening college mental health crisis. Due to funding priorities, CAPS only provides short-term services, leaving many UC students to seek out their own mental health treatment. In addressing the crisis at the University of California, we can develop solutions for the state and the college student population at large.

A College Crisis

Midst a Mental Health Emergency

College students across the U.S. are undergoing a mental health crisis. At the lowest estimate, 30% of them — about 6.4 million people — suffer from a psychiatric disorder. And this number is rapidly growing. In 2009, 9.3% and 9.0% of college students had anxiety and depression, respectively. By 2015, however, these percentages had swelled to 14.9% and 12.2%.

With the onset of the COVID-19 pandemic in March 2020, these already-dire circumstances worsened. Social distancing and remote learning measures took a considerable toll on college students’ mental health. Evidence suggests that 2020 shelter-in-place orders led to higher rates of depression. One study at the University of North Carolina, Chapel Hill found that within just four months after the pandemic began, the prevalence of moderate-severe anxiety and moderate-severe depression increased 6.9% and 10.2%, respectively.

Yet given this urgent mental health crisis, not nearly enough college students receive the services and support they need. International studies found that less than 25% of college students with a disorder lasting one year or longer received any kind of treatment. And although mental health services are already underutilized across the country, college students are especially unlikely to recognize they need professional help and seek it out.

Why It Matters

Mental health is not an isolated issue; it affects almost every aspect of life. Mental disorders amongst college students can lead to lower academic achievement and higher dropout rates. More severe suicidal ideations and mental health problems, for example, are correlated with lower grade point averages.

Beyond college, these disorders are associated with lower odds of employment, increased substance use, and impaired social functioning. A Canadian study found that enduring a single major depressive episode can lead to lower annual earnings — not solely in the year the episode was reported, but as long as a decade later. According to a 2015 meta-analysis, having a mental disorder reduced life expectancy by anywhere from 1.4 to 32 years, with a median of 10.1 years. The evidence is clear: mental health can quite literally be a matter of life and death.

Such negative outcomes also do not affect everyone equally. Studies surmise that lesbian, gay, bisexual, queer, or questioning college students are at a higher risk for mental health problems. College students of color — that is, Black, Latinx, Asian, and Arab students — have lower rates of diagnoses, medication use, and therapy relative to white students. A 2018 study found that Asian students had the lowest prevalence of treatment while Arab students had the highest prevalence of mental health problems. Additionally, low-income students facing financial strain — especially women — are more likely to have anxiety. Mitigating mental health-related harms, therefore, is a crucial part of achieving racial, socioeconomic, and gender justice.

University of California at the Center

California is home to 2.7 million college students, about 14% of the national total. One of the state’s major school systems is the University of California (UC). First established in 1868, it now has 10 campuses: UC Berkeley, UC Davis, UCSF, UC Merced, UCLA, UC Riverside, UC Santa Barbara, UC San Diego, UC Irvine, and UC Santa Cruz.

The prominence of the UC system within California’s higher educational landscape is difficult to overstate. As of fall 2020, there were 230,529 enrolled undergraduate UC students. Their budget for the 21-22 school year was $44 billion, more than the funding for the state’s other two public college systems (California State University and California Community College) combined — despite having only about one tenth of their student populations.

Six of the UC campuses are ranked in the top 50 universities across the country. Seven are members of the renowned research Association of American Universities. The UC system has produced 70 Nobel Prize winners, 40 Pulitzer Prize winners, and 93 MacArthur Fellowship recipients. In Fiscal Year 2020 alone, UC researchers created 1,706 inventions and were awarded $6.77 billion in research grants. All in all, the UC system has contributed a sizable $55.8 billion to California’s gross product.

Given its enormous social, cultural, political, and economic presence, the scope of this paper will focus on CAPS, the Counseling and Psychological Services within the UC system. Early adulthood is a turbulent period of developing self-image and social relationships. It is unsurprising, then, that the median age-of-onset for mental health disorders ranges from the late teens to early 20s — the typical college undergraduate years. By examining college students — perhaps one of the most vulnerable populations to experiencing psychological distress — we can address mental illness at its inception and mitigate lifelong affliction. And by specifically examining UC students, we can find solutions that may have ripple effects on the state and country at large.

The Limitations of CAPS

Treatment is Inaccessible

Unless they can provide proof of having other coverage, the UCs require students to enroll in the school’s own health plan: UC Student Health Insurance Plan, or UC SHIP. If a student enrolls in UC SHIP, they can utilize the Counseling and Psychological Services (CAPS). If students do not enroll in UC SHIP, their own health insurance “must provide unrestricted access to...[a] mental health provider within a reasonable distance” of campus. The main insurance companies in California are Kaiser Permanente, Blue Shield, Anthem Blue Cross, Sharp, LA Care Health Plan, Valley Health Plan, Western Health Plan, Chinese Community Health Plan, and Contra Costa Health Plan.

Such an arrangement may seem sufficient. Ultimately, all UC students can access some form of mental health treatment — either through their own personal insurance plans or through UC SHIP’s CAPS. In reality, however, this existing infrastructure is grossly inadequate.

The UC Office of the President describes CAPS as “short-term counseling for academic, career, and personal issues” such as “adjusting to school,” “deciding on a career or major,” and “dealing with family or relationships.” But these services, while they certainly can offer helpful advice and stress-coping mechanisms, cannot treat a mental illness. In fact, the paragraph below notes that those “struggling with depression, anxiety and other emotional concerns that have a biological component” must take an additional step: undergoing “evaluations by primary care or psychiatric clinicians.” As a result, students on SHIP — at UCLA, about two-thirds of the population — do not have direct means by which to access a clinical psychologist or psychiatrist.

For UC students on their own health plans, the situation is a little different. In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA and subsequent amendments require insurance companies to provide the same coverage for mental/behavioral and physical health, both financially and quantitatively. But the law only made nominal changes. One 2017 study found that behavioral health spending only increased by $1.05 per enrollee (substantially less than the predicted growth of $7.35) and visits only increased by 0.00578 per enrollee. A 2018 evaluation study similarly determined that “MHPAEA did not lead to broad reductions” in copayments or coinsurance for mental health services. Another 2019 panel study confirmed the trend: MHPAEA had “at most small effects” on mental health service utilization and spending.

After all, the MHPAEA does not require comprehensive mental health coverage — only that mental health benefits do not have more restrictions than physical health benefits. And this is a serious problem. In 2016, 21% of the U.S. population reported that they or a family member had to forgo needed mental health services because they could not afford it or their insurance did not cover it.

How UC Fits In

Between summer 2019 and 2020 alone, individual CAPS visits climbed 23%. But as established above, CAPS does not deliver dependable, good-quality access to mental health services. Given these dismal circumstances, UC has a responsibility to attend to this issue.

The extent to which universities are responsible for their students’ health has been a long-debated topic. In 1991, Furek v. University of Delaware ruled that while the university does not have to ensure the safety of all students, it cannot be negligent and must address harmful third-party behavior. More recently in 2018, the Nguyen v. MIT court case concluded that universities and their students have a “special relationship,” and that the administration has duty to protect students if they learn of suicidal idiations, plans, or attempts.

But regardless, the University of California claims to put its students first.54 According to their diversity statement, they strive to “suppor[t] diversity and equal opportunity” and “remove barriers...[for] historically excluded populations.” With severe disparities in mental disorder incidence and treatment across different races, socioeconomic statuses, genders, and sexualities, improving CAPS is part of the UC mission. Saving students’ lives is part of the UC mission.

Short Supply and Access Barriers

The UC must establish long-term mental health care at CAPS. But before such an effort is underway, there are two main issues to address: lack of supply and barriers to access. Despite adding counseling staff members, administering online assessments, and even collaborating with local hospitals, many universities are struggling to meet the growing demand for mental health services.

But even if with adequate staff, there would still be barriers to accessing their services. After all, a 2018 study found that counseling services were only effective in increasing GPAs and graduation rates if students “remained in counseling as recommended.” A 2019 survey of more than 9,000 college students found that only 24.6% of them would seek treatment if they had emotional problems — the most common reasons being a preference to handle the problem alone (56.4%) and wanting to talk to family and friends instead (48.0%). Similarly, a 2010 systematic review found that “stigma and embarrassment, problems recognising symptoms (poor mental health literacy), and a preference for self-reliance” were the primary reasons students did not seek help.

Organization Program Integration Audit (OPIA)

This paper will focus on the Counseling and Psychological Services (CAPS) program, which is the main access point to mental health care at the University of California. The biggest discrepancies between CAPS and the UC administration at large are 1) target audiences, 2) financial resources, and 3) culture and power.

Target Audiences

The UC’s target audience is not only their students, but their funders. The majority (26.4%) of UC funding comes from the government and another 6% comes from “private support,” typically alumni or corporate donations. In short, 32.4% of funding — and therefore the UC’s targeted audience — is external to the students.

The primary target audience for CAPS, however, is the students themselves. The services have been implemented to tend to student’s emotional and psychological needs. They are not directly beholden to donors, state legislators, or other external entities. They cater to the students who call their office or walk through their doors.

Financial Resources

As mentioned above, the UC system has a wide variety of funding sources. Their total budget for the 21-22 academic year is $43.9 billion. But according to 20-21 data, only 2.7% of total expenditures go towards student services. An even smaller percentage, 0.09%, specifically goes towards CAPS. Clearly, funding mental health care is low on the list of priorities for the UC administration.

An obvious way to mitigate this issue is to increase CAPS funding. The UC system, however, has a history of failing to provide enough money for mental health services. In 07-08 and 08-09, it only allocated $12 million for mental health care, only 28% of the recommended $43 million. Increasing funding will be discussed in further detail under “Transforming CAPS.”

Culture and Power

The University of California system has immense political autonomy. When it became a public trust in 1879, its Regents (governing body members) were granted virtually independent control over their university’s operations “entirely independent of all political and sectarian influence.” The UC became akin to a fourth branch of government, a level of self-rule unparalleled to any other statewide school system.

This autonomy, however, does not trickle down to CAPS. CAPS is beholden to the limited funding from the administration. Most students do not even know about the services. According to one psychologist at UCR, students often “‘forget’ about [therapy] after orientation (when they all hear about it).”

The CAPS Budget

As a part of student services, CAPS receives its funding from the UC administration. Overall, CAPS comprise about 3.5% of student service expenditures — $38 million out of $1.1 billion. The rest goes to other services such as student health (presumably physical and medical), financial aid, social and cultural activities, and career guidance. In 2020, CAPS only accounted for 0.09% of the total $40.4 billion spending.

Increased funding is direly needed. In the 19-20 school year, 24% students — nearly one in four — waited longer than two weeks to be seen at CAPS. In January 2022, UC Davis only had 34 counselors, setting the student-counselor ratio to 1,210:1. Associate vice chancellor Dr. Cory Vu described the grim reality: UC Davis is not only competing for counselors with CSUs, hospitals, and private practices, but other UC universities. “Every college campus is looking for counselors,” he admitted, “but so is every other health entity, public and private.”

Interestingly enough, most of the funding for student services does not come directly from the state government. In the 19-20 academic year, 73% of the student service funding sources were from tuition or tuition-related fees. But this means that increasing CAPS funding ultimately hurts the very individuals CAPS would be aiming to help. In 2016, for example, the #UCLAWellness initiative referendum raised student fees by $6, 25% of which ($1.50) went to CAPS.81 And even that was not nearly enough. By May 2018, CAPS had only collected about $200,000 from that referendum, equivalent to about four counselors’ yearly pay.

University of California Politics

The most powerful individuals at the University of California are on the Board of Regents. It consists of 26 voting members, 18 of whom are appointed by the governor to a 12-year term. One is an actual student appointed by the Regents to a one-year term. The remaining seven are “ex officio” members, those who are on the Board due to their status — the Governor, Lieutenant Governor, Speaker of the Assembly, Superintendent of Public Instruction, president and vice president of the Alumni Associations of UC, and the UC president.

Some members purport a commitment to changing the status quo. Maria Anguiano claims to be an “equity and access champion,” and according to his website biography, Jose Perez advocates for the “affordability and accessibility of higher education.” Current governor, Gavin Newsom, has also shown commitment to mental health advocacy. His “Care Court” proposal, launched earlier in March 2022, enlists Superior Court judges, clinical teams, and county case managers to funnel unhoused people into services providing psychiatrist appointments, medication prescriptions, and housing.

Most of the Regents, however, are business executives of NBA teams, consulting firms, real estate corporations, entertainment companies, and investment ventures. The primary goal of the Board of Regents, one might surmise, is to maximize financial gain — not protect the well-being of the students themselves.

And their track record indicates such an ethos. Many of the Board’s decisions have been met with student outcry. In 2016, for example, UC Berkeley students stormed a Board meeting planning to hike tuition and temporarily shut it down. The protests were met with police threatening arrest. One student at the time, political science major and third-year transfer Juniper Cordova-Goff, told Los Angeles Times: “The fact that they cleared the room and called police, especially on black and brown students — I feel betrayed once again by my representatives.” In April 2017, a state audit revealed that the UC Office of the President had raised more than $175 million and then created undisclosed budgets to spend it. Shortly after the news broke, UC students and workers rallied outside a Board meeting at UCSF chanting for the administration to “put students before profit.”

Overall, the Board of Regents seems to be rather conservative in their fund allocations and relatively unresponsive to student opposition. And given the fact that Regents have “full powers of organization and governance” and are (hypothetically) “entirely independent of all political and sectarian influence,” targeting the Regents — as well as their advisors, donors, and corporations — seems to be the most sound approach.

Counselors on the Frontlines

Some counselors are content with the status quo. A Counseling Psychologist who has been working at UCR CAPS for the past four and a half years rates the services 9 out of 10. He claims that the program has “diverse staff” and “prompt intake assessment.”

Others, however, see the need for major change. Dr. Nicole Green, the director of UCLA CAPS, explains that there is one mental health professional per 1,150 students — just a “drop in the bucket.” As a result, intakes are often backed up through the entire quarter. This accumulation can be so severe that CAPS is “backed five weeks after finals.”

Many UCs also have trouble retaining counselors. At UCLA, for example, student fees are not enough to keep clinicians long-term. And even if they were, there would simply be insufficient office space — not enough physical room for these clinicians to work.

Students’ Experiences

UC students, the target group members of CAPS, have mixed reviews about the services. For many students, CAPS services are extremely helpful. Maria (fictitious names are used to protect the identity of respondents), a political science major at UC Merced in 2020, rated the services an 8 out 10. “I got paired with a therapist of my similar background,” she explained, “so it was more comfortable for me to share my experiences without having to explain how specific things in my culture work.” UCLA student with Reddit username barkupatree lauded the program for being “prepared to help students dealing with anxiety and depression for all sorts of reasons.” Gabrielle, a student who graduated from UCLA in 2021, said that the CAPS phone number was well-circulated, regularly appearing on professors’ syllabi and departmental emails.

But in gleaning perspectives from different students at different UCs, there seemed to be an overwhelming consensus: wait times were long and even finding an available appointment at all was difficult. Maria remarked that it “took a while to get an initial appointment.” Reddit user astrophys described how it was “often pretty hard to see a therapist more than once a month” at UCLA. User ILoveCatsandBirds went so far as to claim that it was “almost impossible to schedule appointments” and that “they couldn’t get an appointment for...2 weeks” while in the midst of a mental health crisis. Destinesia commented that one of the biggest issues with UCSD CAPS “was the waiting,” and that a student looking for services should “try to reach out as soon as possible before it gets...further saturated as the school year starts.” Olivia, a former undergraduate student at UCR, succinctly described CAPS as “very inaccessible.”

To students, the biggest reason behind these long wait times seems to be understaffing. UCSD student and Reddit user HotTeaHaven wrote that “CAPS [was] overloaded..with understaffing and the demand [of] lots of students.” Reddit user santanac82 complained that UCSB simply did not “hire enough people to help its students.”

The main issue is that CAPS only offers short-term services. UCLA student and Reddit user Jdtwister spells it out: “They limit the number of times you can see [a] therapist there, so if you want frequent sessions, you may want to look elsewhere.” As of 2018, UCLA only offered six sessions for students with SHIP and three sessions for students with their own health coverage. An anonymous writer at UCSB’s newspaper The Bottom Line reached a similar conclusion in their April 2022 article aptly named “The Problem with CAPS”: “CAPS is best equipped to help short-term problems but lacks in helping long-term mental health situations.” Under the Reddit username Doomhobo, UCI student confessed that the “counseling center [was] great and free but [it was] not a good place for long term therapy.” “Their goal,” they further elaborated, was “to try to get most students through their issues in 4-5 sessions.” HotTeaHeaven corroborated that at UCSD, “CAPS [was] generally for short-term emergency care and they [would] eventually push you to an off-campus provider.”

While these off-campus referrals may be a useful starting point, they are not enough. They are simply another step — and therefore another barrier — to receiving adequate mental health care. In an “In the Know” podcast episode published in UCLA’s Daily Bruin, hosts Keshav Tadimeti and Kristie-Valerie Hoang elaborate on the shortcomings of an off-campus referral system: “When you force that student to go and travel extra miles just to see a therapist, it brings up the question of whether or not that travel to see that therapist is even worth it.” Not every student has access to a car, ride-sharing services like Uber and Lyft are fairly expensive, and the public transportation in university cities (i.e. Los Angeles and Irvine) is rudimentary. Even if you are commuting and have a reliable method of transportation, it is still a challenge to access off-campus services. One student who commuted 30 miles to UCLA was disheartened that she had to drive an additional 10-15 miles to see a therapist through her own insurance. And in a climate in which 75.4% of college students with emotional problems already eschew treatment due to stigma, embarrassment, and poor mental health literacy, a few more miles may feel like an ocean.

In addition, while CAPS services are free, seeing a provider (even if covered by insurance) requires a copay. For people like soicon1998, this copay can be the difference between accessing lifesaving services or not. “My financial situation doesn’t allow me to pay $10 copays,” they wrote, “so I'm stuck with what CAPS.” If this student had a recurring anxiety disorder, depression, or other mental illness, they would simply be unable to get the help they need.

Transforming CAPS

The next step is to evaluate the feasibility of instituting long-term mental health care at CAPS. Such an approach is double-pronged; one the one hand, it is imperative to grow and improve the existing infrastructure. On the other hand, UCs must work to address the systemic stigma and poor mental health literacy rampant throughout college campuses to ensure that students actually utilize services.

Existing Infrastructure

As discussed earlier, the main issue with CAPS is that it is nothing more than an access point, a stop on the way to treatment rather than the destination. As UCLA’s Daily Bruin described, CAPS is a “conduit for people to pass into other services.” But such limited resources are not enough. Instead, the UCs can establish comprehensive mental health care.

To begin, CAPS would need to expand its staff. A large proportion of CAPS staff have a research-based degree (PhD) or social work degree (LCSW). While these degrees train people in important therapy skills, CAPS must place a larger emphasis on clinical degrees such as LMFTs (licensed marriage and family therapist), PsyDs (psychologist), and MDs (psychiatrist). Those with an LMFT, PsyD, or psychiatry-focused MD typically provide the gold standard for professional mental health treatment.

Additionally, CAPS must hire clinicians with a wide range of specialties. There are often specific treatments for different conditions, such as Exposure Response Prevention (ERP) for obsessive-compulsive disorder or Dialectical Behavior Therapy (DBT) for borderline personality disorder. It is imperative that all students, no matter their condition or disorder, can find some form of help.

Increasing the number of clinical professionals will not only initiate the transition to providing long-term service. It may also mitigate the severe shortage across UC campuses and potentially reduce intake wait times. The primary goal is that CAPS’ infrastructure is robust enough to directly and efficiently treat students on campus — without session limits, off-campus referrals, or backlogs.

It is also important that CAPS increases its cultural influence on campus. They can launch awareness campaigns with flyers and university-wide emails. They can cultivate their social media presence to foster a virtual connection with students and keep them updated. A briefing at orientation is not enough. Students must receive constant, interactive, and targeted information.

Addressing the Stigma

Hiring more clinically trained professionals is not the only solution. UC students must feel empowered to actually use these services. One of the main methods by which to achieve this effect is through mental health awareness movements. A 2006 study in Austrialia, for example, found that a multimedia campaign was associated with increased understanding of the risk of suicide, decreased “nothing can help” thinking, and increased understanding of the benefits of treatment.

Given the broad social media networks available, there are multiple mediums to combat misinformation and normalize talking about mental health. CAPS should grow their Instagram presence (i.e. employing different engagement methods like Stories and Reels) as well as their Twitter presence (which has been overwhelmingly silent; the last post from UCLA CAPS was in 2014).

It’s All About Funding

The main method by which to accomplish these goals is funding. In August 2019, UC Health estimated that $35.2 million would be needed annually from 2020-2025 in order to adequately support student mental health. The following 19-20 school year, however, the state only appropriated $5.3 million. This amount was enough to hold current mental health staffing levels constant, but not nearly enough to meet projected levels for enrollment growth.

The main method by which to increase funding without exorbitantly charging students is to turn to public funding from the state and federal government. Some experts even recommend partnering with the California State University (CSU) and California Community College (CCC) systems to apply for additional funding.

There have also been efforts to increase student representation on the Board of Regents. California Senate Constitutional Amendment 5, passed but not yet enacted, would endow a second student member on the Board of Regents with voting rights. Such proposals could increase the power of students, who could in turn campaign for increased CAPS services.

After Graduation

Although offering these services is absolutely crucial, students cannot be dependent on CAPS. After graduation, they will suddenly lose their primary mental health provider. Instead, CAPS could implement a transition program in which counselors inform students of different mental health insurances and networks they can access after they exit the UC system. This program could entail hard-copy resources, meetings, and workshops. If possible, the UC administration can even partner with local health insurance companies to offer recent graduates discounted packages or simply assist with the sign-up process.

The Bottom Line

With the onset of the COVID-19 pandemic, prioritizing the mental health of college students is as important as ever. And with its enormous budget and deep cultural influence, the UCs are an ideal place to start.

As of now, Counseling and Psychological Services (CAPS) only offer short-term therapy sessions. They are not the destination for mental health care, but a stop on the way. With rampant mental health misinformation and the financial constraints students face, short-term services are not enough. And, like so many other issues, such a crisis requires a major shift in funding allocations.

Of course, the mental health of University of California (UC) students is by no means limited to their undergraduate years. Mental health treatment is a lifelong process that can begin before college and continue far beyond graduation. And there are many factors besides genetics and neurochemistry that impact one’s mental health. A plethora of research suggests that social and environmental factors can play a substantial role in the development of mental disorders. In order to investigate the mental health landscape of UC students, then, we must consider a range of cultural entities such as families, primary and secondary education, and even religious institutions.

The time to act is now. The well-being of our college students — future scientists, business owners, teachers, parents, and more — is worth our utmost attention.

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