This spring, as the coronavirus pandemic disrupted campus life for college students across California, UC San Diego sophomore Kayla Monnette had trouble sleeping at night.

The stress of moving to online classes, figuring out how to safely buy food during quarantine, and worrying about the well-being of her immunocompromised family manifested in what Monnette described as persistent anxiety. Not knowing how many students on campus might have contracted coronavirus, she said, added to her fears that she could become infected.

“Whenever I go to sleep, I get a terrible feeling in my stomach and I can’t sleep,” she told  CalMatters at the time.

The pandemic has increased the mental strain on a generation of college students already reporting record levels of psychological challenges, state and national surveys show.  California colleges have responded by moving therapy appointments online and using state grants to add services. But some mental health advocates say the coronavirus crisis highlights the fragility of a system that even before the pandemic was not doing enough to meet students’ needs.

Eighty percent of college students nationwide say that COVID-19 has negatively impacted their mental health, and over half say that they don’t know where to go for help, according to a survey conducted in April by Active Minds, an organization that seeks to support student mental health. California students polled by the state’s Student Aid Commission were similarly stressed, reporting significant increases in worry over paying for their education, staying healthy, and taking care of family members compared with before the pandemic.

The economic crisis has put many students and their family members out of work. Remote instruction comes with its own stressors, from unusual schedules to racist Zoombombers. First-generation and immigrant students sheltering at home say they are taking on more family responsibilities, while many Black students face compounded anxiety over the killing of George Floyd and violent police responses to ensuing protests.

And that’s on top of the stress already affecting students before the coronavirus hit.

“Our students are dealing with really large social problems on a regular basis — they’re thinking about school shootings, climate change, big issues we haven’t begun to solve,” said Laura Horne, chief program officer at Active Minds. “Young adults demonstrate a tremendous amount of resiliency in the face of that kind of culture.”

With most colleges planning a mix of online and in-person classes for fall, mental health services have moved to teletherapy — therapy conducted online, by phone or by video chat. Some campuses say their health centers will also offer in-person urgent care visits.

At California State University, demand for mental health services has grown since the pandemic hit, said Dr. Lea Jarnagin, special assistant to the chancellor for student affairs. The university took therapy sessions online in the spring, and they’ll remain that way for fall, Jarnagin said, in part because it’s difficult to maintain the intimacy of in-person therapy sessions while socially distanced and wearing masks. The university is also considering contracting with an outside company to increase the number of hours that counselors are available, administrators say.

Dr. Peter Yellowlees, a psychiatrist and chief wellness officer at UC Davis Health, said studies show teletherapy is just as effective as in-person therapy, and he sees a future in which patients use a hybrid of teletherapy and in-person treatment depending on convenience.

“Everyone is different; some prefer in person therapy, some prefer video,” Dr. Yellowlees said. “There is extra distance involved. That can be a good thing and can encourage people to hold more intimate conversations, especially about stigmatized issues.”

One concern about teletherapy during the pandemic is access to private space. Eric Pederson, associate professor of Psychiatry and Behavioral Sciences at the University of Southern California, said that students may choose not to bring up issues related to sex, substance use, or family if they know their family can overhear. While patients with access to cars can hold sessions in the car, he says that there are another set of privacy concerns if someone decides to take a walk or go to the park to hold their session away from family.

Licensing requirements can also prevent some students living out of state from accessing teletherapy, said Reina Juarez, the counseling and psychological services director at UC San Diego.

Valerie Johnson, a senior at UC Berkeley, was having trouble staying motivated and completing projects when she decided to see a campus counselor. She had to cancel her first appointment to attend a professor’s office hours and opted not to reschedule when she realized the appointment would be online.

“I don’t see myself doing well in an online [therapy] environment because I can barely show up to online classes,” Johnson said. “I don’t think I would benefit the same as in-person. I feed off other people’s energy, eye contact, and body language.”

Even before COVID-19, campuses were struggling to meet the growing student demand for mental health services. As of 2018, there were more than 2,000 students for every counselor in the California State University system, and 7,000 per counselor in the California Community Colleges, according to a legislative analysis. The International Association of Counseling Services — the national accreditor for campus counseling centers — recommends a ratio of one counselor for every 1,000-1,500 students.  

The University of California has more counselors per student, at about 1 for every 1,100, funded by a student services fee that also covers recreation and other health care; it’s set at $1,128 for the 2020-21 school year. After lobbying by students in 2018, the state legislature set aside an additional $5 million per year to support mental health services at UC. CSU campuses also have a student health fee, part of which funds mental health services.

But mental health care must compete with other student services for funding from the fees. Allocations to mental health at UC have remained relatively steady while the cost of care has increased, said Emily Estus, a UC Berkeley graduate student who has researched campus mental health policy on behalf of the Institute for Young Americans.

“It’s not enough money for students who need mental health services,” Estus said. “It’s not increasing at all, but the price of healthcare and cost of living has gone up.”

In response, she said, some campuses have limited the amount of mental health care students can receive for free before referring them off campus.

Students on five UC campuses have taken matters into their own hands, voting to charge themselves additional fees to fund mental health services.

In 2016, UCLA students passed a referendum to create a mental health services fee of $1.50 per quarter. The university’s counseling center used the money to set up a student advisory board and a 24-hour hotline for international students to receive therapy in multiple languages, The Daily Bruin reported. UC San Diego students approved a similar fee in late May. While the funds will be controlled by a student committee, Juarez told CalMatters she will ask that they go towards hiring more counselors to lower the student-to-staff ratio. The counseling center has already increased the number of sessions students can receive during the pandemic, Juarez said.

Some community colleges charge a student health fee, but others don’t provide mental health services at all. California Community Colleges Chancellor Eloy Ortiz Oakley said at a recent CalMatters town hall that his office is encouraging colleges to spend some of the $120 million they received from the state legislature for Covid response on mental health services. But, he said, “It’s still just a drop in the bucket.”

The legislature also set up a $12 million grant program last year to improve the quality of mental health services at 16 community colleges.

At College of the Canyons in Santa Clarita, one of the colleges to receive the grants, all students are entitled to 6-8 therapy sessions a semester before they are referred off campus, said Larry Schallert, assistant director of the mental health program. If students do not have insurance, they can receive more sessions on campus. “Students will not be turned away,” Schallert said.

Santa Monica College, another grant winner, has its own counseling center, but has also sought to destigmatize mental health by embedding clinicians in other programs, like Black Collegians and the Center for Students with Disabilities. Students are screened for depression and suicide risk during doctor’s appointments, allowing nurses to connect them to treatment.

Even with all those services, Director of Health and Wellness Susan Fila says the therapist to student ratio is about 1:6,000. That means students receive fewer sessions than they might need, Fila said, and it’s harder to support students with more severe mental health issues.

The college partners with nonprofit agencies that provide additional mental health services on campus, but those are only for students with Medi-Cal and uninsured students. Students with private insurance are referred off campus, Fila said.

“Students want to access services on campus,” Fila said. “Our students have transportation needs, they might be working a full time job in addition to college, so the convenience of having therapy on campus is huge.”

Both Fila and Schallert said that one-time funding is helpful, but community colleges need more ongoing funding from the state to provide adequate mental health services.

“Student health fees were really only created to provide physical health services, and over the years we’ve seen a dramatic increase in mental health,” Fila said. “With that, the student health fee is not sufficient to cover appropriate mental health ratios.”

Monnette, the UC San Diego student, never ended up seeing a therapist for her anxiety. She had met with an on-campus therapist before the pandemic, but felt the therapist was dismissive of her concerns, and said she had trouble scheduling a follow-up. In June, she moved to an off-campus apartment, where fewer people have access to her building, and she worries less about becoming infected. Her stress, she said, has eased.

“I think a huge contribution to my anxiety was the insecure and temporary feeling that being on campus [during a pandemic] gave me,” she said.

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.