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Sylvia Mathews Burwell, Generation Stress, 97 Foreign
Aff. 150 (2018)
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Generation Stress
The Mental Health Crisis on Campus
Sylvia Mathews Burwell
t is supposed to be the time of their life-the halcyon days of college,
when young adults grow, acquire knowledge, and learn new skills. But
according to the 2016-17 Healthy Minds Study, an annual survey of
mental health on American college campuses, while 44 percent of students
said that they were flourishing, 39 percent reported experiencing symp-
toms of depression or anxiety. The proportion of students experiencing
suicidal ideation has grown from six percent in 2007 to 11 percent in 2017.
The percentage of students receiving psychotherapy has jumped from
13 percent to 24 percent over the same period. Even though more stu-
dents are getting help, only a little more than half of those with symptoms
of depression and anxiety had received treatment in the previous year.
The rise in mental health challenges is not limited to college students.
One in every four adults in the United States will suffer from an anxiety
disorder in the course of his or her lifetime, and suicide rates for men
and women have risen since 2000. Whether these figures are a passing
trend, the new normal, or a harbinger of greater challenges to come,
one cannot fully know. But no matter what, universities need to deal
with this uptick in psychological distress. No longer can they consider
students’ mental health to be outside their area of responsibility.
Nowadays, that responsibility has broadened to include increasing
students’ resiliency-that is, helping them not just avoid stress but
also develop the tools to work through it. Resiliency is about decreasing
students’ sense of overwhelming stress while fostering their growing
autonomy to tackle difficult life challenges. It’s also about treating their
very real depression and anxiety.
Taking responsibility for students’ mental health needs is particularly
complex at a time when universities are rightfully under pressure about
SYLVIA MATHEWS BURWELL is President of American University. From 2014 to 2017,
she was U.S. Secretary of Health and Human Services.
150 FOREIGN AFFAIRS
Generation Stress
cost and access. And it is all the more complex given that part of the core
mission of higher education is to challenge students. To put it succinctly,
college is supposed to be hard. How to balance the natural challenges
and stress that university life presents while supporting students’ mental
health is an increasingly difficult tightrope to walk. Yet it needs to be walked,
since students’ mental health is a growing concern, and when that health
is poor, it can inhibit the core mission of learning. To address the issue,
universities must raise awareness of the problem through education inside
and outside the academy; focus on prevention, detection, and treatment;
and acknowledge the importance of community-all while recognizing
that stress is a part of life.
Following World War II, the United States built a thriving middle
class and became the engine of the global economy thanks to the founda-
tion of a thriving higher education system. Now, that same system must
be a part of resolving today’s mental health crisis, which presents a
broad challenge to American competitiveness and productivity.
STRESSED OUT
In my first year as president of American University, I met with students
from a variety of backgrounds and quickly learned that they have a
great deal of insight into why they experience more stress and anxiety
than previous generations. The answer boils down to three factors:
safety, economics, and technology.
Students’ concerns about safety stem from different sources. Most
undergraduates have no memory of a world before 9/11. They have
grown up with bag searches on subways, SWAT teams at stadiums, and
body scanners at airports -constant visual reminders that the United
States was attacked and could be again. Students of an older generation
would note that those are no different from Cold War-era “duck
and cover” drills. Yet today’s students point out that Americans never
experienced nuclear war, only the threat of it.
They have also grown up with increasingly deadly mass shootings.
This fall, students arrived on campus with the 2018 attack at Marjory
Stoneman Douglas High School, in Parkland, Florida, fresh in their
minds, but they also remember the attacks in 2017 at a concert in Las
Vegas, in 2016 at the Pulse nightclub in Orlando, in 2012 at Sandy Hook
Elementary School, and in 2007 at Virginia Tech. For some students
on campus, incidents that have involved racially motivated acts of
violence-such as the events in Charlottesville, Virginia, in 2017-
November/December 2018 151
Sylvia Mathews Burwell
add to their fear, stress, and anxiety. Female students have additional
cause for worry. While the increasing transparency about how often
sexual assault occurs on campus has helped advance the conversation
about the issue, it has also added to safety concerns.
Other fears are rooted in economics. A college education is essential
to social mobility, but tuition at both public and private universities
continues to rise. Many students, especially first-generation college
students, come from families with already stretched budgets and little
experience in the nuances of financing higher education, making the
prospect of student debt particularly daunting.
Students also worry about the economy they are graduating into-
they are old enough to remember the Great Recession-and fear
that they will end up jobless, unable to pay off their debt, and forced
to live with their parents. Although unemployment is now low in the
United States, wage growth has stayed relatively flat throughout the
recovery, and early career salaries, in particular, dropped
during the recession.
As a result, many students worry that they will do
no better than their parents, and with good reason:
in the United States, the likelihood that a child
will earn more than his or her parents has dropped
from 90 percent to 50 percent over the past half
century. Students also see an economy that offers
them not a single career choice but an ever-
changing panoply of career steps. Such a path
may be exciting, but it is nowhere as conducive to
stable health insurance and a secure retirement as
the one their parents and grandparents followed.
Then there is the anxiety that results from social
media. Part of the stress has to do with the pressure on
young people to constantly present a curated version of their
lives on Instagram, Snapchat, and other platforms. The way I
translate this concern to older generations is by asking, “What
would it be like if you had to update your resume every day?” The
obvious answer: incredibly stressful. Another part of the stress
comes from the observing side of social media. Because people tend
to heavily curate what they present, it can sometimes seem as if
everyone else has better internships, earns higher grades, and attends
more exclusive parties.
152 FOREIGN AFFAIRS
/ N
THINGS REALLY ARE DIFFERENT
Some argue that all this is nothing new, that school has always been
anxiety inducing. But regardless of whether today’s students really do
face a greater number of stressors than generations past, there is little
doubt that the impact of those stressors is felt more than before. Today’s
young adults seem to arrive at college with less resiliency and a lower
appetite for risk and failure.
November/December 2018 153
Sylvia Mathews Burwell
In raising their children, parents have focused more on protecting
them from stress and anxiety and less on teaching them how to cope.
Today’s incoming classes are of a generation that received athletic
trophies merely for participating. Becoming so used to winning makes
it all the harder to deal with losing. It
Today’s young adults seem makes it harder to learn resiliency.
On top of this, parents have created a
to arrive at college with less culture of risk aversion. Today’s students
resiliency and a lower were warned as children not to walk
appetite for risk and failure. home alone, and they grew up playing
on playgrounds designed to break their
falls. In many ways, children have been
taught both explicitly and implicitly to avoid risk, and for many of
them, the resulting safety has made them less capable of coping with
failure and disappointment.
When students have a panic attack because they received a B minus
on a test, it becomes clear that parents have probably not done enough
to prepare them for the fact that life involves both success and failure.
Today, high school graduates arrive on American University’s campus
with higher SAT scores, more Advanced Placement credits, and more
International Baccalaureate degrees than ever before. They are book
smart but perhaps less life ready. This problem can be seen not only
in how they deal with bad news but also in what they know about basic
life skills, from managing their finances to doing their laundry. There
are exceptions, of course, but American University’s faculty and staff
are probably not unique in observing that students increasingly come
to college with less mastery of such skills.
Another way that today’s students differ from their predecessors is
in their relationships with their parents and other adults in their lives.
Gone are the days when a five-minute phone call every Sunday was the
extent of communication with family. For many students, thanks in
part to advances in technology, there is nearly constant communication
with parents through texting and calls. In the interactions I see with
faculty and staff on campus, students seem to seek more adult guidance
and assistance with problem solving than previous generations did.
Stress can play out in different ways. One common type of student
is the overachiever: a first-year student who was at the top of his class
in high school and never needed to exert much effort to get there. In
his first semester at college, he fails a couple of midterm exams and
154 FOREIGN AFFAIRS
Generation Stress
finds himself too embarrassed to lean on his support network from
home. At night, when his friends have gone to bed, he heads to the
library and immerses himself in his studies. Eventually, he’s sleeping
less than four hours a night. And only when he reaches a breaking
point does he seek out counseling that can help him work through his
own expectations and time management.
Another common type is the overcommitted student. She comes to
college with a strong sense of what she wants to do afterward-say,
work on a political campaign-and loads up on extracurricular activities
in pursuit of that goal. In her first semester, she joins several political
clubs, runs for student government, and takes on a part-time internship
on Capitol Hill. She even adds an extra class to get ahead. Without
this level of commitment, she fears, she won’t be competitive for the
best campaigns. The result is long days of meetings, work, and classes,
along with late nights trying to catch up. Only after she breaks down
emotionally does she confide in her dorm’s resident assistant, who
refers her to the counseling center.
CHALLENGE AND RESPONSE
According to a 2015 report from the Center for Collegiate Mental
Health, the number of students visiting counseling centers increased by
30 percent between 2009 and 2015 (enrollment grew by only six percent).
Across the country, colleges and universities are adding extra professional
staff to help students, in part because the types of counseling needs have
also expanded. Some students arrive with complex medication regimes,
whereas others are part of the growing number of students experiencing
thoughts of suicide, a trend that requires more emergency services, such
as 24-hour rapid-response counseling. As student bodies become more
diverse, schools need support staff who can reach across cultural divides.
Adding all these resources is not easy, especially for schools in rural areas,
where mental health providers are in short supply.
Universities are struggling to keep up with rising numbers of students
seeking support: according to the Association for University and College
Counseling Center Directors, in 2016-17, 34 percent of college counsel-
ing centers had to put some students on a waitlist. And it’s important to
note that many students remain reluctant to talk to a professional: while
stigma concerning mental health today is less than what it was in the
past, it still impedes students from recognizing their challenges, seeking
out help, and committing to treatment.
November/December 2018 155
Sylvia Mathews Burwell
Universities are putting more effort into prevention. Harvard
University has started the Success-Failure Project, a program that hosts
discussions aimed at redefining success and dealing with rejection.
Duke University offers a mindfulness program designed to help students
manage stress. At American University, we introduced a mandatory,
two-semester course aimed at helping students adjust to their first year
in college. Of course, it’s important to make sure such programs don’t end
up adding to the problem: when I asked students if stress-reduction
seminars might be helpful, one responded, “Please don’t add anything
to my already packed schedule that will further stress me out!”
Campuses that focus on creating a sense of community and belonging
find that students who have support networks to turn to are better able
to work through their challenges and stress. This sense of belonging
can act as a preventive tool, countering students’ feelings of loneliness
and depression and providing a way for them to alert others to the
problems they are facing. Increasing a campus’ sense of community can
often mean running into long-standing questions-for instance, about
the value of fraternities and sororities and about whether to increase
student engagement by offering more activities and clubs. Universities
must face these old questions in the new context of growing mental
health issues.
PRODUCING HAPPIER GRADUATES
Universities are in the early stages of grappling with the increase in
stress and anxiety. Although there is no agreed-on formula at this time,
there are some approaches that show promise.
There is general agreement that the solution lies in more education
about the issue, inside and outside the academy. Creating awareness
of the problem and teaching faculty, staff, and students how to prevent,
recognize, and respond to it can help. Just as many campuses have
made progress on educating students about sexual assault, they can do
the same when it comes to mental health.
Moreover, as odd as it may sound, universities should draw on some
of the lessons learned during the 2014 Ebola outbreak-a global health
threat that emerged during my tenure as U.S. secretary of health and
human services-and adopt a public health approach to the problem.
With Ebola, the priorities were prevention, detection, and treatment.
These core elements can also guide universities in framing their approach
to mental health. Prevention can mean introducing courses that help
156 FOREIGN AFFAIRS
Generation Stress
students adjust to college life. Detection might mean developing ways
to quickly notice when a student doesn’t download an assignment or
show up for classes.
As for treatment, universities need to secure adequate resources for
counseling so that students seeking help receive timely and effective
care. On many campuses, triage systems prioritize the most acute
cases, determine which students can be treated in a limited number of
sessions, and refer to other providers those who require long-term
care. No university is capable of offering unlimited sessions and all
kinds of care, so administrators need to determine which cases to
refer and which to keep in house. They must also have the capacity to
meet demand without long waitlists for treatment. To inform their
investments, universities should use data about their campus’ particular
needs-especially at a time when the economics of higher education
are under both scrutiny and pressure.
Universities also need to acknowledge the power of communities.
Communities can not only act as a knowledge base and a source of
referrals; at a more basic level, they can also stem the problem to begin
with. Study after study has found that social connectedness is correlated
with well-being and resiliency, so universities should strive to build
inclusive communities. Encouraging in-person (not Instagram) con-
nections can help. Administrators should make sure that students are
aware of the clubs and groups on campus, offer a sense of belonging,
and invest in first-year residence halls and other communities for living
and learning. Faculty and staff should recognize the value of engaging
with students.
Finally, students, parents, and universities should embrace the
healthy idea that stress is a part of what makes college great. College
students develop intellectually, socially, and morally through a com-
bination of challenge and support. Their time on campus should be
not so overwhelming that they retreat, yet not so comfortable that
there is no incentive to grow. Thus, the college experience should
teach students not to avoid challenges-life is full of them, after
all-but how to handle the stress that results. Recognizing this is
the first step to producing more resilient students, as well as happier,
better-adjusted graduates.0
November/December 2018 157