TAMPA — Somewhere deep in the fog of depression, Breanna Eaton made a call.
She needed help, she told the University of South Florida's counseling center.
After class, she would lie in bed and sob until sleep overtook her. She'd stare at the quotes on her mirror — You're worth more than harming yourself, or her favorite Bible verse, She is clothed with strength and dignity — and cry, willing herself to believe them.
Just try to be happy, her husband would say, driving her to campus when Eaton felt more like a rag doll than a person. Showering became overwhelming, migraines and nausea disorienting. She felt trapped in her own exhausted brain, screening calls from her niece, unable to find words to describe the depths of this smothering numbness.
Counselors were on call for students in crisis, the USF center told her. Eaton was desperate, but was this an emergency? She made a regular appointment, two to three weeks away.
She hung up, then reconsidered. In the past, she had hurt herself when she wasn't getting help. She knew she couldn't wait so long.
• • •
Florida's higher education leaders are calling it a crisis. College students wait up to a month for appointments at short-staffed centers. They get shorter appointments, less often, as universities flounder under the pressure of unprecedented demand for mental health services.
As enrollment has boomed, counseling staff hasn't kept pace. Effects of budget cuts linger. Meanwhile, more and more students with serious mental health issues are entering college.
The Florida Legislature rejected a push for more mental health funding last year, but higher education leaders have returned with a bigger request. With a $14.5 million investment, universities could hire 137 new staffers for counseling centers.
"We know that the number of counselors we need per student is way off at every university," said Norman Tripp, a member of the state's higher education board and a leader of the charge. "We know for a fact that students who need immediate service are told that they have to come back three or four weeks later. We know that when they should be providing a one-hour service, they're getting a half hour."
Ten of Florida's 12 state universities fail to meet recommended staffing levels of 1 counselor per 1,000 students. The ratio goes as high as 1 to 3,400.
USF, where the need is highest, stands to gain the most. With 25 new hires on the table, staff would more than double.
Some experts worry that without a serious commitment to collegiate mental health, many students will face serious long-term harm.
"If we do nothing," said USF psychology professor Jonathan Rottenberg, "we're going to have something of a lost generation."
• • •
The college years are a hot spot for mental health issues. Friends, family and all things familiar are stripped away as students enter the major leagues of academic and social stress.
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"Depression and anxiety rear their heads at that moment," Rottenberg said.
But the problem is intensifying, leaving experts pointing to a litany of factors: financial stress, a millennial "lack of resilency," social media that both aids connection and fuels isolation. Better treatments have also opened college doors for those with serious psychological issues.
The numbers bear out the trend. Reports by Pennsylvania State University have found that counseling center use has far outpaced enrollment growth.
A 2016 American College Health Association survey found that 58 percent of students had felt overwhelming anxiety in the last year, and 37 percent reported feeling so depressed it was "difficult to function." A national survey of counseling center directors in 2014 found that more than half of clients had severe psychological problems — a steep increase from 16 percent in 2000.
In Florida, over a six-year period, student counseling clients have jumped nearly 50 percent.
• • •
"Cut the umbilical cord," Breanna Eaton says her mother always told her. It was like her mom didn't want to believe what she was seeing, that it was depression and a vicious eating disorder that kept Eaton close to home in Tulsa.
Eaton dipped in and out of "her moods," as her family called them. She cut herself. When her mom finally told her she needed help, Eaton cried.
A therapist helped. So did in-patient treatment and the birth of her niece. Eaton decided to leave Oklahoma. She got into USF, aloft on hope. She would be a counselor one day.
But depression's shadow followed her to Florida. Maybe Eaton shouldn't have signed up for classes that fall, after a stint at Tampa Bay Behavioral Health, but she was grasping for routine.
When USF listed a wait time in weeks, she was adrift again.
• • •
Not long after arriving at USF for medical school, Nikos Karakashian made an appointment. With all of the stress to come, he knew being proactive was key.
In counseling, he worked to build a more intentional life.
"I've always looked at it as something that you can do to promote health, not just something you would do to remedy an illness," he said.
Now 27, a fourth-year student in the Morsani College of Medicine, Karakashian said having a regular counselor can give students stability and hope.
"It helps people feel like you're not alone, that progress is being made, that there's someone out there who, if you need, you can give a call," he said. "It's a relief."
USF's counseling center prizes access and quality care above all. But in these days of increased demand, the center has extended hours and made adjustments so its wait list doesn't grow unwieldy.
Students are encouraged to try group therapy. Between sessions, they can drop in on mindfulness seminars or try online modules. In the last six weeks of the semester, USF slashes sessions in half to keep students churning through.
Last year, the center served nearly 2,900 clients, most for anxiety, stress and depression. Sessions are free and unlimited. At the semester's peak, students wait up to 14 days for counseling. For a more intensive psychiatric appointment, housed in Student Health Services, students may wait 18 days. Urgent needs take priority.
"When students are in a mental health crisis, it's not something where you can say, 'Hang in there, see you in the morning,' " said Dr. Joe Puccio, medical director of USF's Student Health Services and interim co-director of the counseling center. "When they're in crisis, they're in crisis."
With more staffers, USF could further extend hours and bring students in earlier, instead of at critical moments, said Lisa Ferdinand, interim co-director.
"We would do more outreach, more consultation, more education," she said. "I think we're all hopeful that it will happen."
• • •
On Wednesday, in the cavernous sunlit center of Florida Poly's main academic building, a question hung over the state's higher education leaders in their suits and ties.
How can they make the strongest case for this need?
Slides on TV screens showed dramatic increases in student well-being after counseling. Surveys showed rising retention and graduation rates. Colorful bubbles framed testimonials: "My life felt like it was up in flames when I first started counseling. My counselor really helped me."
Board of Governors chairman Tom Kuntz said he worried that the picture seemed too rosy. To make the case for funding, he said, the board would need to show the reality of the crisis.
"When the students come to see the counselors, there's dramatic success," Kuntz said. "However, we don't have the counselors we need, so the next slide should be showing, here's our deficiency and why we're sounding the alarm and asking for a lot of money."
A few leaders asked why, if the problem was a crisis, universities hadn't prioritized it already.
"It's like a triple tsunami," explained Jan Ignash, the board's chief academic officer. "It's a perfect storm. It's unprecedented."
The board's student representative, Jacob Hebert of the University of West Florida, called it a symptom of the system's pressure on students to perform.
"We are trying to be more competitive while maintaining a higher level of students," he said. "We have to treat the side effects, and this is the side effect."
After the discussion adjourned, USF System president Judy Genshaft vowed to fight for funding in Tallahassee.
"We need to work very hard to make a difference in the staffing of our counselors," Genshaft said. "Student success is all about feeling good mentally."
USF also has plans for a wellness center complex that would expand space for health needs, including psychiatric services.
Creating a system of care isn't enough, said Rep. Kathleen Peters, R-South Pasadena, a mental health advocate. "If we don't fund it, it's meaningless," she said.
• • •
Her grades slipping, Breanna Eaton called a therapist she'd seen before, outside of USF. She got an appointment in a few days.
Together, they decided she would drop her classes for the fall 2016 semester. Eaton knew she'd be back when she was ready.
She's easy to find in her behavioral health care classes now, with bright blue and purple hair. She still sees outside specialists on her own dime.
"I need to be able to just schedule it when I need it," she said.
She's always writing down quotes for her mirror to remind herself she's strong, a warrior. The depression lingers, but she knows who to call.
Contact Claire McNeill at firstname.lastname@example.org or (727) 893-8321.