Long Reads

Making a good grade in mental health is an increasingly tough assignment

A good home life. A college scholarship. A suicide attempt.

Promising college students like Olivia Eiler (above) hit rock bottom with mental illness. A record number of college students now experience anxiety, depression, and consider suicide while chasing degrees and dealing with the stress that comes with it, a new report shows.

Story by Rasmus Straka

and photo by Lydia Schweickart

Olivia Eiler held 100 antidepressants in her hand.

The 18-year-old freshman at Western Kentucky University kept telling herself not to swallow them.

After enjoying a privileged childhood, she thought about her dream of becoming a television producer.

But the impulse to end her life came fueled with one semester without friends, and an “unhealthy” relationship with her boyfriend, who lived two hours away.

She suffered from anxiety and depression.

Eiler lived in a dorm room that she left only when she needed to eat, exercise or attend classes. That led to travel frequently from Bowling Green, Kentucky, to her hometown in New Albany, Indiana, where her parents lived.

“College is intense,” said Eiler, now 20 and a junior. “I thought that if I got home, it would be OK with my anxiety and depression because it was OK when I went to high school in New Albany. But it just got worse.”

At her parent’s house, she sat on the floor in her childhood bedroom with the pills in hand. Her usual supply lasted a month, but her doctor prescribed her a two-month’s supply, so she would not have to leave campus to get a refill.

She did her research. On an internet forum, she read about a girl who went into coma, developed heart problems and was hospitalized after taking too many antidepressants.

That girl took 600 milligrams.

Eiler would take 1,000 milligrams.

The bottom line: College can be a killer, figuratively and literally.

Eiler is among thousands of college students, who grapple with mental health issues on campuses throughout the United States.

The American College Health Organization began surveying the mental health of college students in 2000 and recently published its report “National College Health Assessment II.”

A comparison of survey results from fall 2008 to spring 2018, found that a record number of students now cope with mental health issues.

  • In 2008, 18.2 percent of students said anxiety impacted their academics. It rose to 26.6 percent in 2018.
  • In 2008, 11.2 percent of students said depression impacted their academics. It rose 18.7 percent in 2018.
  • In 2008, 27.2 percent of students said stress impacted their academics. It rose 33.2 percent in 2018.
  • In 2008, 6.4 percent of students said they considered suicide. It rose to 12.1 percent in 2018.
  • In 2008, 1.3 percent of students said they attempted suicide. It rose to 1.7 percent in 2018.
  • In 2008, 30.6 percent of students said they were so depressed they struggled to function. It rose to 41.9 percent in 2018.

These numbers have never been higher since ACHA began surveying college students, said Marta J. Hopkinson. She is the chair of the organization’s Mental Health Section and director of mental health at the Health Center at the University of Maryland.

“It is alarming that the number of students in distress and seeking services are rising,” she wrote in an email.

While Eiler still struggles with mental illness, she has found ways to tackle her anxiety and depression. She receives the Cherry Presidential Scholarship – $12,000 a year – and she has earned A grades in all classes while attending Western Kentucky University, the transcripts she provided show.

And she started a chapter of a mental health support group in Bowling Green in collaboration with the nonprofit organization the Depression and Bipolar Support Alliance.

But that is now.

This was “then.”

Eiler grew up in New Albany, a city of about 36,000.

Her father, Jeff, worked as a manager for an electronic manufacturing company, and her mother, Becky, taught eighth to 10th grade students in math.

When Becky had Eiler’s two older siblings, Emily and Owen, she became a “stay-at-home-mom,” Eiler said.

Unlike half of marriages in the United States, her parents stayed married, so she avoided the trauma divorce causes. She never worried about money, and the family only moved once to a house which was two streets away. Schools and friends stayed intact.

But the mind does not always recognize the good life, and in fourth grade, Eiler showed symptoms of depression and anxiety — “a lot of mood swings” and feeling “really insecure.”

“I was overweight — I always knew that, but it just hit me in fourth grade that I should be more insecure about it, so I stopped eating,” she said. “In hindsight, that was when it really started.”

Her parents did not notice the symptoms because her brother Owen, who also suffered from depression and anxiety, was “outward,” “would yell,” and “break things.”

Eiler behaved differently.

Secretly, she would harm herself. Besides restricting her eating, she began to cut herself. Most of the time she used a shaving razor or safety pins.

“Everybody is different,” she said. “It’s just whatever is available. I felt that my parents had so much to worry about with my brother, so I didn’t want them to worry about me, too.”

She burned herself with hot water or a curling iron. The harm happened “a lot of times,” when the anxiety and depression overwhelmed her, she said.

“For me, instead of focusing on fixing what’s emotionally going on, I’ll just create the physical wound that I then have to fix,” Eiler said. “It’s a kind of distraction. The wound lasts for like three or four days, where I’m not focused on my emotions but focused on the pain.”

She hid the wounds by not cutting her arms or legs “like a lot of people.” Instead, she cut her stomach or hips.

In eighth grade, Eiler told her friend of four years, Jack, that she harmed herself.

“Hey, you can’t tell anybody,” she demanded.

He promised not to, but few months later, Jack told the school counselor. The counselor said Eiler needed to see a doctor, who diagnosed her with anxiety and depression.

The anxiety was not a specified disorder such as social anxiety or a phobia such as a fear of flying, the doctor told her. She could suffer a panic attack when grocery shopping.

She also suffered from chronic depression, the doctor told her. Unlike seasonal depression, such as winter depression, her depression disorder could hit her any time.

Eiler went to her first counseling appointment with her parents.

It was “awkward.”

Her father behaved like a “stereotypical” man who “didn’t like to talk about feelings,” and her mother was disappointed because Eiler hid her struggles.

“Why didn’t you tell me,” her mother said.

“Well, you had stuff going on,” Eiler replied.

She understood her mother’s disappointment.

“She thought that it was me being sneaky and deceitful, whereas I thought that I was doing her a favor,” Eiler said.

She began to take an antidepressant pill called Lexapro used for treating depression and anxiety by restoring serotonin in the brain. There were 25 million prescriptions in the United States in 2016, shows data from the medical database ClinCalc.

She took the antidepressant from eighth grade until halfway through her freshman year of college – from the spring 2012 to winter 2016.

But Eiler said the prescription stopped working after six months.

During her high school years, she seemed “well adjusted,” and did not notice that the Lexapro stopped working. But when she started college, she said to herself:

“Whoa, this is getting tough.”

The college student mental health crisis is not new.

The International Association of Counseling Services reported in 2014 that 94 percent of directors identified recent trends toward greater number of students with severe psychological problems continues to be true on their campuses. And 89 percent of the directors also noted increases in anxiety disorders.

Karl Laves holds a doctorate in counseling psychology and serves as the associate director of counseling at WKU. He agreed that the problem has been long term and growing. During the past 10 years, 50 to 100 more students each year seek counseling at the center.

“Counseling centers across America are all saying the same thing — each year, more students come in for help,” he said. “You bring in young, bright people into a very intense environment. Even if they had problems before that weren’t related to the academics, the academics are going to make those problems more troubling and more disruptive.”

In 2018, a study was published in the Depression and Anxiety medical journal. It found that three in four college students encountered at least one stressful life event in the past year.

The students become vulnerable to mental health issues because of mounting expectations, a strive for finding self-identity and shock from leaving home for the first time, the study found.

Before Eiler started college, she knew what to expect.

Her sister — a nursing student at the time — would be studying all the time when Eiler would peek into her room.

But she did not expect the social change.

“Both of my parents, both of my siblings, and both of my sibling’s spouses went to the same college in New Albany,” Eiler said. “I was the first to go away for school.”

In summer 2016, she started her first semester at WKU.

A new home greeted her: a tiny, white-walled dorm room with Spartan furniture and little sunlight — and a girl she never met before.

“We had a small kitchen in the dorms that the entire floor shared — 50 people would share it,” she said.

Dorm life requires a drastic change in lifestyle.

“It’s a ton of different rules, and I was just like ‘I’m in college. I want my own spot with my own rules,’” she said.”

The dorms never felt like a home.

She continued to score high in classes, but her anxiety and stress scores rose, too.

“I always felt like it was expected of me to be perfect,” Eiler said. “I needed to get the highest grades as the WKU scholarship required a certain a GPA.”

During her first semester, Eiler also coped with an eating disorder, which made the meal offerings on the campus “kind of intimidating.”

She avoided fast-food places, which speckle Western Kentucky University.

“There are hippies that say that what you put into your body is how you’re going to feel,” she said. “To some extend that is true. I couldn’t eat pizza every day.”

Her peers at the college ate together in groups, Eiler noticed in her first semester. It seemed that the students never ate alone.

“I didn’t have anybody to eat with, and I thought ‘I guess I’m just not going to eat,’” she said.

She also noticed that the students went to grocery store in groups.

“It seemed that everybody has to have somebody with them to do something,” Eiler said. “Everything is a social thing in college — that is stressful (for me).”

Her solution: she fled into her dark dorm room and sleep for 12 hours to 14 hours a day.

“My roommate was probably noticing that I was sleeping all the time, but we didn’t talk about it,” she said. “She was nice. I liked her as a person, but we weren’t friends, so it was like I couldn’t tell her what I was going through.”

In winter 2016, she fled home with the 1,000 milligrams of antidepressants.

Western Kentucky University with an estimated 20,000 students did not file a 2018 report with ACHA, which 140 other universities did, the organization reported.

The university does not participate in the surveys anymore, said Rachel Franklin, a graduate assistant at Health Education & Promotion department.

“WKU was unable to complete the 2018 survey due to a reduction in staffing and funds,” Franklin wrote in an email. “The process is a rather large undertaking and requires a lot of manpower to distribute it and ensure accurate data is returned. Our most recent survey was completed in spring of 2016.”

Initially, a request for the university’s previous reports was denied because it is “not best practice for us to release the entire report to individuals,” Franklin wrote.

However, a freedom of information request resulted in the release of four reports covering the spring of 2010, 2012, 2014 and 2016. Deborah Wilkins, the college’s general counsel, said these were the only reports available.

They showed that while fewer students at Western Kentucky University reported that their academics were influenced by anxiety, depression, and stress compared with students in the rest of the United States, the number of students who experience mental health issues — such as anxiety — rose at the college.

The Western Kentucky University reports show that in spring 2008, 12 percent of student respondents coped with anxiety, and in spring 2016 it rose to 16.4 percent.

“The 2016 data is still relatively accurate and representative of today’s statistics,” Franklin wrote.

When students cope with mental health issues, it comes with myriad consequences. They might struggle with their academics, get more prescribed medicine and consider suicide.

While students at WKU suffered less challenges from anxiety, stress, and depression compared with their national peers, the number of students at the college who in spring 2016 tried committing suicide was 2.2 percent.

Likewise, the number of students on prescription medicine represents a growing problem, show several reports, including a recent study by the Center for Alcohol and Addiction Studies at Brown University.

It found that 5 percent to 35 percent of college students misused prescription stimulants, primarily for studying.

At Western Kentucky University, the number of new freshman students – which are legally on prescription medicine – has grown, too.

It is a problem, confirmed the university’s President Timothy Caboni during an interview aired in November on Kentucky Educational Television’s “Connections with Renee Shaw.”

“We know a fully a third of our students come to campus now on some sort of medication,” Caboni said. “We need to be able to address those mental health challenges and do it proactively to help them with the support they need.”


Students with mental health issues could go to the Counseling & Testing Center staff at Western Kentucky University.

“The research that I have seen states that less than 50 percent of students that have been diagnosed with a mental illness actually seek the services of the university,” said Matt Davis, assistant director of the Student Accessibility Resource Center.

“This may be due to the fear of possible stigma that is associated with being ‘labeled’ as mentally ill or it could be the student is in denial and doesn’t believe services would be beneficial.”

Some students may have their symptoms under control and do not need assistance, Davis said.

When students do go to the counseling center, they fall into two groups, Laves said.

The first group — anxious, nervous or worried students — indicates “that something bad has yet to happen, but they’re worried that it’s going to,” he said.

They do not worry about grades. Instead, they worry about relationships or if they have chosen the wrong major.

The second group — depressed students — “were probably anxious or worried for a while, but they have worried for so long that they’re depressed,” Laves said.

They can hardly get out of bed, and if they go to class, they rarely pay attention. They feel flat, trapped or helpless.”

Laves mentioned several reasons for why the students struggle.

“American education, well, it’s American,” he said. “That is not a compliment. It’s always about getting, obtaining, achieving and winning. We put way too much pressure on American high school students. Not only do they need to decide if they’re going to college or what college they’re going to, but also what they’re going to major in.”

When the students enter college, they live on their own for the first time.

“You’re talking about students that never done their laundry, cleaned their own room, cooked their own food or fed themselves,” Laves said. “But you’re also talking about a lot of students that have never shared a room. Their whole life they have had their own room with their own TV, and then they come here, where they have to share with others. It freaks them out.”

Lastly, many college students turn their mental illness inward. In particular, female college students “are often depressed because they will not let themselves be angry,” Laves said.

“Even now in America, there’s still so much sexism. Women are taught to be passive and that being angry is wrong,” he said.

Besides the counseling center, Western Kentucky University arranges training events for suicide prevention.

In November, the college hosted a training event, called “QPR” — “question, persuade and refer.”

With a PowerPoint-presentation facing 11 faculty members stood the event’s coordinator, Betsy Pierce, the university’s outreach coordinator with a master’s degree in clinical psychology.

“Let us say you have seen some clue or sign that could indicate that the person is suicidal,” Pierce said. “If you are wondering, ‘Should I ask the question?’ please, ask the question.”

Pierce said one way is to use a direct approach, and she provided this example:

“When some people seem as upset as you are, as sad as you are, as down as you are, as hopeless as you seem to be, sometimes they wish that they were dead. So, I am wondering if you are feeling that way, too?”

“See, you put it out there,” Pierce said. “You have asked the question for them to talk a little bit more.”

But not every faculty member is as interested in understanding the student’s mental health, said Laves and several students, who attended a meeting with the Depression and Bipolar Support Alliance on the campus.

A student at the meeting who attended another college said flyers were handed out to students asking “are you feeling down?”

It was a “simple, not a hardcore question,” but the student had not seen that approach at Western Kentucky University, she said.

Another student mentioned that the support group previously could send emails to every student to encourage them to attend the meetings. But this year that service ended, she said.

A student had a professor who was an “asshole,” she said.

After the student experienced a rough patch, a professor wrote on the student’s paper that “you are wasting my time.” But the professor was not aware of what the student was going through.

And a student said that she experienced panic attacks in class, left the class and got docked for attendance. Some professors do not acknowledge panic attacks as an excuse miss class, doubting they are real, the student said.

Laves agreed.

Although “some” faculty understand student mental health issues and work well with students, “some don’t care and don’t want to help the students — no matter what,” he said.

And Laves said that staff also might want to help, but sometimes they fear making things worse by talking with students. Or they are not qualified to assist. A QPR-training event or a book, which Laves is working on, could educate them.

“When dealing with mental health issues, some people will have a better understanding than others, but anyone can refer a student who needs assistance to the appropriate resources,” Caboni stated in an email.

In New Albany in December 2016, Eiler looked at the antidepressant pills. Then she swallowed them.

As time passed, she experienced a drunken feeling. She found it odd that she did not throw up. On the Internet, she read that if people overdosed, they would tend to vomit.

She grabbed her phone and dialed a “Poison Control Hotline” to ask why she was not vomiting.

“Hello, this is Poison Control,” said the woman who answered the call in a deep voice. The woman sounded bored and disappointed, Eiler thought.

Eiler hung up and laid on the floor. For a while, she daydreamed. And then she went into her parent’s bedroom to wake up her father.

“Hey, dad, I probably need to go to the doctor,” she said.

In the car, her mother was worried — and mad — because she woke up her father instead of her mother.

The bedroom door was closest to the father’s side of the bed, Eiler told her mother.

In the emergency room, the doctors gave her a charcoal-based liquid — black and gritty, she remembered.

Charcoal prevents the body from absorbing poisons.

“It tastes like you’re eating chalk,” she said. “I had to drink a Solo-cup worth of it.”

While lying in the hospital bed, she still felt drunk. When people came in the room, she could not recognize them. And her arm felt lazy, like when a limb falls asleep.

She stayed in the hospital for two days and stayed in a room with glass windows. Through them, she glanced through into the emergency room.

“It was weird because they had a hospital employee, called a ‘sitter,’ who is like a babysitter,” she said. “My parents stayed with me the whole time, but still, the sitter had to sit in the room with me 24 hours a day to make sure I didn’t do it again. They wouldn’t even let me go to the bathroom alone.”

Eiler was transferred from the hospital to a mental health hospital, where she stayed for five days.

A staff worker noted the triggers which led to her suicide attempt. The end of the relationship with her boyfriend, lack of exercise and communication with her mother served as three of the triggers, show documents provided by Eiler.

But she had other triggers. It was “college” and “grades,” stated the document completed and signed by the staff worker.

She lived in a ward with 20 others from teenagers to adults.

“You couldn’t have shoelaces, you couldn’t have jewelry, and you couldn’t have a belt,” she said. “You could have crayons, but you couldn’t have colored pencils because you might stab yourself with it.”

Eiler shared a room with a woman who overdosed on methamphetamine or heroin, she recalled. Close to their room stayed a man, who would wake up every morning at exactly 5 a.m. Then he would scream.

At first, Eiler feared the people at the mental health hospital. They had taken drugs. They were dangerous, she thought. But aside from two, all were “pretty nice people,” she said,

“The first day was just scary,” she said. “I just wanted to go home and said ‘I promise that I won’t do it again, come on.’”

But when the time came to leave the hospital, she did not want to go home.

“It was like in this little environment with those 20 people, we were all kind of messed up,” she said. “The only thing that you focused on was yourself. When I was going back home, I had to deal with my parents again, deal with work, and deal with stress.”

And she would have to deal with school.

When she returned home, her mother told Eiler’s supervisor at work that her daughter went to the hospital because of low levels of potassium.

Since then, Eiler’s colleagues at Old Navy ask her how her potassium is doing. She usually said “Oh, good, thanks.”

After she left the mental health hospital, she faced a tough decision about college.

Initially, she chose Western Kentucky University because at the college in New Albany she could only take classes in business, education and nursing, she said.

“It was a big decision to decide it if was going to come back because I had felt terrible at the university,” Eiler said. “I was afraid what would happen if I returned.”

But she wanted to be a broadcaster.

“I was telling myself ‘If you want to do this, you’re going to keep studying at Western,’” she said.

Laves said that it is not easy to fight against the mental health epidemic, which requires universities, students and politicians to work together.

Some universities in United States have general policies that do not ask students to declare majors their first year, which he supports.

“I think that college students should spend the first year to take their general required classes and explore,” Laves said. “I think that’s why college students change majors so often because the first one was forced or rushed.”

During the past 20 years, kids have been diagnosed with the mental health disorders before going to college and are getting treatment earlier, said Hopkinson.

“However, they then need support when they get to college,” Hopkinson wrote. “Some of the tactics colleges are employing now in attempt to prevent crises include resiliency training to help students do proactive self-care before they enter a crisis, meditation and other stress reduction methods, dog therapy, and now there are smartphone apps to assist students in doing self-care.”

Caboni said that demonstrating that you are learning and understanding the material presented is a necessary part of the classroom experience.

“Instead of looking for ways to reduce pressures, both internal and external, we should focus on helping students effectively deal with those pressures,” Caboni wrote. “Pressures will continue long beyond college, and this knowledge will help prepare students for a good life.”

Eiler came back to Western Kentucky University for her second semester in spring 2017.

She went to counseling at the university and made friends by working voluntarily for the student news station, News Channel 12, where she currently serves as news director.

When she met three other female students, she said farewell to dorm life and moved into a student apartment with them.

“We have the kitchen, we have a living room, a laundry room – it’s things that I didn’t have before,” she said. “It’s so nice. We each have our own room and our own bathroom, which is nice because my roommates are messy, so I can keep my space clean.”

But she still struggles with her mental illness.

Recently, two of her friends went to dinner without her.

“Well, they didn’t invite me, so I guess that they hate me,” Eiler said about her first thought. “But it’s ridiculous. Of course, they do not hate you. But with anxiety and depression, you can think that nobody likes you.”

But a change occurred, she said.

She went to the counseling center several times, where Laves helps her.

When she thinks friends do not like her, she learned to repeatedly tell herself that she is making it up. And when someone is rude to her, she does not internalize it and think she is a “terrible person.”

“No, he’s being an ass,” she said. “That’s him – that’s not me who is terrible.”

And when she does not exercise six days a week, she calms herself by saying that training only four or five days a week is fine.

In June and July 2017, she helped organize the Bowling Green chapter of the Depression and Bipolar Support Alliance. Last summer, Eiler filled out almost 40 pages of forms.

The group holds meetings each Wednesday during which students talk about their mental health issues.

“The biggest thing for me has been to help other people realize that they’re not alone,” she said.

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