Statement Regarding Recommended Staff to Student Ratios
The roots of IACS go back to the 1950's when accreditation was first extended to counseling services. Representatives of the counseling settings comprising IACS worked for more than two years to establish an accrediting program relevant to the Association's diverse constituency. The result of this effort was adoption, by the Board of Directors in April, 1973, of common principles and procedures to govern accreditation and separate criteria and standards for the evaluation of each counseling setting. The standards are periodically reviewed by the IACS Board of Accreditation and any changes must be approved by the Board of Directors. The latest update was in 2010.The Board of Accreditation and Board of Directors are comprised of directors of counseling centers who are very experienced and are among the most prominent experts in the area of university and college counseling center administration and service. They represent the 200 counseling centers worldwide that are accredited by IACS.
In addition to the IACS standards, there is another set of standards that have been published with application to university counseling centers. The Council for the Advancement of Standards (CAS) has published standards for all student services areas, including counseling centers. However, some counseling centers find them too marginal for their purposes. The University of California Counseling Center Directors agreed, for instance, to adopt the IACS standards as minimum standards for university counseling services practice, feeling they were more appropriate, and more rigorous, than the CAS standards.
The standard that addresses level of staffing is V.C.1., which states, “Every effort should be made to maintain minimum staffing ratios in the range of one F.T.E. professional staff member (excluding trainees) to every 1,000 to 1,500 students, depending on services offered and other campus mental health agencies”. This ratio is aspirational by nature, encouraging counseling centers to approximate the range in order to ensure that there are an adequate number of professional staff members to meet the clinical needs of the students, as well as the other service needs of the campus community.
The ratio was originally established through the combination of empirical analysis and judgment of experienced counseling center directors who were leading experts in their field. It is very difficult to come up with a specific ratio that ensures adequate staffing at all university counseling centers, hence there is a range and not a specific number. Counseling centers at larger educational institutions tend to have slightly higher ratios than those at smaller colleges or universities. The average ratio of mental health professionals to students as reported in the National Survey of Counseling Center Directors (2013) is 1 to 1,600. Below are some of the likely consequences when the ratio increases beyond the upper limits recommended by IACS:
1. The waiting list will increase. This diminishes a counseling center’s capacity to serve all students. Students in crisis tend to get the greater share of limited resources resulting in less assistance to other students who are not so acute, but who are dealing with more “traditional” adjustment and developmental disorders. These students may fall through the cracks. Due to the wait list, students may choose to not seek counseling at the counseling center. Also, students who are put on a wait list are more likely to leave the university. A study by Wilson, Mason and Ewing (1997) in the Journal of Counseling Psychology found that attrition rates increased by 14% for those students who were put on a wait list compared to those who received timely counseling. Also, the longer the wait list, the greater the liability for the counseling center and university (see number 3).
2. Difficulty providing services to students experiencing increasingly more severe psychological issues. Of the 367 universities and colleges that filled out the National Survey of Counseling Center Directors (2013), 95% reported that the number of students with severe psychological problems has increased in recent years. As the severity increases, so does the time that’s required by the mental health professional to adequately manage the case. Thus, the ratio of counselors to students should actually decrease as severity of issues increase. This will probably be a factor that will be considered the next time that the IACS standards are reviewed.
3. Liability risks to the counseling center and university increases. Not all disturbed students who seek counseling present themselves in crisis. In fact, some are quite guarded and may not divulge all of their issues in an intake. When counseling resources are stretched, these students may be triaged at a lower level and put on a wait list. Imagine the liability that the counseling center and university would have if it was discovered that a student who went on a shooting spree had gone to the counseling center for help only to be put on a wait list. In addition, counseling center directors report an increased level of concern about liability risks regarding student suicides. The legal litmus test when an entity is being sued is did that person or agency adhere to the “standards of the profession”. Since the standard ratio of mental health professionals to students is 1 to 1,000-1,500, a counseling center with a higher ratio is legally vulnerable. That vulnerability increases as the center’s ratio increases.
Recently, there has been an increase in both the amount and complexity of case law involving student mental health and institutions of higher education. Administrators and governing boards are increasingly more aware of the need to take reasonable and prudent measures to protect students, staff, and faculty who are affected by mental health crises within the campus community in order to minimize exposure to legal risk. Counseling centers maintaining the ratio recommended by IACS, would help to accomplish this goal.
4. The support for the academic success of students is decreased. The Association of University and College Counseling Center Director Survey (2013) indicates that nationally, 69% of students who filled out satisfaction surveys said that counseling helped their academic performance. As resources get stretched, fewer students experience this benefit.
5. Counseling centers are less available to help support the campus community. As the ratio of mental health professionals to students increase, less time is available for staff to train faculty and staff, provide preventive outreaches to student groups, serve on university committees, and provide consultations for faculty, staff, and administrators who are trying to handle difficult student situations. In the aftermath of the Virginia Tech tragedy, many counseling centers around the country have been asked to provide training to faculty and staff to help them detect warning signs of students who might be a risk to themselves or others. It would be very difficult to find the time to do this when the counselors are hardly able to keep up with the growing clinical demand.
Given these consequences, it is very important that college and university counseling centers are provided with the resources necessary to maintain staffing levels within the ratio range recommended by IACS.