"I found her after she tried to kill herself," Marybeth Abbott said in an interview with Lumen. Abbott, a junior elementary education major from Sparta, Wis., remembers entering a close friend's apartment to see her throwing up in the sink outside of the bathroom. "I suspected what she had done," Abbott said. "She had mentioned that she had thought of it once when she was in high school, and I knew she was hurting." Her friend insisted that she was fine, Abbott said, but admitted that she was "throwing up" her anti-depressant medication. "I called security right after that," Abbott said. Security and residence life personnel suggested that Abbott consider the counseling services available on campus, but Abbott was apprehensive "I didn't want to go at first," Abbott said. "I wasn't sure what to expect." Abbot was not alone in her reluctance to seek out counseling. "There is still a stigma about coming to counseling," said Lesley Stugelmayer, Viterbo's director of counseling, "but it's gotten better." Stugelmayer, who is in her 35th year at Viterbo, taught as a clinical instructor in the nursing program from 1976 to 1980, taking her current position in 1980 after completing her master's degree in counseling. On campuses nationwide, 5 to 13 percent of students seek help at a counseling center, Stugelmayer said. More services and more outreach are needed to serve people who aren't willing to seek out counseling, she added. Male students in particular are less likely to seek counseling than their female counterparts, although the disparity is slowly decreasing, Stugelmayer said. "On all campuses, more students are struggling with mental health issues," Stugelmayer said. Higher rates of diagnosis have contributed to the increase in the number of students with mental health issues, Stugelmayer said. Rising enrollment figures in general are one reason for the increasing number of students with mental health issues, Stugelmayer said. The increasing rate of mental health issues among students is not just a matter of new standards of diagnosis and medication, however. The current recession has also contributed to students' mental health issues, Stugelmayer said. The loss of a parent's job is an increasingly common concern, Stugelmayer said. Students also worry about how to pay for school, and weigh their increasing debt against their future job prospects, she added. "Students' lives are often busy and complicated," Stugelmayer said, adding that other common stressors may include academic issues, domestic violence, grief over a loss, and sexual assault or abuse. Although the three most common mental health issues for students remain depression, anxiety, and relationship issues, the number of students with "more complex, multi-faceted, and severe mental health issues" has increased, Stugelmayer said. In recent years, more students have come to counseling services with serious crises such as severe depression, significant suicidal thoughts, and self-injury, Stugelmayer said. Suicide was the third leading cause of death for 15- to 24-year-olds in 2007, according to the Centers for Disease Control and Prevention's website. Unintentional injury was the first leading cause of death for that age group, followed by homicide. The warning signs of a potential mental health issue, however, are not always clear, Stugelmayer said. Suicidal students may not tell anyone that they are thinking about killing themselves, Stugelmayer said, but they may make vague comments about things not going well. "A loss of hope" is a warning sign of potentially suicidal thoughts, Stugelmayer said.In Abbott's case, a sense of guilt over the possibility of having missed the warning signs led her to seek counseling. "Before I went to counseling, I was blaming myself for what she did," Abbott said. "I thought I should have seen it coming. "Lesley helped me to realize that it wasn't my fault," Abbott said. "Lesley explained that when my friend made up her mind that she wanted to take her own life, there was nothing I could have done to stop her. "Lesley treated me like a person," Abbott said. "She didn't act like I was broken because I was in a bad place. That was what helped me to trust her enough to talk openly to her," Abbott said. "We focus on short-term care and referral," Stugelmayer said of the role of Viterbo's counseling service, adding that there is no strict limit on the number of visits a student is allowed. "Here in La Crosse, we have good health services," Stugelmayer said, noting that both Gundersen Lutheran and Franciscan Skemp offer "out-patient behavioral health" services through which students can receive counseling. Students without insurance may be referred to St. Clare Health Mission, Stugelmayer said. St. Clare Health Mission offers medical care and medication assistance to individuals without insurance in La Crosse, Monroe, Houston, Vernon, and Trempealeau counties who fall below federal poverty guidelines, according to its website. Prescriptions written at St. Clare Health Mission can be filled at no cost at the mission's pharmacy, and patients can receive assistance in applying to pharmaceutical companies for free medicine, according to the mission's website. Identifying potential mental health issues early can save on the pain they cause and the cost of treatment, and is a top priority of Stugelmayer's. "I do a lot of consultations with faculty and staff members," said Stugelmayer, who also conducts training sessions with resident assistants during orientation and explains the most common signs of trouble. The warning signs of a potential mental health issue generally include some noticeable change in behavior, Stugelmayer said. Students may suffer from mood swings, become unusually emotional, or withdraw socially. A change in academic performance could also indicate a potential mental health issue, Stugelmayer said. Lowered quality of work, an increased number of absences, and lowered grades can serve as warning signs. A drop in academic performance could stem from any number of alternative causes, however, Stugelmayer added. In addition to training Viterbo staff and resident assistants to identify signs of trouble, Stugelmayer's outreach also includes going into classes and conducting "Lunch ‘N' Learn" programs to raise the exposure of counseling services on campus. Stugelmayer also encourages concerned students to come forward on their own. "It's a strength to acknowledge that one is struggling," Stugelmayer said. After her experience with counseling services, Abbott offers similar encouragement to students considering seeking counseling. "They should definitely go," Abbott said. "Even if it's just stress from finals or midterms. Even if it's not a huge tragedy."