As a child, Xiomara Garcia, 21, assumed that attending a four-year college was out of reach.
Her parents had never finished middle school, and money was tight. But there she was — a bioengineering major at Santa Clara University with a generous scholarship.
In some of her classes, she was the only person of color. “It was like the biggest culture shock of my life,” Ms. Garcia said.
She began to worry that she was an impostor who didn’t belong. Then a family member died. All of this, plus a stressful course load and unresolved childhood trauma, made it difficult to control her emotions.
She tried online therapy, but finding a place to log in to her sessions privately, away from her roommate, proved difficult. Once, she talked to her therapist over video from underneath a stairwell on campus, steps away from a cafe. Eventually, she decided to see someone in person.
Her new therapist had an office in the dorm where she had lived during her freshman year. The space included shells and rocks that her therapist had found, as well as soft lighting, cozy chairs and a basket of snacks — a welcome change from hiding in a busy building or braving the clinical environment of the main counseling center, she said.
A growing number of campus mental health professionals, often referred to as “embedded counselors,” are now working out of dorms and other academic buildings. Schools say the setup reduces the stigma around getting help while also making the counselors more visible and accessible at a time when 37 percent of college students say they are grappling with depression. In a recent survey of school counseling center directors, nearly one-third said they used embedded counselors, up from 20 percent five years prior. The shift shows how colleges are rethinking the way they deliver mental health care, by adopting a model designed to meet students where they are, ideally before they face a crisis.
“I used to come in crying every week,” Ms. Garcia said of her early counseling sessions. Now, two years later, she added, she feels more confident and better able to manage her feelings. Had she not found a therapist with a warm and inviting office who was also quickly accessible, she might not have kept going to therapy, she said.
Late-night drop-ins
At schools like Virginia Tech, which is nestled in a rural area between the Blue Ridge and Allegheny Mountains, on-campus counselors are a lifeline for many students because off-campus therapists are few and far between. But the main counseling office is about a 15-minute walk from the dorms and has traditional office hours, which can make it tough for busy students to squeeze in appointments.
There are now four embedded counselors working out of a campus dorm who take drop-ins as late as 10 p.m.
In the evening, as a student’s busy day winds down, “everything else is kind of coming to the surface,” said Claire Cabellos, assistant director of embedded counseling at Virginia Tech. “Mental health crises don’t happen on a 9 to 5 schedule.”
Since the introduction of embedded counselors, and other campus mental health initiatives, there have been fewer after-hours crisis calls and the resident assistants, also known as student leaders, have been more inclined to return to the role, Ms. Cabellos said.
The student leaders were getting burned out and feeling stressed after being approached by students with urgent mental health concerns, she said.
During the 2024-25 academic year, five embedded counselors saw 391 students for a total of 1,805 sessions. In 2022-23, the inaugural year, four embedded counselors saw 200 students and held 504 sessions. Some students have even been known to show up in their pajamas.
Having the embedded counselors nearby — and available late at night — has been a big help to Rosi Escobar, 21, a student leader whose dorm is mostly full of first-year students. She has referred multiple students to the counselors, including one who was having a panic attack and another who hadn’t gotten out of bed all week.
“I’m not the person who has to catch all these problems and fix it myself,” she said.
It can be an enormous challenge for colleges and universities to provide accessible and quick mental health care to a large population of students. Data from the most recent Healthy Minds Survey, which was taken online by more than 84,000 students at colleges and universities across the country, found that only 47 percent of students who had reported screening positive for anxiety or depression said they had received counseling over the past year.
Those who did not receive help cited roadblocks that included limited time, not knowing where to go, financial barriers and difficulty finding an appointment, among other issues.
A friendly dog and an open door
Kristin Tappan, a Santa Clara University graduate who is now a therapist there, is a familiar presence to many students. She’s often accompanied on campus by her dog, a Maltipoo named Tiramisu, and can sometimes be found handing out homemade lemon bars to students while introducing herself. It helps “make things feel a little bit more like home,” she said.
“The doors are just a lot more open than I think they ever have been before,” she said.
In one of her offices, which is set up like a family room, students will curl up in an armchair with Tiramisu nearby and talk about anything: what it’s like to live away from their family, relationship problems, academic stressors and worries about life after graduation. But oftentimes, Ms. Tappan said, deeper issues will surface, such as family trauma, like abuse, or problems with drugs or alcohol.
“There’s so much under the surface,” she said.
While there are several benefits to placing therapists in academic settings or dorms, the role can be particularly challenging.
Melissa Bottiglio, a therapist and the assistant director of the Embedded Program at the University of Colorado Boulder, worked with a team to survey embedded providers across the United States and Canada in 2024 and found that counselors who work alone in academic buildings or dorms at times feel isolated, and find it harder to maintain boundaries when their work space intersects with campus life.
“Counselors have to be firm about where their scope of care begins and ends,” she said.
But when a school finds a formula that works, embedded counselors can draw in students who might otherwise feel hesitant to ask for help. The therapists can also tailor programming for specific campus groups.
The University of Iowa currently has two embedded therapists supporting students in 11 residence halls. And Ohio State University now has 18 embedded clinicians located across its campus.
The embedded counseling program at the University of Arizona, which started in 2020 with three counselors, currently has 12 counselors in places such as the Native American student affairs office, the medical school and the veterinary college.
Sarah Heinzl, a licensed professional counselor at U.A., recalled a campus event where a student looked right at her, and joked, “We’ll talk about this on Friday.” Another student added, “My counselor is also here.”
Later that week, after seeing how their peers had used the counseling services, several students stopped by her office to ask about them.
“This is what embedded counseling does,” she said. “It breaks down misconceptions about therapy and normalizes counseling as part of their world. And when they see that, more students step forward to ask for help.”
Christina Caron is a Times reporter covering mental health.
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