The National College Health Assessment Survey (NCHA), sponsored by the American College Health Association, measured depression, suicidal ideation, and suicide attempts among 15,977 college students in the academic year 1999-2000. Similar to the National College Health Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention in 1995, 9.5% of students reported that they had seriously considered attempting suicide and 1.5% of students reported that they had attempted suicide within the last school year. The NCHA findings show a relationship between suicidal behavior and depressed mood. Depressed mood, difficulties of sexual identity, and problematic relationships all increase the likelihood of vulnerability to suicidal behavior. Less than 20% of students reporting suicidal ideation or attempts were receiving treatment.

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Many of the problems encountered in the attempts to evaluate psychotherapy stem from a basic difficulty in determining evaluation criteria. While case histories and subjective reports point to beneficial effects of psychotherapy, more rigorous and controlled studies are unable to demonstrate either clear-cut efficacy to psychotherapy, or adequate descriptions of the effective therapist or effective techniques. The distinction between meaningfulness and effectiveness, namely, experienced worth and demonstrated utility, appears to be critical, since the same methods do not elicit information pertaining to both criteria. This problem has serious implications for the rights of consumers to informed participation in contracting for services, as well as the controversy over justification of third party reimbursement of psychotherapy. While the public needs to be educated as to the limitations of psychotherapy and its potential abuses, public and practitioners alike need to be alert that government, using its own standards of accountability, may resolve the controversy as to the value of psychotherapy on fiscal grounds alone.