The 2019 Annual Report summarizes data contributed to the Center for Collegiate Mental Health (CCMH) during the 2018-2019 academic year, beginning July 1, 2018 and ending on June 30, 2019. De-identified data were contributed by 163 college and university counseling centers, describing 207,818 unique college students seeking mental health treatment, 4,059 clinicians, and 1,580,951 appointments. The following are key findings and implications contained in this year's report: (1) To better measure comparable staff levels and related impacts across counseling centers nationally, CCMH developed the Clinical Load Index (CLI) during the 2018-2019 year with support from the Association for University and College Counseling Center Directors (AUCCCD) and International Accreditation of Counseling Services (IACS). The CLI provides each counseling center with a standardized and comparable score that can be thought of as "clients per standardized counselor" (per year) or the "standardized caseload" for the counseling center; and (2) Findings demonstrated that higher CLI scores are associated with the following: (1) Institutions with larger enrollments and counseling centers that serve more unique students; (2) The provision of significantly lower treatment dosages (fewer appointments with more days between appointments); and (3) Significantly less improvement in depression, anxiety, and general distress by students receiving treatment. [Additional support for this research comes from the collaborative efforts of approximately 600 university and college counseling centers and the Penn State University Counseling and Psychological Services. For the 2018 report, see ED592771.]