The 2020 Annual Report summarizes data contributed to the Center for Collegiate Mental Health (CCMH) during the 2019-2020 academic year, beginning July 1, 2019 and closing on June 30, 2020. De-identified data describing 185,440 unique college students seeking mental health treatment, 3,890 clinicians, and 1,395,685 appointments. The following are key findings and implications contained in this year's report: (1) The Clinical Load Index (CLI), first released in the Fall of 2019, can be conceptually thought of as the "average annual caseload" for a "standardized counselor" within a counseling center. The CLI was designed to provide a more accurate and consistently comparable metric that describes the landscape of staffing levels rather than offering a single recommendation. The 2020 Annual Report built on this foundation with two additional goals: (1) replicate, update, and expand the 2017-2018 CLI distribution to represent more colleges and universities; and (2) evaluate differences in counseling center practices between centers at the low and high ends of the CLI distribution; and (2) Findings demonstrated the following: (1) Low CLI Centers are more likely to be at smaller institutions and provide full-length assessments at the outset of services as well as ongoing weekly counseling that produces more improvement in symptoms. These centers are much less likely to run out of treatment capacity during periods of high demand; and (2) High CLI Centers are more likely to be at larger institutions and implement clinical systems that maximize efficiency in an effort to serve the masses while limiting access to weekly individual therapy. Case Management services and referrals to external. [Additional support for this research comes from the collaborative efforts of over 600 university and college counseling centers and the Penn State University Counseling and Psychological Services. For the 2019 report, see ED602859.]