||The objective of this study was to examine patterns over time related to severity and utilization of mental health services in a university setting. Twelve years of archival data from a university counseling center were analyzed, which included a total of 8,623 clients and 83,095 sessions. Various descriptive analyses and regressions were used to answer research questions about trends of severity and utilization between 1999 and 2011. The main findings were: a) there were small increases in severity with time for some measures of severity (total OQ-45score, specific OQ-45items, and mental health history); b) a small percentage of users accounted for a large percentage of service usage (i.e. top 20% utilized 64% of services); c) the percentage of services that these high utilizers accounted for did not grow over time; and d) clients who had higher initial OQ-45scores, prior counseling, prior suicide attempts, prior hospitalization for mental health concerns, use of psychotropic medication, and a family member diagnosed with a mental disorder tended to utilize more sessions.