Over the last decade, rates of mental illness among college and university students have been steadily on the rise. According to a 2020 study conducted by the Healthy Minds Network in collaboration with the American College Health Association, rates of student anxiety across college campuses have nearly doubled in just the last six years, jumping from 17 percent to 31 percent; while a 2019 study reported that depression rates among students 18-25 years old increased by more than 60 percent between 2009 and 2017. More alarming, the Healthy Minds Network also found that 13 percent of students screened experienced thoughts of suicide within the past year—a rate that has tripled since the early 2000s. Throughout isolated studies, these numbers are even worse, as a recent online survey from Texas A&M University found that nearly half of screened students showed moderate to severe levels of depression and anxiety, while nearly 1 in 5 students (18 percent) had suicidal thoughts.
While rates of mental illness are expected to be higher among college and university students than amongst the general population, as post-secondary years are the peak period for the onset of most mood and anxiety disorders, recent studies have sought to determine why students of Gen Z (those born after 1996 and before 2013) seem to be more depressed than previous generations of students.1 Arguably the principal agent contributing to Gen Z’s exorbitant rates of distress is the COVID-19 pandemic. In its annual Stress in America Survey report, the American Psychological Association revealed that nearly 2 in 3 Gen Z adults (67 percent) reported that the pandemic has made them feel helpless and hopeless about the future; while its 2021 survey found that the pandemic has significantly inhibited their ability to make basic and major life decisions, and cope with pandemic-related stress. This comes as the Texas A&M survey found that 71 percent of their students reported an increase in their stress and anxiety levels during the pandemic, and an international study of higher education students across 10 countries—including the UK, USA, Netherlands, France, Spain, Australia, and the Nordic countries—found that a majority of screened students (76 percent) struggled to maintain their wellbeing as a result of the pandemic.2
As a response to this alarming data, the results of ACE’s 2021 Pulse Point survey of 268 college and university presidents revealed that nearly 70 percent of presidents have identified student mental health as one of their most pressing issues, while nearly half have already acted on their commitment to improving student wellbeing. Despite these efforts, however, a recent Student Voice survey found that up to 68 percent of students who meet the criteria for anxiety, mood, or substance abuse disorders still do not access mental health services on campus, while a recent Fortune survey indicates that rates of depression, stress, and anxiety are still on the rise ahead of the 2022-2023 academic year—suggesting that current efforts are not enough to curb the trajectory of this growing crisis.
Where‘s the Disconnect?
While more college and university presidents are embracing flexibility and accessibility, as ACE’s survey found that nearly 60 percent of universities have invested in virtual and telehealth services, emerging research has found that in the wake of the pandemic, post-secondary students prefer face-to-face counseling over internet-delivered counseling—mirroring the recent finding that Gen Z adults prefer working in-person as opposed to working remote, which has surprised some employers. But while the digital age has been widely regarded as an era of increased connection and communication among older generations, growing evidence reveals that for younger generations, social media and internet usage is associated with increased feelings of loneliness.3 According to a recent survey conducted by the Healthy Minds Network in December of this past year, nearly 70 percent of students screened reported feeling isolated, alienated, and lonely at least some of the time, which has damaging implications for their mental health. In order to reduce these numbers and strengthen students’ overall wellbeing, institutions need to invest in both in-person and digital services, rather than prioritize one over the other, so that students have more opportunities to network and develop a sense of community and belonging, and have greater access to physical spaces to speak freely and safely about experiences related to their mental health.
Another factor contributing to low service usage is the fact that students do not know where to go to access resources. As students returned to campus for the 2021-2022 academic year this past fall—many of them returning for the first time since the onset of the pandemic—the Healthy Minds Network found that over 1 in 3 of screened students admitted that they were not sure where on campus they could seek professional help for their mental health and wellbeing. Additional findings from the Student Voice survey also revealed that—when asked to grade their institution’s mental health services—nearly a third of students did not know enough about their campus’s services to assign a letter grade, while B’s and C’s were the most common responses provided by the remaining students. With that said, while it is crucial that leaders adopt new strategies and update current methods of improving students’ wellbeing, they first need to assess how well they’re promoting these resources and services to their students, and ensure that they are getting the information needed to act on these opportunities for care and support.
How Universities Can Promote Services and Resources
While students make their return to the campus—some perhaps for the first time in over a year—and new students arrive for the first time, many will need to be told where on campus they can access mental health resources, services, and information. While targeting first-year students may be the most effective way to raise awareness of campus resources, there are plenty of collaborative campaigns that institutions can execute to promote awareness among returning or transfer students as well. Some ways that institutions can advertise their mental health services include:
- Incorporating mental health into orientation agendas. Transitioning to a new school is challenging for many students—especially when making the jump from secondary education to higher education. Research has shown that the first few months of a student’s first year are often marked by loneliness and the onset of anxiety and mood disorders; making orientation a pivotal opportunity for institutions to educate new students on available mental health resources, and how and when to access them.4 Approaches to incorporating mental health into orientation agendas include traditional presentations, passing out flyers or brochures, showing short videos, demonstrating how to use services, and offering a tour of counseling centers and other related facilities.
- Implementing first-year seminar courses that educate students on services and resources on campus. First-year seminars (FYS) have become immensely popular over the years, as a study from 2017 by the University of South Carolina’s National Resource Center for the First-Year Experience and Students in Transition found that 73.5 percent of all colleges and universities screened had implemented a FYS. FYS are courses designed for first-year students to support them during their transition to college. They offer students the opportunity to form connections and foster a sense of belonging; they promote strategies and survival skills to enhance academic success, including how to manage workload; and they provide an overview of campus facilities, services, resources, technology tools, and online programs that students will work with throughout their college career, including enrollment services, advising offices, libraries and online databases, and tutoring centers. While these primarily focus on improving students’ learning, and are not often required courses, some institutions have begun to offer FYS as a mandatory semester-long course that touches upon a range of non-academic topics including self-care and mental health, educating students on how to access counseling, health, and wellbeing services.
- Collaborating with student-led groups and organizations on mental health events and presentations. While mental health seminars, presentations, and events hosted by the institution may not immediately entice students, collaborating on campaigns with student-led organizations is a great way to spread the word about mental health services and resources on campus. This could be as simple as asking student leaders to talk about campus services during their club meetings, or hosting seminars for both members and non-members, or even potentially going to different lectures, seminars, and residence halls to give presentations during classes or evening hours. This can be a great way to target information to students who may have a greater need for these services, such as the Black Student Union (BSU), Asian Students Association (ASA), Army ROTC, Cape Verdean Student Association (CVSA), Latin American Student Association (LASA), and LGBTQIA+ Student Union. Additionally, most campuses now have student-led groups that are centered around mental health advocacy, including To Write Love on Her Arms (TWLOHA), Active Minds, National Alliance on Mental Illness (NAMI), and Mental Health America (MHA), that would be great organizations to start this initiative with.
- Training passionate students, staff, and faculty to be Wellbeing Ambassadors. In addition to collaborating with student organizations on campus, institutions can also reach out to students who are passionate about mental health advocacy and train them to become wellbeing ambassadors for their campus. Generally, wellbeing ambassadors are a first point of contact for students who may feel concerned about their mental health or who may be experiencing stress, anxiety, depression, and other disordered moods, yet may not wish to seek professional or clinical care. But touting wellbeing ambassadors on campus is also a great way to spread information about services and resources to students via more informal, interpersonal, one-on-one communication; additionally, ambassadors can demonstrate how to access resources, destigmatize their use, and help to create an environment where students feel comfortable to seek help and talk openly about their mental health.
Limitations to Clinical Mental Health Support on Campus
In the wake of the pandemic, the increased demand for mental health support, coupled with an ever-diversifying student body, is placing a considerable strain on campus counseling centers and on-campus clinicians, who are already understaffed. Even collegiate centers that are fully staffed are only able to provide an average of 199 clinical hours per week, according to the Center for Collegiate Mental Health’s 2021 annual report, which translates to fewer than 200 students who are seen each week, based on standard individual session time frames. Further, the Association for University and College Counseling Center Directors (AUCCCD) 2021 annual report found that on average, colleges have the equivalent of about eight counselors on staff, after determining the ratio between the number of clinical hours available and the number of students requesting services. Consequently, students are often unable to get the timely help that they need, as Fortune’s survey also found that nearly 60 percent of screened students reported being on a waitlist at their college’s counseling center—an experience that has been associated with low utilization rates of campus services.5
In a prior report, the AUCCCD also found that an overwhelming majority of on-campus counseling center staff (70 percent) are white, while 75 percent are cis-females. This serves as a significant barrier to supporting students who are members of minority groups on campus, including BIPOC, LGBTQIA+, ESL, neurodiverse, and disabled students; as well as groups of students who exhibit greater demands for care, yet struggle to recognize markers of poor mental health and are resistant to accessing services—particularly cis-males.6 Students want to be represented and feel understood by their counselors; when they perceive their counselors to lack cultural competency, understanding, and sympathy towards their mental health concerns and lived experiences, they can be dissuaded from utilizing resources and services on campus in the future—an action that is already a challenge for minority students who avoid seeking access to care in response to the stigma attached to counseling and help-seeking within their cultures.7 This has damaging implications for minority students’ mental health, as studies have shown that these students exhibit a higher demand for mental health care than any other group.8
What This Means for Institutions
While investing in a more diverse, sufficiently-staffed, and well-trained counseling center is imperative, focusing solely on this facet of student mental health support is not a sustainable nor effective strategy if not in tandem with non-clinical community interventions, especially if students are hesitant or resistant to utilizing these services. But studies have found that by targeting interventions toward changing campus culture—specifically, attitudes, knowledge, beliefs, and behaviors regarding mental health—institutions can increase appropriate utilization rates, in addition to building resiliency in students to cope with and manage stress, depression, anxiety, and other health issues; these interventions include improving mental health literacy among students, reducing the stigma surrounding mental health and help-seeking, and providing students with the social capital needed to address their mental health problems independently, and feel motivated to address them either independently or by seeking assistance. The latter is a critical mental health intervention for institutions to adopt, as Fortune found that nearly half of students avoided seeking care as they believed their problems were not big or serious enough to warrant care, while a quarter cited that reaching out for help was too overwhelming.
While these attitudes may be partially attributed to stigma or a lack of mental health literacy, they are principally a matter of self-efficacy: or the belief in one’s own capabilities to perform tasks and achieve desired goals. Students need to have a high level of self-efficacy in order to be able to identify signs of mental health problems, perceive them as manageable and conquerable, and feel motivated to take action against them. Institutions can strengthen students’ sense of self-efficacy by fostering positive interpersonal relationships and social networks on campus. By developing a sense of community among staff, faculty, and students on campus, students have more access to social capital—or the tangible and emotional resources needed to thrive and flourish, or believe that they can. When students believe in themselves and believe that they are supported by others around them, they become highly motivated to manage and cope with daily stressors that they endure and reach out when they are feeling overwhelmed. By organizing and implementing community-based, non-clinical wellness interventions, institutions can improve students’ perceived access to social support while simultaneously educating them on the signs, symptoms, and causes of mental health issues and how they can prevent or alleviate them, as well as inspiring them to do so.
How Universities Can Promote Better Wellbeing
Developing sustainable wellbeing strategies on campus takes time, effort, and thoughtful collaboration with staff, faculty, and students—demanding a long-term commitment to supporting mental health even when it is no longer a trend to do so, or even after the end of a stressful semester or academic year, such as those that are upended by a global pandemic. While its final Pulse Point Survey from this past December did find that more than two-thirds of college and university presidents cited the mental health of their students as their most pressing issue, ACE did however recognize that this was a five percent decrease from those that claimed so in its November 2021 survey. As colleges and universities make a full return to in-person learning and student life—dropping mask mandates, retiring social distance and capacity restrictions, and hopefully closing the door on Covid—they need to be mindful of the fact that the pandemic’s effects on students’ mental health still linger, as do the effects of inflation, the war in Ukraine and current housing crisis in the United States—making the current student mental health crisis not just a pandemic-related problem, but a concerning trend.
While more time-consuming, long-term wellness projects may discourage some institutions from pursuing them, there are still an abundance of practical and expedient wellbeing strategies that universities can realistically adopt and execute ahead of and during the approaching fall term. These include:
- Setting an example by practicing kind and vulnerable leadership. Campus leadership is responsible for setting the precedent for what attitudes, behaviors, and actions will be tolerated on campus; for instance, speaking out against racism, xenophobia, discrimination, violence, sexual assault and harassment, and bullying. But leaders should not wait until these events happen before declaring their stance on such issues. Instead, effective leaders will seek to initiate open and compassionate dialog with their campus communities to break down stereotypes, stigmas, and gaps and barriers surrounding various topics, including mental health. This may include being open about one’s own mental health struggles, as Santo Ono, former president of the University of British Columbia and the University of Cincinatti and soon-to-be president of the University of Michigan, did back in 2016, when he spoke openly about his battle with depression and his attempted suicide, encouraging students to seek help and normalizing experiencing and talking about mental health issues. Leaders should also be mindful of the language used throughout university policies; ensuring that policies surrounding bullying and harassment, discrimination, and sexual assault—for example—protect the wellbeing of victims and prioritize their mental health.9
- Providing Diversity, Equity, and Inclusion (DEI) training to students, faculty, and staff. As discussed, lack of diversity and cultural awareness among counseling staff poses as a considerable barrier to providing adequate mental health support to students. While the process of hiring and onboarding a more diverse counseling staff will take time and dedication, institutions can prioritize training their current staff to be more mindful of the issues and concerns that pertain to the mental health needs of minority students. This includes hosting seminars and training on topics such as racism, LGBTQIA+ identities, cultural and religious practices, attitudes, and behaviors, social determinants of health, and other themes that promote cultural competency.
In addition to training campus staff, institutions can extend this training and education to students and faculty in order to promote a more inclusive and equitable campus climate within all areas of student life. Leaders can host webinars and seminars, conduct role playing exercises, and share videos or PowerPoint presentations for professors to incorporate into their lectures. Professors may also be trained and encouraged to incorporate DEI activities into their curriculum—especially during the start of the semester—like the Social Identity Wheel, which encourages students to identify their various social identities and reflect on the impact they have on their life, which promotes empathy and understanding toward peers, and thus better mental health and wellbeing outcomes for all students.
- Establishing peer support groups on campus. In its survey from this past year, Fortune asked students which services they would like to see their institutions invest in, and reported that over a tenth of students selected student-run peer counseling groups, in addition group counseling services on campus. Student-led groups give students the opportunity to form connections with their peers—alleviating isolation, loneliness, and feelings of exclusion—and in turn promote student engagement on campus and self-help behaviors, which are associated with a decreased risk of mental health disorders.11 Establishing peer support groups is also an effective way to target support to students who are resistant to seeking professional care or clinical care; oftentimes, students feel more comfortable opening up about their mental health struggles with peers, and hearing peers talk about similar and shared experiences with mental health, as well as their experiences accessing campus services, may help to breakdown students’ perceived stigma surrounding help-seeking and talking about mental health.
Similar to wellbeing ambassadors, institutions can train passionate and exemplary students to become student counselors and facilitate peer support groups, providing therapeutic services to peers, sharing their experiences with mental health, referring students to additional services and resources on campus, and helping students learn to cope with anxiety, depression, stress, loneliness, and campus or academic stressors. For a better understanding of the structure and execution of peer support groups, leaders should explore existing support groups that universities already offer, such as Uncle Joe’s Peer Counseling and Resource Centre at Washington University in St. Louis, which offers 24/7 access to peer counselors who have undergone over 100 hours of intensive training, and holds one-on-one sessions with students in addition to providing referrals to professional care both on campus and around St. Louis.
- Offering a variety of pathways to online support. According to a recent international survey conducted by Salesforce.org, about a third of students argue that online communities foster a sense of belonging to their institutions and support their wellbeing; this comes as Fortune found that nearly a quarter of students said that they would like to see their institutions invest in new or expanded telehealth counseling services and online support. Investing in telehealth services and online support options are a great way for institutions to provide additional support to students outside of office hours; promote connectedness, understanding, and empathy among students; and encourage them to practice self-care and self-help behaviors, including mindful breathing exercises, relaxation and meditation, and socialization. In order to provide appropriate and effective online support to students, institutions should assess what platforms or channels would be most beneficial and accessible to their students; whether support should be provided via emails, texts, chatbots, helplines, social media, or wellness apps.12
- Promoting wellbeing practices during orientation, first-year seminars, and collaborations with student organizations. In addition to promoting services and resources on campus, orientation, first-year seminars, and collaborations with student organizations are great way to promote general mental health awareness to students, educating them on signs, symptoms, and risk factors to be mindful of, and preventive and responsive behaviors they can adapt to mitigate them. Approaches include panel discussions, student testimonials, and role-playing activities that encourage students to connect with and open up to their peers while learning more about causes and symptoms of mental health issues, how to prevent them, and how to seek treatment when needed.10 Additionally, students may be offered free mental health screenings to gain a better understanding of the current state of their mental health, as well as gain a better understanding of what the warning signs for stress, depression, anxiety, and other disorders may look like in themselves.
In addition to peer support groups and expanded access to online support, the Student Voice survey also reported that 22 percent of students want their colleges to invest in campus-wide wellness programs. These programs can be promoted during or factored into orientation and first-year seminars, and can be organized and hosted in collaboration with student-led groups. Some examples of wellness programs include workshops on stress-management, yoga and meditation, and practicing mindfulness; seminars or webinars on the importance and benefits of exercise, sleep, nutrition; and workshops or seminars on how to practice gratitude, kindness, and generosity. For more examples to model, leaders can take a look at what other institutions are already doing, including Brown University and the University of South Carolina.
Ultimately, effective, long-term mental health support cannot fit exclusively into a 9-to-5 time frame. While investing in diverse, flexible, and comprehensive clinical services is pivotal to providing adequate mental health support to students, addressing campus culture is an essential step toward establishing an environment that is conducive to students’ long-term wellbeing and provides students with round-the-clock access to the support and resources needed to mitigate health-related issues that they currently face, as well as ward off future threats to their mental health.