The mental health of students is in crisis. Campuses have rethought their approach.

As the demand for mental health care increases, psychologists help colleges and universities adopt a culture of wellness and equip faculty to support better students in need.

Student mental health is deteriorating by nearly all metrics. According to the Healthy Minds Study, which collected data from 373 colleges nationwide, during the 2020-2021 academic year, over 60% of college students had at least one mental illness. 306, 2022). In a national survey, nearly three-quarters of students reported severe or moderate psychological distress ( National College Health Assessment by the American College Health Association 2021).

Before the pandemic, schools faced a demand for services far exceeding their capacity. It has become more apparent that the traditional model of counseling centers needs to be equipped to handle the situation.

Michael Gerard Mason, Ph., associate professor of African American Affairs and long-time college counselor at the University of Virginia, said that counseling centers had seen a dramatic increase in demand during the last decade. "[At UVA], the counseling staff has nearly tripled, but I don't believe we can staff ourselves out of this problem even if we continue to hire."

This increase has many positive reasons. According to Micky Sharma (PsyD), the director of student life at Ohio State University's counseling and consulting service, more students today seek mental health treatment before college than in previous generations. Higher education has become a viable option for a more significant segment of society. The stigma surrounding mental health issues continues to decrease, leading to more people seeking help rather than suffering in silence.

College students face many challenges today, from the pressures of coursework, relationships, and adjusting to campus life to economic stress, social injustice, mass violence, and various losses related to COVID-19.

In response, school leaders have begun to look for new ways to help. Many institutions are adopting approaches like group therapy, peer counseling, and telehealth. The institutions are also equipping their faculty and staff with the tools to identify and support distressed students and rethink what to do during a crisis. Many schools are incorporating a culture of wellness in their daily campus life, policies, and systems.

Kevin Shollenberger is the vice-provost at Johns Hopkins University for student health and wellbeing. He said that this increase in demand had forced institutions to adopt a holistic and multifaceted approach when supporting students. Everyone must promote a culture that encourages wellbeing at the university.

Increased caseloads and creative solutions

According to the Center for Collegiate Mental Health at Penn State University, a network of over 700 college and university counselors, the number of students who sought help in campus counseling centers increased by almost 40% between 2009-2015.

Increased funding has yet to meet the rising demand for college counselors. This has resulted in higher caseloads. The average caseload of a full-time college counselor is 120 students nationwide, and some centers have more than 300 students on average per counselor. (Annual Report 2021).

The executive director of CCMH, Brett Scofield, Ph..., said, "We find that high caseload centers tend not to give as much care to students with various problems. This includes those who have safety concerns or critical issues, such as suicidality or trauma, which institutions often give priority."

Many schools dedicate more resources towards rapid access and assessment to prevent students from falling through and slipping between the cracks. Students can now walk in for an intake or counseling session on the same day instead of waiting weeks or months for a spot. After an evaluation, schools often use a step-care model where students in the greatest need are given the most intensive treatment.

Given their various issues, experts say this approach is more sensible than traditional therapy for all students.

Carla McCowan, PhD, the director of the University of Illinois at Urbana Champaign's counseling center, said, "Early on, it was all about more, and more, and more clinicians." Many centers have been thinking of creative ways to meet demand in recent years. Many students must build resilience, learn new skills, and connect with others.

Workshops on sleep, goal-setting, stress management, and time management may benefit students who struggle with academic demands. Peer counseling is a good option for those who have lost the typical college experience due to the pandemic or are struggling with adjustment issues like loneliness, low self-esteem, and interpersonal conflict. Students with more serious concerns, such as disordered eating or trauma from a sexual assault, can also access professional counseling.

Schools are working to change the perception of mental health on campus as they shift away from individual therapy. Scofield said setting expectations with students and families as soon as possible (ideally, before enrollment) is essential. Most counseling centers will not be able to offer unlimited weekly sessions throughout the student's entire college career. A referral would better serve those who need this support from community providers.

Scofield stated, "We want to encourage institutions to be transparent about what services they can provide realistically based on current staffing levels of a counseling center."

First line of defense

Hideko Sera, PsyD, director of Morehouse College, a historically Black men's college located in Atlanta, explained that while faculty are hired to teach, they also serve as "first responders" who can identify students in distress. This trend was accelerated during the pandemic.

Bridgette Har, Ph.D., associate professor and director for undergraduate studies in neuroscience and psychology at Duke University, said faculty members became the main contact points with students during the remote learning phase. It became more crucial than ever that faculty be able to detect when a child is struggling.

Mason noted that many felt unprepared to talk to students about mental health. Some wondered if they were qualified to do this without special training.

Schools use a variety of approaches to give faculty tools and help them understand what is expected. Around 900 University of North Carolina faculty and staff have been trained in mental health first aid. This training provides essential skills to support people with substance abuse and mental health issues. Many other institutions offer workshops and materials to teach faculty how to "recognize, respond, and refer," including Penn State's Red Folder Campaign.

The faculty is taught that sudden changes in behavior, such as a decrease in attendance, a failure to complete assignments, or an untidy appearance, may indicate that the student is struggling. Staff on campus, such as athletic coaches and academic advisors, can monitor students for signs of stress. Counseling psychologist Natalie Hernandez DePalma, Ph.D., senior director for the school's counseling and psychological services, says that at Penn State, referrals for eating disorders can come from food service staff. Reaching out to ask if things are going well can be a simple way to respond.

Hernandez DePalma explained that referral options, including sending a student to a wellness workshop or calling the counseling center to schedule an appointment, can vary. This will help students access services they might not otherwise seek out independently. There are also reporting systems at many schools, like DukeReach. These allow anyone to report concerns about a particular student, even if they don't know how to react. Care providers who are trained can follow up by doing a welfare check on the student or offering other types of support.

Shollenberger explained that faculty members are not expected to be counselors. They should only show concern and know how to refer their students to the appropriate resources.

He and his team at Johns Hopkins have worked with the faculty to find ways to bring up complex world events in class. This was after students complained that they felt uncomfortable when incidents like George Floyd's death or the conflict in Ukraine were not discussed.

Some schools support their faculty by embedding counselors in academic units to be more visible to the students and develop cultural expertise. (The needs of students studying fine arts may differ from those studying engineering, for example).

Even small changes in course policies can significantly impact students, according to Diana Brecher, Ph.D., clinical psychologist and scholar-in-residence for positive psychology at Toronto Metropolitan University, formerly Ryerson University. Instructors may allow students to submit their assignments within seven days, allowing them to plan around other obligations and coursework. Set deadlines for late afternoons or early evenings, rather than midnight, to promote student wellbeing.

Shelita, assistant professor of communication at Moraine Valley Community College near Chicago, created new policies and assignments after noticing students' struggles with motivation and mental health. Those implemented were mental health days, mindful journals, and a family trip to a Chicago landmark such as Millennium Park, Navy Pier, or the Chicago River.

The faculty in psychology departments may have an opportunity to use their discipline's insights to improve students' wellbeing. Thorny, who teaches introductory Psychology at Duke, weaves messages about how to apply research insights into emotion regulation, memory and learning, and a "positive stress mindset" in their lives. (Crum, A. J., et al., Anxiety, Stress, & Coping, vol. 30, No. 4, 2017).

Brecher and Deena Shaffer, Ph., and her colleague co-created TMU's Thriving In Action curriculum. This is delivered via a 10-week in-person workshop series and a credit elective course. Students can also explore the material online. The system, offered for credit, includes lectures about gratitude, attention, and healthy habits. These topics are based on psychological research and are intended to help students succeed in their studies, relationships, and campus life.

Brecher explained that they try to integrate a healthy study approach into teaching. "For instance, we change activities every 20 minutes to help students maintain attention and stamina during the lesson."

Supporting creative approaches

Many schools invest in group therapy because of the importance of social connections in maintaining and restoring mental wellbeing. With the help of peers and professional counselors, groups can assist students in overcoming challenges like social anxiety, eating disorders, racial abuse, sexual assault, grief and loss, and chronic illness. Some groups cater to specific populations, such as those less likely to seek traditional counseling. For example, the "Bold Eagles," a Florida Gulf Coast University support group, welcomes men who want to explore their emotions and gender roles.

Jon Brunner, Ph.D., senior director of counseling at FGCU, says that the popularity of group therapy shows the decline in the stigma surrounding mental health services. Brunner says that creating peer support groups in smaller schools can be difficult, but students will feel more at ease by providing evident group participation and confidentiality guidelines.

These less formal groups (sometimes called "counselor talks") meet in public around campus. They are handy for reaching out to underserved populations, such as international students, first-generation college graduates, and students of color, who may not be inclined to visit a counseling center. A thriving group of international students at Johns Hopkins meets weekly in a café next to the university library. These meetings are usually led by counselors, sometimes in partnership with campus centers and groups that support specific populations such as LGBTQ students, student-athletes, or other student groups.

McCowan stated that it is essential for students to see their counselors engaging with the campus community. Only the students who feel comfortable will come in if you don't.

Peer counseling can also leverage social connections to keep students healthy. Mason and his UVA colleagues found that 75% of students first reached out to their peers when distressed. Only 11% then contacted faculty or staff.

He said, "We began to understand that the people with the least ability to offer professional help were those most likely to do so."

Project Rise was a peer-counseling service created by and for Black UVA students. It is one way to combat this. Mason helped launch "Hoos helping Hoos," a two-part training course to teach students at UVA about empathy, mentoring, and active listening.

At Washington University, Uncle Joe's Peer Counseling and Resource Center provides confidential one-on-one in-person and phone sessions to help students deal with anxiety, depression, and academic stress. Each peer counselor receives more than 100 training hours, covering everything from basic counseling to dealing with suicidality.

Colleen Avila and Ruchika Kajjala are the codirectors of Uncle Joe's. They say the service is top-rated because students run it, and it does not require a lengthy investment like traditional psychotherapy.

"We can form a connection, but it doesn't have to feel like a commitment," said Avila, a senior studying studio art and philosophy neuroscience-psychology. It's anonymous, and you can use it whenever you want.

As part of the move towards rapid access, many schools offer "Let's Talk" programs that allow students to come in for a one-on-one informal session with a counselor. Many schools also use telehealth platforms such as WellTrack or SilverCloud to ensure services are always available. Students can increasingly access various resources, including sleep seminars, stress-management workshops, wellness coaching, and free subscriptions for Calm, Headspace, and other apps.

These approaches can help address many concerns of students, but some institutions are also rethinking the best way to assist them during a crisis. Penn State has a 24/7 crisis line staffed by counselors ready to speak or go on active rescue. Johns Hopkins has piloted a behavioral support program similar to the one used by the New York City Police Department. Crisis clinicians are dispatched alongside public safety officers for wellness checks.

Wellness as a culture

Schools must find a way to help students access various mental health services, as they are no longer limited to counseling centers. Sharma, a student at OSU, was part of the group of students, administrators, and staff who visited Apple Park, Cupertino in California, to create the Ohio State Wellness App.

The app allows students to create a "wellness plan" and access relevant content, such as tips for managing stress when final exams are approaching. Students can connect with their friends to share articles and set goals. For example, they could challenge a friend to attend two weekly yoga classes for one month. OSU apps were used by more than 244,000 people last year.

Shollenberger stated that administrators at Johns Hopkins are exploring ways to adapt policies and procedures to support student wellbeing. They adopted the leave policy, including how refunds, grades, and health insurance were handled so students could take time off without barriers. This fall, the university launched an education campaign to help international students understand student health insurance after noticing that this group used it less than average.

Students play a crucial role in the fight to improve mental healthcare, even at the systemic levels. Sera is the adviser of CHILL at Morehouse College. The organization, which includes Spelman College, Clark Atlanta University, and other HBCUs, is student-led and aims to promote mental health. The group received federal advocacy training from APA's Advocacy Office in the first half of this year. Its goal is to lobby public officials, including U.S. Senator Raphael Warnock, a Morehouse College graduate who wants to increase mental health resources available for students of color.

Sera stated, "This work is aligned very well with the spirit and goals of HBCUs. They are often the ones who raise voices at the federal level to advocate for improving Black communities."

Students continue to need help despite the innovative approaches taken by students, faculty, administrators, and staff. Most of those involved in this work agree that additional support is urgently required.

Kamojjala of Uncle Joe's Peer Counseling, which volunteers run, said their work can be tiring. "Students need more support, and this work will not be sustainable if it doesn't happen."