Student Mental Health A Guide to Identifying Disorders and Promoting Wellness

Mental health is a growing concern on today’s college campuses. Learn about the various mental health challenges facing college students, the support and counseling resources available to them, and practical measures and coping strategies to help students overcome behavioral, emotional, and psychological obstacles.

Meet the Experts
Margaret Bertram Associate Director of Training and Education, Active Minds

Bertram holds a Master’s Degree in Education from the University of Connecticut, and has been working in the field of mental health advocacy, education, and awareness for the past five years with the non-profit organization Active Minds. She is a senior member of the Active Minds speaker’s bureau, where she trains and works on professional development with incoming speakers. Her work takes her to college campuses across the country, where she talks about her own experiences with mental health issues and encourages students to advocate on their own behalf for mental health awareness, support, and services.

Anne Hershbell Director of the Counseling Center, Randolph College

Hershbell is a Licensed Clinical Psychologist with a Psy.D. in Counseling Psychology from the University of St. Thomas, an MBA from Wharton, and a BA from Wellesley. She’s been working in the counseling center at Randolph since 1999, when it was still Randolph-Macon Woman’s College. During that time, she also worked as a mental health counselor at Lynchburg College and at Sweet Briar College.

Sara Hirst Assistant Director of the Counseling Center and Coordinator of Sexual Misconduct and Education Advocacy, Randolph College

Hirst holds a Psy.D. from Antioch University, and a BS from Lycoming College. She joined the counseling center staff at Randolph College in 2011, and now helms the college’s sexual misconduct education and advocacy efforts for the Dean of Student’s office. She also serves as a liaison to the City of Lynchburg Sexual Assault Response Team.

Craig Rodgers Bureau of Study Counselor, Harvard University

Rogers holds a Psy.D. in Clinical Psychology from George Washington University, a J.D. from GWU’s Law School, an Ed.M. in Adolescent Risk and Prevention from the Harvard Graduate School of Education, and both an S.B. and S.M. degree from Massachusetts Institute of Technology. He works in counseling for academic and personal development at Harvard University, and is a Certified Consultant in Sports Psychology. He is also a Licensed Psychologist in Massachusetts.


What constitutes a normal level of stress? When does sadness cross into depression? Where does someone go for guidance and counseling when these feelings become too much to bear? This guide serves as a resource for college students who need (or think they might need) help. Leveraging the expertise of several mental health and counseling experts, this resource explores the various mental health concerns that today’s college students face and discusses where and how students can find help. These experts bring with them years of on-the-ground professional experience with student mental health issues, along with answers to some of the more pressing questions about anxiety, depression, stress, and other concerns that have become intertwined in the fabric of college life.

Factors Disrupting Academic Performance

Factors Disrupting
Source: American College Health Association’s National College Health Assessment, Spring 2014 Reference Group Executive Summary

Top Mental Health Concerns & Getting Help

Drawing a clear line between what falls within the range of “normal” mental health and what crosses over into emotional, behavioral, and/or psychological dysfunction is a complicated and, at times, controversial proposition. It’s not entirely surprising, for example, that a high school graduate who’s away from home and the support of his or her family and friends would feel a certain amount of stress and anxiety in the competitive atmosphere of college. As Craig Rodgers, a doctor of psychology who’s been working as a Bureau of Study Counselor at Harvard University for over a decade explains, “The shift from high school to college itself can cause students to be stressed out, to feel anxious, and to have trouble focusing. Those are natural stresses, but they can be very real.”

As Margaret Bertram of Active Minds points out, “The transition from high school to college is a big one, so we work through our local chapters and our national office in Washington DC to lower the stigmas and raise awareness about mental health issues.

There are students who come to campus not knowing how to seek help because of cultural reasons or because they’ve never had the option before. Maybe they’ve wanted to seek counseling in a private way, and college is their first opportunity to do so.

And, in some cases students haven’t had the financial resources to get proper counseling prior to college. One of our biggest areas of success has been in letting students know that counseling services exists, helping and encouraging students to get the mental health resources that they need, and breaking down the barriers to doing that.”

Awareness begins with understanding the characteristics of various mental health issues, the causal factors, and the way in which they impact college students in particular. There are a number of professional organizations and advocacy groups, including the American Psychological Association (APA), the American College Health Association (ACHA), and the National Institute of Mental Health (NIMH), that collect data on the incidence of specific mental health complaints and conditions among college students and the general population. Here’s a rundown of the most pressing issues on campus, and where students can go to get help.

Anxiety and Stress

Anxiety can be a symptom and a diagnosis. It is a component of PTSD and OCD, as well as the primary cause of social phobias, panic disorders, and what is known clinically as generalized anxiety disorder (GAD). Stress and anxiety regularly rank highest among mental health complains for college students. The numbers vary, but 86 percent of college students report being overwhelmed and 81 percent report being exhausted, both of which can be linked to anxiety. An APA report on the most recent Association for University and College Counseling Center Directors survey found that anxiety is the top concern among college students.

The NIMH notes that anxiety is a natural reaction to stressful situations and that it can be beneficial in some instances. However, abnormal levels of anxiety can be triggered by environmental factors, ranging from stress, diet, sleep, and even exposure to certain chemical pollutants. Anxiety can also be the result of neurochemical imbalances, centered at the amygdala and the hippocampus. In addition, anxiety is considered one of the primary symptoms of post-traumatic stress disorder (PTSD), and can often be related to trauma effects not specifically classified as PTSD.

Get Help: Anxiety & Stress Resources
On Campus

Stress & Anxiety Management Peer Groups: Although many institutions have counselors who focus on test anxiety, stress management, and related areas, more and more campuses tackle the issue at the peer level. For example, the health services center may organize a weekly drop-in group for students to share thoughts, feelings, and actions with professionals and peers.

Puppy Therapy: In recent years, more and more colleges have turned to puppy therapy during finals week, where certified therapy dogs come to campus and play with students during study breaks. Research has shown that people who interact with pets have lower levels of cortisol—the stress hormone—and increased endorphins—the happiness hormone. Many colleges have reported success with such programs and some now offer it year-round at their recreation center.

Student Health Ambassadors: For some, it may be easier to talk one-on-one with a peer rather than an older adult. As a result, in addition to counselors, some colleges also have student health ambassadors. These students serve as peer educators and also act as liaisons between students and the campus health center. Ambassadors may also hold recurring workshops where students can gather and discuss stress and anxiety management strategies.

Motivational Gifts: At some colleges, students can go to their campus health center during midterms and finals weeks to receive goodie bags of motivational—and healthy—treats to get them through exam stress and anxiety.


Even though the moods and feelings they evoke can be quite different, depression and anxiety are actually quite similar in terms of causal factors, behavioral effects, and even treatment protocols. Everyone feels sadness from time to time, but the emotion usually passes. However, if that sadness lingers well beyond feeling down or blue until it morphs into debilitating dread and hopelessness, that’s a sign of depression.

The APA ranks depression as the second most prominent mental health concern for college students, affecting an estimated 36.4 percent, and ranks relationship problems–which are commonly at the root of depression–right below it at 35.8 percent. A study by the ACHS in 2010, as reported by the APA, found 45.6 percent of students had feelings of hopelessness and 30.7 percent were functionally impaired by depression over the course of a 12-month period. The ACHA’s 2014 numbers are in keeping with that general trend, with 32.6 percent of students reporting episodes of severe depression.

Get Help: Depression Resources
On Campus

Medical and Mental Health Assessments: For students who are unsure whether they suffer from depression or a temporary case of the blues, many college campus health centers offer on-site medical and mental health assessments. Some centers may also have online self-assessments for those who are not quite ready to speak with a counselor or wellness professional.

Counseling & Psychology Services: Many college campuses have counseling resources to help students identify and cope with depression. These departments and services have trained professionals with years of experience working with students and staff to both manage depression and maintain positive mental health.

Nutritional Counseling: Increasing research has shown that the food we eat can affect not only our physical health, but also our emotional and mental health. As a result, many colleges offer nutritional counseling to help students adopt eating habits and diets that support emotional and mental wellness. Students can speak with certified nutritionists to discuss concerns and problems, as well as design individualized wellness and/or coping strategies.

Alcohol and Drug Abuse and Addiction

Drugs and alcohol use among college students is nothing new, but there are new concerns about the impact of substance abuse and addiction, specifically in terms of their relationship to anxiety, depression, and other mental health issues. Excessive and habitual use of alcohol, prescription medications, and other narcotics is often a symptom of a deeper problem, and can be used to self-medicate. Recent reports have singled out prescription drug abuse as a particularly pernicious problem–according to the Center for Disease Control and Prevention, pharmaceutical drug overdoses surpassed firearms and motor vehicle accidents as a leading case of death in 2010. And, while the cognitive and developmental impairments associated with substance abuse are a genuine concern, there is increasing awareness that such behavior can lead to suicide, sexual assault, and other serious consequences.

Get Help: Alcohol & Drug Abuse Resources
On Campus

Alcohol Screening and Intervention: College students who have been caught violating campus alcohol policies are often referred to the health center for alcohol screen and intervention. Students will be screen for alcohol abuse and other related issues such as depression and anxiety and will speak with a trained counselor to receive personalized feedback and guidance. Many campus programs also allow students to self-refer if they feel they need professional help.

Social Media Campaigns: Many experts argue that the most effective way to combat alcohol abuse and binge drinking on college campuses is by changing the culture around drinking. Most college students, particularly freshmen, think binge drinking is “normal” and end up going beyond their alcohol limits when attending parties and social activities. In an attempt to change the way students think about drinking, many colleges have created social media campaigns to illustrate the darker side of binge drinking. These usually go beyond just statistical numbers, offering unattractive, bothersome, or embarrassing images and visuals of drunken students.

Community Involvement: Some colleges and universities have turned to the surrounding community to combat binge drinking on and around campus. Instead of relying on just police, schools have asked parents, local businesses, and city officials to help tackle underage and binge drinking among students, particularly at off-campus parties.

University-Run Bars and Pubs: Although controversial, some colleges have campus bars or pubs that are run by the university, which gives the school a chance to monitor how much students are drinking, crack down on underage drinking, and cut students off once they have reached their alcohol limits. Colleges that have taken this approach argue that having a university-run bar on campus creates a safer drinking environment—even for those who are not drinking—and has helped reduce incidents of drunk driving and sexual assault.

Attention Deficit Hyperactivity Disorder

ADHD, also referred to as ADD, essentially amounts to a spectrum of behaviors that include hyperactivity, impulsivity, and difficulty in focusing and organizing one’s thoughts. In a recent episode of NPR’s New Tech City podcast, psychologist Michael Pietrus, a clinician who specializes in ADHD and works as a counselor at the University of Chicago, referenced recent data that shows ADHD to be on the rise. “The current number of people being diagnosed with ADHD is somewhere around 11 percent and in the college population it’s closer to 18 to 20 percent. That has been going up year by year. The thing to understand about ADHD is that it’s a rule-out diagnosis, or a diagnosis of exclusion. There are a lot of potential things that contribute to attention problems in people, things like mood disorders, anxiety disorders, substance abuse, and sleep disorders.” In other words, there are many causal factors for ADHD, and those factors can also be read as symptoms of the disorder.

Get Help: ADHD Resources
On Campus

Specialized Programs: Several colleges and universities offer specialized academic programs for students with ADHD, executive function issues, and other learning challenges. In such programs, students take classes as any other student would, but also received individualized support from faculty members, including help with organization and time management.

Strategic Alternative Learning Centers: Some colleges have dedicated learning centers that serve students with specific learning and/or psychological needs. Students interested in a program like this will likely need to apply, but once accepted, they will be assigned a learning specialist who will help them create a learning plan that is designed specifically for their needs.

Colleges Exclusively for Students with LDs: While most colleges offer special programs or learning centers, there are some campuses that are exclusively for students with learning disabilities such as dyslexia, autism spectrum disorder, and ADHD. In addition to working towards a college degree, students at these colleges also receive personal assistance and individualized attention in smaller classes. Most courses are tailored to meet these students’ academic needs, and professors and advisors are highly trained and experienced to work with students with various LDs.

Gap Year Programs: Sometimes referred to as “pre-college transitional experiences”, some colleges offer programs in which students live on campus with peers and take regular college courses while also taking workshops to help them transition into college life. These workshops can cover important topics such as studying skills, time management, organizational skills, and money management. Usually, these types of programs are open to any prospective college student who is not quite ready to dive headfirst into college, but they can be particularly helpful for students with learning disabilities.

Bipolar Disorder

Also known as manic-depressive illness or manic-depression, bipolar disorder is characterized by drastic and unusual mood swings. It can feel like anxiety during the upswings, and depression during the downs. The symptoms to look out for are episodes of overexcitement, or mania, followed by dark swings into depression. Mike Fitzpatrick, the executive director of NAMI, points out that, “Parents should talk to their kids about mental illness before they leave for college and maintain a regular dialogue throughout the school,” emphasizing that, “the majority of people with bipolar disorder experience an onset of symptoms before the age of 20, making adolescence an essential time for awareness.”

Get Help: Bipolar Disorder Resources
On Campus

Counseling & Support: Because bipolar disorder is a more complex issue, actual support services on campus may be limited at smaller colleges. Many colleges and universities, however, do offer counseling for students who suffer from bipolar disorder and its symptoms, but may refer students and their families to outside therapy.

Eating Disorders

The two most common and familiar forms of eating disorders are:

Anorexia Nervosa – Extreme weight loss, centered on severe portion control and dietary restriction
Bulimia Nervosa – Extreme weight loss, involving episodes of binge eating followed by purging

Eating disorders disproportionately affect women, but the NIMH says that 10-15 percent of anorexics and bulimics are male. The NIMH also estimates that up to a quarter of all college students suffer from some form of eating disorder, although the severity can vary. Again, depression, anxiety, and trauma can be causal factors and symptoms of eating disorders, which can then lead to what’s called a dual diagnosis.

Get Help: Eating Disorder Resources
On Campus

Counseling & Behavioral Therapy: Many colleges offer counseling and psychological support through their health center to help students address and manage various eating disorders, as well as help them shift their attitudes, thoughts, and feelings about weight and body image.

Nutritional Counseling: Students can also seek nutritional counseling and work with a certified nutritionist to improve eating habits, diet, and implement daily strategies that promote healthy eating.

Student-Organized Sports: Managing eating habits and diet is just one part of the equation. Often times, regular exercise can also help students have a more positive body image, which in turn, can help alleviate some of the thoughts, feelings, and emotions that may trigger negative eating habits. Although the ultimate goal of student-organized sports may not necessarily to be combat eating disorders, it can still be a healthy and positive coping mechanism.

Obsessive-Compulsive Disorder

OCD, as its known, is an extreme version of what might otherwise be normative behavior. Students with OCD can be beset by overwhelming urges to repeatedly perform certain routines and rituals, and by upsetting thoughts that won’t abate. It’s estimated that OCD affects 2.2 million American adults, and the symptoms tend to become most apparent and disruptive in late adolescence and young adulthood. There are also linkages between OCD and eating disorders, anxiety disorders and depression.

Get Help: OCD Resources
On Campus

Psychological Support & Therapy: Colleges and universities offer counseling support to help students cope with OCD, as well as understand the underlying causes and triggers so that they can lead healthy and productive lives. Counselors and specialists can also help students develop strategies to help alleviate fear and anxiety, which are often triggers of OCD.

Post-Traumatic Stress Disorder

PTSD initially came to widespread attention by veterans who returned from the frontlines unable to escape the heightened fight-or-flight response that is a natural defense in times of extreme stress. But, over time it’s become clear that traumatic incidents of all kinds can lead to symptoms of PTSD. Those symptoms can include episodes of panic and extreme anxiety, depression, emotional numbness, sleep disturbances, memory lapses, and hyper-arousal. The Anxiety and Depression Association of America estimates that 7.7 million American over the age of 18 suffer from PTSD in some form.

Get Help: PTSD Resources
On Campus

Counseling: Many colleges offer counseling and psychological services to help students overcome PTSD. Whether the student suffers from long-term PTSD or is suffering from PTSD after a brief, isolated incident, counselors are trained to recognize symptoms and help students develop new coping skills.

Support Groups: College students suffering from PTSD can find support groups on many college campuses. These groups allow students to find and meet with others who face similar struggles and discuss their challenges in a safe environment.

Special Accommodations: Depending on the trauma and severity of PTSD, a college may be able to allow for special accommodations to ensure that a student with PTSD can achieve academic success. For example, some PTSD students—such as student Veterans—may find it difficult to be around a lot of people in a larger classroom or handle certain noises and stimuli. In such situations, students may be able to take the class online or arrange for special office hours with a professor in order to go over course material.

General Wellness Strategies for All College Students

Different disorders call for different treatment protocols in the realm of mental health and each person has his or her own unique set of symptoms, circumstances, and challenges. Counseling paired with an array of medications that target various aspects of anxiety, depression, and other specific disorders can be beneficial, depending on any number of variables. And, it has become more and more common for students to come to college already on prescription medication for a mental health condition. A survey by the American College Counseling Association and International Association of Counseling Services found that 26 percent of students seeking counseling in college were already taking psychiatric medications, which was up from nine percent in 1994. But, in almost every case, managing a mental health issue ultimately comes down to developing coping skills and lifestyle routines that address the symptoms as well as the root causes of the problem, particularly when it comes to anxiety and depression.

Sleep, diet, and physical activity are the three most underutilized antidepressants,” explains Hirst. “That’s also true for stress management.” That’s a sentiment and a recommendation that you’ll find more or less across the board in mental health care, counseling, and advocacy. Because, on some level, mental health is similar to physical health–treat your mind and body well, and it’ll be more likely to return the favor.

Craig Rodgers does have a unique set of recommendations for the students who come to him for guidance at Harvard. He sums them up in three steps:

1. Focus on the controllable.

If you find yourself thinking constantly about matters that are largely or entirely outside of your direct control, like “I must get an A grade on this midterm exam” or “I must win my next athletic competition,” then frustration and angst often ensue. Instead, focus on matters that are as controllable as possible, and that will maximize the likelihood that you will achieve your desired outcome. For example, try changing your thought process to “I need to make enough time tonight to review the last three chapters of my textbook so that I’m more likely to get an A grade on tomorrow’s midterm” or “I need to pay attention to the position of my arms when they enter the water during my next swim race in order to maximize the likelihood of winning.”

2. Expectations are adjustable, so adjust them accordingly.

Frustration, disappointment, etc., often result when one’s expectations are not met. It’s important to think about where your expectations come from–are they internally generated, externally imposed, explicit, implicit–and whether they are realistic and appropriate.

3. Know that you are not alone.

In most cases, far more of your classmates than you will ever realize are feeling and experiencing similar adjustment issues and stresses. People just don’t generally talk about them except perhaps with very close friends, family, therapists, or spiritual counselors. Ask yourself this question: “When I’m sitting in the dining hall worrying about something, can the people around me tell what’s on my mind?” For most of us, the answer is “no.”

Here are some additional strategies for success in managing mental health issues for college students, particularly online students who may not be able to utilize campus services, culled from our experts.

Get Up and Move

The APA has been trumpeting the benefits of exercise for years, as a means of relieving stress that can cause anxiety, and boosting one’s mood to combat depression. It can also boost self-confidence, stimulate cognitive function, and there are even studies that show it improves creativity and sharpens memory. If that’s not enough, even small amounts of exercise can release dopamine, which can ease the pull of addictive substances and help normalize sleeping patterns. Of course, telling someone to get more exercise and getting them to do it are two different things entirely. Sara Hirst has a couple of strategies she uses with students at Randolph College. “I’ll tell students to put on their shoes and walk one lap about their dorm. If you tell them to walk around the track for a mile, that can seem intimidating. But, a lap around the dorm is more attainable and easier to approach. Sometimes in counseling I’ll even walk with people, just to get them outside and moving”.

Get Some Sleep

Again, it’s probably no surprise that chronic sleep problems disproportionately affect students suffering from anxiety, depression, bipolar disorder, ADHD, and other clinical mental health conditions, or that getting more sleep is often a good prescription. But, it’s much harder to actually affect significant changes in sleeping patterns. Hirst has a pragmatic approach to this challenge as well: “I talk with students about getting more sleep and regular sleep. But, it can be really difficult to re-regulate sleep unless there’s a break. So, if we’re coming up on winter break or spring break, then that can be a good way to approach recalibrating sleep habits or starting a new exercise program.”

Eat More Thoughtfully and Consistently

Some of this may seem painfully obvious, but sugar and caffeine, for example, aren’t the best way to start the day for someone who’s having issues with anxiety. For Anne Hershbell, this is familiar ground. As she puts it.

You ask students who are stressed and anxious what they had for breakfast that morning, and if they tell you it was coffee and a chocolate muffin then, well, that could be a contributing factor.

Unfortunately, there isn’t any one dietary regimen that will cure all of your ills. However, there are some easy-to-follow guidelines. Mental Health America recommends avoiding sugary drinks and excessive amounts of caffeine, and replacing them with water. They also recommend a diet that’s rich in fruits, vegetable, nuts, whole grains, fish, and unsaturated fats, and there is some evidence to suggest that people who eat less meat and dairy may suffer less from depression. But, the one aspect of nutrition that there’s a consensus on is that it’s generally a good idea in terms of maintaining good mental health to eat regular meals rather than skipping, say, breakfast or lunch.

Just Relax, Musically.

Another obvious one, and a command that’s easier said than done. But Sara Hirst has one technique that she’s hand success with in fostering relaxation in stressed-out students. “The ten-minute relaxation videos on YouTube are my best friend. I give them out like candy. I have a couple that I use a lot because I’ve gotten such good feedback from students on them. One is called Floating on a Cloud and it’s a Guided Imagery Relaxation Script. Students like it a lot. It’s like a little journey with music in the background. I also use calming meditation music and nature sounds, depending on the particular student. I tell them to put it on when they get up in the morning or when they’re going to sleep.

Just Relax, Behaviorally

There’s more than one way to calm the nerves, and there are mental health concerns that can’t be entirely addressed by a walk in the park or soothing music. In cases where a therapist can pinpoint a specific thought, pressure, or stressor that’s causing anxiety or depression, cognitive behavioral therapy can be the answer. “When it’s anxiety, we start by focusing on relaxation strategies,” explains Hershbell. ” But, we’ll also use cognitive behavioral therapy, which involves unpacking some of the thoughts and beliefs the student is carrying that drives the anxiety. For example, a student might say, ‘I have to get into med school.’ So, we’ll get into the thinking behind that and try to alleviate some of the stress around that idea.”

Get Connected

Most mental health professionals use the word “connectedness” to describe a healthy feeling of belonging to empathetic community of supportive people. And, even the Surgeon General lists social connectedness and community engagement as a key to mental and emotional wellbeing. Unfortunately, a new wave of behavioral research data seems to suggest that college students are spending less time actively making connections with real people. As the New York Times reported in February 2015, “In 1987, 37.9 percent of incoming college students socialized at least 16 hours per week with friends, while 18.1 percent spent five hours or less. But by 2014, only 18 percent of students reported spending at least 16 hours per week socializing with friends–an all-time low.” While it’s hard to quantify connectedness, it’s something that Margaret Bertram has seen work for students at the college level. “In my experience working with students, the sooner they can make positive and conscientious connections on campus, the better. Try to cultivate those kinds of relationships, not just with your peers, but also with professors. And find people who can not only be your friends, but also be your mentors. Most of the time, a mental health professional is the last stop. It’s good to have a solid support system in place before that.”


As a corollary to the benefits of making one-on-one personal connections, there’s also an emerging body of evidence to support the contention that getting away from you screen, whether it be a laptop, desktop, tablet, or mobile device, may have very real mental health benefits. In particular, it appears that digital media may be an aggravating factor in ADHD and other attention deficit problems, and that certain kinds of online activities increase stress and anxiety levels. If nothing else, a little less screen time means more time for the kind of socializing and connectedness activity that the Surgeon General recommends.

Mental Health Trends on Campus

The national and local headlines tend to speak for themselves when it comes to an issue as inherently complex and potentially vexing as mental health. “College Kids Are Getting More Depressed,” proclaimed a February 6, 2015 New York Times report about the latest findings of an annual UCLA Higher Education Research Institute report, which noted that 9.5 percent of respondents to the survey had felt “frequently” depressed during the previous years, a 6.1 percent increase from just five years earlier. In February of 2014, Psychology Today ran a story titled “The College Student Mental Health Crisis.” A January 27, 2011 piece in the LA Times announced the results of that year’s UCLA study in an article with the subhead, “Emotional Health is at a Record Low, with Many Students Reporting Stress Over Tuition, and a High Rate of Unemployed Parents.”

There are numbers to back up these worrisome headlines, but also good news in the form of more resources going towards college mental health services. Here’s a quick breakdown of the current picture in college mental health counseling and the trends that reporters and analysts have been seeing.

Mood Swings

What Goes Through a Typical College Student’s Mind Over a 12-Month Period
Mood Swings
Source: The American College Health Association’s National College Health Assessment, Spring 2014 Reference Group Executive Summary

Counseling Center Staffing Resources on the Rise

Counseling Center Staffing Resources on the Rise
Source: Association for University and College Counseling Center Directors annual survey

Mental Health Concerns on the Rise

Mental Health Concerns on the Rise
Source: American Psychological Association analysis of data collected by the Center for Collegiate Mental Health

Interview with Margaret Bertram, Active Minds

The good news is that finding help and counseling for mental health issues is probably easier now than at any time in the past. Awareness about mental health issues, and serious concerns about the consequences of not addressing mental health in a rigorous, thoughtful, and comprehensive manner have led to improved mental health counseling protocols, better access to such services, and improved resources across the board at colleges and universities. As the most recent Association for University and College Counseling Center Directors annual survey data indicates, the trend is toward hiring more professional clinical or psychiatric staff, as well as increasing staff salaries and counseling center operating budges.

Margaret Bertram of Active Minds has taken note of the improvements and she’s visited various schools on speaking engagements. “Every campus is different,” she notes. “We take that into account with each of our chapters. A lot has changed in just the last several years. The most recent counseling center director survey says that generally they are continuing to add staff each year. They’re responding with clinical staff. A lot more of them have suicide prevention plans in place, and they’re investing in gatekeeper training for staff, faculty, and student leaders. Campuses with residential populations have become a lot more aware of mental health issues. I’ve seen great strides with campus police and campus safety in terms of creating relationships with administrators and local police and hospitals. That’s been really encouraging and significant over the last ten years.”

As an organization, Active Minds has been doing its part to put forth proactive initiatives. “We’ve had chapters involved in everything from getting the mental health counseling crisis numbers printed on the back of student IDs, to including mental health modules in student orientations and first-year experience classes,” Bertram details. “And then we’ve had chapters that have worked with administrators to get better access to counseling services. It’s also good to see counseling centers marketing themselves, and being more visible on campus through programs and screenings.

But, one of the most effective ways to spread awareness and to empower people around the issue of mental health is through people sharing their own stories. It helps to normalize the issue, and explain recovery in a personal way. And it breaks down the scariness and the shame around the issue.

It’s also important to realize that, as a student, there is often a multi-tiered support system in place at residential colleges and universities to deal with the nuances of mental health issues. For example, at Harvard University, there is a dedicated mental health counseling center and staff who provide clinical care to students in need. But Craig Rodgers, a psychologist by training, works in a different area, offering personal and academic guidance to students who might simply be struggling with normal identity issues, moderate levels of social and academic stress, and short episodes of anxiety and/or depression.

“One approach with students who are not at any sort of safety risk is to start with non-clinical, non-pharmacological coping strategies, and see if those work before entering into a health care system to see a clinician and/or a prescriber,” Rodgers explains. “For example, there is a greater concern among students about the degree to which college will prepare them to get a job. And that can manifest in term of students feeling increased anxiety over what they’re studying in college, and even what they’re doing outside of school. They’re in the position of asking themselves, ‘Who am I and what motivates me?’

I tell a lot of students that the things that are going to satisfy you most in life may not be the things that you go looking for; often, they turn out to be the things that find you. And, you have to be open to letting that happen.

In cases where clinical mental health counseling is indeed necessary, the path to treatment has become easier to navigate, in part because fewer and fewer schools charge a fee for counseling services. Randolph College, for example, is one of those places: “Our center and many others do not accept payment,” explains the center’s director Anne Hershbell. “The center is covered by a fee that all students pay. What that means is that you don’t have to have a diagnosable condition to get counseling. So, you can talk to someone in the counseling center about life issues and career-oriented thoughts. There is a career development center here, but it’s an issue that comes up in mental health counseling as well.”

Schools are also working to create a more integrated approach to confronting the challenges of student mental health and wellbeing. As Hershbell explains in relation to Randolph’s new approach, “We now have something called care teams, or sometimes they’re called behavioral intervention teams. They were actually legislated in Virginia after the shooting incident at Virginia Tech several years ago. It’s basically a way to connect the dots between different educational and administrative offices. It’s a way to gather few key players who meet regularly to talk about students who may be at risk, and to come up with ways to address those problems for safety reasons and also for retention.”

Support for Online Students

Providing the proper mental health support services for online students poses new challenges that are now being addressed. Brick-and-mortar colleges and universities with online programs typically allow online students access to all on-campus mental health services, which is helpful for students who live within the area. But, for students who are taking advantage of the flexibility and convenience of earning an online degree from a different location, such access may not be of much help. Nevertheless, because helping students through episodes of anxiety and depression can be an important factor in retention and graduation rates–and because it’s ultimately the right thing to do–most online schools do provide some form of telecounseling and other telepsychology services. In fact, it’s an emerging subdiscipline and the APA already has professional guidelines for the practice of telepsychology and counseling.

The APA recommends that counselors engaging in telepsychology services, adhere to the following standards of care:

Apply the same ethical considerations and professional practices that are required when providing in-person psychological services.
Obtain informed consent from patients through making reasonable efforts to offer complete and clear descriptions of the telepsychology services they provide.
Insure the confidentiality of data and information related to their clients/patients through consultation with technology experts in order to apply security measures designed to protect and maintain data and information related to clients/patients.
Take into account the limitations of psychological testing and assessment procedures that have been designed and developed for in-person administration when implementing telepsychological evaluation procedures.
Psychologists should make reasonable effort to be familiar with and, as appropriate, to address the laws and regulations that govern telepsychology service delivery within the jurisdictions in which they are situated and the jurisdictions where their clients/patients are located.

However, just because a student is receiving his or her degree online, doesn’t mean that he or she must seek mental health counseling online through his or her college. The Affordable Care Act contained provisions that require health insurance companies to provide for clinical mental health counseling and services, and the APA, as well as the ACHA, NIMH, and other organizations, including the Mayo Clinic and the National Alliance for the Mentally Ill, provide online tools for finding proper counseling, regardless of one’s location. It may take a little more effort, but there are several mental health resources and services that online learners can take advantage of outside of their college or university.

Additional Resources

Active Minds

Active Minds is a non-profit mental health advocacy organization that has chapters at various colleges and universities around the country. It started at the University of Pennsylvania in 2000, after the suicide of a student who was later diagnosed as suffering from schizoaffective disorder. The website features a blog that addresses mental health issues for college students, as well as links to local chapters, and various mental health awareness campaigns.

National Alliance on Mental Illness

NAMI is a comprehensive online resource, guide, and advocacy hub for people with mental health, but it also features an entire area devoted to student resources, including information on NAMI campus-based programs, details on various mental health conditions, and other ways to get involved in the larger community of people dealing with mental health issues.

An online resource that provides access to US government mental health information. The site provides a range of information from myths and facts to helpful articles to information on how and where to get help.

The Jed Foundation

The Jed Foundation’s goal is to promote emotional health among college students through awareness and understanding of mental illness, well being, and suicide prevention. The foundation offers a range of information–including ways to get involved–for parents, students, colleges, and individuals interested in supporting overall student mental and emotional wellness.


A project of The Jed Foundation, ULifeline is a confidential and anonymous online resource center for students who are in need of help and information regarding mental and emotional health. ULifeline was developed with insight from experts in higher education and mental health, and there are currently more than 1,500 colleges participating in the organization’s network.