Mental Health, Substance Use, and Wellbeing in Higher Education: Supporting the Whole Student (2021)

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Alan I. Leshner and Layne A. Scherer, Editors Committee on Mental Health, Substance Use, and Wellbeing in STEMM Undergraduate and Graduate Education Board on Higher Education and Workforce Policy and Global Affairs Board on Health Sciences Policy Health and Medicine Division A Consensus Study Report of PREPUBLICATION COPY - uncorrected proofs 

THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the Substance Abuse and Mental Health Services Administration (SAMHSA) under award HHSP2333201400020B, the National Institute on Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) under award HHSN263201800029I. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-XXX-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26015 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2021 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Mental Health, Substance Use, and Wellbeing in Higher Education: Supporting the Whole Student. Washington, DC: The National Academies Press. https://doi.org/10.17226/26015. PREPUBLICATION COPY - uncorrected proofs 

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medi- cine at www.nationalacademies.org. PREPUBLICATION COPY - uncorrected proofs 

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin- ions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY - uncorrected proofs 

COMMITTEE ON MENTAL HEALTH, SUBSTANCE USE, AND WELLBEING IN STEMM UNDERGRADUATE AND GRADUATE EDUCATION ALAN I. LESHNER (NAM) (Chair), CEO Emeritus, American Association for the Advancement of Science CHRIS BROWNSON, Associate Vice President for Student Affairs, Director of Counseling and Mental Health Center; Clinical Associate Professor, Department of Educational Psychology, University of Texas at Austin GERARD CLANCY, Senior Associate Dean, University of Iowa Carver College of Medicine; Past President, The University of Tulsa BONNIE DURAN, Professor, Schools of Social Work and Public Health, University of Washington DANIEL EISENBERG, Professor of Health Policy and Management, University of California at Los Angeles; Director, Healthy Minds Network RAYNARD S. KINGTON (NAM), Head of School, Phillips Academy, Andover; President Emeritus, Grinnell College AMY LENHART, Professional Counselor, Collin College FRANCES LESLIE, Professor of Pharmaceutical Sciences; Dean, Graduate Division (ret.), University of California, Irvine BENJAMIN LOCKE, Executive Director, Center for Collegiate Mental Health and Senior Director, Counseling and Psychology Services, Pennsylvania State University GAIL A. MATTOX, Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine MARIA A. OQUENDO (NAM), Ruth Meltzer Professor of Psychiatry, and Chairman of Psychiatry, Perelman School of Medicine, University of Pennsylvania STEPHANIE PINDER-AMAKER, Chief Diversity, Equity, and Inclusion Officer and Director, College Mental Health Program, McLean Hospital; Assistant Professor of Psychology, Department of Psychiatry, Harvard Medical School JULIE POSSELT, Associate Professor, Higher Education, Rossier School of Education, University of Southern California CLAIRE E. STERK (NAM), President, Emerita and Charles Howard Candler Professor of Public Health, Emory University JEANIE TIETJEN, Director, Institute for Trauma, Adversity, and Resilience in Higher Education; Professor of English, MassBay Community College v PREPUBLICATION COPY - uncorrected proofs 

Study Staff LAYNE A. SCHERER, Study Director MARILYN BAKER, Acting Study Director (September–December 2020) JOHN VERAS, Senior Program Assistant AUSTEN APPLEGATE, Research Associate MIRIAM AKEJU, Christine Mirzayan Science and Technology Policy Fellow, 2020 ADRIANA COUREMBIS, Senior Financial Business Partner (until April 2020) CLARA SAVAGE, Senior Financial Business Partner BARDIA MASSOUDKHAN, Senior Financial Business Partner Consultants JOSEPH ALPER, Consultant writer JENNIFER SAUNDERS, Consultant writer vi PREPUBLICATION COPY - uncorrected proofs 

BOARD ON HIGHER EDUCATION AND WORKFORCE KUMBLE R. SUBBASWAMY (Chair), Chancellor, University of Massachusetts, Amherst ANGELA BYARS-WINSTON, Professor of Medicine, University of Wisconsin-Madison JAIME CURTIS-FISK, Scientist and STEM Education Program Leader, Dow Chemical Company MARIELENA DESANCTIS, College Provost, Senior Vice President, Academic Affairs and Student Services, Broward College APRILLE J. ERICSSON, SBIR/STTR Program Manager, NASA Goddard Space Flight Center JOAN FERRINI-MUNDY, President, University of Maine GABRIELA GONZALEZ (NAS), Professor of Physics and Astronomy, Louisiana State University TASHA R. INNISS, Associate Provost for Research, Spelman College SALLY K. MASON, President Emerita, University of Iowa DOUGLAS S. MASSEY (NAS), Henry G. Bryant Professor of Sociology and Public Affairs, Princeton University RICHARD K. MILLER (NAE), President Emeritus, Olin College of Engineering PATRICIA SILVEYRA, Associate Professor, Beerstecher-Blackwell Distinguished Term Scholar, and Director, Biobehavioral Laboratory, University of North Carolina at Chapel Hill KATE STOLL, Senior Policy Advisor, Massachusetts Institute of Technology Washington Office MEGHNA TARE, Executive Director, Institute for Sustainability and Global Impact, University of Texas MARY WOOLLEY (NAM), President and CEO, Research! America Staff THOMAS RUDIN, Senior Board Director AUSTEN APPLEGATE, Research Associate ASHLEY BEAR, Senior Program Officer LIDA BENINSON, Senior Program Officer IMANI BRAXTON-ALLEN, Senior Program Assistant MARIA LUND DAHLBERG, Senior Program Officer LEIGH MILES JACKSON, Senior Program Officer PRIYANKA NALAMADA, Associate Program Officer LAYNE A. SCHERER, Senior Program Officer JOHN VERAS, Senior Program Assistant vii PREPUBLICATION COPY - uncorrected proofs 

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Preface The ability of students to succeed in higher education and beyond is de- pendent on their physical and mental wellbeing, and the nation’s institutions of higher education are seeing increasing levels of mental illness, substance use, and other forms of emotional distress among their students. Some of the prob- lematic trends have been ongoing for decades. Some have been exacerbated by the COVID-19 pandemic and resulting economic consequences. Some are the result of long-festering systemic racism in almost every sphere of American life that are becoming more widely acknowledged throughout society and must, at last, be addressed. Although the causal factors for each have their own idiosyncratic solutions, the increase in mental health and related problems has put tremendous pressure on the capacity of existing traditional college counseling and other support sys- tems to handle the need for their services, leading to what some have called a “mental health crisis” on college campuses. Whether this constitutes a genuine crisis or not may be debated, but there is no question that new approaches and strategies are needed to deal with the increasing demand for help. This report lays out a variety of possible strategies and approaches, based on the available evidence on the nature of the issues and what works in various situations. Although the report includes an array of recommendations, no real progress will be made unless individual institutions decide to promote a climate that clearly values the wellbeing of every student. The overall tone for that campus- wide atmosphere must, of course, be articulated by the leadership—the president, the board of trustees, faculty leaders—but must also involve all sectors of the institution—faculty, staff and students. Each has a role to play. ix PREPUBLICATION COPY - uncorrected proofs 

x PREFACE A part of that culture change will require devoting more resources to pro- moting mental wellbeing, and that need is coming at a terrible time. Financial resources at almost every institution are severely constrained. However, this is- sue is of sufficient importance that, if necessary, priorities should be reevaluated and rearranged. The impacts of this problem are critical and broad enough that ensuring the wellbeing of all students must be near the top of the priority list. Hopefully, this report will help articulate the need for additional resources and provide a basis for moving forward on this issue. I am extremely grateful to my superb colleagues on the National Academies of Sciences, Engineering and Medicine’s committee that authored this report. Leading such an expert and committed group of scholars has been an extremely rewarding experience. I also want to express, on behalf of the whole committee, our gratitude to the exceptionally competent and dedicated staff of the National Academies and the many others cited in the acknowledgments that follow. Alan I. Leshner (NAM), Chair Committee on Mental Health, Substance Use, and Wellbeing in STEMM Undergraduate and Graduate Education PREPUBLICATION COPY - uncorrected proofs 

Acknowledgments The committee would like to thank the following staff members for their hard work and dedication in bringing this report to fruition: Layne Scherer, Austen Applegate, Marilyn Baker, Ashley Bear, and John Veras, as well as consultants Joseph Alper and Jennifer Saunders. Without their commitment, this report would not have been possible. This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institu- tional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Amelia Arria, University of Maryland; Stephen Beckley, Hodgkins Beckley Consulting; Traci Callandrillo, American University; Kafui Dzirasa, Duke University; Patricia Frazier, University of Minnesota; Sylvia Gonzalez, Austin Community College; Renée Jenkins, Howard University; Julia Kent, Council of Graduate Schools; Em- ily Lattie, Northwestern University; Juanita Limas, University of North Carolina; Sarah Lipson, Boston University; Olivia Lubarsky, John W. Brick Foundation; and Michelle Riba, University of Michigan. Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or xi PREPUBLICATION COPY - uncorrected proofs 

xii ACKNOWLEDGMENTS recommendations of this report, nor did they see the final draft before its re- lease. The review of this report was overseen by Antonia Villarruel, University of Pennsylvania, and Paul Gray, University of California, Berkeley. They were responsible for making certain that an independent examination of the report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY - uncorrected proofs 

Contents Summary 1 Chapter 1 Introduction 17 Chapter 2 Mental Health, Substance Use, and Wellbeing in Higher Education in the United States 33 Chapter 3 Environments to Support Wellbeing for All Students 63 Chapter 4 Clinical Mental Health and Substance Use Services for Students in Higher Education 95 Chapter 5 Moving Forward 111 Chapter 6 A Research Agenda 143 References 151 Appendix A Committee Biographies 175 Appendix B Minority Serving Institutions 185 Appendix C Acronyms and Abbreviations 187 Appendix D The Rate of Student Death from Suicide from the Big Ten Academic Alliance: 2009-2018 191 xiii PREPUBLICATION COPY - uncorrected proofs 

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