MENTAL HEALTH, SUBSTANCE USE,
and WELLBEING in HIGHER EDUCATION

Supporting the Whole Student

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

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

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: 978-0-309-12412-6
International Standard Book Number-10: 0-309-12412-3
Digital Object Identifier: https://doi.org/10.17226/26015
Library of Congress Control Number: 2021930903

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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.

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

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

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

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Preface

The ability of students to succeed in higher education and beyond is dependent 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 problematic 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 systems 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.

A part of that culture change will require devoting more resources to promoting mental wellbeing, and that need is coming at a terrible time. Financial resources at almost every institution are severely constrained. However, this issue 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

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. The committee also thanks senior librarians Anne Marie Houppert and Rebecca Morgan, as well as the National Academies’ research library, for assistance with fact checking and literature searches.

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 institutional 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; Emily 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 comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. 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.

Contents

Summary

Chapter 1 Introduction

Chapter 2 Mental Health, Substance Use, and Wellbeing in Higher Education in the United States

Chapter 3 Environments to Support Wellbeing for All Students

Chapter 4 Clinical Mental Health and Substance Use Services for Students in Higher Education

Chapter 5 Moving Forward

Chapter 6 A Research Agenda

References

Appendix A Committee Biographies

Appendix B Minority Serving Institutions

Appendix C Acronyms and Abbreviations

Appendix D The Rate of Student Death from Suicide from the Big Ten Counseling Centers: 2009-2018

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