Summary

The United States has been struck simultaneously by three historic events: the SARS-CoV-2/COVID-19 pandemic, the associated precipitous rise in unemployment and cratering of the U.S. economy, and the killing of George Floyd, Breonna Taylor, and Ahmaud Arbery and the resulting national reckoning of the legacy of slavery, racism, and the increased awareness that people of color have different lived experiences and much more difficult lives than white people. One consequence of these three simultaneous events is an increase in anxiety and depression across the U.S. population, one that appears to be spreading and accelerating, according to a May 2020 survey conducted by Mental Health America. The rise in mental health, emotional, and behavioral issues is reflected in a marked increase in psychological distress being reported by the students at our nation’s colleges and universities.¹ This is particularly true in light of the social isolation many students have experienced over the past several months, the uncertainty of how and when campuses will reopen, and existential concerns about their futures given the extreme harm the U.S. economy has suffered.

This more recent rise in student distress resulting from these three converging phenomena highlights what has long been an increasing trend in student mental health and substance use problems reported by many institutions of higher education. Data from the 2018-2019 Healthy Minds Study of more than 300,000 students at some 300 colleges and universities (Eisenberg et al., 2019), conducted before the COVID pandemic, identified the pervasiveness of this problem across

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¹ For the purposes of this report, the term mental health will be used to refer to mental health, emotional issues, and behavioral issues. The term mental illness will be used specifically in reference to diagnosed serious mental health disorders, including depression, schizophrenia, bipolar disorder, or anxiety disorder.

the nation; almost 40 percent of students—or some 8 million postsecondary students nationwide—reported experiencing a significant mental health problem. That same survey found that 60 percent of college undergraduates have been having an increasingly difficult time accessing mental health care even before most campuses closed and instruction moved online. These increases are severely limiting the ability of the nation’s colleges and universities to provide the kind of atmosphere and services needed to ensure that all students succeed and achieve their full potential. This situation also has broader implications for completion and career success of postsecondary students necessary to build and diversify the nation’s workforce.

At the same time, the U.S. higher education enterprise is under tremendous financial distress, also triggered by the pandemic and resulting harm to the U.S. economy, so that finding new funds to provide additional resources for students experiencing mental health problems is proving to be problematic. Nonetheless, a December 2020 survey by the American Council on Education found that 68 percent of university presidents ranked student mental health concerns as among their most pressing issues. In fact, the top two most pressing issues for presidents across all sectors were “mental health of students” and “mental health of faculty and staff” (Turk et al., 2020). However, this understanding of the need does not always result in making student mental health concerns a priority.

While the short- and long-term outcomes of the current situation remain unknown and difficult to predict, the long-term consequences for the mental health of students in higher education are likely to be significant given the already increasing level of distress that postsecondary students were experiencing in general prior to the current challenges. Colleges and universities of all types and sizes will have to deal with this likelihood, if not for the benefit of their students and the nation that needs their graduates, then certainly for the sake of their financial situation—every student that drops out of school because of a mental health issue is a student who is not paying tuition.

In June 2019, the Substance Abuse and Mental Health Services Administration, along with the National Institute of Mental Health, National Institute on Alcohol Abuse and Alcoholism, and National Institute on Drug Abuse requested that the National Academies of Sciences, Engineering, and Medicine launch an 18-month consensus study to examine the degree to which the support systems on campuses provide services, programming, and other resources to students and the faculty, staff, and health systems with whom students interact. Under the auspices of the Board on Higher Education and Workforce, and in collaboration with the Health and Medicine Division, the National Academies appointed a committee of experts to examine the most current research and consider the ways that institutions of higher education, including community colleges, provide treatment and support for the mental health and wellbeing of undergraduate and graduate students in all fields of study. For the purposes of this report, the term mental health will be used to refer to mental health and emotional and behavioral

issues. The term mental illness will be used specifically in reference to diagnosed serious mental disorders, including depression, schizophrenia, bipolar disorder, or anxiety disorder.

By contrast, wellbeing is a holistic concept referring to both physical and mental health. It includes a sense of personal safety and security, emotional support and connection, mechanisms to cope with stressors, and access to services when appropriate for short- and long-term care. The committee believes that institutions have a responsibility both to enhance the wellbeing of all students and to provide additional support to a subset of students with more severe emotional distress and mental illness. Over the course of the study, the committee:

• Identified and reviewed programs, practices, resources, and policies that institutions of higher education have developed to treat mental health issues and to support wellbeing on campuses;
• Analyzed the challenges institutions face—including financial, cultural, and human resource obstacles and methods to address these challenges;
• Investigated factors related to the funding of and access to mental health services and support for student wellbeing, such as student academic performance and campus climate;
• Examined, to the extent possible, the relationship between student mental health, wellbeing, and rates of alcohol and drug use, and recommend ways in which institutions can address substance use and its effects on campus climate; and
• Produced a consensus report with recommendations that will be broadly distributed on campuses, at professional society meetings, and in other venues.

This report presents the findings of the Committee on Supporting the Whole Student: Mental Health, Substance Abuse, and Wellbeing in Higher Education and the recommendations it developed that, if followed, would improve the delivery of mental health, wellness, and substance use services by the nation’s institutions of higher education. This report also contains the committee’s suggestions for further research on student wellbeing and mental health and on the delivery of such services to benefit all students. While the committee acknowledges throughout the report the potential for the COVID-19 pandemic to exacerbate mental health issues for this population, this was not the focus of the report.

The report contains some information on graduate students and medical students, but focuses primarily on undergraduate students. Even though the committee was asked to investigate mental health issues among science, technology, engineering, mathematics, and medical (STEMM) students where feasible, most of the data relevant to this study are not disaggregated by field. In addition, the issues of mental health, substance use, and wellbeing affect all students in all disciplines, as do the campus services provided to deal with them.

Similarly, although mental health issues affect students in all professional fields of study, the committee was explicitly asked by the study sponsors to focus on medical students. It has provided some information on medical students, although, given the broad scope of the study, that information is necessarily brief. In its focus on medical students, the committee acknowledges that the mental health issues facing this population frequently also apply to other health professionals, including students pursuing degrees in other health-related fields. These mental health issues have likely been exacerbated by the COVID-19 crisis, where all health professionals are facing front line stresses related to the diagnosis, treatment, and care of patients, and have been found to be at higher risk of developing psychological distress and other mental health symptoms.

WHY DOES STUDENT WELLBEING MATTER TO HIGHER EDUCATION?

Student wellbeing is foundational to academic success. One recent survey of postsecondary educators found that nearly 80 percent believed emotional wellbeing is a “very” or “extremely” important factor in student success. Studies have found that the dropout rates for students with a diagnosed mental health problem range from 43 percent to as high as 86 percent. While dealing with stress is a normal part of life, for some students, stress can adversely affect their physical, emotional, and psychological health, particularly given that adolescence and early adulthood are when most mental illnesses are first manifested. In addition to students who may develop mental health challenges during their time in postsecondary education, many students arrive on campus with a mental health problem or having experienced significant trauma in their lives, which can also negatively affect physical, emotional, and psychological wellbeing.

Although it is a time of emotional and intellectual growth, pursuing a postsecondary education at any level can be a stressful and challenging experience for many students. A variety of factors affect students’ stress, including rising tuition and student debt. While these financial stressors affect many undergraduates, graduate students and medical students often face the increased burden of additional student debt after completing their undergraduate education.

First-generation students, students who graduate from underresourced high schools, non-native English speakers, and students from underrepresented groups such as students of color and sexual and gender minorities face additional challenges and stress. Moreover, the stigma of mental illness is particularly powerful for many young people in these groups, thus exacerbating the problems.

While student wellbeing is foundational to their success in postsecondary education, research shows that far too many students at all levels of their education and in all fields of study are not achieving a level of wellbeing that will enable them to thrive in an academic setting and reach their full potential.

For some students who do graduate, mental health problems are associated with breaks in their education, longer times to graduation, and lower grade-point averages. A report from the American Council on Education emphasizes the point, saying that, “the connection between mental health issues and student retention, particularly for students from historically marginalized groups, has implications for the economic wellbeing of students and institutions alike. Specifically, the negative effects of behavioral health problems on student retention suggest that institutional investments in student mental health are likely to generate both increased tuition revenues for institutions and higher earnings for students who attain a college degree” (Bruce-Sanford and Soares, 2019).

INSTITUTIONAL RESPONSIBILITY

Nearly every institution of higher education provides some version of mental health and substance use counseling and treatment services, often through a counseling and psychological services center. This institutionalized function can lead college and university leaders to assume that simply bolstering their counseling centers would be a sufficient solution to the mental health and wellbeing problems that today’s students face. It is the committee’s judgment, however, that counseling centers cannot and should not be expected to solve these problems alone given that the factors and forces affecting student wellbeing go well beyond the purview and resources that counseling centers can bring to bear. Rather, the committee believes institutions of higher education need to tackle two significant challenges. First, institutions must address the challenges arising from the increasing incidence of mental health problems among students in postsecondary education. Doing so will involve dedicating more resources to increase capacity for promoting wellbeing and serving those students who need help for a mental health concern or substance use. A multi-pronged approach is needed to address these challenges—including a focus on prevention, identification of high-risk students in a thoughtful way, effective community-based approaches, treatment services for identified cases, and relapse prevention and post-treatment support.

In addition, both the institutions and their faculty and staff need to address the issues within higher education institutions themselves, for example, institutional culture, that contribute to this increasing incidence of mental health and wellbeing concerns. An “all-hands” approach, one that emphasizes shared responsibility and a holistic understanding of what it means in practice to support students, is needed if institutions of higher education are to intervene from anything more than a reactive standpoint. Creating this systemic change requires that institutions examine their entire culture and environment and accept more responsibility for forming learning environments where a changing student population can thrive. Specifically, institutions of higher education need to create conditions that support mental health and help students deal with such issues when they arise. At a

minimum, this requires developing a culture of support throughout the institution. The committee strongly believes that only through such a multi-pronged strategy can our nation’s institutions of higher education create a supportive environment that will benefit everyone, including faculty and staff who must be active participants in this effort.

In addition to being aware of the ways in which faculty and staff might exacerbate conditions that undermine student health, these people have an underacknowledged role in promoting student wellbeing. To be successful, though, they need basic training in identifying and speaking with students who may benefit from a mental health referral. In addition, faculty need opportunities to develop skills and norms that improve their work in these areas. Faculty and staff should not be expected to act in the place of licensed counselors, but they do need to recognize issues and warning signs, empathize with students, and refer them to professionals who can help. There also is a role for undergraduate student peers and graduate teaching and research assistants in laboratories and classrooms who may be the people to whom students in crisis turn for help. The burden lies with the entire campus. Institutions should improve their infrastructure to respond to needs that arise, and their efforts must include building an institution-wide culture that values and supports student wellbeing.

MOVING FORWARD

There are no one-size-fits-all solutions to the challenges institutions of higher education are facing to meet student demand for mental health, substance use, and wellness services. A community college with an exclusively commuter student body, for example, is likely to encounter a different constellation of issues and have different resources available to deal with them when compared with a large public land-grant institution, a small private liberal arts college, or a university with a largely residential student body. The issues faced by undergraduates and graduate or professional school students can be quite different and must be recognized as such. Moreover, research has documented differences in the prevalence of symptoms and use of services across race and ethnicity, socioeconomic backgrounds, gender identities, and academic fields.

When appropriate, the committee mentions interventions designed for specific types of institutions or student populations. However, it is the committee’s judgment that there are multiple proven approaches for addressing mental health and substance use issues and promoting student wellbeing and that individual institutions can best determine the approaches most appropriate to their local conditions. For that reason, the committee is not advocating for a single “ideal” that all institutions of higher education should adopt or strive toward. Instead, the committee examines five major issues confronting institutions of higher education as they work to better meet students’ needs, provides examples of promising practices that have been effective at other institutions, identifies ways institutions

might address barriers to progress, and points out gaps in our knowledge that future research should address. These include the following:

• Addressing institutional culture and policies
• Prioritizing mental health amid financial constraints
• Understanding the state of student mental health and wellbeing on each campus
• Assessing institutional capacity to provide needed services
• Developing faculty, staff, and student capability to support emotional wellbeing and mental health

INSTITUTIONAL CULTURE AND POLICIES

Institutions of higher education must ensure that their culture is one of acceptance of and support for those students experiencing problems with mental health and substance use. Moreover, the committee believes that ensuring this culture must start with the institution’s leadership, the president and board of trustees/regents. Without institutional support and leadership, progress will be spotty, and too many students with problems will fall through the cracks. The Okanagan Charter² is a useful guide that can help colleges and universities embed health into all aspects of campus culture and promote collaborative action to create a health-promoting culture.

The committee acknowledges how difficult it is to change the culture of institutions of higher education, which tend to value the status quo and tradition. Nonetheless, the committee recognizes that accomplishing difficult tasks is a hallmark of the U.S. higher education enterprise. The committee believes as well that the COVID-19 pandemic and the George Floyd killing in Minneapolis have catalyzed a social movement around the disparities and racism that people of color and of low socioeconomic status experience daily in the United States. It is in the spirit of this moment that the committee believes our institutions of higher education have a special opportunity to bring together the different communities on campus to address those aspects of institutional culture that do not support, or in some instances even harm, mental health and wellbeing of all students, particularly for students from groups that have historically been excluded. At the same time, this kind of culture change, even with the highest levels of support, cannot be implemented solely by administrators, counseling center staff, and an institution’s student affairs office. Rather, it requires the entire faculty, staff, and student body working together to establish a culture that recognizes the importance of attending to the demand for services that now exists, proactively addresses student mental health and substance use, supports those students who have issues, and creates an environment that supports the wellbeing of everyone

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² See: https://wellbeing.ubc.ca/okanagan-charter.

on campus. Importantly, this culture change should also consider how best to engage part-time, adjunct faculty who may have significant student interaction and can support this broader culture change. Establishing a campus-wide action commission with representatives from faculty, students, staff, and administrative units, with a clear and effective leader, dedicated resources, and a clear charge to build a culture that supports student wellbeing, would be a strong first step toward promoting culture change and creating such an environment.

Aside from campus culture, institutional medical leave and re-enrollment policies can serve as barriers for students whose mental health or substance use problems are severe enough that they lead the student to withdraw from school at least temporarily. Many institutions have a limit to how long a student’s leave of absence can last before having to reapply for readmission, and withdrawal from school can affect students’ financial aid. However, students with disabilities, including those related to mental health (the most common type) and substance use, have the right to reasonable accommodations for their disability according to the Americans with Disabilities Act. Such accommodations include extra time on exams or assignments, the ability to withdraw from specific classes, and leaves of absence that allow for re-enrollment.

An important step toward creating an integrated approach to supporting students would be to establish a closer collaboration between academic affairs and student affairs. This step has been shown to help increase the chances for students with mental health or substance use issues to access services and succeed in school.

Considering Student Voices and Perspectives

Colleges and universities need to listen carefully to the voices and perspectives of the students themselves, both to understand how the institutions contribute to student stress as well as to understand how to change the campus culture and environment in order to minimize that stress and promote emotional wellness on campus. Students are often keenly aware of what needs to change in their environment and what is needed to support their own and others’ mental health. In addition, they are often the first to witness unusual or troubling behavior in their peers and are often the first line of support. A concerted effort on the part of administrative leadership, faculty, and staff is needed to create both formal and informal ways to include students in actions to change the culture on campus, revise policies that contribute to emotional and financial distress or threaten physical safety, combat systemic racism, publicize widely the availability of mental health resources, develop training to faculty and staff, and offer multiple ways for individual students to seek help. Most of these efforts will benefit the entire community.

PRIORITIZING MENTAL HEALTH AMID FINANCIAL CONSTRAINTS

Economic pressures, including increased operating costs, and greater market competition, have been on the rise for U.S. institutions of higher education for well over a decade. A 2014 survey of college and university board chairs and presidents, for example, found that 77 percent believe the financial stability of higher education is moving in the wrong direction (Selingo, 2015). This situation has been made worse by the COVID-19 pandemic that forced colleges and universities to effectively close their campuses for educational purposes and move to online instruction. The report notes, too, that the cost of student services and student facilities, such as campus counseling centers, represent a major concern to university presidents.

All of this is to say that academic budgets at all types of institutions are already constrained, a situation that makes creating new programs or embarking on new initiatives challenging for academic leaders. However, the assumption that bolstering the capabilities of the counseling and psychological services centers and creating other programs aimed at improving student wellbeing will simply create another major financial burden for colleges and universities with no tangible benefits is not necessarily true. Colleges and universities lose revenues when students drop out because of mental health or substance use problems. In fact, the Healthy Minds Network, which has developed a return on investment tool, has calculated that a counseling center treating 500 students a year will help an average of 30 students remain enrolled in college and increase tuition revenues by $1.2 million. In addition, those 30 students’ lifetime earnings would increase by an estimated $3 million (Lipson and Roy, 2015). Other research has shown that counseling services have a positive impact on retention.

Another approach colleges and universities can take is to start or expand billing of insurance companies for services rendered, something that less than 5 percent of institutions currently do, in part because the time, expense, and human resources needed to create the infrastructure to bill insurance companies may be beyond the capabilities of smaller institutions and community colleges. Colleges and universities that do bill insurance have not completely solved the demand/supply concern, highlighting that this problem is a broader institutional priority question. In addition, for colleges and universities that do not mandate that students have insurance coverage, there will be uninsured students who would not be able to afford services that require payment. The insurance reimbursement issue is further complicated by state insurance regulations that need to be changed.

UNDERSTANDING THE STATE OF STUDENT MENTAL HEALTH AND WELLBEING ON EACH CAMPUS

Data on mental health and substance use in students can be challenging to interpret for a number of reasons. These data are drawn from different groups of

students, including those seeking mental health services in counseling centers, subjects of targeted surveys on specific problems, higher education students in general, and broader segments of an age-equivalent population in and outside academia. Also, multiple methods are used in data collection, with varying strengths and limitations.

Much of the information on the incidence of mental health and substance use problems among students is based on self-reports from general population surveys, not actual clinical evaluations. This approach provides an economical way to collect data from entire student populations, but it typically relies on brief screens that are correlated with but not equivalent to clinical evaluations.

Data from clinical settings are drawn from students who use mental health services from a counseling center in order to be evaluated or receive treatment. These data have the potential to characterize the full sub-population, and they include assessments by clinicians instead of or in addition to self-reported symptoms. They are, however, limited to those who use clinical services and therefore do not represent students who are not accessing those services.

No single data point or source of data is capable of conveying the complexity of mental health and substance use problems among students. Multiple approaches and methodologies contribute to a richer understanding of the issues, but the strengths and limitations of each approach need to be taken into account in forming conclusions about the prevalence of mental health and substance use issues in higher education.

INSTITUTIONAL CAPACITY TO PROVIDE NEEDED SERVICES

Once an institution has determined the extent of mental health and substance use issues among its students, it needs to determine whether it has the resources available—either on campus or in the local community—to support student mental health and to provide adequate care for those students suffering from those conditions. The great majority of university presidents surveyed indicated that they provide mental health services for their students, and another 12 percent are considering different options to address student mental health and substance use in light of COVID-19. However, there is not enough capacity in terms of mental health and substance use professionals for the general population, let alone to help every student who needs help, whether in a campus setting or via a community resource. According to the Health Resources and Services Administration, this situation is projected to get worse, not better, in the years ahead.

Possible partial solutions include increasing the use of teletherapy, enabling peer-to-peer support initiatives, and turning to the community, including university and local health services, to increase capacity, particularly for students with more serious mental health issues. In addition, institutions of higher education should initiate campus-wide efforts to raise mental health awareness and to

prevent suicide, which they can do through mandatory orientations for new faculty, staff, and students. Some institutions of higher education have established mental health teams. The Jed Foundation highlights Campus Behavioral Intervention Teams (BIT) that “promote student, faculty and staff success and campus safety by facilitating the identification and support of individuals who demonstrate behaviors that may be early warning signs of possible troubled, disruptive or violent behavior” (Jed Foundation, 2016).

In whatever way an institution decides to increase its capacity to address student mental health and substance use problems, it should ensure that available resources can support diverse student populations. The Equity in Mental Health Framework, for example, is an accessible resource for schools seeking to promote mental health and wellbeing among Black, Indigenous, and people of color, as well as students with other identities, including sexual and gender minorities.

DEVELOPING FACULTY, STAFF, AND STUDENT CAPABILITY TO SUPPORT EMOTIONAL WELLBEING AND MENTAL HEALTH

It takes everyone on campus to contribute to an environment that fosters student wellbeing, protects students from developing mental health and substance use issues, and helps facilitate access to services that would benefit them. Faculty and staff, including graduate student teaching assistants and residence hall assistants, have an important role to play in this effort given that they are in regular contact with students. At some institutions, particularly community colleges, faculty are likely to be the only members with whom students interact on a regular basis. The culture of many institutions of higher education and their incentive structures—at both the disciplinary levels and within the specific workplaces where research is carried out—have been poorly aligned with creating inclusive environments, and faculty have not been held accountable nor rewarded for creating an environment that supports wellbeing among students, whether in the classroom or the laboratory.

Faculty members can, however, play a significant role if appropriately trained. Periodic training on mental health issues as well as ways to help reduce stress and promote wellbeing in classrooms is needed for faculty and staff, particularly for those who directly support students, including graduate teaching and research assistants and postdoctoral researchers. Training related to mental health should include understanding of racial/ethnic, class, and other disparities in experiences of and attitudes toward mental health treatment. Most importantly, faculty should be taught how to identify and respond to students in distress and feel confident to help them access services. What the committee envisions is an approach that would provide faculty with basic training in four areas:

• how to identify, initiate conversations with, and refer students who may be having problems with mental health or substance use;

• how to make learning environments inclusive and supportive of student wellbeing;
• how to model preventive strategies and coping skills in class; and
• how to improve mentorship skills and pedagogical skills so that relationships and instruction support wellbeing.

RECOMMENDATIONS

The committee presents 10 sets of recommendations, all in Chapter 5, to improve the ability to provide wellbeing, mental health and substance use services for students that meet the increasing demands for such services. The recommendations are as follows:

RECOMMENDATION 5-1

Institutional leaders, starting with the president and board of trustees or regents, should articulate the importance of creating a culture of wellbeing on their campus, one that recognizes the range of individual behaviors and community norms that affect wellbeing, acknowledges the magnitude of mental health and substance use issues on campus, addresses the stigma associated with mental illness and substance use disorders, and provides a range of resources to support students with different levels of need.

RECOMMENDATION 5-2

Leadership from all segments of the campus community is needed to promote a culture of wellbeing.

• Institutions of higher education should establish and/or maintain a team or teams that involves all sectors of the institution’s community that coordinates, reviews, and addresses mental health, substance use, and wellbeing concerns.
• Any approach should have shared responsibility for addressing issues that negatively affect student wellbeing, a clear leadership structure and mandate, appropriate access to financial resources, and a charge to develop and implement an action plan to promote and support student wellbeing.

RECOMMENDATION 5-3

Institutions should ensure their leave of absence and reenrollment policies and practices will accommodate the needs of students experiencing mental health and substance use problems and the time needed for effective treatment and recovery.

• Institutions should implement methods to reduce and/or alleviate financial burden on students related to medical leave and other issues related to course completion.

• Academic affairs and student affairs units should develop collaborations to share information appropriately, while also respecting a student’s right to private/confidential treatment, in order to support students at the intersection of mental health and academic concerns.

RECOMMENDATION 5-4

Institutions of higher education and the government agencies that support them should increase the priority given to funding for campus and community mental health and substance use services.

• National, state, and local funders of higher education should incentivize colleges and universities to effectively provide support for students’ mental health and substance use problems.
• In their budgets, hiring, programming, expectations for serving students, and assessment/evaluation activities, institutions should make mental health a higher priority on campus. They should also work more directly with state and local governments, where relevant, to help bring this about.
• To ensure that mental health and emotional wellness services are prioritized, institutions should consider reallocating existing institutional funds to support counseling centers, support the increased use of online mental health services (when appropriate), and support data collection on the need for and use of mental health services by students.
• Institutions should actively collaborate with local health care services and facilities and community providers, for example, by considering hiring staff to help students navigate and manage off-campus services.
• States should modify insurance laws or regulations, or provide administrative guidance, to enable institutions to use general funds and/or designated health fees for expenses that are not covered by students’ personal insurance.

RECOMMENDATION 5-5

Institutions of higher education should work with insurance companies and health plans and federal, state and local regulators to remove barriers to seeking reimbursement for student mental health and substance use costs for covered students.

• Insurance companies should keep up with market rates for reimbursement to incentivize more providers to accept insurance carried by students, support providers from institutions of higher education in becoming paneled quickly, and communicate and improve the confidentiality measures in place to dependent subscribers between the ages of 18-26 to ensure that they can seek services using their parents’ insurance and be afforded the confidentiality they are entitled to receive.
• States should modify insurance laws or regulations, or provide administrative guidance, to enable institutions to use general funds and/or designated

• health fees for expenses that are not covered by students’ personal insurance for charges incurred at student health and counseling services. This is commonly referred to as a secondary payor provision in coordination of benefits.

RECOMMENDATION 5-6

Institutions of higher education should conduct a regular (preferably at least every 2 years) assessment that addresses student mental health, substance use, wellbeing, and campus climate. The data generated from these assessments should be compared to peer institution data (as available for disaggregation). Analysts should create a data collection system that allows for disaggregation by unit, program level, and student identities. This assessment should include the extent that students are aware of and know how to access available resources, both on campus and in the local community, to address students’ mental health and substance use problems.

• At the end of the academic year, institutions should review the many data points collected about their clinical trends and utilization as a way to understand how resources on campus can be used most effectively. These data would include the percentage of students who received treatment at the institution, the percentage that went outside of the institution for treatment, and the percentage of students that report needing help but did not seek or receive it, and should be further analyzed across demographic and identity groups.
• Funding agencies and private organizations should provide grants to under-resourced institutions, notably community colleges, historically Black colleges and universities, and tribal colleges and universities, to collect, analyze, and share data with the goal of implementing findings.

RECOMMENDATION 5-7

Institutions of higher education should work to ensure students have access to high-quality mental health and substance use treatment services. These services can be provided either on campus or in the local community. In order to ensure students have this access:

• After conducting a needs assessment and reviewing available mental health resources on and off campus, institutional leadership should attempt to measure and define the “gap” between need for mental health care and capacity for care. That gap should then be examined for solutions from multiple angles but especially long-term funding strategies and/or community partnerships.
• Institutions of higher education should design and implement culturally responsive services and programs to serve the needs and identities of all students.

• Colleges and universities should make behaviorally focused mental health services more readily available in primary care settings to facilitate students’ access to care and improve coordination between mental health and primary care providers, both on campus and in telehealth services.
• Institutions of higher education should create collaborative relationships in the community that will increase clinician diversity to better serve diverse student populations.
• If counseling centers rely on community-based resources to meet the mental health needs of their students, they should consider investing in case managers/resource navigators to help students connect with these community-based resources.
• Institutions can make wide use of telehealth options for those populations and situations for which it is appropriate.

RECOMMENDATION 5-8

Provide and require faculty training on how to create an inclusive and healthy learning environment.

• Provide and require faculty training about how to recognize students in distress and appropriately refer them to appropriate care.
• Provide mentor training, starting in graduate school, for all faculty, recognizing that good mentorship practices serve as a protective factor for student mental health.

RECOMMENDATION 5-9

As a part of formal orientation to college life, all students should participate in structured opportunities to learn about individual wellbeing and the cultivation of a healthy, respectful campus climate. This orientation should also include material on how to develop resilience in the face of inevitable challenges they will experience both in college and in life.

• To enable students’ self-awareness and resilience, training should acknowledge how behaviors such as sleep, nutrition, exercise, social media, and work can be both levers for wellbeing as well as affected by wellbeing.
• Training should also include information on how to recognize and address implicit bias, and about the essential role students themselves play in creating a community that supports each other’s wellbeing.
• The institution should also periodically offer refresher or “booster” training on these issues.
• Institutions should regularly and widely provide guidance to students and faculty on mental health resources available on campus and in the community.

RECOMMENDATION 5-10

Institutions of higher education should recognize that there is no single approach to promoting wellbeing and dealing with mental health and substance use problems that will be appropriate for all student populations.

• Support services should be tailored to the unique histories, circumstances, and needs of individual student populations.
• Support services should recognize and respond to the fact that many students from diverse populations will have experienced interpersonal racism, systemic racism, and implicit bias both before and during their time in higher education.