Colleges and Universities Need Campuswide Culture Change

This post is adapted from a National Academies press release:

A new report from the National Academies of Sciences, Engineering, and Medicine calls on US colleges and universities to take comprehensive, campuswide approaches to more effectively address mental health and substance use problems among students and to develop cultures that support well-being.

Rates of mental health and substance use problems reported by students have been rising for years on campuses, the report says. In addition, the three crises that marked 2020 — the COVID-19 pandemic, the economic crisis caused by it, and the killing of George Floyd, Breonna Taylor, and Ahmaud Arbery and the national reckoning with racism that has followed — have led to a marked increase in psychological distress being reported by college and university students.

“These long-standing problems cannot be allowed to go on unchecked — for the sake of the students themselves, and for the sake of society, which needs graduates who are not only well-educated but also mentally and physically healthy,” said Alan Leshner, chair of the committee that wrote the report, and CEO emeritus of the American Association for the Advancement of Science. Students reporting mental health problems are twice as likely as other students to drop out of school before completing their degree, the report notes.

Universities and colleges need to take a new approach to mental health challenges — changing their cultures to emphasize shared responsibility and a holistic understanding of what it means in practice to support students, the report says. For example, faculty should be trained on how to support healthy learning environments and to recognize when students may benefit from a mental health referral, and students should be taught about habits that affect well-being and the mental health resources available to them.

“No real progress will be made unless institutions decide to promote a climate that clearly values the well-being of every student,” said Leshner. “The overall tone for that campuswide atmosphere must be articulated by institutional leadership, and all sectors of the institution — faculty, staff, and students — should be involved. Each has a role to play.”

Student Mental Health Problems Pervasive, Even Before Pandemic

Research shows that student mental health problems are pervasive across the nation’s colleges and universities, the report says. The 2018-2019 Healthy Minds survey of over 300,000 students at about 300 colleges and universities, conducted before the pandemic, found that almost 40% of postsecondary students — or some 8 million students nationwide — reported experiencing a significant mental health problem. 

That same survey found that 60% of college undergraduates have been having an increasingly difficult time accessing mental health care — even before most campuses closed and instruction moved online. And a December 2020 survey by the American Council on Education found that the top two most-pressing issues for university and college presidents across all sectors were “mental health of students” and “mental health of faculty and staff.”

Campus Cultures Must Change to Better Support Student Well-Being

While college and university leaders may assume that simply bolstering their counseling centers would be a sufficient solution, counseling centers cannot and should not be expected to solve these problems alone, the report says. Rather, colleges and universities should broaden their efforts, striving to create campuswide conditions that support mental health and help students deal with issues when they arise. 

The report recommends a range of actions to support this approach, including:

• Institutional leaders, starting with the president and board of trustees or regents, should articulate the importance of creating a culture of well-being on campus — one that recognizes the range of individual behaviors and community norms that affect well-being, 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.
• Institutions should provide and require faculty training on how to create an inclusive and healthy learning environment. Faculty and staff have an underacknowledged role in promoting student well-being. Faculty need to be aware of the ways in which they might exacerbate conditions that undermine student health; they also need basic training in identifying and speaking with students who may benefit from a mental health referral.
• Students should be provided, as part of formal orientation, structured opportunities to learn about individual well-being and the cultivation of a healthy, respectful campus climate. The orientation should acknowledge how behaviors such as sleep, nutrition, exercise, social media, and work can be both levers for well-being as well as affected by well-being. Training should also include information on how to recognize and address implicit bias, and about the role students play in creating a community that supports one another’s well-being.
• Institutions of higher education should work to ensure students have access to high-quality mental health and substance use treatment services, either on campus or in the local community. After conducting a needs assessment and reviewing available mental health resources, institutional leaders should attempt to measure the “gap” between need for mental health care and capacity for care. That gap should then be examined for solutions from multiple angles, especially long-term funding strategies and/or community partnerships.
• 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. Currently, policies often act as barriers, limiting how long a student’s leave of absence can last before they must reapply for readmission, and affecting financial aid.

Meeting Financial Challenges

Colleges and universities are now under tremendous financial distress, also triggered by the pandemic and resulting harm to the US economy, so that finding new funds to provide additional resources for students experiencing mental health issues is problematic, the report acknowledges.

However, it also notes that colleges and universities lose revenues when students drop out because of mental health or substance use problems, and that research shows that counseling services have a positive impact on retention. The report recommends that institutions of higher education and the government agencies that support them increase the priority given to funding for campus and community mental health and substance use services — if necessary, reallocating existing institutional funds to support counseling centers and, when appropriate, the increased use of online mental health services. Institutions should also actively collaborate with local health care services and facilities and community providers.

Institutions should also 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. Currently, under 5% of institutions seek reimbursement in this way, the report notes.