Category: Mental Health

When your house is burning, it feels like the whole world is on fire. That is how one student described her experience since October 7, when the heated protests and divisive debates over the war in Gaza erupted on her campus and on campuses across the country. For many students like her, the conflict is personal, it is political, and it is tangled up in all the things she is already struggling with: finding her identity, navigating friendships, and striving to retain intellectual curiosity while also feeling really angry.

For higher education, the Israel-Hamas war has rocked its own foundation, exposing not just elephants in the room but real wooly mammoths like the definition of free speech, the role of the presidential pulpit in geopolitical events, and the degree to which institutions tolerate or enable extreme political views. All of these issues relate to the overall wellbeing of students and of campus communities, issues that have emerged as important priorities for colleges and universities given the rates of anxiety and depression students, and faculty and staff, have been reporting.  

It would seem there would be no better time for campuses to be working on those elements that we know help humans flourish, such as empathy, civility, community and self-awareness. But very little of that is cutting through the vitriol, blame, and anger that are unavoidably replayed on non-silenced screens.  How can higher education use this moment in time, and others before it, to understand some of what is happening and to begin to heal through the power of its own resources and assets? LearningWell asked a number of people what they think.  Here is our first guest interview.

Gene Beresin, MD, MA, is executive director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital (MGH), a full professor of psychiatry at Harvard Medical School (HMS), and senior educator in child and adolescent psychiatry at MGH.

LW: What is your reaction to the way the conflict in the Middle East is playing out on college campuses?  

GB: Colleges are places that can raise issues that are highly controversial, that involve conflict, that generate high levels of emotion and that require civil conversations.  We want college campuses to be places where students feel safe enough to speak their minds, to disagree in ways that are interesting, that engage them. The problem in this particular instance with the war between Israel and Hamas is that I don’t think that there has been sufficient attention given to how to deal with conflict.

We try to teach our younger kids social emotional learning, principles of wellbeing, controlling our own emotions such as rage, shame, humiliation, passion, and in ways which are helpful. But what’s happened here in my view is that lines are being drawn in the sand. The students have been taking sides. And even though the leadership of many colleges have said, “we want this to be a safe place, and that there’s no room for terrorism or hatred or brutal behavior,” I have not heard much at all about principles of conflict resolution. It seems to me that students on both sides of the issue need to understand that there’s tremendous power to resolving conflict and dealing with conflict. And there are principles, for example, of noting the appreciation of differences, of acceptance, of tolerance, and the ability to love and respect each other despite our disagreements. But that does not seem to be happening.  I’ve heard a lot about free speech. I’ve heard a lot about the right to express your own opinions. I’ve heard a lot of platitudes, but I have not heard anything about principles.

LW:  How would these principles apply on college campuses today where disagreement appears to be the only thing people are focused on? 

GB:  We need to hold open conversations and active listening to both points of view. If we take a pedantic view of this and we look at history, both the Palestinians and the Jewish people in that region, both groups of people have been conquered, oppressed, displaced and brutalized by outside influences. If you look at it, there’s a lot in common between the Palestinian people and the Jewish people and we should take a step back and appreciate both points of view. 

“I’ve heard a lot about free speech. I’ve heard a lot about the right to express your own opinions. I’ve heard a lot of platitudes, but I have not heard anything about principles.”

Principle two is avoid being judgmental. When one is a subject of criticism or rage or a personal affront from a mental health standpoint, there’s the risk of feeling blamed, devalued, shamed, humiliated.  When on the defensive, the impulse is to counterattack. It basically fires up the amygdala and the fight or flight response, and it doesn’t generate oxytocin, which is the kind of neurochemical that brings us together.

Another principle is having frequent conversations that are under control. Many of the protests that I’ve seen have not been well controlled. They’ve been people screaming at each other. We’re not going to get anywhere by screaming at each other. We’re not going to resolve conflict. Another principle is learning to apologize. If I’ve offended you, if you’ve offended me, there’s tremendous power in apologizing for lashing out, for attacking another point of view. And what do you have to lose? Nothing really. You have a lot to gain by seeing what’s in common and by making one’s own reparations. I think that’s another principle of conflict resolution that I have not seen much of at all. 

Violence should, in every case, not be tolerated. Not tolerated in the Middle East, not tolerated in the United States, not tolerated on college campuses. And violence, I mean in word as well as in deed. Name-calling, attacking personally, ruthless behavior should be unacceptable. 

I think another principle is that the solution to this problem is not going to be easy, and it’s not one side giving into another or one side being right or one side being wrong.  It’s complicated, it’s nuanced. It requires accountability. You don’t resolve a conflict like this by a win or a loss. You resolve it in a way that leaves some things unresolved by demonstration of empathy, putting yourself in the other person’s shoes. I have not heard much at all from anyone including administrations or studentprotesters, about empathically understanding what the other side has endured. I can’t stress it enough. If the students can’t empathize with the impact of these horrifying events, if they can’t see that the trauma that’s happened to virtually everyone is extraordinarily traumatic, extraordinarily sad, extraordinarily dehumanizing, then we’re not going to get anywhere.

We want our kids from toddlerhood through young adulthood and beyond to understand principles of having civil conversations. And for the most part, these have not been civilized. So is there demonstration of respect? When you’re all fired up, you don’t demonstrate respect. And when you don’t demonstrate respect, you foster trauma, you foster distrust, dishonesty in some sense, and saying things that are hurtful and traumatic to other people. We should be able to respect differences. We try to teach our young children to take turns, to use the golden rule, to do unto others as you would have them do unto you. I don’t see much of that. I’m getting back to basics here. Basics that are psychological principles and principles of conversation and understanding that we want to teach kids from toddlerhood through adulthood.

Another principle of civil conversations is telling stories. What we’ve learned from all of our major scriptures, whether it’s the Quran or the Torah or the Bible, is that every scripture in the world lives through narratives and I think people can really begin to listen to each other through stories and through narratives. One of the reasons why all the scriptures have been built upon narratives is because narratives generate not only emotions, but questions about trajectories, about lives, about family, about loss, about trauma.

LW: What do you think about this from a mental health perspective?

GB: The bottom line is that this insoluble situation, this inflammatory situation is not only traumatizing, but breeds depression, anxiety, stress, and in some cases, hopelessness, loneliness, and suicidal thinking. I mean, it has all the elements of inflaming the mental health crisis that our college students are already undergoing. 

Stages of rage and trauma and high levels of emotion are not good for physical, emotional, or mental health. They fire up the immune system. They affect our sleep. They change our hormonal systems. They suppress the releases of oxytocin that makes us feel together and connected. So they have physiological effects that are dangerous. They have mental health effects that are dangerous, and they foster social disconnection, which I think is very detrimental for students on college campuses. So neurophysiologically, emotionally, and behaviorally and psychologically, these kinds of vitriolic demonstrations are not conducive to mental health. One can still express one’s point of view in a powerful way and not take a beating physically, mentally, emotionally, behaviorally.

Look, anger is a normal response. Anger prepares us for fight or flight. It’s a normal emotion. But when anger is extreme, when anger becomes laced with rage and hate, it is uncontrollable, and it clouds our cognition. It clouds our thinking. It clouds our ability to engage with others, and it puts us in an attack mode. So I think one of the other things that I would welcome is for not just students, but everyone involved in this very difficult and traumatic situation, is to use principles of anger management. If we can cool our jets, we’re in a much better place to actually talkwith each other and have civil conversations and have some kind of conflict resolution. And what this means is knowing when you’re angry and knowing when you’re coming from a place of anger rather than a more neutral emotional state.

Identifying your triggers for anger is really important. We all know road rage – the car that cuts us off, we want to just kind of slam into it. But we don’t do it. It’s okay to have impulses and angry impulses, but it’s not okay to act out on it. And one has toidentify one’s triggers. A lot of times the triggers here are identification with one’s cultural heritage, but that doesn’t necessarily mean attacking the other person. And a third principle of anger management is controlling your thoughts. Yes, we’re feeling angry. Yes, we’re feeling hateful. Yes, we’re feeling that we’ve got to do something, but it’s like one of my favorite supervisors said to me once, “A lot of times when you’re doing therapy, don’t just do something, sit there.” And I don’t see people just sitting there.  I don’t see people sitting there and taking things in and processing it without impulsively blurting things out. 

LW: How do you think colleges and universities should react? 

GB: I think the role of the leadership should be to provide and empower different segments on campus to actually promote these principles, so we need faculty and student training in conflict resolution,  civil conversations, and anger management. Secondly, this is not a “one-off.”  As a child, you learn things in places of worship, in the boys and girls club, in the community, in the home, on the playground.  We need stakeholders on campus to communicate these principles in reinforcing ways.  The dorm leaders, the heads of our student mental health service, the dean of wellbeing, our clubs, our athletic teams, our coaches to all engage in some way in modeling civilized behavior because what we are seeing now is not civilized. 

It’s not as though we need to have an assembly or a meeting at the student center and have a debate and then we’re done. No, it’s not one and done. These are ongoing conversations that need to occur with dignity and with respect and with thoughtfulness and kindness and compassion and empathy in multiple different forums so that they can reinforce each other.  The leadership of colleges can say, “Look, there are no simple solutions.” Not many presidents have said this. “There are no simple solutions. But let’s try to turn things around.”

Let’s not let rage and hate lead to what we’re seeing in the Middle East with tragedy and loss of life. Let’s try to make our campus a model of civility. Let’s have multiple places in which we can communicate with each other respectfully in a calm fashion, present opposing points of view, agree to disagree, bring in history, bring in culture, bring in personal narratives, bring in spiritual narratives.  And let’s do it differently. Do we want to replicate this? Do we want to perpetuate a stalemate, or do we want to do something that actually brings us to a higher level of empathy and understanding?

Larry Moneta, EdD, served as vice president for Student Affairs at Duke University from 2001 to 2019, when he retired to a life of consulting, teaching, and grandparenting. Dr. Moneta serves as adjunct professor at the University of Pennsylvania Graduate School of Education and teaches in the Global Higher Education Management program and the Executive Doctorate Program for Higher Education Management. He can be reached at lmoneta@gmail.com.

Sometimes, it’s all about choosing where to eat. On this particular day in 2012, I was deciding between a couple of places on the Duke University campus, with just enough time between Board of Trustee sessions to grab a bite. Fortuitously, I elected to grab a bagel in a venue in the student union where the president and vice president of The Duke Endowment (this is the Duke family endowment…not Duke University’s) also happened to be eating. At their invitation, I joined them where we engaged in a fascinating and, what would eventually become a significant, conversation about the status of students’ mental health.

The leadership of the Duke Endowment had apparently been following the news of rising suicides, greater expression of vulnerability and declining overall mental health of students and wondered to what I attributed all of this. I shared my thoughts which included concerns about over-protective parents, over-scheduled children, excessive use of technology and social media, overwhelming and global news dissemination, persistent and pronounced hate incidents, and more. In response to questions of solutions to this crisis, I offered vague but unclear ideas about population-level, preventative interventions rather than simply relying on more counselors and other forms of distress response efforts. We began focusing on resiliency-building techniques rather than disease response approaches.

At the urging of my luncheon colleagues, I began to develop a proposal for a research study that would lead to the development of population-level interventions to strengthen students’ resiliency. Over the course of that year, this idea germinated into a multi-million-dollar proposal that involved nearly 20 faculty and administrators, engaged four colleges and universities, and focused on tracking the undergraduate class of 2018 through their entire collegiate experience. The Student Resilience and Well-Being Project collected data on more than 6,600 variables across 11 waves of data collection from more than 2,000 students.

Unfortunately, just as our efforts to summarize and disseminate our findings were about to happen, the Covid crisis hit, and all attention was justifiably diverted to addressing that pernicious situation. Ironically and alarmingly, the post-Covid conditions on college and university campuses make this work even more important and valuable. According to the American Psychological Association:

“By nearly every metric, student mental health is worsening. During the 2020–2021 school year, more than 60% of college students met the criteria for at least one mental health problem, according to the Healthy Minds Study, which collects data from 373 campuses nationwide (Lipson, S. K., et al., Journal of Affective Disorders, Vol. 306, 2022). In another national survey, almost three quarters of students reported moderate or severe psychological distress (National College Health Assessment, American College Health Association, 2021).”

The article goes on to identify a variety of approaches campuses are taking to address this issue. Unfortunately, most efforts seem more reactive than proactive, requiring more and more precious resources which have begun to dwindle as Covid emergency relief funds dissipate.

In the years since the completion of our Resiliency and Well-Being Study, many of the faculty and staff associated with the project have retired or moved on to other roles and assignments. I retired in 2019 but remain active as a consultant and teacher and have been involved with various approaches to virtual and campus-based healthcare. It seems clear to me that the outcomes of our study and the key areas of intervention identified by the study are more important than ever.

The study identified four key foundations of resilience as noted in this graphic.

The Duke Endowment publication notes several initiatives that were launched towards the end of the study period, based on preliminary findings that confirmed the influence of these four focal areas. But, years and the impact of Covid have passed since that time, and a fresh look at potential interventions guided by these findings is warranted. In the rest of this article, I want to offer my thoughts, as someone with 50 years of collegiate student support experience, on further ways to address the campus mental health crisis based on our findings.

Self-Control (Self-Regulation)

Can colleges really teach or even modestly influence students’ self-control? Vulnerability to negative influences seems well-established by high school age, so the challenge to campuses is to reverse a years-long period of social conformity and group-think mentality. We’ve struggled with students’ alcohol consumption and substance abuse for as long as I’ve been an administrator…and much longer. I do believe that campuses have made a difference but can do much more to establish a culture with reduced peer pressures and reduced willingness by students to conform to destructive behaviors.

Creating a culture and climate of positive self-control—one where most students will make behavioral choices that conform to their values and ideals, rather than submit to the will of others—requires persistence and patience.  There’s no inoculation for foolish or dangerous behaviors and occasional but measured risk-taking is well-recognized as part of the journey to maturity. But diminishing overt hazing, drug and alcohol abuse, sexual misconduct and other common, destructive aspects of American collegiate behavior is essential. In my experience, the practices that have had the best effect to achieve this objective include:

• Surrounding incoming students with peer influencers and mentors who model healthy behaviors, reinforce messages of self-empowerment, and invite healthy forms of engagement. The selection and training of resident assistants, for example, at residential campuses is key. The same is true for peer academic advisors, orientation leaders, and any students who serve as mentors and advisors to entering students.

• The development of communities that are self-governed and guided by principles of inclusion, care, and forgiveness. Again, residential campuses have a great opportunity to accomplish this through residence hall models that foster small and frequent gatherings. The science of space^[1] can inform how best to create physical spaces that foster these exact conditions. Non-residential campuses can accomplish the same through learning cohorts, clubs and organizations, study groups, and other facilitated group gatherings.

• Adjudication practices that are less punitive and more educational with a focus on self-reflection, self-awareness, and self-compassion. Early intervention at the point of modest miscues can offer opportunities to prevent irrecoverable disasters.

• Well-being coaches who can work with teams of students on nutritional guidance, fitness plans, stress avoidance, relief tools and more.

• Faculty development programs that inform faculty about the science of self-control, encourage the development of effective time management skills for students and advise them how to respond to early indications of procrastination and incomplete assignments.

As may be obvious, moving the needle on a culture of self-control requires campus-wide coordination and consistency. Messaging about institutional values and norms regarding student behaviors must begin with enrollment recruitment messaging, continue through onboarding processes, and extend through academic and co-curricular student engagement. Healthy behaviors need to be modeled by peer and professional staff, by faculty and by deans. Even alumni who might signal historical patterns of behaviors perhaps previously tolerated but now recognized as inappropriate must be ‘re-educated.’ For campuses with significant graduate and professional students in attendance, customized versions of this approach may be useful as well. This is especially true where graduate students represent a significant part of the instructional staff.

With a new crop of students arriving each year, socialized by mass media, ill-informed peers, and romantic historians (their parents), the process of acculturation to healthy norms and of reinforcing the positive attributed of self-control is ongoing. Measures of changing patterns of behavior are available and should be part of a campus analysis of movement towards good community health and well-being.

Academic Engagement

Our study, unsurprisingly, found that students who were most excited and most engaged by their studies were also among the healthiest of our students. Being academically engaged doesn’t mean having the highest grades (though engaged students do tend to score above average). These students, in the words of one of our researchers, have a ‘gusto’ for their studies. They love what they’re learning and can’t wait to get back to it. For faculty, in particular, having a classroom full of engaged students is the holy grail!

Recent research by Gallup-Purdue University offers insights into practices which stimulate academic engagement and post-graduate career and personal success.

The findings highlight the importance of faculty who are great teachers, who actually get to know their students, and who provide opportunities for project work, in collaboration with others, for more than a brief period of time. Guided immersion into some intellectual effort is key.

In addition to caring and engaged faculty, students benefit from a variety of mentors which can include alumni, campus administrators, and volunteers from the local community. The development of practical skills through apprenticeships and internships is also critical as is leadership and followership opportunities through campus clubs and organizations.

This study focused on the power and influence of engagement in the academic realm, but in my experience, engagement across the campus environment is equally advantageous. The students whom I knew to be deeply involved in athletics, campus newspapers, community service, campus social groups, and more always seemed to me to be among the healthiest. Of course, there are outliers…I know plenty of students who were highly functioning alcoholics. But it was always quite clear to me and my colleagues that disaffected students struggled the most while engaged students thrived.

The broad literature on ‘belongingness’ (space limitations prohibit from a full treatment in this article) reinforces the findings on academic (and non-academic) engagement. The stronger the sense of belongingness at and to an institution, the greater the likelihood of engagement and well-being.

Self-Compassion

Being resilient doesn’t mean never failing. In fact, I imagine that healthier people are more self-confident and are prone to taking calculated risks. On campus, self-confident students pursue leadership roles, try out for lead roles in campus stage productions, take more challenging courses and take greater advantage of all the opportunities available to them. But self-confidence doesn’t always equal self-compassion, and inevitable failures, especially among the most ambitious students, can result in extremely debilitating consequences.

Our study showed that students who scored highest on self-compassionate scores also scored highest on our overall well-being indices. This means that healthy students accepted their failures but didn’t wallow in them. They learned from their mistakes, gave themselves grace for their missteps and moved on. If only we were all so kind to ourselves!

Can self-compassion be taught to all students? Absolutely! There’s considerable evidence of the relationship between mindfulness practices and self-compassion reinforcing the value of mindfulness training for all students as a campus-wide practice. In my time at Duke University, members of our counseling staff developed a program called Koru Mindfulness (now The Mindfulness Institute) which was promoted widely among first-year students. For other students, faith-based practices and engagements offer support for self-kindness and compassion. Athletics teams have begun to adopt self-compassion awareness to assist with recovery from losses and academic advisors are increasingly being trained to assist students with recovery from exam and course underperformance.

Relationships

What’s better than good friends? And I don’t mean all those Facebook or other social media friends! When it comes to the power of friends as stimulant for health, it’s not about the numbers. Having even one or two really good friends—friends who will look out for you, forgive your missteps, and celebrate/grieve with you unconditionally—makes a huge difference, according to our study. This may seem pretty obvious to all of us, but institutional efforts to promote friendships aren’t quite so simple.

Sometimes you have to break a model to build a better model. For example, at Duke, I discovered through our ongoing assessments that every year, more and more incoming students were pre-selecting a roommate rather than letting one be assigned to them randomly. Digging into the data, I discovered that most who chose this option were white students and mostly from wealthy families. This wasn’t too surprising as these students had the social capital to meet other students at summer camps or from their high schools and chose to room with one another rather than risk assignment with someone perceived to be ‘less compatible.” The problem, in addition to the self-segregation outcome, was that these roommates rarely actually became friends. The superficial characteristics they had in common rarely served as the foundation for a good friendship so, in time, these relationships drifted apart.

Given what we learned, we made a change. With the support of institutional leaders, we prohibited the pre-selection of roommates and mandated random assignments of all students (with some exceptions among varsity athletes). I also enlisted the support of a faculty member who had previously conducted research around roommates, friendships and diversity of relationships who agreed to track the consequences of the random assignments. It was gratifying to learn that random assignments lead to longer-lasting friendships and greater appreciation of differences among students from varying identities and cultures.

Residential campuses have ample opportunities to sponsor options for exposure to potential friends and non-residential campuses can do so through various student clubs and organizations. The point is to be deliberate about connecting students in pairs, teams, and communities. The student projects mentioned in the academic engagement foundation can also help forge friendships. The quality of a campus environment can also encourage friendship development. One of my first projects at Duke was to convert a passageway that promoted unengaged movement into a beautiful plaza where students (and others) preferred to stop, relax, and converse with those around them. I’m a huge proponent of campus architecture, both indoors and outside, that foster connections and engagement.

The four foundations I’ve noted are proven elements that promote students’ well-being. I’ve shared a few practices that align with the principles embedded in each foundation, but every campus will have their own approaches. If your campus has uniquely addressed one or more of these foundations, I’d love to hear about it!

^[1]Strange CC, Banning JH. Designing for Learning : Creating Campus Environments for Student Success. Second ed. San Francisco CA: Jossey-Bass; 2015.

Carson Domey is a youth mental health advocate in his sophomore year at The University of Texas at Austin, studying Economics and Government. Carson currently serves as the chair of The Mary Christie Institute’s National Youth Council on College Student Mental Health.

In an increasingly connected world, it might seem paradoxical that loneliness has been deemed an epidemic by the U.S. Surgeon General. Yet, the profound impact of isolation on youth mental health is undeniable, as the life-altering effects of the COVID-19 pandemic highlighted the need for community and social connections, particularly within education.

For college students like myself, who left behind support systems and existing relationships, the need for a sense of belonging and companionship becomes ever-so-critical. The pandemic only exacerbated this challenge of socially acclimating into a new environment, as during COVID-19, opportunities to develop such skills were limited.

The impact of the pandemic on students cannot be understated. The abrupt shift to online learning equally impacted students’ social and academic development. The absence of in-person interactions and hallmark experiences throughout high school and college resulted in students missing crucial social development opportunities. These skills, such as forming relationships, effective communication, and collaboration, hindered as a result of the lack of ample opportunities to hone such traits.

While online classes offered some benefits in terms of flexibility and accessibility, this medium certainly came with a price. The absence of natural social interactions in classrooms, lecture halls, and hallways left a void that no virtual meeting or Zoom icebreaker questions could fill. The spontaneous lighthearted moments during class and the collective energy and camaraderie lacked due to the nature of this new means of education.

As a student at the University of Texas at Austin, this fall, I have witnessed firsthand the commitment by faculty to address this issue. The first week of school included not only overviews of syllabi, but an emphasis from professors on the importance of fostering community in and out of the classroom. For example, many professors allot specific times for students to meet and engage with their peers during lectures, and we have furthered these bonds throughout the semester by working together on group projects.  The dedication to creating a connected environment was echoed throughout classes as small as 30 students to lectures as large as 150 students. This trend sends a resounding message: even in the face of adversity, the critical essence of community is irreplaceable.

Fostering such an environment requires educators to go beyond the conventional boundaries of their roles and see themselves as facilitators of both knowledge and community. Equally, students must be willing to step out of their comfort zones, engage with their peers, and invest in the bonds that will endure throughout their academic journeys and lives. The benefits of community and a connected college experience can contribute positively to mental health, academic performance, and overall well-being. 

The declaration of a loneliness epidemic and post-pandemic landscape underlines the urgent need to invest in and prioritize building community through education. The impact of COVID-19 on students’ ability to socialize and develop essential interpersonal skills warrants a response. It is my hope that educators’ dedication to building connections will continue to grow and serve as a beacon of resilience in the face of the recent adversity experienced by students and faculty alike. By recognizing and embracing the importance of community on college campuses, we can shape a culture and environment capable of bringing out the best in the next generation. 

In March 2023, the Association for University and College Counseling Center Directors (AUCCCD) released a policy paper that provides a foundation for structuring how higher education can approach mental health support. “Navigating a Path Forward for Mental Health Services in Higher Education” lays out some of the issues facing the field, including staff burnout and turnover, misallocation of resources, lack of coordination between campus stakeholders, ineffective or incongruous treatment models and the proliferation of third-party vendors. The paper offers some recommendations for addressing these concerns with an overarching theme that campus stakeholders must work together to create a realistic, agreed-upon, campus-wide approach–and then act on that plan with consistent messaging and communication to all constituents. This month, LearningWell (LW) magazine interviewed Dr. Marcus Hotaling, director of the Eppler-Wolff Counseling Center at Union College and president of the AUCCCD, to discuss the paper and “the path forward.”

LW: The AUCCCD recently published a paper that lays out a path forward for college mental health services amid high rates of mental health concerns and help-seeking among college students, and at the same time, increased burnout and dissatisfaction among counselors. What led the AUCCCD to develop this paper?

MH:  I think we’ve all been feeling the burnout for some years. Every year, up until the pandemic, my counseling center was seeing increased utilization—more students and more sessions. And while more students is understandable, we continuously saw more sessions with the same amount of staff, going above the national standard of about 65% face-to-face time for counselor. When I became president of AUCCCD in 2021, we had started to look at themes as to why people were leaving. We have 895 active members. In that first year, 81 of our members left for various reasons. Burnout was a huge factor, due to, in large part, getting pressure from all directions. You’re getting pressure from the students who want to be seen right away. You’re getting pressure from parents calling you. And then you’re getting pressure from the higher-ups who are getting called by parents or faculty members.

We also looked at where these counselors were going. The majority of them, two thirds, left the field of higher education and went into private practice. And there were two factors that led to that. The first was salary—you can make more in private practice. Some people went to the local hospitals and the salary is $50,000 more than their institution was paying. And the second reason was that, when you’re in private practice and you’re full, you just say, “I’m sorry, I’m not accepting new patients.” You can’t do that in a college setting. So, we started to look at the burnout piece and how higher ed and counseling can work together to try to resolve this problem.

LW: What were your goals in issuing this paper? What was it meant to convey?

MH:  We didn’t want to just say, “Colleges, you just need to hire more people,” because we know that’s not realistic. But what is realistic is everybody coming to the table and saying, “What services do we want to offer?” Let’s all be on the same page; let’s all have the same messaging around that, and then let’s actually do that. Because, in the counseling center, we can develop whatever service model we want, but if admissions or faculty or someone else is telling a student they could be seen six times a week, that’s not helpful. If we have people saying there are session limits when we don’t have session limits, that’s not helpful.

It’s important for counseling center leadership and student affairs leadership, and presidents, to come up with a plan of action to determine, based on the staffing we have, what we can provide. There needs to be a plan of action.

LW: The paper points out that colleges are making decisions about the service delivery model based on meeting the volume of demand, rather than taking an outcomes-based approach. Why, in your view, are institutions approaching mental health care that way? 

MH: I think part of it is that, for the most part, it’s really just fallen onto the counseling center staff to say what we need to do. And the reality is, that can be really hard when you don’t have the opportunity to step back and try something different or think about how it can be done differently.

I’m going to use my center as an example. There was one day that I opened up the schedule and there were just tons of appointments. And I said to my associate director, “Look, I’m seeing your schedule today. That’s not healthy. Your last patient is getting nothing from you. You’re exhausted.” So, we sat down over a school break and looked at how to change things. Everything was on the table. And that takes time, and it takes trust. We did get some pushback from our staff, but the approach was to give it a shot until the end of the year. And if it didn’t work, we’d change it again.

The reason why the usual approach is all over the place is that we’re just trying to meet the demand. And it’s like a dam that’s breaking where we plug one hole, and then all of a sudden there’s another hole over here. It’s still coming in; the water’s still flowing. And how many fingers do I have to plug these holes? And it’s only when you can take that step back that you can come up with a new way of doing things.

The demand is so high and you’re just trying to bail water out of the boat before you can actually sit down and plan. And that’s what we were trying to say in this paper: Do the planning, take the initiative to sit down with your leadership and say, “What can I do? What do you want? What does this school want to offer?” And we will work around that with the current staff. And maybe we’ll need to grow staff in the future.

But we are starting to see the numbers fall. One of the positives that came out of the pandemic is that states are starting to look at patients being able to cross over state lines for care. Clinicians are also more comfortable using telehealth and teletherapy. So, if you’ve been working with somebody for a long time, rather than saying, “Go see somebody at college because you’re two hours away,” counselors can continue to see their patients. So, the numbers are falling a little bit, but a little bit from a flood is still a flood.

LW: You point out that there is a mismatch of expectations, like having admissions promote a certain number of sessions that does not align with the reality of what can be offered. But even if you fix that inconsistency in messaging, do you think there’s also a cultural expectation that students, when they get to college, are going to be cared for in this way and they’re going to have access to therapy? And if so, is there going to be a difficulty in pushing back against that cultural expectation?

MH: Absolutely. Look, students are paying a lot of money to go to college, and with that comes a certain level of expectation across the board. When it comes to the expectations that parents have or families have, we also need to move away from the normalcy that every student is going to get through in four years. And that taking some time off isn’t a bad thing if you’re making good use of that time by working on yourself and getting healthy, so that when you come back, you’re going to be in a better place.

LW: So many issues, like leaves of absence as you suggest, involve more of a public health approach. What is the role of the counseling center in this approach?

MH: This whole thing is a public health problem. And I say that not to remove our responsibility or the individual responsibility of the students or counseling center. There are two reasons I say this is a public health problem. One, counseling centers and mental health for the past 20 years has been pushing for parity. We should be treated just like physical health. Let’s reduce the stigma. And it worked and that’s good. And then you have a challenging outside world. There’s war, there’s political unrest, a recession, a pandemic, school shootings. All these things create anxiety. On top of that, we have these expectations, real or imagined, that everybody else’s life is perfect, which we can see on their Instagram reel.

So, for a public health approach, yes, the community needs to do better about addressing gun violence and addressing systemic racism. But once they’re on our campuses, we can give students the tools to stay happy and healthy, while also recognizing that [every person is] going to have bad days.

We also need to help our constituents around campus recognize when somebody actually needs therapy versus when they might just need empathy or a listening ear. We need to help faculty and staff understand that referring a student to counseling is not the first thing you do. The first thing to do is say, “Are you okay? What do you need? I’m so sorry.”

These are public health approaches that are very, very simple and need no training from a mental health professional. All of us on a college campus can be approaching this from a public health perspective. It’s a public health issue, and now we need to be using our public health solutions.

LW: All of this – counseling staff wellbeing, policies and procedures and service delivery–its all about overall student health, correct? 

MH: Absolutely. Because if we’re not healthy, how are we helping anybody?

And evidence shows that students who utilize mental health services are retained and graduate at a higher percentage than those who don’t receive mental health care. And in theory, those are the students that are most at risk—the ones that are unhappy, the ones that have a mental health diagnosis. In a National Association of Mental Illness report, 64% of students that are no longer enrolled in higher ed list mental health as the main reason. So, it’s about student success as well.

The numbers are startling. Mental health challenges among United States college students increased by more than 100% in eight years, with the largest increase seen among non-white students, according to a recent study by the Healthy Minds Network. And, while the good news is that more students are seeking help and the stigma around mental illness is slowly fading, demand for support services far outpaces supply, particularly for students of color. 

As president of American University (AU), these numbers keep me up at night. I don’t have to look at the data to know that mental health challenges can impact every aspect of our students’ lives. I see these impacts across our campus every day, and I know others are experiencing similar trends on campuses across our nation. 

If we’re going to create and implement long-term solutions that address both the supply and the demand issues, we need to apply the same three-pronged approach we have used in other public health crises: prevention, detection, and response.  

At the same time, we must ensure we’re differentiating what services are needed throughout every stage of our approach by understanding the unique needs of each individual student, and by accurately assessing their situation to provide an appropriate level of care.   

At AU, our approach to prevention begins with a comprehensive focus on the whole person. Student thriving is a campuswide priority. We ask ourselves: What does our unique population of students need to be healthy physically, mentally, and socially? 

If we’re going to create and implement long-term solutions that address both the supply and the demand issues, we need to apply the same three-pronged approach we have used in other public health crises: prevention, detection, and response.

We are finding creative ways to meet those needs in our campus environment—from our 84-acre campuswide arboretum that provides space for our community to gather, engage, and recharge; to our specialty housing communities that bring students together to live and explore a common interest or academic pursuit. 

We know that financial challenges cause stress for many of our students. We’re working to address this stress through the Elevate Scholarship Initiative, a philanthropic effort to raise $25 million—matched by another $25 million from the university—to support undergraduate students enrolled at AU who are experiencing financial hardships. 

And we’re working to create a sense of inclusion and belonging throughout our community to ensure that our students have support networks that both help to counter feelings of loneliness and depression and provide opportunities to seek, and find, assistance.  

We believe that detection must be a community effort—our Care Network empowers all AU community members to identify students experiencing mental health and other challenges and help them access the assistance they need. 

And, as part of our strategic focus on scholarship, learning, and community, we’re working to address the root causes of this crisis on a macro level. Our faculty are at the cutting-edge of mental health research—from Dr. Terry Davidson’s work with the Center for Behavioral Neuroscience, which is poised to transform our understanding of addiction; to Dr. Kate Gunthert’s work with the Stress and Emotion Lab, which uses intensive daily monitoring techniques to better understand and address symptoms of depression. 

We also know that a comprehensive response is important, both in terms of providing timely and effective care, and being thoughtful about what we can do with our resources. Above all, we anchor our response in the idea of the whole student and our values of inclusion.

When students access our services, the first step is a solid initial assessment from a strong clinical team. We offer both individual and group therapy, with specific services for specific populations, such as racially-diverse clinicians who are skilled at providing services to students of color at predominantly white institutions, or through our use of technology to connect our students with a licensed clinician any time of the day or night. 

If we are to make progress on this crisis, we need to know what success looks like by asking ourselves crucial questions about growth, responsibility, and accountability. College students need to be supported and challenged to develop intellectually, socially, and morally. The college experience shouldn’t be so overwhelming that our students retreat and ultimately face mental health challenges, or so comfortable that there is no incentive to grow.  

And we must embrace the power of communities to act as the ultimate prevention tool—study after study has shown that building inclusive communities creates the social connections our students need to develop resiliency, be challenged and supported, and ultimately become the changemakers of tomorrow. 

Together, we can learn from today’s numbers and create a new story of mental health and wellness for our students.

Sylvia Mathews Burwell is the 15^th president of American University and the first woman to serve as president. She previously served as Secretary of the U.S. Department of Health and Human Services and as Director of the Office of Management and Budget.