Mental health challenges are becoming an increasingly prevalent issue on college campuses. During the 2020-2021 school year, more than 60% of college students met the criteria for at least one mental health problem. Additionally, almost three-quarters of students reported experiencing either moderate or severe psychological distress during that year.
The impact of the COVID-19 pandemic is one of the most notable factors that may be contributing to this trend. According to a 2020 survey, 71% of college students reported experiencing increased stress and anxiety due to the pandemic.
Some of the most commonly mentioned pandemic-related stressors for students included concerns about their health and the health of loved ones, social isolation due to distancing requirements and greater difficulty concentrating on academics.
What stressors can affect mental health?
There are a variety of different stressors that can affect the mental health of college students, some of these are specific to college life, while others are universal and may be common among people of all age groups. These stressors include:
- Relationship breakups
- Academic pressures
- Poor grades
- Financial stress
- Social status pressures
- Feeling alone or homesick
- Feeling marginalized, misunderstood or like you don’t fit in
- Concern or worry about your family members at home
- Loss of day-to-day support from community or family members
- Drug and/or alcohol use
- Inadequate sleep
- Feeling overwhelmed
- Grief
- Gender and sexuality questioning
- Conflicts with friends
- Difficulty in extracurricular activities, such as frequent losses in sports
- Unmet expectations
It’s important to remember that this list is not exhaustive, and college students could be impacted by any number of stressors not discussed here. Keeping track of the specific stressors in your life can help you manage them more effectively and protect your mental health.
Common mental health challenges on campus
If you’re struggling with your mental health, it’s critical to accurately identify the type of problem(s) you may be dealing with, as different conditions often require different approaches to treatment. Just like any group of people, college students can experience a wide variety of mental health challenges. Below are some of the most commonly reported mental issues on campuses.
Depression
Depression has always been a fairly common mental health concern for people in all age groups. However, rates of depression and anxiety among college students have been increasing rather quickly, especially in the wake of the COVID-19 pandemic. Recent research has found that one in three undergraduates reported experiencing significant anxiety and depression during their first year of study. Some of the most common symptoms of depression in college students include:
- Lack of energy
- Difficulty concentrating on schoolwork
- Loss of interest in extracurricular activities
- Changes in eating or sleeping habits
- Sudden emotional outbursts
- Feeling overwhelmed
- Thoughts of suicide or self-harm
Students must seek help if they find themselves experiencing these symptoms, as untreated depression can lead to a number of negative outcomes for college students; including declining academic performance and increased risk for substance abuse, self-harm and suicide.
Anxiety
Anxiety is an extremely common problem on college campuses. One 2018 study found that 63% of college students had experienced overwhelming anxiety. The same report found that 23% had been diagnosed and/or treated for anxiety by a mental health professional within the past year. Some of the most common symptoms of anxiety include:
- Irritability
- Fatigue
- Restlessness
- Difficulty concentrating
- Sleep disruptions
- Uncontrollable feelings of worry
- Frequent unexplained pains such as headaches, stomach aches and muscle aches
Common causes of anxiety for college students can include academic pressure, poor sleep patterns, busy schedules, stressful life events and coping with a new environment (particularly for first-time students). If it’s left unchecked, anxiety can interfere with daily life and adversely affect the body in several ways; such as increasing the risk of high blood pressure, heart disease and coronary events.
Stress
Stress is one of the most common factors that can impact the well-being of college students. In 2022, around 88% of surveyed college students described their school life as stressful, with exams and financial issues being the most frequently cited individual stressors. Some of the most common signs and symptoms of chronic and severe stress include:
- Headaches
- Stomach aches
- Lack of energy
- Frequent chest pain and/or shortness of breath
- Feelings of anxiety or worry
- Persistent negative thoughts
- Procrastinating and/or neglecting academic responsibilities.
While everyone experiences some stress from time to time, unmanaged chronic stress can adversely affect health and well-being in many serious ways; including cognitive impairment, decreased immune function, sleep problems, and an increased risk of substance abuse, high blood pressure, heart disease, heart attack and stroke.
Self-harm and suicide
While they’re not as prevalent as depression and anxiety, self-harm and suicidal ideation are very serious problems on college campuses. A 2019 survey found that 7.2% of surveyed college students reported that they had suicidal thoughts during the past year, with 0.4% reporting that they had attempted suicide within that same time frame.
Additionally, 19.6% of students reported engaging in NSSH (non-suicidal self-harm) behaviors such as cutting during their lives. Some common signs of suicidal ideation and NSSH behaviors in college students include:
- Changes in mood; such as becoming withdrawn or irritable
- Changes in eating or sleeping habits
- Frequently crying or showing signs of sadness
- Neglect of personal appearance
- Frequently wearing long pants and long sleeves in hot weather
- Drastic changes in behavior; including increased risk-taking or sudden unexpected improvement in mood.
- Giving personal items away
If you notice any of these behaviors being displayed by a friend or loved one, it’s important to reach out to them, as many students may be reluctant to seek help for these issues on their own. Dealing with these situations requires careful consideration, and you should reach out to a mental health care professional for guidance if you are unsure how to handle it.
Eating disorders
Eating disorders can take many forms, ranging from fasting to binge eating. While it’s unclear exactly what proportion of college students suffer from eating disorders, their prevalence seems to be increasing. An eight-year of study of college students found that eating-disorder risk increased by 13 percent from 2013 to 2020. While the exact symptoms of eating disorders can vary depending on the exact nature of the condition, there are several signs to look for in college students:
- Weight fluctuations
- Shifting relationship with food; including developing an obsession with food or becoming more averse to certain types of food, or to eating in general.
- Erratic moods
- Lack of energy
- Decreasing interest in usual hobbies or activities
- Scabbing on the backs of their hands.
- Frequently wearing layers or covering up with blankets in warm conditions
- Memory loss
If left untreated, eating disorders can lead to a variety of serious health problems over time; including decreased bone density, tooth decay, muscle loss, severe dehydration, esophageal damage, high blood pressure, increased diabetes risk and an abnormally slow or irregular heart rate.
While the stigma of eating disorders, and mental care in general, may deter you from seeking help, there are virtual eating disorder treatment services available that can enable you to access care more comfortably and privately. If you believe you or someone you know is dealing with an eating disorder, addressing the situation early lovingly and respectfully can help you prevent the disorder from progressing and can mitigate potential long-term health impacts.
Substance abuse and addiction
Substance abuse is another serious issue facing campus communities. While college is often associated with drinking “for fun,” it is not at all uncommon for students to develop unhealthy relationships with alcohol and/or drugs. One study found that nearly half of college students met the criteria for at least one substance use disorder at some point between their freshman and junior year.
Uncontrolled substance abuse can cause significant health problems and adversely impact the well-being, relationships and academic performance of students. While they can be difficult to detect in some cases, there are several potential indicators of substance use disorders that you can look for:
- Changes in eating and/or sleeping patterns
- Deterioration of personal appearance
- Deterioration of finances
- Mood swings
- Frequently bloodshot eyes and/or fluctuating pupil sizes
- Secretive behavior
- Difficulty with personal relationships
- Frequently getting into trouble with school officials, police, teachers and/or peers
- Neglecting responsibilities
If suspect you or someone you know may be dealing with a substance abuse issue, it’s important to reach out for help as soon as possible. In many cases, college students with substance use disorders will be reluctant to ask for help on their own, but research also shows that students who received prompting from friends or family were significantly more likely to seek treatment than those who did not.
Attention deficit hyperactivity disorder (ADHD)
While ADHD was originally thought of as a childhood disorder that people outgrew with age, it is now known that at least half of children with ADHD experience symptoms well into adolescence and adulthood. Students with ADHD may experience a range of symptoms that can impact their college life and their transition to adulthood, including:
- Inability to focus
- Inattention to detail
- Impulsiveness
- Lack of organizational skills
- Restlessness
- Irritability
- Low self-esteem
- Extreme impatience
- Difficulty keeping quiet
- Tendency to engage in risk-taking behaviors
If they’re not properly managed, behavioral problems associated with ADHD can significantly impact students’ academic performance, put a strain on their personal relationships, and contribute to other issues such as substance abuse, anxiety and depression. Fortunately, current treatments can substantially improve long-term outcomes for people with ADHD.
When should you seek help?
Seeking help for a mental health challenge can be a daunting prospect for college students. Additionally, mental health issues can be difficult to diagnose, and it may be unclear if and when professional intervention is necessary, or which type of care will be most effective.
If you suspect you or someone you care about may need help with a mental health challenge, watching for the following changes in mood, behavior and physical appearance can help you determine when it’s time to reach out:
- Mood changes: Extreme fluctuations in mood, feeling sad for long periods, constantly feeling worried, sudden apathy toward former interests, difficulty relating to others.
- Physical changes: Dramatic changes in sleep patterns (either sleeping too much or too little), constant fatigue, changes in sex drive, changes in eating habits, nausea, sweating, and increased heart rate.
- Behavioral changes: Suicidal ideation, self-harm behaviors, withdrawal from friends and family, delusions, hostility toward others.
While these changes can be important signs that you might need to see a therapist or another type of mental health care professional, this is not an exhaustive list, and it’s important to make note of any symptoms or behaviors that you consider alarming.
Confidentiality and mental health
Privacy is a common concern for students seeking mental health treatment or accommodations. Even people who want to receive care may be deterred from reaching out due to the fear of being discriminated against by teachers or peers. Fortunately, the privacy of students’ medical information is protected by two major federal laws:
HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPPA) is a federal law that protects the privacy of patient health information. It establishes strict rules for the disclosure of patient information by HIPAA-covered entities. While colleges are not generally considered to be HIPAA-covered entities, they can be protected under HIPAA in some cases if they provide health care services to students.
FERPA
The Family Education Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student education records. It applies to all schools that receive funds under an applicable program of the U.S. Department of Education. The law is designed to keep education records private between students and institutions.
Under FERPA, any psychological treatment records disclosed to the school are considered education records as well, including records from school counselors and outside providers. These records are then protected by the law and become unavailable to anyone other than the professionals providing care to the student.
Utilizing campus resources for mental health
Today, many colleges and universities offer a variety of on-campus resources that can help support students’ mental health. Even services that aren’t directly focused on mental health can still provide struggling students with comfort and valuable guidance. While the exact resources you’ll find on campus may vary from institution to institution, several services are common at many colleges:
Campus counseling or health center
A significant number of colleges now have counseling and health centers that offer on-campus mental health services to students. At these centers, students can receive various services from trained mental health professionals; including one-on-one counseling, group therapy, crisis assessment and referral services.
Many health centers may also offer wellness workshops and may conduct outreach designed to help students spot health misinformation as well as raise awareness of mental health issues. Staff at these centers understand the unique mental health concerns of college students and know how to tailor their approach to treatment accordingly.
Resident advisor
While they’re not trained professionals, resident advisors can still be helpful resources for students struggling with mental health. Discussing mental health issues in college can be difficult, and some students may feel more comfortable addressing this subject openly with a trusted peer.
Even if students don’t want to discuss mental health directly, RAs can provide them with experience-based advice and guidance about managing the various aspects of college life. Additionally, resident advisors at most colleges are required to have extensive knowledge of the health services available on campus and should be able to direct students to their school’s counseling or crisis center if they need additional care.
Academic advisors or other trusted faculty members
Trusted faculty members such as professors and academic advisors can also be highly valuable resources for students with mental health struggles. In addition to providing guidance and allowing students to express their concerns about mental health, academic advisors can help them determine what accommodations they may need, and assess if their current accommodations are appropriate.
Off-campus resources for finding mental health services
In addition to the assistance offered on campus, college students can also utilize the same types of mental health care services as the general public. While it can be more complicated, going off-campus for mental health care enables students to access a wider variety of services and providers as well as receive treatment on a more flexible schedule.
Primary care doctors
Primary care doctors are often a good starting point for those seeking mental health care, as they are usually qualified to diagnose mental health conditions. While they may simply refer you to a specialist for further analysis and treatment, primary care providers can prescribe medications for mental health in some cases. The exact approach your doctor will take can depend on the specific issues you’re dealing with.
Therapists/Counselors
If you’re dealing with stressors or mental health challenges that you’d like to address, it may be tempting to confide in close friends or family. While this can provide short-term relief from angst, using your friends as therapists can damage relationships over time. To protect your personal relationships and your overall mental well-being, it’s far more beneficial to consult with a professionally trained therapist or counselor.
Therapists can help diagnose mental health conditions and develop treatment plans, though they cannot prescribe medication. The treatments used by therapists and counselors mostly consist of verbal communication with patients. This can make adjusting to a new therapist somewhat complicated, as this process typically involves some degree of information-sharing and rapport-building.
While finding a therapist or counselor may be challenging for college students in some areas, there are a variety of ways to access care more easily, including teletherapy services that allow them to conduct video visits with therapists from out-of-state. Additionally, there are multiple types of therapy that involve different approaches, so it’s critical to research different providers and their methods carefully.
Psychiatrists
Unlike therapists, psychiatrists focus on both the mental and physical aspects of mental health disorders. Their work involves studying behavior and assessing chemical imbalances to diagnose conditions. Psychiatrists are medical doctors, meaning they can prescribe medication if they deem it necessary.
They can also provide verbal counseling, though they may refer you to a therapist for these services. If you’re dealing with mental health challenges that you suspect may be caused by an underlying condition or chemical imbalance, finding a psychiatrist can help you identify the origins of the issue and determine an effective treatment strategy.
Psychologists
A psychologist is a mental health professional who specializes in the study of behaviors and mental processes. Their work primarily focuses on cognitive processes and the way that people interact with their environment. While psychologists do diagnose and treat mental disorders and behavioral problems, they cannot prescribe medication, as they are not medical doctors.
Similar to therapists, psychologists’ primary treatment method is talk therapy. They use therapy to help patients manage illnesses, addictions, stress and a variety of other problems. Students may consider finding a psychologist if they’re dealing with substance abuse issues, long-term anxiety, behavioral changes, social difficulties or trauma from a major life event.
Campus accommodations for students with psychiatric disabilities
In addition to counseling services, colleges can also provide several different accommodations and protections for students with psychiatric disabilities.
What is the Americans With Disabilities Act, and how can it protect me?
The Americans With Disabilities Act (ADA) is a law designed to protect people with disabilities from discrimination. It requires all colleges and universities to provide equal access to postsecondary education for students with disabilities. This law applies to all programs offered by the institution, including extracurricular activities.
People with psychiatric disabilities are protected under the ADA in nearly every case. The law states that individuals can request accommodations for any mental health condition that would, if left untreated, substantially limit their ability to concentrate, interact with others, communicate, eat, sleep, care for themselves, regulate their thoughts or actions or do any other “major life activity.”
Academic accommodations
Under the ADA, every student with a disability is entitled to individualized accommodations that meet their unique needs. For students with psychiatric disabilities, academic accommodations can take on many different forms; including preferential seating, prearranged breaks, tape recorder privileges, early access to course materials and private feedback from professors and advisors.
Students with disabilities may also request exam accommodations if necessary, such as alternate format exams, extended time, personal proctors, private testing rooms or the use of assistive computer programs such as text-to-speech software. To ensure your accommodations meet your needs, it’s important to discuss your situation with your counselor and/or care provider before making a request.
How to request accommodations
To request and receive accommodations, you’ll typically need to register with the disabilities services office at your college or university. Once you’re registered, this office will send a letter to your instructors detailing the types of accommodations or modifications you’ll need.
It’s often beneficial for you to meet with your instructors and disabilities services personnel as a group to discuss the plan. Additionally, it’s important to periodically review your accommodations with disabilities services, to identify if any adjustments need to be made.
Affording mental health services
For many people with mental health complications, the perceived cost of care may be preventing them from seeking help. This is especially true for college students with limited financial resources. Fortunately, several tools and resources can help you pay for therapy and other mental health services.
On-campus resources
While getting mental health care from outside providers may be very costly, many colleges offer a variety of free or low-cost resources for students that you can find directly on-campus, including individual or group therapy services, grief counseling, crisis intervention, mindfulness workshops and access to mental health literature.
Health insurance
While paying for mental health services can be difficult, many students may be able to get certain types of care covered by their insurance provider. In addition to public programs like Medicare and Medicaid, many private insurance plans now offer at least some degree of coverage for mental health care.
However, the level of coverage you’ll receive can vary depending on your specific plan, so it’s important to research your benefits to determine what your insurance will cover, and what it will not. This can save you the hassle of disputing claims and help you get the treatment you need in less time.
Low-cost options
Besides insurance and on-campus resources, there are several other ways for college students to receive low-cost mental health care:
- NAFC: The NAFC (National Association of Free and Charitable Clinics) is a network of free and charitable clinics and pharmacies around the country. On their website, you can enter your zip code and look up affordable or no-cost service providers near you.
- Open Path Psychotherapy Collective: A network of mental health professionals that offers in-person and virtual care at discounted rates. Similar to the NAFC, Open Path’s website allows patients to look up providers in or near their zip code.
- University clinics: Many university hospitals and medical schools operate clinics that allow you to talk with a therapist or psychiatrist in training for free or at a significantly discounted rate. Contact nearby medical schools or visit their websites to find out if this is an option for you.
- Sliding scale payment plans: Sliding scale is a payment structure where the cost is based on the income of the payer. In some cases, private therapists will be willing to modify their rates or pricing structure to suit your needs, but it’s important to discuss this carefully with your provider.
Additional mental health resources
If you’d like to keep reading, check out these resources for more information and access to additional mental healthcare services:
- ULifeline: Online resource focused on mental health in college. Here, you can access information about specific conditions and treatments, and look up what mental health services are available at different universities.
- SAMHSA Treatment Locator: An online tool that you can use to find treatment facilities for substance use and/or mental health in your area. Operated by the Substance Abuse and Mental Health Services Administration.
- Mentalhelp.net: A website where you can find information about conditions and treatments, mental health news, online communities and links to other resources.
- Brain and Behavior Foundation: A nonprofit group that provides funding for mental health research. On their website, you can find an extensive volume of mental health information, as well as event schedules for virtual events and seminars focused on mental health.
While not all of these are exclusively geared toward college students, they can still provide valuable information and beneficial services. Utilizing every possible resource can help you get the most out of your college experience and protect your long-term well-being.