Mental Health: What Works?

It takes a student with the will to confront a difficult problem. It takes a friend who offers encouragement, a faculty member who provides guidance, a counselor who offers assistance. It takes courage, compassion, and strength.

The need for this campus-wide support network has never been higher. Seventy percent of students say they have struggled with mental health issues since starting college, a March 2024 U.S. News/Generation Lab survey found. In the 2022–23 Healthy Minds Network’s annual student survey, 41 percent of college students screened positive for major or moderate depression, 36 percent screened positive for major or moderate anxiety, and 14 percent said they had seriously considered suicide.

Another statistic, however, offers hope. The number of students participating in counseling increased from 30 percent to 37 percent between 2020 and 2022, according to a study of Healthy Minds survey data. Students are seeking aid—and campuses are rising to the mental-health moment. Here are some ways that they are helping students with emotional and psychological challenges ranging from building resilience to coping with grief.

Resilience

Stories of Adversity and Strength

Emory University
Atlanta, Georgia

Enku Gelaye came to the United States from Ethiopia when she was seven. She studied engineering in college to fulfill her father’s wishes but sought a different path. Kristina Bethea Odejimi was a student-athlete who injured her right knee in high school, then injured the left one as a college senior, ending her basketball career. Munir Meghjani was on the debate team in high school, but at his first tournament, he had to race to the bathroom with an upset stomach. The problem resurfaced for months when he tried to debate.

What do these people have in common? Each faced challenges, each overcame them, each saw it as a turning point in their lives—and each is a staff member, faculty member, or alumnus of Emory University. Gelaye defied her family’s expectations by trading engineering for a journalism degree. She is now senior vice president and dean of campus life. Odejimi’s basketball career ended, but she learned that “my sport was a piece of my identity and not my total identity.” Today, she is associate vice president for belonging, engagement and community and dean of students. Meghjani slowly summoned the “grit and resilience that I was taught by my family and my community” and overcame his fears to become a top high school debater. He is a commercial real estate agent and past president of the Emory alumni board.

Emory’s Campus Life Office collected all three of their stories for a project called “Reframes: Discovering the Possible.” The idea: to show how various faculty, staff, and alumni reframed life’s unexpected detours and embraced change. In the student centers at Emory’s Atlanta and Oxford campuses, a series of black-and-white portraits show Reframes participants. Next to each photo is another black-and-white shot, this one of a participant’s hand holding a card that reveals lessons learned from the participant’s mistakes. A QR code takes viewers to three-minute videos in which the participants—from an executive associate dean whose son was an addict to an associate dean who got divorced—share a personal crisis and how they coped. Videos are also shared via Emory’s social media accounts and email communications (you can find videos at reframes.emory.edu).
 

A key Reframes message is that challenges and self-doubt are inevitable. “We don’t succeed by being perfect,” Emory President Gregory L. Fenves says in a video. “You grow through experience, by making mistakes, learning, and allowing yourself time and grace.” That’s an important statement at colleges and universities like Emory, where high achievers often feel enormous self-pressure to succeed, points out James Raper, associate vice president for health, well-being, access, and prevention at Emory. 
 

“They’ve gotten really good outcomes from that, but it’s not sustainable,” Raper says. “It’s often in college or university where [students] realize, ‘This approach isn’t working for me’—the rigid, toxic perfectionism that they approach their lives with.”

It’s not just fear of failure. It’s fear of being average. Students at Emory, Raper has found, abhor a “C” more than an “F.” 
 

“Every time I say that to a student group, they all kind of groan and nod,” he says. “A ‘C’ is the worst. It’s the seeds of mediocrity that they really fear.”

In addition to the videos, Reframes creates opportunities to discuss those anxieties via in-person events. During the spring 2024 semester, the Campus Life Office hosted small-group dinners, from a picnic on a campus lawn to meals in private dining rooms at the student centers, where students were able to talk with faculty and staff about life’s hurdles and failures. Campus Life also sets up an on-campus photo booth where students can share their own stories.

These efforts help address another issue: loneliness. Emory’s student well-being surveys consistently show high loneliness numbers. The Reframes activities help combat that by building connections and a sense of belonging on campus. 
 

“We’re creating lots of opportunities for students to practice connecting with one another in a more authentic way,” Raper says.

Raper, too, has embraced that authenticity. He appears in one of the Reframes videos in which he shares his own collegiate setback.

“I got kicked out of college academically, and I had mental health issues,” he says. “I was very fortunate to get back into that university.” Raper has told that story over the years to show students that their lives won’t end if they fail. And as he and his colleagues have shown through Reframes, failure is often not an ending but a beginning.

A Student Well-Being Committee

If you want to improve students’ well-being, shouldn’t they have a say in what they need? That thinking led James Raper, associate vice president for health, well-being, access, and prevention, to form the Student Well-Being Advisory Committee (SWAC) at Emory shortly after he was hired in 2022. The committee—a mix of undergraduate and graduate students—meets at least monthly through the academic year and provides input on well-being strategies, programming, and more. SWAC helped develop the “Reframes: Discovering the Possible” project, suggesting candidates for interviews (committee members wanted to hear from university faculty and leaders) and offering feedback on the project’s look and feel. The committee recruits members via word of mouth; recommendations from staff, faculty, and peers; and recruitment emails and social media posts. “We can’t be making decisions for our students and guessing what’s going to work,” says Raper, who also meets individually with members. “The committee really informs me and my team.”

Eating Disorders

A Partnership to Save Lives

Texas Christian University
Fort Worth, Texas

For psychologist Amanda Swartz and her colleagues, the numbers were frightening. Between 2019 and 2022, the Texas Christian University (TCU) Counseling and Mental Health Center had seen a 442 percent increase in eating concern and body image appointments. The center had an eating disorder team, which included a certified eating disorder specialist and supervisor, but Swartz and the other staff knew they needed to strengthen their services. They contacted the Eating Recovery Center (ERC) and established a unique partnership to provide an in-person, on-campus intensive outpatient program for students.

“This is very rare,” Swartz says of the partnership, which launched in August 2023. “We are hoping to use our experience to provide education and training to other schools.”

Headquartered in Denver, the ERC provides therapy at thirty-five centers in seven states, with virtual programs in eight other states. The intensive outpatient program helps students with severe symptoms or long-term issues, including the three most common eating disorders: anorexia (having a low body weight and using severe methods to shed pounds and limit calories), bulimia (which includes periods of bingeing followed by purging), and binge-eating disorder (in which bingeing is followed not by purging but feelings of guilt, shame, or revulsion). 
 

The intensive outpatient program at TCU is identical to those at the ERC’s own facilities. Students who enter the program attend a three-hour group session three times a week, along with weekly individual sessions with a therapist and a dietitian. The average time in the program is about eight weeks. 
 

TCU chose the ERC because it’s a nationally recognized leader in eating disorder treatments, it has a location in Dallas (about thirty-five miles away), and it was willing to tailor the days and times of the sessions to best meet students’ schedules. This allows students to access care and continue their studies while participating in treatment. 
 

“A key point of having the program is that they remain in school. This gets rid of the difficulty of driving to Dallas, which adds an extra two hours onto their treatment day,” Swartz says. “It also puts them with other TCU peers, and it allows them to get treatment in a familiar setting. It doesn’t seem quite as scary because even though it’s a different program, it’s still in our counseling center, it’s still on their campus, but they’re able to get that higher level of care that they need.”

A growing number of students nationwide need treatment. From 2013 to 2021, the risk of developing an eating disorder jumped from 15 percent to 28 percent among US college students, according to a study of Healthy Minds survey data. During the pandemic, eating disorders among teens nearly doubled, a study in JAMA Pediatrics found.

Many types of students can be susceptible to eating disorders. Some are overachievers and perfectionists. Others have been sexually abused. Some fall into both categories. Whether they’re binge eating or suffering from conditions such as anorexia, many are seeking a type of emotional numbing, experts say. Genetics can also be a factor.

“There’s actually a huge genetic component to eating disorders,” says Landry Weatherston-Yarborough, ERC executive director of the south region, who helped open the facility at TCU. “It’s one of the most inheritable mental health diagnoses, second only to autism spectrum disorder.”
 

Although eating disorders can start in childhood, college students are often vulnerable because they’re undergoing a major life transition. 
 

“So many of them are moving away from home for the first time, living independently, managing their own schedules,” Weatherston-Yarborough says. “They may have new financial stressors. Maybe they’re holding down a job as they’re going to school, dealing with roommates. Those are traditionally vulnerable times for an eating disorder, even if someone never had one before. And the hard thing about eating disorders is that people often feel in control when they’re engaging in those behaviors, but the eating disorder actually has the control.”

The intensive outpatient program is helping students develop the tools to regain that control and rebuild their lives. The partnership is only one year old, so the counseling staff is still collecting data, but “it seems that the students who went through the program had good outcomes. I’ve had students tell me they wouldn’t have graduated if they hadn’t had eating support on campus,” Swartz says. “And some say they don’t think they’d be in recovery if they hadn’t gotten treatment.”

Mental Health First Aid

An Awareness of when People Need Help

University of North Carolina
Chapel Hill, North Carolina

Sam Deal had noticed an occasional bandage on his colleague’s hand. The coworker claimed it was a burn injury from a cooking mishap, but the wound kept recurring. Deal, a facilities manager in the School of Social Work at the University of North Carolina (UNC) at Chapel Hill, suspected self-harm and that the bandage was a cry for help.

Deal’s suspicions were informed not only by personal experience with a family member but also by his training in Mental Health First Aid (MHFA), a course that teaches faculty, staff, and students how to “identify, understand, and respond to signs of mental illnesses and substance use disorders.” Developed by the National Council of Mental Well-Being, the MHFA course is offered by the School of Social Work’s Behavioral Health Springboard (a program that provides health-related programming and assists other organizations with programming). Instructors, who receive training from the National Council for Mental Wellbeing, include UNC-Chapel Hill staff and faculty in the School of Social Work, School of Nursing, School of Pharmacy, School of Education, and School of Medicine.

Not long after receiving training, Deal invited the coworker to lunch, followed by a walk, and shared his concerns.

“The floodgates opened,” he says of his colleague’s response. The coworker had struggled for years with emotional and physical abuse, and the self-inflicted burns were an attempt to mask the internal pain. After their talk, Deal contacted his MHFA coordinator, who quickly shared free county and state resources (coordinators help with the logistics of offering the MHFA course). Deal’s coworker accepted the assistance, began seeing a counselor, and is now thriving professionally and personally.

UNC-Chapel Hill has offered the course since 2015; more than a thousand faculty members, staff, and students voluntarily participated in 2022 alone. Some enroll individually, while others participate as part of a group: the UNC-Chapel Hill library staff, for example, underwent group training. Library staff observe numerous students during their workdays; the training might help them to spot students who are struggling emotionally. Once participants complete the course, they are certified in MHFA for three years (and they can retake the course to become recertified).

Participants learn a variety of mental health warning signs (for example, changes to typical behaviors, such as increased sleeping and decreased eating) along with “how to approach people and how to respond and what resources you can recommend,” says Alicia Freeman, the MHFA program manager at UNC-Chapel Hill and a licensed clinical mental health counselor and addictions specialist. Many participants say that MHFA has not only helped them identify students and colleagues struggling with mental health issues but also family members and even strangers.

“I’ve had faculty and staff say that since COVID, it just seems like everybody is under more stress and experiencing more mental health [challenges],” Freeman says. “People want to be informed and better equipped to support the community.”

The course begins with two hours of self-paced online work, followed by five and a half hours of live course sessions. Some sessions are virtual, others are in person, and they’re available throughout the week, including evenings and Saturdays. That flexibility helps students juggle the training with classes and extracurricular activities. Zoe Anne Biebesheimer, a senior majoring in human development and family science, took the training in 2023. It was required for a student organization called LSN (Listen, Support, Navigate), a peer group that monitors chats on the Heels Care Network, a UNC-Chapel Hill mental health website.

“It was a great way to build my confidence in terms of how to approach certain situations and how to begin certain tough conversations regarding mental health challenges,” says Biebesheimer, who’s interested in becoming an MHFA instructor. “The training was helpful in giving me a baseline for assessing risk and assisting peers.”

Deal is equally enthusiastic. Since receiving his initial instruction in 2016, he has twice retaken the course to remain certified.

“Each time, I’ve learned something new and taken away a better understanding of the mental health challenges that so many in our society deal with,” he says. “Had it not been for this training, I might have never given a second thought to the recurrence of my colleague’s injuries.”

Academics

Well-Being in the Classroom

Georgetown University
Washington, District of Columbia

At the start of each semester, associate biology professor Heidi Elmendorf shares information with her students that goes far beyond the syllabus. She tells them about her struggles with depression, and sharing that vulnerability, she believes, changes the dynamics of her course, Foundations in Biology. Instead of a detached, me-and-them, professor-and-student relationship, she says, the class becomes an “us.” Elmendorf then asks students to take an anonymous mental health survey, the results of which guide the semester’s discussions and students’ research paper topics. As she notes in the course description, Elmendorf hopes the class gives students “a sense of comfort as a community” and “unexpected resources for coping.”

If this doesn’t sound like a standard undergraduate biology course, there’s a reason: it’s not. Foundations in Biology is an Engelhard Course, which is part of Georgetown’s Engelhard Project for Connecting Life and Learning. Supported by an endowment from the Charles Engelhard Foundation, the project’s primary function is to help integrate well-being topics in courses across the university to connect “students’ academic studies and their broader life experiences, especially in the areas of well-being, flourishing, and mental health.” The result: students feel that courses are more relevant to their lives and engage more with course material. 
 

Since 2005, more than 20,000 students have taken an Engelhard Course, and close to 220 faculty members and 95 campus resource professionals have participated in 650 courses. When the program started, Georgetown offered five Engelhard Courses. In the spring 2024 semester, the university offered fifty-eight. 
 

Each semester, faculty apply with the Engelhard Protect to be fellows and submit course proposals. Among the proposal requirements: each course must feature an in-class visit from a Georgetown campus resource professional, such as a staff member from the student health center or the LGBTQ+ resource center. Course subjects range from psychology to ethics and even math. One example of an Englehard Course is Introduction to Math Modeling, which incorporates data sets involving nutrition, gambling, and alcohol. Other examples are Art of the Monologue, which features discussions of mindfulness, and an intro-to-ethics course that teaches Immanuel Kant’s writings on topics like substance abuse and sexual objectification. Georgetown’s associate director for sexual assault response and prevention services gives a guest lecture to “bring campus life into the classroom,” as the course description states.

Not all courses work as an Engelhard Course. But in those that do, instructors say, students often have an easier time learning the subject matter and enjoy a deeper relationship with professors.

“One faculty member said to me that ‘Engelhard has helped me see my students as whole people and bring more of my whole self to the course and to my teaching,’ ” says Joselyn Schulz Lewis, co-lead for the Engelhard Project for Connecting Life and Learning and senior associate director for inclusive teaching and learning initiatives at the Center for New Designs in Learning and Scholarship. “ ‘When I do that, I enjoy it more. I think they’re learning better. I think I’m teaching better.’ ”

Students often don’t realize they’re taking an Engelhard Course, yet for many, the impact can be profound. Nestory Ngolle is a pre-med junior who took an Engelhard Course called Introduction to Medical Anthropology, which changed his thinking about patient care.

“The professor aimed to break that mold of what we think of as health care and reshape it in a form that essentially targets a patient’s needs,” says Ngolle, who serves on Engelhard’s student advisory council. “If someone has a cold, maybe they need NyQuil to feel well physically. But maybe they would feel mentally well if they could take the day off and rest. Those are two different kinds of wellness. And being in a class that recognizes those differences, and illuminates them. . . . I found that to be a great experience with the Engelhard project.”

For faculty like Elmendorf—who before the Engelhard project hadn’t revealed her depression—the experience has been equally transformative. You cannot “legitimately invite your students into this space if you’re not willing to join them in this space,” Elmendorf says in a video on the Engelhard website (engelhard.georgetown.edu). “To understand that a faculty member is also struggling with mental health issues . . . instantly changes their perception about who our community is and who they can be.”

Indigenous Teachings for Healing

Diane Schenandoah is a Syracuse University (SU) alumna. She’s also a faith keeper (someone who oversees her peoples’ spiritual well-being) of the Wolf Clan of the Oneida Nation, which is part of the Six Nations Haudenosaunee Confederacy. And she is the first to serve in the role of Honwadiyenawa’sek, a Haudenosaunee word for “one who helps them,” at the university. Syracuse is located on the ancestral lands of the Haudenosaunee Confederacy—also known as the Iroquois Confederacy, which includes the Cayuga, Mohawk, Oneida, Onondaga, Seneca, and Tuscarora peoples—and the university has committed to “empowering and supporting Indigenous students of any tribe or nation.” That included hiring Schenandoah in 2021 as a part-time employee in the SU counseling center. Schenandoah is available to any students seeking her support and uses traditional energy work practices, including acupressure, art therapy, and tuning forks (the vibrations are supposed to balance the body’s circadian rhythms) to help students feel more centered, balanced, and grateful. “We’re all creative beings, and we need to give thanks for all things that surround us,” she explained in an interview for an SU podcast. “It’s really rewarding to see the students’ faces light up when they discover their own inner strengths and their own energy.”

Grief and Loss

An Understanding That It’s Not Just about Death

Indiana University South Bend
South Bend, Indiana

Indiana University (IU) South Bend’s Student Counseling Center recognizes that grief, loss, and trauma can result from more than the death of a loved one. They can also stem from life challenges such as divorce, unemployment, and even academic disappointments.

“It is not uncommon for a medical school student to come in and say, ‘I’ve never had anything below an A minus in my entire academic career, and now I haven’t passed an exam,’ ” says Kevin Griffith, associate vice chancellor for student engagement. “All of our populations face academic hurdles and challenges, and grief, loss, and trauma therapy can help them navigate it.”

Grief, loss, and trauma can also involve financial insecurity. 
 

“About one-third of college students on small regional campuses such as ours, which serve a number of underrepresented students, will experience food insecurity while they are in college,” Griffith says. “And about 8 percent of those students will face homelessness at some point during their undergraduate experience. So grief, loss, and trauma include all kinds of loss.”

The counseling center provides everything from one-on-one sessions with counselors (who are certified in grief, loss, and trauma) to community workshops. The goal of the offerings: “to get a conversation going on grief, loss, and trauma and to help students and community members break down the stigma of asking for help when it comes to mental health,” says Griffith, who oversees the Office of Veteran Student Services and the Office of Accessible Educational Services in addition to the counseling center. “The populations that we support—veterans and people with disabilities, as well as our general population of students—experience a great deal of loss and trauma.”

The counseling center also works with local nonprofits and government agencies, as well as individuals in private practice, to provide students with grief-and-loss services such as pet therapy and art and music therapy. The intent, Griffith says, is to “introduce holistic support through the therapeutic process” and offer services beyond what counseling centers usually provide. 
 

Confronting grief is important for students, not just personally but academically, whether they’re mourning the death of a loved one, a breakup, or the loss of a scholarship, Griffith has found.

“It’s an extra level of pressure and stress that students are feeling,” he says. And sometimes students are coping with death, often for the first time. Some may have lost a grandparent who helped raise them. Others, particularly those from underrepresented communities, may have lost a friend to violence. Encouraging these students to seek help involves a simple message: it’s OK to seek help. The counseling center delivers that message through classroom presentations, workshops, discussions, and marketing campaigns and by engaging with student groups, student leaders, faculty, and staff. One campaign, called “Unboxed: Open Up about Mental Health,” encourages students to “overcome the tendency to box up and suppress internal struggles.” As part of the campaign, the counseling center distributes “Unboxed” buttons to promote the message and offers funds for on-campus student-led mental health events. 
 

IU also partners with U Bring Change to Mind (UBC2M), a national student-led organization that works to reduce stigmas associated with mental health care. Efforts include an annual spring event where students share anonymous stories from their mental health journeys. UBC2M student members also work with other groups, such as the Black Student Union, to create safe spaces for discussing mental health issues—including grief.

“It takes a lot of work to build trust,” Griffith says. “But it’s not uncommon for students to come back a year later, to stop in someone’s office and say, ‘I want to thank you for helping me open that door to grief and loss, and to get it out, and I’m in a better place today.’ The trauma doesn’t just, poof, go away, but by giving students a name to identify their feelings, and helping them to learn how to process them, they’re developing lifelong skills to have healthy relationships and express their emotions.”

Suicide Prevention

Research on Ways to Better Help Students

University of Oregon
Eugene, Oregon

The study is unprecedented. Researchers at four universities—Duke University; the University of Nevada, Reno; the University of Oregon (UO); and Rutgers, the State University of New Jersey—are evaluating the effectiveness of four suicide intervention approaches in college and university counseling centers. It is the first multisite, National Institutes of Health (NIH)–funded, randomized controlled trial to do so—and it is fueled by a common problem: counseling centers typically don’t treat at-risk students on campus. 
 

“Counseling centers have had to really shrink the number of services and sessions they can provide to students, and that results in referring students with longer-term issues and higher levels of need out into the community,” says Shelly Kerr, UO’s director of counseling services. “The study is designed in such a way to say, What can be done in a short amount of time? Can we do some of this work in-house rather than referring students out?” 
 

The urgency may be rising. Fourteen percent of undergraduate and graduate students nationwide considered suicide in the 2022–23 academic year, up from 11.7 percent between 2007 and 2021, according to a study of Healthy Minds data. In addition, suicide at the high school level has become “a crisis,” says John Seeley, associate dean for research at UO and UO’s principal investigator for the NIH-funded study. In 2021, 13 percent of high school girls attempted suicide, and 30 percent had seriously considered it, according to the Centers for Disease Control and Prevention. Among LGBTQ+ teens, 22 percent attempted suicide in 2021. 
 

The joint-university study, known as CAMPUS (the Comprehensive Adaptive Multisite Prevention of University Student Suicide), is testing four different strategies “for treating students with moderate to severe suicidal ideation through counseling centers, so that we can avoid that delay in connection to outside services,” Seeley notes. About two hundred students, aged eighteen to twenty-five, are seeking services at counseling centers across the four universities. Data collection on the success of the different treatment approaches will conclude in the fall of 2024. 
 

Beyond the research, UO is involved in suicide prevention efforts both on and off campus. It is one of fifteen member institutions in Oregon Campuses United for Suicide Prevention, which promotes best practices, offers training, and advocates for policies and procedures to prevent suicide on Oregon campuses. The university has a suicide prevention team that provides training to faculty and staff, as well as a student suicide prevention team. UO also offers a two-day suicide first-aid education workshop for local community members. 
 

Meeting with the counseling center’s Mental Health Access Team is the first step for students who are feeling suicidal or dealing with other mental health issues. No appointment is required. The team includes intake/crisis specialists and case managers. The university has a twenty-four-hour crisis hotline, and the number is on every student’s ID card. Anyone who is worried about a student can submit a “Report a Concern” form via the UO website. Depending on the situation, someone from the Office of the Dean of Students may contact the student and suggest on-campus resources. If the student is considered a threat to others or themselves, campus police will respond. 
 

The study and its funding are providing an additional benefit for UO students: they are allowing the counseling center to not only provide more sessions to students at risk of suicide (normally it offers up to seven sessions per year) but place them with therapists who specialize in suicide assessment and treatment. UO is also training fourth- and fifth-year doctoral students in counseling psychology to help deliver these treatments through the Counseling Center. Five doctoral students are currently working there.

“This innovation can help meet the demand, but it also provides a preservice training opportunity,” Seeley says. “These clinicians are going to be trained in suicide-specific treatments before they go into practice.”

A Growing Epidemic

• Among college students aged 18 to 24, suicide is the second-highest cause of death.
• Suicide rates among Americans aged 10 to 24 rose by 62 percent from 2007 through 2021.
• 11 percent of adults aged 18 to 25 have had “serious thoughts” about suicide.
• 41 percent of LGBTQ+ young people age 13 to 24 seriously considered suicide in the past year.

Source: “A Growing epidemic”: Journal of College Student Psychotherapy, Centers for Disease Control and Prevention, National Alliance of Mental Illness, Trevor Project

Know the Warning Signs

• Deteriorating academic performance
• Depression, dramatic mood changes, anxiety, agitation
• Hopelessness and preoccupation with death
• Uncontrolled anger or rage
• Engagement in risky activities
• Withdrawal from friends and family
• Neglect of appearance and hygiene
• Increased alcohol use or drug use
• Giving away prized possessions

For national 24/7 help, call 988 to reach the 988 Suicide and Crisis Lifeline.

Source: Governors State University
 

Illustrations by Edmon de Haro