Tested: College Students and Mental Health

Choosing to continue your education is a big deal. Whether you’re going for your AA, BA, AS, BS or an industry-specific license, you’re doing a lot more than just hitting the books. You’re making big, hard decisions, stepping out of your comfort zone, embracing new challenges and — at least sometimes — making mistakes.

That’s a lot of growth and change for one person to handle. And the stress can be overwhelming at times, for sure. So, how are you supposed to tell the difference between pressure that’s productive and pressure that’s destructive? How do you tell when you’ve crossed the threshold into mental illness?

Psychologist Susan Albers, PsyD, explains why there’s a mental health crisis in higher education — and what to do if you or somebody you love is struggling.

How extreme is the mental health crisis in college students?

While the word “crisis” sometimes gets overused, Dr. Albers believes it’s accurate in the case of mental health in higher education. And the data suggests she’s right.

Gallup and the Lumina Foundation released the results of their 2023 State of Higher Education report in March. Many of us expected that the easing of COVID-19 restrictions in 2022 would have a positive impact on data around enrollment and retention. But that’s proven not to be true. In fact, students are more likely to consider “stopping out” of a certificate or degree program now than they were in 2020 and 2021.

Forty-one percent of students currently enrolled in a degree or certificate program described staying enrolled as “difficult” or “very difficult.” That answer is slightly more common for Black, Hispanic and Asian students than for white students. It was also slightly more common for male-identifying students to report staying enrolled was difficult.

“Difficult” is a pretty vague description. But when you put it in practical terms, the numbers are truly staggering. The Gallup/Lumina study found that 44% of associate degree students and 36% of bachelor’s degree students are considering stopping their coursework for at least one term. Of those students, 55% cited emotional stress as one of the reasons — 47% cited “personal mental health reasons.”

Mental health also prevents enrollment

Mental health is also a major factor preventing people from accessing higher education. The Gallup/Lumina study also examined barriers to enrollment in higher education. In their survey of the top reasons why adults haven’t enrolled in a degree or certificate program, 30% cited emotional stress and 28% named “personal mental health reasons” as “very important” factors that informed their decision.

The results suggest women and Black and Hispanic adults are the most impacted populations.

Broken down by age, over 40% of young adults — people between the ages of 18 and 24 — say mental health and emotional stress are significant barriers to attending secondary school.

Why are college students struggling with mental health?

There are a lot of factors contributing to the proliferation of mental health issues on college campuses. In some ways, the biggest issue is also the most obvious, according to Dr. Albers. “The primary issue is that the number of students that are entering college that have mental health issues is greater than the resources available to help them,” she explains.

There is a silver lining to that particular cloud. There was a time in the United States where individuals living with mental health or cognitive issues weren’t considered “college material.” The system we have today is under-resourced, in part, because higher education is accessible to a broader range of students than it used to be.

Another silver lining: The stigma around mental health is slowly diminishing. More students are using campus resources like disability services, counseling and support groups. And it’s increasingly common to talk about emotional health concerns with friends, professors and staff. In other words, the mental health crisis in higher education is easier to see now, because of this generation’s willingness to speak up and get help.

Of course, that’s just one facet of the situation. There are a lot of reasons college students are struggling. Dr. Albers highlights the following issues.

Timing

Many students start their higher education journey while still going through the physical and developmental changes that come with puberty. “It’s a common time for mental health issues to either occur for the first time or be exacerbated due to all the transition,” Dr. Albers notes.

Academic pressure

Regardless of what higher ed path a student takes, their ability to pursue a career in their chosen field may hinge, in part, on their academic performance. And for many students, transitioning to college-level coursework can take time, and some not-so-great grades.

Financial stress

In the United States, higher education isn’t free — in fact, it’s prohibitively expensive for most people. While many people take out student loans to relieve some of the financial pressure, most still have to work at least part time to make ends meet.

But even that’s often not enough. While rarely discussed, housing and food insecurity are such common problems on college campuses that many now have food pantries on site. And, of course, those student loans have to be paid back, whether you leave with a degree or not.

Even students who aren’t paying for their own education can feel pressure to make sure the people or organizations investing in them “get their money’s worth.”

Fear of the future

Dr. Albers notes that even the most self-assured individual will likely face anxiety about their future in college. Fear of making the wrong decision can be paralyzing under the best of circumstances … and many students aren’t in the best of circumstances. They’re overtired, overworked and under stress. This can all lead to what is known as “catastrophic thinking.” This is a thought or worry that spirals quickly into the worst case scenario. For example, “If I don’t get a good grade in this class, I wont graduate with honors, I will never get a job and I will end up homeless.”

Loneliness and changing support structures

College is a time when the support structures you’ve relied on all your life may become a bit more remote. Being away from parents, mentors, therapists, churches and high school friends can leave you feeling disconnected from your community.

As Dr. Albers puts it, “You have people and relationships that help you during times of transition and mental health issues. And those can become lost or fragmented when you go to college.” The sense of dislocation can be especially acute for students from marginalized groups, international students, veterans, parents, part-time students and commuters.

Physical health concerns

It’s probably fair to say that, as a population, undergrads tend not to be the healthiest bunch of people on the planet.

“Diet, exercise and sleep often fall low on the priority list,” Dr. Albers says. “Students feel like they don’t have time for them. But those three things are the cornerstones of mental health.” When you add stress to the equation, she adds that, “It’s like pulling the rug out from underneath someone who’s already struggling to stay balanced.”

Substance use and abuse

“Substance use can exacerbate or trigger mental health issues,” Dr. Albers states. You don’t have to have a substance use disorder (SUD) for substance use to impact your mental health. That said, there’s a clear relationship between dependency and mental illness. The National Institute of Mental Health explains the relationship this way:

• Substance use can trigger changes in the structure and function of the brain in a way that makes individuals more likely to develop a mental illness.
• People who have a mental illness sometimes self-medicate to relieve their symptoms. While it can sometimes seem misusing substances helps in the moment, it actually exacerbates symptoms in the long run.
• Brain changes in people with mental illness can sometimes amp up the reward effect of a mind-altering substance, which may make a person more likely to use it again.

In other words, the relationship between substance abuse and mental illness isn’t necessarily one of cause and effect. Instead, think of them as mutually reinforcing.

Trauma

“Sometimes, people have high levels of trauma — invisible wounds that they arrive to college with,” Dr. Albers notes. For people in that situation, the stress of transitioning to college can be extremely destabilizing.

Still others experience trauma on campus. Campus sexual violence (CSV) is a particularly pervasive problem.

The American Psychological Association reports that 43% of the crimes committed on college campuses fall into the category of sexual assault (CSA). The mental health impact of campus sexual violence is significant. Not only is it associated with poor academic performance and dropping out, but it’s also linked to alcohol use and mental illness.

How much stress is ‘normal’ in college?

Here’s the thing about college: It’s supposed to be stressful. To a point.

“Stress is built in,” Dr. Albers clarifies. “It is normal and it is to be expected. A little bit of stress helps to prevent boredom and is also a sign that you’re being challenged. So, if stress isn’t there, that would be a little odd.”

So, how do you tell the difference between healthy and unhealthy levels of stress?

According to Dr. Albers, the following changes in day-to-day functioning are red flags:

1. Sleeping too much or not at all.
2. Losing one’s appetite or eating emotionally.
3. Isolating oneself from other people.
4. Missing classes, practices, work and social engagements.

“Basically, you’re too stressed out when the ability to learn is being overshadowed by the mental health struggle,” Dr. Alberts states.

Varsity blues: Mental health in college athletes

Most college students experience stress of one sort or another during their tenure. But researchers have noticed that student athletes are particularly prone to mental health issues. Here’s why:

• Sleep deprivation. Because of scheduling issues, student athletes often have to practice early in the morning or late at night.
• Less time. Practices, travel, competition: That stuff takes a lot of time and energy that might otherwise be spent studying, sleeping, socializing or earning money.
• High stakes. For students on athletic scholarships, their ability to attend school is frequently tied to both academic and athletic success.
• Physical health concerns. Athletes need nourishing food and sleep to fuel their performance, but they’re just as likely as any other student to see their diet and sleep schedule suffer during college. Depending on the sport in question, they may also be more vulnerable to injury.
• Fear of seeking help. Dr. Albers notes that college athletes often worry about the consequences of accessing student support services. “They think that that if they reveal they’ve got a mental health issue that it will be held against them, or that there will be assumptions made about their athletic performance.” The data from the 2022 NCAA Student-Athlete Well-Being Study bears that out. The survey found that only 47% of student athletes would “be comfortable personally seeking support from a mental health provider on campus.”

Mental health tips for college students

Reading all of this information, college could easily start to sound less like a great educational opportunity and more like a psychological trap. But that doesn’t have to be true. Dr. Albers offers these tips for protecting your mental health in an academic pressure cooker.

Eat, sleep and move

Have you ever heard of Maslow’s hierarchy of needs? It’s a psychological model of human motivation. It’s shaped like a pyramid; you have to satisfy the needs at the bottom of the pyramid before you can move up.

Guess what comprises the base of the pyramid? Physiological needs. That’s food, water, clothing, shelter and sleep. If you’re struggling on any of those fronts, you aren’t going to be able to take care of higher-order concerns like grades or career preparation. In other words, prioritizing sleep, nutrition and exercise is one of the best things you can do to ensure you get the most out of your education.

If you don’t have enough food to eat, clothing to wear or a safe place to sleep, that’s something you should talk to a counselor, dean or professor about. They have those conversations much more often than you might realize. And even if they can’t personally help you, they will know who can.

Stay connected with friends and family

Who are the people that know you best? That are most likely to notice when something’s not quite right? To have tough conversations? They’re not always going to be your peers in your degree or certificate program — especially when you’re just starting out. That why it’s a good idea to keep in touch with your friends and family, even if you’re living on the other side of the world.

Of course, not all people have healthy of safe relationships with their biological families. If staying connected to the people who raised you will harm more than help, then focus on your maintaining your relationship with your chosen family or finding a mentor.

Join student organizations

Combatting isolation can be fun! That can be especially true on college campuses, which are teeming with opportunities to meet new people and try new things. Join an intermural sports team, an affinity group, student government or a volunteer organization. (And try not to worry too much about whether the activities you choose will look good on your resume. The best thing you can possibly do for your future is to focus on your health and well-being.)

Know your resources

No matter where you go to school, the first couple weeks will be like drinking from a firehose. You’ll get lost, you’ll forget people’s names and you’ll be lucky if you remember even half of the things you learn about during orientation.

That’s why it’s important to be proactive when it comes to learning about the mental health resources available to you on campus … all of them. You might not end up needing them, but somebody else might.

Having a list of the school-specific, local and national resources saved in your phone means you won’t be caught flat-footed in a crisis. Here are a few phone numbers for students in the U.S. to get you started:

• 988 Suicide and Crisis Lifeline: 988
• The Trevor Project: 1.866.488.7386 or text START to 678-678
• Transgender Suicide Hotline: 1.877.565.8860
• National Domestic Violence Hotline: 1.800.799.7233 or text LOVEIS to 1-866-331-9474
• The Crisis Text Line: Text HOME to 741-741
• The Veterans Crisis Line: 1.800.273.8255 and Press 1 or text to 838255
• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1.800.662.4357 or send your zip code via text message to 435748 (HELP4U)
• Disaster Distress Helpline: Call or text 1.800.985.5990
• National Sexual Assault Hotline: 1.800.656.HOPE (4673)

Register with disability services if needed

If you have a documented mental health, physical health or learning issue that requires disability accommodations, register with your school’s disability services department as soon as you get to campus. Depending on your mental health diagnosis, you may be entitled to accommodations like a reduced courseload, single housing, flexible attendance, extended time on tests … the list goes on.

Remember: Having accommodations and using them are two very different things. It’s possible you’ll never need to use any of your approved accommodations. But here’s the thing: Accommodations are never granted retroactively. And getting them involves meetings and paperwork, which takes time. That’s why it’s important to have them set up before you need them.

Focus on what you can control

If you’re feeling overwhelmed, Dr. Albers suggests making a list of the things that are stressing you out. “Some of those things can probably be addressed and some things are out of your control. Identifying what they are and taking action on the things you can change can be really helpful,” she explains. Prioritize problems that are fixable, or that you can get help from other people on.

Look for the helpers — and be one, too!

Higher education institutions can be unkind in many ways, but the “helpers” (as Fred Rogers put it) tend to be pretty easy to find. Whether it’s a professor, coach, counselor, a residential adviser or even a fellow student, there’s always somebody who’s going to be willing to hear you and help you.

Helping other people can also be healing. Volunteer for an afternoon once a month at the local children’s hospital. Take an hour to chat with a friend who’s going through a rough time. Send a high school friend a hand-written letter to let them know you’re thinking of them. Set up a study group for that final exam that everybody’s so worried about. Stepping outside of yourself and making a difference in other people’s lives can really help put things in perspective.

When is time to consider a medical leave?

“Muscling through” your problems can be a good thing, but only to a point. But where exactly is that point? How do you know when it’s time to consider taking some time off to focus on improving your mental health. Dr. Alber’s checklist looks like this:

• Are you so depressed that you’re not getting out of your bed, or leaving your room?
• Are you isolating yourself from other people?
• Are you missing your classes? When you are in class, are you struggling to absorb the information you’re learning?

If your answer to those questions is “yes,” Dr. Albers says it’s probably time to take a medical leave of absence. “You need to make getting help a top priority because there’s no point in being in college if you are unable to learn the information and really take it in. Instead, take a pause, address your mental health and return when you are truly ready emotionally and physically.”

Word to the wise

It’s a truth broadly acknowledged: There’s a mental health crisis in higher education. Need has been outstripping resources for years. And the COVID-19 pandemic has only made matters worse.

The good news is, there are lots of resources available to help students, whether they just need a little extra support, or find themselves in a full-blown crisis. Getting and staying well can be difficult, but it’s more important than any class, grade or degree will ever be.