Student Mental Health Status Report: Struggles, Stressors and Supports

In counseling sessions, Jonathan Mitchell will jokingly tell students, “My goal is to never see you again.” They’ll laugh, but he will add that he means it and “I shouldn’t be in your life forever.”

That goal is a realistic one at this counseling center at the University of South Florida, St. Petersburg, which is generally designed for brief interventions to address more routine issues in students’ lives.

But familiar faces do sometimes appear. A licensed psychologist and one of just a few mental health providers serving the campus of nearly 5,000 students, Mitchell just had his first in-person counseling session in two years. Coincidentally, he last saw that student in office in March 2020, and he recalls saying, “We’re just going to go online for a couple of weeks and then we’ll be back.”

Her needs met for the time being, the student and Mitchell parted ways for about a year, and then he worked with her virtually for a bit before she took a break again. Now a senior, she felt the need to reconnect a second time.

As many studies at this point have confirmed, the mounting mental health issues for college students have piled up even more during the pandemic. In the latest Student Voice survey of 2,000 undergraduates:

• Students were over twice as likely to rate their overall mental health as poor (22 percent) than excellent (9 percent), with 56 percent responding “fair” or “poor.”
• Looking just at students who accessed mental health counseling prior to college, 70 percent selected “fair” or “poor.” That same grim number applies to LGBTQIA+ students and to students identifying as part of a lower socioeconomic class.
• Even among the 205 respondents who did not say they’d experienced any of seven common mental health challenges among college students asked about in the survey, 12 percent rate their mental well-being as fair (none rated it poor).

Conducted March 16 to 22 with support from Kaplan, the Inside Higher Ed and College Pulse survey found nearly one in five students had struggled with suicidal ideation during college. “Loneliness during the pandemic was at an all-time high,” says Kevin Thomas, a licensed psychologist and associate director for student wellness and counseling and psychological services at California State University, Fullerton. For students already “in a deep, dark place, suicide feels like an answer,” as they think they’re going through it all by themselves and have no one to talk to.

In addition, says Kristina Canfield of the Association of Recovery in Higher Education, “we did see a sharp rise in overdose deaths in 2020 and 2021, largely attributed to the pandemic and isolation.” Interim executive director and member/program manager for the organization, which currently has 156 member institutions in the U.S., U.K. and Canada, Canfield has heard this time referred to as having interlocking pandemics: COVID-19 and substance abuse.

Seven percent of Student Voice survey respondents identify substance abuse as a recent mental health challenge (although, Canfield notes, national research estimates that one in four college students meets the diagnostic criteria for substance use disorders). Three-quarters of Student Voice respondents have struggled with anxiety and/or depression during college, while about one in four has dealt with disordered eating or significant mood swings.

When asked about when exactly during the pandemic their mental health was at its worst, the vast majority could name a specific time period, with just 14 percent responding that their mental health got worse at the beginning of the pandemic and stayed that way.

In the March 2021 Student Voice survey on mental health—taken as widespread COVID vaccine rollouts were approaching—self-assessments of overall mental health were worse than in March 2022 by about 10 percentage points.

The greatest percentage of students taking the 2022 survey identified “now” as the point where their mental health has been the best. But just as COVID is clearly sticking around, so are wellness struggles.

“Students are going to continue to carry this with them for some time after the pandemic,” says Amy Gatto, director of research and evaluation at Active Minds, which supports mental health awareness and education for young adults and has over 600 chapters and a presence on more than 1,000 college campuses and communities. “And if they are, what does it mean for campuses to support students like this?”

As higher ed leaders consider where it’s best to focus efforts and expand supports, at least some are also keeping in mind that “what students are experiencing has an impact on staff and instructors caring for them and supporting them,” says Megan Kennedy, director of the UW Resilience Lab at the University of Washington, which operates within undergraduate academic affairs and partners with other departments to promote well-being. One of its projects, a six-week program for staff and students called Be REAL, helps participants manage stressful emotions and situations, develop mindfulness skills and compassionately foster community well-being and mental health.

The Student Voice survey offers a closer look at where students have been mentally and emotionally, where they are now—including how the pandemic has shifted their priorities—and whether they know where to go for support.

Students in Distress

No one time during the pandemic, the Student Voice data show, has proven to be a clear best or worst point for students and their mental health.

Fall 2020, which emerged as the second most difficult time for students over all, is one Mitchell recalls as being rough. “People at that point were starting to realize this just doesn’t go away,” he says. “The urge to be back was so strong, but students were realizing their whole college experience was going to be colored by this. And once we got to a year, that sentiment really took hold.”

Fall 2021 stands out most for Jenny Ortiz, associate director of wellness and health promotions at St. Olaf College, which supports students in nine areas of well-being: emotional (formerly mental), environmental, financial, intellectual, physical, sexual, social, spiritual and substance (relationship building with various substances in life). Last fall is when campus had opened up to fully in person, but, she says, “we saw record numbers of students seeking support—record numbers coming in crying, just needing someone in the moment. I think the adjustment was hard. Everyone was looking forward to this idea of this old normal.” Ortiz saw students who had never struggled much really struggling.

The new Wellness Center at Montgomery County Community College in Pennsylvania is working up to its goal of offering 24-7 support for mental health and physical wellness needs. Director Nichole Kang says she saw this past fall a lot of “anxiety around just what it means to be back around other people. Isolated during the pandemic, they were trying to understand what they missed and how to be around peers again. Balancing schedules with travel was also a huge challenge to students.”

Heightened anxiety is how Liadan Solomon, a 2021 University of Michigan graduate now at Boston University pursuing a dual master’s in social work and public health, describes being back in person this fall for the first time in two years. As a research data and report analyst for the Healthy Minds Network (which conducts an annual survey on student mental health plus research on the role and health of faculty and staff), Solomon says, “A lot of students experienced this renegotiation of relationships that has previously been defined.” Some people, for example, were willing to engage in a higher level of risk than others in their social circles, adding a tension that didn’t exist pre-pandemic. One positive to campus reopenings, she adds, is how conversation about mental health has opened up much more. The shared trauma helped remove the stigma some people felt in talking about mental health.

That trauma has certainly included the surges and declines in COVID cases, as the situation seemed in control until suddenly it didn’t. One example, UW’s Kennedy says, is “when we thought things were heading in a positive direction and then Omicron hit.”

The American Psychological Association’s CEO, Arthur C. Evans Jr., recently wrote about how “the mental health situation is not going to get better even as the virus recedes.” Research from Sept. 11 and Hurricane Katrina show that “we should expect to see people experiencing problems for at least another seven to 10 years.” COVID’s mental health effects on the general population, he added, are evident in 2021’s 100,000 overdose deaths, anxiety and depression being four times the pre-pandemic rate, and an increase in the number of children going to emergency departments in psychiatric distress.

The Center for Collegiate Mental Health’s fall 2021 report on how COVID impacted college student mental health, based on annual surveys of students being seen for services at CCMH-participating counseling centers, revealed social anxiety and academic distress as the most notable increases in types of student challenges between fall 2019 and fall 2021. Other areas seeing small to moderate increases in distress are depression, generalized anxiety, eating concerns, family distress and overall distress.

Four of the top five current stressors among Student Voice survey respondents relate to academics in some way, with the last (No. 3) relating to finances.

Fewer than one in five students selected the Russian invasion of Ukraine or other international conflicts in the news as a top stressor.

Thomas from Cal State Fullerton sees the selections being heavy in typical college student stressors as a sign of how when “we want normal again—we’re able to just block everything else out.”

“At small private liberal arts schools, sometimes you have this culture where you’re almost in this bubble,” says St. Olaf’s Ortiz. “Unless you’re an international student, you’re not closely impacted by [world events].” Students might advocate for or attend a protest about an incident, but when all is said and done, professors are still expecting coursework to be completed.

When Solomon was an undergrad, she found it difficult to keep up with the news unless she was actively seeking it out. At one point, COVID-related news became something she labeled as “equally as harmful as helpful for me to know,” she says. Regarding Ukraine, “I know quite a few people in my social circles have said, ‘I’m keeping up with the bottom line of what’s happening, but I’m staying away from [photos and video footage].’ Everyone’s trying to assess the benefit of consuming these versus getting put in a state that’s net negative.” The news can especially be activating for those already dealing with anxiety, substance abuse or depression, she adds.

From what Mitchell at USF has seen, “The dumpster fire of the world is kind of crushing [students]. When something else pops up, it gets folded in.” Students may think, “Of course this nuclear power has invaded another country, because that’s how this goes—this goes poorly.” He doesn’t view these thoughts as a lack of empathy but rather a lack of hope that things are going to get better.

Hope and Help

Asked to reflect on how the pandemic shifted their priorities in life, many Student Voice respondents indicate being more focused on positive aspects of their life, including relationships, health and education.

“This has really been a collectively traumatic experience, and those types of experiences tend to shift your priorities,” says Solomon, whose final undergrad years at Michigan involved initially moving back home to Los Angeles. The Healthy Minds Network research found that students clearly desired connection strongly throughout the pandemic, so the focus now on relationships and mental and physical health makes sense to her. “If I had to guess based on what I know and what I have experienced, I think these sentiments will last, at least longer than the end of the pandemic,” she adds. “You have to make the most of the now.”

The Student Voice survey also asked respondents to identify whom they relied on most for emotional and mental support in the early days of the pandemic compared to now. The top three responses—close family/parents or siblings, friends, and romantic partners—were the same for each question, with family providing the most support back in spring 2020 and friends taking that top spot now.

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Students are less likely to be seeking more formal support from their colleges, with just 13 percent having utilized on-campus counseling during the pandemic and 17 percent using telecounseling.

When students turn to friends, it often puts pressure on them, and then the friends struggle, says Ortiz. She attributes the high numbers of overall poor mental well-being in part to students feeling as if they are supporting so many people. “I’d love for students to feel they didn’t just have to use their friends, parents or romantic partners for support,” she says, adding that professionals trained to support could be not just counselors but also health and wellness coaches.

The survey also captured how many students agree they have at least one person in their life to talk to when stressed or anxious, with nearly half agreeing strongly and another three in 10 agreeing somewhat.

In terms of knowing where to seek help on campus for mental health struggles, students are much less likely to agree; one in four disagrees at least somewhat about knowing where to go. And that stat applies to respondents at all size institutions, not just small ones that may have very limited services. One survey respondent, from a large Southwest university, wrote that he’s unaware of any mental health counseling or support on campus.

Even less likely to be aware of campus mental health resources are students who have struggled with substance abuse issues (39 percent disagree they know where to turn) or have had suicidal ideation (30 percent disagree).

Substance abusers, Canfield notes, may actually not know because they aren’t interested in where to go. They often don’t recognize they have a problem or may fear what would happen if they reveal the problem. “The stigma is so deep, that people who struggle with drugs are bad people. These are not bad people trying to get good—these are sick people trying to get well,” says Canfield. She has been in recovery herself since 2005—an experience that led her to establish a recovery community at her university.

Solomon believes those with suicidal ideation may be less likely to know where to turn because they often struggle silently and don’t have anyone asking if they’re OK. At Michigan, she was part of an effort to train student leaders in using the emergency mental health intervention for people in crisis known as Question, Persuade, Refer. “We saw very high utilization,” she says, adding that one in four who got training wound up using the triaging tools at least once.

“It can be hard for students to come forward and get help themselves,” Solomon explains. In fact, she believes the “dominant narrative” among students today is viewing campus counseling as involving long wait lists and being stressful to initiate. Many comments on the Student Voice survey back up that assumption, both with direct experiences and hearing about campus counseling from friends. “I was on the wait list for over a month, and I know many other students have been waiting as well,” wrote one student at a private institution in New York.

Solomon’s peers who had training in helping other students had knowledge about noncounseling avenues as well, such as more holistic wellness programs, physical health supports and academic help. “They could provide a wealth of knowledge on the resources available, which allows them to present this idea of choice,” Solomon says. “If students have a choice, they can guide their own journey, and it can be very empowering.”

More results from the Student Voice survey, including how students rate the quality of campus mental health services and what areas they would like their institutions to invest in, can be found in part two of this article.