SMA–4310

2007

Building Bridges
 

Mental Health on Campus: 

Student Mental Health Leaders and 

College Administrators, Counselors, 

and Faculty in Dialogue 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Substance Abuse and Mental Health Services Administration
 

Center for Mental Health Services
 

www.samhsa.gov
 

 

 

Acknowledgments 

Numerous people contributed to the development of this 

publication (see the “Participant List”). The publication was 

prepared for the Substance Abuse and Mental Health Services 

Administration (SAMHSA), U.S. Department of Health and Human 

Services (HHS), under contract number 208-02-0405. Christopher 

Marshall and Paolo del Vecchio served as the Government Project 

Officers. Irene Saunders Goldstein served as the author of the 

monograph. 

Disclaimer 

The views, opinions, and content of this publication are 

those of the dialogue participants and do not necessarily reflect 

the views, opinions, or policies of the Center for Mental Health 

Services (CMHS), SAMHSA, or HHS. 

Public Domain Notice 

All material appearing in this document is in the public 

domain and may be reproduced without permission from 

SAMHSA. Citation of the source is appreciated. This publication 

may not be reproduced or distributed for a fee without specific 

written authorization of the Office of Communications, 

SAMHSA, HHS. 

Electronic Access and Copies of Publication 

This publication can be accessed electronically on the Internet 

at www.samhsa.gov. For additional free copies of this publication, 

call SAMHSA’s National Mental Health Information Center at 

1-800-789-2647. 

Recommended Citation 

Building Bridges. Mental Health on Campus: Student Mental 

Health Leaders and College Administrators, Counselors, and 

Faculty in Dialogue. (2007). HHS Pub. No. SMA-4310. Rockville, 

MD: Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration. 

Originating Office 

Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 1 Choke Cherry Road, 

Rockville, MD 20857 

HHS Publication No. SMA-4310 

Printed 2007 

iii 

Foreword
 Since 1997, the Center for Mental Health Services (CMHS), 

within the Substance Abuse and Mental Health Services 

Administration (SAMHSA), has sponsored a series of participatory 

dialogues that offer mental health consumers and representatives 

from other groups an opportunity to enhance communication 

and build partnerships to improve mental health services and 

promote recovery. These meetings have led to concrete outcomes, 

including advances in networking, training and technical 

assistance, and valuable recommendations for CMHS and the field. 

Student mental health consumer leaders on college and 

university campuses met in December 2005 with representatives 

from a variety of sectors of the college mental health system, 

including researchers, clinicians, college administrators and 

counselors, and leaders of national and local organizations that 

address student mental health issues. 

The Mental Health on Campus dialogue meeting provided 

an opportunity for student mental health consumers and college 

representatives to discuss openly attitudes and practices that 

either hinder or promote recovery. Meeting participants identified 

attitudinal, cultural, and systemic barriers to mental health, and 

developed a set of recommendations to overcome them. 

iii 
 

 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

National Strategy for Suicide Prevention 

Objective 4.3: Increase the proportion of colleges 

and universities with evidence-based programs 

designed to address serious young adult distress 

and prevent suicide. 

. . . Because many of the risk and protective factors for 

suicide among young adults are similar to those for mental 

disorders and other problem behaviors, including alcohol, 

drug abuse and interpersonal violence . . . , suicide prevention 

may be best integrated within broad prevention efforts. 

Source: U.S. Department of Health and Human Services, 

National Strategy for Suicide Prevention: Goals and Objectives 

for Action. (2001). Rockville, MD: U.S. Public Health Service; 

www.mentalhealth.samhsa.gov/publications/allpubs/SMA01­

3517/ch4.asp 

iv 
 

Contents 

Overview 1
 

Dialogue Themes and Findings 9
 

In Their Own Words 9
 

Individuals’ Mental Health Care Issues 14 


 Individual and Health Care Factors That Promote Recovery 14 


 Individual and Health Care Factors That Hinder Recovery 17 


Issues Related to Systems and Contexts 20 


 System-Level Factors That Promote Recovery 20


 System-Level Factors That Hinder Recovery 23
 

Recommendations for Action 25
 

Improve Campus Culture 26
 

Improve Access to Information 28
 

Manage Expectations 32
 

Selected References and Resources 39
 

References and Related Publications 39 


Resources 41 


Participant List 47
 

v 

Overview
 We stand at a confluence of several forces: increasing numbers 

of students, with increasingly severe emotional problems; students 

and families who look increasingly to universities to provide 

mental health and other supportive services for their students; 

levels of student stress and clinical depression that show no signs 

of abating; and budgetary cutbacks that make growth in mental 

health staffing difficult at best, unlikely at worst. (Marsh, 2004) 

Suicides on campus make national headlines. In addition, 

these tragic events underscore the critical necessity to address 

significant increases in the mental health needs of college 

students on campuses. Recent national surveys validate what long 

has been evident to college counseling services—students’ needs 

are changing and growing. 

What’s behind these trends? 

Ninety-two percent of counseling center directors believe 

that the number of students with severe psychological problems 

has increased in recent years and is a growing concern in their 

centers (Gallagher, 2006). Mental illnesses such as depression, 

bipolar disorder, and anxiety disorder with panic attacks are on 

the rise (Gallagher, 2006). That same year, the National College 

Health Assessment revealed that more than half of the students 

surveyed reported feeling “things were hopeless” and that 

more than a third felt “so depressed it was difficult to function” 

(American College Health Association [ACHA], 2006). Almost a 

tenth of the students reported seriously considering attempting 

suicide, and more than 1 percent reported attempting suicide 

(Marsh, 2004). More than 1,000 on-campus suicides take place 

each year (National Mental Health Association [NMHA] & Jed 

Foundation, 2002). 

More than 16 million young people attend colleges and 

universities in the United States (ACHA, 2006). According to the 

Suicide Prevention Resource Center, one-fifth of college students 

experience a mental illness, and more and more students arrive 

on campus these days having received mental health services 

before starting their college careers (Suicide Prevention Resource 

Center, 2004). Also, increasing numbers of students are seeking 

help for emotional problems that occur after they arrive at college. 

Clinical depression often emerges for the first time in adolescence 

(Centers for Disease Control and Prevention, 1997). 

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Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Compounding the problem, campus resources are often 

strained to meet the student demand for mental health services 

(Gallagher, 2006). Increasingly, student groups are calling for 

awareness, education, and resources for peer and self-help 

programs (www.activemindsoncampus.org). 

What can campuses do? Not too long ago, counseling services 

typically focused on relationship problems and career concerns. 

Now, though, colleges and universities are called upon to shift 

and expand their priorities dramatically to address students’ 

growing demand for mental health services—and many schools 

are developing plans. How can administrators balance the 

competing priorities of limited resources and burgeoning need? 

How can campuses determine the best mix of services to provide? 

And how should administrators deal with the hovering specter of 

suicide on their campuses? 

The complex problem of suicide and suicidal behaviors on 

campus demands a multifaceted, collaborative approach. 

. . . College administrators must work to ensure that all 

elements of the campus and the entire community are 

working together. (NMHA & Jed Foundation, 2002) 

What can students do? Are services and supports available to 

help students recover from mental health problems and succeed 

academically and personally? How can they navigate their campus 

mental health systems to take advantage of services and supports? 

How can students influence and work with college administrators 

to create a comprehensive, user-friendly system? How can they 

work together to change the campus culture and put an end to 

the stigma and discrimination that deter students from seeking 

help in the first place? 

To further this conversation, a group of campus mental health 

leaders met in dialogue with college administrators, counselors, 

faculty members, and a legal expert in December 2005. Two 

dozen people engaged in a forum, sponsored by CMHS/SAMHSA, 

in which they developed trust and built mutual understanding and 

respect—a first step toward creating effective alliances that support 

recovery for college students who are consumers of mental health 

services. Among other topics, dialogue participants discussed— 

•	 Access to, availability, affordability, and quantity of mental 

health services delivered on campuses; 

•	 Interaction of administration policies and mental 

health services; 

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•	 Discrimination and stigma; 

•	 Student engagement and advocacy; 

•	 Wellness and prevention; 

•	 Communication among multiple stakeholders; 

•	 Confidentiality; 

•	 Differing cultural responses to mental illness; 

•	 Disability rights and accommodation; 

•	 Legal and liability issues; 

•	 College as a safety net; and 

•	 Training of multiple stakeholders to identify 

problems and take appropriate action. 

The dialogue offered an opportunity for all participants 

to learn from the firsthand experiences of students who live 

with these issues and also from professionals with institutional 

policy, service provision, and research perspectives. Participants 

synthesized their discussions and developed recommendations 

to address attitudinal and institutional barriers and to create 

opportunities for promoting recovery. 

We always hear about increased numbers of students coming 

in for mental health services and the need to do more. But is 

that really the solution? Can we keep increasing resources? Or 

are we going to prepare kids better to deal with life skills, to 

become more self-aware on the spectrum, and not to rely solely 

on crisis intervention? 

—Campus mental health advocate 

3
 
 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Current U.S. Government Suicide Prevention Programs 

In 2001, the U.S. Department of Health and Human 

Services (HHS) published the National Strategy for Suicide 

Prevention: Goals and Objectives for Action (NSSP), the 

culmination of years of concerted effort by advocates, 

clinicians, researchers, government officials, and survivors 

of suicide loss, to place suicide prevention on the Nation’s 

public health agenda. A national “roadmap for action,” the 

NSSP outlined goals and objectives to prevent premature 

deaths due to suicide across the lifespan; reduce the rates 

of other suicidal behaviors; reduce the harmful aftereffects 

associated with suicidal behaviors and traumatic impact of 

suicide on family and friends; and promote opportunities and 

settings to enhance resiliency, resourcefulness, respect, and 

interconnectedness for individuals, families, and communities. 

Other influential reports, including the Institute of 

Medicine’s Reducing Suicide: A National Imperative (2002) 

and the President’s New Freedom Commission on Mental 

Health’s Achieving the Promise: Transforming Mental Health 

Care in America (2003), endorsed the need for a public or 

private coordinating body. 

On October 21, 2004, President Bush signed the Nation’s 

first youth suicide prevention bill into law. Named in memory 

of Senator Gordon Smith’s (R-OR) son who died by suicide 

in September 2003, the Garrett Lee Smith Memorial Act [P.L. 

108-355] recognized that youth suicide is a public health crisis 

linked to underlying mental health problems and authorized 

funding for youth suicide prevention programs. 

In his presentation, Richard McKeon, Ph.D., SAMHSA’s 

special advisor on suicide prevention, explained that CMHS 

is able to support a number of initiatives. They improve 

public and professional awareness of suicide as a preventable 

public health problem and enhance the capabilities of the 

systems that promote prevention and recovery. SAMHSA 

also seeks to advance the National Strategy for Suicide 

Prevention, the Nation’s comprehensive and integrated 

approach to reducing the loss and suffering from suicide and 

suicidal behaviors across the life course. SAMHSA’s grant 

programs include the following: 

•	 As part of the Garrett Lee Smith Memorial Act, the Campus 

Suicide Prevention Grants Program provides funding to 

4
 
 

 

 

 

 

 

 

 

 

 

 

 

 

support institutions of higher education to prevent suicide 

and suicide attempts. The program also provides funding 

to enhance services for students with mental health 

problems such as depression and substance abuse that put 

them at risk for suicide or suicide attempts. Grantees build 

a public health infrastructure by implementing activities 

such as training students and staff as “gatekeepers” to 

engage and facilitate referrals for students who are in crisis 

or at risk; creating a network to link the institution with 

health care providers from the broader community who 

can treat mental and behavioral problems; conducting 

workshops and distributing suicide prevention materials; 

and creating a local hotline or promoting use of the 

National Suicide Prevention Lifeline at 1-800-273-TALK 

(8255). SAMHSA currently funds 55 campuses at up to 

$75,000 (plus an equivalent match from the institution) 

for up to 3 years. 

•	 Also authorized by the Garrett Lee Smith Memorial 

Act, the State/Tribal Youth Suicide Prevention and Early 

Intervention Grant Program builds on the foundation 

of prior suicide prevention efforts to support States and 

Tribes in developing and implementing State or tribal 

youth suicide prevention and early intervention strategies 

grounded in public–private partnerships. The 29 States and 

seven Tribes and tribal organizations that were awarded 

these 3-year grants implement programs involving public– 

private collaboration among youth-serving institutions and 

agencies that include schools, educational institutions, 

juvenile justice systems, foster care systems, substance 

abuse and mental health programs, and other child- and 

youth-supporting organizations. 

•	 The Suicide Prevention Resource Center (SPRC) is a 

technical assistance center for SAMHSA’s State/Tribal 

Youth Suicide Prevention and Campus Suicide Prevention 

grantees, as well as for State, Territorial, and tribal suicide 

prevention coordinators and for local suicide prevention 

coalitions. The services provided by SPRC include 

conducting training sessions and conferences; developing 

publications and Web content on suicide and suicide 

prevention for professionals, consumers, and community 

leaders; identifying and disseminating best practices; and 

promoting suicide prevention as a component of mental 

health transformation. 

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Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Every dollar that helps heal those battling life-threatening 

depression brings us closer to saving our children and 

families. Young people can be lost in the deep darkness of 

mental illness and these programs will help find sufferers 

and get them life saving help. 

—Senator Gordon Smith (R-OR), 

SAMHSA press release, September 20, 2005 

Investing in college campus mental health programs and 

suicide prevention programs can yield benefits far beyond 

the contribution these programs make to the personal 

well-being of students. They can help ensure that the 

Federal investment in post-secondary education [almost 

$70 billion in 2004] is returned to the taxpayers in the 

form of academically successful and emotionally sound 

college graduates ready to contribute as members of 

families, communities, and the workforce. (SPRC, 2004) 

•	 The Jed Foundation and SPRC, together with a consortium 

of diverse colleges, are working to apply the U.S. Air 

Force’s successful, comprehensive, multidimensional 

model of suicide prevention on college campuses. 

•	 CMHS also supports the National Suicide Prevention 

Lifeline, a system of toll-free telephone numbers, 

including 1-800-273-TALK (8255). This service routes 

calls from anywhere in the United States to a network of 

certified local crisis centers that can link callers to local 

emergency, mental health, and social service resources. 

The technology permits calls to be directed immediately to 

a suicide prevention worker who is geographically closest 

to the caller. Colleges can order free promotional materials 

(including English and Spanish wallet cards listing the 

warning signs of suicide), in bulk, from SAMHSA’s National 

Mental Health Information Center at 1-800-789-2647. 

6
 
Suicide Warning Signs 

Seek help as soon as possible by contacting a mental 

health professional or by calling the National Suicide 

Prevention Lifeline at 1-800-273-TALK if you or someone you 

know exhibits any of the following signs: 

•	 Threatening to hurt or kill oneself or talking about wanting 

to hurt or kill oneself 

•	 Looking for ways to kill oneself by seeking access to 

firearms, available pills, or other means 

•	 Talking or writing about death, dying, or suicide when 

these actions are out of the ordinary for the person 

•	 Feeling hopeless 

•	 Feeling rage or uncontrolled anger or seeking revenge 

•	 Acting reckless or engaging in risky activities—seemingly 

without thinking 

•	 Feeling trapped—like there’s no way out 

•	 Increasing alcohol or drug use 

•	 Withdrawing from friends, family, and society 

•	 Feeling anxious, agitated, or unable to sleep or sleeping all 

the time 

•	 Experiencing dramatic mood changes 

•	 Seeing no reason for living or having no sense of purpose 

in life 

7
 

 

Dialogue Themes and Findings
 Your social life is alive. You’re trying to figure out who you are. 

You don’t want to admit you have a mental illness. 

— Student consumer, campus mental health advocate 

In Their Own Words 

Participants in the dialogue shared observations about 

their personal and professional experiences with mental health 

problems on campuses. 

Virtually everyone commented on the overarching shadow and 

pain—and consequences—of stigma and discrimination . . . 

Stigma is the greatest impediment to recovery. 

—National mental health advocate 

I omitted my psychiatric meds on the university health 

form because I was afraid of discrimination. 

—Student mental health activist 

We filed a suit against George Washington University on behalf of a 

student no longer there. His roommate had committed suicide and 

he found himself thinking about suicide. The student went for help 

and committed himself to GWU Hospital, where he was served with 

notice of disciplinary infraction for endangering others. He was 

counseled in the end to withdraw, rather than go through a process 

that might involve serious sanctions. This case struck a chord 

with us in terms of discrimination and failure to accommodate. 

—National mental health legal advocate 

It’s important for people who have serious mental 

conditions to self-identify, to be able to say, “I have a 

serious mental health issue and I am really doing well.” 

—National mental health advocate 

Students say “I’m depressed,” and the term depression is bandied 

about. Yes, it trivializes major clinical depression—but more 

students are able to come to terms with seeking out services. 

—Student mental health activist 

9
 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Some participants offered perspectives on the unique 

challenges faced by persons who are members of minority 

groups and other special populations . . . 

We offer medical leaves and accommodations for psych issues, but 

many students do not use them, particularly students of color, even 

though we have a large percentage of minority counselors. 

—University administrator 

In Asian and Latino cultures, saving face is an important 

value—not revealing certain things to extended family. 

This attitude does not foster discourse about treatment. 

Stereotyping and lack of cultural competency on the 

part of caregivers also are barriers to getting help. 

—Student mental health activist 

Special populations have a difficult time getting services. 

The Office of Lesbian Gay Bisexual Transgender Services 

and the Office of Multicultural Programming and Services 

are two portals where some students gain access. 

—Administrator, student counseling services 

Some described the inadequacy of colleges’ services to 

meet students’ growing needs for mental health services . . . 

The needs students bring to our counseling 

center well exceed our resources. 

—Administrator, student counseling services 

A business-oriented administration focused on faster-bettercheaper is reflected in our diminished counseling resources. 

—Psychologist, campus counseling center 

Over the last five years, the numbers of students seen 

in our counseling service rose by 61 percent—despite 

deep budget cutbacks. Students are more willing to 

come to counseling services, but because of our budget 

crisis, it’s very difficult to accommodate them. 

—Administrator, student counseling services 

10 
And others pointed to specific successes . . . 

Psych medications enable more students 


to come to colleges than before. 


Even though there’s not that big a reduction in 


stigma, we see more health-seeking behaviors. 


—Campus mental health advocate 

Our university does good advertising about our services. 

—University administrator 

Ulifeline.org provides online support services on 

hundreds of campuses to five million students, 

including information on local resources. 

—Campus mental health advocate 

I have been responding to student advocacy groups and media 

complaining about services not provided and disconnects between 

services on campus. We decided to create a comprehensive 

counseling structure that coordinates overlapping services 

into one place for strategic planning and services. 

—University administrator 

As an undergrad resident assistant and then as a fraternity 

officer, three people I knew attempted suicide. All three survived, 

but later I was diagnosed with clinical depression. I got help 

and had a good experience with my campus resources. 

—Student mental health activist 

Some described colleges’ lack of adequate communication 

to students about the services available to them . . . 

A lot of students don’t know where mental health services 

are offered or how many sessions they can use. 

—Student mental health activist 

I tried to seek counseling on campus, and they immediately 

referred me out. I didn’t know how insurance worked 

or how to get off campus. I ended up not going, 

and got progressively worse through the year. 

—Student mental health activist 

I always seem to find out about the university’s many services after 

I need them. Recently I learned I could have done something about 

turning in work late. I was in the hospital for a week or two, and 

I found out too late about the provision. It was just so frustrating! 

—Student mental health activist 

11
 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

And others pointed to positive campus practices to inform 

and communicate about helpful resources . . . 

We show all of our freshman a short video, “Empowering 

You.” It’s reality TV, and they see it in their dorm and then 

have a party to talk about it. We created a pamphlet based 

on the images in the video, which we give to all students, 

administrators, and residential staff, that also includes 

comprehensive information about available resources. 

—University administrator 

Parents often call us now before their children apply 

to our school to talk about the services we offer. 

—Administrator, student counseling services 

Our counseling service was never before involved with 

parent orientation, but now we spend an hour with 

parents talking about facilitating the students’ transitions 

and helping them understand the services we offer. 

—Administrator, student counseling services 

Some participants described how student advocacy 

groups empower their members and create positive awareness 

on campus . . . 

Students are action oriented and want to do things. 

Advocacy groups help in recovery, because students 

feel worthwhile and part of campus life. 

—National mental health advocate 

On our campus, a group of about 40 student volunteers started 

a suicide prevention telephone helpline, backed up by a team 

of psychologists. That instant contact had a major impact. 

—Administrator, student counseling services 

We’re starting student groups. One person shares 

a story and then others share theirs, too. 

—National mental health advocate 

Members of our student advocacy group talked to psychiatric 

emergency staff about what we students need when we come to 

emergency services. We also created a handout for them to use. 

The clinicians now have a better sense of how to help students. 

—Student mental health activist 

My organization sponsors campus-wide events, 

including Mental Health Awareness Day. 

—Student mental health activist 

12 
 

I suffered from major depression. I used substances, hid in 

stairways, did not get out of bed. The campus counseling 

center told me to come back in two or three weeks. In the 

meantime I saw a sign that advertised a work/study job at 

a local mental health association in telephone counseling. I 

entered the world of interacting with my peers in self-help. 

—National mental health advocate 

Some participants recounted instances in which administrative 

policies impacted students’ recovery and academic success . 

. . 

I self-injured, and when the dean found out, he said 

that if I did it again, he would kick me off campus. 

“Great! I’m really going to tell you if I do it again!” 

—Student mental health activist 

I found out after my first hospitalization while I was in college that 

there are no excused absences from classes. I was shocked, and 

thought, “What am I going to do about getting help?” Some students 

might give more weight to unexcused absences than to getting help. 

—Student mental health activist 

Academic success comes before help, and students 

will not get help unless they’re in crisis mode. Referral 

to outside help is too overwhelming, and students are 

not told where to get help or what are the costs. 

—Student mental health activist 

In response to increased faculty and staff anxiety because 

of national press coverage of college students’ mental 

health problems and suicides, our counseling service 

has developed workshops and programs for faculty 

and staff on distressed and distressing students. 

—Administrator, student counseling services 

And others emphasized their institutions’ conflicting 

priorities . . . 

Students receive the same e-mail for self-injury as they 

do for a noise violation or minor possession. 

—Student mental health activist 

I learned firsthand what an administrator has to do 

to help students and how complicated it is because 

of conflicts of interest and confidentiality. 

—Professor, administrator, provider 

13 
 

 

 

 

 

 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Keeping the university safe is a benign goal, and we all want 

that. On the other hand, “keeping kids safe” may mean more 

to universities than “we want students safe.” It also can mean, 

“We want our reputation untarnished and for us to have no 

liability.” Some say, “We’re not concerned about whether or not 

you commit suicide, but don’t do it around our university.” 

—National mental health advocate 

We’re getting more involved in evaluating students. When a suicide 

attempt takes place, our counseling staff evaluate with deans about 

when the student is ready to come back to the residence halls, or 

whether we recommend seeking treatment before the student comes 

back. We’re concerned that it sounds punitive, but we are thinking 

of the best interests of students and other people in the community. 

—Psychologist, campus counseling center 

Several participants identified the need for attention to 

students who lose family and friends to suicide . . . 

I am a suicide survivor. My brother took his life at college after 

having heard voices for three years and being depressed—but 

not telling anyone. I started Active Minds on my campus 

to get students talking about their experiences and to 

encourage students to seek treatment. Later, I founded a 

nonprofit organization to create a movement of young adult 

advocates. We now have almost 30 campus chapters. 

—National mental health advocate 

Many people with mental health needs are not ill, and 

schools are not good at identifying survivors of suicide. Four 

hundred kids showed up at a meeting to talk about suicide. 

More of them were survivors than people with illnesses, 

and they wanted to talk about the ongoing effect. 

—University administrator 

Individuals’ Mental Health Care Issues 

Dialogue participants identified a series of person-level 

factors regarding their mental health care that promote and hinder 

recovery. These factors are listed below. 

Individual and Health Care Factors That Promote Recovery 

Participants discussed factors that promote recovery from 

mental health problems, including actions to reduce or eliminate 

the effects of stigma and discrimination, student control and 

choice, access to information and supports, mental health care 

issues, and policies, rights, liability, and accommodation issues. 

14 
 

 

Elimination or reduction of stigma and discrimination 

1.	 Location and signage for counseling services that preserve 

students’ confidentiality and anonymity 

2.	 Subtle approaches to inform all students about 


mental illnesses 


3.	 Positive role models on campus for living with 


mental problems 


4.	 Multiple portals of entry to counseling services— 


a “no wrong door” approach 


5.	 Monitoring campus or local media for appropriate mental 

health messages 

Student control and choice 

6.	 Student participation in campus advocacy groups for 

mental health to promote awareness and to provide 

mutual support 

7.	 Student input into service provision and policies 

8.	 Web-based support group sponsored by a trusted entity 

9.	 Peer support groups, including informal buddy systems, 

both online and in person 

A lot of students deal with psych disorders and do not 

receive the help they need. Within our group we empowered 

each other to talk, and then our circle grew. 

—Student mental health activist 

Access to information and supports 

10. 	In the college selection process, awareness about the 

availability of mental health services 

11. 	Comprehensive orientation on mental health services for 

freshmen and transfer students, and refresher orientation 

for continuing students 

Students need information about mental health services every year 

because different issues come up—sophomore slump, junior year 

abroad, and seniors’ concerns about what to do with their lives. 

—National mental health advocate 

12. 	Student awareness of easy-to-access, comprehensive 

information about campus and other local resources, 

including a well-designed Web site with relevant links 

15 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

13.	 Peer wellness educators who present information 

on mental health and mental illnesses to students in 

residence halls 

We need to educate students, with special emphasis on 

getting them in the door and then working on their issues. 

—Campus mental health advocate 

14.	 Culturally competent information on mental health and 

mental illnesses 

15.	 Timely access to counseling services staffed by adequate 

numbers of counselors to meet demand 

Freshmen are inundated with information at orientation, 

so it is important to have a discussion a week later. 

—National mental health advocate 

16. Telephone helplines 

17.	 Student-to-student outreach to facilitate referrals for 

clinical services 

18.	 Campus-wide panel discussions and dialogues on mental 

health and mental illnesses 

19.	 Awareness that the college Office of Disability Services 

may offer help 

20.	 Training for students, faculty, counselors, administrators, 

and other staff on the components of, and how to 

navigate, the mental health system 

A key to helping students seek recovery is to concentrate 

on friends and family members. It’s important to educate 

family members and friends—and anyone on campus—to 

know the warning signs, what to do, and who to call. 

—Student mental health activist 

Mental health care issues 

21.	 Availability of services when students need them, 

including walk-in, same-day, and afterhours telephone 

counseling services 

22.	 Availability of a spectrum of psychodynamic approaches 

to meet students’ diverse needs 

23.	 Continuity of counseling services, including before and 

during exams, and between semesters 

16 
24.	 Counselor followup with students during and after mental 

health crises 

25.	 Culturally competent counselors or therapists 

26. Recognition that college may be the first time to assess a 

student’s mental health problems 

27. 	Explicit guidance that medications take time to work and 

do not offer a quick fix 

28. 	Advance directives regarding communication in 

emergency situations with the university, or parents, 

or both 

29.	 Supports appropriate for students with abusive 


home situations 


30.	 Helpful policies regarding confidentiality 

The best approach seems to be to offer people in crisis the 

services they want and need, including trying to reduce 

wstigma in seeking help. Universities can ask students whether 

information can be shared in an advance directive. Offering 

choice before a crisis may be the best we can do. 

—National mental health legal advocate 

Individual and Health Care Factors That Hinder Recovery 

Dialogue participants also identified a number of factors that 

hinder recovery, particularly the overarching shadow of stigma 

and discrimination. They cited particular features of campus 

culture, inadequate access to information and supports, and a 

number of health care issues as barriers to recovery. They also 

called attention to academic and career pressures and social 

stressors as factors that impede recovery. 

Stigma and discrimination 

1.	 Successful students concealing, and not addressing, their 

mental health problems 

2.	 Fears about breach of confidentiality related to 


self-disclosure 


3.	 Discontinuing treatment (especially medications) because 

of feelings about stigma 

4.	 Fear of violence linked to persons with mental 


health problems 


17 
 

 

 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

5. 	 Culturally specific negative attitudes toward mental 

health problems 

Cultural issues play into students’ expectations. International 

students and students from various socioeconomic levels 

and family heritage have different expectations, which 

do not always jive with what caregivers can offer. 

—Administrator, student counseling services 

Campus culture 

6.	 Language barriers: lack of knowledge about how to talk 

about mental health concerns 

7.	 High incidence of substance use or abuse, binge 

drinking, and recreational use of prescription drugs, 

any of which may represent self-medication for mental 

health problems 

Drinking is out of control on campuses, and co-occurring 

disorders—the intersection between alcohol and substance abuse 

and depression—are huge. The amount of drinking and the harm 

students do to one another may be a measure of anxiety and stress. 

—University administrator 

8.	 Lack of understanding of students’ mental health concerns 

9. 	 Isolation experienced, for example, by commuter students 

and international students 

10. 	Perceived lack of respect by college administration for 

students with mental health problems 

11. 	Reduced courseload as an accommodation, but 

limited by the requirement to relinquish academic 

or sports scholarships 

12.	 Fear of using too many college resources 

Do I want to let the administration know that they may 

have made a mistake in admitting me? I worry that I’m 

using too many resources or costing too much. 

—University administrator 

18 
Access to information and supports 

13.	 Inadequate information about, and difficulties 


in navigating, separate departments to access 


support services, for example, disability, housing, 


or academic policies 


14. 	Loss of relationships and social connections 

Students may be in isolation, having left their familiar 

high school friends and teachers and family, and not 

having yet created a new support system on campus. 

—Faculty member and counselor 

15. 	Financial barriers to treatment, including limited health 

insurance and high cost of medications 

16. Delays in accessing services 

Students get their courage worked up to go for counseling, 

but it falls away when they have to wait. 

—Administrator, student counseling services 

Mental health care issues 

17. 	Students’ choice not to address their mental 


health problems 


18. 	Disconnect between students’ problem-solving motivation 

and counselors’ therapeutic approaches (administration 

unaware of the kinds of counseling services students 

really want) 

19.	 Inadequate culturally competent mental health services 

20. 	Insufficient time for relationship building between 

students and service providers 

We used to provide unlimited visits, but now, 

because of constraints on resources, we need to 

set session limits and spread visits out. 

—University administrator 

19 
 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

21. 	Co-occurring alcohol, illicit drug, and prescription drug 

use or abuse, which complicates treatment 

22. 	Services unavailable at the midterm or before finals 

23. 	Self-injury treated as a disciplinary, not a mental 

health, issue 

24. 	Lack of resources for referrals into the community 

25. 	Pharmaceutical advertising that raises expectations of 

unrealistically rapid recovery 

26. Reputation for poor services, so students 

avoid consultation 

Issues Related to Systems and Contexts 

Acknowledging the need for administrators to balance the 

welfare of the institution as a whole with the welfare of individual 

students, participants identified a number of system-level factors 

that they know promote or hinder recovery. 

System-Level Factors That Promote Recovery 

Dialogue participants identified a series of system-level factors 

that promote mental health recovery on campuses. 

Helping keep students safe drives our approach to services. 

—Psychologist, campus counseling center 

Elimination or reduce reduction of stigma and 

discrimination 

1.	 Effective confidentiality practices that encourage 

seeking help 

2.	 Student-run campaigns on mental health awareness 

3.	 Policies for students with mental health problems that 

avoid inappropriate disciplinary measures 

4.	 Law enforcement and mental health issues covered 

appropriately in student media 

Student control and choice 

5. 	 Student partnerships with the college community on 

mental health policy 

6. 	 Student participation on search committees for counseling 

service directors and key staff 

20 
 

 

 

 

 

7. 	 Students trained to facilitate referrals for their friends to 

mental health services 

Access to information and supports 

8. 	 Use of multimedia approaches and easy access to 


information on mental health resources 


9. 	 Use of campus orientation: all first-year students tour 

counseling centers, attend student-to-student seminars 

held on mental health issues and services, and participate 

in followup discussions conducted after orientation about 

mental health services and in annual orientations given 

on mental health services 

10. 	Online appointment scheduling for counseling services 

11. 	Mental health education embedded in broad-based, 

student-delivered wellness programs in residence halls 

12. 	Education on mental illnesses made fun to attract 


students’ interest 


13. 	Timely access to mental health services 

14. 	Outreach to the community to broaden the availability of 

referral services 

15. 	Counselors’ followup with students during and after 

mental health crises 

16. Data on counseling services tracked 

The phone number of our campus help line is printed on the back 

of every faculty and student ID card. We make presentations to 

freshmen, transfer students, and parents during orientation. 

We run a successful gatekeeper training program—for example, 

for police—on how to talk with students and clues to look for. 

—Administrator, student counseling services 

Policies, rights, liability, and accommodation issues 

17.	 College policies and practices designed, provided, and 

promoted to help students succeed 

18. 	Students welcomed to bring problems to the 


administration’s attention
 

21 
 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

19. 	Human rights approach to address mental health issues 

on campus 

20. 	Reasonable, flexible accommodations in compliance with 

the Americans with Disabilities Act 

21. 	Confidentiality procedures that allow for choices and 

sensible behavior (e.g., use of advance directives) 

22. 	Students as members of valued partnerships on mental 

health policy within the college or university 

23. 	College support for peer education and peer support 

networks, designed and developed by or with students 

24. 	Sufficient mental health providers to meet the demand for 

services where and when it exists 

25. 	Student health fees that cover mental health services 

26. Campus-wide collaborations to coordinate 

services, reallocate resources, and create cost savings— 

interdisciplinary, one-stop health services on campus 

27. 	Consolidated peer advocacy groups with funds allocated 

from the student life budget 

28.	 Faculty adequately trained to identify problems 

and/or intervene 

29. 	Common sense applied to handling suicide attempts, 

on a case-by-case basis 

30. 	Appeals process for administration’s determinations 

related to mental health 

31. 	College presidents engaged in development 

and implementation of prevention and earlyintervention programs 

32. 	Accommodations for students unable to return to abusive 

situations in their homes 

Counselors ask, “How do we provide services for students, 

particularly those with significant history? How do 

we do best with our resources?” Administrators must 

decide what kind of services they want to provide. 

—Administrator, student counseling services 

22 
 

 

System-Level Factors That Hinder Recovery 

Students on college campuses across America who experience 

significant mental health problems encounter common barriers 

to getting help. Students may not have easy access to the 

information they need. Their schools’ counseling services may be 

underfunded, understaffed, and overwhelmed by students seeking 

services, with wait times for an initial appointment of weeks, not 

hours or even days. 

Participants identified system-related factors that impede 

recovery. These factors include issues related to administrations’ 

fear of legal consequences related to campus suicides that may 

outweigh their motivation to do all they can to help students with 

mental health problems to succeed. Participants also identified a 

number of other concerns. 

Campus culture 

1.	 Lack of administration support of student mental 


health groups 


2.	 Shift of focus away from student well-being and acting in 

place of a parent (in loco parentis) 

Higher education has shifted from a nurturing alma 

mater, where students were well cared for and faculty 

lived with students, to fragmentation and a decline in 

institutional capability to care about students’ well-being. 

—Faculty member and counselor 

Inadequate access to information and supports 

3.	 Information on mental health services offered only at the 

start of the school year 

4.	 Insufficient campus supports to combat isolation and loss 

of social network 

5.	 Untimely or inconvenient access to services, or both 

6.	 Lack of coordination among college services, such as 

mental health counseling, disability, and academics, in 

serving students 

Counseling services might help ease housing situations, 

but universities typically silo their departments. 

—Campus mental health advocate 

23 
 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Students have the burden of proving a disability, but they 

don’t know about the availability of disability benefits. 

—Student mental health activist 

7. 	 Mental health policies driven by fears of malpractice suits, 

institutional liability, and adverse publicity, rather than 

focused on students’ success 

8. 	 Self-injury dealt with as a disciplinary issue, not a mental 

health issue 

9. 	 Students excluded from the decisionmaking process 

about mental health policies by the administration for fear 

of losing control of the proces 

The campus culture offers incentives for students to 

pretend nothing is amiss. If a student is in the hospital, 

no opportunities are offered to make up missed work. 

—Student mental health activist 

Even when counseling services enabled students to obtain 

the help they needed, we could not pull together the 

academic piece. That was the breaking point as to whether 

students could continue. We routinely spoke to faculty, but 

encountered bias, insensitivity, and lack of support. 

—Faculty member and counselor 

24 
Recommendations for Action
 Dialogue participants suggested several overarching 

recommendations critical for college campuses to improve their 

mental health approaches and policies, and the relevance and 

access to the services they offer their students. 

I.	 Articulate a policy of “campus as safety net.” 

II.	 Recognize the critical importance of meaningful 


representation by all campus stakeholders in 


policy development. 


III. 	Recognize the critical importance of engagement and 

participation of top administrators in strategic planning 

and their sustained interest in evolving changes. 

IV. 	Establish or enhance communication channels among 

administrators, counselors, faculty, and students. Here are 

some examples: 

A. 	 Create a high-level task force on mental health and 

welfare that includes students and representatives 

of every office on campus. Counseling center staff 

would serve as experts on student mental health. 

B. 	 Hold a campus dialogue on student health and safety, 

planned and attended by multiple stakeholders, 

including, for example, students, faculty, upperlevel administrators, counseling services personnel, 

researchers, law enforcement and security 

representatives, and grant writers. 

C. 	 Include students meaningfully in policy 

development efforts. 

V.	 Create a broad climate of interest in students’ mental 

health on campus. 

A. 	 Offer a mandatory program during freshman year on 

mental health and wellness, with emphasis on mental 

health, alcohol and substance abuse, sexual health, 

and other universal issues, including stress. 

B. 	 Mount a public relations campaign using 

best practices. 

25 
 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

C. 	 Develop and offer education and training to faculty 

and other staff on student mental health issues and 

campus practices. 

VI.	 Advocate for, broaden, and simplify access to counseling 

services to reflect the growing need and demand for 

student mental health care. 

Participants also proposed a series of specific 

recommendations for action. Major categories included improving 

the campus culture, improving access to information, and 

managing expectations. Participants suggested specific activities 

for a variety of stakeholder groups, but strongly advocated for 

creating and working in partnerships. 

1. 	Improve Campus Culture 

Culture change must come from the top. And from the 

grassroots. And from the middle out. A comprehensive approach 

works best. 

Stigma 

1.1	 Conduct campus awareness campaigns. 

1.2	 Include mental illnesses as an awareness issue in 

residential life programs. 

1.3	 Operate a speaker’s bureau on mental health and 

mental illnesses. 

1.4	 Co-locate counseling centers with health centers 

to desegregate mental health services and protect 

students’ anonymity. 

1.5	 Create a warm and welcoming atmosphere in counseling 

centers, including conducting training for reception staff. 

1.6	 Use and monitor campus and local media to ensure 

appropriate representation of mental health and 

mental illnesses. 

1.7	 Recognize that students minimize their symptoms; be 

alert to unarticulated need for emergency services. 

Trust, respect, dignity, and sensitivity 

1.8	 Adopt a campus-wide “encouraging” approach to students 

with mental health issues. 

26 
Campus Awareness Campaigns: Suggested Activities 

•	 Mental Health Awareness Week 

•	 Faces of Mental Illness: students’ smiling headshot photos 

displayed in glass cases 

•	 Information disseminated on counseling services and other 

mental health resources 

•	 Art exhibit with visual/written entries by students with 

psychological disorders, with partitioned-off workspace 

where students or others can create and post their own 

art. Ideal timing: during study days or Mental Health 

Awareness Week, or both 

•	 Distribute silver ribbons attached to cards with mental 

health facts 

•	 “Wake-Up Call”: early morning beating of drums in 

residence halls 

1.9 Conduct student dialogues in which student advocates 

serve as positive role models to convey the experience 

of a mental illness. 

1.10 Target mental wellness for all college students. 

1.11 Develop a holistic mental health mission statement 

written with an accountability framework and based 

on a needs assessment. 

Cultural competency 

1.12	 Create partnerships to help minorities access counseling 

services, including identifying points of entry such as 

residence halls, ethnic group organizations on campus, 

fraternities, and sororities. 

1.13	 Reach out to underserved populations, including men 

and minorities. 

1.14	 Develop and implement a strategy to meet mental health 

needs of college students studying abroad. 

1.15	 Develop and implement a strategy to meet special needs 

of veterans on campus returning from combat. 

27 
 

 

 

 

 

 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

2. Improve Access to Information 

Information needed 

2.1	 Create and disseminate Frequently Asked Questions (in 

print and online) on aspects of mental health and mental 

illnesses on campus, including medical leave, insurance, 

description of a first appointment at counseling services, 

community resources, medications, confidentiality, parent 

notification, hospitalization options, students’ rights and 

appeals, ways to help a friend, and other resources. 

2.2	 Provide information on college counseling centers’ 

Web sites, including what to do when counseling centers 

are closed. 

2.3	 Provide a mental health, voluntary, self-screening tool 

online, accompanied by a scoring rubric and contact 

information for help. 

2.4	 Establish mechanisms and materials to help survivors of 

suicide loss. 

2.5	 Inform students of “magic words” that prompt immediate 

care from counseling centers or other providers—“crisis” 

and “emergency.” 

Communication and dissemination practices 

2.6	 Provide training and disseminate information 

health problems. 

2.6.1 Target faculty. 

2.6.1.1 	 Offer short presentations at 

faculty meetings. 

2.6.1.2 	 Offer workshops on how to recognize 

problems and access help. 

2.6.1.3 	 Incorporate ample opportunity for faculty 

dialogue at all meetings and workshops. 

2.6.1.4 	 Designate persons on whom faculty can 

rely for consultation. 

2.6.1.5 	 Address adjunct professors and teaching 

assistants in addition to full-time, tenuretrack professors. 

28 
 

2.6.1.6 	 Engage mentors and faculty advisors 

to target department chairs and other 

faculty to talk about mental health. 

2.6.1.7 	 Place mental health information on tables 

in faculty dining halls. 

2.6.1.8 	 Provide business cards to faculty to 

help get mental health resources into 

the hands of students. Information 

can include resources for faculty for 

consultation about students, guidelines 

on responses to imminent danger— call 

911, not the counseling center—and to 

ambiguous danger. 

2.6.1.9 	 Establish a faculty and staff mental 

health network that holds monthly 

meetings. Expand the network eventually 

throughout the community. 

2.6.2 Target administrators. 

2.6.2.1	 Frame communications about campus 

changes in language that resonates with 

administrators, for example, “We’re afraid 

a student will be hurt,” or “We want to 

avert the crisis of a completed or 

interrupted suicide.” 

2.6.2.2	 Write short letters with many signatures. 

2.6.2.3	 Ensure that counseling centers and 

mental health facilities share records 

and communicate with each other. 

2.6.2.4	 Capitalize on a campus crisis to get 

administrators’ attention, as well as 

advocate on an ongoing basis for 

culture and systemic change. 

2.6.2.5 	 Increase student input to the 

administration, including students 

sitting on advisory boards. 

2.6.2.6	 Capitalize on personnel changes to 

inform new administrators about 

students’ mental health needs. 

29 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

2.6.2.7 	 Encourage creative ways to meet needs 

for mental health services. For example, 

increase student activities or health 

fee according to calculations based on 

increased hours or staff that would meet 

the student need. 

2.6.3	 Target other staff, including, for example, resident 

advisors, public safety personnel, and custodians, 

and provide information on identification and 

responses to mental health problems. 

2.6.4	 Target students. 

2.6.4.1 	 Expand and enhance freshman 

orientation programs to include 

annual refreshers and additional target 

audiences. Involve student advocates. 

Freshmen have orientation. Let us older students 

give a little seminar with them, because they’ll 

probably tune out some of the administrators. 

—Student mental health activist 

2.6.4.2 	 At parent orientation, distribute two 

card-size refrigerator magnets that list 

important telephone numbers, Web sites, 

and addresses—one for parents, one for 

students. 

2.6.4.3 	 Post counselors’ photos and video clips 

on the Web site to introduce themselves 

and describe their focus. 

Students can access services through different portals of entry—no 

wrong door. They may have trouble with a roommate, trouble 

studying, trouble with a certain professor. We want resident 

advisors in dorms, professors, and other academic advisors to 

know what the resources are, and we don’t care what door they 

come in. We should make it generic and easy, and not force 

students to decide that they need “mental health” assistance. 

—University administrator 

2.7	 Compile and use campus data to describe services and 

influence change. 

30 
 

2.8 Disseminate mental health information. Examples: 

2.8.1 Expand the role of counseling centers to do 

general wellness programming, incorporating 

mental health along with other issues. 

2.8.2 Print helpline telephone numbers on backs of 

student and faculty ID cards. 

2.8.3 Use the multiple capabilities of the Internet, 

including e-mail, a newsletter, and an online 

“face book.” 

2.8.4 Distribute brochures, pamphlets, and 

other handouts. 

2.8.5 Distribute a “Toilet Paper” publication in 

restrooms, with monthly themes on a mental 

illness—symptoms and famous people with 

the disorder—and specific directions to access 

counseling services. 

2.8.6 Develop a resource book or Web site with 

available services. 

2.8.7 Involve the student newspaper in 

investigative reporting. 

Campus Mental Health Web Sites: 

Selected Guidelines 

•	 In the search engine capability, include keywords and 

background on specific topics students search for, such as 

depression, anxiety, and eating disorders. 

•	 Provide online appointment-scheduling capability. 

•	 Provide online mental health screening tools. 

•	 Include information on emergency services. 

•	 Place mental health services Web site on the home 

page (optimal). 

•	 Offer links to www.ulifeline.org and other relevant 

Web sites. 

•	 Offer capability for student blogs, contributions, and links. 

•	 Use listserv to disseminate information. 

31 
 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

2.9	 Use approaches successful in creating HIV/AIDS 

awareness to promote awareness of mental health and 

mental illnesses. 

3. Manage Expectations 

Dialogue participants articulated expectations of their campus 

mental health systems, and of themselves, in order to transform 

the system to promote mental health and recovery on campus. 

Student control and choice 

3.1	 Enlist and advocate for students as partners in developing 

campus mental health policies, practices, and resources. 

3.2	 Use a report card system, or comparison to a set of 

standards, to describe and/or measure adequacy of 

campuses’ mental health programs. 

3.2.1	 Encourage U.S. News and World Report to report 

on health-related matters related to their review 

of colleges and universities. 

3.2.2	 Devise ways to collect and/or use existing 

data, for example, on students-to-counselors or 

psychologists ratio. 

3.2.3	 Incorporate a section on mental health system 

measurements in commercial college guidebooks. 

3.2.4	 Create separate standards and guidelines for 

small and large educational institutions. 

3.3	 Be aware of available mental health services and 

supports in the college selection process. 

3.4	 Offer career guidance services in addition to 

counseling services. 

3.5	 Collaborate on developing programs at counseling centers. 

3.6	 Establish and participate in student advocacy groups on 

campus and in the community. 

3.7	 Offer opportunities for supported education—provides 

resources and supports to people with mental health 

problems who are pursuing a college education. 

32 
 

 

 

 

 

 

 

 

 

3.8	 Inform students about steps in the campus counseling 

process. Provide timetables, guidance on what to 

expect, introduction to the organization of services, and 

definitions of services. 

3.9	 Define recovery and treatment for each student, with 

each student. 

3.10 	 Inform students that the magic word for immediate help 

is “crisis,” regardless of the length of wait times for 

counseling services. 

3.11 	 Establish a buddy system for students with mental 

health issues. 

3.12 	 Provide a proactive menu of activities for students waiting 

for medications to work. 

3.13 	 Train counseling center reception staff to handle students 

effectively regarding crisis response, the need to be warm 

and welcoming and nonconfrontational, confidentiality 

and Health Insurance Portability and Accountability Act 

of 1996 (HIPAA) practices, and available resources. 

3.14 	 Offer opportunities for students to learn how to identify 

symptoms of mental distress and mental illnesses, as 

well as the normal process of maturation to adulthood. 

3.15 	 Educate students to engage in therapy in a proactive way. 

Content should include disorders, stress, medications, what 

makes a good counselor, ability to switch counselors, 

types of therapy, and expectations of therapy. 

3.16 	 Encourage student participation in decisionmaking about 

the supports and treatments that are provided. 

3.17 	 Implement a standard medical leave or readmission plan 

that focuses on student well-being. 

3.17.1	 Develop a plan that is reasonable, understandable 

by students, transparent, and flexible; preserves 

students’ rights; is nonpunitive (academically, 

legally, and financially); is nonstigmatizing (no 

adverse record on transcript); includes an appeals 

process for involuntary leave; and is discussed 

personally and effectively with students. 

33 
 

 

 

 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

3.17.2 	 Convene an advisory board of diverse 

stakeholders, including student 

representatives, to develop medical leave or 

readmission policies. 

3.17.3 	 Describe the plan in information about campus 

mental health services. 

3.17.4 	 Enlist crisis management teams to work with 

students to create and monitor individualized, 

structured plans for readmission. 

3.18 	 Develop and implement a plan to support survivors 

of suicide loss, including sensitive reporting of suicides 

on campus and recognition of the grieving process. 

3.19 	 Use advance directives to guide treatment for students in 

times of crisis. 

Mental health care expectations 

3.20 	Offer a comprehensive, voluntary screening process, 

including one for substance abuse, with an emphasis 

on prevention. 

3.21 	 Provide a spectrum of services to reflect an 

understanding of student needs, including counseling 

on developmental issues, intervention and care for 

serious mental illnesses, promotion of wellness and 

mental health, and prevention of mental health problems. 

3.22 	Offer same-day appointments at counseling centers for 

students who call in the morning. 

3.23 	Offer afterhour and emergency services, in addition to 

daytime counseling services. 

3.24 	Teach faculty and staff how to handle student crises 

on campus. 

3.25 	Conduct outreach programs. 

3.26 	Offer peer education and supports, as well as peer 

training and peer-provided services. 

3.27 	Offer case management services in addition to 

clinical services. 

34 
3.28 	Develop methods to help students with the 


referrals process. 


3.29 	Establish standards of care for counseling centers in the 

context of campus mental health services as a whole. 

3.30 	 Focus on general sources of stress that affect students. 

3.31 	 Encourage proactive student involvement in therapies to 

promote progress. 

3.32 	 Emphasize understanding the reasons why students 

discontinue their medications, instead of focusing on the 

concept of noncompliance. 

Administrative expectations 

3.33 	 Establish a campus Americans with Disabilities Act 

(ADA) committee for mental health to prompt attention 

and action. 

3.34 	Approach the administration about risk management. 

3.35 	 Develop a needs assessment task force of multiple 

stakeholders (including students) to examine the current 

state of campus mental health practices and to begin a 

strategic planning process. 

3.36 	Conduct an ongoing campus dialogue on standards to 

achieve buy-in and sustainability. 

Accommodations and policy 

3.37 	 Develop and implement flexible accommodation policies, 

based on the ADA and the disability community’s 

experience, understanding that psychiatric problems 

constitute disabilities. 

3.38 	Take a proactive approach in describing disability 

services and other supports to students and parents. 

3.39	 Adopt flexible attendance policies that do not require 

students to choose between caring for themselves and 

attending class. 

3.40 	Use academic advisors as points of contact. 

3.41 	 Locate psychologists at campus disability centers to 

consult on legal accommodations and decisionmaking; 

engage legal counsel to enhance understanding 

about disabilities. 

35 
 

 

 

 

 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

3.42 	 Promote awareness that disability records may affect 

employment later in life. 

Community approaches 

3.43 	 Devise ways to enhance student mental health advocacy 

with funds and logistical support. 

3.44 	Conduct panel discussions with directors of all 


community counseling services. 


3.45 	 Use principles of community organization to gain buy-in 

of the administration. 

3.46 	Engage alumni, State and local government 

representatives, members of Congress, and other 

financial supporters in discussions of long-term mental 

health needs on campus. 

3.47 	 Engage the media to publicize mental health policy 

and other successes, including letters to the editor and 

op-ed pieces. 

3.48 	Encourage mental health experts to serve on various 

campus health committees. 

3.49 	 Share responsibility for balancing the needs of 

students with mental health issues against the needs 

of all students. 

3.50 	 Identify, and take advantage of, funding opportunities. 

SAMHSA actions 

3.51 	 Convene a group to develop baseline standards of 

care, best practices, or a list of items to consider when 

developing standards, for institutions of higher learning. 

Examples of topics include crisis team, hotline, safety 

net, medical leave or readmissions, review and appeals 

process, monitoring, stakeholder advisory board, 

accreditation of counseling centers, and national 

measures to facilitate comparison between schools. 

Disseminate the completed document broadly and to 

relevant organizations. 

3.52 	 Publicize all resources and programs, including grant 

programs, to campus counseling services. 

3.53 	 Coordinate a clearinghouse for best practices, accessible 

through the Internet and conferences. 

36 
3.54 	 Encourage professional mental health guilds and 

insurance companies to join in awareness campaigns 

about mental health needs and services on campus in 

the college selection process. 

3.55 	 Avoid creating unfunded mandates in grant programs. 

3.56 	 Convene a group to formulate strategies for working 

in partnership with other agencies and organizations 

to promote mental health on campuses. Organizations 

should include the International Association of 

Counseling Services (accrediting body), the Association 

of University Centers on Disabilities, the Association of 

University and College Counseling Center Directors, and 

companies that offer college exam prep courses (which 

could offer a curriculum on life skill sets). 

37 

Selected References 

and Resources* 

References and Related Publications 

Active Minds. (2007). www.activemindsoncampus.org. Accessed 

August 8, 2007. 

American College Health Association. (2006). National College 

Health Assessment: Reference Group Executive Summary, Fall 

2006. Baltimore: American College Health Association. 

American College Health Association. (April 2006). Data 

Highlights. American College Health Association-National 

College Health Assessment. www.acha-ncha.org/data_ 

highlights.html. Accessed August 8, 2007. 

American College Health Association. (April 2006). NCHA Web 

Summary. American College Health Association-National 

College Health Assessment. www.acha-ncha.org/data/ 

PHYSMENTALS06.html. Accessed August 8, 2007. 

Archer, J., Jr., & Cooper, S. (1998). Counseling and mental health 

services on campus: A handbook of contemporary practices 

and challenges. San Francisco: Jossey-Bass. 

Centers for Disease Control and Prevention. (1997, November 14). 

Youth Risk Behavior Surveillance: National College Health 

Risk Behavior Survey—United States, 1995. Morbidity and 

Mortality Weekly Report, 46(SS-6), 1–54. 

DeNoon, D. (2003, February 5). College mental-health woes on 

the rise: Student problems grow more complex—and more 

severe. WebMD Medical News Archive. Retrieved June 27, 

2006, from http://aolsvc.health.webmd.aol.com/content/ 

article/60/67089.htm?z=~ 

Gallagher, R. P. (2006). National Survey of Counseling Center 

Directors 2006. Alexandria, VA: International Association of 

Counseling Services. 

Institute of Medicine. (2002). Reducing suicide: A national 

imperative. S. K. Goldsmith et al. (Eds.). Washington, DC: 

National Academies Press. 

* This list is provided as a resource. It is not exhaustive, and it does not

 imply endorsement by SAMHSA. 

39 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Kadison, R., & DiGeronimo, T. F. (2004). College of the 

overwhelmed: The campus mental health crisis and what to do 

about it. San Francisco: Jossey-Bass. 

Marsh, K. (2004, March). Emerging trends in college mental 

health. Student Health Spectrum, 3–7. 

National Mental Health Association & Jed Foundation. (2002). 

Safeguarding your students against suicide—Expanding 

the safety net. Proceedings from an Expert Panel on 

Vulnerability, Depressive Symptoms, and Suicidal Behavior 

on College Campuses. www.jedfoundation.com/articles/ 

SafeguardingYourStudents.pdf 

New Freedom Commission on Mental Health. (2003). Achieving 

the promise: Transforming mental health care in America. 

Final report. DHHS Pub. No. SMA-03-3832. Rockville, MD. 

www.mentalhealthcommission.gov 

New Freedom Commission on Mental Health, Subcommittee 

on Suicide Prevention. (2002, December 3). Summary 

report, Waltraud Prechter, Chair. Download from www. 

mentalhealthcommission.gov/subcommittee/Sub_chairs.htm 

Smith, G. (2005, September 20). SAMHSA press release. 

Sontag, D. (2002, April 28). Who was responsible for Elizabeth 

Shin? The New York Times. Retrieved September 25, 2006, 

from www.mit.edu/afs/sipb/user/jhawk/www/tmp/28MIT.html 

Substance Abuse and Mental Health Services Administration, 

U.S. Department of Health and Human Services. (2005). 

Transforming mental health care in America. Federal action 

agenda: First steps. DHHS Pub. No. SMA-05-4060. Rockville, 

MD: Author. 

Suicide Prevention Resource Center. (2004). Promoting mental 

health and preventing suicide in college and university 

settings. Newton, MA: Education Development Center. 

Swaner, L. E. (2005). Linking engaged learning, student mental 

health and well-being, and civic development: A review of the 

literature. Association of American Colleges and Universities, 

Bringing Theory to Practice Project. Unpublished manuscript. 

U.S. Public Health Service. (1999). Mental health: A report of the 

surgeon general. Rockville, MD: Author. 

40 
 

U.S. Public Health Service. (1999). The surgeon general’s call to 

action to prevent suicide. Washington, DC: Author. 

U.S. Public Health Service. (2001). National strategy for 

suicide prevention: Goals and objectives for action. 

Rockville, MD: Author. 

Young, J. R. (2003, February 14). Prozac campus. The Chronicle of 

Higher Education, 49(23). Retrieved June 27, 2006, from http:// 

chronicle.com/free/v49/i23/23a03701.htm 

Resources† 

Center for Mental Health Services 

Substance Abuse and Mental Health Services Administration 

U.S. Department of Health and Human Services 

The Center for Mental Health Services leads the national system 

that delivers mental health services in order to provide the 

treatment and support services needed by adults with mental 

disorders and children with serious emotional problems. 

Address: 1 Choke Cherry Road 


Rockville, MD 20857 


Web site: www.mentalhealth.samhsa.gov 


Enews Alert: Consumer/Survivor Mental Health Information 

www.mentalhealth.samhsa.gov/consumersurvivor 

(see signup at bottom of screen) 

Suicide Prevention Resource Center: www.sprc.gov, 

and see below 

Funding opportunities: www.samhsa.gov (click on 

Hot Topics, “New Grant Funding Opportunities”) 

Resource Center to Address Discrimination and Stigma: 

www.adscenter.org; 1-800-540-0320 

† This document provides contact addresses and Web sites for information 

created and maintained by other public and private organizations. This 

information is provided for the reader’s convenience. SAMHSA does not 

control or guarantee the accuracy, relevance, timeliness, or completeness 

of this outside information. Furthermore, the inclusion of information or 

addresses or Web sites for particular items does not reflect their importance 

and is not intended to endorse any views expressed or products or 

services offered. 

41 
 

Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Active Minds on Campus 

Active Minds is a nonprofit, student-run mental health awareness, 

education, and advocacy organization for young adults on the 

high school and college levels. Its mission is to use peer outreach 

to increase students’ awareness of mental health issues, provide 

information about available resources, encourage students to seek 

help as soon as they need it, and serve as liaison between students 

and the mental health community. By planning campus-wide 

events that promote awareness and education, the group aims to 

remove the stigma that surrounds mental illness and to create an 

open environment for discussion of mental health issues. Its Web 

site offers fact sheets and information on how to start a chapter. 

Address: 1875 Connecticut Avenue, N.W., Suite 418 

Washington, DC 20009 

Telephone: 202-719-1177 

E-mail: info@activeminds.org 

Web site: www.activeminds.org 

American Foundation for Suicide Prevention 

The American Foundation for Suicide Prevention (AFSP) is the 

only national nonprofit organization exclusively dedicated to 

understanding and preventing suicide through research and 

education, and to reaching out to people with mood disorders and 

those affected by suicide. 

Film: “The Truth about Suicide: Real Stories of Depression in 

College” (DVD and VHS), with downloadable Facilitator’s 

Guide including Frequently Asked Questions and 

discussion topics, plus feedback forms 

Project: College and University Screening Project 

(planned publications based on pilot tests) 

Web site: www.afsp.org 

American Psychiatric Association 

The American Psychiatric Association posts a Web page on college 

mental health on its Web site. 

Address: 1000 Wilson Boulevard, Suite 1825 

Arlington, VA 22209 

Web sites: www.psych.org; www.healthyminds. 

org (college focus); and www.healthyminds.org/ 

collegementalhealth.cfm 

42 
 

Association for University and College Counseling 

Center Directors 

The Association for University and College Counseling Center 

Directors (AUCCCD) assists college and university directors in 

providing effective leadership and management of their counseling 

centers, in accord with the professional principles and standards of 

psychology, counseling, and higher education. AUCCCD promotes 

awareness of college student mental health through research, 

education, and training provided to members, professional 

organizations, and the public, with special attention to issues of 

diversity and multiculturalism. 

Web site: www.aucccd.org 

Jed Foundation 

The Jed Foundation is a nonprofit public charity committed to 

reducing the young adult suicide rate and improving the mental 

health safety net provided to college students nationwide. The 

foundation works to identify and address young adults at risk for 

depression and other emotional disorders. It also develops models 

that colleges can follow in introducing campus interventions that 

increase protective factors and reduce risk factors for suicide. 

More than 500 colleges and universities participate in ULifeline, 

an Internet-based resource that provides a self-screening tool and 

information to students about mental health and the signs and 

symptoms of emotional problems. 

Projects: 

ULifeline 

National College Suicide Registry 

Evaluation of existing and new mental health and suicide 

prevention programs and development of support for 

their dissemination, in collaboration with the Educational 

Development Center, Inc. (EDC), and the University of 

Rochester Center for the Study and Prevention of Suicide 

Address: 583 Broadway, Suite 8B 

New York, NY 10012 

Telephone: 212-647-7544 

Fax: 320-210-6089 

E-mail: emailus@jedfoundation.org 

Web site: www.jedfoundation.org 

Helpline: www.ulifeline.org 

43 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

NAMI on Campus 

NAMI on Campus is part of the National Alliance on Mental Illness 

and has affiliates in all 50 States, the District of Columbia, Puerto 

Rico, and more than a thousand local affiliates. The 23 NAMI on 

Campus affiliates specially focus on college campuses and students 

and have the same goals as NAMI: commitment to improving the 

lives of all individuals affected by mental illness, dedication to 

ending its stigma, and eradication of mental illness. 

Address: Colonial Place Three 

2107 Wilson Boulevard, Suite 300 

Arlington, VA 22201-3042 

Telephone: 703-524-7600 

Fax: 703-524-9094 

TDD: 703-516-7227 

Member services: 1-888-999-NAMI (6264) 

E-mail: namioncampus@nami.org 

National Institute of Mental Health 

In addition to conducting world-class research on mental and 

behavioral disorders, the National Institute of Mental Health 

(NIMH) carries out educational activities. NIMH also publishes 

and distributes research reports, press releases, fact sheets, and 

publications intended for researchers, health care providers, and 

the general public. 

Address: Office of Communications and Public Liaison 

Information Resources and Inquiries Branch 

6001 Executive Boulevard, Room 8184, MSC 9663 

Bethesda, MD 20892-9663 

Telephone: 301-443-4513 


TTY: 301-443-8431 


E-mail: nimhinfo@nih.gov 


Web site: www.nimh.nih.gov 


44 
Mental Health America 

Through its Finding Hope and Help: College Student and 

Depression Initiative, Mental Health America (formerly known as 

the National Mental Health Association (NMHA)) addresses mental 

health issues facing college-age students. Several local mental 

health associations work with eight universities in a pilot project to 

form campus coalitions. 

Address: 2000 North Beauregard Street, 6th Floor 


Alexandria, VA 22311 


Telephone: 1-800-969-6642 


Fax: 703-684-5968 


E-mail: infoctr@nmha.org 


Web site: www.nmha.org/index.cfm or 


www.mentalhealthamerica.net 


National Organization for People of Color Against Suicide 

The National Organization for People of Color Against Suicide 

(NOPCAS) offers various educational and training programs for 

citizens and professionals. Some training programs are approved 

for college credits or continuing education credits for counselors, 

correctional workers, law enforcement, and a variety of health 

care providers. In addition, NOPCAS offers a support group in 

Washington, DC, and a speakers bureau. 

Address: 4715 Sargent Road, N.E.
 

Washington, DC 20017 


Telephone: 202-549-6039 


Fax/voicemail: 1-866-899-5317 


E-mail: info@nopcas.org 


Web site: www.nopcas.com 


National Suicide Prevention Lifeline 

The National Suicide Prevention Lifeline is a network of crisis 

centers around the country. Persons can call a single toll-free 

number from anywhere in the Nation, and the call is routed 

automatically to the nearest crisis center to talk with a trained 

crisis counselor. 

Lifeline: 1-800-273-TALK (8255) 

45 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Suicide Prevention Action Network USA 

The Suicide Prevention Action Network USA (SPAN USA) is a 

public grassroots advocacy organization composed of survivors of 

suicide loss, attempters of suicide, community activists, and health 

and mental health clinicians. The organization raises awareness, 

builds political will, and calls for action with regard to creating, 

advancing, implementing, and evaluating a national strategy 

to address suicide in the United States. Grassroots volunteers 

and staff work in communities, state capitols, and Washington, 

DC, to advance the public policy response to the problem of 

suicide in America. 

Address: 1025 Vermont Avenue, N.W., Suite 1066 

Washington, DC 20005 

Telephone: 202-449-3600 

Fax: 202-449-3601 

E-mail: info@spanusa.org 

Web site: www.spanusa.org 

Suicide Prevention Resource Center 

The Suicide Prevention Resource Center (SPRC), a SAMHSAsponsored project, promotes implementation of the National 

Strategy for Suicide Prevention (2001) and enhances the Nation’s 

mental health infrastructure. SPRC provides States, Government 

Agencies, private organizations, colleges and universities, and 

suicide survivor and mental health consumer groups with access 

to the science and experience that can support their efforts to 

develop programs, implement interventions, and promote policies 

to prevent suicide. 

Address: 55 Chapel Street 

Newton, MA 02458-1060 

Telephone: 1-877-GET-SPRC (438-7772) 

TTY: 1-617-964-5448 

Fax: 1-617-969-9186 

Web site: www.sprc.org 

Also: 

Address: 1000 Potomac Street, N.W., Suite 350 

Washington, DC 20007 

Fax: 202-572-3795 

46 
Participant List 

Planning Committee 

Rachel Glick, M.D. 

Associate Professor of Psychiatry 

University of Michigan 

Alison Malmon 

Executive Director 

Active Minds on Campus 

Ted Stachowiak, Ph.D. 

Associate Director 

Student Counseling Service 

Texas A&M University 

Dialogue Participants 

Rahul Banerji 

Founder, Cornell Minds Matter 

Cornell University 

Ithaca, NY 

Paul Barreira, M.D. 

Associate Professor of Psychiatry 

Harvard University 

Cambridge, MA 

Ira Burnim, Esq. 

Legal Director 

Bazelon Center for Mental Health Law 

Washington, DC 

Meredith Canada 

Indiana University 

Bloomington, IN 

Alexis Chappell 

American University 

Washington, DC 

Dana Crudo 

President 

National Alliance for the Mentally Ill 

University of Arizona 

Tucson, AZ 

47 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Dialogue Participants (continued) 

Ron Gibori 

Director, Ulifeline 

Jed Foundation 

New York, NY 

Rachel Glick, M.D. 

Associate Professor of Psychiatry 

University of Michigan 

Ann Arbor, MI 

Karen Latus 

Executive Officer 

Finding Voice 

University of Michigan 

Ann Arbor, MI 

Alison Malmon 

Executive Director 

Active Minds on Campus 

Washington, DC 

Glen Martin, Ph.D. 

Counseling and Psychological Services 

University of North Carolina at Chapel Hill 

Chapel Hill, NC 

Mark McLeod, Ph.D. 

Director Student Counseling 

Center Emory University 

Atlanta, GA 

Jim Monti 

President 

National Alliance on Mental Illness 

University of Illinois at Urbana–Champaign 

Champaign, IL 

48 
Dialogue Participants (continued) 

Maggie Olona, Ph.D. 

Director 

Student Counseling Service 

Texas A&M University 

College Station, TX 

Erin Polk 

University of Mary Washington 

Fredericksburg, VA 

Emil Rodolfa, Ph.D. 

Psychologist/Director 

Counseling and Psychological Services 

University of California–Davis 

Davis, CA 

Robert Samuels, Ph.D. 

Associate Dean 

Director, Office of Student Life 

Brown University 

Providence, RI 

Matt Sinovic 

Washburn University 

Topeka, KS 

Ted Stachowiak, Ph.D. 

Associate Director 

Student Counseling Service 

Texas A&M University 

College Station, TX 

Lynn Swaner, Ed.D. 

Evaluation and Planning Board Member 

Bringing Theory to Practice Project 

Assistant Professor of Counseling and Development 

CW Post, Long Island University 

Brookville, NY 

49 
Mental Health on Campus: Student Mental Health Leaders and 

College Administrators, Counselors, and Faculty in Dialogue 

Federal Representatives 

SAMHSA/Center for Mental Health Services 

Paolo del Vecchio, M.S.W. 


Associate Director for Consumer Affairs 


Christopher Marshall 


Consumer Affairs Specialist 


Carole Schauer, R.N., M.S. 


Senior Consumer Affairs Specialist 


Richard T. McKeon, Ph.D., M.P.H. 


Special Expert 


Carlton Speight 


Consumer Affairs Specialist 


Diana Ortiz 


Intern 


Facilitator 

Sheila Thorne 

President and CEO 

Multicultural Healthcare Marketing Group, LLC 

Teaneck, NJ 

Writer 

Irene Saunders Goldstein 

Arlington, VA 

50 

SMA–4310
 

2007