Mental Health on College 

Campuses: 

Investments, Accommodations 

Needed to Address Student Needs

National Council on Disability

July 21, 2017

Letter of Transmittal

July 21, 2017

President Donald Trump

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20500

Dear Mr. President:

The National Council on Disability (NCD) is pleased to submit its report, Mental Health on College 

Campuses: Investments, Accommodations Needed to Address Student Needs, the culmination of 

a study conducted to determine the current challenges facing college students with mental health 

disabilities on campus and to provide practical, targeted recommendations to resolve them. Report 

findings highlight laws, policies, and procedures that pose substantial challenges to the academic 

success of college students with mental health disabilities.

NCD is an independent federal agency, composed of nine members appointed by the President 

and the U.S. Congress. The purpose of NCD is to promote policies, programs, practices, and 

procedures that guarantee equal opportunity for all individuals with disabilities and empower 

individuals with disabilities to achieve economic self-sufficiency, independent living, and inclusion 

and integration into all aspects of society.

Consistent with NCD’s overall purpose, this report:

■ Identifies institutional barriers to mental health service on campus;

■ Identifies federal law and policy barriers to academic achievement for students with mental 

health disabilities; and

■ Offers solutions through targeted recommendations and best practices, to Congress, federal 

agencies, and colleges.

NCD stands ready to be a resource to the Administration, Congress, and other federal agencies on 

the contents of this report. We encourage the White House and Congress to engage college students 

with disabilities, college administrators, and federal agencies whose policies impact college students, 

as mental health services and supports on college campuses are discussed now and in the future.

Sincerely,

Clyde Terry

Chair

National Council on Disability

An independent federal agency making recommendations to the President and Congress 

to enhance the quality of life for all Americans with disabilities and their families.

1331 F Street, NW ■ Suite 850 ■ Washington, DC 20004

202-272-2004 Voice ■ 202-272-2074 TTY ■ 202-272-2022 Fax ■ www.ncd.gov

National Council on Disability Members and Staff

Members

Clyde E. Terry, Chairperson

Benro T. Ogunyipe, Vice Chair

Billy W. Altom

Rabia Belt

James T. Brett

Bob Brown

Lt. Col. Daniel Gade

Wendy Harbour

Neil Romano

Staff

Rebecca Cokley, Executive Director

Phoebe Ball, Legislative Affairs Specialist

Stacey S. Brown, Staff Assistant

Lawrence Carter-Long, Public Affairs Specialist

Joan M. Durocher, General Counsel & Director of Policy

Lisa Grubb, Director of Operations and Administration

Amy Nicholas, Attorney Advisor

Amged Soliman, Attorney Advisor

Anne Sommers, Director of Legislative Affairs & Outreach

Ana Torres-Davis, Attorney Advisor

Keith Woods, Financial Management Analyst

Mental Health on College Campuses 3
Acknowledgments

The National Council on Disability wishes to thank RTI International, particularly Jay Feldman and his 

team—Deborah Tull and Remmert Dekker—for the research conducted in developing this report.

4 National Council on Disability
Table of Contents

A Note on Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Definition of Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Mental Health Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Determinants of Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

List of Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Key Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Recommendations to Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

Recommendations to U.S. Department of Education (ED) . . . . . . . . . 

Recommendations to the U.S. Department of Health an

Human Services (HHS), Substance Abuse and Mental 

Health Services Administration (SAMHSA) . . . . . . . . . . . . . . . . . . .  1

Chapter 1. Introduction and Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Prevalence of Students with Mental Health Challenges in 

Institutions of Higher Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Chapter 2. Benefits of Providing Mental Health Services and Supports . . . . . . . . . . .  

Improved Academic Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Increased Resilience and Reduced Stress . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Reduced Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Reduced Suicide Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Economic Benefits for Colleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Chapter 3. Purpose and Structure of Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Chapter 4. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Practitioner and Expert Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Student Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  2

Mental Health on College Campuses 5
Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Practitioner/Expert and Student Questionnaires . . . . . . . . . . . . . . . . .  3

Twitter Chat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Chapter 5. Federal Laws Impacting College Mental Health Services . . . . . . . . . . . . .  

Federal Disability Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Section 504 of the Rehabilitation Act . . . . . . . . . . . . . . . . . . . . . . . . . .  3

The Americans with Disabilities Act . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Postsecondary School Provision of Auxiliary Aids . . . . . . . . . . . . . . .  3

The Fair Housing Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Federal Privacy Laws...

Family Educational Rights and Privacy Act . . . . . . . . . . . . . . . . . . . . .  3

Health Insurance and Portability Accountability Act . . . . . . . . . . . . . .  3

Policies and Practices Negatively Impacting Provision of Campus 

Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Threat to Self Policies Requiring Mandatory Withdrawal or 

Mandatory Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Readmission Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Financial Aid and Other Financial Policies . . . . . . . . . . . . . . . . . . . . . .  3

Funding Policies for Programs and Supports . . . . . . . . . . . . . . . . . . .  3

Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Chapter 6. Access to Quality Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . .  

Policies and Practices That Enhance the Inclusion, Retention, and 

Graduation of Students with Mental Health Disabilities . . . . . . . . . . . . .  4

Improving Access to Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Increased Training for Faculty and Staff . . . . . . . . . . . . . . . . . . . . . . . .  4

Policy Reforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Outreach and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Integrated Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Availability of Mental Health Services on Campus . . . . . . . . . . . . . . . . . .  4

Hours of Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Afterhours Access to Counseling and Helplines . . . . . . . . . . . . . . . . .  4

Fees at Counseling Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

6 National Council on Disability
Waitlists at Counseling Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Limited Sessions at Counseling Services . . . . . . . . . . . . . . . . . . . . . .  4

Streamlined Referral Network to Outside Agencies . . . . . . . . . . . . . .  4

Availability of Counseling Staff with Mental Health Licensure . . . . .  4

Availability of a Diverse Mental Health Counseling Staff . . . . . . . . . .  4

Availability of Psychiatric Services . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Barriers to Services Faced by Students . . . . . . . . . . . . . . . . . . . . . . . . . . . .  4

Physical Accessibility and Paperwork Requirement Barriers . . . . . . .  4

Providing Services to Students with Physical or Sensory Disabilities 48

Reasonable Modifications and Accommodations . . . . . . . . . . . . . . . . . . .  4

Chapter 7. Promising Best Practices and Emerging Trends . . . . . . . . . . . . . . . . . . . . .  

Student and Practitioner Perceptions of Emerging and Best Practices . .  5

Stigma Reduction, Education, and Outreach . . . . . . . . . . . . . . . . . . . . . . .  5

Training and Other Anti-Stigma Activities . . . . . . . . . . . . . . . . . . . . . .  5

Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Transparency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Campus-Wide Conversations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Universal Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Student Engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Peer-to-Peer Support Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Student Voice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Faculty and Staff Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Faculty and Staff Training to Identify and Provide Support to 

Students Who Have Mental Illnesses or Are Experiencing 

Extreme Emotional Distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  5

Faculty, Staff, and Academic Advisors . . . . . . . . . . . . . . . . . . . . . . . . .  6

Faculty and Staff Training on Mental Health Issues and 

Reasonable Accommodations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Suicide Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Crisis Management Plan in Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Behavioral Intervention Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Mental Health on College Campuses 7
Pedagogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

List Service Sites and Accommodation Policies on Class Syllabi . . .  6

Faculty Discusses Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Integrate Stigma Reduction and Help-Seeking into Classes . . . . . . .  6

Increased Access: Multiple Touchpoints . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Anchor Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Coordinated Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Case Management Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Parent and Family Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Telecounseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Substance Use Recovery Center on Campus . . . . . . . . . . . . . . . . . . . . . . .  6

Partnerships with Mental Health Providers in the Community . . . . . . . . .  6

Other Organizational Collaborations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

College Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

College Collaborations with Other Organizations . . . . . . . . . . . . . . . .  6

Postvention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Considering the Needs of Diverse Populations . . . . . . . . . . . . . . . . . . . . .  6

Students of Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

Foster Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

International Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Veterans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Sexual Orientation and Sexual Identity . . . . . . . . . . . . . . . . . . . . . . . .  7

Students with Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Graduate Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Community College Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Student Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Chapter 8. Full Findings and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  

Recommendations to Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Recommendations to ED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Recommendations to HHS/SAMHSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7

Recommendations to Colleges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  8

8 National Council on Disability
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9

Appendix A: List of Interviewees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Interviewee Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Appendix B: Student Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Student Interview Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Appendix C: Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Practitioner/Expert Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Appendix D: Twitter Chat Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Appendix E: Sample Screening and Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . 111

Appendix F: Common Modifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Mental Health on College Campuses 9
10 National Council on Disability
A Note on Terminology

Definition of Mental Health

“Mental health is defined as a state of well-being in which an individual realizes his or her own 

potential, can cope with the normal stresses of life, can work productively and fruitfully, and is 

able to make a contribution to his or her community. The positive dimension of mental health 

is stressed in the World Health Organization’s (WHO’s) definition of health as contained in its 

constitution: “Health is a state of complete physical, mental, and social well-being and not merely 

the absence of disease or infirmity.”1

“Mental health and well-being are fundamental to humans’ collective and individual ability to 

think, emote, interact with one another, earn a living, and enjoy life. On this basis, the promotion, 

protection, and restoration of mental health can be regarded as a vital concern for individuals, 

communities, and societies throughout the world.”2

Mental Health Disability

The definition of disability in the Americans with Disabilities Act (ADA) includes people with mental 

illness who meet one of these three definitions:3

■ A physical or mental impairment that substantially limits one or more major life activities of an 

individual

■ A record of such an impairment

■ Being regarded as having such an impairment

A mental impairment is defined by the ADA as “any mental or psychological disorder, such as mental 

retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.”4

When applied to higher education settings, a mental health disability is defined as a persistent 

psychological or psychiatric disorder, emotional or mental illness that adversely affects educational 

performance. A mental health disability is a condition which: 1) is listed in the most current American 

Psychiatric Association Diagnostic and Statistical Manual and/or the ADA, as amended, and/or the 

International Classification of Diseases (ICD); 2) reflects a psychiatric or psychological condition that 

interferes with a major life activity; and 3) poses a functional limitation in the educational setting.5

Reference is made throughout this report to students who manifest the symptomology of mental 

illness. Terminology used includes: mental illness, mental health disorder, mental health disability, and 

mental health challenge. Increasing numbers of students have mental health challenges, which impair 

or limit their ability to succeed academically and attain life success; some of these challenges rise to 

the level of a mental health “disability” for purposes of civil rights protections.

Mental Health on College Campuses 11
Determinants of Mental Health

Multiple social, psychological, and biological factors determine a person’s level of mental health. 

Persistent socioeconomic pressures are recognized risks to mental health for individuals and 

communities. The clearest evidence is associated with indicators of poverty, including low levels of 

education. Poor mental health is also associated with rapid social change, stressful work conditions, 

discrimination, social exclusion, unhealthy lifestyle, risks of violence, physical ill-health, and human 

rights violations. In addition, specific psychological and personality factors make people vulnerable 

to mental disorders. Lastly, there are biological causes of mental disorders, including genetic factors 

which contribute to imbalances in brain chemicals.6

National mental health policies should not be solely concerned with mental disorders but should 

also recognize and address the broader issues that promote mental health. Mental health promotion 

should be mainstreamed into policies and programs in governmental and nongovernmental sectors. 

In addition to the health sector, it is essential to involve the education, labor, justice, transport, 

environment, housing, and welfare sectors.7

12 National Council on Disability
List of Acronyms

ACCA American College Counseling Association

ADA Americans with Disabilities Act

AHEAD Association on Higher Education and Disability

APA American Psychiatric Association

AUCCCD Association for University and College Counseling Center Directors

BIT Behavioral Intervention Team

CalMHSA California Mental Health Services Authority

CCC California Community College

CCMH Center for Collegiate Mental Health

DHH Deaf and hard of hearing

DOJ U.S. Department of Justice

DSS Disability Support Services

ED U.S. Department of Education

EMR electronic medical records

FAFSA Free Application for Federal Student Aid

FERPA Family Educational Rights and Privacy Act of 1974

FHAct Fair Housing Act

FSA federal student aid

HHS U.S. Department of Health and Human Services

HIPAA Health Insurance and Portability and Accountability Act of 1996

HOH hard of hearing

ICD International Classification of Diseases

LGBTQ lesbian, gay, bisexual, transgender, queer, or questioning

LOA leave of absence

NCD National Council on Disability

NSCCC National Survey of College Counseling Centers

OCR Office of Civil Rights

SAMHSA Substance Abuse and Mental Health Services Administration

TAO Therapy Assisted Online

VA Veterans Administration

Mental Health on College Campuses 13
14 National Council on Disability
T

he percentage of students seeking support 

for mental health disabilities, including 

those of a severe degree,8 while attending 

institutions of higher education (colleges) is 

increasing,9 however too many are not receiving 

treatment. Given the increased demand for 

mental health services on campus and limited 

funding for campus mental health services,10

some have argued that the nation has reached a 

“campus mental health crisis.”11 Students with 

mental health disabilities who do not receive 

assistance are not as academically successful as 

their peers, with lower GPAs and higher dropout 

rates; however, when students get support, they 

are successful.12

Strong mental and behavioral health 

supports on campus can improve the academic 

performance of students and increase their 

resilience and ability to handle stress, with 

reduced suicide rates, substance abuse, and 

eating disorders, but this study reveals that 

students with mental health disabilities continue 

to face barriers to accessing counseling services 

on campus and in receiving disability-related 

accommodations that are necessary to help them 

participate in their education on an equal footing 

with students without disabilities.

This study identified two main areas that pose 

barriers to the academic achievement of students 

with mental health disabilities: 1) institutional 

policies and practices, and 2) federal laws and 

policies. All need attention and reform in order 

to remove barriers that impede the academic 

success of students with mental health 

disabilities on campuses across the nation.

Objective

This National Council on Disability (NCD) study 

examines and assesses the status of college 

mental health services and policies in the 

United States, and provides recommendations 

for Congress, federal agencies, and colleges to 

improve college mental health services and posteducational outcomes for students with mental 

health disabilities.

Methodology

To understand the challenges, best practices, and 

emerging trends of supporting college students 

with mental health disabilities and to provide 

relevant, practical recommendations for reform, 

NCD’s research team conducted structured 

45-minute telephone interviews with 37 key 

informants, including social science researchers, 

advocates, college administrators, college 

policymakers, college legal counsels, disability 

specialists and mental health service providers, 

and specific subpopulations, including individuals 

(both at the college and in the community serving 

college students) who are Deaf and/or hard of 

hearing (HOH), graduate students, those involved 

in Greek life, and athletes.

Executive Summary

Mental Health on College Campuses 15
NCD’s research team trained eight college 

students with knowledge of mental health 

services on leading in-person interviews with 

48 fellow students, aged 18 or older, to gain 

an understanding of students’ experiences 

on campus, students’ need for services, 

available services on campuses, the services 

students found most helpful, and challenges 

or barriers to accessing mental health services 

on campus.

NCD’s research team also administered an 

open-ended questionnaire to provide context 

for the themes identified in the interviews and 

received over 101 responses from practitioners 

and 148 responses from students.

Key Findings

NCD provides detailed findings and offers 

recommendations for reform aimed at the most 

significant barriers to postsecondary success 

of students with mental health disabilities in 

Chapter 8 of this report. The recommendations 

are directed to Congress, the U.S. Department 

of Education (ED), the U.S. Department of Health 

and Human Services (HHS), and colleges. Key 

findings are as follows:

■ Colleges are struggling to provide adequate 

mental health services and supports for 

students with mental health disabilities due 

largely to increased numbers of students 

with mental health challenges attending 

college and a lack of financial resources.

■ Students frequently are placed on waiting 

lists for college mental health services 

due to the high demand for services and 

insufficient numbers of mental health staff. 

This is particularly problematic for students 

in crisis.

■ The U.S. Department of Education, Office of 

Civil Rights (OCR) has not provided guidance 

to colleges on how to respond to students 

that pose a threat to themselves.

■ Multiple restrictions in the provision of 

federal and college financial aid negatively 

impact the ability of students with mental 

health disabilities to complete their 

postsecondary education.

■ College faculty, staff, and administrators 

need training to 1) identify and support 

students with mental health disabilities 

and 2) responsibly provide disability-related 

modifications and accommodations as 

required under federal disability laws.

■ Community colleges are the least equipped 

to deal with college student mental health 

issues when compared with state colleges 

and universities, even though they serve the 

most at-risk student populations. Many rural 

community colleges lack on-campus mental 

health services and access to community 

mental health services due to geographic 

limitations.

■ College counselors do not typically reflect 

the diversity of the student populations that 

they serve.

■ There are many emerging trends and best 

practices in college provision of services 

and supports to students with mental health 

disabilities.

Key Recommendations

Recommendations to Congress

Recommendation: Congress should fully fund 

Section 9031of the 21st Century Cures Act 

(mental health and substance abuse disorder 

services on campus) to assist colleges in 

16 National Council on Disability
meeting the increased need for mental health 

services and supports for students.13

Recommendation: Congress should increase 

funding for the Garrett Lee Smith Campus 

Suicide Prevention Program.

Recommendation: Congress should make 

federal financial assistance available to colleges 

contingent on those colleges implementing a 

mental health program, just as federal law makes 

federal financial assistance available contingent 

on a college’s implementation of a program to 

prevent student use/abuse of illicit drugs and 

alcohol.14

Recommendation: Congress should 

substantially increase Pell Grants to provide 

opportunities to students with disabilities who 

are disproportionately low-income, so they are 

able to attend and achieve higher education.

Recommendation: Congress should amend 

the Higher Education Act to extend the length 

of time a student with a disability is eligible for 

federal financial aid when, due to the disability, 

a student needs more time to complete degree 

requirements than is allowed under federal 

financial aid time parameters.

Recommendation: Congress should amend 

the Higher Education Act to allow students 

whose disabilities cause them to require 

additional semesters of financial aid to retain their 

eligibility for Pell Grants beyond 12 semesters.15

Recommendation: Because college 

students with disabilities may require a medical 

leave of absence (LOA) that extends past six 

months while they are pursuing a degree, 

Congress should amend the Higher Education 

Act requirement that loan repayments begin 

six months after leaving college,16 to allow 

a time-extension as a disability-related 

accommodation.

Recommendations to U.S. Department 

of Education (ED)

Recommendation: ED/OCR should provide 

colleges with best practices for responding to 

students who exhibit or threaten self-harming 

behavior.

Recommendation: ED/OCR should provide 

colleges with best practices for providing legally 

required modifications and accommodations for 

students with mental health disabilities.

Recommendation: ED should modify the Free 

Application for Federal Student Aid (FAFSA) to 

allow students to directly input disability-related 

expenses. ED should provide technical assistance 

to financial aid offices to ensure that they apply 

disability-related expenses when determining the 

amount of a student’s financial aid.

Recommendation: ED should clarify 

to colleges that Student Support Services 

funding can be used to provide mental health 

counseling services.17 Further, ED should direct 

technical assistance providers for Student 

Support Services Projects to stress the need 

for mental health services. Additionally, during 

grant competitions, ED should direct technical 

assistance providers conducting workshops to 

inform applicants that mental health counseling is 

a permissible service.

Recommendations to the U.S. 

Department of Health and Human 

Services (HHS), Substance Abuse 

and Mental Health Services 

Administration (SAMHSA)

Recommendation: SAMHSA should take 

actions to increase the awareness of colleges 

about mental health grant funding opportunities, 

including funds available under the 21st Century 

Cures Act.

Mental Health on College Campuses 17
Recommendation: SAMHSA should require 

colleges that apply for mental health-related 

grant funding to hire mental health staff, describe 

how they will recruit and hire culturally-competent 

and diverse counselors, and have a system in 

place to ensure that colleges that receive grant 

funds comply with these requirements.

Recommendation: SAMHSA should 

require colleges that apply for mental healthrelated grant funding to provide, as part of each 

application, their policies on providing reasonable 

modifications, reasonable accommodations, 

and auxiliary aids for students with disabilities. 

SAMHSA should also require colleges to post 

these policies on their websites, at their offices 

of Disability Support Services (DSS), and in their 

counseling centers.

Recommendation: SAMHSA should require 

colleges that apply for mental health-related grant 

funding to describe, as part of each application, 

how they will collaborate with community mental 

health service providers to meet student needs, 

as currently required from applicants under the 

Garret Lee Smith Campus Suicide Prevention 

program.

Recommendation: SAMHSA should give 

mental health grant-funding priority to colleges 

that will use the funds for direct services that are 

proven best practices in providing mental health 

services to college students.

Recommendation: SAMHSA should 

liberally approve waivers to the matching funds 

requirement for mental health grant funding to 

colleges that do not have the financial capacity to 

provide campus mental health services without 

federal grant funds, and that show that they have 

high populations of at-risk students and students 

with multiple disabilities. 

18 National Council on Disability
Given increased demand and limited funding for 

mental health services, some have argued that 

the country has reached a “campus mental health 

crisis.” Considering this, colleges must develop 

a culture that supports the mental and emotional [ well-being of students.

Mental Health on College Campuses 19
20 National Council on Disability
Prevalence of Students with Mental 

Health Challenges in Institutions of 

Higher Education

The percentage of students seeking support for 

mental health disabilities, including those of a 

severe degree,18 while attending Institutions of 

higher education (colleges) has increased even 

within the last three years.19 While expanding 

access to college is positive, the growth in the 

number of students needing mental health 

services highlights weaknesses in current 

services and supports offered by colleges. 

Students with mental health disabilities who do 

not receive assistance are not as academically 

successful as their peers, with lower GPAs and 

higher dropout rates. Given increased demand 

and limited funding for mental health services, 

some have argued that the country has reached 

a “campus mental health crisis.” Considering 

this, colleges must develop a culture that 

supports the mental and emotional well-being of 

students.

Many issues have contributed to the rise 

in the number of students with mental health 

disabilities. The number of people going to 

college is increasing. Enrollment in degreegranting institutions increased by 11 percent 

from 1991 to 2001 and another 32 percent 

from 2001 to 2011, per the National Center 

for Education Statistics.20 The number of 

nontraditional students on campus, such as 

veterans; lesbian, gay, bisexual, transgender, 

queer, or questioning (LGBTQ) students; firstgeneration students; international students; and 

foster youth, has grown significantly. Members 

of these groups are believed to be at greater risk 

for mental health challenges due to stressors 

such as racism, prejudice, low socioeconomic 

status, undereducation, and acculturation.21

Further, people with mental health disabilities 

have a strong interest in higher education and 

are enrolling in college in greater numbers. 

Finally, for many students, college is their 

first attempt at independent living, one they 

undertake while trying to balance a high level 

of academic achievement and adjusting to a 

new social environment. In this context, many 

college students experience the first onset of 

mental health and substance use problems or an 

exacerbation of their symptoms.22

College students deal with a range of mental 

health challenges. The Healthy Minds Study23

surveyed over 16,000 college students on 

more than 100 campuses using questions from 

standardized assessment instruments that 

incorporate criteria from the Diagnostic and 

Statistical Manual of the American Psychiatric 

Association.24 The survey attempted to identify 

students who are likely to have a mental 

disorder and whether they had been evaluated 

Chapter 1. Introduction and Backgroun

Mental Health on College Campuses 21
by a professional. The survey suggested 

that 35 percent of students met the criteria 

for at least one mental disorder in the prior 

12 months.25 Further, in any year, six percent 

of undergraduate students and four percent of 

graduate students will have seriously considered 

suicide.26 Twenty percent of students have 

considered suicide at some point during their 

college career.27

Too many students with mental health 

disabilities are not receiving treatment. According 

to the Healthy Minds Study, 61 percent of 

those meeting the criteria for a mental disorder 

were not getting any treatment. The American 

Psychiatric Association (APA) reports that only 

approximately 35 percent of students with a 

mood disorder received mental health services 

in the previous year.28 The 2014 National Survey 

of College Counseling Center29 Directors found 

that 86 percent of students who died by suicide 

did not seek help at the school’s counseling 

center.30 Other research uncovered that over half 

of college students who seriously considered 

attempting suicide had not received professional 

help in the past year.31

22 National Council on Disability
Strong mental and behavioral health 

services and supports can improve the 

academic performance of students and 

increase their resilience and ability to handle 

stress, with reduced suicide rates, substance 

abuse, and eating disorders. Additionally, colleges 

face less liability by addressing student mental 

health issues and benefit financially by retaining 

and graduating more students. Colleges have 

a unique opportunity through which they can 

“make a positive impact on the mental health 

of their students—college represents the only 

time in many people’s lives when a single setting 

encompasses their main activities as well as 

health services.”32

Improved Academic Performance

Mental health problems can have a negative 

impact on the academic performance, retention, 

and graduation rates of students who do 

not receive support. The American College 

Health Association finds strong evidence that 

mental health needs are related to measures 

of academic success. Their survey found that 

students who reported psychological distress 

also reported the following:

■ They received lower grades on exams or 

important projects.

■ They received lower grades in courses.

■ They received incompletes or dropped 

courses.

■ They experienced significant disruptions in 

thesis, dissertation, research, or practicum 

work.33

Students who experience mild or moderate 

symptoms of depression or anxiety also 

demonstrate more academic difficulties and 

lower GPAs than nondepressed students.34

Not surprisingly, students who receive 

treatment for mental health disabilities report gains 

in academic performance. For example, 31 percent 

of students at one university receiving treatment 

for depression reported an increase in satisfaction 

Chapter 2. Benefits of Providing Mental Health

Services and Supports

Students Who Receive Mental 

Health Treatments

Gains in academic performance:

■ 31 percent of students at one university 

receiving treatment for depression 

reported an increase in satisfaction with 

their ability to study or work.

■ 34 percent reported an increased sense 

of satisfaction with how much schoolwork 

they could do.

Mental Health on College Campuses 23
with their ability to study or work, and 34 percent 

reported an increased sense of satisfaction with 

how much schoolwork they could do.35

Increased Resilience and Reduced 

Stress

Resilience is a personality characteristic that 

moderates the negative effects of stress, 

promotes adaptation, and has been associated 

with increased psychological well-being. Pidgeon 

et al.36 found that university students with low 

levels of resilience reported significantly lower 

levels of perceived social support or campus 

connectedness and higher levels of psychological 

distress in comparison to those with high levels 

of resilience. According to the American Council 

on Education’s Strategic Primer on College 

Student Mental Health,

37 “the best way for 

colleges and universities to nurture resilience 

among students is to promote health and wellbeing, especially mental and behavioral health, at 

both individual and community levels.” Resilient 

students learn more and graduate more prepared; 

less resilient students take fewer intellectual and 

creative risks.38

Reduced Substance Abuse

Arria et al.39 found that excessive alcohol and drug 

use during college is linked to negative academic 

performance: students who use substances are 

more likely to have disruptions in their enrollment 

in college and fail to graduate. Weitzman40

found that students with poor mental health 

or depression were less likely to report never 

drinking; as likely to report frequent, heavy, and 

heavy episodic drinking; and more likely to report 

drinking to get drunk than other students. Further, 

the former group of students was more likely to 

report drinking-related harms and alcohol abuse.

Reduced Suicide Rates

Suicide is the second leading cause of death 

among college students.41 The suicide rate 

among people 15–24 years of age has tripled 

since the 1950s.42 In any year, six percent of 

undergraduate students and four percent of 

graduate students will have seriously considered 

suicide.43 Community colleges serve a high 

proportion of students, including older students 

and commuter students, who are at greater risk 

of suicide than traditional students. Also at high 

risk are international students, LGBTQ students, 

and veterans. The Suicide Prevention Resource 

Center’s44 guidebook to promoting mental health 

and preventing suicide in college and university 

settings argues that college campuses with 

a comprehensive approach in place to assist 

in early intervention have a greater chance at 

reducing student suicide rates. This guidebook 

cites research by Joffe,45 who found that 

suicide rates at one Midwestern university 

were cut in half when the university instituted 

a policy requiring students who threatened or 

24 National Council on Disability
Impact of Investments in Mental 

Health Programs at California 

Public Colleges

For every dollar invested by California 

Mental Health Services Authority (CalMHSA) 

in prevention and early intervention, an 

estimated $6.49 in net benefit was achieved.

attempted suicide to attend four sessions of 

professional assessment.

Economic Benefits for Colleges

Students who receive support for mental health 

disabilities such as depression are more likely to 

stay in school and to graduate. Eisenberg et al.46

note that increased student retention leads to 

higher tuition revenue, a strong financial benefit 

to the institution. A recent report of a survey to 

assess the impact of California Mental Health 

Services Authority (CalMHSA) investments 

in mental health programs at California public 

colleges estimated the net benefit of $6.49 for 

each dollar invested by CalMHSA in prevention 

and early intervention programs. More students 

used mental health services, more students 

graduated after receiving treatment, and 

these additional graduates will see increased 

lifetime earnings.47

Mental Health on College Campuses 25
26 National Council on Disability
Providing individualized mental health 

support to students with mental health 

disabilities can lead to increased retention 

and graduation rates. Rather than requiring 

students to leave school when mental health 

issues challenge their 

ability to meet academic 

and social expectations, 

colleges can engage 

students in on-campus 

interventions such 

as individual or group 

counseling, provision of medication, workshops, 

and disability-related accommodations to help 

address underlying problems with substance use, 

mental health, or other issues. This individualized 

approach has shown promise for improving 

students’ chances of persisting and eventually 

completing college.48

Based upon interviews and questionnaires 

with key experts, mental health practitioners, and 

students, as well as a review of recent research, 

this report provides an overview of the current 

mental health services and policies in colleges in 

the United States. It documents the challenges 

faced by students with mental health disabilities 

and highlights the most promising policies and 

practices that promote their mental health and 

enhance their ability to access services and to 

continue in and graduate from postsecondary 

institutions and seek gainful employment 

once they graduate. Finally, we provide 

recommendations to improve mental health 

services and policies in postsecondary settings 

for students with mental health disabilities.

The study that 

informed this report was 

guided by the following 

research questions.

Policy: This includes 

gaps, weaknesses, 

and discriminatory 

aspects of current federal and college policy and 

recommendations for policy and system reforms 

at the postsecondary level.

■ Q1: What are the federal policies, particularly 

at the postsecondary level, that can reduce 

or remove barriers to mental health services 

on campus? How feasible are these policies 

in the current context?

■ Q2: What is the current landscape of mental 

health services and policies in colleges in 

the United States?

■ Q3: What gaps, weaknesses, and 

discriminatory policies exist in these services?

■ Q4: What are schools’ policies regarding 

voluntary and involuntary leaves of absence, 

and confidentiality of mental health 

services?

Chapter 3. Purpose and Structure of Repor

[T]his report provides an overview 

of the current mental health services 

and policies in colleges in the 

United States

Mental Health on College Campuses 27
■ Q5: What policy and system reforms 

affecting students with mental health 

disabilities in postsecondary settings are 

needed?

Access: This includes availability of mental 

health services on campuses; policy and physical 

barriers to students accessing services, as well 

as programmatic barriers; and whether students 

receive the appropriate reasonable modifications 

and accommodations to help them remain and 

succeed in school.

■ Q6: What barriers prevent colleges from 

providing accessible mental health services 

for students that are required by law?

■ Q7: What can be done to enhance the 

inclusion, retention, and graduation of 

students with mental health disabilities in 

higher education?

■ Q8: Are mental health services adequately 

available on campus, including physical 

accessibility, appointment availability, and 

paperwork requirements?

■ Q9: Does the college provide services to all 

students regardless of physical or sensory 

disabilities?

■ Q10: Are students who disclose mental health 

disabilities provided reasonable modifications 

to policies and/or accommodations to remain 

in school, such as excused absences for 

mental health treatment, flexibility in class 

schedules, mental health leave, and emotional 

support animals in college housing (Fair 

Housing Act & Section 504)?

Practice: This includes the services that 

colleges provide to students with mental health 

disabilities, best and/or promising practices 

and emerging trends in the field in providing 

support to students, as well as best practices 

in training mental health professionals and 

college faculty and staff to effectively provide 

services.

■ Q11: What are current promising and best 

practices and emerging trends in providing 

support to students with mental health 

disabilities?

■ Q12: Have staff and faculty received 

adequate training to identify and provide 

support for students with mental illnesses 

or students who are experiencing extreme 

emotional distress?

■ Q13: Are faculty and staff trained on mental 

health issues and reasonable modifications 

and accommodations for students with 

mental health disabilities?

■ Q14: Does the college maintain 

relationships with available mental health 

providers in the community?

■ Q15: Is there a crisis management plan in 

place for students and staff to deal with a 

suicide or traumatic event?

■ Q16: Does the college use a peer-mentoring 

model as part of its services?

■ Q17: Does the college attempt to reduce 

stigma by, for example, locating mental 

health services in an area that respects the 

privacy of students?

28 National Council on Disability
Interviews

Practitioner and Expert Interviews

To understand the challenges, best practices, 

and emerging trends of supporting students with 

mental health disabilities and to provide relevant, 

practical recommendations for reform at all levels, 

structured, 45-minute telephone interviews were 

conducted with 37 key informants, including 

social science researchers, advocates, disability 

specialist and mental health service providers, 

and specific subpopulations, including individuals 

(both at the college and in the community 

serving college students) who are Deaf or HOH, 

graduate students, those involved in Greek life, 

and athletes. Interviews were also conducted 

with college administrators, college policymakers, 

and college legal counsel, among others. 

(For a list of interview questions posed and 

interviewees, see Appendix A.) A representative 

sample of key stakeholders was chosen based 

on several factors, including: type of institution 

(two- and four-year colleges), type of organization 

(government, nonprofit, university), role (mental 

health provider, college legal counsel), and 

geographical location. Interviewees were notified 

that all responses would be shared anonymously, 

thus all data in this report is de-identified. 

Interviews were recorded to ensure accurate 

notes. All recordings were deleted after the study.

Student Interviews

Eight students with knowledge of mental 

health services provided on their campuses 

were trained to lead in-person interviews with 

fellow students, aged 18 or older, to gain an 

understanding of students’ experiences on 

campus; students’ need for services; available 

services on campuses; the services students 

found most helpful; and challenges or barriers 

to access. Students were recruited through a 

NAMI [National Alliance on Mental Illness] On 

Campus listserv. Students who completed the 

questionnaire also had the opportunity to note 

their interest in interviewing other students. 

Students represented a sample of universities 

and colleges based on geographic diversity 

and type of institution. (For a list of interview 

questions and universities/colleges, see Appendix 

B.) Students were trained to ask questions, 

conduct follow-ups, and document responses. 

Student interviewers scanned and emailed, or 

mailed, interview responses, and responses 

were aggregated and integrated throughout 

the final report. Interviewees were asked to 

sign an informed consent that clarified, among 

other things, the purpose of the study, that the 

information provided would be de-identified, and 

that participants were free to withdraw from 

the interview at any time. After training, these 

Chapter 4. Methodolog

Mental Health on College Campuses 29
students conducted a total of 48 interviews of 

other students.

Questionnaires

Practitioner/Expert and Student 

Questionnaires

Open-ended online and paper questionnaires 

were also administered to provide context for 

the themes identified in the interviews (e.g., 

providing rates for how common certain best 

practices are in colleges). Key informants and 

stakeholders were asked about the federal 

and college policies identified as impacting 

students with mental health disabilities and 

about practices and barriers identified in the 

literature review and other research. Practitioners 

and students were asked to complete an online 

SurveyGizmo questionnaire with open-ended 

responses, which was distributed at the 2016 

Association on Higher Education and Disability 

(AHEAD) Annual Conference and the 2016 

Disability Summit held by the Los Angeles 

Community College District. Further, links to the 

questionnaire were distributed through mental 

health organization listservs including NAMI, 

AHEAD, Disabled Student Programs and Services 

of the California Community College Chancellor’s 

Office, and Active Minds. In total, NCD received 

over 101 responses from practitioners and 148 

responses from students. The questionnaires can 

be found in Appendix C.

Twitter Chat

To engage a wider audience of individuals 

interested in college mental health, particularly 

among a younger demographic, NCD hosted 

a Twitter chat to discuss the current status of 

the field, the challenges faced by students with 

mental health disabilities, and the most promising 

practices to provide these students with support. 

NCD recruited six panelists with backgrounds in 

mental health or who were mental health service 

providers on their college campuses. To ensure 

a broad reach, NCD recruited organizations or 

individuals with many Twitter followers who were 

active users and then chose those accounts 

that represented diverse perspectives and 

organization types. Panelists included two mental 

health advocacy organizations (NAMI and the 

JED Foundation); two students with backgrounds 

in mental health advocacy; one student group 

with a focus on mental health (YouthMove); and 

one company that develops research-proven, 

online role-play simulations with the goal of 

improving individuals’ mental health (Kognito).

NCD’s Twitter account (@NatCounDis) posed 

the seven questions in Appendix D to panelists 

over the course of one hour, in roughly nineminute intervals, in a “Q1/A1” format. The goal 

of the Twitter chat was to engage other Twitter 

users in the conversation. There was a total of 

598 posts, 448 of which directly addressed the 

seven questions posed. In addition to the Twitter 

chat host and six panelists, there were 106 other 

participants who tweeted directly about the 

proposed questions. See Appendix D for the list 

of questions posed throughout the Twitter chat.

NCD Twitter Chat

Goal: Engage Twitter users in conversation 

about mental health services and supports 

on college campuses.

Engagement: 1 Twitter chat host, 6 panelists, 

106 participants, 598 posts (448 of which 

directly addressed seven posed questions).

30 National Council on Disability
Federal Disability Laws

The two primary federal laws that apply to 

students with disabilities are Section 504 of the 

Rehabilitation Act of 1973 (Section 504)49 and the 

Americans with Disabilities Act of 1990 (ADA).50

Section 504 of the Rehabilitation Act

Section 504 states, “No otherwise qualified 

individual with handicaps in the United States . . . 

shall, solely by reason of her or his handicap, 

be excluded from the participation in, be denied 

the benefits of, or be subjected to discrimination 

under any program or activity receiving Federal 

financial assistance.” This prevents any college 

that receives direct or indirect federal financial 

assistance, including those that accept 

students who receive federal financial aid, from 

discriminating against an individual because of his 

or her disability. Thus, Section 504 covers almost 

all colleges and universities, public or private, 

protecting the rights not only of individuals with 

visible disabilities but also those with disabilities 

that are not visible.

The Americans with Disabilities Act

Both public and private colleges and universities 

must provide equal access to postsecondary 

education for students with disabilities. Title II 

of the ADA covers publicly-funded universities, 

community colleges, and vocational schools. 

Title III of the ADA covers privately-funded 

schools. All schools, public or private, that receive 

federal funding are required under Section 504 

of the Rehabilitation Act to make their programs 

accessible to students with disabilities.51

Title II of the ADA extends section 504’s 

nondiscrimination requirement to all activities 

of state and local governments, not only those 

that receive federal financial assistance. Title II 

states: “[N]o qualified individual with a disability 

shall, by reason of such disability, be excluded 

from participation in or be denied the benefits of 

the services, programs, or activities of a public 

entity, or be subjected to discrimination by any 

such entity.”52

The protections of Section 504 and Title II, 

which are generally the same in the context of 

education, cover all aspects of these institutions’ 

programs and activities. Under Section 504 and 

Title II, colleges are required to make reasonable 

modifications in policies, practices, or procedures 

when the modifications are necessary to avoid 

discrimination based on disability, unless it can 

demonstrate that making the modifications 

would fundamentally alter the nature of the 

service, program, or activity53 or would result in 

an undue financial or administrative burden on 

the institution.54

Chapter 5. Federal Laws Impacting College

Mental Health Services

Mental Health on College Campuses 31
Postsecondary School Provision 

of Auxiliary Aids

Mental health services require communication 

between a student and a counselor, but for 

students with disabilities that impair their ability 

to communicate, such as students who are 

deaf or hard of hearing, auxiliary aids may be 

necessary to facilitate communication. Section 

504 and Title II require postsecondary schools 

receiving federal financial assistance to provide 

effective auxiliary aids to students who are 

disabled to enable them to participate and 

benefit from a school’s services, programs, and 

activities.55

If an auxiliary aid is necessary for students to 

participate in mental health counseling services 

provided by the college, the college must make 

it available, unless provision of the aid would 

cause undue burden. A student with a disability 

may not be required to pay for that aid or 

service; however, a student in need of such aid 

is obligated to provide notice of the nature of the 

disabling condition to the college and to assist it 

in identifying appropriate and effective auxiliary 

aids.56

The Departments of Justice (DOJ) and 

Education, Office for Civil Rights (OCR) share 

responsibility for protecting the rights of college 

students with disabilities. DOJ enforces title 

III of the ADA, and DOJ and ED both have 

enforcement authority under Title II of the 

ADA. In addition, the ED enforces Section 504 

with respect to public and private colleges 

and universities that receive federal financial 

assistance from the ED.57

The Fair Housing Act

The Fair Housing Act58 (FHAct) makes it 

unlawful to deny a dwelling to a person based 

on the person’s disability, and requires housing 

providers, including colleges that provide student 

housing, to make reasonable accommodations 

for persons with disabilities if needed to afford 

them an equal opportunity to use and enjoy a 

dwelling.59 The FHAct is relevant for students 

with mental health disabilities who live in 

college housing and require the assistance of 

an emotional support animal60 as a reasonable 

accommodation.61 Section 504 may also be used 

to request the accommodation of an emotional 

support animal in college housing.62

The Office of Fair Housing and Equal 

Opportunity, U.S. Department of Housing and 

Urban Development enforces the FHAct.

Federal Privacy Laws

In addition to ADA and Section 504, the key 

federal laws that apply to students with mental 

health issues and institutions’ treatment of the 

students are the Family Educational Rights and 

Privacy Act of 1974 (FERPA) and the Health 

Insurance and Portability and Accountability Act 

of 1996 (HIPAA).

Family Educational Rights 

and Privacy Act

FERPA regulates the keeping and dissemination 

of education records at all institutions that receive 

federal funds or who have students receiving 

federal funds. Consent must be obtained to 

release education records to a third party, with 

certain exceptions contained in the law. College 

officials with a legitimate educational interest in 

the record may have access to it.63–64

Health Insurance and Portability 

Accountability Act

HIPAA (in addition to state law) governs 

the release of uniquely identifiable medical 

32 National Council on Disability
information on patients by health care providers. 

Medical information is defined as all information, 

either written or oral, obtained during a course of 

treatment.65

Policies and Practices Negatively 

Impacting Provision of Campus 

Mental Health Services

Interviewees and questionnaire respondents 

highlighted several significant barriers to the 

academic success of students with mental health 

disabilities. This section discusses each of these 

policy barriers in detail.

Threat to Self Policies Requiring 

Mandatory Withdrawal or Mandatory 

Leave of Absence

In responding to students with mental health 

crises, discussion often focuses on whether, 

consistent with ADA, 

schools can use 

disciplinary action, 

LOA, or suspension to 

remove students from 

campus. Each of the 

legal experts interviewed 

and questionnaire 

respondents identified the need for clear 

direction from ED OCR on how to respond 

to a student who may self-harm and for clear 

guidance on when colleges may require a student 

that threatens self-harm to withdraw or take a 

medical LOA.

The regulations under Title I of ADA expressly 

recognize that employers need not accommodate 

employees who pose a “direct threat” to the 

health or safety of themselves or others, and 

provide a framework for assessing whether an 

employee poses such a threat.66 In the absence 

of a Title II regulation that provided colleges with 

a framework that applied to students, many 

colleges adopted the Title I framework and 

developed policies and procedures, including 

those related to medical withdrawal and 

involuntary withdrawal, to respond to students 

who posed a direct threat to the health or safety 

of themselves or others. Colleges anticipated 

that the 2011 Title II regulations would include 

“direct threat” provisions applying to students, 

but the regulations did not. Colleges have not 

received guidance from OCR or DOJ on how 

they can properly respond to students at risk of 

self-harm or harming others while maintaining 

compliance with disability laws.

Students are also impacted by the lack of 

guidance to colleges. One result of this lack of 

guidance has been discrimination complaints 

filed with OCR and lawsuits alleging disability 

discrimination. 

Colleges have evicted 

students from their 

dormitories or placed 

them on involuntary 

leave in response 

to threats to hurt 

themselves. Colleges 

have also encouraged voluntary or involuntary 

hospitalization for students in response to mental 

health crises.67 Such policies result in students 

not seeking help for fear of being forced to leave 

school.68

A fundamental problem is that, without 

considering students’ individual 

circumstances, disciplinary charges or 

mandatory leaves of absence are imposed 

on students who appear to have selfinjurious behaviors or thoughts and/or 

Each of the legal experts interviewed 

and questionnaire respondents 

identified the need for clear direction 

from ED OCR on how to respond to 

a student who may self-harm

Mental Health on College Campuses 33
seek psychiatric treatment. If students fear 

reprisal when their efforts to obtain help 

come to administrators’ attention, many will 

suffer in silence.69

Colleges should know that they have to 

consider alternatives to forcing a student 

with a mental health condition to withdraw.70

In a discrimination settlement at Quinnipiac 

University, a student went to the counseling 

center, was then “transported to the hospital, 

evaluated, and released a few hours later. In that 

brief time, the university had already placed her 

on mandatory medical 

leave, pending a review 

by a university-approved 

psychiatrist, according 

to her attorneys.”71

Under the terms of the 

settlement, in addition 

to compensating the 

student, Quinnipiac 

had to “develop a 

nondiscrimination 

policy and provide training on the ADA with an 

emphasis on mental health-related disabilities.”72

In fall 2004 at George Washington University, 

a straight-A sophomore sought emergency 

psychiatric care for depression. “When they 

learned of [the student’s] hospitalization, 

university officials charged him with violating the 

school code of conduct, suspended him, evicted 

him from his dorm, and threatened him with 

arrest for trespassing if he set foot on university 

property.”73 The student filed a lawsuit which 

resulted in an out-of-court settlement.74

According to the Bazelon Center for Mental 

Health Law, the decision to impose an LOA 

should only be made in the uncommon 

circumstance that a student cannot safely remain 

at a university or meet academic standards, 

even with accommodations and other supports. 

The same applies to exclusion from university 

housing, which should be imposed only if a 

student cannot safely remain in the housing, 

even with accommodations. A school should 

impose an LOA or require a student to live off 

campus only after an individualized assessment. 

The assessment should consider whether 

there is a significant risk that the student will 

harm him/herself or another and whether the 

risk cannot be eliminated or reduced to an 

acceptable level through 

accommodations. 

Information from mental 

health professionals may 

be vital in making this 

assessment.

If the school then 

does decide to act, the 

student is entitled to 

what are called “due 

process protections.” 

These include notifying the student of the action 

the school is considering and an explanation 

of why the school believes that such an action 

is necessary. The student and his or her 

representative should have an opportunity to 

respond and provide relevant information. The 

school may inquire into a student’s current 

condition and request recent mental health 

information and records. But it can only request 

information and records that are necessary 

to determine whether the student is a threat. 

The school cannot insist on unlimited access 

to confidential information or records. Students 

have a right to limit a release of information to 

specific dates, and have a right to approve and to 

[T]he decision to impose a leave 

of absence should only be made 

in the uncommon circumstance 

that a student cannot safely 

remain at a university or meet 

academic standards, even with 

accommodations and other supports

34 National Council on Disability
review information that is being made available 

to the school. At the very least, the school should 

provide the same arrangements for withdrawal 

from classes, incompletes, and refunds of tuition 

or other costs as it does for a student who takes 

an LOA or leaves college housing for physical 

health reasons.75

Interviewees expressed concern that when 

students are suspended or expelled from school, 

they must grapple with a cascading set of 

issues, including treatment options, residency 

requirements, the impact of the interruption 

on their academic progress, and economic 

consequences such as the jeopardizing of 

scholarship and financial aid eligibility, lost tuition, 

and effects on student loans and insurance. 

Furthermore, students 

on LOAs for mental 

health challenges 

often do not get tuition 

reimbursements or may 

only get partial refunds. 

There are instances in 

which students who 

take leave for a physical 

health reason are 

provided with different 

supports in terms 

of their transcript, GPA, and return. The best 

practice, according to interviewees, is to ensure 

that course withdrawals are taken off students’ 

transcripts or to cite “leave of absence” with the 

dates on students’ academic records to prevent 

unfairly impacting students.

There are no hard and fast answers—each 

situation requires individualized assessment of 

the risk and whether accommodations can be 

provided that can keep the student in school. 

In keeping with the guideline of doing what 

is best to support students on a case-by-case 

basis, colleges have multiple options depending 

on the situation. Colleges can employ flexible 

academic policies for leave, reduced course 

load, and remote learning, among other 

methods, to accommodate students with 

mental health crises. Georgetown University 

has a policy of “freshmen forgiveness”—grades 

can be forgiven in recognition of the difficult 

transition from high school to college. While not 

currently used for students with mental health 

challenges, this policy is an example of an 

accommodation if grades are impacted by such 

challenges.

OCR held discussions with members of the 

National Association of College and University 

Attorneys and the National 

Association of Student 

Personnel Administrators 

through 2016 to discuss 

the organizations’ 

concerns and requests 

for guidance, but to date, 

OCR has not provided 

guidance on the issue. 

Colleges reported that 

they continue to rely 

on individual campusby-campus settlements, OCR resolution 

agreements, and court cases to shape their 

policies.

Readmission Policies

Legal experts also expressed the need for 

practical guidelines on readmitting students 

to colleges after mandatory LOAs, particularly 

if they can require medical records or other 

documentation before allowing students to 

be reinstated. The experts noted that some 

[W]hen students are suspended or 

expelled from school, they must 

grapple with a cascading set of 

issues, including treatment options, 

residency requirements, the 

impact of the interruption of their 

academic progress, and economic 

consequences 

Mental Health on College Campuses 35
colleges may have onerous requirements for 

readmittance, including stipulating that students 

submit applications to return by a certain 

date. In some cases, this date is four months 

in advance—too long a period for situations 

involving students’ mental health. Colleges also 

often have blanket policies requiring one or two 

semesters off, rather than the length of time 

that best supports each student on a case-bycase basis. Often, students get their letters of 

readmission in August, so close to the beginning 

of the semester that it is difficult for students 

to return.

Cases resolved by OCR inform on practices 

that do not discriminate on the basis of disability, 

including mental illness.76 Based on these cases, 

students do not need to be “cured,” “well,” 

or “no longer needing accommodations” to 

return to school, nor does it have to be the case 

that the “disability-related behavior not recur 

unless that behavior creates a direct threat that 

cannot be reduced to an acceptable level with 

accommodations.”77 Further, students are not 

required to submit medical records as a condition 

of return from medical leave because the 

University did not require students taking medical 

leave for other reasons to submit medical 

records.78

The Bazelon Center outlines a model policy, 

based upon these court cases, that allows 

students to request a return at any time, honors 

opinions on students’ capabilities to return 

to school from their treating mental health 

professionals, treats standards or procedures 

to return to school equally for students who 

have taken leave for physical health or mental 

health reasons, and asks colleges to consider 

accommodations that would allow students to 

meet academic standards and remain safely in 

school.79

Financial Aid and Other 

Financial Policies

The second most common policy change 

suggestion (nine percent of suggestions) from 

practitioner questionnaire respondents was for 

more flexible financial aid policies and financially 

forgiving policies (i.e., no penalties) if students 

must take LOAs. Student respondents also noted 

the need for supportive medical LOA policies, 

including a full tuition refund and the ability to 

enroll part time and still access scholarships and 

financial aid.

36 National Council on Disability
The Higher Education Act includes several 

provisions for the financial needs of students 

with disabilities, including funds for student 

support services, increased student financial aid 

when disability-related expenses are significant, 

and discretion for financial aid officers to adjust 

aid packages according to special circumstances. 

However, practitioners and students still noted 

that restrictions in the provision of aid negatively 

impact the ability of students with mental health 

challenges to succeed in school. For example, the 

Pell Grant program provides need-based grants 

to undergraduate students and is the foundation 

for all federal student aid (FSA) awarded to 

undergraduates. To be eligible to receive Pell 

Grants, students must meet the general eligibility 

criteria for all FSA programs and be enrolled at 

eligible colleges to earn degrees or certificates. 

Students are subject to a cumulative lifetime 

eligibility cap of 18 full-time semesters (or the 

equivalent), which is prorated for students who 

attend on less than a full-time basis.80 However, 

many students with mental health disabilities are 

not able to complete what is considered full-time 

course loads and are much more successful 

taking one or two courses at a time. According 

to one survey respondent, “the majority of the 

students at my institution are receiving federal 

financial aid, and because they find partial course 

loads more mentally achievable than the full 

load, they are more successful in completing 

the requirements of their associate’s degrees. 

Unfortunately, the college is being held to 

students completing degrees within the [set] 

time frame, and so the pressure falls on students 

who have mental challenges to take full loads 

even though they are more likely to have mental 

lapses in their various diagnoses.”

Other federal student support services 

programs, such as TRIO,81 primarily serve 

individuals who are or would be low-income, 

first-generation college students, but also serve 

students with disabilities, students at-risk of 

academic failure, veterans, homeless youth, 

foster youth, and individuals underrepresented 

in graduate education by providing financial 

assistance through grant aid,82 as do veterans’ 

benefits programs.

“Funds from campus-based programs 

(Supplemental Grants, Perkins Loans, and Work 

Study) can be awarded to students with any 

level of attendance. However, first preference in 

granting these scarce funds is usually given by 

financial aid administrators to students pursuing 

the standard full-time course load,”83 which 

places burden on students with mental health 

disabilities who may not be able to successfully 

attend full time.

Students with mental health disabilities 

often have expenses related to their disabilities, 

further increasing their need. These expenses 

impact students in many ways. First, the FAFSA 

does not explicitly ask about disability-related 

costs, instead advising the student, “If you or 

your family have unusual circumstances that 

should be taken into account, contact your 

college’s financial aid office.”84 This stipulation 

requires students with disabilities to navigate 

an additional step and make their cases to the 

student financial aid administrator. Further, 

disclosure of a disability does not always result 

in increased aid.85 Second, many students with 

disabilities, including mental health disabilities, 

are worried about student loans because 

of their disability-related needs. They worry 

that they may not be able to work enough to 

Mental Health on College Campuses 37
repay the loans. Third, 

financial aid often 

comes in a package of 

grants that need not be 

repaid, loans, and work. 

Students with mental 

health disabilities—

many of whom need to 

have reduced course 

loads anyway—may not be able to add work 

study hours on top of their course loads due 

to limitations of their time, skills, or capacity 

for work.86 Fourth, if students are required 

to leave school for a semester or a year, the 

repayment on their loans kick in, which can 

create enormous financial stress and increase 

the psychiatric issues students already have.

Funding Policies for Programs 

and Supports

Practitioner questionnaire responses highlighted 

issues of access to and provision of quality 

services to students with mental health 

disabilities, and that a key barrier to increasing 

access, providing services, and training faculty 

and staff was a lack of financial resources.

Forty-seven percent of practitioners believed 

that restricted availability of mental health 

services due to funding limitations was a major 

problem impeding the success of students 

with mental health disabilities. Thirty-three 

percent noted that services provided currently 

were not adequate (only two respondents said 

they did have comprehensive services, and 

the remaining participants did not respond). 

Practitioners noted the lack of funds to hire 

additional staff to provide services to the 

increasing number of students seeking aid. 

Practitioners also 

said that the services 

colleges did offer 

need to be enhanced, 

and community 

health providers were 

sometimes not available 

to meet students’ 

needs. Practitioners 

reported that lack of funding was the reason 

that many colleges have limited hours of 

operation, fees, waitlists to see a counselor, and 

may suffer from a lack of licensed counselors. 

They also noted the need for increased training 

for faculty and staff.

Confidentiality

Finally, three interviewees noted challenges in 

understanding and adhering to confidentiality 

laws as related to student treatment records. 

Responses to a survey of 765 students 

conducted by NAMI also found that a top 

five reason why some college students 

did not disclose their diagnoses to receive 

accommodations, was because they feared 

the lack of confidentiality.87 Fear of lack of 

confidentiality is a key barrier in students not 

seeking help.

Legal counsel who were interviewed 

reported that some colleges are confused 

over how FERPA and HIPAA work together 

and what information may be disclosed about 

a student, under what circumstances, and to 

whom. Several student and expert interviewees 

noted that students are not likely to go to the 

school counseling center if they worry about 

the confidentiality of the visit, noting that 

some students prefer off-campus services 

[I]f students are required to leave 

school for a semester or a year, the 

repayment on their loans kick in, 

which can create enormous financial 

stress and increase the psychiatric 

issues students already have

38 National Council on Disability
because of the confidentiality. Another tension 

is between college confidentiality for adult 

students and parents wanting to know what 

is going on.88 “Universities walk a fine line 

when providing treatment or mental-health 

services to students. If campus officials don’t 

know what’s going on or disclose too little, 

they risk being blamed if a student harms 

himself, herself, or others. If they pry too 

deeply, they may be accused of invading 

privacy, thereby discouraging students from 

seeking treatment.”89

Mental Health on College Campuses 39
40 National Council on Disability
The bottom line is services. If you don’t have services available when students need it, nothing 

else is going to correct for that. If you have a mental health challenge and you need access to 

services in that moment—it’s not that you need service a month later. If you’re going to treat the 

student, you need to provide full treatment up to specialty referrals. This would enable the vast 

majority of students with mental health challenges to be successful.

—College Counseling and Psychological Services Director

T

his section discusses the availability 

of mental health services, provision of 

qualified mental health professionals 

on campuses, barriers to services faced by 

students, and whether appropriate reasonable 

accommodations are provided for students to 

remain and succeed in school.

Policies and Practices That 

Enhance the Inclusion, Retention, 

and Graduation of Students 

with Mental Health Disabilities

Seventy-six practitioners and 148 students 

responded to the question about what practices 

their colleges can engage in to enhance the 

inclusion, retention, and graduation of students 

with mental health disabilities. Table 1 shows 

their responses as percentages.

Improving Access to Services

The largest number of practitioner respondents 

(47 percent) believed that restricted availability 

of services due to federal, state, and college 

funding limitations was a major problem 

impeding the success of students with mental 

health disabilities. Of these respondents, 

83 percent responded that mental health 

services could be improved through having 

Chapter 6. Access to Quality Mental Health Service

Table 1: Percentage of practitioners and students who named certain practices 

their colleges can engage in to enhance inclusion, retention, and graduation of 

students with mental health disabilities

Practice Percentage of practitioners Percentage of students

Improving access to services 47 54

Increased training for faculty 

and staff

34 13

Policy reforms 33 0

Outreach and education 17 0

Integrated services 14 34

Mental Health on College Campuses 41
more trained staff on campus, including 

counselors, case managers, academic 

advisors, and support staff, and making 

available psychiatrists and medications, as 

well as support from peer-to-peer workers 

who have been successful in their own 

mental health recovery efforts and educational 

pursuits. Increasing the number of trained 

staff would decrease (or eliminate) waiting 

lists for appointments. Seventeen percent of 

respondents suggested improving the process 

to better support 

students, including 

the following:

■ developing better 

screening and 

diagnostic procedures,

■ giving students access 

to more technologybased tools to help 

them succeed,

■ referring students in a timely and 

streamlined manner to outside services and 

supports and following up,

■ increasing community support as well as 

campus outreach,

■ developing appropriate new programs,

■ creating individualized success plans with 

students, and

■ training counselors on cultural diversity.

The largest number of student respondents 

(54 percent) reported that providing adequate 

services and accommodations, including more 

counselors, free appointments, case managers, 

mentoring, and flexible accommodations, would 

most help students succeed.

Increased Training for Faculty and Staff

The second most common response to the 

practitioner questionnaire regarding barriers 

to access for students with mental health 

disabilities was the need for increased training 

for faculty and staff (34 percent). Thirteen 

percent of students also argued for more 

training of faculty and staff. Most respondents 

suggested increased faculty and staff mental 

health awareness training in general; a few 

suggested, more specifically, specific training on 

the ADA’s requirements 

and compassionate 

responses to those 

seeking help, best 

support strategies and 

available resources, and 

identification and referral 

of students in crisis.

Policy Reforms

Practitioner respondents suggested various 

policy reforms to improve access (33 percent). 

The most common suggestion (36 percent 

of policy suggestions) was to allow students 

to take reduced course loads and extended 

degree completion timelines, and still be 

eligible for financial aid and support from other 

categorical programs and federal programs, 

such as Student Support Services Projects. 

One respondent wrote, “Federal guidelines 

for financial aid can discriminate against 

mentally ill or physically ill students (who have 

to drop out due to illness) and then do not 

meet the 75 percent enrollment rate. There is 

a need to make taking a reduced credit load 

more commonly accepted. This would allow 

students to carry a more manageable course 

“Federal guidelines for financial aid 

can discriminate against mentally 

ill or physically ill students (who 

have to drop out due to illness) and 

then do not meet the 75 percent 

enrollment rate.

42 National Council on Disability
load, which helps significantly with symptom 

management for many students with mental 

health conditions.”

Other policy reform suggestions aimed 

at enhancing the inclusion, retention, and 

graduation of students with disabilities included 

implementing financial forgiveness policies (i.e., 

no penalties) if students with mental health 

disabilities need to take LOAs (24 percent of 

policy responses), mandating education of 

faculty on accommodating students with mental 

health disabilities, avoiding discrimination on 

the basis of mental 

health assumptions, 

and providing risk 

assessment (or ways 

to reach out to campus 

colleagues at the 

first signs of student 

distress) (8 percent 

of policy responses). 

Other suggestions 

included flexible deadlines for assignments and 

class attendance leniency, having transparent 

guidelines for LOA and other enrollment 

policies, more mental health services, and more 

financial support for students with mental health 

disabilities.

Outreach and Education

Practitioner respondents suggested increased and 

more effective outreach and education for students 

(17 percent of all responses) including, in about 

equal numbers, self-advocacy training, support to 

more easily seek help, training in resiliency skills, 

and education on campus policies and federal 

regulations. Full transparency of available services 

was a key factor in these suggestions.

Integrated Services

Practitioner respondents (14 percent) discussed 

integrating mental health promotion into the 

larger college community through making 

diversity and inclusion a priority (including hiring 

a chief diversity officer), modifying the campus 

climate to acknowledge disability as a diversity 

issue (e.g., other aspects of diversity are valued, 

both visible and invisible forms of disability should 

be recognized and respected), and providing 

“universal design” in the classroom and in the 

campus community: a comprehensive mental 

health system of services 

and supports throughout 

the campus rather than in 

just counseling services 

and disability services.

Thirty-four percent 

of students reported 

that creating a culture of 

support, not currently in 

place, and reducing stigma 

would help students with mental health disabilities 

succeed. Students thought that colleges have 

“a culture that does not recognize the need for a 

more robust system of mental health services” 

and that they have a lack of “will power” when it 

comes to supporting students with mental health 

disabilities. Other students believed that “a lot 

of it is due to image. [Colleges] want to protect 

their image and think that by not acknowledging 

the issue this will protect them. The fact that they 

kick out students who have attempted suicide 

proves this. It’s awful.” Students also suggested 

increasing opportunities for students to be heard, 

such as through student organizations.

One respondent noted that it is “critical that 

students with disabilities have a voice in shaping 

“[Colleges] want to protect their 

image and think that by not 

acknowledging the issue this will 

protect them. The fact that they kick

out students who have attempted 

suicide proves this. It’s awful

Mental Health on College Campuses 43
the services on their campus. The understanding 

of this population has frequently been through 

the lens of the medical model centering on illness 

issues, and not a recovery model. Thus, many 

times the student voice has not been valued when 

making decisions about their own lives, never 

mind about policies and practices at colleges.”

Availability of Mental Health 

Services on Campus

Per interviewees and practitioner questionnaire 

respondents, colleges ensure, to the extent 

possible, that they use their resources to meet 

the largest need; however, they face multiple 

barriers to providing access to mental health 

support for students.

In the practitioner questionnaire sample, as 

noted earlier in the Funding Policies for Programs 

and Supports section, 33 percent of respondents 

noted that currently provided services were 

not adequate (while only two respondents said 

they did have comprehensive services and the 

remaining participants did not respond). One 

respondent wrote,

No, available services are not adequate. That 

said, our health center provides 55 hours a 

week of individual therapy, group therapy, 

crisis intervention and outreach. We try to 

collaborate with our county mental health 

department, but with limited resources 

we are often not present at our service 

area meetings to collaborate with them. In 

addition, without the presence of a full-time 

supervising psychologist, staff and faculty 

training is minimal. Our mental health 

department is paid for by student health 

fees, meaning they only see students. 

We need a psychologist paid for out of 

the general fund so faculty/staff training 

can be incorporated into the [psychologist] 

job description. —Health Center Director, 

Community College

Most students interviewed were not sure 

(15 percent) or did not respond to the question 

(52 percent) of whether their colleges provided 

adequate services. Twenty-one percent of students 

believed that their colleges provided adequate 

services and 13 percent reported services were 

not adequate. One student said, “I think they are 

adequately available, for students who have the 

initiative to seek them out.” Even when students 

generally thought that services were available, 

they still recognized barriers to access.

In addition to the questionnaire and 

interviews, the study drew upon three other 

nationwide surveys and data sets that document 

services that colleges provide to students.90

■ The Association for University and 

College Counseling Center Directors 

(AUCCCD). The 2015 AUCCD survey, 

which captures institutional demographics 

and services, counseling center staffing 

and service trends, and counseling center 

director demographics, was completed by 

529 counseling center directors.91 Public 

(46 percent) and private (44 percent) 

institutions were equally represented, with 

an additional four percent representing 

community colleges (n = 20).

■ The National Survey of College 

Counseling Centers (NSCCC). This survey 

includes data provided by the administrative 

heads of college and university counseling 

centers in the United States and Canada. 

The purpose of the survey has been to 

stay abreast of current trends in college 

counseling and to provide counseling 

44 National Council on Disability
center directors with ready access to the 

administrative, ethical, and clinical issues 

faced by their colleagues in the field. The 

2014 report includes data from 246 four-year 

institutions and 29 two-year institutions.92

■ Center for Collegiate Mental Health 

(CCMH). This annual survey, administered 

by Penn State University, is based upon 

standardized data embedded within 

electronic medical records (EMR). This data 

set is a large collection of standardized 

questions, answers, and instruments that 

CCMH makes available to participating 

counseling centers through EMR vendors. 

The 2016 report was based upon data 

contributed by 139 four-year college and 

university counseling centers, describing 

150,483 unique college students seeking 

mental health treatment, 3,419 clinicians, 

and over 1,034,510 appointments.93

In general, these surveys support the finding 

from the questionnaires and interviews that 

colleges provide some access to a variety of 

services, but those services may be limited by 

time availability, fees, extensive waiting lists, and 

limited access to a diverse, qualified staff.

Hours of Service

Only 24 percent of campus mental health centers 

offered services outside the normal 8 a.m. to 

5 p.m. hours, five days a week and just over 

1 percent offer services 6 or 7 days a week. 

Forty-seven percent did not offer any services 

outside of these hours.94

Afterhours Access to Counseling 

and Helplines

Almost 92 percent of respondents indicated that 

there is an active crisis hotline available in the 

community that students can use, while almost 

45 percent said there is an active crisis hotline 

provided by the campus that students can use.95

Fees at Counseling Services

According to the 2017 STAT survey of four-year 

colleges, 88 percent of colleges reported offering 

free counseling services and nine percent 

offered between one and nine free sessions 

before charging $10 to $30 per session.96 In 

the CCMH survey, 16 percent of university and 

college counseling centers charge a fee for initial 

psychiatric medication evaluation, 17 percent 

charge a fee for ongoing medication psychiatric 

follow-up, and 10 percent charge a fee for formal 

psychological assessment, which provides a 

diagnosis and establishes functional limitations. 

Likewise, according to the NSCCC survey, 

5 percent of college counseling centers charge 

fees for counseling (no community college 

centers charge a fee), and that the average cost 

for such a fee is $20. It should be noted that fees 

for services most negatively impact students of 

color and low-income students, who may most 

be in need of such services.97

Waitlists at Counseling Services

Waitlists for mental health services have been 

documented for several years and in several 

Limitations of Existing College 

Mental Health Services

■ Availability

■ Fees

■ Extensive waiting lists

■ Limited access to a diverse, qualified staff

Mental Health on College Campuses 45
studies. Ninety-seven percent of four-year 

colleges responding to a 2017 STAT survey 

reported having waiting lists that spanned from 

a couple of days to over a month, depending 

on the time of year.98 Only three of these 

colleges required staff to screen students for 

emergencies when the student sought help. In 

2016, 36 percent of college counseling center 

directors reported having a waiting list for clients 

to receive treatment. The maximum number 

of clients on the waiting list during the year 

(mean) ranged from 18 to 75, depending on the 

school.99 The 2011 NAMI On Campus survey of 

765 students found that 39 percent of students 

reported having to wait longer than five days for 

an appointment.100

Limited Sessions at Counseling Services

According to interviewees, most institutions 

focus on access—getting students through the 

door—but the quality and quantity of counseling 

services, especially ongoing ones, are lacking. 

Interviewees described services offered 

by colleges as short term or used for crisis 

management and as varying in availability based 

on the semester.

The surveys showed some variation in the 

percentage of colleges that limit the number of 

counseling sessions offered. Seventy percent 

of colleges did not limit sessions according to 

the 2017 STAT survey,101 and the colleges that 

did have limited sessions provided anywhere 

between 6 to 16 sessions. Another study showed 

54 percent of colleges have a maximum number 

of counseling sessions before clients are referred 

out.102 About one-third of college counseling 

centers provide a limited number of counseling 

sessions (35 percent offer limited sessions, 

according to the CCMH survey, and 30 percent 

limit the number of sessions of counseling they 

allow, according to the NSCCC survey). The 

ability to provide counseling sessions seems 

to be determined to some degree by the size 

of the college. According to the NSCCC survey, 

49 percent of schools with over 15,000 students 

limit the number of sessions offered compared 

to just 19 percent for schools with less than 

7,500 students. Community colleges are more 

likely to limit sessions compared with four-year 

colleges. Some colleges provide referrals to 

community mental health providers for students 

that need longer term care.

46 National Council on Disability
Streamlined Referral Network 

to Outside Agencies

According to interviewees, some colleges have 

Memoranda of Understanding which allow for 

streamlined referral of students with mental 

health needs to County Mental Health Clinics. 

However, priority care is usually given to students 

who have severe and persistent mental illness. 

Optimal streamlined referral processes have 

signed releases in place so colleges and clinics 

can most effectively share information about the 

student to support their academic and wellness 

goals.

Availability of Counseling Staff 

with Mental Health Licensure

Colleges can offer mental health services in a 

variety of locations, including health centers, 

standalone mental health sites, programs 

for students with disabilities, and counseling 

centers. Only 70 percent of four-year college 

counseling center professional staff were 

required to be licensed to practice in the center, 

although 96 percent of them were expected to 

get licensed to continue 

practicing. Eighty-five 

percent of four-year 

college counseling 

centers provided new 

staff the supervision 

required for licensure 

of mental health 

professionals in their 

states.103

Availability of a Diverse Mental 

Health Counseling Staff

More than 70 percent of professional 

counseling staff are White, while the 

percentage of Black or African American 

(10 percent) and Latino/a (7 percent) staff 

makes up less than 20 percent. An additional 

eight percent are Asian/

Asian American, and 

less than 10 percent 

make up the other 

racial categories: 

Multiracial (two 

percent), Other (two 

percent), and Indian/

Native American (less 

than one percent).104 Respondents highlighted 

the need for mental health counseling staff to 

be as diverse as the student body they serve as 

there are important cultural considerations to 

take into account when providing mental health 

services.

Only 70 percent of four-year college 

counseling center professional 

staff were required to be licensed 

to practice in the center, although 

96 percent of them were expected to 

get licensed to continue practicing

Mental Health on College Campuses 47
Availability of Psychiatric Services

Sixty-four percent of four-year college 

respondents reported having counseling center 

mental health psychiatric services on campus; 

another 27 percent reported not having access 

to psychiatrists except as a private referral; 

three percent reported not having mental health 

psychiatric services on campus but contracting 

with external psychiatrists for a fee. The 

remaining six percent of respondents replied 

“Other,” though about 50 percent of those 

mentioned having a referral system in place with 

a community provider.105

According to the 

NSCCC survey, only 

seven percent of 

community colleges 

have access to oncampus psychiatrists.106

Thus, outside referrals are the only option for 

community college students if they need to be 

treated by a psychiatrist.

Barriers to Services Faced 

by Students

This section examines potential barriers faced by 

students in accessing services, including physical 

accessibility and paperwork requirements and 

the ability of colleges to provide services to all 

students, regardless of their physical or sensory 

disabilities.

Physical Accessibility and Paperwork 

Requirement Barriers

One serious access barrier for students, 

mentioned by one student and multiple 

practitioners in the questionnaire, is the basic 

process students must engage in before 

receiving mental health services. Institutions 

may have extensive paperwork students must fill 

out before receiving services or require students 

to provide their own disability verification prior 

to service. Additionally, as detailed earlier, 

appointment backlogs are extremely problematic 

for crisis-ridden students who need immediate 

assistance and follow-up care.

The ADA stipulates that all colleges must have 

barrier-free and physically accessible facilities. 

According to interviewees, most colleges adhere 

to these regulations; however, there are times 

when elevators cease to work or some other 

barrier exists within mental health program 

areas so that entry 

is impeded. It is also 

possible that students 

in mental health crisis, 

with physical or sensory 

disabilities may not be 

able to travel to the mental health site for help. 

To appropriately attend to these possibilities, 

college mental health providers must ensure 

their policies allow for flexibility as to where 

counselors can meet with students and ensure 

that accessibility features such as elevators, 

ramps, automatic doors, and communication 

devices are maintained.

Providing Services to Students with 

Physical or Sensory Disabilities

In general, interviewees and practitioner 

questionnaire respondents believed that 

colleges try to provide services to all students 

as required by federal law (ADA, Section 504, 

Fair Housing Act). However, barriers to receiving 

accommodations do exist. Practitioners noted 

each of the following barriers: difficulty finding 

transportation to community mental health 

providers; physical barriers; a lack of training 

According to the NSCCC survey, 

only seven percent of community 

colleges have access to on-campus 

psychiatrists

48 National Council on Disability
in cross-cultural counseling (to help treat 

students with disabilities, students of color, 

and undocumented students); and a dearth of 

mental health counselors fluent in American 

Sign Language and aware of the different levels 

of hearing loss and low vision with hearing loss. 

One respondent noted that international students 

with language barriers are often deprived 

of immediate access to foreign language 

interpreters.

Deaf and hard of hearing (DHH) students 

face barriers to accessing care in their preferred 

language modality and finding people who 

understand the nuances of their culture. In 

DHH culture, there are many people who have 

difficulty signing, but counselors cannot tell if this 

is a result of a mental challenge or lack of proper 

training. Further, access to sign-fluent clinicians is 

a challenge. While technology supports (such as 

remote interpreting) have helped, these supports 

are not always available during a time-sensitive 

crisis period. One interviewee noted that access 

to sign-fluent clinicians through video phone is 

underutilized because of insurance difficulties 

and other related policies that block or prohibit 

provisions across state lines.107 Finally, DHH 

students who are also blind or students of color 

have more of a barrier to finding counselors with 

similar experiences.

Reasonable Modifications and 

Accommodations

Under the ADA and Section 504, colleges must 

provide students with disabilities reasonable 

modifications to their policies, practices, and 

procedures unless doing so would fundamentally 

alter the nature of its service, program, or activity. 

Modifications are made on a case-by-case basis. 

Colleges should, however, have reasonable 

modification policies in place and ensure that 

all staff that work with students receive training 

on those policies. Colleges should ensure that 

students have access to those policies as well. 

The University of Washington is a good example 

of how a college can share information about 

modifications/accommodations for students with 

disabilities via the college website.108 Reasonable 

modifications may include flexible class and/or 

attendance schedules, LOAs without financial 

penalties, and other changes to standard polices 

that allow students with mental health disabilities 

to remain in, and succeed in, college. (See 

Appendix F for a list of common modifications.)

In addition, the Fair Housing Act109 and 

Section 504110 require colleges to allow students 

with mental health disabilities who require an 

emotional support animal to keep such animals in 

college housing as a reasonable accommodation.

According to NAMI’s survey, 62 percent 

of students said they knew how to access 

accommodations, and 43 percent did access 

them.111 Students reported that their most 

Most Important Accommodations 

for Students with Mental Health 

Disabilities

■ Excused absences for treatment (54%)

■ Medical leaves of absence and course 

withdrawals without penalty (46%)

■ Adjustments in test settings (34%)

■ Homework deadline extensions and 

adjustments in test times (33%)

■ Increased availability of academic 

advisors (32%)

Mental Health on College Campuses 49
important accommodations were excused 

absences for treatment (54 percent), medical 

LOAs and course withdrawals without penalty 

(46 percent), adjustments in test settings 

(34 percent), homework deadline extensions 

and adjustments in test times (33 percent), 

and increased availability of academic advisors 

(32 percent).

Ten percent of the practitioner questionnaire 

respondents reported that institutional bias could 

be creating barriers to mental health services 

and supports. Some believed lack of training for 

faculty allowed some students to slip through the 

cracks. One respondent noted that there is likely 

“some institutional cultural bias that colleges 

should not be providing health services to 

students and/or a reluctance to promote service 

availability” that helps lead to barriers that keeps 

students away.

Because mental health disabilities are 

invisible, students often find themselves trying 

to negotiate accommodations with faculty 

members who do not understand their disabilityrelated needs. Students must be diagnosed with 

a disability to request reasonable modifications/

accommodations, as students without a verified 

disability are not covered by the ADA, Section 

504, or the FHAct. Faculty that have not received 

training can be resistant to making “exceptions,” 

especially for “invisible” disabilities, even when 

appropriate disability verification is in place.112

This finding relates to previous findings from both 

practitioners and students that faculty need more 

training in disability-related accommodations.

50 National Council on Disability
Student and Practitioner Perceptions 

of Emerging and Best Practices

Forty-two of the practitioners and 48 of the 

students interviewed named current promising 

or best practices trends, shown in Table 2. Both 

groups (26 percent of practitioners and 65 percent 

of students) selected training and anti-stigma 

activities, such as campus-wide discussions, 

normalizing activities, or disability as part of 

diversity efforts as the most promising practices. 

Both groups (17 percent of practitioners and 

15 percent of students) 

also highly ranked 

student engagement, 

such as peer-to-peer 

models or student clubs. 

Practitioners noted 

a trend of increasing 

access to services for 

students, such as hiring more psychologists or 

providing more counseling sessions. This section 

discusses these practices in greater detail.

Stigma Reduction, Education, 

and Outreach

Training and Other Anti-Stigma 

Activities

Only 50 percent of the students NAMI surveyed 

disclosed their diagnoses on campus. They 

did so to receive accommodations, to be role 

models and educate others, to avoid disciplinary 

action, and to receive financial aid.113 Students 

who did not disclose their diagnoses did not 

need accommodations, did not realize they 

could receive accommodations, worried 

about lack of confidentiality, or feared how 

they would be perceived. This concern over 

stigma prevents students from disclosing their 

disabilities and results in students not receiving 

accommodations and possibly dropping out of 

school. Colleges attempt 

to reduce stigma in 

multiple ways. According 

to the practitioner 

questionnaire, 41 percent 

of respondents said 

they conduct outreach, 

30 percent facilitate 

staff workshops and professional development, 

20 percent note the efforts of student groups 

and student-led programs (such as those 

provided by Active Minds and NAMI), 18 percent 

mention campus-wide events or activities, and 

four percent work with external groups such 

as NAMI.

Thirty-eight percent of the students 

interviewed believed that student groups were 

most responsible for reducing stigma on campus. 

Thirty-two percent thought that awareness events 

Chapter 7. Promising Best Practices

and Emerging Trends

This concern over stigma prevents 

students from disclosing their 

disabilities and results in students 

not receiving accommodations and 

possibly dropping out of school

Mental Health on College Campuses 51
helped reduce stigma, though most students did 

not specify whether these events were college 

run or student run. Thirteen percent reported 

creating integrated support services throughout 

campus to promote general inclusivity. One 

student said the department “asks us to evaluate 

teachers on how they include mental health 

resources in their class, as they expect teachers 

to break social stigma.”

According to interviewees, best practices for 

reducing stigma include normalization, such as 

campus-wide wellness initiatives; integrating 

mental and physical health; and framing disability 

as a diversity issue.

In general, there does have to be ongoing 

efforts to reduce stigma and discrimination. 

Not just against people who have mental 

illness, but also racism and systemic 

issues that favor certain types of students 

over others. For example, the stigma 

within the African American community 

around mental illness is greater than in the 

White community. We need to get rid of 

discriminatory practices that are woven into 

our policies. Working with folks who aren’t 

themselves clinicians or mental health 

providers but have a lot of access to the 

students—training those people on when 

a student is having a problem and being 

able to point that out and refer them to the 

right person. —College counseling center 

counselor

Table 2: Percentage of practitioners and students who named certain practices 

as best practices in mental health services

Practice Percentage of Practitioners Percentage of Students

Training/anti-stigma/outreach 26 65

Increased access 21 19

Student engagement 17 15

Faculty support/training 14 6

Crisis response/behavioral 

intervention teams

7 0

Pedagogy/universal design 5 0

Culturally competent practices 5 0

Technology access 5 0

Intracollege collaboration 2 0

Suicide prevention 2 0

More data availability 2 0

Skills training 2 0

Policy 2 0

Emotional support animals 2 0

52 National Council on Disability
An example, given in interviews, of such 

integration would be the co-location of mental 

and physical health services. According to 

interviewees, co-location places physical 

and mental health at the same level. Further, 

students are more likely to seek services when 

the mental health center 

is not in a separate 

location and it is not 

obvious they are seeking 

mental health support. 

Also important is the 

nonpejorative naming of 

the mental health area, 

such as The Life Skills Program.

According to an AUCCCD survey, only about 

23 percent of physical and mental health centers 

shared a floor or suite in the same building; 

in 31 percent of cases, physical and mental 

health centers were located across campus 

from each other; 28 percent of physical and 

mental health centers were in separate spaces 

in the same building; 10 percent were adjacent, 

but in separate buildings; and eight percent of 

campuses did not have health services.114

Orientation

Respondents believed that outreach to 

students about mental health and mental 

health services should begin before students 

even start school, with information posted 

on college websites. Then, when students 

arrive on campus for orientation, they could 

be supported in developing skills like time 

management, decision making, resilience, and 

coping—skills that will help students avoid 

mental health problems. Orientation could help 

set up a culture where mental health is not 

viewed as a disease or permanent state and the 

complete normativeness of anxiety and other 

mental health concerns is acknowledged, which 

is more empowering to students than saying 

“we have these programs for special needs.” 

Students want to be seen as “normal,” so 

mental health services should not be separated. 

Pre-enrollment in support 

services should be 

allowed at orientation, 

as it provides an easy, 

confidential manner 

for students to identify 

themselves. Additionally, 

orientation could include 

a simple, self-scored mental health assessment 

with resource listings.

In 2016, NAMI and The Jed Foundation 

developed a guide,115 including information on 

HIPAA and FERPA, for college-bound students 

and families. The guide asks, “How do we 

incentivize students to talk with their parents 

about mental health, even if students do not 

have mental health issues?” Standardized 

survey questionnaires are also available to 

campuses for measuring student mental 

health. Some widely used tools are provided in 

Appendix E.

Transparency

Many college students go online to access 

information about the mental health services 

offered by their colleges. The NAMI survey 

on college student experiences found that 

64 percent of students responded either “no” 

or “did not know” to the question of whether 

their colleges’ websites included information on 

mental health resources. Forty-six percent of 

students who did use their colleges’ websites 

found them to be “helpful” or “very helpful.” 

[S]tudents are more likely to seek 

services when the mental health 

center is not in a separate location 

and it is not obvious that they are 

seeking mental health support

Mental Health on College Campuses 53
Students reported that helpful websites provided 

the following:

■ Information about resources on and off 

campus

■ The ability to make appointments online

■ An online mental health screening tool that 

links to help when needed

■ Frequently asked questions about mental 

health

■ Information on when and where to access 

accommodations and free mental health 

services and supports.116

The NSCCC survey cited that 96 percent 

of campus counseling centers had websites: 

100 percent of websites provided information 

about center services, 

and 70 percent provided 

educational information 

on psychological issues.117

The Center for Mental 

Health Services funded 

the Center for Psychiatric 

Rehabilitation and NAMI’s STAR Center to collect 

and analyze web-based resources for college 

students who have mental health concerns. The 

Center for Psychiatric Rehabilitation reported the 

following preliminary trends in the provision of 

online promotional mental health material:118

■ All schools provide a similar range of 

services and share many of the same 

means of contacting students, but schools 

in different parts of the country target 

different mental health problems.

■ More than half of schools target depression, 

yet only slightly more than a quarter target 

suicide.

■ Schools located east of the Mississippi 

River target a wider variety of mental health 

challenges, yet regardless of where they are 

located, schools provide basically the same 

services.

■ Public schools both provide more services 

and target a greater number of mental 

health challenges than private schools.

■ Thirteen percent of all schools had no online 

resources for mental health issues.

While some people believe that listing 

accommodations in a transparent fashion for 

students to review could mislead students into 

thinking that they have a shopping list of services 

to choose from, doing so is intended to educate 

and empower students—when they know what is 

available, they have better 

opportunities to find what 

they need. Ultimately, 

college professionals and 

students collaborate on 

the necessary services.

Campus-Wide Conversations

One key approach campuses are taking to 

highlight mental health and integrate mental 

and physical health into the culture is using 

different communication strategies. These 

strategies include hosting public speakers and 

holding events, including national awareness 

campaigns on suicide prevention; mental health 

awareness days; and fun runs to raise money for 

depression, autism, and anxiety, among other 

issues.

Additionally, by openly discussing mental 

health issues and supports, college leaders create 

a culture where these discussions are the norm. 

As an example, one interviewee spoke of how a 

[B]y openly discussing mental 

health issues and supports, college 

leaders create a culture where these 

discussions are the norm

54 National Council on Disability
speech teacher asks students to give speeches 

on suicide prevention. College presidents could 

convene committees made up of students with 

disabilities, LGBTQ 

students, foster students, 

veterans, faculty, staff, 

and counseling center 

staff to understand the 

mental health challenges 

within their colleges and 

how to address them.

Universal Design

Research cites many benefits of applying a 

universal design approach to mental health 

promotion. This approach promotes mental 

health for all students, not just those with a 

specific mental health disability, and integrates 

mental health supports into everyday college 

activities (such as having advisors link academic 

success with mental 

health well-being). 

Universal wellness 

services and policies 

would benefit all 

students, removing 

liability for self-disclosure 

of disability and helping identify those with 

undiagnosed mental health disabilities.

Treating mental health as part of wellness 

for the entire campus would improve academic 

success and promote safety. One interviewee 

spoke of a spa center, available to the entire 

campus community, which offered a light 

Treating mental health as part of 

wellness for the entire campus 

would improve academic success 

and promote safety

Mental Health on College Campuses 55
room, meditation room, and individual and 

group therapy sessions, among other things. 

Participants would go to the spa in support of 

overall wellness, not just to target mental health 

disorder symptoms.

Student Engagement

Peer-to-Peer Support Services

Both students and practitioners reported that 

student-led groups and activities are key ways to 

address and reduce stigma.

The AUCCCD survey found the following:

■ Sixty-three percent of counseling directors 

reported that their campuses had a student 

mental health organization.119

■ Sixty-two percent of counseling directors 

reported that students are provided 

gatekeeper 

training (designed 

to increase the 

knowledge and skills 

to identify those at 

risk of mental health 

disorders and make 

referrals when necessary).120

■ Only 22 percent of respondents reported 

that students are directly involved in their 

counseling centers’ strategic planning.121

■ Sixty-nine percent of respondents reported 

that their counseling centers included 

students in outreach strategies.122

■ Thirty percent reported that campuses had 

trained peer counselors.123

Student-led organizations are bringing mental 

illness into the light to lower suicide rates among 

young people.124 Postsecondary institutions could 

train student leaders to counsel classmates, as 

some students may be uncomfortable meeting 

with a counselor or resident advisor, providing 

an alternative for students hesitant to seek 

support.125 Colleges would need to recruit a 

diverse group of students to serve as leaders. 

It is crucial for colleges to acknowledge and 

validate the unique experiences of students of 

color or students that reflect other populations 

by ensuring their representation within student 

leadership.

Student Voice

It is clear through the practitioner questionnaires, 

student questionnaires, and interviews that 

students play a key role in supporting their 

peers through formal and informal networks 

and by having a voice in campus policy, helping 

create a culture that normalizes discussion of, 

and support for, mental 

health challenges.

First, respondents 

believe that students 

should play an integral 

role in holding college 

leadership accountable. 

For example, the need for college and university 

leadership to create a committee on campus 

mental health was discussed. This committee 

would include a racially diverse group, including 

students with disabilities, LGTBQ students, 

foster students, veterans, faculty, staff, and 

counseling center staff. The committee would 

focus on understanding the scope of mental 

health challenges and how to address them. 

Including students as stakeholders in the 

decision-making process regarding the mental 

health services available on campus would 

increase trust among the campus leadership, 

mental health professionals, and students.

[S]tudents play a key role in 

supporting their peers through 

formal and informal networks and by 

having a voice in campus policy 

56 National Council on Disability
Second, the role of students beyond that 

of resident advisors, as peer support leaders, 

and the research on gatekeeper training 

programs suggests that training a high 

percentage of students on campus would 

help create a supportive peer environment. 

It is key to train students who represent 

campus diversity, and the training should help 

students recognize warning signs, question 

suicidal intent, listen to problems, and refer 

students for help.

Third, student-led organizations are a key 

formal structure in which students can support 

other students. Two such groups are Active 

Minds and NAMI on Campus. They raise mental 

health awareness on campus, educate peers 

and faculty about mental health challenges and 

supports, advocate for improved mental health 

services, and support fellow students. These 

student-run clubs can access a wide range of 

programming to support their work on campus.

Finally, campuses could expand 

nonprofessional support, such as informal 

networking groups of students, staff, and faculty. 

Increasing the number of informal networks 

around campus increases student connections, 

which is particularly helpful for students of 

color126 and other nonmajority groups.

Greek Life

Greek life offers many benefits to students. It 

promotes policies and procedures that support 

wellness and academic success and allows 

students to network and expand their social 

circles, develop leadership skills, and live in 

housing with a family structure.

Sororities and fraternities can play a key role in 

supporting the mental health of their members. 

Many chapters have engaged in campus-wide 

events and partnered with different organizations 

to give their members the mental health support 

they need, as well as to raise awareness on 

campus.

■ Kappa Alpha Theta started Sisters 

Supporting Sisters, “a mental health 

initiative designed to increase the dialog 

concerning support for all aspects of 

mental health, with the goals of creating a 

safe environment for members to discuss 

mental health issues, providing guidance for 

recognizing signs of and helping members 

with mental health challenges, and 

supporting members facing mental health 

challenges and disorders.”127

■ At Cornell University, the Greek 

system partnered with health services; 

representatives of chapters, named Health 

and Wellness Chairs, undergo training and 

meet every two weeks to inform their 

houses about wellness-related events and 

resources offered by the university.128

■ At Michigan University, the Greek Council 

sponsored a campus-wide mental health 

speak-out.129 The goal of the event was to 

raise awareness about mental health and 

allow for open discussions among students 

and faculty.

Social Media

Social media (e.g., Facebook, Twitter, and 

Snapchat) has drastically changed the student 

environment by allowing users to exchange ideas, 

feelings, and activities at an unprecedented 

rate. Teens and young adults heavily use social 

media—a large part of their social and emotional 

lives now happens on the Internet. Because 

social media is relatively new, few studies have 

Mental Health on College Campuses 57
examined its overall effect on users’ mental 

health and well-being.

Social media can have both negative and 

positive impacts on students. It could prompt 

unfavorable comparisons between peers.130

Students are likely to publish the most 

impressive and attractive versions of themselves, 

providing a false impression of how much happier 

or more successful they are than their peers.131

The natural inclination toward comparison can 

lead to anxiety in students and intensify their 

symptoms of mental health disorders. Negative 

feedback such as cyberbullying—or no feedback 

at all—can also increase anxiety.

Students surveyed were slightly more positive 

about social media (50 percent said it had a 

positive impact) but many (38 percent) still said 

it had a negative impact. The remaining students 

were not sure or did not think it had any impact. 

In discussing positive impact, students noted 

that social media can communicate favorable 

images of people with mental health challenges, 

raise awareness, and provide support. In 

discussing negative impact, many students 

reported that social media raises their anxiety, 

often through negative stories or because it is 

distracting.

Though social media may have some negative 

effects, colleges can harness its positive power 

in multiple ways. Universities are using social 

media to communicate with students and gather 

feedback on campus culture. Schools can use 

social media, email, and other platforms to reach 

students globally regarding available mental 

health services and supports and providing 

examples of success stories. Further, universities 

and students are using technology to reach 

“those who are struggling, from Facebook 

support groups and mental health apps to online 

therapy games.”132

One respondent discussed a situation where 

a student attempted suicide, and the only way 

the college was able to identify the student was 

by the pictures the student posted on Facebook: 

“It’s very vivid for me because it’s very impactful 

and frightening. The awareness and the value of 

social media as a connector and investigative tool 

is important. From a preventative standpoint, you 

can figure out what’s going on and it’s valuable.”

In an example shared in an article on the 

Huffington Post,133 a student at the University 

of Michigan posted a suicide note on the 

anonymous social media app Yik Yak. Immediately 

afterward, many students posted their support 

and advice. The school’s social media director 

contacted campus police and located the student 

within 24 hours.

58 National Council on Disability
Faculty and Staff Training

Both students and practitioners reported that 

training staff and faculty are key ways to address 

and reduce stigma. The assumption is that 

identifying students in need and referring them 

so that they receive the support they need, rather 

than reporting them so that they are penalized, 

would help provide more and earlier support. 

While faculty and staff can play important roles 

in supporting students, they must be adequately 

trained to identify students who may be 

experiencing distress, refer students, and provide 

reasonable accommodations.

As part of the CalMHSA Evaluation of 

Statewide Prevention and Early Intervention 

Initiatives, RAND 

conducted surveys of 

California college and 

university faculty, staff, 

and students during the 

spring and fall of 2013. 

The study found that 

53 percent of faculty and 

staff reported talking to 

students about mental health problems at least 

once in the six months before the survey. Prior 

to this survey, the California college system 

had launched campus-wide campaigns to train 

faculty and staff to support students with mental 

health problems. These trainings were offered 

throughout the academic year, at no cost, and 

in various locations. Eighteen percent of faculty 

and staff reported that they had participated 

in trainings in the preceding six months. While 

some faculty felt equipped to identify and refer 

students with mental health problems, less than 

40 percent of faculty and staff believed they had 

the skills to directly help students with mental 

health problems.134 Some faculty are talking 

to students, but those faculty do not feel well 

trained to do so.

Faculty and Staff Training to Identify 

and Provide Support to Students 

Who Have Mental Illnesses 

or Are Experiencing Extreme 

Emotional Distress

About an equal percentage of students 

interviewed believed that faculty and staff 

had received training (30 percent) as had not 

(28 percent). Other students noted that they 

thought some faculty had received some training 

(13 percent) and that faculty discussed mental 

health resources for students at the start of 

the semester (11 percent), which one student 

felt was likely part of 

training. The remaining 

19 percent did not know. 

Even among students 

who reported that 

faculty were trained, 

some believed that 

faculty were resistant to 

training, noting, “I think 

they do [receive training], some are just stuck in 

their ways.”

One counseling center staff member 

interviewed noted that faculty and staff at 

her university understood that they are not 

prepared to help students, noting that “faculty 

are recognizing their own inadequacies and 

understanding how to reach out with compassion 

and sensitivity.” She noted that she is working 

closely with the faculty senate on how to 

help faculty become “more comfortable and 

competent in terms of helping students who are 

looking like they are having problems.”

Another counseling center staff member 

interviewed reported,

[I]dentifying students in need and 

referring them so that they receive 

the support they need, rather than 

reporting them so that they are 

penalized, would help provide more 

and earlier support

Mental Health on College Campuses 59
Oftentimes, what’s happening is that 

professors or faculty just send students 

to our CARE Team instead of talking to 

them and trying to figure out what’s going 

on. The CARE Team is really tied to the 

university’s prevention of school shootings. 

So, accommodations are being provided 

through a process that’s very clunky, not 

person-centered, and very “shamey.” We are 

moving in the right direction, though. We just 

trained all of the academic advisors [here]. 

There are also some faculty and staff who 

are self-disclosing and this disclosure starts 

a conversation that normalizes and takes 

away the classism of talking about mental 

health. —Counseling center staff member

However, the same counselor noted that 

some trainings are not effective and in fact 

contribute to stigma and fear:

I actually attended a training because I was 

going to teach a college success class 

focused on exactly where students are 

coming from. In the training I attended, they 

completely correlated mental health with 

“safety” and “reporting” of students—it 

was really terrible. —Counseling center 

staff member

The NSCCC survey found that 64 percent of 

counseling center directors reported spending 

more time training faculty and others on campus 

to respond to students in distress and to make 

more appropriate referrals. This was the highest 

response to the question of what actions the 

center has taken due to increased student 

demand.

While gatekeeper training programs, which 

develop individuals’ “knowledge, attitudes, and 

skills to identify [those] at risk, determine levels 

of risk, and make referrals when necessary,”135

seem to make a lot of sense, few such efforts 

have been empirically evaluated. Osilla et al.136

examined more than 250,000 teachers, students, 

and staff in California’s kindergartens, elementary 

schools, high schools, and colleges who had 

been trained to recognize students in distress 

and connect them to resources. They found 

preliminary evidence that such trainings were 

helpful in increasing participant confidence in 

their ability to intervene and refer. Although this 

study examined K–16, the authors note that 

this finding was consistent across the higher 

education system and across a diverse group of 

training participants. Programs such as Mental 

Health First Aid, Jed Program training, and QPR 

(Question, Persuade, Refer) have been found to 

be of great benefit.

Faculty, Staff, and Academic Advisors

As noted, many students are not seeking help for 

fear of being stigmatized, and many do not feel 

an urgent need for help when in fact they may be 

under considerable distress. Gatekeeper training 

programs, which are proactive in identifying 

students in need of help and encouraging them, 

can assist in these cases. The training can 

also be integrated into what is already routine 

for students, such as meeting with academic 

advisors. Further, seeing the link between 

academic success and mental health wellness 

might encourage students to act.

In addition to training advisors who have 

a touchpoint with students, training faculty 

members to understand what to look for 

and how they can help is important. Faculty 

may see students multiple times each week, 

so helping faculty recognize key indicators 

60 National Council on Disability
(e.g., the students’ grades dropping, students 

missing classes) and make referrals is important.

The AUCCCD Annual Survey collected more 

than 500 responses from counseling center 

administrators to understand the status of 

staffing, practice, services, and staffing trends 

and demographics.137 Only 58 percent of 

respondents indicated faculty and staff training 

as an area that represents an integral part of 

their counseling services’ missions.138 Beyond 

faculty and staff, training is needed at all levels 

of the university (e.g., resident assistants, 

administrators, and students).

Faculty and Staff Training on Mental 

Health Issues and Reasonable 

Accommodations

Although faculty are required to provide 

reasonable accommodations by law, evidence 

that this occurs is mixed. 

Both practitioner and 

student interviewees 

noted that faculty 

members are sometimes 

resistant to providing 

accommodations. 

Research has found 

that some instructors are concerned that 

accommodations might compromise the 

academic integrity of their courses.139 Faculty 

members sometimes consider accommodations 

to be unfair advantages to students, rather than 

designed to provide equal opportunity. These 

mistaken beliefs reflect a lack of knowledge 

about disabilities and assistive technology.140

Further, faculty have been found to be more 

willing to provide accommodations for students 

with physical and sensory impairments than 

those with invisible disabilities, such as psychiatric 

impairments.141 “Both faculty and students 

report that instructors and administrators need 

training to help them better understand their legal 

obligations to provide academic accommodations, 

strategies for communicating with and teaching 

students with disabilities, and resources to help 

them provide accommodations for their students 

with disabilities.”142

According to questionnaire respondents, 

“most faculty are flexible and willing to bend 

requirements. But there are a few who are very 

rigid, and for those individuals, intervention in 

the form of policy requirements are needed in 

the form of spelling out what they must do to 

accommodate those students.” In addition, some 

“faculty do not understand that mental health 

can (and does) get in the way of attending class 

and completing assignments. There needs to 

be a system or procedure for this that does not 

overly tax the disability 

administrators AND 

doesn’t put the student 

in the middle position 

of negotiating their own 

accommodations in 

this area.”

Suicide Prevention

Suicide is a major concern on college campuses 

because it is the second leading cause of 

death of college students. Many campuses 

are engaging in suicide prevention efforts. 

Model Suicide Prevention Plans include those 

promoted by the JED Foundation,143 the Suicide 

Prevention Resource Center,144 Mental Health 

First Aid USA,145 and QPR.146 Some campuses 

are taking advantage of SAMHSA’s Garrett Lee 

Smith Campus Suicide Prevention Program, 

which provides limited funding to colleges to 

Faculty members sometimes 

consider accommodations to be 

unfair advantages to students, rather 

than designed to provide equal 

opportunity

Mental Health on College Campuses 61
identify students who are at risk for suicide and 

suicide attempts, increase protective factors that 

promote mental health, and reduce risk factors 

for suicide. Eels et al. describe a public health 

approach to campus mental health promotion 

and suicide prevention, which also highlights the 

need to restrict access to the means of suicide.147

Crisis Management Plan in Place

Practitioner interviewees noted that most 

colleges, motivated by safety concerns, had 

crisis management plans in place. After the 

Virginia Tech tragedy, colleges discovered that 

they were ill equipped to handle crisis events 

such as shootings. They then formed Behavioral 

Intervention Teams (BIT) for the assessment 

of threat of violence and Care and Concern 

Committees to address mental health concerns. 

Supplemental research is needed to measure the 

effectiveness of the current BIT structures and 

the overall functioning of the Care of Concern 

Committees. One important point is to ensure 

that colleges do not automatically label students 

with mental health disabilities as violent since 

these students tend to be withdrawn.

The interviewed students either reported that 

there was a crisis management plan in place at 

their schools (57 percent), they were not sure 

(23 percent), or they did not think there was a 

plan in place (19 percent). Most students reported 

that the crisis management plan was a crisis or 

suicide hotline; only a handful mentioned that 

psychiatrists were available in the event of a crisis 

or that they had participated in an active shooter 

training session. Only two students reported that 

their college had a Student Behavior Team, which 

was responsible for crisis management and 

plans. These responses indicated that students 

were not very aware of their college’s plans.

Behavioral Intervention Teams

The formal establishment of care teams and BITs 

that try to identify students who are struggling or 

pose some threat to themselves are a promising 

trend. A BIT is “a multidisciplinary group whose 

purpose is meeting regularly to support its target 

audience (students, employees, faculty, and 

staff) via an established protocol. The team tracks 

‘red flags’ over time, detecting patterns, trends, 

and disturbances in individual or group behavior. 

The team receives reports (from coworkers, 

community members, friends, colleagues, etc.) 

of disruptive, problematic, or concerning behavior 

or misconduct and investigates, performs a 

threat assessment, and determines the best 

mechanisms for support, intervention, warning 

and notification, and response. The team then 

deploys its resources and coordinates followups.”148

The National Behavioral Intervention Team 

Association administered a survey which was 

completed by 313 colleges in 2016. It found 

that 97 percent of colleges had BITs, and that 

the BITs had been in existence for six years on 

average.

Sokolow and Lewis149 laid out 12 best 

practices for second-generation BITs, as 

compared with first-generations BITs, which 

were short-term problem-solvers. Secondgeneration BITs include a role nominally 

addressing threats but primarily supporting and 

providing resources to students, being guided 

by formal protocols and rubrics for assessment, 

training and educating the community on what 

and how to report, developing comprehensive 

databases that provide a longitudinal view of 

student behavior patterns and trends, focusing 

not only on student-based risks but also on 

faculty and staff, and intentionally integrating with 

62 National Council on Disability
campus risk-management programs and riskmitigation strategies.

Note that a Care and Concern Team is different 

from a BIT. BITs analyze and process threats 

while Care and Concern Teams respond to 

student mental health challenges. One responds 

to safety protocols and the other to mental health 

interventions.

Pedagogy

List Service Sites and Accommodation 

Policies on Class Syllabi

As another way to reduce stigma around mental 

health, all course syllabi could have a standard 

section that includes statements for students 

with physical or mental health disabilities, 

including why and where to seek support and the 

procedures to take time off. However, according 

to an interviewee, there is often pushback on 

such simple changes:

Every year I fight 

to get our faculty 

to include language 

in their syllabi, but 

our Academic Dean 

forwarded the email 

with “I have been asked by the Office of 

Disability Service to forward this to you.” 

Are we working as hard as we should to 

reduce stigma? No.

Faculty Discusses Stress

Faculty talking openly about mental health issues 

is very important. One interviewer related, “I was 

impressed when we dropped our oldest daughter 

off at college a couple of months ago, and the 

head of the student body said, ‘You’re going to 

hear about how everyone is proud of you, but 

I’m going to talk to you about how hard it is.’ He 

normalized feeling overwhelmed, depressed, 

etc.—he put it out in the open. He made it 

normal to go see a therapist.”

Integrate Stigma Reduction and 

Help-Seeking into Classes

Interviewees suggested incorporating mental 

health discussions into curricula to reduce 

stigma. Faculty should be able to easily integrate 

this type of material into their content areas. 

One respondent suggested creating a general 

education course requirement about mental 

health issues.

Increased Access: Multiple 

Touchpoints

Interviewees argued for multiple ways for 

students to access services. For some students, 

going to a mental health office is very scary. 

Creating a safe venue 

where students with 

mental health disabilities 

can access services 

and not feel singled out 

is key. Services should 

be designed to provide 

students with multiple on-ramps to treatment—

telephone, chat, in-person, online. The goal is 

to meet students where they are and get them 

into services as needed. Institutional levels of 

service availability need to be clearly articulated 

(everyone needs to know what is available) to 

allow students to make the right choices.

Anchor Adults

The inaugural Gallup-Purdue Index, a joint 

research effort with Purdue University and the 

Lumina Foundation to study the relationship 

[A]ll course syllabi could have 

a standard section that includes 

statements for students with physical 

or mental health disabilities 

Mental Health on College Campuses 63
between the college experience and college 

graduates’ lives, found,

The support and experiences in college 

had more of a relationship to long-term 

outcomes for these college graduates. 

For example, if graduates recalled having 

a professor who cared about them as a 

person, made them excited about learning, 

and encouraged them to pursue their 

dreams, their odds of being engaged at 

work more than doubled, as did their odds 

of thriving in all aspects of their well-being.150

Respondents discussed the role of “anchor 

adult” in supporting students with mental 

health challenges. Respondents agreed that 

students need a sense of 

belonging and connection 

with someone on 

campus. Students who 

have a meaningful 

connection with at least 

one adult are more likely 

to graduate and be successful. This core element 

is found in most retention theories. Anchor adults 

can also proactively connect students to services 

and resources. This demand for an anchor adult 

suggests emphasizing training for college faculty 

and staff to serve effectively in this role.

College Chaplain

The role of the chaplain was not discussed by 

respondents, but college and university chaplains 

do play a role in providing support to students. 

Studies with college students outside the United 

States have found that chaplains often meet 

with students suffering from depression or other 

mental health disabilities.151 College students 

often find comfort from a group where they can 

practice their faith, and groups can be a place 

to get counseling in conjunction with medical 

treatment for depression. Students can check 

with their schools’ chaplains or religious leaders 

to see if spiritual counseling is available. Further, 

college and university chaplains are likely to 

meet with students in the campus community 

who are grieving. They should serve on campus 

postvention152 committees, assisting with 

coordinating the appropriate messaging to the 

community.

Coordinated Support

It is important for the office for students with 

disabilities, the counseling center, academic 

departments, student support, and other groups 

to work together. Faculty, students, and the 

entities that support 

students, including 

the Greek system, 

need better training 

and communication. 

Currently, these 

offices do not 

typically communicate unless there is a crisis. 

Coordination among these entities would allow 

colleges to provide better outreach to at-risk 

students, offer a diverse group of service 

providers and supports, and offer wraparound 

services. If the groups met frequently, colleges 

could establish a student of concern network that 

would be able to address a broader spectrum of 

mental health issues.

Case Management Approach

A new best practice is for colleges and 

universities to hire case managers to provide 

resources to students in distress, thus freeing up 

mental health counselors to provide treatment. 

The case management approach allows for much 

better oversight and follow-up with the student 

A new best practice is for colleges 

and universities to hire case 

managers to provide resources to 

students in distress 

64 National Council on Disability
resource process. Case managers ensure that 

students have different touchpoints with college 

and university resources. They coordinate care 

and communication for students across the 

different services the colleges have available. 

They make sure there is no duplication in the use 

of resources. They can be liaisons for students 

who are on LOAs. In addition, case managers 

are community liaisons, maintaining relationships 

with community providers and keeping databases 

showing who is taking clients and who accepts 

student insurance. Further, case managers can 

serve on college-wide committees, including 

BITs. One student interviewed noted the need 

for “case managers at every school. We need 

people to be checking in 

on us and see how we’re 

doing. We have academic 

advisors—high risk 

students need emotional/

mental ones too!”

Parent and Family Programs

Respondents noted an expansion in parent and 

family programs over the last decade. Parents 

are often the strongest advocates for their 

own children in terms of access to services. 

Campuses now recognize that family members 

are an important part of students’ mental health 

and are trying to include them. For example, 

NAMI chapters host mental health awareness 

classes on many college campuses to teach 

family members how to best support their 

college-aged children.

Telecounseling

Few colleges offer mental health services online. 

Only 10 percent of college directors reported 

that their colleges provide clinical services 

by telephone.153 However, this is up from just 

under seven percent in 2013–2014. Colleges 

are now using online and texting tools to make 

mental health services more accessible. While 

not intended to replace in-person counseling, 

the goal is to reach students who would not 

otherwise receive any counseling. For some, 

going to a mental health office is very scary—

some students indicated that they want chat lines 

or texting lines. For others, “therapy via webcams 

is a great idea for people like me who physically 

have issues getting to therapy and sitting for a 

therapeutic hour.”

Research is still under way to determine the 

effectiveness and best uses for telecounseling. 

Respondents believe that it is a promising 

way to supplement 

in-person counseling 

and that it seems to be 

effective for treating 

anxiety. The key is to 

increase access, making 

it more likely students get the treatment they 

need. In this respect, telecounseling holds 

great promise, especially for rural areas and 

special populations, such as students with 

physical disabilities. Programs have included the 

following:

■ TAO Connect: The University of Florida’s 

Counseling and Wellness Center Therapist 

Assisted Online (TAO) program delivers 

therapy to students with anxiety disorders 

via a computer or smartphone. TAO is a 

seven-week program that “‘consists of 

several modules that teach students to 

observe their anxiety, live one day at a time, 

and face fears. Students also have weekly 

10- to 12-minute video conferences with 

counselors as well as homework that they 

do via an app. They even get text message 

Few colleges offer mental health 

services online. Only 9% ... prov

clinical services by telephone

Mental Health on College Campuses 65
reminders to prompt them to complete 

their assignments,” says Sherry Benton, 

Ph.D., the former director of the University 

of Florida counseling center who led TAO’s 

development.154

■ The University of Southern California 

TelehealthTM program is a completely virtual 

counseling and therapy clinic that uses 

online and video technologies to serve 

a diverse set of students. Students can 

connect with high-quality counseling and 

therapy providers from the comfort and 

security of their homes or other private 

locations.

■ The National Technical Institute for the 

Deaf uses technological advances to help 

DHH students. Practices include video 

relay and video remote interpreting, which 

can support counseling sessions. Access 

to sign-fluent clinicians is made possible 

through computer screens. This is only 

newly available because of increases in 

bandwidth to accommodate motion and not 

just voices.

Substance Use Recovery Center 

on Campus

SAMHSA’s 2012 National Survey on Drug Use and 

Health 155 found the following:

■ College students aged 18 to 22 were more 

likely than their peers who were not enrolled 

full time (i.e., part-time college students and 

persons not currently enrolled in college) 

to report current, binge, or heavy drinking. 

Among full-time college students in 2012, 

60 percent were current drinkers, 40 

percent were binge drinkers, and 14 percent 

were heavy drinkers, compared with 52, 35, 

and 11 percent, respectively. This pattern 

has remained consistent since 2002.

■ In 2012, the rate of current use of illicit 

drugs was 22 percent among full-time 

college students aged 18 to 22. This rate 

was similar to that of other persons aged 

18 to 22 (24.0 percent), including part-time 

college students, students in other grades 

or types of institutions, and nonstudents.

According to one interviewee:

We have a recovery program on our campus 

that is sort of a national trend. In 2015 we 

got a grant to start a collegiate recovery 

program. We hired some staff and we’ve 

started this. At the very top it’s SAMHSA. 

Funds were funneled through Governor’s 

office, then department of mental health 

and substance use.

Sometimes, substance use results in 

charges or results in students having to 

leave the university. For some of these 

66 National Council on Disability
students, some of the most effective 

mental health care that they’ll ever have 

will be on this campus. Forcing students 

to leave school where they don’t have 

access to this is really doing the students 

a disservice. Substance use—seeing this 

as a particular person’s fault rather than as 

an illness is a stigma. —College counseling 

center staff member

Collegiate Recovery Programs are an 

emerging trend, designed to provide a peer 

and professional support network for students 

recovering from 

alcohol and other drug 

dependency.156 Many 

Collegiate Recovery 

Communities are 

currently participating 

in a survey, led by Texas 

Tech University, to create 

a national collegiate 

recovery database.157

Partnerships with Mental Health 

Providers in the Community

Colleges are becoming very good at recognizing 

when they do not have the capacity to support 

students and, when this is the case, developing 

partnerships with community providers. 

Colleges and universities generally provide 

short-term services to students and, if they have 

connections with community-based clinics, refer 

students for assistance with long-term needs. If 

there is a fee for service, it is helpful if colleges 

offer a voucher system for off-campus mental 

health services. In colleges that use the casemanagement model, case managers are often 

responsible for managing relationships with 

community-based providers. Case managers also 

help students transition to off-campus services, 

which is especially necessary for students who 

are not from the community and lack a way to 

determine which provider would be best for 

them. Fifty percent of the students interviewed 

reported that they were aware or thought 

that their colleges had some relationship with 

community mental health providers, 44 percent 

were not sure, and six percent did not think their 

colleges had these relationships.

In addition to providing services to students, 

community organizations have trained college 

faculty, staff, and students. For example, one 

respondent noted that 

community partners, 

such as New Avenues 

for Youth, come to the 

college to offer training 

and workshops on 

supporting youth with 

mental health challenges.

Colleges and universities have also 

developed partnerships with law enforcement 

and county mental health entities to streamline 

the mental health threat assessment process. 

A model practice is the L.A. County Department 

of Mental Health School Threat Assessment 

and Response Team. All California colleges 

and universities in L.A. County are eligible to 

participate.

Some colleges and universities, however, 

do not have local community resources to 

turn to; those resources focus on different 

demographic groups (the needs of a college 

student are different from those of a 12-yearold or a 40-year-old), organizations are unable 

to provide services, or transportation is not 

provided and students have difficulty reaching a 

local provider.

Colleges are becoming very good 

at recognizing when they do 

not have the capacity to support 

students and, when this is the 

case, developing partnerships with 

community providers

Mental Health on College Campuses 67
Other Organizational Collaborations

College Collaboration

As an African proverb cited by an interviewee 

states, “If you want to walk fast, walk alone. 

If you want to walk far, walk together.” In 

the face of increasing student mental health 

needs, interviewees highlighted the need 

for colleges to collaborate internally with oncampus student services and academic affairs 

programs to create a web of support as well as 

externally with community-based organizations, 

county organizations, and other colleges to 

work together toward common mental health 

support goals. Successful teamwork is essential 

if colleges are to fully meet the mental health 

needs of their students.

One example of successful collaboration is 

the California Community College (CCC) Student 

Mental Health Program.158

The statewide program 

is funded by CalMHSA, 

developed when the state’s 

voters approved Proposition 

63, which levied a one 

percent tax on millionaires 

to support mental health efforts in the state. 

A percentage of the CalMHSA revenue went to 

support campus-based mental health programs 

in California colleges. The CCC Student Mental 

Health Program works with colleges throughout 

the state to build strong collaborations within 

colleges, between colleges, and between 

community mental health departments. The 

program also developed a collaboration toolkit, 

which is available at the CCC Student Mental 

Health Program website.159 One collaboration 

was the Building Healthy Communities Initiative 

in Los Angeles, California, in which college and 

Department of Mental Health partners agreed 

on multiple strategies to support students. These 

strategies ranged from cross-participation on 

committees in each organization, populationspecific mental health services for different 

populations, strategies for increased access to 

services, faculty and staff training, inclusion of 

student voice, and parity between physical and 

mental health budgets.160

College Collaborations with Other 

Organizations

Other successful collaborations include those 

between colleges and universities and NAMI 

and Active Minds. In 2011 NAMI conducted a 

survey161 to identify important mental healthrelated issues for students; an overwhelming 

majority of survey respondents said they were 

no longer in college (attendance stopped within 

the past five years) and 

were not attending college 

because of mental healthrelated reasons. They 

identified factors that would 

support students remaining 

in school, including: receiving 

accommodations (e.g., tutoring, books on tape, 

lower course loads, help with communicating 

their needs to professors or online classes); 

accessing mental health services and supports on 

campus; connecting with mental health providers 

earlier; availability of peer-run support groups; and 

assistance with medical bills and transportation.

Respondents also shared that colleges could 

keep students with mental health challenges in 

school by doing the following: publicizing available 

accommodations, services, and supports on 

and off campus; encouraging students to get 

help before issues grow; sharing resources and 

strategies for addressing mental health issues 

“If you want to walk fast, walk 

alone. If you want to walk far,

walk together.

—African proverb

68 National Council on Disability
and staying in school; proactively reaching 

out to students who are struggling; reducing 

burdensome paperwork needed to get help; 

not penalizing students or revoking financial aid 

because of mental health issues; encouraging 

peer support and clubs; and asking about and 

addressing barriers to getting help.

Respondents also shared tips on the 

following: disclosing disability; raising awareness, 

including pertinent information on college 

websites; improving accommodations; improving 

disabled student program services; improving 

campus mental health care on campus; reducing 

stigma; supporting students; and addressing and 

preventing crises.162

Other important collaborations are between 

colleges and entities such as the Jed Foundation 

and the Clinton Health Matters initiative, 

which assist colleges and universities in 

creating more comprehensive solutions to help 

students maintain healthier and safer learning 

environments.

Postvention

Regarding services provided to students, 

faculty, and staff following a traumatic event, 

respondents reported that policies vary widely 

across schools and that services are often 

inadequate. In the event of suicide, a “contagion 

effect” is likely among young people in contained 

communities such as college campuses.163 Thus, 

adequate postvention plans are critical to prevent 

further occurrences. While schools mostly have 

policies in place for specific traumatic events 

such as an active shooter, support services 

are typically only increased in the immediate 

aftermath of these events.

A best practice mentioned by multiple 

respondents was delivery of a coordinated crisis 

management response by pooling different 

resources across campus and creating a 

community support team,164 which can provide 

necessary support in the aftermath of a traumatic 

event when confusion is common and services 

are most needed. These teams often comprise 

diverse groups across the campus, including 

academic support staff, students, and mental 

health professionals, and create relationships 

with law enforcement and mental health units 

at local hospitals. These teams demonstrate 

that it is not always necessary to rely solely on 

trained mental health professionals, and that 

peer support groups of fellow students and staff 

can be helpful and cost-effective. The key to 

effective community support teams is training to 

ensure that teams understand the basic policies, 

procedures, and mental health concerns of their 

campuses. These community teams offer support 

and maintain stability for the campus community, 

mainly through meetings to share information 

and resources.

Finally, postvention plans must include 

opportunities for iterative evaluation and 

modification of the college’s assessment, 

prevention, and intervention policies.165

Considering the Needs of Diverse 

Populations

Research highlights the unique stressors that 

impact a number of student populations, and 

colleges should ensure they consider the needs 

of these populations when developing and 

providing mental health services

Students of Color

Some studies suggest that students of color 

face higher levels of mental health difficulties 

compared with White peers166 due to the 

Mental Health on College Campuses 69
impact of racial discrimination,167 stigma, the 

tendency for students of color not to engage 

in help-seeking behaviors as often as their 

White peers,168 and issues related to the lack of 

culturally relevant support services.169 Students of 

color are also more likely to discontinue mental 

health services prematurely.

Foster Youth

Foster youth are twice as likely as nonfoster 

youth to have contemplated suicide in the past 

12 months and almost four times as likely to have 

attempted it.170 Eighty-five percent of foster youth 

live with serious mental 

health challenges,171

more so than nonfoster 

peers.172 These mental 

health problems may 

interfere with the ability of former foster youth 

to succeed in school, particularly if the treatment 

they received while in care is discontinued after 

emancipation—a common occurrence.173

International Students

The number of international students studying 

at U.S. colleges and universities has grown 

steadily since the 1950s. While all students 

experience academic and personal pressures, 

international students face unique academic 

and social challenges that increase the potential 

for stress.174 Stressors include language 

barriers, financial pressures, and isolation from 

family and friends. Since the stigma of mental 

illness is greater in many countries than it is 

in the United States, culture may be an added 

barrier to students accessing mental health 

services.175 Hyun et al. analyzed 551 surveys from 

international graduate students at one university 

asking about the prevalence of mental health 

needs, students’ knowledge of mental health 

services, and students’ use of on- and off-campus 

counseling services. They found that 44 percent 

of international graduate students reported 

experiencing a stress- or emotion-related problem 

affecting their health and well-being.176

Veterans

Colleges are seeing the largest number of 

student veterans since World War II because 

of the financial support provided by the post9/11 GI Bill. Veterans may come to colleges 

and universities with serious mental health 

challenges or traumatic 

brain injuries. Veterans 

commonly report 

problems associated 

with academic demands, 

socialization with peers, and limited access to 

services in postsecondary institutions.177 Veterans 

also face stressors such as transitioning to a 

new environment and feeling out of sync with 

fellow students due to age and experience. 

Research cites that current veterans face 

dropout rates as high as 88 percent.178 It is fairly 

common for student veterans to experience 

cognitive impairments such as disruption in 

attention or verbal memory or challenges 

with new learning.179 More than 50 percent of 

veterans believe their deployments increased 

their personal stress levels, 32 percent believe 

their combat experience changed the way they 

learned, and 11 percent marked “my combat 

experiences now interfere with my participation 

in education”180 on the survey. Furthermore, 

according to an interview with Student Veterans 

of America, underreporting of disabilities is 

common among veterans, and testing for learning 

disabilities is costly and often difficult to receive.

85% of foster youth live with serious 

mental health challenges 

70 National Council on Disability
Sexual Orientation and Sexual Identity

Since 2000, the number of college students 

who identify as LGBTQ has roughly doubled.181

These students have higher risks and 

stressors when compared with traditional 

students. In a recent survey of 10,000 youth, 

LGBTQ youth were nearly twice as likely 

as non-LGBTQ youth to report having been 

excluded by peers at school, twice as likely to 

have been verbally harassed at school, three 

times as likely to feel that they do not fit in, 

and one-third less likely to report having an 

adult they can turn to for help.182 The 2015 

Cooperative Institutional Research Program 

(CIRP) Freshman Survey reported on 141,189 

freshmen entering 199 four-year U.S. colleges 

and universities.183 They found that students 

who identify as lesbian, gay, bisexual, queer, 

or “other” (LGBQ/other) more frequently have 

felt overwhelmed and depressed in the past 

year compared to their heterosexual/straight 

classmates. Students identifying as queer 

were the most likely to have felt overwhelmed 

(64 percent) and depressed (46 percent) in 

the past year. Further, while more than half 

(53 percent) of heterosexual/straight students 

rate their emotional health as either “above 

average” or in the “highest 10 percent,” 

just 25 percent of LGBQ/other students 

reported the same.184 Further, compared 

to heterosexual students, sexual minority 

students had higher rates of psychological 

distress (26 percent versus 18 percent), were 

more likely to report academic impairment 

related to mental health problems (17 percent 

versus 11 percent), and reported higher 

overall levels of stress over the past month 

(63 percent versus 55 percent).185

Finally, transgender university and college 

students are at a significantly higher risk 

for suicide attempts when their campus 

experience includes being denied access to 

bathrooms and gender-appropriate campus 

housing. Using data from the National 

Transgender Discrimination Survey (NTDS), 

the largest survey of transgender individuals 

conducted in the United States, Seelman found 

that 47 percent of transgender individuals 

participating in this study had a history of 

attempted suicide, and that rate was even 

higher for those who had been denied 

access to bathrooms (61 percent) or genderappropriate campus housing (61 percent).186

Because there are an increasing number of 

students who identify as LGBTQ on college 

campuses, and they have unique mental health 

stressors, this requires a corresponding increase 

in the availability of mental health services to 

support them.

Mental Health on College Campuses 71
Students with Disabilities

In the last two decades, the number of students 

with disabilities on college campuses has 

doubled.187 Students with physical, mental, 

and learning disabilities are at higher risk for 

mental health problems than those without such 

disabilities and typically have higher rates of 

depression and more thoughts and attempts of 

suicide.188 Additionally, students’ risk for suicidal 

behavior has been shown to be higher if the 

disability is less visible.

Students with disabilities face similar 

problems to those experienced by other 

students, except their 

problems are often 

compounded by unique 

factors that cause 

additional stress, such 

as lack of access to 

accommodations and/

or modifications that 

allow them to have 

equal access and participate on equal footing 

with students without disabilities; prejudice 

and discrimination; and the daily challenges of 

a disability.

Graduate Students

Graduate students face unique stress and 

challenges compared with undergraduate 

students, including an increased risk for 

social isolation and consequences of stigma 

when working closely with faculty whose 

recommendations are crucial for career 

advancement.189 In one study at a large 

university, nearly half of the graduate students 

surveyed (45 percent) reported having an 

emotional or stress-related problem in the 

past year, and over half of the respondents 

(58 percent) reported a colleague with a similar 

problem.190 A survey of law students across 

15 law schools found that 17 percent of law 

students screened positive for depression, 

23 percent screened positive for mild to 

moderate anxiety, and 14 percent screened 

positive for severe anxiety.191

Community College Students

CalMHSA and RAND Corporation research 

found that CCC students, compared with 

their four-year state school counterparts, had 

higher rates of impaired academic performance 

due to mental health 

issues; received less 

information from their 

campuses about mental 

health and wellness; 

received and used half 

the number of mental 

health referrals; and 

most often had to be referred to community 

mental health resources due to the lack of 

on-campus resources.

Despite the challenges among students at 

community colleges, a 2012 American College 

Counseling Association (ACCA) study involving 

294 community college counselors found that 

fewer than 13 percent of community colleges 

provided psychiatric services for students.192

By contrast, 56 percent of four-year colleges 

and universities offered on-campus psychiatric 

services.193 The lack of psychiatric care was 

a concern because many community college 

students were at an increased risk for mental 

health problems compared with their traditional 

university student counterparts.194

... [In a study involving 2

community college counselors], 

fewer than 13 percent of community 

colleges provided psychiatric 

services for students

72 National Council on Disability
Student Athletes

Student athletes face many of the same 

challenges as their nonathlete peers; however, 

they are exposed to an additional set of 

risk factors, including less time to focus on 

schoolwork, pressures to perform at the 

highest level in their sport, and a culture that 

encourages risk behaviors and discourages 

help-seeking.195 Student athletes, coaches, 

and staff tend to minimize mental disorders 

or mental stress because of expectations of 

strength, stability, and “mental toughness” 

inherent in the sports culture. Thus, student 

athletes often do not disclose mental health 

concerns for fear of being perceived negatively 

by teammates or coaches.

Mental Health on College Campuses 73
74 National Council on Disability
Chapter 8. Full Findings and Recommendation

The findings of this study demonstrate that 

student mental health services are needed to 

support the mental well-being of students and 

important for academic success and retention—

but resources are lacking and barriers are 

prevalent. It is vital that Congress make additional 

resources available to colleges and universities 

to support their mental health services and 

supports. The policy recommendations that 

follow are aimed at ensuring student success by 

removing barriers that prevent college students 

with mental health disabilities from participating 

and succeeding in college and, consequently, 

employment.

Recommendations to Congress

Lack of financial resources are a major barrier to colleges in meeting the mental health needs 

of their students. NCD commends Congress for passage of the 21st Century Cures Act, 

which broadens the criteria by which institutions of higher education may receive grants 

for mental and behavioral health services, and authorizes an increased appropriation of 

$2,000,000 per year for fiscal years 2018–2012. The allowable uses of grant funds correspond 

very closely with the findings and recommendations in this report, including the need for 

training of students, faculty, and staff; increasing mental health prevention and treatment 

services; outreach to students about mental health services; linking college mental health 

services to community mental health providers; and hiring appropriately trained mental 

health staff.

Recommendation: Congress should fully fund Section 9031 of the 21st Century Cures 

Act (mental health and substance use disorder services on campus) to assist colleges in 

addressing the increased need for mental health services and supports for students.196

Recommendation: Congress should make federal financial assistance to colleges 

contingent on colleges implementing a mental health program, just as federal law makes 

federal financial assistance contingent on a college’s implementation of a program to prevent 

student use/abuse of illicit drugs and alcohol.197

(continued)

Mental Health on College Campuses 75
Recommendation: Congress should increase funding for the Garrett Lee Smith Campus 

Suicide Prevention Program.

Finding 1: Multiple restrictions in the provision of federal and college financial aid 

negatively impact the ability of students with mental health disabilities to complete 

their postsecondary education.

Practitioners and students noted that multiple restrictions in the provision of financial aid 

negatively impact the ability of students with mental health disabilities to succeed in school.

Many students with mental health disabilities are unable to complete full-time course loads 

and are much more successful taking one or two courses at a time. Students with lightened 

course loads are at risk of not completing their education within the 12-semester limit of 

Pell Grants and are therefore in danger of losing financial aid. Further, colleges are held 

accountable to students completing degrees within this time frame, so the pressure falls on 

students with mental health disabilities to take full loads even though it is not in their best 

interest to do so.

Students are required to maintain a certain GPA or lose their scholarships or financial aid. 

Students with mental health disabilities who are unable to uphold their GPAs because of 

their disabilities, or who are on medical leave due to their disabilities, are at risk of losing 

scholarships and must begin loan repayments if their LOA is longer than the grace period to 

begin paying their loan.

Borrowers do not have to begin repaying most federal student loans until a semester 

or a year after graduation when they have had time to get financially settled, determine 

expected income and expenses, and select a repayment plan. However, the unemployment 

rate of many individuals with mental disabilities is high at graduation and beyond, and the 

loan amounts are also high because of longer degree completion time frames. Thus, loan 

repayment is very burdensome for individuals with mental disabilities.

Recommendation: Congress should amend the Higher Education Act to extend the 

length of time a student with a disability is eligible for federal financial aid when, due to 

the disability, a student needs more time to complete degree requirements than is allowed 

under federal financial aid time parameters.

Recommendation: Congress should amend the Higher Education Act to allow students 

whose disabilities cause them to require additional semesters of financial aid to retain their 

eligibility for Pell Grants beyond 12 semesters.198

Recommendations to Congress, continued

76 National Council on Disability
Recommendation: Because college students with disabilities may require a medical LOA 

that extends past six months while they are pursuing a degree, Congress should amend 

the Higher Education Act requirement that loan repayments begin 6 months after leaving 

college,199 to allow a time extension as a disability-related accommodation.

Recommendation: Congress should substantially increase Pell Grants to provide 

opportunities to students with disabilities who are disproportionately low-income to attend 

and achieve higher education.

Recommendations to Congress, continued

Recommendations to ED

Finding 2: The U.S. Department of Education has not provided guidance to colleges on 

how to respond to students that pose a threat to themselves.

The regulations under Title I of ADA expressly recognize that employers need not 

accommodate employees who pose a “direct threat” to the health or safety of themselves 

or others, and provide a framework for assessing whether an employee poses such a 

threat.200 In the absence of a Title II regulation that provided colleges with a framework that 

applied to students, many colleges adopted the Title I framework and developed policies 

and procedures, including those related to medical withdrawal and involuntary withdrawal, 

to respond to students who posed a direct threat to the health or safety of themselves or 

others. Colleges anticipated that the 2011 Title II regulations would include “direct threat” 

provisions applying to students, but the regulations did not. Colleges have not received 

guidance from OCR or DOJ on how they can properly respond to students at risk of selfharm or harm while maintaining compliance with disability laws. According to interviewees, 

this places colleges in an unfair position as they have little guidance on what to do, what 

works, and what is lawful. Students who are forced to withdraw or take medical LOA 

because they report feeling suicidal, for example, are also burdened by the lack of guidance 

to colleges.

Recommendation: ED/OCR should provide colleges with best practices for responding to 

students who exhibit or threaten self-harming behavior.

(continued)

Mental Health on College Campuses 77
Recommendation: ED/OCR should provide colleges with best practices for providing legally 

required modifications and accommodations for students with mental health disabilities.

Finding 3: The FAFSA does not contain fields in which an applicant may include 

disability-related expenses.

Despite references to including disability-related expenses in calculating Pell Grants and the 

Cost of Attendance, FAFSA does not provide an option for students to disclose disabilityrelated expenses. The lack of an easy option to disclose disability-related expenses is a 

barrier to students with disabilities.

Recommendation: Modify the FAFSA to allow students to directly input disability related 

expenses.

Finding 4: More financial support is necessary for students with mental health 

disabilities to achieve academic success.

As noted, students with mental health disabilities incur greater costs related to their 

disabilities and have more difficulty in repaying loans.

Recommendation: Substantially increase financial aid for students with mental health 

disabilities who are disproportionately low-income to improve their higher education 

opportunities. Expansion of the federal Pell Grant would be most beneficial and is highly 

recommended.

Finding 5: There is a perception among colleges that they cannot use federal 

Student Support Services funds to provide mental health counseling and other 

psychoeducational support services to eligible students.

Some interviewees were told, during the grant competition period, that their application 

would be scored lower if the use of mental health counseling was part of their application 

because it was not explicitly stated in the allowable services. However, Student Support 

Services regulations do allow for counselors.201 According to one interviewee, they assumed 

that this can refer to licensed counselors who conduct actual psychological sessions, to aid 

with the student’s retention.

Recommendation: ED should clarify that Student Support Services funding can be used to 

provide mental health counseling. Further, ED should direct technical assistance providers for 

Student Support Services projects to stress the importance of the mental health counseling. 

Additionally, during grant competitions, ED should direct technical assistance providers 

conducting workshops to inform applicants that mental health counseling is a permissible 

service.

Recommendations to ED, continued

78 National Council on Disability
Recommendations to HHS/SAMHSA

Recommendation: SAMHSA should take actions to increase the awareness of colleges 

about mental health grant-funding opportunities, including funds available under the 21st 

Century Cures Act.

Recommendation: SAMHSA should require colleges that apply for mental health-related 

grant funding to hire mental health staff, describe how they will recruit and hire culturally 

competent and diverse counselors, and have a system in place to ensure that colleges that 

receive grant funds comply with these requirements.

Recommendation: SAMHSA should require colleges that apply for mental health-related 

grant funding to provide, as part of each application, their policies on providing reasonable 

modifications, reasonable accommodations, and auxiliary aids for students with disabilities. 

SAMHSA should also require colleges to post these policies on their websites, at their DSS 

offices, and in their counseling centers.

Recommendation: SAMHSA should require colleges that apply for mental health-related 

grant funding to describe, as part of each application, how they will collaborate with 

community mental health service providers to meet student needs, as currently required 

from applicants under the Garret Lee Smith Campus Suicide Prevention program.

Recommendation: SAMHSA should give mental health grant-funding priority to colleges 

that will use the funds for direct services that are proven best practices in providing mental 

health services to college students.

Recommendation: SAMHSA should liberally approve waivers to the matching funds 

requirement for mental health grant funding to colleges that do not have the financial 

capacity to provide campus mental health services without federal grant funds, and 

that show that they have high populations of at-risk students and students with multiple 

disabilities.

Mental Health on College Campuses 79
Recommendations to Colleges

Finding 6: College policies do not reward help-seeking behavior from students.

Colleges should develop policies that put students first. Because students are a captive 

audience, colleges offer a unique opportunity to engage students and connect them to an 

array of services. As one interviewee said, “College may be the place they receive the best 

medical care.”

Colleges must be committed to finding ways to retain students and reward help-seeking 

behavior. Interviewees described effective college policies and practices as those where 

the college creates a culture that allows students to seek help and supports those who do. 

They believed that colleges have tried in recent years to take a public health approach202 to 

behavioral health issues in general.

When students know schools are putting them first, they are more likely to seek out the 

services they need. The academic affairs office should coordinate with the counseling/

student support office to make decisions that are flexible enough to work on an individual, 

case-by-case basis.

Interviewees argued that colleges should have parity between the provision of physical and 

mental health services and that they should be funded to do so. One respondent stated, 

“You would never identify a student with strep throat and give them half a prescription. If 

you’re going to treat the student, you need to provide full treatment up to specialty referrals.” 

The same goes for mental health services. If colleges have no limits on the amount of 

physical medicine clinic visits, they should not have limits on mental health counseling visits. 

Further, as with physical ailments, referrals to off-campus doctors or counselors should be 

made only when the staff on campus does not have the expertise to provide appropriate 

treatment.

Finding 7: Lack of financial resources are a major barrier to colleges in meeting the 

mental health needs of their students.

Recommendation: Colleges should work with their own shared governance structures to 

access funds for mental health services and supports through existing on-campus programs 

and services. The shared governance structures usually include college administrators, 

faculty and staff, advisory committee members, and students.

Recommendation: Colleges should examine the service structure within campus health 

centers to ensure that parity exists between mental and physical health services. Policies 

should be adjusted to adhere to parity regulations if needed.

80 National Council on Disability
Recommendation: Colleges should collaborate with local Department of Mental Health, 

veteran support, and Department of Rehabilitation entities to develop supplemental mental 

health services and supports on campuses.

Recommendation: Community colleges should work with their governance structure to 

raise the college student health fees if they are not at approved state levels so they are 

equipped to offer more comprehensive mental and physical health care services.

Recommendation: Colleges should examine the benefits and use of master’s- and doctorallevel psychology internship programs in serving students with mental health disabilities to 

cover more students in a cost-effective manner.

Recommendation: Colleges should explore the use of web-based counseling applications 

for outreach and to serve more students in a cost-effective manner.

Recommendation: Colleges should work with state legislators to develop legislation that 

funds supplemental mental health services and supports for colleges and universities. An 

example of successful legislation is California’s Proposition 63, which established mental 

health funding from an ongoing one-percent tax on millionaires. The current level of funding 

is insufficient for the state’s college mental health needs, but it is adequately building a state 

infrastructure of support.

Recommendation: States should develop an infrastructure that supports increased capacity 

building for mental health services and supports within colleges. An example is California’s 

CalMHSA service structure for colleges, state universities, and University of California 

campuses.203

Finding 8: College faculty, staff, and administrators need more training to identify and 

support students with mental health disabilities.

Finding 9: College faculty, staff, and administrators need training in disability-related 

accommodations.

Most institutions lack the resources for faculty/staff/student mental health awareness 

training and suicide prevention training, which would support efforts to identify and refer 

at-risk students. Lack of training was highlighted as a key barrier for students to receive the 

services they need to be academically successful.

Recommendation: Provide mandatory mental health sensitivity and awareness training for 

faculty, staff, and administrators, including streamlined identification and referral protocols 

and reasonable accommodation suggestions for students who have mental health disabilities.

Recommendations to Colleges, continued

(continued)

Mental Health on College Campuses 81
Recommendation: Provide mandatory faculty training on ADA and Section 504 regulations 

so that colleges comply with federal law and faculty understand their obligations. Encourage 

faculty to team with programs for college students with disabilities.

Recommendation: Professional associations of student aid administrators, including the 

National Association of Student Financial Aid Administrators, should provide enhanced 

training to improve their members’ understanding of the special problems and circumstances 

facing low-income students with mental health disabilities. These organizations should 

evaluate the extent to which their members’ understanding of the time demands and the 

financial burdens faced by those with mental health disabilities impacts their guidance to 

these students and the provision of financial support. In addition, student aid administrators 

should understand the inappropriateness of applying standard packaging rules to students 

with mental health disabilities.

Finding 10: Institutions can have extensive paperwork requirements for students to 

complete before receiving mental health services, and students often experience long 

waits for college mental health services because of appointment backlogs. Students 

may also experience a long wait for professional mental health disability assessments 

because of appointment backlogs. This process is extremely problematic for crisis-ridden 

students who need immediate assistance and follow-up care.

Recommendation: Colleges and universities should work with their own shared governance 

structures to ensure that students have immediate access to crisis services by developing 

and implementing streamlined intake processes.

Finding 11: Colleges can better serve today’s student population by employing 

counselors that adequately reflect the student populations they serve. Additionally, 

interviewees stressed the importance of professional organizations and mental health 

licensure professionals conducting outreach and inclusion activities to support the integration 

of more professionals of color into the field.

Recommendation: To encourage more mental health practitioners of color, forgive student 

loans of professionals committed to working with students with mental health disabilities in 

college.

Finding 12: Colleges are struggling with the goal of supporting students with 

mental health disabilities. In addition to financial barriers that impact colleges’ 

ability to provide adequate services, colleges also need support and training in the 

implementation of best practices.

Recommendations to Colleges, continued

82 National Council on Disability
Recommendation: Colleges should implement the best practices identified in this report. 

Several organizations and community entities, such as the Jed Foundation (Campus Mental 

Health Action Plan), California Community College Student Mental Health Program (CCC 

SMHP), NAMI on Campus, and Active Minds offer abundant information on best practice 

implementation.

Recommendation: Each state should develop a website that captures materials, training 

videos, public service announcements, and best practice programming to support students 

with mental health disabilities, such as developed by the CCC Chancellor’s Office Mental 

Health program.204

Finding 13: This report identified the following best policies for colleges.

Recommendation: Leave of Absence and Student Code of Conduct

It is critical that colleges and universities provide a time-sensitive assessment to determine 

whether a discipline situation is occurring or a mental health crisis is occurring. The 

pathways to successful outcomes for either of these situations depends on it. Colleges 

too often use punitive rather than supportive measures when students are presumed to be 

“acting out” or presenting some form of disruption that is out of the norm. Such punitive 

measures, however, discourage students—not just the penalized student but all others—

from seeking help. They isolate students from social and professional supports—friends 

and understanding counselors and teachers—at a time of crisis, increasing the risk of 

harm. These punitive measures may also result in loss of insurance coverage for mental 

health care.

Implementation of college LOA and code of conduct policies should put students first. This 

includes looking at student behaviors to determine whether a situation is one of violence 

or a mental health crisis. All student disruptions should not be considered in breach of 

the student code of conduct. Once it is determined that students are undergoing mental 

health episodes that necessitate intervention, colleges should not apply disciplinary 

policies and punish behavior. Instead, they should provide due process and take student 

experiences into consideration, including appropriate interventions, such as whether 

students have a supportive home life if they were to be suspended or expelled from 

school. When students know they are first and know that their schools are not solely 

relying on punitive measures, they are more likely to seek out the services they need 

during times of crisis.

Recommendations to Colleges, continued

(continued)

Mental Health on College Campuses 83
Following are best practices around LOA and student code of conduct policies:

■ Coordination between the academic affairs office and counseling/student support office 

to make decisions that are flexible enough to appropriately respond to student needs on 

a case-by-case basis. Immediately dismissing students from campus because of a mental 

health episode helps neither the students nor the schools. The students’ chances of 

returning and matriculating are slim.

■ Clear communication to students contemplating LOAs of the impact of the LOA on their 

grades when they leave school, and their re-entry options.

■ Elimination of mandatory LOAs for students with mental health issues (e.g., students who 

have eating disorders, are cutting themselves, or have suicidal thoughts—regardless of 

whether they are suicidal or pose a significant risk).

■ Consider flexible academic policies for leave, reduced course load, and other 

accommodations to help students work through mental health issues and maintain active 

student status.

■ Georgetown University has a policy of “freshmen forgiveness”—grades can be forgiven 

in recognition of the difficult transition from high school to college. While not currently 

used for students with mental health challenges, this policy could be an appropriate 

accommodation.

■ Removal of withdrawals from student transcripts in cases of mental health disabilities.

■ Provision of a school contact or liaison (see Case Management Approach section) for 

students taking LOAs.

■ Policies that allow administrations to report crisis incidents so students, faculty, and staff 

receive fact-based communication, not just word of mouth.

Recommendation: Revise scholarship rules that require a certain GPA to accommodate 

students who can show that the drop in grades was clearly related to either mental 

disabilities or unaccommodated disabilities.

Finding 14: This report identified as a best practice stigma reduction, education, and 

outreach.

Recommendation: Best practices include the following:

■ Orientation for students can help set up a culture where mental health is not viewed 

as a disease or permanent state, and the complete normativeness of anxiety and other 

mental health concerns is acknowledged. Orientation could include a simple mental 

Recommendations to Colleges, continued

84 National Council on Disability
health assessment, with resource listings, that is self-scored by students. Students can 

be supported in developing skills that will help avoid mental health problems, such as 

time management, decision making, resilience, and coping. Orientation should allow 

opportunities for preenrollment in support service programs at freshman orientation, as it 

provides an easy, confidential manner for students to identify themselves.

■ Greater transparency of mental health services and supports through campus websites, 

with clear guidance on campus policies governing student LOAs and ADA mandates for 

accommodations.

■ College students must know about the services available to them. Colleges report that 

they provide mental health services, but they need to better articulate exactly what 

services they provide and publish information on the Internet to encourage students to get 

help. Colleges should disseminate information on websites and social media that is clearly 

articulated to encourage students to come forward to get help.

■ The campus community should be informed that mental health conditions are common 

and getting help is important (signage such as suicide prevention magnets and stickers 

in dorms and around campus are helpful). The link between mental health and academic 

success should be presented.

■ Open conversation on campus among faculty and staff about mental health issues should 

be an ongoing practice.

■ Creation of a broad-based committee on campus mental health that would include a 

racially diverse group of students with disabilities, LGTBQ students, foster students, and 

veterans as well as faculty, staff, and counseling center staff. The committee would discuss 

campus mental health needs and hold the college leadership accountable for addressing 

identified needs.

■ Co-location of mental and physical health services is a prime example of how colleges can 

place these two at the same level. Co-locating services signals to students that mental 

health is as important as physical health and reduces the stigma attached to seeking help.

■ Spotlighting of students, faculty, and staff who have achieved success living with a mental 

health condition to fight stigma and offer hope.

■ Hosting of on-campus educational activities and campaigns that combat stigma.

■ Faculty openly discussing mental health challenges normalizes the issue.

■ Assembly of celebrity speakers on mental health.

Recommendations to Colleges, continued

(continued)

Mental Health on College Campuses 85
Finding 15: This report identified as a best practice increasing student voice.

Recommendation: Best practices include the following:

■ Train student leaders or reach out to NAMI or Active Minds to identify potential peer-topeer workers to counsel classmates, as some students may not feel comfortable meeting 

with a counselor or resident advisor and may not seek support.

■ Encourage student-led organizations to get involved in campus mental health discussions 

and participate in efforts to destigmatize mental illness.

■ Participation in a Broad-Based Committee on Campus Mental Health, which integrates the 

voice of all constituency groups.

Finding 16: This report identified multiple best practices in pedagogy.

Recommendation: Best practices include the following:

■ Faculty talking openly about mental health issues.

■ Discussions of mental health challenges and resolutions can be incorporated into curricula 

to reduce stigma and normalize the process of embracing mental health wellness.

■ Requirement of all course syllabi to have a standard section that includes statements 

for students with physical or mental health disabilities, including why and where to seek 

support.

Finding 17: This report identified as a best practice the creation of a coordinated 

support system.

Recommendation: Best practices include the following:

■ Encourage the office for students with disabilities, the counseling center, academic 

departments, and student support groups, among others, to work together. Better training 

and communication is needed among faculty, students, and the entities that support 

students, including the Greek system. Currently, these offices do not communicate often 

enough unless there is a crisis.

■ Train faculty, staff, administrators, resident advisors, and students to recognize symptoms 

of mental health disorders and act appropriately to refer students. Training can be 

integrated into what is already routine for students, such as meeting with faculty and 

academic advisors, or it can be a web-based or college event training.

■ Identify faculty and staff who can be anchor adults. Students need a sense of belonging 

and connection with someone on campus. Students who have a meaningful connection 

with at least one adult are more likely to graduate and be successful.

Recommendations to Colleges, continued

86 National Council on Disability
■ Establish BITs and Care Teams that identify students who are struggling and need help or 

pose some threat.

■ Hire case managers to oversee the provision of resources for students in distress. 

By adopting this practice, colleges and universities can dedicate their mental health 

counselors to provision of treatment. The case management approach allows for much 

better oversight and follow-up with the student resource process.

■ Have a case manager in the counseling center, as well as one in the Dean of Students 

office, to coordinate between the two offices.

■ Create parent/family programs. Parents are often the strongest advocates of their own 

children in terms of access to services. Campuses can become more proactive in involving 

family members, including providing easier pathways for parents in terms of guiding 

institutions in terms of what services need to be provided.

■ Integrate mental health promotion into what is already routine for students, such as 

meetings with academic advisors. Determining students’ academic goals with their mental 

health concerns in mind may help them to help themselves.

Finding 18: This report identified as a best practice creating collaboration and 

partnerships with community-based organizations and other colleges.

Recommendation: Best practices include the following:

■ Connections with community-based organizations help address long-term mental health 

needs. Campuses that cannot provide all services can establish relationships with local 

providers to assist in supporting their needs. A case manager often is responsible for 

managing relationships with community-based organizations and helps students transition 

to those off campus services.

■ Colleges should collaborate with one another, especially those within the same region, to 

share best practices and available local resources, such as information about adequate off 

campus referrals. An example of a successful collaboration is the California Community 

College Student Mental Health Program.205

Finding 19: This report identified as a best practice multiple ways to increase access 

to care.

Recommendation: Best practices include the following:

■ Increase the size and diversity of the counseling and health center staff by using master’sand doctoral-level psychology interns who work with an expanded number of students 

under the supervision of licensed mental health professionals. This approach has proven to 

be student-friendly and cost-effective.

Recommendations to Colleges, continued

(continued)

Mental Health on College Campuses 87
■ Ensure that all counselors have cultural competency. Provide professional development in 

understanding the cultural considerations of students of color and other vulnerable student 

groups, if necessary. It is important to have a mental health counseling staff that is as 

diverse as the student body they serve.

■ Offer multiple types of services, including after-hours access to counseling, helplines, 

streamlined referral network to outside agencies, and telecounseling (especially helpful in 

rural areas).

■ Use technology, from Facebook support groups and mental health apps to online therapy 

games, to reach those who are struggling.

Finding 20: This report identified as best practices multiple ways to prevent suicide.

Recommendation: Best practices include the following:

■ The Suicide Prevention Resource Center’s guidebook to promoting mental health and 

preventing suicide in college and university settings argues that college campuses with 

a comprehensive wellness system in place to assist in early intervention have a greater 

chance at reducing student suicide rates.206

■ The Jed Foundation provides a thorough suicide prevention strategic planning guide. 

The purpose of this guide is to assist campuses in the development of suicide 

prevention protocols, including suggestions for developing leadership capacity on college 

campuses.207

■ The National Suicide Prevention Lifeline offers connection with live responders at any time. 

They can be reached at 1-800-273-TALK.

■ The American Foundation for Suicide Prevention and the Suicide Prevention Resource 

Center have collaborated to produce a toolkit to assist schools in the aftermath of a 

suicide. Although written for high schools, much of the information and many of the tools 

are applicable to the community college context as well.208

■ Colleges must use a comprehensive approach that includes promoting social networks and 

connectedness, identifying and assisting those who may be at risk, improving access to 

mental health services, and being prepared to respond when an incident occurs.

■ Suicide rates were cut in half when a college instituted a policy requiring students who 

threatened or attempted suicide to attend four sessions of professional assessment.209

■ Rather than requiring students to leave school because of mental health concerns, offering 

personalized interventions with college staff can address underlying problems with 

substance use, mental health, or other personal issues.

Recommendations to Colleges, continued

88 National Council on Disability
■ Reduction of access to means of suicide: prevent people from obtaining lethal methods 

of self-harm by educating families of those in crisis about safely storing medications and 

firearms; provide environmental deterrents to means of suicide by installing barriers on 

bridges and parking garages.

■ Offering life skills and resilience classes as part of a comprehensive health promotion effort 

along with the integration of mental health curricula in regular classes.

Finding 21: This report identified as a best practice multiple ways to prevent violence.

Recommendation: Best practices include the following:

■ Use threat assessment teams and increase staffing levels, services, and training across 

the mental health continuum of care.

■ Address attitudes, beliefs, perceptions, and skills that contribute to violence through 

education, skill building, curriculum infusion, and other efforts.

■ Support healthy group norms and promote bystander intervention during times of crisis.

■ Convey clear expectations for conduct among students, faculty, staff, and visitors.

■ Create and disseminate comprehensive policies and procedures addressing each type of 

violent behavior, and institute training programs to ensure that policies are followed and 

enforced.

■ Provide a range of support services for students, including mental health services, crisis 

management, and comprehensive and compassionate services for victims and bystanders 

who may have witnessed traumatic events.

■ Help students avoid harm by offering escort services and self-defense classes.

■ Develop, implement, and enhance comprehensive alcohol and other drug prevention 

programs as per financial aid regulations.

Finding 22: This report identified as a best practice bereavement and postvention 

approaches.

Recommendation: Best practices include the following:

■ A plan should be in place to help the community respond to an incident and reduce the risk 

to other vulnerable people, both in the short- and long-term.

■ Delivery of a coordinated crisis management response by pooling different resources 

across campus and creating a community support team. These teams often comprise 

diverse groups across the campus, including academic support staff, students, mental 

health professionals, along with mental health units at local hospitals.

Recommendations to Colleges, continued

(continued)

Mental Health on College Campuses 89
■ Numerous states have issued reports identifying policy recommendations for preventing 

and responding to campus violence. These recommendations acknowledged the need for 

stronger mental health services and supports, and proposed that states and colleges find 

ways to increase the funding dedicated to campus mental health and wellness. Less than 

one year after the Virginia Tech shooting, the Virginia legislature improved the emergency 

evaluation process, modified the criteria for involuntary commitment, tightened procedures 

for mandatory outpatient treatment, and increased state funding for community mental 

health services.

Finding 23: This report identified as a best practice multiple ways to support students 

of color with mental health disabilities.

Recommendation: Best practices include the following:

■ Acknowledge and validate the unique experiences of students of color on campus, both at 

the individual and institutional level, by providing physical and social spaces for people of 

color to caucus within their own communities, with other communities of color, and with 

the larger campus community.

■ Provide messages that highlight mental health as a universal concern and decrease stigma; 

provide access to financial support for at-risk students.

■ Promote trust between mental health professionals and students of color (e.g., by making 

students of color stakeholders in decision making processes regarding the availability of 

mental health services on college campuses).

■ Increase the number of professionals and peer leaders of color and ensure that they have 

adequate training.

■ Offer professional development to understand the cultural considerations of students of 

color and provide general cultural sensitivity and awareness training that addresses the 

issue of microaggression.

■ Increase nonprofessional support, such as informal networking groups of students, staff, 

and faculty of color.

Finding 24: This report identified as a best practice multiple ways to support foster 

youth with mental health disabilities.

Recommendation: Best practices include the following:

■ Lift limits on the number of mental health sessions available to foster youth.

■ Provide free life skills training and tutoring to foster youth to learn employment and job 

readiness skills, financial literacy and management, and home and living skills.

Recommendations to Colleges, continued

90 National Council on Disability
■ Extend eligibility for services and financial resources to students older than 21, since many 

foster youth are not ready to begin postsecondary education at age 18.

■ Create a Transitional Independent Living Plan, a document that provides the basis for all the 

financial benefits and services, such as housing, college financial aid, and tutoring, to help 

foster youth succeed in a college environment.

Finding 25: This report identified as a best practice multiple ways to support veterans 

with mental health disabilities.

Recommendation: Best practices include the following:

■ Identify and reach out to veterans before they arrive on campus to answer questions about 

housing and benefits, among others.

■ Provide drop-in hours for counseling services, telecounseling outside of regular business 

hours, and an overall willingness and ability to respond rapidly when veteran students are 

in need of assistance.

■ Provide coordinated support by assisting veterans in accessing local resources, such as 

the local Veterans Affairs medical center if one exists, student-run veterans groups, and 

campus mental health providers.

■ Provide counselors with similar backgrounds who have at least a basic understanding of 

where veterans are coming from and, therefore, are better equipped to assist with mental 

health services.

Finding 26: This report identified as a best practice multiple ways to support LGBTQ 

students with mental health disabilities.

Recommendation: Best practices include:

■ Provide a welcoming environment for LGBTQ students across the entire campus 

community, such as offering visual cues in office spaces or in providers’ verbal and 

nonverbal communication.

■ Provide anti-bullying education.

■ Provide Safe Zone programs to educate peers, faculty, and staff.

■ Develop and implement specific policies that take into account nondiscrimination and 

confidentiality for LGBTQ youth.

Recommendations to Colleges, continued

(continued)

Mental Health on College Campuses 91
Finding 27: This report identified as a best practice multiple ways to support students 

with disabilities who also have mental health disabilities.

Recommendation: Best practices include the following:

■ Ensure that policies and practices comply with ADA, Sections 504 and 508, and the Fair 

Housing Act.

■ Provide physical and programmatic access to services and programs, making sure 

counseling services are in physically accessible buildings and that sign language 

interpreters are available for DHH students.

■ Provide college faculty and staff with disability sensitivity and awareness training.

■ Provide DSS office staff and other student programs with mental health sensitivity and 

awareness training.

■ Provide access to technological advances that allow students with disabilities to participate 

on equal footing with students without disabilities (e.g., video remote interpreting for DHH 

students and other assistive technology).

■ Provide telecounseling as an alternative for students who may have difficulty getting to 

campus counseling offices.

Recommendations to Colleges, continued

92 National Council on Disability
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Mental Health on College Campuses 99
100 National Council on Disability
Appendix A: List of Interviewees

(continued)

Table A-1: List of practitioner and expert interviewees

Interviewee Organization Organization Type

Glenn Albright Kognito Private

Cindy Miller Aron NCAA–Mental Health Taskforce Special population

Tony Beliz Los Angeles County Mental Health Emergency 

Outreach Bureau

County government

Johanna Bergan YouthMove Nonprofit

Joanna Boval AHEAD Special Interest Group–Graduate 

Students

Nonprofit, Special 

population

Karen Bower Attorney, Mental Health Law (Former Bazelon 

Center)

Independent

Greg Eells Cornell University Counseling Center University

Daniel Eisenberg University of Michigan Ann Arbor–Dept. of

Health Management and Policy

University

James Ferg-Cadima U.S. DoE–Office of Civil Rights Federal Governme

Dana Fink Institute for Educational Leadership Nonprofit

Paul Gionfriddo Mental Health America Nonprofit

Paul Goodman AHEAD, retired Professional association

Darcy Gruttadaro NAMI Nonprofit

Heather Kirk North American Interfraternity Conference Nonprofit, Special 

population

Kevin Kruger NASPA Student Affairs Administrators in 

Higher Education

Nonprofit

Paul Lannon National Association of College and university 

Attorneys (NACUA) 

University, Professional 

association

Marni Lennon University of Miami School of Law University

Ben Locke Penn State University–Counseling Center University

Cindi Love American College Personnel Association, 

Commission for Counseling and Psychological 

Services

Nonprofit

Alison Malmon Active Minds Nonprofit

Mental Health on College Campuses 101
Interviewee Organization Organization Type

Dr. Mary Karol 

Matchett

National Technical Institute for the Deaf at RIT 

University

University, Special 

population

Jennifer Mathis Bazelon Center Foundation

Lisa Meeks AHEAD Special Interest Group–Graduate 

Students

Nonprofit, Special 

population

Sherri Nelson Western Washington University–Counseling 

Center

University

Cheryl 

Newman-Tarwater

Los Angeles Sherriff’s Community College 

Bureau

County government

Dr. Robert Pollard National Technical Institute for the Deaf at RIT 

University

University, Special 

population

Monica Porter Disability Rights Advocates Advocacy

Keilan Rickard University of North Carolina Greensboro–

Counseling Center

University

Elyn Saks University of Southern California–Saks Center University

Victor Schwartz JED Foundation Foundation

Betsy Schwartz National Council for Behavioral Health Nonprofit

Susan Stefan Bazelon Center Foundation

Susan Swearer Born This Way Foundation Foundation

Ross Szabo Independent Consultant, Greek Life Independent, Special 

population

Shannon Turner Portland State University–FUTURES Project 

Manager

University

Madelyn Wessel Virginia Commonwealth University University

Francie Zimmerman Center for the Study of Social Policy Nonprofit

102 National Council on Disability
Interviewee Questions

National Council on Disability Interview Questions

POLICY

1. What policies and reforms at colleges and universities address barrier removal for full access to 

mental health services and accommodations as mandated by federal law?

2. What policy and system reforms affecting students with mental health disabilities in 

postsecondary settings are needed?

3. Stigma and discrimination are often experienced by students with mental health challenges. What 

gaps, weaknesses, and discriminatory policies and/or practices have you observed?

ACCESS

4. What can be done to enhance the inclusion, retention, and graduation of students with mental 

health disabilities in higher education?

5. What barriers prevent colleges or universities from providing accessible mental health services for 

students that are required by law?

6. Are students who disclose mental health disabilities provided reasonable accommodations to 

remain in school? Please describe a sampling of any accommodations that you are aware of.

PRACTICE

7. What services do colleges and universities provide for students with mental health challenges 

and/or disabilities? Are the services adequately available?

8. Do most colleges and universities maintain relationships with community mental health providers?

9. Do colleges and universities provide mental health services to all students regardless of physical 

or sensory disabilities?

10. What efforts do colleges or universities employ to reduce stigma and discrimination?

11. Have faculty and staff received adequate training to identify, refer, and support students who have 

mental health disabilities or who are experiencing emotional distress?

12. Are there adequate crisis management plans in place for students, faculty, and staff to deal with 

suicide, acts of violence, or traumatic events? Please describe.

13. What are promising best practices and emerging trends?

Mental Health on College Campuses 103
104 National Council on Disability
Appendix B: Student Interviews

Colleges and universities where student interviews were conducted:

■ University of Texas–San Antonio (2)

■ Columbia University

■ Texas Southern University

■ University of Maine

■ Los Angeles Harbor College

■ University of California–Berkeley

■ Central New Mexico Community College

Student Interview Questions

National Council on Disability Interview Questions

STUDENT GROUPS:

1. What types of changes affecting students with mental health disabilities in your college (or other 

colleges that you’ve heard about) are needed? Clarification: E.g., additional policies or programs 

needed?

2. Are students who disclose mental health disabilities provided reasonable accommodations to 

remain in school? Please describe a sampling of the accommodations provided on your campus. 

Clarification: Examples may include: access to adequate counseling services, extended time on 

tests, leave of absence, 24-hour hotlines, etc.

3. What services does your college or university provide for students with mental health challenges 

and/or disabilities? Are the services adequately available? Clarification: See examples above to 

jog your thinking

4. Do you know if your college or university maintains relationships with community mental health 

providers? Clarification: If so, which providers? Do you know if these organizations are helpful?

5. Do you know if your college or university provides mental health services to all students 

regardless of physical or sensory disabilities? Clarification: Are there any limitations on mental 

health services based on the type of disability that a student has?

Mental Health on College Campuses 105
6. What efforts does your college or university employ to reduce stigma and discrimination? 

Clarification: E.g., awareness events, your school’s disciplinary process for students with mental 

health problems. Does your college president or other administrators routinely discuss student 

mental health?

7. Have faculty and staff received adequate training to identify, refer, and support students who have 

mental health disabilities or who are experiencing emotional distress? Clarification: Do college 

faculty or staff ever discuss with students any mental health services that are available? Do they 

note mental health services on class syllabi?

8. Is there an adequate crisis management plan in place for students, faculty, and staff to deal with 

suicide, acts of violence, or traumatic events? Please describe. Clarification: What resources 

does your campus provide after traumatic events?

9. What are promising best practices and emerging trends? Clarification: How do you see the 

discussion of mental health on college campuses evolving?

106 National Council on Disability
Appendix C: Questionnaires

Practitioner/Expert Questionnaire

POLICY

1. What policies and reforms at your college or university address barrier removal for full access to 

mental health services and accommodations as mandated by federal law?

2. What policy and system reforms affecting students with mental health disabilities in 

postsecondary settings are needed?

ACCESS

3. What can be done to enhance the inclusion, retention, and graduation of students with mental 

health disabilities in higher education?

4. What barriers prevent your college or university from providing accessible mental health services 

for students that are required by law?

PRACTICE

5. What services does your college or university provide for students with mental health challenges 

and/or disabilities? Are the services adequately available? (This may include crisis management, 

relationships with community mental health providers, faculty and staff training.)

6. What efforts does your college or university employ to reduce stigma and discrimination?

7. What are promising best practices and emerging trends that you are aware of nationwide?

Student Questionnaire

PRACTICE

1. What services does your college or university provide for students with mental health challenges 

and/or disabilities? Are the services adequately available? (This may include crisis management, 

relationships with community mental health providers, faculty and staff training.)

2. What efforts does your college or university employ to reduce stigma and discrimination?

3. What are promising best practices and emerging trends that you are aware of nationwide?

4. In what ways does social media positively or negatively impact your campus’ culture surrounding 

mental health? Does social media have any effect on your own mental health?

Mental Health on College Campuses 107
ACCESS

5. What can be done to enhance the inclusion, retention, and graduation of students with mental 

health disabilities in higher education?

6. What barriers prevent your college or university from providing accessible mental health services 

for students that are required by law?

POLICY

7. What policies and reforms at your college or university address barrier removal for full access to 

mental health services and accommodations as mandated by federal law?

8. What policy and system reforms affecting students with mental health disabilities in postsecondary 

settings are needed?

108 National Council on Disability
Appendix D: Twitter Chat Questions

Q1. Why are Mental Health services and supports needed on college campuses?

Q2. What are some specific ways that campuses are offering support for a student’s #mentalhealth 

needs?

Q3. Are campuses providing support for all populations? (veterans, grad students, LGBTQ, etc.). What 

is working? What can be improved?

Q4. What are colleges doing to reduce stigma about receiving mental health services?

Q5. What type of training do faculty, staff, & students receive to support students with #mentalhealth 

challenges? What are the best practices?

Q6. In what ways can colleges and universities improve access to #mentalhealth services?

Q7. If you had to pick only one, what piece of advice would you give to students who think they may 

want or need mental health supports or services?

Mental Health on College Campuses 109
110 National Council on Disability
Appendix E: Sample Screening and Assessment Tools

Columbia-Suicide Severity Rating Scale (C-SSRS)

An evidence-supported, low-burden screening tool developed by a team of investigators from Columbia 

University, the University of Pennsylvania, and the University of Pittsburgh, with support from the 

National Institute of Mental Health. This questionnaire for suicide prevention was adopted by the 

Centers for Disease Control and Prevention, to be delivered by all gatekeepers, enabling blanket 

coverage and linking of systems (e.g., campus counseling, security, corrections, hospitals/behavioral 

health, crisis assessment), and fostering prevention.

www.cssrs.columbia.edu

Interactive Screening Program (ISP) (American Foundation for Suicide 

Prevention)

ISP provides a safe and confidential way for individuals to take a brief screening for stress, depression, 

and other mental health conditions, and receive a personalized response from a caring mental health 

counselor. ISP is being used by college and university counseling centers, medical and professional 

degree schools, hospital networks, corporation, and Employee Assistance Programs, connecting 

thousands of people to help.

https://afsp.org/our-work/interactive-screening-program/

National Institute on Drug Abuse—Modified Alcohol, Smoking, and 

Substance Involvement Screening Tool (ASSIST)

This guide is designed to assist clinicians serving adult patients in screening for drug use.

www.drugabuse.gov/sites/default/files/pdf/nmassist.pdf

Suicide Assessment 5-Step Evaluation and Triage

Assessment tool for mental health providers that measures the risk of suicidality through the lens of 

risk and protective factors.

www.integration.samhsa.gov/images/res/SAFE_T.pdf

The Suicide Behavior Questionnaire

Screening tool for suicide prevention that includes a brief questionnaire and scoring instructions to 

assess for risk of suicide.

www.integration.samhsa.gov/images/res/SBQ.pdf

Mental Health on College Campuses 111
Suicide Prevention Training

Kognito is an award-winning developer of role-playing training simulations and games in the areas 

of health and behavioral health. Through online and mobile simulations, users learn effective 

communication tactics for managing challenging conversations by practicing speaking with intelligent, 

fully animated, and emotionally responsive avatars that act and respond like real humans. The 

simulations promote behavioral change, early intervention, prevention, and treatment adherence.

www.kognito.com

■ Other tools are listed below:

■ The Jed Foundation Campus Program: www.thecampusprogram.org

■ California Community Colleges Student Mental Health Program: www.cccstudentmentalhealth

.org/

■ Los Angeles College Mental Health Consortium: www.lahc.edu/studentmentalhealth

■ Half of Us: http://www.halfofus.com/

■ Lifeline: http://www.ulifeline.org/

■ Each Mind Matters: http://www.eachmindmatters.org/

■ My Life Project: http://www.pdx.edu/profile/my-life

■ Bazelon Campus Mental Health Know Your Rights Guide: http://www.bazelon.org/Portals/0/pdf/

YourMind-YourRights.pdf

112 National Council on Disability
Appendix F: Common Modifications

Accommodations Commonly Recognized as Effective

■ Reduced course load

■ Notetakers

■ Taking exams in a quiet space or isolation

■ Extended time for assignments

■ Extended time for exams or refresh time

Accommodations Recognized as Effective but Not Easy to 

Get or to Implement

■ Flexibility in dropping courses

■ Flexibility in rescheduling exams when symptoms cycle on

■ Flexibility in excusing absences when symptoms cycle on

■ Flexibility in withdrawal, including retroactive withdrawal

Accommodations for Traumatic Brain Injury and Post-Traumatic Stress 

Disorder (PTSD)

■ Recommended by the U.S. Department of Veterans Affairs (VA) and other sources

❍ Safe parking

❍ Safe classroom location

❍ Service, companion, and assistance animals

❍ Place of refuge

❍ Vets’ center

❍ Reduction of triggers:

■ Noise and distraction reduction (e.g., construction)

■ Group assignments

■ Crowded classrooms

■ Class assignments and lectures related to war

Mental Health on College Campuses 113
■ Timed tests

■ Drug, suicide, and marital counseling services

What Works

■ An effective counseling center

❍ Students know what counseling services are available

❍ Provide services in a nonstigmatized setting with good physical features, respecting anonymity

❍ Electronic scheduling through an accessible website

❍ Electronic record-keeping

❍ Center staff connected to student health services, psychiatric services, local hospitals, the VA, etc.

❍ Solid coordination with DSS office

■ Counsel center policies

❍ Do not discourage students from seeking treatment, such as forced medical leave for sharing 

suicidal ideation, treatment, or attempts

❍ Demonstrate a respect for confidentiality

❍ Have students identify who they wish to be contacted in case of a psychiatric or medical 

emergency

❍ Always be clear whether you are acting in a treatment relationship or on behalf of the university

■ An effective DSS office

❍ Insight into the attitudes that face students with disabilities in higher education, such as 

association with violence

❍ Ability to get functional limitation information, including differences when limitations cycle on 

and off

❍ Ability to convert functional limitations to workable accommodations

❍ Ability to advocate directly with faculty for accommodations rather than rely on a self-advocacy 

model

■ An effective DSS office continued:

❍ Knowledge of and relationships with community service providers

■ Family

■ Mental health care providers

■ Vocational rehabilitation

114 National Council on Disability
❍ Knowledge of and relationships with rest of campus

■ Student health services

■ Counseling

■ Student affairs

■ Academic affairs

■ Residential life

■ Veterans center

■ Campus staff members who can be “natural supports”

■ Financial aid

■ Security services

■ Threat assessment team

■ Disciplinary officers

■ An effective threat assessment team:

❍ Postsecondary teaching is the second safest profession in America!

❍ However, three percent of counseling center students report they fear that they may lose 

control and act in a violent manner.210

❍ Violence on campus does occur (e.g., Virginia Tech)

■ Threat assessment team functions

❍ While balancing privacy, autonomy, and safety, identify individuals of interest

❍ Prevent premature inquiries into direct threat

❍ Identify appropriate times for such inquiries

❍ Assign someone to commence the direct threat determination process and monitor it to 

completion, assuring procedures that comply with FERPA, HIPAA, Section 504, and the ADA

❍ Help evaluate the effectiveness of current level of counseling, student health, and intervention 

services including alcohol, drug, and suicide programs, BUT DO NOT assign this committee a 

leading role in developing mental health policies or emergency response planning— too much 

stigma

❍ Threat assessment team continued:

■ Multidisciplinary team

❍ Membership should vary consistent with need for confidentiality balanced against the 

degree of the threat

❍ Core:

Mental Health on College Campuses 115
■ House counsel particularly for guidance of FERPA and HIPAA

■ Counseling center

■ Student health services

❍ Variable

■ DSS

■ Security/EMT services

■ Veterans’ affairs

■ Student affairs

■ Student housing

■ Dean, faculty, staff witnessing concerning conduct, events, or statements

■ Threat assessment team limits

■ Profiling is a danger

❍ “There is no useful profile in terms of gender, SES, or ethnic background.”

❍ There is a debate among experts if there are any predictive indicia

■ “Most individuals who engage in targeted violence are suicidal with no escape plan” 

Eells at p. 47.

■ Drug and alcohol abuse

■ Access to tools of violent

■ Breach of confidentiality is a danger: FERPA, HIPAA, State Law

116 National Council on Disability
1 “Mental health: a state of well-being.” World Health Organization, accessed March 22, 2017, http://www.who.

int/features/factfiles/mental_health/en/

2 “Mental health: strengthening our response.” World Health Organization, accessed March 22, 2017, http://

www.who.int/mediacentre/factsheets/fs220/en/

3 42 U.S. Code § 12102

4 45 CFR 1181.103

5 California Community College Chancellors Office, 2015 Implementing Guidelines for Title 5 Regulations, 

Section 56042, Mental Health Disability.

6 “Mental health.” World Health Organization, accessed March 22, 2017, http://www.wpro.who.int/mediacentre/

factsheets/fs_201203_mental_health/en/

7 “Mental health.” World Health Organization, accessed March 22, 2017, http://www.wpro.who.int/mediacentre/

factsheets/fs_201203_mental_health/en/

8 Reetz, David R., Carolyn Bershad, Peter LeViness, and Monica Whitlock. “The Association for University and 

College Counseling Center Directors Annual Survey.” (2016). https://www.aucccd.org/assets/documents/

aucccd%202016%20monograph%20-%20public.pdf; In Gallagher, Robert. National Survey of College 

Counseling Centers 2014. Project Report. The International Association of Counseling Services (IACS), 2015, 

counseling center directors report that 52 percent of center clients (students) have severe psychological 

problems (up from 44 percent in 2013). Of these, 8 percent have impairment so serious they cannot remain 

in school or can only do so with extensive psychological or psychiatric help; 44 percent experience periods 

of severe distress (e.g., depression, anxiety, panic attacks, suicidal ideation) but can be treated successfully 

with available treatment modalities. In schools with more than 15,000 students, percentages are higher, with 

59 percent of clients having severe problems. Of these, 50 percent are successfully treated and 9 percent 

cannot remain in school or can remain only with extensive help, which is not generally available.] In a 2016 

survey by the American College Health Association, 70 percent of directors said the number of students on 

their campuses with severe psychological problems had increased in the past year.

9 Snyder, T. D., C., de Brey, and S. A. Dillow, Table 311.1. “Number and Percentage Distribution of Students 

Enrolled in Postsecondary Institutions, by Level, Disability Status, and Selected Student Characteristics: 

2007–08 and 2011–12.” In Digest of Education Statistics 2014 (NCES 2016-006). National Center for Education 

Statistics, Institute of Education Sciences, U.S. Department of Education. Washington, DC, 2016. https://nces.

ed.gov/programs/digest/d13/tables/dt13_311.10.asp; Robert Gallagher, National Survey of College Counseling 

Centers 2014. Project Report. The International Association of Counseling Services (IACS), 2015

10 Gallagher, Robert, National Survey of College Counseling Centers 2014

11 Kadison, Richard, and Theresa Foy Digeronimo. College of the Overwhelmed. New York, NY: John Wiley & 

Sons, 2004.

12 Klein, M., J. Behen, and N. Roy. National College Depression Partnership. Depression, Recovery, and Student 

Success. (2010).

13 114 P.L. 255 (2016). See Section 9031: Mental Health and Substance Use Disorder Services on Campus

14 20 USC §2011i.

15 20 U.S.C. § 1070a(c).

16 20 U.S.C. § 1078(b)(7).

Endnotes

Mental Health on College Campuses 117
17 28 U.S.C. § 1070a-14(c).

18 Reetz, D. R., C. Bershad, P. LeViness, and M. Whitlock. The Association for University and College Counseling 

Center Directors Annual Survey. (2016). https://www.aucccd.org/assets/documents/aucccd%202016%20

monograph%20-%20public.pdf; In Gallagher, National Survey of College Counseling Centers 2014, counseling 

center directors report that 52 percent of center clients (students) have severe psychological problems (up 

from 44 percent in 2013). Of these, eight percent have impairment so serious they cannot remain in school 

or can only do so with extensive psychological or psychiatric help; 44 percent experience periods of severe 

distress (e.g., depression, anxiety, panic attacks, suicidal ideation) but can be treated successfully with 

available treatment modalities. In schools with more than 15,000 students, percentages are higher, with 

59 percent of clients having severe problems. Of these, 50 percent are successfully treated and nine percent 

cannot remain in school or can remain only with extensive help, which is not generally available.] In a 2016 

survey by the American College Health Association, 70 percent of directors said the number of students on 

their campuses with severe psychological problems had increased in the past year.

19 Snyder, Table 311.10; Gallagher, National Survey of College Counseling Centers 2014.

20 Digest of Education Statistics. 2012. p. 307. Accessed March 22, 2017, https://nces.ed.gov/

pubs2014/2014015_3.pdf

21 See McMillen, J. C., B. T. Zima, L. D. Scott Jr., W. F. Auslander, M. R. Munson, M. T. Olie, and E. L. Spitznagel. 

“Prevalence of Psychiatric Disorders among Older Youths in the Foster Care System.” Journal of the American 

Academy of Child and Adolescent Psychiatry 44, no. 1 (2005): 88–95; Shin, S. “Need for and Actual Use of 

Mental Health Service by Adolescents in the Child Welfare System.” Children and Youth Services Review

27 (2006): 1071–1083; DiRamio, D., R. Ackerman, and R. Mitchell. “From Combat to Campus: Voices of 

Student-Veterans.” NASPA Journal 45, no. 1 (2008): 73–102; Ostovary, F., and J. Dapprich. “Challenges and 

Opportunities of Operation Enduring Freedom/Operation Iraqi Freedom Veterans with Disabilities Transitioning 

into Learning and Workplace Environments.” New Directions for Adult and Continuing Education 2011: 63–73. 

doi: 10.1002/ace.432; Garofalo, R., C. Wolf, S. Kessel, J. Palfrey, and R. DuRant. “The Association between 

Health Risk Behaviors and Sexual Orientation among a High School Sample of Adolescents.” Pediatrics 101, 

no. 5 (1998): 895–902; Westefeld, J., M. Maples, B. Buford, and S. Taylor. “Gay, Lesbian and Bisexual College 

Students: The Relationship between Sexual Orientation and Depression, Loneliness and Suicide.” Journal of 

College Student Psychotherapy 15 (2001): 71–82; M. B. Neilans. Today ’s College Students and Their Mental 

Health Needs Are Requiring a Change in the Way College Campuses Address Mental Health Issues. The 

College at Brockport, Counselor Education Master’s Theses, 2007.

22 Pedrelli, P., M. Nyer, A. Yeung, C. Zulauf, and T. Wilens. “College Students: Mental Health Problems and 

Treatment Considerations.” Academic Psychiatry: The Journal of the American Association of Directors of 

Psychiatric Residency Training and the Association for Academic Psychiatry 39, no. 5 (2015): 503–511. http://

doi.org/10.1007/s40596-014-0205-9

23 Eisenberg, D., and S. Ketchen Lipson. “Healthy Minds Survey.” In Healthy Minds Network, 2016. Accessed 

March 22, 2017, Retrieved from http://healthymindsnetwork.org

24 For more information, view here: https://www.psychiatry.org/psychiatrists/practice/dsm

25 This included 20 percent of students meeting the criteria for moderate or more severe depression and 12 

percent for major depression, as well as 20 percent of students meeting the criteria for anxiety, with 40 

percent of these students meeting the criteria for severe anxiety.

26 The American Psychological Association, Press Release (August, 2008), citing “Key Findings From the Suicide 

Ideation Survey,” Adryon Burton Denmark, University of Texas at Austin and “Defining the New Paradigm for 

Addressing Suicidality,” David J. Drum, Ph.D, University of Texas at Austin. http://www.apa.org/news/press/

releases/2008/08/suicidal-thoughts.aspx (accessed March 23, 2017).

27 Douce, L., and R. Keeling. A Strategic Primer on College Student Mental Health. Washington, DC: American 

Council on Education, 2014.

28 Eisenberg, D., E. Golberstein, and S. E. Gollust. “Help-seeking and Access to Mental Health Care in a 

University Student Population.” Medical Care 45 (2007): 594–601.

118 National Council on Disability
29 The American College Counseling Association is made up of diverse mental health professionals from 

the fields of counseling, psychology, and social work, who work within higher education settings. ACCA 

membership includes professionals and student members who work largely in college counseling settings. 

Accessed March 22, 2017, http://www.collegecounseling.org/

30 Gallagher, National Survey of College Counseling Centers 2014.

31 Drum, D. J., C. Brownson, A. Burton Denmark, and S. E. Smith. “New Data on the Nature of Suicidal Crises in 

College Students: Shifting the Paradigm.” Professional Psychology, Research and Practice 40 (2009): 213–222.

32 Hunt, Justin B., Daphne Watkins, and Daniel Eisenberg. “How Do College Campuses Make Decisions About 

Allocating Resources for Student Mental Health?: Findings from Key Participant Interviews.” Journal of 

College Student Development 53, no. 6 (2012): 850–856. Accessed March 23, 2017, https://muse.jhu.edu/

article/490942

33 The American College Health Association. American College Health Association? National College Health 

Assessment II: California Community Colleges Reference Group Executive Summary Spring 2013. Hanover, 

MD: American College Health Association, 2013, p. 8. Accessed March 22, 2017, http://www.acha-ncha.org/

docs/ACHA-NCHA-II_ReferenceGroup_ExecutiveSummary_Fall2013.pdf

34 Locke, 2009; Deroma, Leach, and Leverett, 2009.

35 Klein, Behen, and Roy, National College Depression Partnership. Depression, Recovery, and Student Success,

2010.

36 Pidgeon, A. M., N. F. Rowe, P. Stapleton, H. B. Magyar, and B.C.Y. Lo. “Examining Characteristics of Resilience 

among University Students: An International Study.” Open Journal of Social Sciences 2 (2014): 14–22. http://

dx.doi.org/10.4236/jss.2014.211003

37 Douce and Keeling, A Strategic Primer on College Student Mental Health, 2014. Accessed June 21, 2017, 

https://www.apa.org/pubs/newsletters/access/2014/10-14/college-mental-health.pdf

38 Douce and Keeling, A Strategic Primer on College Student Mental Health, 2014. Accessed June 21, 2017, 

https://www.apa.org/pubs/newsletters/access/2014/10-14/college-mental-health.pdf

39 Arria, A. M., K. M. Caldeira, B. A. Bugbee, K. B. Vincent, and K. E. O’Grady. The Academic Opportunity Costs 

of Substance Use during College. College Park, MD: Center on Young Adult Health and Development, 2013.

40 Weitzman E. R. “Poor Mental Health, Depression, and Associations with Alcohol Consumption, Harm, and 

Abuse in a National Sample of Young Adults in College.” Journal of Nervous and Mental Disease 192, no. 4 

(2004): 269–277.

41 Eiser, A. “The Crisis on Campus.” American Psychological Association 42, no. 8 (September, 2011); Wilcox, 

H. C., A. M. Arria, K. M. Caldeira, K. B. Vincent, G. M. Pinchevsky, & K. E. O’Grady. “Prevalence and Predictors 

of Persistent Suicide Ideation, Plans, and Attempts during College.” Journal of Affective Disorders 127, no. 1–3 

(2010); 287–294.

42 College Degree Search. “Crisis on Campus: The Untold Story of Student Suicides.” College Degree Search. 

(2012). Accessed March 22, 2017, http://www.collegedegreesearch.net/student-suicides/

43 College Degree Search, “Crisis on Campus: The Untold Story of Student Suicides,” 2012.

44 Suicide Prevention Resource Center. Promoting Mental Health and Preventing Suicide in College and 

University Settings. Newton, MA: Education Development Center, Inc., 2004. Accessed March 22, 2017, http://

www.sprc.org/sites/default/files/migrate/library/college_sp_whitepaper.pdf

45 Joffe, P. “An Empirically Supported Program to Prevent Suicide in a College Student Population.” Suicide and 

Life-Threatening Behavior 38, no. 1 (2008): 87–103.

46 Eisenberg, D., E. Golberstein, and J. B. Hunt. “Mental Health and Academic Success in College” the B.E. 

Journal of Economic Analysis Policy 9, no. 1 (2009). Retrieved June 19, 2017, doi:10.2202/1935–1682.2191.

47 Ashwood, J. S., D. Bradley, B. B. Stein, L. Padilla, M. W. Woodbridge, L. May, R. Seelam, and M. A. Burnam. 

Payoffs for California College Students and Taxpayers from Investing in Student Mental Health. Santa Monica, 

CA: RAND Corporation, 2015. http://www.rand.org/pubs/research_reports/RR1370.html.

48 Arria, A. M., K. M. Caldeira, B. A. Bugbee, K. B. Vincent, and K. E. O’Grady. The Academic Opportunity Costs 

of Substance Use During College.” College Park, MD: Center on Young Adult Health and Development, 2013.

Mental Health on College Campuses 119
49 Pub. L. 93–112, 87 Stat. 394 (29 U.S.C. 794), as amended.

50 42 U.S.C. §§ 12101–12300

51 What are a public or private college-university’s responsibilities to students with disabilities? Accessed March 4, 

2017, https://adata.org/faq/what-are-public-or-private-college-universitys-responsibilities-students-disabilities

52 42 U.S.C. §§ 12132

53 Department of Justice, ADA Title III, Technical Assistance Manual, covering Public accommodations and 

commercial facilities, section III- 4.3600 (1993), http://www.ada.gov/taman3.html. A “fundamental alteration” 

is a modification that is so significant that it alters the essential nature of the goods, services, facilities, 

privileges, advantages, or accommodations offered.

54 28 C.F.R. § 36.104 (“undue burden means significant difficulty or expense”); 20 42 U.S.C. § 12182(b)(2)(A)

(ii)-(iii).

55 The Section 504 regulation contains the following requirement relating to a postsecondary school’s obligation 

to provide auxiliary aids to qualified students who have disabilities: “A recipient . . . shall take such steps as 

are necessary to ensure that no handicapped student is denied the benefits of, excluded from participation 

in, or otherwise subjected to discrimination under the education program or activity operated by the recipient 

because of the absence of educational auxiliary aids for students with impaired sensory, manual, or speaking 

skills.” 34 C.F.R. 104.4(d).

The Title II regulation states: “A public entity shall furnish appropriate auxiliary aids and services where 

necessary to afford an individual with a disability an equal opportunity to participate in, and enjoy the benefits 

of, a service, program, or activity conducted by a public entity.” 28 C.F.R. 35.160(b)(1).

56 https://www2.ed.gov/about/offices/list/ocr/docs/auxaids.html, accessed 4/6/2017

57 https://www.ada.gov/kindle_ltr_eddoj.htm

58 42 U.S.C. § 3601 et seq.

59 42 U.S.C. § 3601 et seq.

60 Emotional support animals are expressly precluded from qualifying as “service animals” under the ADA. 28 

C.F.R. 35.104.

61 See U.S. v. University Of Nebraska at Kearney, et al., which held that University of Nebraska student housing 

facilities are clearly “dwellings” within the meaning of the FHA. Accessed May 20, 2017 from https://www.

ada.gov/kearney_order.pdf

62 https://portal.hud.gov/hudportal/documents/huddoc?id=servanimals_ntcfheo2013-01.pdf, accessed 4.4.17

63 Lannon, Paul. “Using Student Medical Records: Department of Education Issues New 

Guidance.” (2015). Accessed March 22, 2017, https://www.hklaw.com/publications/

Using-Student-Medical-Records-Department-of-Education-Issues-New-Guidance-09-02-2015/

64 The U.S. Department of Education issued new guidance on college obligations under FERPA in a “Dear 

Colleague” letter, dated August 18, 2015, which addressed four exceptions: (1) treatment records, (2) 

school officials, (3) litigation, and (4) health or safety emergencies. See McBain, Lesley. “Balancing 

Student Privacy, Campus Security, and Public Safety: Issues for Campus Leaders.” Perspectives, American 

Association of State Colleges and Universities (Winter 2008); According to the Bazelon Center: “As 

permitted by law, the counseling center may disclose information about a student to the extent needed 

to protect the student or others from a serious and imminent threat to safety, for example, by making 

disclosures to crisis intervention or emergency personnel. Disclosures are permitted only if the student 

will not consent to interventions that will ameliorate the risk. See American Psychiatric Association. 

Practice Guideline for Assessment and Treatment of Patients with Suicidal Behaviors, 2003 (disclosures 

permitted to protect safety of patient and others if patient is or is likely to become dangerous and will not 

consent to interventions that will ameliorate the risk). Cf. Health Insurance Portability and Accountability 

Act (HIPAA), 42 U.S.C. 201 et seq., 45 C.F.R. 164.512(j) (disclosures permitted to prevent or lessen 

serious and imminent threat to a person or the public), 45 C.F.R. 164.512(f) (disclosures permitted 

for certain law enforcement purposes); Family Education Rights and Privacy Act (FERPA), 20 U.S.C. 

120 National Council on Disability
1232g(b)(1)(I), 34 C.F.R. 99.36 (disclosures permitted in emergency to protect health or safety of student 

or others).” (Bazelon Center for Mental Health Law “Supporting Students: A Model Policy for Colleges and 

Universities,” 2007. Accessed March 22, 2017, https://dmh.mo.gov/mentalillness/docs/supportingstudents

.pdf)

65 http://www.aascu.org/uploadedFiles/AASCU/Content/Root/PolicyAndAdvocacy/PolicyPublications/08_

perspectives(1).pdf

66 29 C.F.R. § 1630.15(b)(2); 29 C.F.R. § 1630.2(r) (Direct Threat means a significant risk of substantial harm 

to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable 

accommodation. The determination that an individual poses a “direct threat” shall be based on an 

individualized assessment of the individual’s present ability to safely perform the essential functions of 

the job. This assessment shall be based on a reasonable medical judgment that relies on the most current 

medical knowledge and/or on the best available objective evidence. In determining whether an individual 

would pose a direct threat, the factors to be considered include: (1) the duration of the risk, (2) the nature and 

severity of the potential harm, (3) the likelihood that the potential harm will occur, and (4) the imminence of 

the potential harm.

67 Bazelon Center for Mental Health Law. “Campus Mental Health Know Your Rights,” 2008. Accessed March 22, 

2017, http://www.bazelon.org/wp-content/uploads/2017/01/YourMind-YourRights.pdf

68 For example, according to the NAMI on Campus survey, a few students reported that they often do not go to 

campus health centers for fear of being sent to the hospital and thus possibly missing exams, being denied 

readmittance to school, or suffering other negative outcomes.

69 Bazelon Center for Mental Health Law. “Student Punished for Getting Help,” 2006. Accessed March 22, 2017, 

http://www.bazelon.org/nott-v-george-washington-university/

70 Mulhere, Kaitlin. “Illegal Mandatory Leave,” January 20, 2015. Accessed March 22, 2017, https://www.

insidehighered.com/news/2015/01/20/mandatory-leaves-mental-health-conditions-raise-discrimination-concerns

71 Kaitlin, “Illegal Mandatory Leave,” 2015.

72 Mulhere, “Illegal Mandatory Leave,” 2015.

73 Bazelon Center for Mental Health Law, Student Punished for Getting Help,” 2006. http://www.bazelon.org/

nott-v-george-washington-university/

74 “Terms of This Settlement Are Confidential.” Accessed April 4, 2017, http://www.bazelon.org/

nott-v-george-washington-university/

75 Bazelon Center for Mental Health Law, “Campus Mental Health Know Your Rights,” 2008. http://www.bazelon.

org/wp-content/uploads/2017/01/YourMind-YourRights.pdf

76 http://www.bazelon.org/wp-content/uploads/2017/01/12.16.10-Spring-Arbor-University-OCR-Letter.pdf

77 Bazelon Center for Mental Health Law, “Campus Mental Health Know Your Rights,” 2008. http://www.bazelon.

org/wp-content/uploads/2017/01/YourMind-YourRights.pdf

78 Petitions from students with mental illness may be handled differently only to the extent necessary to prevent 

direct threats to the safety of others. http://www.bazelon.org/wp-content/uploads/2017/01/12.16.10-SpringArbor-University-OCR-Letter.pdf

79 Bazelon Center for Mental Health Law, “Supporting Students: A Model Policy for Colleges and Universities,” 

2007. Accessed March 22, 2017, https://dmh.mo.gov/mentalillness/docs/supportingstudents.pdf

80 Title IV, Subpart A of The Higher Education Act of 1965. Section 401c: Period of Eligibility for Grants. The HEA 

was last comprehensively reauthorized in 2008 by the Higher Education Opportunity Act of 2008 (HEOA; P.L. 

110-315), but has been extended. “The period during which a student may receive Federal Pell Grants shall 

not exceed 18 semesters, or the equivalent of 18 semesters, as determined by the Secretary by regulation. 

Such regulations shall provide, with respect to a student who received a Federal Pell Grant for a term but 

was enrolled at a fraction of full-time, that only that same fraction of such semester or equivalent shall count 

towards such duration limits. The provisions of this paragraph shall apply only to a student who receives a 

Federal Pell Grant for the first time on or after July 1, 2008.’’

Mental Health on College Campuses 121
81 The Federal TRIO Programs (TRIO) are Federal outreach and student services programs designed to identify 

and provide services for individuals from disadvantaged backgrounds. TRIO includes eight programs targeted 

to serve and assist low-income individuals, first-generation college students, and individuals with disabilities 

to progress through the academic pipeline from middle school to postbaccalaureate programs. TRIO also 

includes a training program for directors and staff of TRIO projects. https://www2.ed.gov/about/offices/list/

ope/trio/index.html?exp=4

82 Section 317 (a) Section 402D of the Higher Education Act of 1965 (20 U.S.C. 1070a-14).

83 Wolanin, Thomas R., and Patricia E. Steele. “Higher Education Opportunities for Students with Disabilities.” 

The Institute for Higher Education Policy, 2004. Accessed March 22, 2017, https://www.ahead.org/uploads/

docs/resources/ada/Opportunities%20for%20Students%20with%20Disabilities.pdf

84 Accessed March 22, 2017, https://fafsa.ed.gov/fotw1617/pdf/PdfFafsa16-17.pdf

85 Moore, Rebecca for the Youth Advisory Committee of the National Council on Disability. Students with 

Disabilities Face Financial Aid Barriers. Washington, DC: National Council on Disability, 2003. Accessed 

March 22, 2017, http://www.ncd.gov/publications/2003/09292003-2#3

86 Moore, Students with Disabilities Face Financial Aid Barriers, 2003; Wolanin, Thomas R. “Students with 

Disabilities: Financial Aid Policy Issues.” NASFAA Journal of Student Financial Aid 35, no. 1 (2005): 17–26. 

Accessed March 22, 2017, http://files.eric.ed.gov/fulltext/EJ965779.pdf

87 Gruttadaro, Darcy, and Dana Crudo. “College Students Speak: A Survey Report on Mental Health.” NAMI.

Arlington, VA: 2012. Accessed March 22, 2017, https://www.nami.org/getattachment/About-NAMI/PublicationsReports/Survey-Reports/College-Students-Speak_A-Survey-Report-on-Mental-Health-NAMI-2012.pdf

88 See Christina Cauterucci. “At Universities, Students’ Medical Records are Open Territory.” October, 2015. 

http://www.slate.com/blogs/xx_factor/2015/10/23/university_students_have_little_right_to_privacy_in_medical_

records.html; and Charles Ornstein “When Students Become Patients, Privacy Suffers.” October, 2015. 

https://www.propublica.org/article/when-students-become-patients-privacy-suffers

89 Ornstein, “When Students Become Patients, Privacy Suffers,” 2015.

90 While these surveys are administered to community colleges as well as four-year institutions, community 

college respondents are a very low percentage of overall responses. In addition, the survey administered by 

the Association for University and College Counseling Center Directors does not provide publicly differentiated 

data according to two- and four-year institutions.

91 Reetz, David R., Brian Krylowicz, and Brian Mistler. “The Association for University and College Counseling 

Center Directors Annual Survey.” 2015. http://www.aucccd.org/assets/documents/aucccd%202015%20

monograph%20-%20public%20version.pdf

92 Gallagher, National Survey of College Counseling Centers 2014, 2015.

93 Center for Collegiate Mental Health. “2016 Annual Report” (Publication No. STA 17-74). January, 2017. 

Accessed May 1, 2017, https://sites.psu.edu/ccmh/files/2017/01/2016-Annual-Report-FINAL_2016_01_09-

1gc2hj6.pdf

94 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 40.

95 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 70.

96 https://www.statnews.com/2017/02/06/mental-health-college-students/. NCD staff interviewed the author 

of this article who shared her survey data from all of the colleges that responded to the STAT survey in the 

categories of fees, limits on counseling sessions and waiting lists.

97 Volpe, Vanessa. What We Know About the Mental Health of Students of Color during College: A Review and 

Call to Action. The Steve Fund, University of North Carolina at Chapel Hill.

98 See endnote 105.

99 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, pp. 65–66.

122 National Council on Disability
100 Gruttadaro and Crudo. “College Students Speak: A Survey Report on Mental Health,” 2012.

101 Gruttadaro and Crudo. “College Students Speak: A Survey Report on Mental Health,” 2012.

102 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 65.

103 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 23.

104 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 28.

105 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 57.

106 Gallagher, National Survey of College Counseling Centers 2014, 2015.

107 In some cases, a state will require that you be licensed in the “remote” site state. For example, someone 

may need to be licensed in Ohio in order to take a video call from an Ohio resident. Psychologists’ licenses do 

not have automatic reciprocity as is the case with many MD licenses. Also, some insurance companies do not 

reimburse “telemedicine” at all or reimburse it at much lower rates than an in-person visit.

108 See http://www.washington.edu/doit/academic-accommodations-students-psychiatric-disabilities

109 U.S.C. § 3601 et seq.

110 https://portal.hud.gov/hudportal/documents/huddoc?id=servanimals_ntcfheo2013-01.pdf, Accessed April 4, 

2017.

111 Gruttadaro and Crudo, “College Students Speak: A Survey Report on Mental Health,” 2012.

112 Burgstahler, Sheryl, and Tanis Doe. “Improving Postsecondary Outcomes for Students with Disabilities: 

Designing Professional Development for Faculty.” In Phase II (MS#060d(2)-H01) Product of Study #23.

University of Hawaii. Accessed March 22, 2017. http://www.rrtc.hawaii.edu/documents/products/phase2/

pdf/060d(2)-H01.pdf

113 Gruttadaro and Crudo, “College Students Speak: A Survey Report on Mental Health,” 2012.

114 Reetz, Krylowicz, and Mistler, “The Association for University and College Counseling Center Directors Annual 

Survey,” p. 53.

115 NAMI and the JED Foundation. “Starting the Conversation: College and Your Mental Health.” 2016. Accessed 

March 22, 2017. http://www.nami.org/collegeguide/download

116 Gruttadaro and Crudo, “College Students Speak: A Survey Report on Mental Health,” 2012.

117 Gallagher, National Survey of College Counseling Centers 2014, 2015.

118 Center for Psychiatric Rehabilitation. Supported Education Initiatives at the Center for Psychiatric 

Rehabilitation. 2009. Accessed March 22, 2017. https://cpr.bu.edu/resources/newsletter/supported-education

119 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 42.

120 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 42.

121 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 41.

122 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 41.

123 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 42.

124 Jackel, Donna. “How College Students Are Resisting the Mental-Illness Stigma.” Yes Magazine,

November, 2015. Accessed March 22, 2017, http://www.yesmagazine.org/issues/good-health/

how-college-students-are-resisting-the-mental-illness-stigma-20151124

125 Walker, Larry. “The Importance of Mental Health Check In’s for College Students,” The Good 

Men Project, February 16, 2016. Accessed March 22, 2017, http://project375.org/news-posts/

Mental Health on College Campuses 123
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126 Grier-Reed, Tabitha. “The African American Student Network: An Informal Networking Group as a Therapeutic 

Intervention for Black College Students on a Predominantly White Campus.” Journal of Black Psychology

39, no. 2 (2013): 169–184; Constantine, M. G., L. Wilton, and L. D. Caldwell. “The Role of Social Support 

in Moderating the Relationship Between Psychological Distress and Willingness to Seek Psychological 

Help Among Black and Latino College Students.” Journal of College Counseling 6 (2003): 155–165. 

doi:10.1002/j.2161-1882.2003.tb00236.

127 Kappa Alpha Theta. Accessed March 22, 2017, https://www.kappaalphatheta.org/alumnae/programs/sisters_

supporting_sisters.cfm?from=HomeHeaderLink

128 Cornell Daily News, 2013. https://issuu.com/cornellsun/docs/05-01-13_entire_issue2

129 St. John, Alexa. “Members of Greek Life Share Struggles at First Mental Health Speak Out.” Michigan 

Daily, December 5, 2016. Accessed March 22, 2017, https://www.michigandaily.com/section/news/

mental-health-speak-out-call-action-better-counseling-services-campus

130 Holterman, Ally. “Mental Health Problems for College Students Are Increasing.” Heathline, August 25, 2016. 

http://www.healthline.com/health-news/mental-health-problems-for-college-students-are-increasing-071715#7

131 Griffin, Riley. “Social Media Is Changing How College Students Deal With Mental Health, For Better Or 

Worse.” The Huffington Post, July 22, 2015. Accessed March 22, 2017, http://www.huffingtonpost.com/entry/

social-media-college-mental-health_us_55ae6649e4b08f57d5d28845

132 Griffin, “Social Media Is Changing How College Students Deal With Mental Health, For Better Or Worse,” 

2015.

133 Griffin, “Social Media Is Changing How College Students Deal With Mental Health, For Better Or Worse,” 2015.

134 Sontag-Padilla, Lisa, Elizabeth Roth, Michelle W. Woodbridge, Courtney Ann Kase, Karen Chan Osilla, Elizabeth 

D’Amico, Lisa H. Jaycox, and Bradley D. Stein. “CalMHSA Student Mental Health Campus-Wide Survey.” 

Accessed March 22, 2017, http://www.cccstudentmentalhealth.org/docs/evaluation/CalMHSA_SMH_Campus_

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135 Gould, M. S., T. Greenberg, D. M. Velting, and D. Shaffer. (2003). “Youth Suicide Risk and Preventive 

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136 Osilla, K. C., M. W. Woodbridge, R. Seelam, C. A. Kase, E. Roth, and B. D. Stein. Mental Health Trainings in 

California’s Higher Education System Are Associated with Increased Confidence and Likelihood to Intervene 

with and Refer Students. Santa Monica, CA: RAND Corporation, 2015. http://www.rand.org/pubs/research_

reports/RR954.html

137 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey. (2016).

138 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey. (2016).

139 Nelson, R. J., J. M. Dodd, and D. J. Smith. (1990). “Faculty Willingness to Accommodate Students with 

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(1990): 185–189.

140 Yuker, H. “Variables That Influence Attitudes Toward People with Disabilities.” Psychosocial Perspectives on 

Disability 9, no. 5 (1994): 3–22.

141 Lehmann, J., T. Davies, and K. Laurin. “Listening to Student Voices about Postsecondary Education.” Teaching 

Exceptional Children 32, no. 5 (2000): 60–65; Leyser, Y. “A Survey of Faculty Attitudes and Accommodations 

for Students with Disabilities.” Journal of Postsecondary Education and Disability 7, no. 3 & 4 (1989): 97–108; 

Leyser, Y., S. Vogel, S. Wyland, and A. Brulle. “Faculty Attitudes and Practices Regarding Students with 

Disabilities: Two Decades after Implementation of Section 504.” Journal of Postsecondary Education and 

Disability 13, no. 3 (1998): 5–19.

124 National Council on Disability
142 Burgstahler and Doe, “Improving Postsecondary Outcomes for Students with Disabilities: Designing 

Professional Development for Faculty.”

143 Jed Foundation and EDC, Inc. “A Guide to Campus Mental Health Action Planning.” 2011. Accessed March 22, 

2017, https://www.jedfoundation.org/wp-content/uploads/2016/07/campus-mental-health-action-planning-jedguide.pdf

144 Suicide Prevention Resource Center, Promoting Mental Health and Preventing Suicide in College and 

University Settings, 2004.

145 See http://www.sprc.org/resources-programs/mental-health-first-aid-usa

146 See https://www.qprinstitute.com/

147 Eells, Gregory, T. C. Marchell, J. Corson-Rikert, and S. Dittman. “A Public Health Approach to Campus Mental 

Health Promotion and Suicide Prevention.” Harvard Health Policy Review 13 (2012). http://www.hcs.harvard.

edu/~hhpr/wp-content/uploads/2012/04/features-1.pdf

148 From The National Behavioral Intervention Team Association (NaBITA) website. Accessed March 22, 2017, 

https://nabita.org/behavioral-intervention-teams/

149 Sokolow, B., and W. S. Lewis. “Second Generation Behavioral Intervention Best Practices.” URMIA Journal 

Reprint 2009. https://nabita.org/download/13Second%20Generation%20Behavioral%20INtervention%20

Best%20Practices%20(URMIA%20Journal,%202009).pdf

150 Ray, Julie, and Stephanie Kafka. “Life in College Matters for Life After College.” GALLUP, Economy. May 6, 

2014. http://www.gallup.com/poll/168848/life-college-matters-life-college.aspx

151 Hughes, P., and M. Sims. The Effectiveness of Chaplaincy: As Provided by the National School Chaplaincy 

Association to Government Schools in Australia. Perth: Edith Cowan University, 2009. http://schoolchaplaincy.

org.au/files/2012/09/chaplaincyeffectiveness.pdf

152 Postvention is counselling and other social care given after the experience of a traumatic event, especially to 

those directly affected by a suicide.

153 Reetz, Bershad, LeViness, and Whitlock. The Association for University and College Counseling Center 

Directors Annual Survey, p. 68.

154 Novotney, A. “Students under Pressure.” Monitor on Psychology 45, no. 8 (2014). http://www.apa.org/

monitor/2014/09/cover-pressure.aspx

155 Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug 

Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. 

Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Accessed March 22, 2017, 

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156 Moore, Abigail. “A Bridge to Recovery.” January, 2012. Accessed March 22, 2017, http://www.nytimes.

com/2012/01/22/education/edlife/a-bridge-to-recovery-on-campus.html; Collegiate Recovery Centers, 

Accessed March 22, 2017 http://collegiaterecovery.org/

157 Accessed March 22, 2017, http://collegiaterecovery.org/research-data/

158 See California Community Colleges Student Mental Health Program Website, http://www.

cccstudentmentalhealth.org/

159 See California Community Colleges Student Mental Health Program Website, http://www.

cccstudentmentalhealth.org/

160 See Los Angeles College Mental Health Consortium, http://www.lahc.edu/studentmentalhealth/

Teambuilding-2.html

161 Gruttadaro and Crudo, “College Students Speak: A Survey Report on Mental Health,” 2012.

162 Gruttadaro and Crudo, “College Students Speak: A Survey Report on Mental Health,” 2012.

163 Haw, C., K. Hawton, C. Niedzwiedz, and S. Platt. “Suicide Clusters: A Review of Risk Factors and 

Mechanisms.” Suicide and Life-Threatening Behavior 43 (2013): 97–108.

164 http://www.hcs.harvard.edu/~hhpr/wp-content/uploads/2012/04/features-1.pdf

165 https://www.jedfoundation.org/schools-institutions-need-to-have-a-postvention-plan/

Mental Health on College Campuses 125
166 Eisenberg, D., J. B. Hunt, and N. Speer. “Mental Health in American Colleges and Universities: Variation 

across Student Subgroups and across Campuses.” Journal of Nervous and Mental Disease 201, no. 1 (2013): 

60–67.

167 Neblett Jr., E. W., and S. O. Roberts. “Racial Identity and Autonomic Responses to Racial Discrimination.” 

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172 McMillen, Zima, Scott Jr., Auslander, Munson, Olie, and Spitznagel, “Prevalence of Psychiatric Disorders 

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178 Wood, D. “Veterans’ College Drop-out Rate Soars.” Huffington Post, October 25, 2012. Retrieved from http://

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179 Sinski, J. B. “Classroom Strategies for Teaching Veterans with Post-Traumatic Stress Disorder and Traumatic 

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181 UC Office of the President. Promoting Student Mental Health. (2016). http://sja.ucdavis.edu/files/PSMH-guide.

pdf; citing national data from American College Health Association (ACHA) nationwide survey, which was 

collected across multiple survey administrations.

126 National Council on Disability
182 Human Rights Campaign. 2012. Accessed March 22, 2017, https://www.hrc.org/videos/

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183 Human Rights Campaign. http://www.hrc.org/files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf

184 Eagan, K., E. B. Stolzenberg, A. K. Bates, M. C. Aragon, M. R. Suchard, and C. Rios-Aguilar. (2015). The 

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185 Sontag-Padilla, Lisa, Elizabeth Roth, Michelle W. Woodbridge, Courtney Ann Kase, Karen Chan Osilla, Elizabeth 

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186 Seelman, Kristie L. “Transgender Adults’ Access to College Bathrooms and Housing and the Relationship to 

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187 Hadley, W. M. “College Students with Disabilities: A Student Development Perspective.” New Directions for 

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188 Center for Disease Control, 2016. Accessed March 22, 2017, https://www.cdc.gov/ncbddd/disabilityandhealth/

relatedconditions.html

189 The Provost’s Committee on Student Mental Health. “The State of Student Mental Health on College and 

University Campuses with a Specific Assessment of the University of Minnesota, Twin Cities Campus.” 2016. 

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190 Hyun, J. K., B. C. Quinn, T. Madon, and S. Lustig. “Graduate Student Mental Health: Needs Assessment and 

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191 Organ, J. M., D. B. Jaffe, and K. M. Bender. “Helping Law Students get the Help They Need: an Analysis 

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192 American College Counseling Association – Community College Task Force Survey of Community/2 Year 

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ACCA%20CCTF%202012-2013%20Survey%20FINAL.PDF

193 Similar numbers to our findings from the AUCCCD survey, which found that 61 percent of IHEs have 

psychiatrists on campus, while according to the NSCCC survey, only 7 percent of community colleges have 

access to on campus psychiatrists.

194 American Psychological Association. “Mental Health Services Remain Scarce at Community Colleges.” Monitor 

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195 Brown G. T. (ed.) Mind, Body and Sport: Understanding and Supporting Student-Athlete Mental Wellness.” 

Indianapolis, IN: National Collegiate Athletic Association, 2014. http://www.ncaapublications.com/

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196 114 P.L. 255 (2016). See Section 9031: Mental Health and Substance Use Disorder Services on Campus

197 20 USC §2011i.

198 20 U.S.C. § 1070a(c).

199 20 U.S.C. § 1078(b)(7).

200 29 C.F.R. § 1630.15(b)(2); 29 C.F.R. § 1630.2(r) (Direct Threat means a significant risk of substantial harm to the 

health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation. 

The determination that an individual poses a “direct threat” shall be based on an individualized assessment 

of the individual’s present ability to safely perform the essential functions of the job. This assessment shall 

be based on a reasonable medical judgment that relies on the most current medical knowledge and/or on the 

best available objective evidence. In determining whether an individual would pose a direct threat, the factors 

to be considered include: (1) The duration of the risk; (2) The nature and severity of the potential harm; (3) The 

likelihood that the potential harm will occur; and (4) The imminence of the potential harm.

Mental Health on College Campuses 127
201 20 U.S.C. 1070a–14(b)(2)

202 A model that addresses health or social problems in a comprehensive way. It considers human factors, 

characteristics of the source of harm, and the environment, identifies causes and suggests possible 

interventions. The public health model takes a population approach to health promotion and disease 

prevention. https://www.slideshare.net/drswaroopsoumya/public-health-model

203 See http://calmhsa.org/.

204 See California Community Colleges Student Mental Health Program Website http://www.cccstudentmentalhealth.

org/. This website provides cost-free training, webinars, and resources to build capacity to implement and sustain 

prevention and early intervention strategies that will allow campuses to better identify and address the mental 

health needs of students. And, ultimately to promote sustainable student mental health systems and policies.

205 http://www.cccstudentmentalhealth.org/.

206 Suicide Prevention Resource Center, Promoting Mental Health and Preventing Suicide in College and 

University Settings, 2004 ; The Suicide Prevention Resource Center, “A Comprehensive Approach to Suicide 

Prevention.”

207 Jed Foundation and EDC, Inc. “A Guide to Campus Mental Health Action Planning.” 2011. Accessed March 22, 

2017, https://www.jedfoundation.org/wp-content/uploads/2016/07/campus-mental-health-action-planning-jedguide.pdf

208 See http://www.sprc.org/sites/sprc.org/files/library/AfteraSuicideToolkitforSchools.pdf

209 Joffe, P. “An Empirically Supported Program to Prevent Suicide in a College Student Population.” Suicide and 

Life-Threatening Behavior 38, no. 1 (2008): 87–103.

210 Ben Locke. Center for the Study of Collegiate Mental Health (CSCMH) 2009 Pilot Study (2010). Center for 

Counseling & Psychological Services; Eells, Marchell, Corson-Rikert, and Dittman, “A Public Health Approach 

to Campus Mental Health Promotion and Suicide Prevention,” p. 47.

128 National Council on Disability

National Council on Disability 

1331 F Street, NW, Suite 850 

Washington, DC 20004