Scanlan Center for School Mental Health
Scanlan Center for School Mental Health
Three students walking down hall

Prioritizing Mental Health in Preparing for College

Kat Krtnick Wilson
Sarah Lipson
written by

Sarah Ketchen Lipson, Ph.D., EdM, Associate Professor in the Department of Health Law Policy and Management, Boston University School of Public Health + Principal Investigator, Healthy Minds Network

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As a prospective college student, or a parent of a prospective college student, there are numerous, nearly universal challenges that new college students experience, including adjusting to a new environment (often having left home for the first time), dealing with homesickness, making friends and building new support networks, establishing routines (often with less structure than in high school), and being responsible for things like healthcare use, sleep, and personal finances, all on top of heightened academic standards and mounting concerns over debt and the cost of higher education. This is far from an exhaustive list of the challenges new students encounter, and of course, there are distinct stressors based on students’ backgrounds and identities (e.g., for international students, there is immersion into new cultures).

College is also a time when mental health problems often begin or intensify. For depression, the average “age of onset” (or time when symptoms first appear) is in the mid-20s, which coincides with the traditional college years. In fact, 75% of lifetime mental health problems will onset by about age 25. With roughly half of all adolescents and young adults in the U.S. enrolled in postsecondary education, mental health in college student populations is increasingly recognized as a public health priority.

As such, the topic of mental health at colleges and universities has received a significant amount of media attention in recent years. National data reveal high and rising prevalence of mental health concerns among students. My colleagues and I lead the Healthy Minds Study, a mental health survey conducted at hundreds of colleges and universities annually.

In our 2022-2023 data, 41% of students screened positive for symptoms of depression and 36% for symptoms of anxiety, nearly doubling in symptom prevalence over the past decade. Though less frequently discussed in the media, many students are also thriving in college; in the most recent Healthy Minds data, 36% of students met criteria for ‘flourishing’ (or positive mental health). Of note, the prevalence of depression, anxiety, flourishing, and other mental health outcomes varies significantly across both student and institutional characteristics; the patterns are complex and point not only to urgent opportunities for system-level change but also to the importance of college “fit,” as discussed below.

My career’s work studying and reporting on the mental health needs of college students was originally motivated by my time working in residence life, where I served as a live-in advisor to first-year undergraduates (most fresh out of high school). Drawing from both the national data my colleagues and I have collected through Healthy Minds as well as my lived experiences in residence life and now as a faculty member, I see many opportunities for high school students (prospective college students) to prepare for holistic success in college by prioritizing their mental health and wellbeing at each stage of the process. What follows are recommendations and considerations primarily aimed at prospective students and their families.

 

Strategies to Prepare

When and Where to Go College

We’ll start with the decisions of when and where to go to college. These are, of course, some of the most important decisions a young person will make in their life. As such, the college application and decision-making processes are riddled with anxiety and uncertainty; naming the anxiety and uncertainty is an important first step. There are resources for handling this stress, including recommendations offered in Set to Go, a program from the Jed Foundation; these include the need to be realistic in where one applies and the importance of avoiding peer comparisons to the extent possible (see Related Resources below). Of course, the prioritization of one’s mental health in deciding when and where to go to college will look different for each individual, but here are some overarching considerations for prospective college students.

In deciding when to go to college, be open to the idea of a gap year.

For a number of reasons, starting college immediately after high school may not be the right timing for you. Generally speaking, a gap year can be thought of as taking the year after high school to work, volunteer, travel, etc. before starting college. Think of the possibility of a gap year as a potentially empowering decision; after 13+ consecutive years of mandatory schooling, you don’t necessarily need to start college immediately after completing your K-12 education. There may be compelling reasons to take a gap year, and these reasons should be taken seriously.

Ideally, you will begin college fueled by curiosity. This may not be possible if you are ‘burned out’ from high school; your academic brain may need a well-deserved break. You may want to get ‘real world’ professional experience; working full-time and saving money during a gap year may alleviate some financial stress, lessening angst about costs when you do begin college. You may simply feel like you need another year to mature.

Parents should be reminded that a gap year is not an indication that your child has lost or will lose momentum. Empirical research has demonstrated that gap year participation positively predicts academic motivation in college (Martin, 2010). The Child Mind Institute offers recommendations for picking a gap year program, and the aforementioned Set to Go program lists pros and cons when considering a gap year (see Related Resources below). Whether logistical, emotional, financial, or otherwise, your reasons to take a gap year should be thought of as signs of self-awareness. A gap year may be the best decision for achieving the longer-term goal of having a positive, enriching college experience.

In deciding where to go for college, prioritize “fit” (and de-prioritize the rankings).

When choosing where to apply and eventually which college or university to attend, prospective students should be focusing on “fit.” “Fit” is related to other terms that are commonly used and measured in survey studies, such as students’ “sense of belonging” in school. But what does it mean to find a school that is a good “fit”? The somewhat nebulous concept is really about the relationship between the person (prospective student) and the environment (college/university). The person-environment fit is not accounted for in the rankings, which some prospective students and their families allow to supersede individual preferences; this rarely works out well in my experience.

Early in my career, as an advisor at arguably the most prestigious university in the world, I once sat with a first-year student who tearfully admitted that they knew this was not the right place for them, but they’d felt they had to apply and then attend because of the institutional reputation. The student was filled with regret, which they recognized as avoidable. The “fit” was not right.

It is important to think about “fit” along several dimensions. In addition to financial fit (the means to attend a school), there are several, concrete things to consider with fit, including:

  • Institutional size: Do you want to go to a big school or a small school?
  • Location: Do you want to be a car or plane ride from home?; In a city or on a less urban campus?
  • Social life: Do you want to be at a school with Greek life (i.e., fraternities/sororities)?
  • Academics: How well do courses/majors and internship opportunities align with your interests/goals?

If you have the ability to visit schools as a prospective student (to tour the campus and potentially spend time with current students), “fit” should be top of mind. Ask yourself versions of: Do I see myself as part of this college community? Why or why not? Virtual tours and admissions open houses are also valuable opportunities to assess fit if visiting a campus is not feasible.

On top of some of the more straightforward considerations listed above about location, size, etc., there may be other dimensions of fit that are important based on your goals (e.g., for student-athletes), your identities, and your needs and preferences. Some lesser-emphasized dimensions that warrant attention are: the institutional policies that govern student life and the resources available to support students at a college or university.

For example, in the U.S. there is significant variation across colleges and universities in terms of policies that may uniquely affect LGBTQ+ prospective students; the Campus Pride Index allows prospective students and families to search a database of LGBTQ-friendly campuses based on such factors as the school’s anti-discrimination and housing policies. Unfortunately, many schools have systems, forms, and facilities that reinforce a gender binary.

Until more institutions adopt protective policies such as allowing students to change their names and pronouns in campus records (a practice that helps prevent against deadnaming and misgendering), it is sadly far from guaranteed that transgender and nonbinary students will be safe and supported on all campuses (even those that may espouse inclusivity in broad terms).

As prospective students, you should educate yourself about a school’s policies and systems and consider these to be indications of a school’s underlying values. Prioritize selecting a school with values that align with your own. This can enhance belonging and prevent future discomfort and potential experiences of systemic discrimination.

Prospective students should also ask about or look into a college or university’s policies and resources pertaining to mental health and well-being. Much of this information is likely to be available online at institutional websites, but can also be asked about on-campus tours, admissions open houses, etc. Understanding a school’s mental health policies and resources is particularly important for the growing number of prospective students who begin college with a history of mental health treatment (more on continuity of care in the next section).

Prospective students and their families should educate themselves about the mental health resources available at a school, including counseling/therapy and psychiatry services on campus and in the local community as well as prevention efforts. Regarding prevention efforts, prospective students and their families should be looking for a school to have a ‘public health ’ (or population-level) approach to mental health on campus, which means that mental health is prioritized not just when it is a problem/crisis, but more holistically and among all students.

Because there is no one-size-fits-all approach to prioritizing population-level mental health, prospective students and their families may find it useful to see examples of colleges and universities that received the Healthy Campus Award from the nonprofit organization, Active Minds for their efforts to “champion student health;” importantly, many past recipients of this award have been schools with fewer resources, including community colleges, underscoring that a school’s prioritization of mental health is in no way contingent on endowment.

Indications that a school prioritizes mental health at a population level may be evident in the promotion of and attention to wellbeing in academics, through extracurriculars, and within residence life as well as changes to the ‘built environment’ to promote social connectedness and reduce means of self-harm.

Relatedly, another discernible signal of a college or university’s approach to student mental health is the institution’s leave of absence policy, which includes their return from absence policy. These policies should be readily available on the college’s website and should be specific but easy to understand. Leave policies should be nonpunitive and should demonstrate parity, meaning that mental health should be held to the same standards as any other medical reason. The Bazelon Center for Mental Health Law provides more detailed information about leave of absence policies, including involuntary leaves, along with a guide to students’ rights under the Americans with Disabilities Act. Additionally, a 2021 guide listed in Related Resources below, details best practices for college and university leave of absence policies.

For prospective students, particularly those with no history of mental health problems, it may seem like an irrelevant policy to consider in the application process, but I argue that leave policies can provide clues as to the degree to which a school supports student well-being and mental health needs.

Before Starting College

We’ve covered some considerations for the decisions of when and where to attend college. Now let’s fast forward to the spring/summer before starting college. Importantly, the strategies offered here will be more effective if built on a foundation of good health behaviors, including healthy sleep, diet, exercise, and use of technology. Preparing to start college will look different for everyone, but what follows are some overarching recommendations.

In my experience working in residence life and now as a faculty member, I can tell you that rejection and “failure ” are inevitable in college. The truth is that there will be setbacks and challenges. I don’t know anyone for whom this is not true. Relative to high school, the stakes may feel higher in college, due in part to factors mentioned earlier, including more rigorous academic standards. For many new college students, failures (subjectively defined) can seem catastrophic. Perspective is important. Remember that everyone around you, including your professors, has failed and been rejected. Myself, I have received far more rejections (from journals, organizations, funders, you name it) than acceptances throughout my career. In my experience, rejections and failures have become easier to deal with over time. But as a first-year undergraduate, I did not have the same resilience or perspective I do now.

A strategy that can be helpful for new college students is ‘coping ahead, ’ an anxiety management technique borrowed from dialectical behavioral therapy. Briefly, ‘coping ahead’ means thinking about and preparing for the inevitable setbacks, challenges, and failures that one will experience. Not getting into a first-year seminar course. Getting passed over for a spot in a club or on a sports team. Not connecting with your roommate. All of these normal experiences can feel all-consuming and devastating. Being prepared for these scenarios can prevent being “blindsided” by the challenges that will definitely (not maybe) come with college. This is of course made easier by building autonomy and self-efficacy before getting to college.

For most students, particularly those who move away, beginning college represents a big leap in independence; just how big a leap depends in part on maturity and life skills. These include executive functioning, time management, and problem-solving skills, all of which can be honed with practice and experience. The Child Mind Institute points to questions that prospective college students can ask themselves, such as: “What would you do if you got a bad grade?” and “Who would you call if you were distressed?”. While many parents may want to help their high school students navigate challenges, doing so may stifle skill development. Importantly, a lack of problem-solving skills has been linked to mental health problems such as depression.

The final recommendation before beginning college applies specifically to prospective students with pre-existing mental health needs. Students need to be comfortable self-administering any mental health medications as prescribed, and students should be educated about how alcohol and other substances may interact with medications. Relatedly, continuity of mental health care is extremely important to plan for in the transition to college, which may involve establishing care networks in a new location.

Starting College

My main advice for the first year of college is to set goals that focus less on grades and academic performance and more on skill-building. Think of the start of college not as a time to achieve, but as a time to grow and set goals accordingly. Take advantage of resources to help you navigate the transition to college; this includes many human resources in the form of peer advisors, faculty mentors, coaches, and student affairs professionals. Ask questions, ask for help, let people support you (and reciprocate when you are in a position to do so).

Despite what social media may portray, loneliness is very common among college students. As with the challenges described above, I don’t know anyone for whom loneliness did not at least creep in during college. In our Healthy Minds data, 20-25% of students report “often” feeling “left out,” “isolated from others” or that they “lack companionship.”

Particularly for first-year students, remember that some degree of loneliness is to be expected. You are in a new environment and that can feel isolating, even if you are physically surrounded by other people. It will take time for most new students to build relationships with peers and faculty. Be patient but proactive. Don’t expect loneliness to resolve on its own (or linearly). Make time to engage in social and extracurricular activities, the offerings for which are often far more extensive than in high school. Get involved in something (but not too many things). The Set to Go program also offers a guide to making connections on campus.

Lastly, students and families need to enhance what is known as ‘mental health literacy.’ Schools should be a setting where this is fostered. Prospective students should look into whether the college/university offers first-year seminars about mental health and wellness. As noted earlier, the traditional college years (~ages 18-25) are a vulnerable time for the onset of mental health problems. Unfortunately, in the U.S., the delay from symptom onset to first treatment contact is, on average, about a decade.

Part of mental health literacy is understanding that treatment is most effective when received early. Students and their families should know the mental health resources available at a school as well as the signs and symptoms to look out for; parents are especially well-positioned to observe any changes in the mental or emotional state of students at the start of college (when peer networks are being established). It is also important to be knowledgeable about other supportive resources such as academic tutoring, peer coaching, and resources specific to certain student groups (e.g., for first-generation college students).

 

Key Implications for Practice

  • In deciding when to go to college, be open to the idea of a gap year. This may be the best decision for having a positive, enriching college experience.
  • In deciding where to go for college, prioritize “fit” along several dimensions, including institutional policies that govern student life and available resources.
  • Expect challenges in college and be prepared by ‘coping ahead.’
  • Build autonomy and problem-solving skills before coming to college, including the skills and knowledge to manage pre-existing mental health conditions.
  • In starting college, set goals that focus less on grades and more on skill-building.
  • Take advantage of resources to help navigate the transition to college.
  • Students and their families should know the mental health resources available at a school as well as the signs and symptoms to look out for.
  • Engage in social/extracurricular activities and get involved in something (but not too many things).

Conclusion

The advice and recommendations offered here are rooted in evidence-based risk and protective factors—that is, reducing factors known to negatively affect mental health and fostering factors known to positively support well-being and flourishing in college populations. I hope that these recommendations help prospective college students and their families prepare for higher education in ways that prioritize mental health and well-being.

Related Resources

Child Mind Institute

Jed Foundation

Leaves of absence and other campus policies

 

https://doi.org/10.17077/rep.006643 

Photo credits: Canva and Scanlan Center for School Mental Health