When it comes to choosing a college, it’s typical for parents and students to pour over metrics like graduation rates, financial aid support, and post-grad job placement. The college campus is scrutinized, dining hall food reviewed, academic programs evaluated, and professors rated.
But there’s little information readily available about university mental health services. And good luck comparing the options school to school, despite the fact that 60% of college students reported being diagnosed with a mental health conditionaccording to an exclusive Fortune survey of 1,000 college students conducted by The Harris Poll in June.
Maybe that’s because parents and students simply assume that college is a safe and nurturing environment and that there will be resources on campus that provide the same—or even a better—level of physical and psychological support than can be found at home.
It’s a message that’s actively promoted by many colleges and universities. But frequently, reality falls short. “One time when I was at Northwestern, I was coming back from my lunch and I happened to fall in the back of a [college campus] tour,” says John Dunkle, who at the time was the executive director of Northwestern University’s Counseling and Psychological Services.
When the tour reached the building that housed student health services, including the counseling department, Dunkle was dismayed to hear the student tour guide say, “And here is the Counseling and Health Services, which is a one-stop shop where you get all of your health care and mental health care needs met.”
“Which isn’t exactly true,” says Dunkle, who now works as the senior clinical director of higher education at The Jed Foundationa nonprofit aimed at suicide prevention among young adults.
Miscommunication about the services provided by campus health programs can cause so much frustration for students and families later on. In most cases, there is no one-stop shop for mental health resources on any campus, Dunkle says. And the counseling services department, in particular, is routinely understaffed at many universities.
In order to mitigate some of this frustration, and perhaps even prevent more desperate situations, experts say there are a number of steps parents and students can take to be more proactive about their mental health needs on campus.
1. Ask questions early in the process
Although some students encounter mental health problems for the first time when they enter college, many have pre-existing issues.
Of the students who have received therapy at some point for a mental health condition, a quarter say they went to counseling even before entering college, according to the Fortune survey. About 15% reported getting therapy prior to and since starting college. Only about 15% reported that they only started counseling while in college.
Parents and students need to ask questions about a school’s mental health programs before getting to campus. There is no real national database where parents and their college-age children can search to find the best university wellness centers. So the work falls on families, who should start making calls or sending emails to the school’s director of counseling prior to even applying to a university.
Parents and students should be asking not only about the ratio of students to teachers, but of students to therapists. They should also ask: What does the counseling approach look like?
Nearly half (47%) of college counseling centers use a version of the “stepped care” model, which starts with the least resource-intensive treatment and intensifies or adds services, as required. Moreover, many colleges cap the number of free individual counseling sessions available. Students who have long-term therapy needs may not get the support they need.
“Families need to be having those very serious conversations before the student even applies,” Dunkle says. If they’re planful, a student can be very successful anywhere they go.
2. Approach college services with reasonable expectations
On-campus wellness centers “can’t be everything to everybody—and that’s sort of what’s happening,” Dunkle says. Students are showing up seeking support for a variety of problems, ranging from generalized anxiety and depression to eating disorders and even more severe mental psychosis. Some of the more intensive problems cannot really be treated by college mental health counselors, but wellness centers are frequently the first line of defense when students need help.
Most colleges have a few therapists and maybe a part-time psychiatrist, and their schedules fill up “almost immediately,” says Dr. Tia Dole, the executive director of The Steve Fund, a nonprofit focused on the mental health of young people of color. “All the therapists are like, ‘I want to see these kids for longer, but we have 30-40 kids on the waitlist. We need to move this along.’”
Parents who know their student needs help ahead of time may want to find a local therapist before a student arrives at school and skip the campus wellness center altogether. More and more therapists also offer telehealth appointments, so a student might be able to stick with their current provider and continue the therapy remotely while they’re at school.
When it comes to the type of campus that’s best suited to handle students with more mental health needs, parents and students shouldn’t just look at size, says Brett Donnelly, vice president of college health business development at Mindpath Healthwhich provides in-person and virtual therapy and psychiatry for college students at seven locations in California and one in Minneapolis.
The level of resources available frequently has more to do with the size of the school’s endowments and financial resources than its overall size, Donnelly says. “That’s where you’re going to really separate the schools that can spend the money to hire more clinicians and have a more robust counseling program,” he adds.
“At the larger public institutions, I think that there’s a lot of resources available on campus. I just think it’s just a simple supply-and-demand issue,” Donnelly adds.
3. Understand what your insurance actually covers
Before a student arrives on campus, colleges typically ask them to verify they’ll be using their parents’ health insurance or require them to sign onto the university’s medical insurance program. This is a good time for parents and students to explore their options.
Students typically can stay on their parents’ health insurance until they turn 26. But this isn’t a failsafe. If a student is attending college out-of-state, for example, their parents’ health insurance network may not offer good coverage, and/or providers near the college may be out of network or simply unavailable. Students may incur significant out-of-pocket costs to see a therapist.
Additionally, it’s worth it analyzing what’s covered by the college health plan. In many cases, these plans do not cover off-campus mental health treatments. That can be an issue if a student needs to find a private therapist or counselor for additional sessions. A third option worth exploring is a marketplace plan offered through the Affordable Care Act.
About 70% of college students who have received mental health treatment report using a form of insurance to pay for it, most commonly their parents’ insurance plan, the Fortune survey found. Among college students who received counseling last semester, the majority found paying for their mental health care was easy. About 38% found it difficult to pay for treatment, and 6% said it was very difficult.
“Teach your son or daughter what a copay is, what the deductible is,” Donnelly says. Knowing how to utilize their health plan, find providers, and calculate the costs ahead of time could alleviate barriers down the road. A common question, for example, that students routinely don’t know is whether their insurance covers telehealth counseling sessions.
Donnelly also suggests parents let their kids know whether they can see any charges incurred. Students may feel guilty about seeking out expensive services, but having conversations in advance can mitigate that issue.
4. Talk about mental health struggles
The stigma around mental health has lessened in recent years. And the pandemic has perhaps pushed that openness even further, but experts say parents should be especially open to talking through these issues with their kids.
Nearly half of college students, 47%, say they would talk to their immediate family if they were experiencing serious emotional distress, according to the Fortune poll. About 51% say they would talk with friends.
One of the worst things a parent can do is expect a change of scenery to alleviate a student’s mental health struggles. “Human beings do a really good job of being like, This is the thing. If I just wait for that, then it will fix itself,” says Dole.
That rarely works. Some parents simply want to drop their adult child off at college and assume that they’re going to be great, Dole says. That’s a “crapshoot.”
5. Look beyond just the counseling center
While the campus counseling center may be the hub of mental health support, Dunkle says it’s important for students and families to evaluate other resources as well. Does the school have support groups or peer-to-peer mental health options like chapters of Active Minds on campus?
Culture is also very important, says Alison Malman, executive director and founder of the campus mental health advocacy group Active Minds. “It is not just about increasing the number of counselors in a counseling center. It’s not just about having the Calm app available. It is about creating a culture where your students or young adults feel comfortable reaching out for the help that they need.”
Even being involved on campus, whether that’s Greek life, a religious organization, or another student group, can help. And a lot of colleges offer freshman programs, where throughout the first year of students’ undergraduate experience they have seminars and activities targeted to them in an effort to build community. Others offer residential learning communities where students in the same major can live in the same dorms. All of that can help, Dunkle says.
“Connection is so important, because we know that as soon as students feel lonely—they may be surrounded by people but still feel lonely—that is correlated with a lot of depressive symptoms of suicidal ideation,” Dunkle says. “So having those programs in place to support students is really critical.”