How to ease the transition to college when mental health is a concern

A 2021 survey by the American College Health Association of close to 100,000 college students found that 16 percent of college men and 33 percent of college women had been diagnosed with anxiety, and 14 percent of college men and 25 percent of college women had been diagnosed with depression.

A study published in June by the Healthy Minds Network — which conducts research on the mental health of college students — involving more than 350,000 students on 373 campuses between 2013 and 2021 found that the number of students who met the criteria for one or more mental health problems in 2021 had doubled since 2013.

Pandemic exposed mental health divide among college students, study says

That was no surprise to Sarah Lipson, a principal investigator for the network and the study’s lead author.

“Living in a new setting and away from home can often create overwhelming and stressful circumstances, and recently we’ve added the stress of the pandemic to the mix,” says Lipson, a professor of health policy at Boston University’s School of Public Health. For students with a diagnosed mental health condition, she adds, their strategy for college success should include making and implementing a mental health plan (see “10 tips for your move to campus”).

Jaiden Singh, 20, a rising junior at the University of Arizona who struggles with academic-related stress and anxiety, is a good example of someone who did the necessary prep work before he landed on campus.

Singh, who was a member of Active Minds in high school, said the fact that the University of Arizona had an Active Minds chapter was “a key factor” in his choice to attend school there. In addition, before he started college in fall 2020, he studied the university’s counseling center website, where he found a robust selection of services, including individual and group counseling.

During his freshman year, classes were remote because of the pandemic. Singh lived at home, but he remembers appreciating an online webinar that helped students reframe their situation.

“I could anticipate the next semester hopefully on campus and be glad that I had a safe place to be in the meantime,” he says.

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Since moving to campus in fall 2021, Singh has taken advantage of one-on-one counseling, among other services.

“I found the intake process … very easy, which was a big factor, and is for many students, because just getting started accessing services can be hard,” Singh says. At Arizona, the counseling center offers an array of services, including sessions on relaxation skills, test anxiety, homesickness and time management.

Treatment and medications

For students continuing therapy and/or medications at college and “who may need to change doctors and pharmacies, it is essential that these transitions take place ahead of the term … so students can avoid interruptions in their care just when their new, exciting college experience is beginning,” says Shabana Khan, a physician and director of telehealth for the Department of Child and Adolescent Psychiatry at the NYU Grossman School of Medicine in New York.

Khan, who chairs the American Psychiatric Association’s telepsychiatry committee, says changing telehealth rules make it especially crucial for students who will be attending college in a different state to find out whether they will be able to continue care with their current treating clinicians.

After the Health and Human Services Department declared a public health emergency in January 2020, many states and insurers expanded the types of health-care providers who are able to see their patients online as well as the types of telehealth services that can be provided.

In some cases, state-specific changes allowed health-care professionals of all kinds, including psychiatrists, psychologists and social workers, to see patients online even when a patient had moved out of state.

Pandemic leads colleges to revise, improve mental health efforts

Today, however, some insurers have started rolling back coverage for telehealth, and many providers worried about flexibility ending (in July, HHS renewed the rules for 90 days) have stopped seeing patients remotely. Patients need to review with their providers whether they will be able to continue care, before heading to college, Khan says. “College counseling centers can help in transitioning students to new practitioners,” she adds.

One evening this spring, hundreds of undergraduates at New York City-based Yeshiva University attended a discussion hosted by the college’s Active Minds chapter, which featured three students speaking about their mental health journeys. The college’s counseling center director, Yael Muskat, was proud and unsurprised.

“We work with our students to make mental health a safe topic to discuss, and seek help for, on our campuses,” Muskat says. Like many campuses, Yeshiva doesn’t just rely on students to seek out the counseling center but also actively promotes its services, which include depression screening events, drop-in anxiety groups, workshops and speakers.

At semester orientations, student-volunteers and staff offer a warm welcome to anyone interested in learning more about the center.

Feeling low, tell someone

Conversations about mental health have become more common since the pandemic began, so find that person who feels safe to speak with, says Kelly Davis, associate vice president of peer and youth advocacy at Mental Health America, which connects people with mental health resources.

Students with mental health concerns should use their first days on campus to introduce themselves to resident advisers, counseling staff and other students they meet in dorms, classes and the dining hall. These steps will help them develop a community for sharing their college experience and for reaching out if life at college starts to seem overwhelming, Davis says.

10 tips for your move to campus

1. Study campus options before leaving home. Students with a mental health diagnosis should ask their provider whether they can continue their sessions in person or remotely, says Shabana Khan, a physician and director of telehealth for the Department of Child and Adolescent Psychiatry at the NYU Grossman School of Medicine in New York. If not, ask the provider’s advice on whether you should continue counseling with a new provider at college; if the answer is yes, contact the campus counseling center for guidance.

2. Review your health insurance. Generally, insurance dictates which providers you can see and how much you will pay for visits and medication. Keep in mind that some students change insurance plans when they start college, says Kelly Davis, associate vice president of peer and youth advocacy at Mental Health America, including switching to a less expensive university health plan. If campus providers charge a fee and don’t take your insurance, ask whether the counseling center offers any free or reduced-price care and if there are local providers who might take your insurance. Also investigate whether local mental health clinics provide services for free or on a sliding scale of fees. If possible, have your current provider speak to your future provider “to catch them up on your treatment,” Khan says.

3. Find the counseling center early. Introduce yourself to the staff, especially if you’re transitioning to care on campus. Keep center contact numbers handy in case of an emergency for you or a classmate, or for any questions that come up.

4. Have a medication plan. According to the Healthy Minds Network, a quarter of college students take mental health medications. It’s important to speak to your doctor about the medications you take and anything you should change or add before you leave for school and fill prescriptions before you head to campus. Once at college, contact the campus counseling center for help getting emergency supplies or assistance in getting prescriptions started at a new pharmacy.

5. Prepare for emergencies. Ask counseling center staffers whom to call if you’re feeling stressed, overwhelmed, unsafe or capable of harming yourself or others, says Victor Schwartz, senior associate dean for wellness and student life at the City University of New York Medical School. Many campuses are also widely posting about 988, a national suicide prevention hotline that launched in July. Students can call or text 988, or call 1-800-273-TALK (1-800-273-8255).

6. Open up with others. Since the pandemic began, conversations about mental health have become more common, so build on that. Campus officials want you to thrive and know the transition can be difficult, Davis says. “In your first days, say hi to resident advisers, faculty, counseling staff, classmates online so that you start to develop a community and feel comfortable sharing how you feel.”

7. Tap into other services. Students with mental health concerns and a diagnosed learning disability or executive functioning issue should also share those records with the academic support center, says Saul Newman, associate dean for undergraduate education in the School of Public Affairs at American University in D.C. “That should be in place before the start of a semester,” Newman adds. If you’re feeling overwhelmed by a class or assignment as the semester moves forward and think you won’t be able to complete it, contact the professor as early as possible, Schwartz says.

8. Participate. Making new friends is the best way to defuse stress and ease anxiety and depression, Schwartz says. Elizabeth Lunzer, 21, who graduated from UCLA this year and was a member of the school’s Active Minds chapter, says being involved gave her a safe place to discuss her anxiety with people who understood and cared about how she was feeling.

9. Find your counseling space. Since the start of the pandemic, many people have switched to remote therapy, even when the provider and patient are on the same campus. Students should be sure to have a private space for the sessions, says Anushka Gupta, 19, a sophomore at New York University. If your room isn’t an option, ask the counseling center, library or student activities center if there is a room you can have to yourself once a week for sessions.

10. Parents may be a support system for some. Parents, guardians and family members aren’t necessarily looped in about health issues when a student is 18 or older. If a student wants to involve parents and others in their care, they can ask the counseling center how to lift confidentiality provisions to keep them informed.