This article originally appeared in Nature. Sara Oswalt, Department Chair and Professor of Public Health, is quoted and her research was used for this piece.
Even at a time of great financial strain and uncertainty, universities and colleges across the United States must invest more resources to address a growing mental-health crisis among students, according to a report from the US National Academies of Sciences, Engineering, and Medicine. “The problem is as great or greater than it’s ever been, and it’s not getting better,” says Alan Leshner, who chaired the committee behind the report and is chief executive emeritus of the American Association for the Advancement of Science. “Unless there’s concerted attention, it will get substantially worse, because the pressures are not going away.”
The COVID-19 pandemic, which struck while the report was in its planning stages, has only added to the urgency for action, Leshner says.
Universities, says Leshner, must pay special attention to the needs of graduate students, many of whom face unusual pressure from having to keep up with their work and family obligations while navigating a career. Graduate students are less likely than undergraduates to feel that they have access to mental-health care, he says. They also tend to rely strongly on guidance and support from their supervisors, with uneven results. “Some mentors are great, and some are terrible,” he says: faculty training to improve mentorship could go a long way towards improving the health and well-being of graduate students.
The required investments will be substantial, but simply throwing money at the problem won’t be enough, Leshner says. The report calls for an “all-hands” approach to mental health that starts at the top, with university presidents, and involves faculty and staff members at all levels. Among other steps, the report calls for faculty members to receive formal training to address and support student well-being. For their part, students should learn about mental-health issues as part of their introductory training. “It will take a cultural shift to produce the healthy, well-educated people that the country needs,” Leshner says.
Surveys suggest that rates of anxiety and depression among graduate students have spiked during the pandemic, especially among economically disadvantaged and under-represented groups (see Nature 585, 147–148; 2020). “Students are under a lot of economic pressure, and they’re worried about their future jobs,” Leshner says.
Most university leaders are already aware of mental-health challenges on their campuses. In a December 2020 survey from the American Council on Education, 68% of university presidents listed student mental health as one of their most pressing issues. Still, Leshner says, institutional leaders might need to be convinced by their boards of trustees to devote extra resources to mental health. The argument could be economic: the National Academies report cites surveys finding that the dropout rate for students with diagnosed mental-health problems ranges from 43% to as high as 86%. “Student dropout isn’t just expensive, it reduces the effectiveness of an institution,” Leshner says.
Students have shown an increased willingness in the past decade to access mental-health services, an encouraging trend that is nonetheless putting extra pressure on counsellors and clinics, says Sara Oswalt, a public-health scientist at the University of Texas at San Antonio. Oswalt was the lead author of a 2020 report1 that tracked rates of mental-health disorders and the use of mental-health services on campuses from 2009 to 2015.
The pandemic has greatly increased the need and demand for support, Oswalt says: “Mental-health services are overwhelmed. The challenges students are facing now are different than they were in the past. It’s hard to quantify what it’s doing to their mental health.” She adds that counselling centres and other services can be especially scarce in small private institutions, community colleges (which, in the United States, usually offer two-year programmes) and other places of learning beyond large universities running four-year courses.
Hiring more counsellors could be an important step, but counsellors alone can’t turn the tide, Leshner says. “Counselling centres are fighting an uphill battle against this culture that works against mental health and emotional well-being.”
The ripple effects of the pandemic could last long after the disease itself fades, says Bill Lechner, a behavioural researcher at Kent State University in Ohio. Lechner co-authored a 2020 study2 that investigated psychological distress and substance abuse both before and after a COVID-19 lockdown at an Ohio university. The students who said that they had more trouble with anxiety or depression after the lockdown also reported greater alcohol use. “The pandemic took away a lot of forms of healthy coping,” Lechner says. “You may not be able to go to the gym like you used to, and you certainly can’t go out and socialize in a healthy way.”
Before the lockdown, the highest alcohol consumption reported by any student was 63 drinks per week. After the lockdown, at least one student reported having 98 drinks in a week. The average number of drinks increased from a more modest three-and-a-half per week to more than five. Lechner warns that any change in drinking habits could linger for years. “There will be long-lasting neural and psychological consequences that are hard to just pull back,” he says.
The report from the National Academies carries no legal weight, and the response from colleges and universities remains to be seen. Still, a forceful statement from a major scientific body could have a real impact, Oswalt says. “I’m hopeful that the National Academies putting out this report and focusing on this issue will give it the increased attention it deserves.”