MENTAL HEALTH, SUBSTANCE USE,
and WELLBEING in HIGHER EDUCATION
Supporting the Whole Student
Alan I. Leshner and Layne A. Scherer, Editors
Committee on Mental Health, Substance Use, and Wellbeing
in STEMM Undergraduate and Graduate Education
Board on Higher Education and Workforce
Policy and Global Affairs
Board on Health Sciences Policy
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the Substance Abuse and Mental Health Services Administration (SAMHSA) under award HHSP2333201400020B, the National Institute on Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) under award HHSN263201800029I. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-12412-6
International Standard Book Number-10: 0-309-12412-3
Digital Object Identifier: https://doi.org/10.17226/26015
Library of Congress Control Number: 2021930903
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Mental Health, Substance Use, and Wellbeing in Higher Education: Supporting the Whole Student. Washington, DC: The National Academies Press. https://doi.org/10.17226/26015.
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COMMITTEE ON MENTAL HEALTH, SUBSTANCE USE, AND WELLBEING IN STEMM UNDERGRADUATE AND GRADUATE EDUCATION
ALAN I. LESHNER (NAM) (Chair), CEO Emeritus, American Association for the Advancement of Science
CHRIS BROWNSON, Associate Vice President for Student Affairs, Director of Counseling and Mental Health Center; Clinical Associate Professor, Department of Educational Psychology, University of Texas at Austin
GERARD CLANCY, Senior Associate Dean, University of Iowa Carver College of Medicine; Past President, The University of Tulsa
BONNIE DURAN, Professor, Schools of Social Work and Public Health, University of Washington
DANIEL EISENBERG, Professor of Health Policy and Management, University of California at Los Angeles; Director, Healthy Minds Network
RAYNARD S. KINGTON (NAM), Head of School, Phillips Academy, Andover; President Emeritus, Grinnell College
AMY LENHART, Professional Counselor, Collin College
FRANCES LESLIE, Professor of Pharmaceutical Sciences; Dean, Graduate Division (ret.), University of California, Irvine
BENJAMIN LOCKE, Executive Director, Center for Collegiate Mental Health and Senior Director, Counseling and Psychology Services, Pennsylvania State University
GAIL A. MATTOX, Professor of Clinical Psychiatry and Chairperson, Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine
MARIA A. OQUENDO (NAM), Ruth Meltzer Professor of Psychiatry, and Chairman of Psychiatry, Perelman School of Medicine, University of Pennsylvania
STEPHANIE PINDER-AMAKER, Chief Diversity, Equity, and Inclusion Officer and Director, College Mental Health Program, McLean Hospital; Assistant Professor of Psychology, Department of Psychiatry, Harvard Medical School
JULIE POSSELT, Associate Professor, Higher Education, Rossier School of Education, University of Southern California
CLAIRE E. STERK (NAM), President, Emerita and Charles Howard Candler Professor of Public Health, Emory University
JEANIE TIETJEN, Director, Institute for Trauma, Adversity, and Resilience in Higher Education; Professor of English, MassBay Community College
LAYNE A. SCHERER, Study Director
MARILYN BAKER, Acting Study Director (September–December 2020)
JOHN VERAS, Senior Program Assistant
AUSTEN APPLEGATE, Research Associate
MIRIAM AKEJU, Christine Mirzayan Science and Technology Policy Fellow, 2020
ADRIANA COUREMBIS, Senior Financial Business Partner (until April 2020)
CLARA SAVAGE, Senior Financial Business Partner
BARDIA MASSOUDKHAN, Senior Financial Business Partner
JOSEPH ALPER, Consultant writer
JENNIFER SAUNDERS, Consultant writer
BOARD ON HIGHER EDUCATION AND WORKFORCE
KUMBLE R. SUBBASWAMY (Chair), Chancellor, University of Massachusetts, Amherst
ANGELA BYARS-WINSTON, Professor of Medicine, University of Wisconsin-Madison
JAIME CURTIS-FISK, Scientist and STEM Education Program Leader, Dow Chemical Company
MARIELENA DESANCTIS, College Provost, Senior Vice President, Academic Affairs and Student Services, Broward College
APRILLE J. ERICSSON, SBIR/STTR Program Manager, NASA Goddard Space Flight Center
JOAN FERRINI-MUNDY, President, University of Maine
GABRIELA GONZALEZ (NAS), Professor of Physics and Astronomy, Louisiana State University
TASHA R. INNISS, Associate Provost for Research, Spelman College
SALLY K. MASON, President Emerita, University of Iowa
DOUGLAS S. MASSEY (NAS), Henry G. Bryant Professor of Sociology and Public Affairs, Princeton University
RICHARD K. MILLER (NAE), President Emeritus, Olin College of Engineering
PATRICIA SILVEYRA, Associate Professor, Beerstecher-Blackwell Distinguished Term Scholar, and Director, Biobehavioral Laboratory, University of North Carolina at Chapel Hill
KATE STOLL, Senior Policy Advisor, Massachusetts Institute of Technology Washington Office
MEGHNA TARE, Executive Director, Institute for Sustainability and Global Impact, University of Texas
MARY WOOLLEY (NAM), President and CEO, Research! America
THOMAS RUDIN, Senior Board Director
AUSTEN APPLEGATE, Research Associate
ASHLEY BEAR, Senior Program Officer
LIDA BENINSON, Senior Program Officer
IMANI BRAXTON-ALLEN, Senior Program Assistant
MARIA LUND DAHLBERG, Senior Program Officer
LEIGH MILES JACKSON, Senior Program Officer
PRIYANKA NALAMADA, Associate Program Officer
LAYNE A. SCHERER, Senior Program Officer
JOHN VERAS, Senior Program Assistant
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The ability of students to succeed in higher education and beyond is dependent on their physical and mental wellbeing, and the nation’s institutions of higher education are seeing increasing levels of mental illness, substance use, and other forms of emotional distress among their students. Some of the problematic trends have been ongoing for decades. Some have been exacerbated by the COVID-19 pandemic and resulting economic consequences. Some are the result of long-festering systemic racism in almost every sphere of American life that are becoming more widely acknowledged throughout society and must, at last, be addressed.
Although the causal factors for each have their own idiosyncratic solutions, the increase in mental health and related problems has put tremendous pressure on the capacity of existing traditional college counseling and other support systems to handle the need for their services, leading to what some have called a “mental health crisis” on college campuses. Whether this constitutes a genuine crisis or not may be debated, but there is no question that new approaches and strategies are needed to deal with the increasing demand for help. This report lays out a variety of possible strategies and approaches, based on the available evidence on the nature of the issues and what works in various situations.
Although the report includes an array of recommendations, no real progress will be made unless individual institutions decide to promote a climate that clearly values the wellbeing of every student. The overall tone for that campus-wide atmosphere must, of course, be articulated by the leadership—the president, the board of trustees, faculty leaders—but must also involve all sectors of the institution—faculty, staff, and students. Each has a role to play.
A part of that culture change will require devoting more resources to promoting mental wellbeing, and that need is coming at a terrible time. Financial resources at almost every institution are severely constrained. However, this issue is of sufficient importance that, if necessary, priorities should be reevaluated and rearranged. The impacts of this problem are critical and broad enough that ensuring the wellbeing of all students must be near the top of the priority list. Hopefully, this report will help articulate the need for additional resources and provide a basis for moving forward on this issue.
I am extremely grateful to my superb colleagues on the National Academies of Sciences, Engineering, and Medicine’s committee that authored this report. Leading such an expert and committed group of scholars has been an extremely rewarding experience. I also want to express, on behalf of the whole committee, our gratitude to the exceptionally competent and dedicated staff of the National Academies and the many others cited in the acknowledgments that follow.
Alan I. Leshner (NAM), Chair
Committee on Mental Health, Substance Use, and Wellbeing in STEMM Undergraduate and Graduate Education
The committee would like to thank the following staff members for their hard work and dedication in bringing this report to fruition: Layne Scherer, Austen Applegate, Marilyn Baker, Ashley Bear, and John Veras, as well as consultants Joseph Alper and Jennifer Saunders. Without their commitment, this report would not have been possible. The committee also thanks senior librarians Anne Marie Houppert and Rebecca Morgan, as well as the National Academies’ research library, for assistance with fact checking and literature searches.
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report: Amelia Arria, University of Maryland; Stephen Beckley, Hodgkins Beckley Consulting; Traci Callandrillo, American University; Kafui Dzirasa, Duke University; Patricia Frazier, University of Minnesota; Sylvia Gonzalez, Austin Community College; Renée Jenkins, Howard University; Julia Kent, Council of Graduate Schools; Emily Lattie, Northwestern University; Juanita Limas, University of North Carolina; Sarah Lipson, Boston University; Olivia Lubarsky, John W. Brick Foundation; and Michelle Riba, University of Michigan.
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Antonia Villarruel, University of Pennsylvania, and Paul Gray, University of California, Berkeley. They were responsible for making certain that an independent examination of the report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Chapter 2 Mental Health, Substance Use, and Wellbeing in Higher Education in the United States
Chapter 3 Environments to Support Wellbeing for All Students
Chapter 4 Clinical Mental Health and Substance Use Services for Students in Higher Education
Appendix A Committee Biographies
Appendix B Minority Serving Institutions
Appendix C Acronyms and Abbreviations
Appendix D The Rate of Student Death from Suicide from the Big Ten Counseling Centers: 2009-2018
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