Mental Health in College

Beginning college is an exciting time, but it’s also a time of greater independence and responsibility. This is true whether you are attending a local college or moving away from home.

This transition can be intimidating, especially if other people in your family have not attended college; if you are a member of a community that has been traditionally marginalized or underrepresented at your school; or if you are a returning student or a student-veteran. Many students work to help cover the cost of attendance, and some have family responsibilities to manage in addition to their coursework. Trying to manage these demands can be difficult.

While college can be emotionally challenging, it’s still possible to enjoy the experience and grow from it. To help support your success in college, it’s important to prioritize your mental health — look out for on-campus supports, social connections and opportunities to engage with your new community.

Even those who have not experienced mental health problems in the past should begin to think ahead and take steps to help ease the emotional challenges of starting a college journey.

Establishing a self-care routine and healthy habits can make a big difference. Whether you are living at home, in a residence hall or in an off-campus apartment with others, getting adequate sleep, maintaining good nutrition and engaging in regular exercise will help keep your mind and body in good condition. Making time for hobbies and social activities can also help you maintain a positive mood. With new demands and responsibilities, finding a good balance and keeping a regular schedule can be very helpful.

Make sure you find out what academic, health and mental health support services are available at your school, where they are located and what they provide. Many students may hesitate to use support services because they are concerned that asking for help is a sign that they are struggling or unable to handle their responsibilities.

It’s important to keep in mind that these services are there to help all students and can be a valuable resource to prevent academic or health problems before they start.

Before college, most young people receive health care through their family’s health insurance and primary care providers, and parents or guardians will often be involved in care decisions. When you turn 18, you gain more control and privacy regarding your health care. For example, your health care providers cannot share your health information with parents, guardians or anyone else without your permission (except in rare circumstances). You can find more info on this topic in our college guide.

It’s important to ensure continuity of care if you have a mental health condition and are moving away to start school. It can be helpful to consider how you will continue your treatment, your options for finding new care (should you need it) and how/when you are comfortable sharing information about your health with family or others in your support system.

Developing A Plan For Treatment

Having a clear plan for how you will manage your mental health care when you start college can be essential to support your wellness or recovery, ensure your safety and maximize your success. Starting college when you already have a mental health condition might feel scary, but a pre-existing diagnosis does not necessarily increase the risk of struggling academically.

Most colleges offer counseling and mental health services, but these are often limited to short-term talk therapy or acute care/crisis services. These services can be essential if you are seeking help for the first time or only have a temporary need for support, and they are usually available at no cost.

However, if you already know that you will need regular visits with a therapist or prescribing clinician to maintain your care, discuss this with your current provider. They may be able to continue working with you through a telehealth format or help you find providers and support options in your new community. If you are not able to find a provider before you move, the counseling service at your school may help you find local clinicians.

Developing A Crisis Plan

In addition to planning for your ongoing or “maintenance” mental health treatment, it is also helpful to consider how you might deal with emerging problems or crises. Have a discussion with your current provider, your family and others in your support network, and consider putting your plan in writing. Every plan is individualized, but common elements include:

Contact information for your current mental health providers
A list of current medications (including dosage)
Contact information for your pharmacy
Notes on your medical history, including physical health conditions
Your preferences for who the school should contact — and under what circumstances

It’s important to remember that mental health symptoms are unpredictable — no one plans to have a crisis, and it can be unpleasant to think about, but the best time to develop a crisis plan is when you are doing well.

Evaluating Your Needs

Starting college is a major life transition, and even the best plans may need adjustments as you settle in. It can be helpful to keep an open conversation with your mental health provider, family and others in your support network to figure out what is going well and what might be necessary to improve your mental wellness plan.

Remember that the law requires colleges to provide reasonable accommodations to any student who has a condition impacting their ability to function at school. If you are unsure about requesting accommodations or unclear on what specific accommodations would be most helpful for you, discuss this with your family and treatment team. These requests are usually managed by your school’s Disability or Accessibility office, and their requirements for eligibility and documentation may vary. If you are considering accommodations, it can be helpful to request an appointment with a counselor or advisor to learn what is available to you.

There may be a time when a serious mental health problem emerges or an existing problem escalates resulting in a crisis. If you feel that you are unable to keep up with your academic responsibilities — or that staying in school/on campus might be unsafe or unhelpful for your well-being — be aware that most colleges and universities have a process for taking time off in a mental health emergency.

If you notice that your mental health is negatively impacting your coursework or your daily responsibilities, letting your advisors and/or counselors know early on can be helpful. Some mental health issues are temporary and may improve with adjustments to your schedule or care strategies, allowing you to successfully complete the term. For example, your advisors and counselors can help you adjust your course schedule. In any case, if you are working with the college support staff, they can help you adjust the plan if your situation changes.

If it is not practical or reasonable for you to continue your current semester, you may consider taking a leave of absence, sometimes called medical or mental health withdrawal (temporarily withdrawing from school due to a medical or mental health issue). In most cases, you will be asked to provide documentation from a treating clinician that you are experiencing a serious problem that is making it difficult or unsafe for you to remain in school. This is a normal process available to any student who is struggling, so your school’s counseling service or your academic advisor will be able to offer guidance and support.

Make sure you consider the practical benefits and consequences of taking a leave of absence. While taking time off from school is not necessarily a problem for future employment or graduate school admissions (in fact, fewer than half of students complete a bachelor’s degree in four years), some colleges do not refund tuition or housing costs when students take a leave late in the term. Tuition insurance may be an option to consider, allowing you to recover tuition costs in a medical crisis requiring a leave of absence.

If you live on campus, also consider that you will not be able to remain in college housing or use school services, such as the counseling or health center for your ongoing care, once you have taken leave. It’s important to discuss this with your family and support network in advance to ensure you can make proper arrangements.

Before taking a leave of absence, make sure you understand your school’s requirements for resuming enrollment. For example, they may require you to wait a specific amount of time before you can return. When discussing a leave of absence with your school’s counseling service or your academic advisor, be sure to clarify what these requirements are — especially if there are any differences between mental health leave and leave due to a medical illness or injury.