II. Learning and Success

Engaging New Approaches: Mental Health and Well-being on our College Campuses

Dr. Jack J. DeGioia

Our nation’s colleges and universities have deep histories of supporting the full development—the formation—of our students. The work of formation is integral to the mission and purpose of our institutions, alongside a commitment to the pursuit of knowledge and the promotion of the common good of the communities in which we are situated. These three elements—formation, inquiry, common good—have formed the core mission of the university for millennia. In recent years, mental health and well-being has emerged as a significant priority and challenge for our campuses. We have new resources—developments in our understanding of neuroscience and cognitive science, the emergence of positive psychology, the psychology of “flow”—that are now available to us as we imagine new structures to support mental health and well-being. There is an urgent need for all of us to engage new strategies and approaches as we work to respond to growing and significant mental health needs identified by our communities. This chapter will seek to answer three questions: how do we understand the current challenges facing our students; what are the resources we have available to us within our campus communities; and what can we do to strengthen our communities to meet the needs of our students?

At a time when the headlines are filled with worrying statistics about young people’s health and well-being, we can look to our college and university campuses for models of support that are available within these institutions—and we should challenge ourselves to do more to help our communities flourish. We have opportunities—institutional structures—to support the mental health and well-being of our students that are unparalleled in the rest of society. This essay delineates the institutional resources that colleges and universities provide in responding to the challenges facing our young people.

Adolescent Mental Health and Our Campuses

The average onset of a mental illness occurs during the ages of sixteen to twenty-four, a moment when many young people—more than sixty percent of our young people—will spend some time on one of our campuses (Bureau of Labor Statistics, U.S. Department of Labor 2022). As Thomas Insel, the former director of the National Institute of Mental Health, tells us: “Seventy-five percent of people with a mental illness report onset before age twenty-five” (Insel 2022).

Frances Lee and coauthors describe an insight provided by Ronald Kessler and his colleagues in 2005: “One in five adolescents have a mental illness that will persist into adulthood” (Lee et al. 2014). Our nation’s postsecondary institutions have a unique opportunity in our society to intervene with support and services at a critical moment in the lives of our young people.

The work ahead: How can we engage the imagination and creativity of our campus communities in response to these challenges?

Extraordinary research into the nature of mental health and illness, adolescent development, clinical interventions, and neurology have emerged over the past century. New approaches to care—beginning with the introduction of talk therapy to a new mental hygiene movement in the early half of the twentieth century were supported by developments within the higher education community, including the establishment of the American College Health Association in 1948. Over the past four decades discoveries in psychopharmacology, the invention of Functional Magnetic Resonance Imaging, and the development of the field of Positive Psychology have contributed to our capacity to care for our young people. Our colleges and universities contribute to this work.

Our campuses provide the strongest possible contexts for addressing issues of mental health and well-being in our society. We have the ability to create intentional communities of care on our campuses, guided by new insights and practices that emerge from the scholarship and research of our faculty. We can coordinate elements of care—ranging from peer counseling to efforts at prevention of harm to self and others, from health education to practices focused on building strengths.

Institutional Structures and Student Mental Health and Well-Being

There is a salience between the challenges facing our young people in critical moments of adolescent development with the capacities and capabilities of our institutions of higher learning. These capacities and capabilities emerge out of three elements that have constituted the idea of the university for a millennium. We support the formation of our students, the inquiry of our faculty, and we contribute to the common good of the communities in which we participate. These three elements are inextricably linked, mutually reinforcing, and cannot be unbundled without risking irreparable harm to the integrity of the enterprise. Together, these three elements constitute the structural integrity of our schools.

All three elements can contribute to addressing the current challenges of mental health within the context of the adolescent development that takes place during the years when our young people join our communities.

Formation

Formation captures the work in which each student is engaged throughout their years on our campuses: they are establishing their own sense of identity. Our students are living the questions that enable each of them to become a distinctive self.

Formation can occur in many different settings: in a religious order, in military training, in an entrepreneurial venture, among many others. What distinguishes the setting of the college and university is the central place of and the emphasis on knowledge. Students are introduced to disciplines and methodologies for engaging in the work of knowing. Students learn how to integrate, challenge, and critique knowledge—how to see patterns, make connections, and identify anomalies. The acquisition and dissemination, the discovery and construction, the interpretation and conservation of knowledge, together determine the orientation of the university; it is the work of our colleges and universities. It is this commitment to knowledge that differentiates the college and university from other settings.

The work of formation—wherever it takes place—is ultimately about identifying the conditions that will sustain human flourishing. In its original context, flourishing is captured in the Greek word eudaimonia. Eudaimonia seeks to capture the balance between and among a range of virtues and goods that constitute our humanity. Many different approaches to eudaimonia have been put forward since it was first introduced by Aristotle in the Nicomachean Ethics. Eudaimonia is best understood to capture a sense of human flourishing. For Aristotle, to flourish involves the exercise of what are characteristic human virtues—courage, justice—in support of the pursuit of goods, like friendship, practical wisdom, and pleasure. The exercise of these distinctly human virtues and the realization of these goods constitute human flourishing.

The contemporary philosopher Charles Taylor builds upon this tradition. Taylor argues that in modern discourse an element of flourishing is found in the term “authenticity.” Taylor finds this idea of authenticity first captured in Johann Gottfried Herder’s idea “that each of us has an original way of being human” (Taylor 1992b). Formation is the work of finding this originality—the authenticity of each of our lives. An authentic self is one living in accord with one’s most deeply held values, one  capable of resisting the forces of darkness that are always pulling one away from the goods that enable one to realize authenticity. One’s decisions and actions are informed by these values, these goods. The goal is to achieve alignment between these goods and one’s decisions and actions (Taylor 1992a).

This work of formation—and the pursuit of a sense of flourishing—has two dimensions in the settings of our colleges and universities: first, we support the formation that is possible through our commitment to knowledge, our commitment to what the historian John O’Malley, S.J., describes as the “style of learning and discoursing . . . the analytical, questing and questioning, restless and relentless style” that characterizes the modern academy (O’Malley 2006).

In addition, we support the interior work of each student, in the process of learning how to make meaning in one’s life. Colleges and universities provide places for protecting and nurturing resources of incomparable value for deepening self-understanding, self-awareness, self-knowledge—resources that support the interior work of making meaning in one’s life.

Our institutions have long provided a multitude of resources that complement the work in our classrooms and laboratories, libraries, and seminar rooms, ranging from co- and extracurricular programs in the performing arts, to volunteerism and community service, intercollegiate and intramural athletics, campus newspapers, literary magazines, and programs in residential living. These opportunities support the pursuit of a self-identity capable of attaining a sense of authenticity, a constitutive condition of human flourishing.

For our students wrestling with a range of issues related to their mental health—when as many as one-fifth will experience a mental illness that will persist into adulthood—addressing these challenges takes place within this context of formation. This adds a new dimension to the work of establishing one’s identity. Mental illness can become closely identified with one’s identity. Navigating this challenge—ensuring that one’s identity is not disproportionately correlated to a diagnosis of mental illness—is a special dimension of the work that many of our young people face.

Inquiry

Formation can take place in many contexts. In the context of the university, the work is centered on knowledge. Those most capable of organizing this work are the members of our faculties. This work orients their lives—the work they bring into the university and the time they spend with our students, bringing them into the flow of their way of seeing and understanding the world. University faculty members seek to understand our world, in all its complexity, and they dedicate their lives to that endeavor, adopting a way of life that immerses them in the pursuit of understanding and in sharing this understanding.

Formation within the university is predicated on the interaction of students with faculty. Faculty members serve as guides for students engaged in the process of personal exploration as well as being immersed in their scholarly projects. John Henry Newman provides an important insight into the conditions for scholarship: “This I conceive to be the advantage of a seat of universal learning… An assemblage of learned [women and] men, zealous for their own sciences, and rivals of each other, are brought, by familiar intercourse and for the sake of intellectual peace, to adjust together the claims and relations of their respective subjects of investigation. They learn to respect, to consult, to aid each other. Thus is created a pure and clear atmosphere of thought, which the student also breathes” (Newman 1982).

The work of scholarship is strongly sustained by a sense of place that enables a community to be built and sustained.

The research and scholarship of the faculty throughout higher education have contributed to the important developments that have emerged throughout the past century. Beginning in the 1970s, psychiatric medicine has been characterized by an explosion in the use of medication. Discoveries have occurred throughout a continuum from basic science to drug discovery. The life science ecosystem that includes our campus laboratories, academic health centers, the National Institutes of Health, and biotechnology and pharmaceutical companies have all contributed to these developments in psychopharmacology.

In 1998, Martin Seligman and Mihaly Csikszentmihalyi developed the term “Positive Psychology” to capture a new approach, building from Aristotle’s understanding of eudaimonia, as an alternative to the field’s long-standing disease model. This approach focused on character and emphasized the strengths of the individual, even developing an alternative to the American Psychiatric Association’s psychopathology classification model provided in the Diagnostic and Statistical Manual of Mental Disorders—first published in 1952—and now in its fifth edition. In 2004, Seligman worked with Christopher Peterson to publish their alternative, Character Strengths and Virtues.

New research in the study of the teenage brain, made possible by new technology in brain imaging, is providing new insights into the role that brain development can play in understanding the health of our young people. While these developments are among the most recent developments in our understanding of the brain and do not yet provide sufficient evidence for clinical intervention, this deepening understanding may reveal insights that can inform future clinical care.

Although these developments have shaped the range of responses, little is settled among scholars and care practitioners. The work of inquiry requires that our campuses continue to contribute to our understanding of how best to support the formation of young people and respond to the challenges of confronting mental illness.

Common Good

Every school—community college, college, university—contributes to the common good of the communities in which they participate. These communities may be local, national, and even global, depending on the specific reach of the school.

Different expectations are projected onto universities. The expectations, in this public role, can include preparing a workforce; developing a regional economy; strengthening national identity; enhancing economic competitiveness, both locally and globally; balancing and ameliorating social inequities; developing citizens; contributing social capital; and playing a role in developing public goods. While these expectations evolve over time, together they constitute the ongoing public and political discourse about the role of universities today. A distinctive characteristic of the university is that knowledge that is attained is to be shared.

The work of our universities is sustained by the communities that are built on our campuses. Campus communities provide models for supporting both the formation of the self-identity of our students and for addressing challenges to their mental health. Our communities can model the responses that are required in the larger communities in which we participate. Our students move out into the world and can bring with them the lived experience of what a campus community can mean and the conditions that can sustain one’s mental health and well-being.

We can ask ourselves, in this moment:

  • How can we more deeply connect the activities that support the work of formation with our programs that support mental health and well-being?
  • How are we engaging new research, from across the academy, to shape a commitment to mental health?
  • What programs and partners can amplify and extend our reach—on our campuses and into our local communities?

There are challenges—but we are uniquely capable of responding.

There are disturbing trends that have emerged in recent years.

In early 2023, the Centers for Disease Control and Prevention issued the findings of its Youth Risk Behavior Survey 2011–2021. Among the findings:

  • The percentage of high school students who experienced persistent feelings of sadness or hopelessness increased dramatically from 28 percent of those surveyed in 2011 to 42 percent in 2021 (“Youth Risk Behavior Survey: Data Summary & Trends Report” 2023).
  • In 2021, 29 percent of high school students experienced “poor mental health during the past 30 days” (“Youth Risk Behavior Survey: Data Summary & Trends Report” 2023).
  • Those seriously contemplating suicide rose from 16 percent to 22 percent (“Youth Risk Behavior Survey: Data Summary & Trends Report” 2023).

The statistics on suicide are particularly concerning. Others have found that:

  • Overall, across the population, the suicide rate in America has increased by 30 percent since 2000, while the rate has dropped globally by 18 percent (Klein and Insel 2022).
  • Suicide was the second leading cause of death for people ages 10–14 and 20–34. It was the highest for males (“Facts About Suicide”).

The Healthy Minds Study is a national mental health survey of college student populations. The survey captures responses from seven hundred colleges and universities.

  • Since 2013, students experiencing depressive symptoms has increased from 22 percent to 44 percent, and students experiencing symptoms of anxiety have increased from 17 percent to 37 percent (Lipson 2023).
  • The Healthy Minds Survey shows an increase in rates of suicidal ideation from 6 percent in 2007 to 15 percent in 2021 (Lipson 2023).

These troubling statistics affect the work of formation in which each of our young people is engaged. Our campuses have long histories of providing “safety nets” to support our young people should they find it difficult to work within our settings. The focus of our campus-based efforts was in addressing risk behavior. We have had programs in place for decades to identify students engaged in behavior that posed a threat to themselves and others. The most dominant focus was on substance abuse—specifically, alcohol. Safety nets also tried to catch students in extreme distress.

The CDC’s report on Youth Risk Behavior—which captured the rising concerns about anxiety, depression, and suicide—also identified areas of improvement in adolescent health and well-being, including declines in those engaged in risky sexual behavior and substance use—including a decline in alcohol use (“Youth Risk Behavior Survey: Data Summary & Trends Report” 2023). Years of focus on risky behavior have produced improvements. Our campuses provide deep resources—perhaps more than can be found in any other community setting in the nation—to support our students.

From peer leaders in the residence halls to the centers for counseling and psychiatry, health education outreach, and support groups—our campuses have deep and strong programs in support of the health and well-being of our young people. Our campuses provide opportunities for experimentation in new approaches to support and development for our students and our communities.

Some examples of creative engagement taking place on our campuses:

  • Colleges are establishing dedicated campus spaces for informal and formal activities that promote well-being. Worcester Polytechnic Institute’s Center for Well-Being, launched in early 2023, provides quiet spaces for meditation, yoga, art, and reflection and programs on nutrition and healthy eating in a central campus location, embedded with other campus health services.
  • Colleges are integrating services and offering programming focused on flourishing. Led by health and wellness leader Kelly Crace, William and Mary has integrated the offices of student health, counseling centers, campus recreation, and health promotion, and created a Center for Mindfulness and Authentic Excellence (CMAX), which “promotes the research and application of the principles of values-centered flourishing, mindfulness, and integrative wellness” through a variety of trainings and programs for the university community (“Center for Mindfulness & Authentic Excellence (CMAX),” n.d.).
  • Colleges are engaging national frameworks. In 2017, the Steve Fund and The JED Foundation developed “The Equity in Mental Health Framework,” a set of recommendations focused on the experiences of students of color on college campuses. Eighteen schools are piloting the framework, with goals adapted for their campuses. Related frameworks focused on health promotion include the Healthy Campus Framework at the ACHA (American College Health Association) and the Okanagan Charter, signed by one hundred international members.
  • Colleges are bringing mental health and well-being into the classroom. Since 2005, the Engelhard Program for Connecting Life and Learning at Georgetown has enabled more than 150 faculty members across disciplines to partner with campus resource professionals to design courses that incorporate topics of mental health and well-being into classroom discussion.
  • Colleges are creating options for digital engagement. The Ohio State University’s Wellness App lets students set goals, create personalized wellness plans, and access critical information and resources.
  • Colleges are focusing academic research on mental health and well-being to change policy and practice in regional, national, and global communities through centers like CUNY’s Center for Innovation in Mental Health in their Graduate School of Public Health and Health Policy and the University of Pittsburgh’s Center for Research on Innovations, Services, and Equity in Mental Health (RISE-MH) in their School of Social Work.

Going Forward

The question we are asking of ourselves now: Where can we contribute to enriching the culture of care and the discoveries that will ensure that we can strengthen the mental health and well-being of those facing difficulties?

In his recent book, Healing, Thomas Insel presents what he calls the “40-40-33 law.”

He writes: “Less than half—actually close to 40 percent—of the people identified with a mental illness in epidemiological studies are in care. Of these, only 40 percent receive ‘minimally acceptable care,’ meaning that the treatment is based on some scientific evidence. That means that only 16 percent (40 percent of 40 percent) have any likelihood of improvement from treatment. And for most treatments, whether psychosocial or medical, in the ways they are delivered today, only about one third respond sufficiently, one third receive some benefit, and one third do not respond. Thus, if 33 percent of 16 percent can be expected to get well with treatment, only a little more than 5 percent of the total population is fully better, what clinicians call ‘in remission’” (Insel 2022).

Our campuses can defy the 40-40-33 law. The concentration of resources and the strength of our communities can contribute to improved access and outcomes. We are capable of coordinating our resources—psychiatric medications, counseling, peer support—and ensuring that the discoveries that have emerged through community-based approaches contribute to the strengthening of our campus communities.

If we can defy Insel’s 40-40-33 law within our campus communities, perhaps we can share our insights in ways that will converge with new developments in our approaches to community mental health. Federal funding to support Certified Community Behavioral Health Centers and investments in children and family mental health services provided in the Bipartisan Safer Communities Act of 2022 represents unprecedented investments—more than $10 billion—in our nation’s infrastructure in support of mental health. Our college and university communities, through our experiences in support of our young people, coupled with the research we are developing and sharing, can enable us to provide an urgent and important contribution to the common good of the communities we serve.

References

Bureau of Labor Statistics, U.S. Department of Labor. May 2022. “61.8 Percent of Recent High School Graduates Enrolled in College in October 2021.” Economics Daily. https://www.bls.gov/opub/ted/2022/61-8-percent-of-recent-high-school-graduates-enrolled-in-college-in-october-2021.htm.

“Center for Mindfulness & Authentic Excellence (CMAX).” n.d. https://www.wm.edu/offices/wellness/ohp/cmax/index.php.

“Facts About Suicide.” n.d. https://www.cdc.gov/suicide/facts/index.html.

Insel, Thomas. 2022. Healing: Our Path from Mental Illness to Mental Health. New York: Penguin Press.

Klein, Ezra, and Thomas Insel. July 2022. “A Top Mental Health Expert on Where America Went Wrong.” Podcast. The Ezra Klein Show. https://www.nytimes.com/2022/07/22/opinion/ezra-klein-podcast-thomas-insel.html.

Lee, Francis S., Hadon Heimer, Jay Giedd, Edward S. Lein, Nenad Šestan Daniel R. Weinberger, and B. J. Casey. 2014. “Adolescent Mental Health—Opportunity and Obligation.” Science 346 (6209): 547–49. https://doi.org/10.1126/science.1260497.

Lipson, Sarah. 2023. “Bringing Together Student Success & Wellbeing: Behavioral Health, Engagement & Retention.” Presented at the President’s Convening on College Student Mental Health and Wellbeing, Georgetown University, March 21.

Newman, John Henry. 1982. The Idea of a University. Notre Dame, IN: University of Notre Dame Press.

O’Malley, John. 2006. Four Cultures of the West. Cambridge, MA: Harvard University Press.

Taylor, Charles. 1992a. Sources of the Self: The Making of the Modern Identity. Cambridge, MA: Harvard University Press.

———. 1992b. The Ethics of Authenticity. Cambridge, MA: Harvard University Press.

“Youth Risk Behavior Survey:  Data Summary & Trends Report.” February 2023. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf.


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