Here’s how university mental health services can rise to the challenge of surging demand
Here’s how university mental health services can rise to the challenge of surging demand
Change in action
By Tess Lawley
As the student population grows and becomes more diverse, universities face new challenges in supporting students to remain enrolled and achieve academic success. Universities now seek to deliver services on a large scale but with the personalised support that students need and, at many universities, the greatest strain is in providing mental health services.
In addition to the growth in diversity of student experiences, there has been an observable trend in increased demand for mental health support and a higher rate of complex mental health cases from students.
Theories to explain this increase include a higher understanding of mental health and supports among Generation Z, prolonged periods of lockdown and change brought on by the COVID pandemic, and greater expectations of institutions to respond to social issues like mental health. It is possible a confluence of these factors is impacting undergraduate and young graduate students.
Regardless of the cause, meeting this sharp increase in demand is not easy. In higher education institutions and health services alike, funding and resources for mental health services are not growing fast enough to meet demand, so counselling and psychology service staff find themselves working at maximum capacity. University counselling staff find themselves turning away students in need, and students struggle to access support from their institution and the broader health sector.
The pressure of increasing demand is being felt by staff and students. This poses a risk of increased drop-out rates among students overwhelmed by mental health burdens, or lower enrolments as students choose institutions that offer full support.
Universities need to take action to adapt to this change
A rapid institutional response is required. We have identified four common and effective solutions to support students seeking mental health support and to lighten the load on support staff unable to continue working over capacity. These solutions are most impactful when deployed in concert.
1. Listen to students with lived experience to design a service that meets varied student needs
Mental health services can be organized and delivered in different ways to achieve different goals. For example, a university looking to minimize turn-away rates would benefit from group therapy, peer support or walk-in models of care, however another university responding to complex mental health concerns would be more successful offering ongoing therapy.
Choosing the right service model and designing how that model will be put into practice requires deep understanding of student needs and resourcing constraints in an institution. Using co-design to answer these critical questions means students and staff are actively involved at every stage of the redesign to highlight these needs and constraints.
Co-designing mental health services is not always easy. Diverse and divergent perspectives are required, alongside a trauma-informed approach to ensure the safety and health of participants. But when done right, the benefits are clear: we can rapidly design the most effective service model for meeting the needs of students.
2. Digitise and streamline administrative processes to free up resources for care
Even as students increasingly want self-service options from universities, many university mental health services still rely heavily on administrative labour for frontline information sharing, taking bookings and managing calendars.
Digital tools that enable students to understand the service offering and make their own bookings are abundant, affordable and appealing to both students and staff. Students can self-educate through online information to overcome personal barriers to accessing mental health support, and administrative and clinical staff can spend less time administering appointments and more time caring for students.
3. Empower students to make decisions about their support and care
The stigma around accessing mental health supports has rapidly faded, and students are more likely than ever to have had access mental health services before or outside of university. Many universities have felt the shift from trying to drive student attendance at mental health services, to requiring staff to work long hours just to meet demand.
Many students are better informed than were previous generations. They seek information on services to inform decision-making about support, rather than paternalistic models that assume the university knows better than the student. Online service information, case studies, mental health support quizzes and other self-education tools allow students to choose the care journey that suits them and decreases pressure on triage and booking staff.
Providing tools as self-service options for most students seeking mental health services then frees up university resources for a smaller number of students facing crisis or overwhelm in navigating service access.
4. Design thoughtful referral processes so students do not fall between the cracks
No university can provide every mental health service required by a diverse and multi-faceted student base, and invariably some students will be referred to services in the local community. However, good mental health cannot be achieved by a university mental health service simply knowing its place in the greater healthcare landscape; university services must have robust referral processes that ensure students get the support they need outside the university.
Building partnerships with the services to which students are commonly referred and designing warm referral methods makes guiding students to community services simpler and more effective for counsellors, psychologists and other allied health professionals in the institution. Smooth and supported access to all services a student needs is critical in getting students the care they need to stay healthy, happy and enrolled in their program.
University of Alberta transforms student mental health services
We are pleased to share an example of us putting some of these learnings into action.
Recently Nous worked with Canada’s University of Alberta, where only 31 per cent of students who submitted an initial application could access counselling services through the previous service model. The counselling service was operating at 99 per cent capacity, so many students were referred to community services that required out-of-pocket payment and the university was unable to track access and support.
The service delivered long-term therapeutic care for students who went through a triage process, were allocated a psychologist and then completed 12 or more regular sessions with a psychologist. The service had extremely high student satisfaction but a long waiting list of students hoping to receive care. With plans to grow enrolment in the coming years, the U of A could not stand still on this issue.
The U of A required a new service model that maximised access, catered to a diversifying student base, and empowered students to make decisions about their care. We worked with staff from the mental health service to redesign a service model and a staffing structure to ensure access for more students.
The future-state service model empowered students to choose their preferred method of therapy by self-educating on types of care. This meant the service could cater to students who require acute support in times of need and those seeking long-term support. With many students needing one-off support, for example to manage stress in exam periods or work through a relationship break up, the new model allows those students to access services quickly and keep waitlists manageable.
We worked with counselling and clinical services staff to design a scalable staffing structure and administrative technologies to streamline the service. We delved into the university’s student feedback and service data to inform all decisions in the initial draft design. Our proposed structure established ratios of administrative and therapeutic staff to deliver the service, allowing the university to adjust investment to achieve their target turn-away rate.
The university has now publicly committed to implement the new model, employ more psychologists and counselling staff, and decrease the turn-away rate.
The time to act is now
There is no reason to think demand for mental health services will fall, so institutions must respond now. Universities have options available; to choose, they need to thoughtfully assess the current state and collaboratively design a new future.
As the University of Alberta has demonstrated, the right interventions can make a big impact on the problem.
Get in touch to discuss how we can work with you to design on-campus mental health services.
Connect with Tess Lawley on LinkedIn.
Published on 19 April 2023.
 Lipson, S. K., et al., “Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013–2021”, Journal of Affective Disorders, Vol. 306, 2022
 World Health Organization, “COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide”, 2 March 2022
 Bethune, Sophie, “Gen Z more likely to report mental health concerns”, Monitor on Psychology, January 2019, Vol 50, No. 1