Mental Health Guide for College Students

By Taylor Nichols | Published 6/21/2021
Pie chart showing 39% of students experience a significant mental health issue in college.

If you struggle with mental health issues, it can be confusing and isolating. Unfortunately, it's also common, especially for college students. According to Active Minds, a nonprofit organization dedicated to college mental health and advocacy on campus, 39% of university students experience a significant mental health issue while in school, and 75% of mental health issues begin by age 24.

Some people deal with mental health issues from a young age, while others may be facing new difficulties as they adapt to a new chapter in their life. College students are under a lot of --pressure, whether they attend school on campus or online. Many struggle to balance a full academic course load on top of work, family, friends, and other responsibilities. The added stress of trying to make new friends or adjust to a new environment can exacerbate ongoing mental health issues or trigger new ones.

Mental health is just as important as physical health. Incorporating activities that contribute to our mental wellbeing into our daily lives can help prevent everyday stress from snowballing into a more significant issue. However, sometimes we need some extra support.

Most college campuses offer mental health services such as counseling to students for free or at a low cost, but these services are often underutilized. While today's college students are much more likely to talk about mental health than previous generations, only one-third of young adults who suffer from anxiety or depression seek treatment.

This guide is meant to act as a resource for students who are navigating difficult mental health situations. It is not all-encompassing, but it touches on common challenges students might face and offers some tips and resources to address them. However, this should not be used as a primary resource if you or a friend are in a dangerous situation.


If you are experiencing a mental health crisis, considering self-injury, or having suicidal thoughts, call the Suicide Prevention Lifeline at 1-800-273-TALK (8255) for free, immediate care. You'll be connected with a trained professional in your area who can direct you to crisis services and mental health resources.


What are the top mental health challenges that college students face?

College students experience a wide range of mental health problems that can be triggered or made worse by different aspects of the college experience, like the added stress of an intensive course load or adapting to a new social environment.

Anxiety and depression are the most common mental health issues for college students and the general population. However, some people also experience co-occurring mental health problems, meaning they may struggle with more than one psychiatric condition. Seeking treatment is the best choice for people who are struggling from any of these or additional mental health issues.

This list is not exhaustive but includes some of the most common mental illnesses and disorders affecting college students. Both Mental Health America and the National Institute of Mental Health provide more information on these and other mental illnesses.

Common mental health issues affecting college students


Anxiety

Everyone experiences stress and anxiety from time to time. Between work, school, family, friends, and everything else in our personal lives, sometimes we feel pulled in too many directions. Sometimes, however, anxiety can become overwhelming and unmanageable. If you struggle with severe anxiety to the point where it interferes with your ability to participate in regular activities or impacts your academic performance, you might have an anxiety disorder.

Anxiety is one of the most common mental health concerns for college students. The American College Health Association found that 3 in 10 college students have been diagnosed with some type of anxiety. Common diagnoses include Generalized Anxiety Disorder, Social Anxiety, and Panic Disorder, all of which can surface during early adulthood.

Chart showing 3 in 10 college students have been diagnosed with anxiety.

3 in 10 college students have been diagnosed with some type of anxiety.

For many students, the transition into college is an especially dangerous time for developing or intensifying anxiety disorders. The added stress of being in a new place away from home, trying to make friends or fit in, the pressure to do well in school, and the new responsibilities of young adulthood can all add up. Lifestyle habits like not getting enough sleep or exercise and drinking too much coffee – all very common in college – can also trigger anxiety or make symptoms worse.

Christine Bowen

"Alcohol and caffeine can compound problems that people with anxiety and depression may already be experiencing and going without could give people a clearer idea of what is actually happening with their mood and energy, without these substances clouding the picture."

Christine Bowen, Naturopathic Doctor and Chief Medical Officer at Inside Health Institute
What are the signs and symptoms of anxiety?

Students who are experiencing irregular anxiety could be suffering from a number of different anxiety disorders. The most common is Generalized Anxiety Disorder (GAD). To be diagnosed with GAD, you must experience excessive, uncontrollable anxiety and worry that spans multiple topics and might not match with what's really going on. The worry must occur more often than not for at least six months, and people with GAD might have anxiety that easily transfers from topic to topic.

In addition to this, you must also display at least three of the following symptoms:

  • Feeling edgy or restless
  • Getting tired or fatigued easily
  • Feeling irritable
  • Muscle aches or soreness – anxiety can cause tension in the neck, jaw, chest, stomach, and other areas of the body
  • Having trouble falling asleep, staying asleep, feeling restless at night, or not feeling well-rested

Other common anxiety disorders include panic disorder (characterized by panic attacks), phobias, social anxiety disorder, agoraphobia, and separation anxiety disorder.

How to manage anxiety, treatment, and coping mechanisms

Whether you're experiencing anxiety due to a specific situation or suffer from an anxiety disorder, the first thing you should do is seek treatment from a licensed counselor. Talk therapy is one of the best resources available to learn how to manage anxiety.

Many therapists use Cognitive Behavioral Therapy (CBT), a type of therapy that focuses on replacing harmful thought patterns with different ways of thinking, behaving, and reacting to things that make us anxious. You might get homework to help you work on developing new coping skills to manage anxiety in CBT therapy.

Exposure therapy can also help those with anxiety disorders overcome their fears and get back to everyday activities without being overwhelmed by worry or panic.

Exposure therapy can also help those with anxiety disorders overcome their fears and get back to everyday activities without being overwhelmed by worry or panic.

Doctors and psychiatrists also may prescribe medications to help alleviate symptoms of anxiety. Common medications include anti-anxiety medications such as benzodiazepines, antidepressants, and beta-blockers.

Therapy is critical for people who suffer from any mental health issues because you can learn to understand yourself better and learn to reduce and manage symptoms. However, it can be hard to access mental health services, especially if they are not offered at your school or you don't have health insurance.

Whether or not you have access to mental health services, scientific research shows that meditation, regular exercise, and other stress management techniques can alleviate anxiety symptoms and help contribute to a healthy mind.

Hotlines and Online Anxiety Resources

Hotlines

Hotlines

Suicide Prevention Hotline: 1-800-273-TALK

Mental Health America Crisis Text Line: Text "MHA" to 741-741 to connect with a trained counselor

Online Resources

Online Resources

The Anxiety and Depression Association of America (ADAA): Offers educational information on different anxiety disorders and depression symptoms and treatment options, resources, coping mechanisms, tests to screen for anxiety and depression disorders, and help finding a therapist.

Mental Health America: Provides a wide range of resources for people struggling with anxiety and other mental health issues. Resources include mental health screening tests for GAD and other disorders, articles and tools to help you cope with different aspects of anxiety, opportunities to connect with other people who have anxiety, treatment options, and help finding a healthcare provider.

Wysa: An app providing support for people experiencing anxiety and depression available for free during the pandemic; Wysa also includes an option to talk with a therapist, with daily texting check-ins and four live sessions per month.

Free mindfulness and meditation apps.

The ADAA provides a list of tips for managing test anxiety.


Depression

Depression is also highly prevalent in college students. In the Fall 2020 National College Health Assessment, the American College Health Association reported that 23% of college students have been diagnosed with depression. More than a quarter of these students did not receive treatment for their depression in the last year.

Left untreated, depression can not only have serious effects on your overall health, wellbeing, and quality of life, it can be dangerous. Suicide is the second leading cause of death for college students after accidental injuries.

People can experience situational depression in response to a hard time in their life, or they can suffer from clinical depression that is not based on circumstances. Both types of depression are difficult to get through, but they are treatable. Stressful events can trigger episodes of depression. For example, many students feel overwhelmed by financial, academic, and social stress, or lonely and homesick as they adjust to being away from home for the first time.

Drug and alcohol use, lack of sleep, not getting enough exercise, and poor diet are all often seen as part of the college experience, and each can negatively impact mood. Recognizing and treating the symptoms of depression early on can help prevent episodes in the future, which is why it's so important for people who are struggling to seek help.

What are the signs and symptoms of depression?

Major Depressive Disorder, also known as major depression or clinical depression, is the most common depressive disorder. People who suffer from major depression usually have a severe and persistent low mood or feelings of sadness or hopelessness that last at least two weeks. However, major depressive episodes often last much longer. Untreated, they can go on for months or years. Depression often significantly impacts many aspects of everyday life and can interfere with school, work, personal relationships, and daily activities.

Depression is different for every person. Other potential symptoms include:
  • Sleeping too much or trouble sleeping
  • Overeating or loss of appetite and weight gain or loss
  • Difficulty concentrating or problems with memory
  • Loss of energy, fatigue
  • Loss of interest or pleasure in activities you used to enjoy
  • Moving slowly or seeming agitated
  • Feelings of worthlessness or guilt, low self-esteem, feeling bad about yourself, or feeling like a failure
  • Indecisiveness
  • Thoughts of death, self-harm, or suicide
How to manage depression, treatment, and coping mechanisms

Without treatment, major depressive episodes can turn into chronic depression. Luckily, depression is treatable through a combination of therapy, counseling, medication, and healthy lifestyle choices. There are many natural remedies thought to help balance mood as well, although students should talk with their doctor before starting new supplements or medications. With proper treatment, people who suffer from depression can learn to manage and reduce symptoms and help prevent another episode from happening.

The most common treatments for depression are talk therapy and antidepressants, and a combination of both has proven to be most effective. Psychotherapy, or talk therapy, can be highly effective in helping people understand their depression and learn to manage their symptoms.

Cognitive Behavioral Therapy (CBT) is a common method for treating depression and is considered to be highly effective. Mental health providers work with patients to identify and replace negative beliefs and thinking patterns and teach skills-based coping mechanisms to help manage depression and anxiety.

Other types of therapy for depression include interpersonal therapy (IPT), where you work on problems in personal relationships, and psychodynamic therapy, which focuses on resolving issues related to past experiences.

Antidepressants are also a common method of managing depression, but they can take two to four weeks to begin having an effect. Selective serotonin reuptake inhibitors (SSRIs) are often the first choice for antidepressants. Common ones include name brands such as Prozac, Zoloft, Paxil, Celexa, and Lexapro. Other common antidepressants include serotonin and norepinephrine reuptake inhibitors (SNRIs) and norepinephrine-dopamine reuptake inhibitors (NDRIs).

Other methods of treatment and symptom management can also dramatically improve your quality of life in conjunction with therapy or medication. Studies show that exercise, spending time outdoors, meditation, and diet can all have positive impacts on mood. There are also herbal supplements available that can help with depression, but you should always check with your doctor before starting a supplement.

Christine Bowen

"Diet change is my most powerful tool for improving mood and energy naturally. Reducing or eliminating white foods such as sugar, white rice, white flour, and white potatoes as well as heavily processed foods is a great first step toward improving health outcomes."

Christine Bowen, ND and Chief Medical Officer at Inside Health Institute

Overall, the most important thing you can do is seek help from a mental health practitioner. They will listen to your concerns and help you find the best methods of treatment for you.

Hotlines and Online Anxiety Resources

Hotlines

Hotlines

Suicide Prevention Hotline: 1-800-273-TALK

Mental Health America Crisis Text Line: Text "MHA" to 741-741 to connect with a trained counselor

Substance Abuse and Mental Health Services Administration Hotline: 1-800-662-HELP

Depression and Bipolar Support Alliance Crisis Hotline: 800-273-TALK, or text DBSA to 741-741

Online Resources

Online Resources

The Anxiety and Depression Association of America (ADAA): Offers educational information on different types of depression, symptoms and treatment options, resources, coping mechanisms, tests to screen for depression disorders, and help finding a therapist

Mental Health America: Provides a wide range of resources for people struggling with depression. Resources include mental health screening tests for depression, articles and tools to help you cope, treatment options, help finding a provider, DIY toolkits for managing depression, and help connecting with a provider

Depression and Bipolar Support Alliance: Offers extensive resources for understanding depression, treatment options, crisis management, wellness tools, and help finding support groups and other support options

Wysa: An app providing support for people experiencing anxiety and depression available for free during the pandemic; Wysa also includes an option to talk with a therapist, with daily texting check-ins and four live sessions per month

GoodRx, Medicine Assistance Tool, NeedyMeds, and Together Rx Access all provide options for low-cost medications


Addiction and Substance Abuse

Drug and alcohol use are fairly common on college campuses, and students are at a higher risk for substance abuse. Substance abuse occurs when someone uses a drug for recreational purposes or reasons other than its intended use. This can include prescription drugs, marijuana, and street drugs. Drinking is considered abuse when it has negative consequences or impacts someone's life. Both drug and alcohol abuse can cause serious health problems, lead to hospitalization and death, and are linked to other mental health issues such as depression and anxiety.

It can be hard to adjust to college and fit in, and college parties are a common way of meeting people and making friends, especially at schools that have fraternities and sororities. Students often feel a social pressure to drink or use drugs, or turn to substances to help them cope with stress. One of the biggest problems with the popular use of both drugs and alcohol in college is that it can lead to a higher risk of traumatic events such as sexual assault, violence, or car accidents from drinking and driving.

Eileen Bowen

"Functional alcoholism often gets started in college and eventually it's going to be a problem. It snowballs, and how fast that snowball is moving is different for each person. Some snowballs just take off and produce an avalanche, and some are kind of slow, but they get to the same place."

Eileen Bowen, LMHP and Director of Counseling at Inside Health Institute
What are the signs and symptoms of substance abuse?

Because alcohol and drug use are so prevalent on college campuses, it can be difficult to tell when it goes from what might be seen as casual use to substance use disorder or addiction, although any use can be harmful. Using drugs or alcohol may be a choice at first, but our brains can become chemically dependent on these substances to the point where we are no longer able to choose not to use them. As public perception has shifted, we have come to see drug and alcohol addiction as a disorder or disease rather than a choice.

Symptoms of substance abuse, dependence, and substance use disorder, according to the DSM 5, include:

  • Hazardous use of drugs or alcohol
  • Social or interpersonal problems due to use
  • Neglecting major roles to use a substance
  • Legal issues
  • Withdrawal from substance
  • Tolerance
  • Using more amounts for longer
  • Wanting to quit or control use but struggling to do so
  • Spending a significant amount of time using the substance
  • Physical or psychological problems related to substance use
  • Giving up activities to use
Substance abuse management and coping mechanisms

Treating substance use disorder or addiction is a difficult process. Addiction is a lifelong disease that can require long-term treatment and management. The U.S. National Library of Medicine outlines stages of drug use that can lead to addiction – experimental use, regular use, problem use, and finally addiction – and notes that young people often move through these stages more rapidly than older adults.

If you are concerned about your drug or alcohol use, it's best to seek treatment as soon as you can to help prevent becoming more heavily dependent. It's also important to seek professional help to make sure you can quit safely. Withdrawal symptoms from some substances can be dangerous or even deadly.

Treatment methods for substance use disorder include detoxification, counseling, medication, treating other mental health issues like depression and anxiety, and long-term care or follow-up. Behavioral therapy is the most common treatment for drug and alcohol abuse and is especially critical for people with co-occurring mental illnesses. In some cases, inpatient treatment such as drug or alcohol rehabilitation may be necessary.

There are also less intensive alternatives to in-patient rehabilitation. You can go to a facility to safely detox, or use outpatient services where you receive treatment weekly or a few times per week rather than staying in a facility. Students should contact their school's counseling center to work with a counselor, set up a treatment plan, or get connected with other services.

Quitting drugs or alcohol can be extremely difficult. These coping mechanisms and strategies can help you succeed:

Reach out to your support system. Friends and family, counselors, a sponsor, and other members of your community will be instrumental in helping you recover.

Join a support group. Many recovered addicts find great support through Alcoholics Anonymous, Narcotics Anonymous, and other support groups.

Learn new ways to handle stress. Getting outside, doing something active, meditating, doing yoga, making art, talking it out with a friend, and other stress relievers will help you learn to cope without substances.

Surround yourself with sober people. Building a new community with people who aren't doing drugs or drinking will alleviate some of the stress and help make you feel supported.

Avoid bars, parties, or other triggering situations. Quitting is hard enough already, and being around substances or people who use them won't help. This will make it easier to avoid the temptation to use drugs or drink.

Get involved in something that makes you feel good. Whether it's volunteering, joining a book club, going to the gym, or getting involved in a faith-based community, getting involved and active with other people will make you feel good and help you build new habits.

Hotlines and Online Addiction and Substance Abuse Resources

Hotlines

Hotlines

Substance Abuse and Mental Health Services Administration Hotline: 1-800-662-HELP

Online Resources

Online Resources

National Institute on Alcohol Abuse and Alcoholism: Provides information on how to find treatment for addiction, what types of treatment are available, and support resources for recovery

Addiction Center: Offers information on drug and alcohol addiction to a wide range of substances, treatment options, and help finding a rehabilitative center

Sober Grid: A free app that offers peer coaching, resources for tracking progress, and connecting with other recovered addicts

Narcotics Anonymous: A support group for recovering drug addicts

Alcoholics Anonymous: Support groups for people who are recovering alcoholics with resources for recovery

Online Intergroup of Alcoholics Anonymous: A virtual option for people seeking support in recovery


Eating Disorders

Eating disorders involve a complex relationship between eating behaviors, thoughts, and emotions, and can have serious negative effects on mental and physical health. Eating disorders are serious psychiatric conditions that usually develop in teenage years and young adulthood.

Although there are many different kinds of eating disorders, the three most widely recognized and common ones are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Other disordered eating conditions include Pica, or the consumption of items that are not food, and Avoidant Restrictive Food Intake Disorder (ARFID), where people lose interest in eating food at all or cut out food based on texture, appearance, color, or smell.

Many people use food and exercise as a source of control when they feel as if they don't have control over other aspects of their life.

Many people use food and exercise as a source of control when they feel as if they don't have control over other aspects of their life. According to an article from the Child Mind Institute, the stress of more intense academic demands on top of navigating a new social landscape can trigger an eating disorder, especially for people who are already concerned about their body image or who are highly anxious.

What are the signs and symptoms of an eating disorder?

Symptoms of eating disorders can be emotional, behavioral, or physical. People who have an eating disorder may show some signs but not others. One of the most common myths about eating disorders is that if someone isn't visibly underweight, they do not suffer from a true disorder. According to the National Eating Disorders Association, most people with an eating disorder aren't underweight, and many people who have them actually gain weight. All types of eating disorders can have lifelong impacts on different aspects of physical and mental health.

Anorexia nervosa

Anorexia nervosa typically occurs when someone thinks they are overweight despite being underweight. It's characterized by weight loss and restricting food intake to control weight. Anorexia nervosa is the deadliest psychiatric disorder, claiming the lives of 10% of people who suffer from it.

The nature of this mental health condition means self-diagnosis is extremely difficult. People who have anorexia nervosa usually have a distorted view of themselves and may struggle to recognize the effects of their condition. It's important to note that people who are not underweight can still have anorexia. Atypical anorexia affects people who are not underweight but meet other criteria for diagnosis.

Other signs and symptoms include:

  • Extremely restricted eating
  • Focus on weight, food, calories, fat grams, and dieting
  • Refusing to eat certain foods or entire food groups (e.g., no fat, no carbohydrates, etc.)
  • Food rituals, which can include eating foods in certain orders, very small bites of food, or burning food to make it taste bad, and experiencing anxiety if the ritual isn't followed
  • Avoiding mealtimes or situations involving food
  • Excessive exercise routine with a focus on burning off calories consumed
  • Intense fear of gaining weight
  • Physical effects of anorexia include dramatic weight loss, being underweight, feeling cold, constipation, fatigue, stomach cramps, acid reflux, sleep problems, fainting or dizziness, anemia, slow heart rate, thinning hair, muscle weakness, and irregular periods or not getting a period at all

One of the most common myths about eating disorders is that if someone isn't visibly underweight, they do not suffer from a true disorder. According to the National Eating Disorders Association, most people with an eating disorder aren't underweight, and many people who have them actually gain weight.


Bulimia nervosa

Bulimia is typically characterized by cycles of bingeing and purging. Binge eating means consuming significantly large amounts of food in a short period of time, coupled with feeling out of control over your eating during this time period. People who suffer from bulimia will engage in potentially harmful ways of preventing themselves from gaining weight. This often includes self-induced vomiting, fasting, or using laxatives. It can also involve other medications or excessive exercise.

Many of the symptoms of anorexia apply to bulimia as well. Other signs and symptoms include stealing and hoarding food in strange places, excessively drinking water or other zero-calorie drinks, evidence of binge eating (empty wrappers and containers or large amounts of food disappearing at once), and evidence of purging (going to the bathroom after meals, signs of vomiting, and laxative or diuretic packaging).

Unlike anorexia, most people who have bulimia are in a normal weight range or overweight. Physical impacts of bulimia can include weight gain or loss, stomach cramps, acid reflux, constipation, anemia, low thyroid or hormone levels, dizziness and fainting, sleep problems, cuts and calluses across the top of the finger joints from vomiting, dental problems, hair thinning, dry skin, and damage to the throat or esophagus.

Treatment options and support for recovery

It can be extremely difficult for people who suffer from eating disorders to recognize when it's time to ask for help. It can also be a difficult and scary process to work on recovery. Seeking treatment is the best thing you can do to help yourself recover from an eating disorder, and there are many different methods of treatment.

Because eating disorders have such significant impacts on different parts of the body, it's also important to have a medical exam to determine if any other medical issues need to be addressed.

Support for recovery and treatment can include friends and family, a therapist or counselor, a treatment facility, a doctor, a nutritionist or dietitian, and support groups. The first step in getting treatment is reaching out to someone for help. Seeking counseling or behavioral health services from your school or from an off-campus clinic are both good options.

Counseling services are key in recovering from an eating disorder because they help you rebuild a positive relationship with food while addressing other mental health issues that can lead to unhealthy eating habits.

There are many treatment options available to help you recover from an eating disorder. For many students, outpatient services may be the best choice. You'll work with a team of health professionals such as a therapist and dietitian or nutritionist a few times a week to overcome the mental and physical aspects.

For more serious cases, inpatient care may be necessary. These are residential facilities where you stay for a period of time and receive medical supervision in addition to structured therapeutic services.

For more serious cases, inpatient care may be necessary. These are residential facilities where you stay for a period of time and receive medical supervision in addition to structured therapeutic services.

Counseling services are key in recovering from an eating disorder because they help you rebuild a positive relationship with food while addressing other mental health issues that can lead to unhealthy eating habits.

Common types of therapy used to help people who have eating disorders include Cognitive Behavioral Therapy (CBT), which helps people replace harmful behaviors and thought patterns with new ways of thinking and responding; Medical Nutrition Therapy (MNT), which involves meal planning and dietary education; Dialectical Behavioral Therapy (DBT), which focuses on developing new coping mechanisms in response to stress and painful emotions; and Acceptance and Commitment Therapy (ACT), which helps people better understand their mental illness and develop a healthier relationship with their emotional experience.

Support Services and Resources for Eating Disorder Recovery

Online Resources

Online Resources

The National Eating Disorders Association: Offers support resources, a database of treatment options, a volunteer-run helpline, online chat or text support options, and a screening tool to help you decide if you need treatment

Eating Disorder Hope: Provides a list of eating disorder treatment centers, online treatment options, a directory of therapists trained to work with patients who have eating disorders, and recovery tools and support

Recovery Record: An app that can help you stay on track during recovery, with meal log and meal plan options, a section on coping skills, and options to work with your clinician or treatment team

The National Association of Anorexia Nervosa and Associated Disorders (ANAD): Offers free peer mentorship services, support group options, a helpline, and a treatment directory

Eating Disorders Anonymous: Provides help in getting connected with a support group in your area

Finding Mental Health Support for College Students

College students struggling with their mental health have many resources available to them, and there is no shame in asking for help. According to the National Alliance for Mental Illness, 20% of American adults experience mental illness, and less than half of them receive treatment in a given year. The stigma surrounding mental health causes many people not to seek help because they are ashamed, embarrassed, afraid, or think they can handle things on their own.

It can be hard to tell if what you're going through is just part of normal life or if it's indicative of a bigger problem. Either way, there are resources available to help you. Counseling and other services can help get you through a tough time and give you lifelong skills to help you navigate difficult times in the future.

Accommodations for On-Campus Students

College Counseling Center

For campus-based students seeking support, the first place to go is the college counseling center. Most campuses offer mental and behavioral health services for students. If your school does not have a counseling center on campus, it may offer mental health services through the campus health clinic. If you can't find information on mental health services, ask someone at your campus health clinic where you can find services.

Many of these services are available for free or at a low cost for students on campus, making it a good choice for students who don't have health insurance. You should always check to make sure you understand what is available to you and how much it will cost.

Care Under Your Health Insurance

Another option is to find care under your health insurance, if you have it. Call your health insurance provider to find out what services are covered, how much your copay will be, and how you can find counseling or psychiatric care covered by your insurance.

Telehealth

Students who use campus mental health services may struggle to continue counseling during school breaks when they are away from campus. Luckily, the growth of telehealth services during COVID-19 has made it easier to access virtual care. Check with your counselor to see if they offer telehealth services or therapy sessions by phone.

If not, you may benefit from connecting with a text therapy service or apps like BetterHelp or Talkspace while on break. Verywell Mind has compiled a list of text therapy services to compare costs and other considerations.

Lower Cost Options

If you can't afford to go to therapy, there are some lower-cost or free options available. Consider joining a support group or other student organization. Common groups to look for include NAMI on Campus clubs, Active Minds chapters, and student support groups geared towards you. There may be a women's or men's group, students of color support groups, an LGBTQ support group, or other clubs on campus where you'll find people who share your experience. Text therapy may also be a more affordable alternative for those without health insurance.

Disability Services on Campus

Students with disabilities should also check with Disability Services on campus to find out what types of accommodations can be made for them. The Disability Services Office can arrange accommodations for students with mental health issues as well, including extended times for taking tests and turning in assignments, reducing course loads, and tutoring or mentoring services. The National Alliance on Mental Illness provides detailed information on how to ask for these accommodations or take a leave of absence due to mental health issues.

Accommodations for Online Students

One significant benefit of being an online student is that it can make it much easier to manage mental health issues from home. Many online schools provide virtual counseling services to support students, which means your care won't be interrupted during a school break.

Enrolling in asynchronous online classes also means you can get your work done when you have the ability to do so, rather than being held to a class schedule. This can make it easier to manage your studies and other responsibilities on top of any mental health problems you may be having.

However, some people may struggle without face-to-face interaction, which could actually exacerbate mental health issues. Keeping in a regular routine through scheduled classes may be a better choice for some students with mental health issues, but this will depend on your personal preferences and situation. If you are having a hard time and feel that keeping to a set schedule would benefit you, synchronous online classes could help you stay on track.

Your Online College's Counseling Center

For online students, seeking out services through your school's online counseling center is the first step. Find out what virtual services are available. Some schools offer free or low-cost options, but there may be a limit on how many appointments each student is offered. If this is the case, work with your counselor to find another low-cost option available to you.

Virtual Therapy

Open Path Collective is another great resource for low-cost counseling. The site charges a $59 lifetime membership fee and helps you get connected with therapists who offer virtual and in-person counseling for $30 to $60 per session. BetterHelp is another virtual therapy option that costs $60 to $80 per week.

Counseling in Your Area

Online students with mental health issues also may benefit from finding counseling services in their area. For some people, the online setting can feel very isolating, which can contribute to or worsen symptoms. Seeking counseling in your area can help boost your mood if you need a face-to-face connection.

What to Do On a Mental Health Day

Sometimes we just need a day to rest and recuperate. Scheduling mental health days should be a regular part of your routine, like scheduling days to work out or days to spend with family or friends. When we incorporate these into our schedule, it helps prevent us from getting stressed and overloaded to the point where we need to do damage control.

It can be difficult to ask for a mental health day, although they're becoming much more common in school and the workplace. It can be beneficial to touch base with professors ahead of time to find out what their policy is for missing class or turning in late assignments, especially if you know your mental health may cause you to miss class at some point in the future.

This is also a great reason to talk with the disabilities office or student services. If your mental health has caused you to struggle in school before, you can and should set up potential accommodations early on so that when you need them, you can use them with no questions asked. Mental Health America provides a great resource for approaching your professor with mental health concerns.

If you're able to plan a mental health day ahead of time, doing it on a weekend will keep you from missing class. However, if you aren't able to plan ahead but know you need a day to take care of yourself, the following tips will help you make the most of your day off. These ideas can also work as coping strategies to help you reset anytime you're feeling overwhelmed, stressed, anxious, or depressed.

Unplug from social media.

Spending too much time on social media can make us feel sad, lonely, and isolated, or make it hard not to compare ourselves to others. Having a social media-free day will help make sure you spend the day doing things that make you feel good rather than getting stuck scrolling for hours.

Do something fun.

Read a book, listen to music, watch a movie or TV, do a low-stress activity that you'll enjoy. This will also allow you to get out of your head if you're hyper-focused on negative thoughts.

Check off an item on your to-do list.

If you're feeling like you have a lot on your plate, doing something productive like cleaning your room, meal-prepping for the week, or running an errand might help alleviate some of your stress. It can also boost your mood to meet a goal, even if it's small.

Talk to someone.

Sharing how you're feeling with someone you trust can help when you're feeling down or anxious. It's often comforting to know that friends and family understand how we feel or know what we're going through. They may also offer a fresh perspective that can help change your mindset.

Hang out with a friend.

Doing something fun with a friend can also help you unplug and take your mind off things when you're feeling overwhelmed.

Do something active.

The positive impacts of exercise on mood, stress levels, and mental health cannot be overstated. While regular aerobic exercise like walking, jogging, or cycling is best for improving mental health long-term, research shows even just one workout can offer some immediate relief from depression and anxiety.

Get outside.

Studies also show spending time outdoors has significant positive effects on mental health. Taking a walk in nature can help lower levels of depression, anxiety, and stress.

Meditate.

Meditation can be especially helpful when you're feeling stressed or anxious. It helps you calm down and remove yourself from negative thought patterns or overwhelming fears in the moment. Meditation is most effective for anxiety and depression when practiced regularly, but guided meditations that include breathing exercises can offer immediate benefits.

Do something creative.

Making art can be a meditative experience, can help you process emotions, can help reduce stress, and has other therapeutic benefits. Whether you enjoy painting, writing, drawing, collaging, or something else, spend some time immersed in a creative endeavor.

Expert Interview: Mental Health Counselor

Eileen and Christine Bowen are the mother-daughter duo who co-founded Inside Health Institute. This non-profit organization offers sliding-scale healthcare services, including counseling and naturopathic medicine, to underserved communities in Seattle and surrounding areas.

Eileen Bowen
LMHP and Director of Counseling at Inside Health Institute

Christine Bowen
Naturopathic Doctor and Chief Medical Officer at Inside Health Institute

Eileen Bowen is a Licensed Mental Health Practitioner with 40 years of experience in mental healthcare. She serves as the Director of Counseling at Inside Health Institute alongside her private therapy practice, where she aims to provide accessible mental health services for anyone who needs them.

She has decades of experience working with students, including those struggling with procrastination in an online environment, working around language barriers as non-native English speakers, people overcoming barriers to returning to college, and those working through substance abuse issues. She's also recently navigated the higher education space as an adult returning to college to finish her master's degree.

Dr. Christine Bowen is the Chief Medical Officer at Inside Health Institute and is a naturopathic doctor specializing in the holistic treatment of digestive problems. On top of her years of experience balancing work and school in a high-stress environment while pursuing her doctorate, she has spent 16 years mentoring and supervising student clinicians.

What are some of the most common issues you see students facing?

Anxiety, feelings of being alone, low self-esteem – these are all top issues students struggle with when in college, Eileen said. These big issues can be obvious, like being too anxious to go to class, or they can come out in smaller, more acute ways. The common thread that amplifies many of these problems is perfectionism. Many students hold themselves to impossibly high standards – instead of recognizing their achievements, they only see what they think they should have done better.

"We never feel like we're going to do it good enough, and when that happens… we can stress ourselves out over a simple A-," Eileen said. "Or we can quit before we even start, depending on how we're impacted by perfectionism."

For many students, perfectionism causes another significant issue: comparing themselves to others. "It's not an accurate portrayal of how you're doing or what your worth is in life, but comparing yourself to other people really can make people spin out, and you start feeling even more overwhelmed," Christine said. It might seem like comparing yourself to others could help you set higher standards for yourself, but more often than not, it just leads to higher levels of stress and anxiety and stands in the way of your success.

Perfectionism can also lead to issues with goal setting, and distort how we see ourselves and our achievements. "If I'm perfectionistic, how I see goals can stress me out," Eileen said. Instead of recognizing their achievement, many students can only see how much they haven't done. "This is the human condition. We do not celebrate goals well," Eileen said. "Even when we get to the goal that we had in mind, as soon as we get close, we move it. We never get to cross the finish line."

Working toward a goal is often compared to climbing a ladder – each rung represents a small step toward the end goal. "If I don't celebrate what I've done, I knock all of the steps that I've taken off of the ladder and say they don't count and fall to the bottom," Eileen said.

Just about all students feel overwhelmed or experience stress at some point. However, without using healthy coping mechanisms to address high stress levels, these acute issues can develop into more significant problems like Generalized Anxiety Disorder or depression.

"Stress, perfectionism, test anxiety, that overall feeling of being overwhelmed – you're going to find that most of us have that," Eileen said. "Depending on how we manage it, it can lead to worse things or better things."


As a student, how can I figure out when my toolkit is enough and when I need more support?

"Always reach out for help, no matter what," Eileen said. "That would be first and foremost."

Eileen recommends that students check in with themselves to see how much of their day they spend struggling with anxiety, depression, worried thoughts, feelings of overwhelm, or other negative feelings. Daily mood tracking apps can give you an overview of how your emotions change over time and what might be influencing your mood.


Anxiety

Anxiety is caused by our brain instinctively responding to situations we perceive to be dangerous by asking, "can I kill it, or is it killing me?" The amygdala governs this response, Eileen said. Once it recognizes a stressor, it starts looking for that stressor in other areas of our life. If that anxiety starts taking over other aspects of your life, it might be time to ask for help.

If you're struggling with anxiety, keep track of how often it affects you and how that has changed over time.

"Am I experiencing anxiety two days out of seven," Eileen said, or have I now gone to five days out of seven? How much time does my negative thinking occupy?"

If your anxiety goes from worrying about whether or not you'll pass a test to consuming more of your time or other areas of your life, talking to a counselor might be necessary. They will work with you to develop healthy coping mechanisms and stress management techniques.


Depression

For students struggling with depression, any significant change in everyday habits over a longer time is concerning. Things like sleeping too much or not enough, overeating or undereating, changes in exercise habits – these can all be signs something is wrong.

"When my patients stop showering, that's when I start worrying about them," Christine said. "Lack of self-care is an outward sign that things are not going smoothly with mood balance."

Another warning sign can be an overindulgence in things that help us check out of a situation, like drugs, alcohol, food, tv, or other vices can indicate it might be time to reach out for some extra support from friends, family, or a therapist.


Substance abuse

Getting an accurate read on substance use and abuse can be tricky, but generally speaking, an increase in substance use is typically a warning sign. Students should also be aware of whether or not they're using drugs or alcohol to cope with stress, make them feel better, or help them check out and avoid dealing with issues in their personal life.

"One of the dangers of alcohol and drugs are that they work really well," Eileen said. "If I don't want to be in touch with how overwhelmed I am, I get this great break. The only thing is, I check back in, and there's still this mess."

Another big warning sign for substance abuse is drinking until you black out. "If you've blacked out even once, I'm concerned," Christine said. Blacking out isn't just a sign that you're overdoing it – it also puts you in a dangerous situation.

Another warning sign is when you begin accepting the consequences of frequent partying as "the new normal" – things like waking up hungover every day, frequently being sick from substance use or withdrawal, or sleeping through classes regularly. "These are all red flags to me," Christine said.

Substance abuse and mood imbalance often go hand in hand – people with mental health concerns might use substances to help them cope or make them feel better, and drugs and alcohol can also cause mental health problems to develop. Substance use changes the chemical makeup of our brain, which can have lifelong negative effects – an issue that isn't discussed as frequently as it should be, Eileen said.

"Alcohol is the one that's the most socially acceptable," Christine said. "Because of how prevalent it is, it also feels like it can be the most insidious."

Throwing substance abuse into the mix on top of other mental health challenges is like "taking a rough situation and setting it on fire," Christine said. This is because it can lead to substance use disorder, a mental health problem that can be difficult to treat on its own.


Any additional advice for students?

The number one recommendation from both Eileen and Christine is to use your resources and reach out for support from the people around you.

"Any of the counselors on campus – career counselors, advisors, professors, but also talk therapy," Christine said. "Throughout my entire schooling, I always had a counselor on board so that when things blew up, I had somebody that was readily available for me to talk to."

Christine said that many people are afraid to talk with a counselor because they're worried they'll find out that something is wrong with them, but counselors help you realize everything you're going through is normal.

"They're not going to make you think differently or persuade you to do things that you don't want to do," Eileen said. "It's more about just having a kind, comforting ear."

Eileen wants students to know that it's very normal to struggle with mental health problems, and it's normal to ask for help.

"It's not only normal, but it's something that you should plan on," Christine said. "And then if you plan on it, then you'll make choices or decisions that will help you to navigate it when it crops up."

Eileen's second recommendation for students: set yourself up for success by knowing your strengths and what you struggle with.

"Finding the solution for how we function rather than beating ourselves up for what our challenges are is one of the main things I would want any student to be considering," Eileen said.

For some students, that might look like choosing an online program with set deadlines if they struggle with procrastination. For others, it might be seeking tutoring at the beginning of the quarter or finding a study buddy if they know a class will be more difficult for them.

"Look at programs and remember what your strengths are. Knowing your strengths can help to make up for the challenges you might encounter," Eileen said. "When I took algebra two, I needed to have tutoring from somebody who really understood math, because I wasn't going to make it through that program without that support."

Eileen Bowen Christine Bowen

The College Student's Mental Health Toolkit

Between the two of them, Eileen and Christine Bowen have many years of combined experience working with college students and coping with stress as students themselves. Eileen retired from community mental health in 2013, and went on to complete her master's degree and open her private practice soon after. Christine completed her doctorate in 2005. These strategies for improving mental health and stress management come from their professional experience working one-on-one with students and their own years in college.

Feelings vs. facts

"One of the strategies I use is separating what feels real versus what is real," Eileen said. Many students are very hard on themselves, and it's easy to get consumed by negative thoughts or emotions over small-scale issues.

If you can't stop ruminating on something, take a step back and ask yourself what the reality of the situation is, Eileen said. So when you're thinking, "I feel like a failure, I just got an A- on my test," ask yourself what is the fact? "The fact is, that's a pretty good grade," Eileen said.

Even when you didn't get a good grade on something, identifying the worst-case scenario and recognizing you can handle it could help ground you. "What's the worst that could happen? Do I have to take the class over again? We sometimes feel like the rug is pulled out from under us, but we also have the skills [to handle a situation]," Eileen said.

Screen for positives

One common aspect of depression, anxiety, and other mental health challenges is an unnecessary focus on negative thoughts over positive thoughts.

"We as human beings often screen for negatives rather than screening for positives, and if you screen for something, you will find it," Eileen says.

This is often easier said than done, but when we repeat a thought process over and over again, our brain remembers it. Positive thinking alone won't cure depression or anxiety, but slowly retraining your brain to develop new thought patterns is a valuable skill to help combat the symptoms of mental health problems. Some exercises to practice positive thinking include doing affirmations, writing a daily gratitude list, or celebrating even the smallest victories.

Take a break

If you're feeling overwhelmed, Eileen recommends students just take a step back and let go of whatever they have going on for the moment. "Detaching from all of it and experiencing what life would be like without school, for ten minutes even, can help give us the motivation to go back," she said.

Taking a step back is helpful when you're feeling overwhelmed with schoolwork, but it's also important to keep in mind when other life events are stressing you out. "Just set it aside, whether it's the rumination about it or the physical doing of it," Christine said. "Sometimes, you just need a break."

When she was in school, her go-to stress reliever was her Victory Playlist – a set of songs that helped her tune out of whatever was getting her down.

"I would stand up and dance in my living room because it was like, everything was too tough and so overwhelming," Christine said. "What do you do at that time? Do you actually quit? Do you lay down and cry, or do you stand up and dance it out? You have to have something to kind of reset your energy in that moment."

Get to know your professors

College students frequently struggle with feeling isolated and lonely, Eileen said. It's hard to feel connected to classmates and your professor, whether in an online setting or in a crowded lecture hall.

During her college years, Christine made a point to get to know her professors to help combat isolation, especially early in the semester. "I know it's harder online, but if they have office hours, take them," Christine said.

Scheduling some time to talk with your professor can help you get a read on their expectations, which works to dispel some of those feelings of doubt or uncertainty that often come up later during the quarter. This is especially important for students with mental health issues. Opening up that dialogue will make it easier to come to your professor later if your symptoms worsen and you need extra support.

Join a study group

Making a point to connect with classmates will set you up for success later on if you're feeling overwhelmed by midterms or struggling to grasp the material. It can also help prevent feeling lonely, isolated, or disconnected from your classmates.

Having some of those bridges can be really important for combating feeling alone or being afraid that you're not getting it," she said.

This is also an important step for students who struggle with procrastination – it can be especially challenging to stay on track in an online setting if your class doesn't meet at a scheduled time. Connecting with peers can help keep you accountable, and keep your momentum going when you may have struggled to manage coursework on your own.

Ask for help

It's easy to get overwhelmed by problems that seem impossible to overcome, and that feeling just gets worse when you don't reach out for support.

"I want students to know it's okay to ask for help," Eileen said. "In fact, how do you plan on it?" Having a plan for who to talk with when you start to feel overwhelmed will make it easier to do so in the moment. Some good people to put on the list include school counselors, advisors, professors, classmates, friends, and family.

Have a crisis plan

Eileen recommends that every student create a crisis plan, whether or not they think they'll need it. Crisis plans are frequently used in CBT and other talk therapies, and usually include warning signs and personal triggers that help you know when you need extra support, and a list of people to call and actions to take that help make you feel better. They act as a safety net when mental health challenges crop up and can be a good indicator of where you're at emotionally.

"If I start to feel sad and I do the first thing on my list, and it helps me to not feel sad and overwhelmed, I'm great," Eileen said. "But if I'm on the fourth thing on my list and I'm still overwhelmed and sad, then I need to take it more seriously."

Using your crisis plan can help you figure out when it's time to seek additional support, like talking with a counselor or seeking other mental health services. "Knowing these are the things that help me to let go, and I'm doing them, and they're not helping," Eileen said, "that means my crisis is bigger."

A crisis plan might also give you some peace of mind when you're feeling overwhelmed. It provides a strategic framework for you to check in with yourself and gives you some easy, actionable items you can do to start feeling better. Including important things for mental healthcare on the list, like meditating, yoga, or exercising outside, may also help prevent you from even going into crisis.

Practice letting go

"If I could give only one tool to people, it would be how to accept the things we can't change and trust in the world that it's all going to be okay no matter what," Eileen said. It doesn't always come easily, but taking a second to check in with yourself and your situation can get you out of your head and help you tune into what's really going on.

When you're feeling overwhelmed, take a step back and assess what's going on. Ask yourself, "Do I have control over this situation or not?"

If you do, what actions can you take to move forward and fix the issue? If not, how can you accept the situation knowing you've done everything you can?

Recognizing when you don't have control can be scary, but choosing to let go and accept it allows you to step outside of the stress and move on from it.

"If you don't choose to accept the things you cannot change in that moment, then that's when it's going to get worse," Christine said. "Your lack of acceptance alone will create more stress that can grow or magnify and ultimately make the situation much worse."

Next Steps

Whether you're struggling with a serious mental illness, going through a hard time, or just feeling increased stress from balancing all your responsibilities, prioritizing your mental health is absolutely critical.

No matter what you're going through, scientific research shows sleep, diet, and exercise are all essential for physical and mental health. Many college students feel the negative impacts of a hectic schedule – losing sleep, cramming for midterms, drinking too much coffee, and eating junk food – on their body and mind.

No matter what you're going through, scientific research shows sleep, diet, and exercise are all essential for physical and mental health. Many college students feel the negative impacts of a hectic schedule – losing sleep, cramming for midterms, drinking too much coffee, and eating junk food – on their body and mind.

The best thing you can do when you're struggling is reach out to someone who can support you. Most students have access to some kind of mental health services through their school and should use them to ensure they set themselves up for success. Everyone feels overwhelmed by stress and anxiety at some point in their lives, and so many factors of the college experience combine to create a perfect storm that can easily draw out and intensify a range of mental health issues. These services are there to help you when you need them and support you through difficult times.