Anashua Dutta, a fellow at the Bazelon Center for Mental Health Law and team member of the Patient-Centered Outcomes Research Institute Award on addressing mental health discrimination in higher education, contributed to this blog.
A new survey recently revealed that 40% of college students considered dropping out in the past six months due to mental health concerns. Although this may shock some, it is not surprising to disability advocates and people with lived experiences of mental health challenges while in college.
The “campus mental health crisis” has been in the headlines for more than a decade, driven by increasing mental health distress and help-seeking among students. Most universities are now acknowledging this problem, with the majority of college presidents stating that student mental health is a top concern for their campus. Though universities often fall short, many have prioritized coordinated efforts to expand clinical services, launch well-being initiatives, and offer digital mental wellness tools. However, with the ongoing prevalence of mental health conditions, loss and trauma from the COVID-19 pandemic, and changing expectations of higher education, it’s a critical time to broaden perspectives on how we address mental health on campus. Increasing access to mental health professionals and campuswide well-being promotion alone will not make campuses accessible for students with mental health disabilities.
Disability and universal design on campuses
Historically, students with mental health disabilities are more likely to drop out of college compared to their peers. If more college students are struggling with mental health conditions, it makes sense that thoughts of leaving college are happening on a larger scale. It also means that students with mental health disabilities, who have been forced to confront and often experience the most extreme failings of colleges and universities, have key insights into solutions.
Students with mental health disabilities, who have been forced to confront and often experience the most extreme failings of colleges and universities, have key insights into solutions.
Instead of treating the needs and demands of students with mental health disabilities as separate or irrelevant to the rest of the student population, campuses can take a universal design approach by listening to and learning from students with mental health disabilities. This can help identify and create new opportunities to enforce the rights of students, make colleges more accessible for the growing number of college students with significant mental health concerns, and ultimately benefit everyone on campus during a time of widespread struggle.
The state of accessibility, accommodations, and student rights
For students with mental health disabilities, higher dropout rates are not an indication of their ability to learn or contribute to their campuses. Instead, it demonstrates that the policies and practices in higher education are often misaligned with – or even harmful to – students’ mental health needs. Students, including those of us writing this blog, can, and do, succeed academically when given access to appropriate and culturally competent support related to mental health disabilities. Typical accommodations, which many are entitled to under federal and often state disability laws, include flexible attendance, the ability to reduce course loads, and extensions on deadlines.
However, many campus policies and practices create unnecessary barriers for students that negatively impact their mental health. Students who have documented disabilities, which can be difficult to obtain due to factors like limited access to the mental health professionals required to provide documentation, often report that course instructors deny academic accommodations already approved by their disability services offices. Even when some populations, like Black students, gain access to disability and mental health services, implicit biases often lead to inadequate services, misdiagnoses, and a lack of cultural competency. This leads to poorer health outcomes, less outreach, and less support for Black students.
Students, including those of us writing this blog, can, and do, succeed academically when given access to appropriate and culturally competent support related to mental health disabilities.
For students generally, studies have repeatedly documented negative attitudes toward psychiatric accommodations among faculty and instructors, including beliefs that psychiatric disabilities are not “real,” reflect laziness, and/or are “not fair to other students.” The survey that found that 40% of students considered dropping out also noted significant differences in negative experiences among students who felt support from professors compared to those who did not.
In the last decade, faculty and instructor training focused on students as a source of risk has arguably further negatively impacted attitudes. For example, almost all campuses now have threat assessment and detection protocols, pushing faculty to think about their students in terms of risk and threat to the campus community. This is particularly true of conditions associated with high levels of stigma (and perceived “dangerousness”), such as schizophrenia and personality disorders. Instructors may also have limited capacity since many higher education environments are unsupportive or toxic for their own mental health.
Gaps in support and resources also mean that students who experience a mental health crisis, something that has been increasing among teens in particular, may face a police response and even an involuntary leave of absence. As a result, they are removed from classes, often prohibited from returning to campus, including on-campus housing. This is a traumatic experience that can result in the loss of community support and income, a derailed educational and career trajectories, expensive medical bills, and family conflict. Universities, notably Brown University and Stanford University, have reached settlements to address unfair requirements for students to return to campus after mental health leaves of absence in recent years. While there is limited data available on the topic, one student we spoke with reported being required to simultaneously attend an intensive five-day outpatient treatment program in a neighboring city while remaining enrolled full-time in courses.
One student we spoke with reported being required to simultaneously attend an intensive five-day outpatient treatment program in a neighboring city while remaining enrolled full-time in courses.
Further, intersections of oppression, including racism and classism, compound the negative impact of these experiences. This is not just because of the lack of representation among providers, the lack of affordable services, and the discrimination present in college environments. It is also because the most harmful responses of our mental health systems, including involuntary commitment and police response, are more likely to be applied to marginalized communities, particularly Black people with and without mental disabilities. Legal organizations in partnership with students and university stakeholders have proposed model policies for years to prevent discrimination and legal violations in these situations so that the punitive nature of these responses does not impact a student’s academic, extracurricular, social life, and general well-being.
Successful, evidence-based programs are available
There are programs focused on students with mental health disabilities that universities can implement or take inspiration from to more effectively address the evolving needs. These initiatives center students’ voices and wants and provide comprehensive support beyond simply increasing access to traditional services. While accommodations are critical, these programs also provide students with the broader support they need to navigate higher education. For example, the NITEO program at Boston University and the Fountain House College Re-entry program both offer a blend of academic support, well-being promotion, and support from peers with shared experiences.
Students themselves are also taking the lead to demand colleges improve accessibility for students with mental health disabilities and remove discriminatory practices. For example, Project LETS is a disability justice organization that provides peer mental health advocates and community organizing for students, and Neurodivergent U focuses on changing policies and practices that harm students.
Listening to lived experience and centering disability advocacy to improve campuses for all students
More students with mental health disabilities are attending institutions of higher education, partially because of disability laws that were largely driven by disabled organizers and people with lived experience. Organizations and organizers who have experienced the harms and failures of our current systems have been advocating for years for solutions like the NITEO program, Fountain House Re-entry, and peer support, as well as enforcing disability laws and changing campus crisis responses. This is not an unrealistic or impossible endeavor. The University of Florida Counseling and Wellness Center has been at the forefront of demanding and changing practices to be grounded in a human rights approach.
While not everyone needs to attend college, and broader issues like the affordability of higher education remain, the choice to obtain a college education should be up to students and not the result of an environment that does not meet their needs.
With nearly half of students considering dropping out of college due to mental health, it is clear that higher education must act. The perspectives and ideas offered by students who have deep experiences of our current failures can help us reimagine research, policies, and practices to build a better and more inclusive future in higher education.
Kelly Davis, associate vice president of peer and youth advocacy at Mental Health America, Jalyn Radziminski of the Bazelon Center for Mental Health Law, and Nev Jones, Ph.D., of the University of Pittsburgh, are co-leads of the Patient-Centered Outcomes Research Institute Award on addressing mental health discrimination in higher education.