Survey of University Students’ Attitudes on Mental Health Reveals Limitations of Mental Health Care Accessibility

Mental health impacts everyone and suicide rates in young adults have tripled over the past 50 years [1]. The number of college students seeking treatment for their mental health has risen by almost 30% from 2009 to 2015, according to the Center for Collegiate Mental Health [2]. Since many of these students rely on their on-campus facilities as the starting point for their mental health needs, it is important that adequate resources are available to meet the demands of mental health support in order to prevent serious incidents from occurring.

Advocating campus-wide support for students with mental health needs is an important mission for students-run mental health support organizations such as Active Minds at University of California, San Diego (UCSD). We believed it was important to provide a platform for students to openly express their concerns pertaining to mental health in order to assess if students feel that their mental health needs are being adequately addressed on our campus. Active Minds conducted an online survey in March of 2018 to research the attitudes among students on mental health and campus-wide mental health resources. 255 of the 1,300 individuals who accessed the survey link responded. The ~19% response rate is similar to that of 2014 Climate Survey conducted by the University of California Regents [3]. Our survey includes questions on how important mental health is regarded in our student body, the degree of which existing mental health resources are being utilized, and how students feel about their experiences relevant to on-campus mental health care. This survey study is an important first step to shed light on future initiatives needed to meet the growing needs of mental health services for our students.

Thirteen multiple choice and free-response questions were included in our survey. Almost all respondents (~94%) reported that mental health is something that should be taken care of on a daily basis. A high percentage (~84%) of responders reported to have been impacted by mental health issues either personally or by someone close to them. However, only 62% of respondents rated mental health as a high priority (4 & 5) (Figure 1). The discrepancy between the percentages of respondents who feel mental health should be taken care of daily (~94%) versus those who actually treat their mental health needs as a priority (62%) suggests that students are aware of their mental health needs but may encounter obstacles preventing them from receiving support. Identifying the barriers that keep students from seeking mental health care is important to improve overall mental health at UCSD as well as other universities.

Figure 1.

How high of a priority is taking care of your mental health?

We asked respondents to report any concerns they believe to be important pertaining to mental health on campus. The answers were categorized into the following: “resources”, “academic pressures”, “stigma/hostile culture”, and “others” (Figure 2a). These answers revealed that a lack of adequate resources was the predominant concern reported by survey respondents (Figure 2a). The “academic pressures” category referred to the stress of the academic cycle, while the “stigma/hostile culture” category described the negative climate surrounding mental health. A high percentage of respondents (44%) commented on the long wait time for seeing a counselor with Counseling and Psychological Services (CAPS) (Figure 2b). Some answers suggested that even in urgent cases, students seeking help were not being responded to in a timely manner. One of the possible explanations for the long wait time may lie in a shortage of counselors per student body in UCSD CAPS. In the 2017–2018 academic year, UCSD has a total of 36,624 students [4] but only about 30 full-time counselors. The International Association of Counseling Services recommends a 1 to 1000 counselor to student ratio [5], a statistic currently unmet by CAPS. Although the long wait time at CAPS appeared to be the biggest complaint, the majority of those (91%) who have utilized CAPS services reported high satisfaction in the service they received [6]. This highlights the need to improve bottlenecks that cause the long wait-time reported by the respondents so those in need of services can receive timely care.

Figure 2A.

Categories of factors affecting mental health for students

Figure 2B.

Breakdown of “Resources” category

Regarding climate and culture that affect mental health, one student commented that “people make jokes about serious mental health issues that are rampant across campus” while another felt that students tend to place a higher priority on academic responsibilities while neglecting their mental health. Other respondents reported feeling that students “competed” with each other on who has the hardest schedule, who slept the least, etc. These behaviors and social interactions among peers contribute to a culture on campus that can stigmatize mental health and foster a stress-inducing environment. While it is important that university students place emphasis on their studies, it is equally important to ensure that students are taking care of their physical and mental well-being.

Lacking knowledge in how to obtain access for mental health treatment (besides CAPS) appears to explain some responses of “having insufficient resources available.” To determine the degree of students’ knowledge of the availability of professional resources on campus, we asked respondents if they were aware of other mental health professional resources available on campus besides CAPS. 84% of respondents could not identify any. While CAPS has been the primary mental service that provides professional counseling to support students, in fact, UCSD now offers College Mental Health Clinic for students that includes a 24/7 emergency help number.

However, not all students are covered by the insurance plans College Mental Health Clinic accepts. Without the accepted form of insurance, students are subject to pay a full session amount, starting at upwards of $180, even with a discount. The lack of easy access to obtain mental health care is alarming as some mental health crises can be serious without immediate intervention. This is a critical problem that university administrators and mental health professionals need to address.

In parallel to professional support, UCSD has many peer-sponsored organizations offering support and mental health resources to students - such as Active Minds, the Zone, the Wellness Peer Educators, and Tritons in Recovery. By taking the time to care for our daily mental well-being, students may be less likely to fall in a crisis situation. Active Minds represents one of the peer-run organizations that regularly host and support de-stress events on UCSD campus. This survey allowed us to gather data from students to better understand what aspects of peer-based mental health support are utilized and valued. We first asked if students had ever attended any de-stress event, the majority of respondents (63%) saying “no.” When asked to elaborate on the reasons why they had not attended an event, about a third said they lacked the time, a third was uninterested, and a third felt uncomfortable. However, those that did attend these events felt they were able to relax and enjoy themselves. Over 50% of those who had attended a de-stress event went to Therapy Fluffies where service dogs were provided for socialization with the students.

Our data demonstrate that the majority of survey participants do value mental health highly. In addition, mental health stigma and campus culture all appear to play a role in opinions and attitudes about mental health and care on campus. Most notably, while students put a high priority on mental health, those who desired and needed help may not be receiving it in a timely fashion, highlighting an urgent need to improve the accessibility of CAPS and other mental health services to all students on campus. The results of our survey have shed light on what immediate steps we can take to begin improving processes and resources so we can better students’ experience with mental health care on campus. We want to encourage the student body to continue the necessary dialogue about the importance of mental health, learn effective communication to de-stigmatize mental health, educate ourselves and others about mental health facts, show support and compassion for each other, and take the time to care for ourselves.