Reimagining Support for Mental Health: What Higher Education Leaders Can Do

By Makenzie Schiemann, TNG Consulting, an AGB sponsor November 9, 2021 January 13th, 2022 Blog Post

Opinions expressed in AGB blogs are those of the authors and not necessarily those of the institutions that employ them or of AGB.

Higher education has seen a continuing increase in the number of students experiencing emotional and mental health challenges. Counseling center directors report a gain in the number of students enrolled on their campuses who have a mental health diagnosis and an increase in the number of students arriving on campus already on psychiatric medication.[i] It is important to also consider students who may not have a mental disorder diagnosis but are not completely mentally healthy. A survey of 428 students at a selective, small private institution found that 30.9 percent of students were experiencing emotional distress and difficulty even without the presence of a mental health diagnosis.[ii] These results suggest that a significant percentage of students either have a mental illness or are struggling emotionally.

The rise in students experiencing mental health issues is straining our existing resources as increasingly more students seek services at counseling centers. The Center for Collegiate Mental Health[iii] found that among the counseling centers it surveyed, institutional enrollment grew by 5.6 percent over a five-year period, while the number of students utilizing services on their campuses grew by 29.6 percent. Additionally, the number of attended appointments increased by 38.4 percent.[iv] These results suggest that even when institutional enrollment remains stagnant, the need for mental health resources may continue to expand, and when institutional enrollment does increase, mental health needs could grow at an exponential rate.

It’s time for trustees and other higher education leaders to reimagine how they can develop support resources to meet the evolving needs of students. Corey L.M. Keyes’s Complete Mental Health Model provides a conceptual framework for support services on campus. Keyes presents the Mental Health Continuum as a scale that represents a range of quality of mental health and scope of mental illness. Historically, Americans have adopted an illness-based approach to health, which views health as the absence of a disorder.[v] Keyes challenges this notion by offering that the absence of mental illness is not the presence of mental health.[vi]

Keyes’s Complete Mental Health Model presents the concept that an individual’s mental disorder is only one contributing factor of overall mental health, not the sole determinant. Complete mental health can exist in the presence of a mental disorder as it is also composed of emotional and psychological well-being and positive social functioning. Therefore, an effective strategy for addressing complete mental health must simultaneously treat mental disorders while also promoting complete mental health in individuals who may not have a mental disorder but are not completely mentally healthy.

Viewed through this framework, boards and other senior leaders need to ensure that resources are in place to treat those individuals who have a mental illness, but they also need to provide support and resources to those who may not have a mental illness but are experiencing distress or difficulty. This means we must reimagine what emotional and mental health supports look like on college campuses. A reimagining of services allows schools to meet the needs of all students who might be struggling while also reducing the overburdening of counseling center staff. Consider the following strategies to improve and expand the services on campus to support complete mental health:

  • Expanded Clinical Services: Institutions should offer treatment services on campus or engage in a memorandum of understanding with an off-campus provider for accessible treatment services. These services should include:
    • One-to-one therapeutic services
    • On-call and crisis support
    • Telehealth services
    • Expanded and flexible hours
  • Behavioral Intervention Team (BIT): BITs are multidisciplinary groups of school officials who identify, assess, and intervene with students experiencing distress or who pose a risk. BITs allow institutions to connect students across the mental health continuum with the right type of support to promote their complete mental health.
  • Non-Clinical Supports: Non-clinical support resources are aimed at destigmatizing help-seeking and increasing student access to resources and interventions. Non-clinical supports include:
    • Wellness programming aimed at improving mental health literacy
    • Trained and organized peer support communities
    • Professional staff trained in identifying, supporting, and referring students who need assistance
    • Non-clinical case managers who provide goal-oriented assessment, intervention, and coordination of services for students experiencing any type of barrier

The goal should be to offer comprehensive services aimed at improving the complete mental health of all students, not just those with a mental illness. This means expanding existing clinical services as well as offering an array of non-clinical services such as BITs, campus-wide initiatives, peer support groups, faculty and staff training, and non-clinical case managers.

[i] Peter LeViness et al., The Association for University and College Counseling Center Directors Annual Survey – Public Version, 2018.

[ii] Katherine Graff Low, Flourishing, substance use, and engagement in students entering college: A preliminary study, Journal of American College Health, 2011, 59(6), 555-561.

[iii] Center for Collegiate Mental Health, Annual Report, 2015. Retrieved from: Annual Reports (

[iv] Center for Collegiate Mental Health, Annual Report, 2015. Retrieved from: Annual Reports (

[v] Corey L.M. Keyes, Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health, American Psychologist, 2007, 62(2): 95-108.

[vi] Corey L.M. Keyes, The mental health continuum: From languishing to flourishing in life, Journal of Health and Social Behavior, 2002, 43(2): 207-222.

Makenzie Schiemann is the vice president, behavioral intervention and threat assessment at TNG and the president of the National Association for Behavioral Intervention and Threat Assessment.

References and Resources

TNG handout: Standards for BITs

TNG handout: Standards for Case Management

AGB webinar: Mental Health Issues on Campus: Time for New Solutions

With Thanks to AGB Sustaining Sponsor: TNG

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Makenzie Schiemann
TNG Consulting