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Wednesday, May 22, 2024

What Students With Mental Health Challenges Should Consider in Their College Search



You’re at the end of your junior year of high school with a list of colleges that interest you because of their history department, the great hiking trails in the nearby mountains or their football team. You’ve also faced some mental health challenges, and the COVID-19 pandemic didn’t help. And maybe you wonder if your preferred colleges will meet your mental health needs.

The answer is reassuring: Most colleges have counseling centers and provide accommodations for documented mental and physical health issues, learning differences and other areas where students may need assistance. Administrators recognize that anxiety, depression and substance abuse among students are on the rise, and the need for these services has increased.

“There will be no judgment,” says Marcus Hotaling, director of the Eppler-Wolff Counseling Center at Union College in New York and president of the Association for University and College Counseling Center Directors. “College administrators have seen and heard it all.”

At the same time, Hotaling and some other experts agree that a student’s mental well-being depends in part on the fit between the college’s policies and the student’s needs.

“All students are different,” Hotaling says.

Experts say that if students and their families do their homework and are clear about the mental health needs and what a college can offer, they will find a good fit.

“There is no one-size-fits-all college,” says Amy Gatto, director of research and evaluation at Active Minds, a nonprofit organization that promotes mental health and has student chapters at 800 colleges and high schools across all 50 states.

Here are some tips to guide you in the college search.

Know Where to Seek Advice

First, it’s important to know who to turn to for advice.

Start with the family pediatrician, therapist, guidance counselors or teachers,” Hotaling suggests.

Coaches, members of your religious community and even friends can also help you sort things out, Gatto adds. “It should be someone you can be your whole self with.”

Consider School Size, Distance From Home

It’s also important to consider how college size and proximity to home may affect mental health and well-being.

“Some students will thrive at a large school where others will fall through the cracks,” Hotaling says. “Some students will be bored at a small school where others will love being the big fish in a small sea.”

Financial wherewithal is another consideration, Hotaling adds. “Will a student be able to come home at any other time than the major holidays? Can they afford the airfare?”

Sarah Pennington, who struggled since middle school with anxiety, depression and a disorder called trichotillomania that compelled her to pull her hair out, was clear on what she needed.

“I wanted a school within driving distance from home for a weekend visit, but not so close that I could randomly stop by,” she says. “This was a good way to push myself outside my comfort zone to rely less on my parents. And I did not want a big school. I wanted classes where the professor would know my name, and a campus I could easily get around. I also didn’t want a city school.”

Ultimately, Pennington chose McDaniel College in Maryland, a school with fewer than 2,000 undergraduates in a town with a population under 20,000 that sits two hours from her home in Pottstown, Pennsylvania.

“I visited around 20 colleges. What sold McDaniel for me was the visit. It felt right,” Pennington says. McDaniel’s “Step Ahead” summer bridge program, which was designed to help first-year students with disabilities make a smooth transition to college, clinched her decision.

“It helped ease some of my anxieties about this big life change,” Pennington says.

In some cases, taking a gap year between high school and college may be a good move for a student experiencing a mental health challenge.

“If you need time to get healthy, to mature, or just time off – I am a big supporter of that,” Hotaling says. “Parents and students get stuck in the normalcy of a four-year education, going straight through. I would much rather see a student take time off rather than struggle with health or mental health issues which might lower their grades.”

Hotaling adds that considering a gap year “is an individual decision, but if you’ve already applied and been accepted to a college, I would talk to that college and make sure you still have the acceptance guaranteed along with any scholarships or financial aid.”

Making the Transition to College

Steve Schneider, a counselor at South High School in Sheboygan, Wisconsin, says it’s crucial for students who have had mental health challenges and their families to have a plan – and to make sure the chosen college’s policies and resources will allow them to adhere to their plan.

“I tell them that if the problem were diabetes, they would have a clear plan,” he says. “They would make sure their kid was hooked up with a doctor who can get them their insulin, and so on. Families have to help their kid make sure the provisions they need are available.”

The transition to college “is big, and the hard work is done before the transition,” Schneider says. “‘Adulting’ is hard for all students,” he adds, and there’s added difficulty for students who have experienced mental health challenges.

“They’ve succeeded because they had what I call a management plan,” Schneider says. “This might include therapy, medication, academic accommodations, diet, living arrangements that support mental health and physical activity.”


Though most colleges have counseling centers, “there are differences from one college to another in relation to the limits to services offered on campus,” Hotaling notes. “Some schools will have session limits for counseling, while others do not.”

During the COVID-19 pandemic, teletherapy increased. Most counseling centers did not offer weekly in-person therapy during the 2020-2021 school year, but 90% aided high-risk students, including through “telemental health” services, according to the “Annual Survey: 2021,” a report by the Association for University and College Counseling Center Directors.

It is not unusual for students to remain in treatment with their pre-college therapist, so families should consider that option as well. 


Different colleges have different policies governing medication management. Families on a campus tour should feel free to ask questions regarding general college policy, such as whether there is a campus psychiatrist who does medication management.

“We had meds delivered to my home address in Pennsylvania and then my mom sent them to me at school,” Pennington recalls. “That meant that we did not need to change the address of where the meds were being sent during summer breaks. Additionally, I always tried to bring a semester’s supply of meds to school with me to avoid needing any last-minute shipments.”

Academic Accommodations

In high school, a student can get accommodations – like extended time for exams and longer deadlines for papers – through arrangements made between the family and school administration. But college is somewhat different, Hotaling points out.

“Campus resources are not going to seek you out,” he says. “It is the student that actually needs to ask for assistance once on campus. And though a parent may red-flag a student, (school officials) may not be able to share information with them (parents) unless there’s a health and safety risk. Also, we cannot force a student to get help.”

Hotaling suggests that students set up accommodations as soon as they arrive on campus, rather than being caught flat-footed when the need for mental health assistance arises. Policies differ from school to school, he notes, but for academic accommodations, most colleges “will require some level of neuropsychological testing and a testing report be sent to the college.”

“We want to reduce any surprises,” Schneider says, “because it’s the wave you don’t see coming that knocks you down, not the wave you’re prepared for.”

Pennington emphasizes that students must become expert at advocating for their own needs. “I changed my language to be more assertive. Rather than saying, ‘I would like to request XYZ accommodations,’ I would say, ‘I need to have XYZ in place to succeed.’“

Living Arrangements

The most basic decision regarding living arrangements is whether you will live on campus or go to a commuter college and live with your family.

If you are required to or decide to live in campus housing, is your mental health better served with a private room or are you fine with a roommate? And is it possible you may be forced to make a change down the road?

“Some colleges have rules about living on campus for four years, where others cannot provide housing after the first year,” Hotaling notes.

What to Do After Acceptance, Before Deciding

By the time you decide to apply to a college, you likely know the college’s mental health offerings.

“The school will give you honest answers about what, according to their policies, they can realistically offer you,” Hotaling says. “Again, every school is different, so though one school says that a student can take a reduced course load with no problems, another school may not be able to do this.”

The time for students to get really specific about their needs is after acceptance but before making a decision, Hotaling says.

“Once you’re admitted, any question can be asked. We’re not taking your acceptance back. At that point, I really do want to know what’s going on with you. Do you have an eating disorder that requires counseling four times a week? We can work with that.”

Pennington says she flourished in college. She entered a beauty pageant in 2019 and was named Miss Central Pennsylvania, the first winner who was bald under her crown.

Gaining greater clarity about her academic and professional goals, she transferred to Savannah College of Art and Design in Georgia, a school with 12,000 undergraduates and a plane trip away from home. She joined Active Minds, became a motivational speaker on mental health and in June 2022 graduated with a Bachelor of Fine Arts degree in film and TV.

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