Picture this: a student sits outside their university’s mental health counseling center, questioning whether or not they should go inside to receive support. It is not that the student is afraid of sharing their emotions. Instead, they are afraid that disclosing this information to a university mental health professional can trigger intervention — a process that can be time-consuming, stressful, and most importantly, affect a student’s academic standing at their university. Unfortunately, this scenario often plays out among college students going through hard times in their lives, leading them to censor their words when meeting with a counselor or, in some cases, avoid seeking professional help entirely when they need it the most.
This type of scenario can be alleviated by using a harm reduction strategy when dealing with mental health issues in universities. Harm reduction is based on a public health framework. It is mainly used in substance abuse treatment through meeting people where they currently are instead of demanding that people be free of risk and harm — expectations that are often impractical and difficult to reach when one is in the deep end of a mental health crisis. When applied in a university’s mental health policy, harm reduction can lower the cost of seeking help, provide support beyond severe mental health cases, and reduce punitive measures. Compassion is essential to this approach, and a student struggling with mental health should be supported exactly how and where they are.
College is an exciting transitional period between being a student and going into the “real world.” Yet, during this time, students can be making big decisions regarding academics, housing, personal life, healthcare, and their future career, which can create or exacerbate anxiety.
Research has shown that most lifetime mental health issues occur before the age of 24: an age range that matches with students in college. This environment can create an opportunity for harm reduction initiatives to thrive, as many college students are still forming their identities, beliefs, and values. Instead, though, the mental health policies of many universities operate on an intervention model where a student is in crisis before providing real support; as a result, research has shown that a vast majority of students who died by suicide had never reached out to their college’s mental health support systems.
Instead of determining how severe a mental health crisis becomes, harm reduction approaches the situation by determining what should change in the resources and policy surrounding mental health so students can feel safe speaking up and sharing their concerns.
On campuses, this can look like many different things.
Some schools have started offering drop-in counseling sessions that don’t require a formal intake or diagnosis, so a student can talk to someone the same day they decide they need to. Others have long used medical amnesty (often known as “Good Samaritan”) policies for alcohol and drug emergencies, which let a student call for help without facing disciplinary action. A 2018 study found that these policies reduce barriers to seeking help without increasing risky consumption. While they remain specifically limited to alcohol and drug incidents at most schools, the implementation of such policies has thus far shown that removing the fear of punishment increases the likelihood that someone reaches out for help: a lesson mental health policy could learn more broadly.
Peer support programs can, for example, help alleviate the internalized fear of sharing mental health struggles with university administration. Peer support gives students a safe space to talk to someone who is a student too, not a clinician writing down every word they say, which can help students avoid university-based interventions that can lead to unwanted issues with their academic standing, housing, or enrollment. For students, speaking with a peer can be a helpful way to be heard by someone who can relate to their experiences in college and can be a first step towards a formal counseling appointment.
A university does not have to change its standards or ignore a severe mental health risk posed to a student — which is what this approach is often misunderstood as suggesting. What a harm reduction strategy changes is that a university can help its students before a potential crisis rather than responding to one because students are more likely to use the resources at their disposal.
Tanish Joshi-Apte is a junior pre-medical student at Washington University in St. Louis.