The crisis narrative of mental health is a macro social narrative that has been quietly driving much of our experience over the last 20 years. It is time for greater awareness and insight; it is time to accept that mental health has become a population concern, fully deserving of new solutions, while we still prioritize growing treatment capacity for those who need it.  

Over the last two decades, the crisis narrative of college student mental health has slowly but surely taken hold as the dominant conceptual framework. It defines the problem, shapes our student/faculty experiences, motivates institutional reactions and choices, and has led to constantly shifting sands of challenge and mirage.  
 
It’s time for us to take a step back, pause, and critically examine why this narrative dominates our experience, identify how it is getting in our way, and map out new ways of thinking and acting.  

On September 19, more than 500 people from higher education and beyond came together to learn about the crisis narrative of college student mental health and begin the process of understanding the many ways it is impacting our collective efforts. The sheer number of people who registered for this event (more than 850) speaks to significant impact the narrative has had on the higher ed community and the need among administrators and clinicians to find useful frameworks to make sense of the challenges. In addition to the number of those in the “room” during the presentation, attendees joined from the US, Canada, and the UK, demonstrating the global interest in the crisis narrative and the desire for new perspectives.

Below we unpack our conversation and further explore: where do we go from here?  

Major themes  

First, it is important to understand that the word “crisis” is nearly always applied to a time-bound event with a clear beginning and resolution. Because it has been applied consistently to college student mental health for nearly 20 years, we need to collectively recognize that the crisis framework is neither applicable or helpful – and may even have direct negative impacts at individual, systemic, and cultural levels.   

During the webinar we reviewed six significant dynamics that have contributed to the evolving narrative including:  

• Advocacy: local providers and administrators, private advocacy organizations, state and federal legislation and funding. All well-intended efforts contributing to our current situation, but often lacking in clearly defined goals. 
• Pathologizing of normative human distress: constant expansion of diagnostic categories inclusive of normative human distress, fear of doing the wrong thing or missing risk, etc. we have reached a point where people assume distress equals pathology and that all distress should go to a mental health professional.   
• Research dynamics: over-reliance on quick surveys among many stakeholders that confirm the narrative, too much attention focused on results that support a crisis narrative, too little attention on results that do not. 
• Evolution of Media: pay per click, rise of social media, and the resulting powerful, shaping forces on our attention, consumption of information, language, behavior, and attitudes.   
• Industry: recognize the influence of industry over decades, from the rise of pharmaceuticals in non-serious mental-illness, the impact of diagnostic requirements for 3rd party reimbursement, and the rapid and unprecedent investment in the mental health market, along with the role of a crisis narrative in motivating buyers.   
• Language and subjectivity: the long-term impacts of integrating specialized jargon (psychology) into the popular culture/ language and the consequences of encouraging the next generation to use mental health language to describe their everyday experiences.  

Key takeaways  

Attendees listened to real-world examples provided by experts in the field of how the crisis narrative is directly impeding their efforts to successfully implement mental health strategies on their campuses.   

Attendees were encouraged to consider the following key takeaways:  

• Recognize that the crisis narrative exists and is impacting your experience, your efforts, your institution, and society as a whole. Question and critically evaluate the use of the crisis narrative as a framework.  
• Facilitate institutional responsibility for re-educating students about normative human distress/coping/support, empowering a wide variety of help-seeking pathways. Beware the consequences of labeling normative distress as a mental health condition. 
• The critical importance of comprehensive/long-term institutional strategies instead of reacting to the crisis of the moment.  
• Acknowledge that the linking of human distress to “mental health’ represents a population-level shared experience. The need for population-level solutions that offer novel and scalable mechanisms of support.  
• The importance of coming to terms with the profound lack of treatment capacity for those in need and the challenges created by routing normative human distress through limited, specialized treatment systems.  
• Seeking alignment among all partners at an institution for a realistic mental health strategy (and its limitations) that is consistent with mission, resources, and expectations. See Penn State University’s The Alignment Model: Using the Clinical Load Index (CLI) to Guide Counseling Center Staffing.  

Finally, it’s important to be passionate, persistent, and patient in the years ahead. The last two decades have seen important progress around mental illness, treatment, and our broader understanding of mental health. We have achieved many important milestones and there is much more work to do. As part of doing that work effectively, we need to become aware that the crisis narrative, as the predominant social framework for understanding mental health, exists and surrounds our efforts, and it’s time for us to begin critically examining its role and impact.  

Perhaps most importantly, mental health as a universal aspect of human concern, is now a population concern that requires population-level supports that are distinct from and yet capable of working hand-in-hand with treatment systems for mental illness.   

Thoughts from attendees  

Over 200 attendees submitted thoughtful and considered questions and comments upon registration and dozens more during the event. Below are just a few of the insightful contributions. 

“Do today’s college students experience more anxiety than previous generations or are they just better able to name the condition?”  

“Part of my attraction to the work was the opportunity to engage in student development. I know that this work has never gone away, but it has been overshadowed by the crisis narrative. How can we get back to this being the emphasis? Wouldn’t this be, at least, part of the solution? Doesn’t a developmental approach help solve the pathologizing of ‘normal’ human experience?”  

“What is the most effective way to discuss mental health in a college setting while still setting up students for success?”  

“The crisis narrative often leads to panicked decisions in higher ed on quick fixes that don’t seem to fix anything at all.”  

“In tandem with the explosion of the crisis narrative, it also seems that students are seen and feel more and more like consumers – how do you think the institutional desire to compete with other institutions and please the customer interacts with the student belief that they need more mental health support?”  

“How can we act in a more proactive holistic supportive way when large numbers of students request acute support/accommodations?”  

“What is the best way to help students self-evaluate their need for counseling services (i.e., sad vs. clinically depressed)?”  

“How can we increase distress tolerance to reduce the presentation of ‘crisis situations’ that drain resources and staff?” 

We appreciate those who attended our presentation, who contributed their time and thoughtful opinions; we hope our discussion provided you with insight and new perspective. If you missed our webinar, don’t worry! The discussion doesn’t end here. More to come on the crisis narrative. 

Watch the webinar:

Mental Health in Higher Ed: Is the crisis narrative getting in our way?

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