STUDENT MENTAL HEALTH
Pronounced problems and strategies to help
By Coleman Cornelius | Photography by Matthew Staver | Jan. 27, 2025
HE HAD experienced periods of prolonged sadness as a teenager, but Peter Fredo was flattened by depression starting in Fall 2021, his first semester attending Colorado State University.
An avid climber, Fredo had seriously injured his wrist during a climbing competition at the Student Recreation Center. It knocked him out of his favorite activity for five months, separated him from climbing friends – and, because the wrist above his dominant hand was injured, the injury made even basic tasks difficult as he adjusted to a new life on campus.
As weeks dragged on, Fredo felt trapped in an increasingly dark hole – plagued by unrelenting sadness, hopelessness, destructive self-talk, suicidal thoughts, and feelings of fatigue, emptiness, and isolation. Nothing seemed interesting or enjoyable, even though he is normally an enthusiastic, energetic, and productive person. The darkness crept in like a poisonous fog, insidiously, so that Fredo could hardly pinpoint the dramatic change.
But his friends noticed.
“What’s wrong?” his roommate and girlfriend began asking.
“I don’t know,” he answered, at a loss to name his problem.
So, they convinced him to seek help from Mental Health Services at the CSU Health Network on the Fort Collins campus. The center offers daytime drop-in hours that function as a triage system: Students may meet immediately with on-call counselors for mental health screenings, strategies for managing problems, and referrals to additional services, such as counseling sessions, group therapy, psychiatry, and crisis care.
Fredo was quickly diagnosed with clinical depression. It was a sign his experience was not a short-term case of feeling down or blue, which is natural with life’s ups and downs, but was a longer-term mood disorder, arising in part from chemical imbalance in the brain and likely influenced by genetics and his physical injury, among other factors; the combination caused acute distress and impairment of daily functions. Fredo began treatment including ongoing counseling and antidepressant medication.
When he felt better, he took an unusual step: Fredo transformed his own difficulties into a focus on helping other students with their mental health and wellness. In 2023, he started working as a student program assistant in Health Education and Prevention Services in the CSU Health Network. In this role, he presents information about mental health challenges, symptoms, skill building, and campus resources to a variety of student groups, ranging from sororities and fraternities to club sports teams and other student organizations. During these peer-to-peer presentations, he often shares information about his own struggles.
“Being able to work in an environment where I can talk about mental health is rewarding,” said Fredo, who will graduate this spring with a degree in human development and family studies and a concentration in prevention and intervention sciences. With his degree, he hopes to work in the field of mental health with older adults. “I like being able to share my story,” he said, “because it helps normalize mental health concerns.”
Like many people with depression, Fredo suffered a physical injury that likely contributed to his mental health concerns. He was seriously injured while climbing during his first year at CSU.
The outcome he is seeking? “I hope there is more awareness about mental health struggles so they’re more manageable and students know about resources to help practice self-care,” said Fredo, who is also an officer in a student club called Active Minds, which works to improve mental health awareness on campus.
He is not alone in suffering mental health troubles that require clinical treatment for significant and timely improvement. In fact, Fredo was among nearly 5,000 students who sought help for mental health problems at CSU’s medical center during the 2021-2022 academic year. That placed the caseload at the university’s Mental Health Services higher than nearly 90 percent of counseling centers in a national sample that year, according to a standardized index developed by the Center for Collegiate Mental Health.
Last academic year, in 2023-2024, about 3,100 students sought help for mental health difficulties at the CSU Health Network, placing the caseload at Mental Health Services in the 74th percentile nationally – slightly higher than the national average. For context, Colorado State had nearly 28,000 students on its main campus last academic year.
The pronounced demand for services shows CSU students are requesting help at higher rates compared to those at other universities. Yet, that could be viewed as an encouraging sign because it means services are available – and students are both identifying their needs and seeking resources to improve their well-being, said Adam Sargent, director of General Counseling Services at the CSU Health Network.
“Part of what has driven demand is awareness of the importance of support,” Sargent said. “Nobody questions that it’s important, and counseling services sit very close to the core of our mission as an institution. As much as there is pain and there are problems, there’s an alignment of priorities among students, staff, and leadership around addressing those concerns, and CSU is rising up to meet the challenge.”
Indeed, medical staff with the CSU Health Network also are attuned to mental health care and routinely screen patients for depression and other concerns; behavioral health providers are part of the medical clinic and are well-positioned to help students connect with counseling resources, Laurel Halsey, executive director of the Health Network, noted. “I cannot stress enough the importance of leaders and staff who take it as a matter of course to cross disciplines and focus together on total health outcomes for the individual,” Halsey said.
There is no doubt that student mental health has worsened at CSU and at colleges and universities nationwide over the past decade, mental health experts say. Students are also aware of the torment.
“I think conversations about mental health need to happen more frequently because the more I know, the more I see it all around me,” said Rachel Thomas, another Active Minds officer and a sophomore studying biology in hopes of becoming a physician. She added: “The level of anxiety in everybody is so unbelievably high.”
A student group called Active Minds works to alleviate stigma attached to mental illness and advocates for campus services to address problems. The group’s officers include, from left, Megan Roepke, Dani Bonesteel, Rachel Thomas, and Taylor MacMahon.
Underscoring that sense, the Healthy Minds Study, a leading national measure, reported that 61 percent of college students met the clinical criteria for at least one mental health problem in 2023-2024. That compares to 46 percent 10 years earlier. The most recent study findings are based on an online survey of nearly 105,000 students at about 200 colleges and universities.
The Healthy Minds Study revealed other important findings: 38 percent of students surveyed reported symptoms of moderate or severe depression; 34 percent reported symptoms of moderate or severe anxiety; and 13 percent said they had thought about suicide. A decade earlier, the survey showed 21 percent of students suffered from depression; 22 percent struggled with anxiety; and 10 percent had considered suicide.
Meantime, data from Inside Higher Ed’s 2024 Student Voice survey of more than 5,000 undergraduates found two in five students say declining mental health is greatly impacting their ability to focus, learn, and perform academically, and one in 10 students rates their mental health as poor.
“Over the past decade, student mental health has grown as a retention concern for higher education leaders as young people nationally report higher rates of anxiety, depression, loneliness, and suicidal ideation,” Inside Higher Ed reported in August.
At CSU, students are experiencing more loneliness, distress, and academic impacts related to anxiety, depression, stress, and sleep problems compared to those at other schools, according to the National College Health Assessment. Anxiety is the biggest concern, followed by depression, trauma, social and relational concerns, and family concerns, Sargent said.
Records show that between 13 percent and 20 percent of the campus student population has sought counseling services at CSU during the past eight years, the period for which most reliable data is available. Need reached its peak at the beginning of the COVID-19 pandemic, when demand for therapists surged throughout society.
“In the past several years, we have seen an increase in both numbers and acuity, meaning the intensity of problems and distress,” Sargent said. “Far and away, the greatest concern we see is anxiety – by a mile. Those numbers have really been on the rise.”
As for why, mental health leaders reject any notion that today’s students are overly emotional or sensitive. Just the opposite is true – students often exhibit remarkable resilience in the face of challenges, experts say. Indeed, modern students have grown up amid striking turmoil: a post-9/11 world of unease and high security; an era of school shootings and lockdown drills; a time when social media is pervasive and can contribute to feelings of isolation; an age of global strife, climate change, and political divisiveness; an environment filled with worries about academic success and college cost of attendance. And, oh right, there was a global pandemic that interrupted school and social life, with notable consequences for many young people.
Against this backdrop, the CSU System Board of Governors has been studying mental health on System campuses and recently launched an initiative called the CSU System Vision for Student Mental Health in 2030. As part of the initiative, the System and its campuses are committed to becoming national leaders in fostering and supporting student mental health so that, by the year 2030, students will perceive that all aspects of campus life – administrative, academic, and student life and services – are designed to promote mental health.
“I am proud to serve a university in a System that prioritizes student mental health, but I also believe that student mental health is inextricably linked to faculty and staff mental health,” Marion Underwood, CSU provost and executive vice president, said during a recent event hosted by her office on the Fort Collins campus, called the Provost’s Ethics Colloquium on Mental Health.
“Everything we strive to achieve in higher education depends on the mental health and well-being of everyone in our community,” said Underwood, who also is a clinical psychologist. “The ability of our students to learn, our ability as educators to teach and prepare the next generation of leaders, it all depends on our mental health and well-being.”
“Being able to work in an environment where I can talk about mental health is rewarding. I like being able to share my story because it helps normalize mental health concerns.”
Critical to improving mental health on campus is continuing work to destigmatize problems including anxiety and depression, Underwood and others noted. Studies show there is work to be done: The most recent Healthy Minds Study, for instance, reported that more than 40 percent of student respondents thought, “Most people would think less of someone who has received mental health treatment.”
That is significant because stigma leads to negative stereotyping and may deter people from seeking help when they are suffering, potentially worsening their problems. That’s true even though mental health problems are widespread on campuses across the country, said Katie Rose Guest Pryal, a faculty member at the University of North Carolina at Chapel Hill and author of A Light in the Tower: A New Reckoning with Mental Health in Higher Education.
“Stopping stigma saves lives,” said Pryal, who was keynote speaker at the provost’s colloquium on mental health.
During her remarks, Pryal pointed to the Latin phrase cogito, ergo sum – I think, therefore I am – the first principle espoused by philosopher René Descartes in the 1600s. The concept is central to higher education’s focus on the life of the mind, Pryal noted. Problem is, mental health challenges could call into question one’s fitness to live the life of the mind – a “heavy-duty, spicy issue” in higher education and another reason to counter stigmas on campuses nationwide, she said.
Stark data regarding the mental health of college students has built a wave of national news headlines centered on the word “crisis.” For instance, in nea-Today: “The Mental Health Crisis on College Campuses.” In Inside Higher Ed: “Getting a Grip on the Student Mental Health Crisis.” In Forbes: “Four Strategies for Resilience Amid a College Mental Health Crisis.”
Many leaders in campus mental health refer to this as “the crisis narrative” and warn that emphasis on crisis tends to obscure complexities, can provoke a snowball effect of incorrectly applying clinical terms and diagnoses to everyday stress, and may create a false sense of unmet urgency among campus counseling centers.
“There’s some positive that comes with shining a light on issues that can sometimes live in the shadows,” said Sargent, of CSU’s General Counseling Services. “On the other hand, problems might seem unmanageable or out of control when something is labeled a crisis.”
At CSU in Fort Collins, the System’s flagship campus, counseling services were established decades ago. But, starting in the early 2000s, CSU began to intentionally expand and integrate programs in the spheres of drug and alcohol awareness, health education and prevention, and mental health services, recognizing connections among mental health, substance abuse, and other high-risk behaviors. These changes were prompted in part by a high-profile case of alcohol poisoning and a series of suicides on campus and in the Fort Collins community, said Anne Hudgens, who helped lead the efforts and retired in 2020 as executive director of the CSU Health Network.
“We started with trying to create a continuum of services that would prevent some of the tragedies,” said Hudgens, who credited university administrators for their willingness to address problems. “It was one of the unique things about CSU that we decided to take these issues on, and we became pioneers in lots of areas.
“Mental health and substance use exist on a continuum, and student success is directly impacted by their ability to get help when they need it,” Hudgens continued. “Our strategy focused on getting the right services to students at the right time, and I think we were phenomenally successful in leading the charge in best practices.”
Use of CSU counseling services
Number of students visiting as a percentage of total student population on campus.
The same principle is at work today, Sargent said. As recently as a decade ago, it was not uncommon for colleges and universities to dismiss students coping with mental health crises, he said. CSU has taken the opposite approach. “We made the bold decision to instead hold these students closer and wrap care around them, rather than excluding them from campus,” Sargent said.
During a panel discussion at the mental health colloquium, he said: “When students at CSU are struggling, we hug them tighter rather than pushing them away.”
In October, Colorado State received evidence of its leadership in mental health: The Princeton Review named the school to its 2025 Mental Health Services Honor Roll. CSU was among just 16 universities nationwide named to the list, which is designed to promote collegiate mental health resources by honoring institutions that display an exceptional commitment to student mental health and well-being. CSU was the only university in Colorado to be honored.
“We are always working to match the level of service most appropriate and beneficial to the student,” said Chris Leck, director of Specialty Counseling Services at the CSU Health Network. “There’s a lot of collaboration that happens behind the scenes to make services a seamless experience for patients.”
Among CSU’s hallmark programs is Student Case Management and Referral Coordination, Hudgens said. In fact, the university was the first in the nation to start a student case management program, which provides crisis prevention and intervention services for students in difficult situations. The office works closely with two other key programs designed to prevent and manage acute health and safety matters: Support and Safety Assessment, which proactively identifies students and employees who may pose a threat to safety and well-being; and the iTeam, which follows through on care after a student is hospitalized for mental health concerns.
The CSU Health Network runs three major programs focused on mental health and well-being, starting with Health Education and Prevention Services, which begins its award-winning work in prevention-based public health when students arrive on campus for orientation. The program annually reaches thousands of students with online and in-person education. Efforts also include early identification, such as online screenings and resources for students at higher risk of mental health and substance misuse concerns. The office encourages students to use an online platform designed for the Colorado State community, called YOU@CSU, which helps students track and improve their well-being – and connects them to needed resources.
Health Education and Prevention Services works in tandem with Mental Health Services in the CSU Health Network, yet it also concentrates on sexual health, substance misuse, and well-being initiatives.
“A lot of the work you see today is a beautiful collaborative effort to build direct patient care and prevention efforts in support of student mental health, well-being, and academic success. In an ideal world, you’re getting upstream, not only providing services for student needs, but also helping develop health-related life skills and creating a campus environment that cultivates belonging to support students in being successful in their college experience,” said Christina Berg, director of Health Education and Prevention Services.
At a meeting of the student group Active Minds, panelists discuss service animals for people with physical and mental challenges.
General Counseling Services, a partner program, not only provides individual therapy, but also is well-known for three key efforts: drop-in and crisis services; group therapy, which is one of the largest programs of its kind in the country; and clinical counselor training accredited by the American Psychological Association.
Specialty Counseling Services is also under the umbrella of Mental Health Services at the CSU Health Network. This office runs Drugs, Alcohol, and You programs, which provide counseling related to substance use and may be attended on a voluntary or mandatory basis, when required by CSU’s Student Resolution Center. Specialty Counseling Services is known for three other programs: the iTeam, which provides follow-up care after a student is hospitalized for mental health concerns; Embedded Counselor Programs, which place counselors where they are often needed, including residence halls, CSU Athletics, the Pride Resource Center, and the Survivor Advocacy and Feminist Education Center; and multicultural counseling, which provides therapy tailored for students from diverse backgrounds.
Psychiatric Services rounds out the university’s Mental Health Services; this office is staffed with psychiatrists and other medical providers who prescribe medication, as appropriate, to help students heal from mental health challenges.
Notably, students receiving help do not pay out of pocket for counseling services at the CSU Health Network. That’s because the annual budget of about $3 million is covered entirely by general student fees. A student board reviews and assesses fees.
“It should be the will of the students to provide counseling services on campus because they’re the institution’s customers,” Sargent said. “Is this a concern that should be addressed on campus? Students consistently have wanted to have mental health services at CSU, and it makes us a stronger and safer community.
“Mental health fits hand-in-glove with academic success,” he continued. “For that reason, it is part of the mission of the university. Our job is to help shape successful citizens, so treating mental health is key.”
Members of the student group Active Minds, the CSU chapter of a national organization, are frontline ambassadors for this concept. Many have struggled with problems themselves, and they dedicate time during weekly meetings to increase their own knowledge about mental health concerns – then look for campus volunteer opportunities, when they may discuss mental health and well-being with other students and community members.
“Mental health is just as important as physical health,” said Dani Bonesteel, Active Minds chapter president and a junior majoring in psychology with a concentration in addictions counseling. A first-generation student, she plans to attend graduate school and pursue a counseling career. “Compassion starts with understanding mental health and psychology,” Bonesteel said. “If we educate ourselves and spread awareness, people can understand it’s not always a matter of pulling yourself up by the bootstraps, and hopefully, we can have a kinder and healthier society as a whole.”
Taylor MacMahon, another club officer, agreed. “No one should have to go through this alone,” she said, describing her struggles with anxiety and depression, which have improved with help from CSU counseling programs and involvement in campus activities. “I’ve been learning there are frightening and hard things in life, but I’ve been realizing I am capable, and I can get through it.”
Mental health resources
- CSU Health Network, Mental Health Services: (970) 491-6053, health.colostate.edu/mental-health-resources
- Tell Someone (to report information about anyone on campus who might present harm to themselves or others): (970) 491-1350
- Student Case Management: (970) 491-8051
- Mental Health Crisis Intervention (24/7): (970) 491-6053
- CSU Police Department (24/7): 911 or (970) 491-6425
- ComPsych Employee Assistance Program (24/7): (800) 497-9133
Leadership in mental health
The Princeton Review recently named Colorado State University to its 2025 Mental Health Services Honor Roll for exceptional commitment to student mental health and well-being. Just 16 universities nationwide were honored; CSU was the only school in Colorado to be included. Through the years, Mental Health Services, which is part of the CSU Health Network, has started several leading-edge programs to meet the needs of students on the Fort Collins campus. Here are a few examples of notable CSU programs that work in concert to support safety, mental health, and wellness on campus.
- Drugs, Alcohol, and You: An early drug court for students required to participate; students may also join DAY programs on a voluntary basis.
- Group therapy: One of the largest programs of its kind in the country. Groups are designed to help students with both general and specific problems, ranging from negative body image to trauma recovery.
- iTeam: Multifaceted support for students who have been hospitalized for mental health concerns. It was the first such program on college campuses.
- Multicultural Counseling Services and the Counselor in Residence Program: Specialty services designed for students with particular needs. Multicultural services help students of color, those in the LGBTQIA community, and students with disabilities; the Counselor in Residence Program embeds therapists in places where they might be most needed, such as residence halls.
- Notice and Respond: An education and prevention program that raises awareness about suicide and encourages those in the campus community to seek emergency help when needed.
- Student Case Management and Referral Coordination: The first of its kind in the country. The team provides crisis prevention and intervention services and supports students with acute medical and mental health problems, among other issues. It connects students with people, offices, and agencies on and off campus.
- Student Consultation Team and Tell Someone: Programs of the Support and Safety Assessment office. The consult team works on cases involving students who may pose a threat to themselves or others. Tell Someone encourages those in the university community to report concerns about individuals who may pose threats; it was among a wave of such reporting programs begun after the mass shooting at Virginia Tech in 2007.
- Training: Counselor training within Mental Health Services recently celebrated 50 years and is accredited by the American Psychological Association. One of the oldest counselor training programs in the country.
- YOU@CSU: An example of emerging digital tools to track and improve mental health and well-being. It was developed at CSU with input from students on campus.
Photo at top: Peter Fredo, a CSU senior, experienced clinical depression in his first year on campus. When he felt better, Fredo became a student-educator on the topic of mental health – part of a broad network of prevention and intervention services on campus.
SHARE