Student Mental Health, Success Tied to Future Health and Affordability

Access to timely mental health care remains a significant challenge across the United States. For college students, barriers to care can jeopardize not just health but also academic aspirations. This issue is especially pronounced at institutions serving rural populations, which often face workforce shortages and can only provide limited or fragmented access to psychiatric care.

The implications extend beyond individual students. When mental health needs go unmet, educational goals can fall short, which contributes to long-term financial and health disparities that may persist across generations.¹ These ripple effects shape community well-being and place avoidable, and costly, strain on the health care system.

Investing in collaborative, technology-enabled care models, including telepsychiatry, can be an effective way to address these challenges.

Education as a Driver of Health

These access challenges are not isolated to the college years. Student mental health can influence whether students stay in school and achieve their educational goals. Because educational attainment is closely linked to health outcomes throughout life, campus mental health care is both an immediate access issue and an upstream investment in long-term health.²

In many ways, education is a foundational social determinant of health. Professional certificates and college degrees open pathways to higher-paying jobs, providing greater access to most of the other resources individuals need to be healthy.³ A college graduate can expect to live, on average, 11 years longer than someone who didn’t complete high school.⁴

In short, what happens today in the classroom shapes what happens tomorrow in the doctor’s office.

Unfortunately, there are significant disparities in educational attainment. Fewer than half of Americans older than 18 have completed a secondary education program or degree.⁵ These gaps in educational opportunity reinforce cycles of health disparity.

Mental health plays a critical role in whether students succeed. Most college students will experience some type of diagnosable mental health need, including depression and anxiety, and many will also experience thoughts of suicide.⁶ Most mental health disorders start early in life and have their peak onset during young adulthood. By the age of 25 years, 75% of those who will have a mental health disorder have had their first onset.⁷ Studies suggest an increase in frequency and severity of mental problems and help-seeking behaviors in university students in the last decade.⁸ These trends suggest an emerging “mental health crisis” in higher education.⁹ For a young person with symptoms of a mental disorder, the earlier treatment is started, the more effective it can be. Early treatment can help prevent more severe, lasting problems.¹⁰

Delays in care and unmet needs are closely linked to student engagement, persistence, and academic performance. In one national survey, 64% of college students who dropped out of college cited unmet mental health needs as a reason for closing the books.¹¹

Expanding Access Through Telepsychiatry

Colleges and universities across the country face persistent challenges in recruiting and retaining mental health providers, particularly in rural areas, leading to care disparities. Even where services exist, demand often exceeds available capacity, resulting in long wait times and limited access to specialty care.

Telepsychiatry and other health technologies can extend clinical capacity and enhance access to improve health equity. A partnership among the Blue Cross and Blue Shield of North Carolina Foundation, several universities in the University of North Carolina System, and the East Carolina University Center for Telepsychiatry and e-Behavioral Health led the North Carolina Statewide Telepsychiatry Program (NC-STeP), which is working to expand access to mental health services for students. Key principles of the NC-STeP model include¹²:

• Treatment where patients feel comfortable receiving care
• Patient-centered collaboration
• Team- and evidence-based care
• The primary care provider remains the driver
• Measurement-based treatment, assessment, and monitoring

Through this model, NC-STeP clinicians collaborate with campus student health centers’ teams to provide hybrid virtual psychiatric care. Students can receive services in familiar campus settings while benefiting from a broader network of providers. By augmenting local resources, telepsychiatry helps reduce wait times and increases the likelihood that students receive timely evaluation and treatment.

Rather than operating as a standalone service, telepsychiatry is embedded within campus workflows, supporting coordination between on-site clinicians and remote specialists. This integration promotes continuity of care, particularly for students with more complex needs. There is also less stigma, better coordination with medical care, and more efficiency.

A Collaborative Path Forward

Early implementation demonstrates the model’s scalability. NC-STeP has expanded services to Elizabeth City State University (ECSU) and, more recently, UNC Pembroke. Notably, both universities serve students in rural areas, reflecting the model’s future potential for extending access to students across diverse and often underserved regions. Robeson County, home to UNC Pembroke, is a designated Health Professional Shortage Area, with one of the lowest psychiatrist-to-population ratios in the state.

Since launching at ECSU, the program has led to more than 3100 practitioner visits. Many received referrals for more intensive follow-up care. All students visiting the student health center are screened for depression and anxiety regardless of the nature of their visit. For those who have received follow-up mental health services, results show a reduction in both depression and anxiety: 68% reported improvement in anxiety, 63% reported improvement in depression, and, as a whole, students expressed near-top satisfaction in understanding, trust, and service quality.

Collaborative, technology-enabled integrated models such as this represent an important step toward strengthening systems of care. By integrating telepsychiatry into campus settings and leveraging statewide clinical expertise, these partnerships can help close access gaps, provide timely access, and improve outcomes for students who might otherwise go without care.

As a cross-sector collaboration among health organizations, academic institutions, and clinical programs, NC-STeP serves as a blueprint for scaling effective, locally adapted solutions that meet the unique needs of rural and underserved communities.

These investments are not only about expanding access—they are about shaping long-term health and affordability. By partnering with universities to support student success, particularly through behavioral health services, insurers can help reduce future morbidity, improve life-course health trajectories, and ease downstream pressure on the health care system.

Brian Brooks is vice president of behavioral health at Blue Cross and Blue Shield of North Carolina.

Sy Atezaz Saeed, MD, MS, FACPsych, is founder and executive director of NC‑STeP and founding director of the East Carolina University Center for Telepsychiatry and e‑Behavioral Health. He is a professor and chair emeritus of the Department of Psychiatry and Behavioral Medicine.

References

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