The number of young people reporting mental health issues has increased both on and off college campuses. This may be due to improved awareness, improvements in psychopharmacology, or contributing factors related to stress. In 2014, college health centers saw an eight percent increase in students seeking mental health services over the last three school years. Of college students who have been seen in college and university counseling centers, half have been in counseling, one third have taken psychiatric medication, and one in ten have been hospitalized for psychiatric reasons.

For college administrators, supporting their students’ mental health is a critical priority and includes issues related to capacity of mental health services on campus, responding to crises, confidentiality, and student safety. More recently, addressing mental health issues on college campuses has expanded to include safe space and trigger warning policies, which are explicit warnings meant to help students avoid potentially distressing material or situations. There is no evidence to support or refute the effectiveness of trigger warnings, and the application of them varies widely in frequency and degree of utilization.

Anxiety: Anxiety has recently overtaken depression as the leading mental health issue on college campuses. A 2013 American College Health Study found that 51.3% of college students felt overwhelming anxiety at some point in the previous 12 months.

Depression: According to the 2014-2015 ACHA National College Health Assessment, 34.5% of college students felt so depressed it was difficult to function at some point in the past year, and 13.1% of college students have been diagnosed or treated for depression in the past 12 months. 9.6% of respondents to this survey reported both depression and anxiety treatment. A recent study from the Higher Research Institute of UCLA reported that incoming freshmen were more depressed than they had been in 30 years.

Eating Disorders: Eating disorders including anorexia nervosa, bulimia nervosa, and binge eating disorder, by definition are characterized by serious and persistent disturbances in eating and weight control behavior, and are associated with a wide range of negative physical, mental and social outcomes. Eating disorders often coexist with other mental health issues including depression, substance abuse and anxiety disorders. Eating disorders are the mental illness with the highest mortality rate. In addition, mental health issues in the college student population, such as eating disorders, are associated with lower GPA and graduation rates.

Eating issues often begin or are exacerbated during transitional stages, making college students especially vulnerable to developing a disorder. The National Institute of Mental Health estimates that 25% of college students have eating disorders, and according to the Substance Abuse and Mental Health Services Administration (SAMHSA), 95% of individuals with an eating disorders are between the ages of 12 and 25. A 2011 study found that at one college, eating disorders increased from 23 to 32% among females over a 13 year period.

Female student athletes are at particularly high risk for eating disorders. Some sport environments emphasize reducing body weight to enhance athletic performance, which may increase the risk of restrictive dieting, pathogenic weight control behavior, and disordered eating. Women athletes in “lean” sports, for which a low weight provides performance advantage, are at the highest risk for eating disorders. Athletes with eating disorders in these sports may be less likely to be identified, as disorder symptoms are perceived to be normal or desired traits.

Stress: According to a study by the American Psychological Association, young adults in America (ages 18 to 33) are significantly more stressed than other age groups. Chronic stress can result in serious health problems including anxiety, insomnia, high blood pressure, and a weakened immune system. Some research shows that it contributes to the development of depression, obesity, and heart disease. Academic pressure is certainly a leading cause of stress on college campuses. Bigotry relating to race, gender, and sexual orientation likely play a large role in increased stress for young adults both on college campuses, and off.

Suicide: Suicide is a leading cause of death for college students. The annual report of Center for Collegiate Mental Health found that, of college students that have visited the counseling center on their campus, 25% have self-harmed, one third have seriously considered suicide, and 10% have made a suicide attempt. Rates of self-injury and serious suicidal ideation appear to be increasing slowly.

Healthy Eating: Proper nutrition is an important aspect of health and wellbeing, both physical and mental. Healthy eating helps prevent obesity, osteoporosis, iron deficiency, dental cavities, and is associated with lower rates of heart disease, cancer, stroke and diabetes. A healthy breakfast has been proven to be associated with improved cognitive function and memory, and improved mood in children and adolescents.

The 2010 Dietary Guidelines for Americans, released by the U.S. Department of Health and Human Services, recommend a diet that is rich in fruit and vegetables, whole grains, and dairy products (fat-free or low fat), and limiting solid fats, cholesterol, sodium, added sugars and refined grains. Most children and adolescents do not following the recommendations of the Dietary Guidelines; not meeting the minimum recommendations for fruits and vegetables or whole grains, and exceeding the maximum daily intake of sodium. According to the ACHA, only 5.4% of college students surveyed were getting minimum Dietary Guidelines recommendation of 5 or more servings of fruit and vegetables per day.

Sexually Transmitted Diseases: According to the CDC 2014 annual report, Sexually Transmitted Disease Surveillance, rates of all three nationally reported STDs -Chlamydia, Gonorrhea, and Syphilis - are increasing. Since data on additional STDs are not routinely reported, the surveillance report only captures a fraction of the true burden of STDs. The CDC estimates that nearly 20 million new sexually transmitted infections occur every year in the United States. The 1.4 million new cases of chlamydia in 2014 represents the highest number of annual cases of any condition ever reported to the CDC.

Young people aged 15-24 are most severely affected by STDs, acquiring about half of all new infections. Sexually active adolescents and young adults are at higher risk of acquiring STDs due to a combination of behavioral, biological, and cultural factors. Among young people aged 15-24, substantial increases were seen in reported cases of gonorrhea and syphilis in 2014.

This increase in sexually transmitted diseases represent a significant public health challenge. STDs pose a threat to immediate and long-term health and well-being, increasing risk of acquiring and transmitting HIV, and potentially causing severe reproductive health complications, such as infertility and ectopic pregnancy. While young men and women are heavily affected by STDs, women face the most serious long-term health consequences. Each year, an estimated 20,000 women become infertile each year due to undiagnosed STDs cause.

Sleep: College students are one of the most sleep-deprived populations. According to a 2011 study, only 11% of college students in a sample of 191 undergrads had good quality sleep regularly. Sleep is essential for daily functioning, performance, learning and health. Lack of quality sleep can affect physical health by weakening the immune system. Implications for mental health include irritability, depression, confusion, and generally lower life satisfaction. Sleep-deprived students perform significantly worse than students who regularly get quality sleep.

High Risk Drinking: High risk drinking, often called binge drinking, is defined as having five or more drinks in a row. High risk drinking is a serious public health issue with significant social, educational and psychological consequences. It is associated with numerous harmful outcomes, including blackouts, unintentional injuries, alcohol poisoning, unprotected sex that could lead to sexually transmitted diseases or unintended pregnancy, liver disease, neurological damage, alcohol dependence, and accidental death. According to the CDC, in the United States there are an average of 79,000 deaths and 2.3 million years of potential life lost due to excessive alcohol use each year. College students who drink alcohol excessively can experience numerous harmful consequences including missed classes, falling grades and academic failure.

Though high risk drinking has been on the decline (from 44% of students reported binge drinking in 1980 to 35% in 2014), it has remained at a very high level. According to a 2012 CDC report, high risk drinking prevalence and intensity was highest among young adults, ages 18-24 years.In addition, the CDC reports that about 90% of the alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinks.

Underage and high risk drinking have long been issues on college campuses, and continue to trouble college administrators. Administrators have attempted to tackle the high risk drinking problem on various levels: affecting access to alcohol, penalizing drinking offenses, changing the campus culture and social norms around drinking, education on the effects, harm prevention, offering counseling services, and abuse intervention.

Marijuana use: Marijuana use is at its highest rate in 35 years: Daily or near-daily marijuana use was reported by 5.9% of college students in 2014. Increases have also been reported in ecstasy use (past 12-month use more than doubling from 2.2% in 2007 to 5.8% in 2012) and cocaine use (2.7 % in 2013 to 4.4% in 2014). The National Institute on Drug Abuse reports that marijuana use during brain development can cause long-term or permanent changes to the brain, and that regular marijuana users display impairment in brain regions used for memory, learning, and impulse control. Additionally, persistent marijuana use has been found to be associated with a loss of an average of 8 IQ points, with young users affected most strongly.

Policies in the United States have traditionally banned marijuana as a controlled substance, but some states have decriminalized or legalized its use in recent years. Additionally, 23 states have enacted laws to legalize medical marijuana. Research is needed on the effect of these new policies on young adults’ mental health, academic success, and physical wellbeing.

Opioid Use: Opiates, traditionally used as a painkiller, have large potential for abuse, as they are highly addictive. There has been a dramatic increase in the use of prescription opioids for the treatment of chronic pain, but people can become addicted with only one prescription. According to the CDC, every day, 44 people die in the United States from prescription painkiller overdose, and almost 7,000 people are treated in emergency departments for using the drugs in a manner other than directed. Opioid abuse and overdoses have reached epidemic proportions in the United States. A recent survey of 1,200 young adults found that almost 16% report having used pain pills not prescribed to them, while over 37 percent said they would not know where to go for help in the event of an overdose. The survey also found that opioid painkillers are readily accessible, and that young people do not appreciate the lethal nature or addictive power of the drugs. Furthermore, the survey found little difference between young adults on and off college campuses.

The Hazelden-Betty Ford Institute for Recovery Advocacy recommends that college campuses, communities and policymakers focus on education on the dangers of opioids and available resources for help, prudent prescribing of pain medications by student health centers and youth-focused medical professionals, and equipping student health centers to provide screening and intervention services.

Prescription Stimulants: Many college age young adults have engaged in non-medical use of prescription stimulants, or “study drugs”. 9.6% of college students admitting to having used Adderall not prescribed to them at least once in a recent survey. A 2014 SAMHSA report found that first nonmedical use of prescription stimulants or painkillers typically happens at about age 21 to 22. Repeated misuse of prescription stimulants can lead to dependency and addiction, feelings of paranoia and hostility, and psychosis. Other risks include irregular heartbeat, elevated body temperature, cardiovascular failure, and seizures.

Health Providers: Rising costs have resulted in decreased capacity at campus health and counseling centers, leaving many students seeking health care elsewhere. Some colleges and universities are cutting back on providers, services offered or hours at the student health centers with common cutbacks in mental health services. Cost reducing strategies are particularly acute at community colleges, where students typically have higher health risks. Community college students tend to have more severe psychological concerns, coupled with less institutional mental health resources than traditional university students.

College Student Hunger and Homelessness: Homeless and food-insecure college students are a largely invisible population, indistinguishable from other students and often overlooked by policymakers. While it is difficult to know the true number of undergraduates experiencing hunger and homelessness, a new national survey of more than 4,000 students at ten community colleges found that half of all students at these schools are struggling with food and/or housing insecurity. Furthermore, 20% are hungry and 13% are homeless. Data from the Free Application for Federal Student Aid indicate that 58,000 students are homeless, an increase from 47,200 in 2009.

This increase in the number of housing and food insecure students is due, in part, to rising costs in the community college sector, which have increased 28% since 2000. College tuition is rising faster than inflation, medical care costs, or need-based financial aid. Other costs associated with a getting a college degree are also rising – books and supplies, transportation and living expenses. Compounding these problems, many social programs meant to provide relief for low income adults are unavailable to undergraduate students. Undergraduates are only eligible to receive food stamps if they meet certain exceptions. Additionally, they are ineligible for Section 8 housing unless they are veterans, parents, or over age 24. Students are paying more than they can borrow in tuition, and their low-paying jobs cannot cover their expenses.

Financial difficulties affect the effort that can be devoted to schoolwork, and compromise a student’s chances of completing their degree. The majority of students who have left college without a degree cite financial hardship as the key cause for their withdrawal. This issue calls for multi-faceted policy change at the institutional, state and federal level.

Sexual Assault: While statistics vary, multiple studies have found that as many as 1 out of 5 have women on college campuses have experienced sexual assault. The Campus Climate Survey on Sexual Assault and Sexual Misconduct, conducted in the spring of 2015, found that 11.7 percent of students at 27 universities reported experiencing nonconsensual sexual contact by physical force, threats of physical force, or incapacitation since enrolling at their college. Furthermore, the incidence of sexual assault and sexual misconduct due to physical force, threats of physical force, or incapacitation among female undergraduate students was 23.1 percent, with 10.8 percent having experienced nonconsensual penetration. Drugs and alcohol were involved in a significant percentage of the incidents of nonconsensual sexual contact.

Sexual assault has become a major topic on college campuses, and administrations are increasingly concerned with their role in sexual assault prevention, and whether they are equipped to act as a judiciary system. The past year has seen an increase in utilization of the Title IX as a tool to combat campus sexual assaults. Many schools educate their student body on consent practices and bystander intervention. Targeted education campaigns directed at high risk groups have become a popular intervention strategy (e.g. fraternities, athletic teams). Affirmative consent policies are on the rise, requiring a determination by the school that assault was “more likely than not”, and shift the burden of proof to the accused, making him or her guilty until proven innocent. Yes-means-yes policies spell out indications that would indicate a person may be incapable of giving consent.

Gun Violence: According to data from the U.S. Department of Education, there has been an increase in campus shootings over the past five years. In 2013, the latest available data, 23 people died on campus at American colleges and universities due to murder or non-negligent manslaughter. That number was 15 in 2008, and 17 in 2009. In 2011, there was a sharp increase to 45 deaths as a result of the Virginia Tech shooting. Everytown Research, which has counted school shootings since the Sandy Hook massacre, reports that there have been 161 since 2013. The increase in active shooter situations on campus reflects the increase in mass shootings at the societal level.

Nationally, campus law enforcement agencies continue to evaluate their practices and train employees and campus officers how to deal with campus violence. Colleges have increasingly adopted full police departments, requiring campus officers to meet identical standards to any other police officer, and having more officers armed.

At the state level, some legislatures have considered regulations on whether or not to permit guns on college campuses. Some lawmakers argue for a need to allow concealed weapons on campus to further prevent these attacks, while others believe the solution to be tightening restrictions to keep guns off campuses completely. In 2013, at least 19 states introduced legislation to allow concealed carry on campus to some extent, and 14 more states introduced similar legislation. Two bills allowing concealed carry on campus passed in 2013, one in Kansas that allowed general concealed carry, and on in Arkansas that gave faculty permission to carry a concealed weapon. Conversely in 2013, five states introduced legislation to prohibit concealed carry weapons on campus. None of these bills passed. Over the past two years, elected officials in more than 30 states have pushed to enact legislation to allow guns on campus.

There is no credible evidence to suggest that students carrying concealed weapons would reduce campus violence. Furthermore, a 2014 study found a correlation between enactment of loosened firearm restrictions in “right to carry” states and an increase in aggravated assaults. A joint statement by Student Affairs Administrators in Higher Education (NASPA) and five other student groups representing 50,000 student affairs administrators, declared their firm opposition to legislation that would allow or expand the legal possession of firearms on college campuses. Their statement cited survey data indicating that 94% of faculty and 78% of students oppose guns on campus.