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More students are turning to their peers to talk about serious mental health issues.

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One in five undergraduates uses peer counseling for mental health support, according to a new survey of more than 2,000 U.S. college students. Two-thirds say they have faced a mental health challenge in the past year.

The survey, “Peer Counseling in College Mental Health,” was conducted by the Mary Christie Institute and Born This Way Foundation, two organizations that focus on the mental health of young people. Zoe Ragouzeos, president of the Mary Christie Institute and executive director of counseling and wellness services at New York University, blames the COVID-19 pandemic for increasing student stress, isolation and rustiness in building social connections.

“I had a colleague recently say they forgot how to be students,” Ragouzeos said. “Some of that is to do with the fact that students have been away from campuses for so long. And then anybody with a clinical diagnosis saw an exacerbation of their symptoms during COVID. So if you had an anxiety disorder, it got worse. If you were depressed, it got worse.”

Among students who have not used peer counseling, 62 percent say they would be interested in doing so—a higher share than before the COVID-19 pandemic began, the survey notes. Fifty percent of student respondents have heard of peer counseling, and 40 percent said peer counseling is available at their institution.

Nearly half of all students reported that disruptions caused by the pandemic make them more likely to seek out peer counseling, including 20 percent who say they are “much more likely.” That number was even higher for certain demographic groups—58 percent of Black students, 54 percent of Latinx students, 61 percent of transgender students and 54 percent of first-generation college students said they were likely to seek out peer counseling.

Students expressed a willingness to talk to their peers about a variety of issues, too; 55 percent said they would discuss stress with a peer counselor, 48 percent said anxiety, 43 percent said depression and 35 percent said loneliness.

Institutions should consider using peer counseling to expand their available counseling services, Ragouzeos said, which could minimize the wait times for students to get help.

Erica Riba, director of higher education and student engagement at the Jed Foundation, a nonprofit that works to prevent suicide among teenagers and young adults, said peer counseling is a useful complement to already existing campus mental health services. Since psychotherapy can be daunting for some students, peer counseling gives them the option to meet with classmates who might better understand their specific challenges, whether they revolve around adjustment issues, relationships, loneliness, managing stress or academic concerns.

However, Riba said peer counseling’s success at any given institution often depends on the capacity of the campus counseling center.

“If a counseling center has one counselor for the entire campus community, developing a peer counseling program can be labor-intensive, especially if one staff member is overseeing clinical service and outreach, along with other administrative responsibilities,” Riba said. “If institutions decide to go this route, it is important to be strategic.”

Ragouzeos noted that peer counseling looks different on every campus. Some peer counseling groups are affiliated with a campus counseling center, while others are independent and more informal, such as group chats that connect peers. She recommends that peer counseling programs be linked to the campus counseling services whenever possible and, at the very least, that peer counselors be trained by professionals.

According to the survey, 16 percent of peer counselors say they are unaware of the emergency protocol to follow if they become worried about a student’s safety—a statistic that concerns Ragouzeos. That means that in some cases, introducing a peer counseling option for students could actually create more work for licensed counselors, she noted.

“Students should be trained to manage the issues of other people without having there be a negative effect on their own mental health,” Ragouzeos said. “As licensed professionals, we are trained for years in our academic settings and professional settings on how to take care of ourselves as we are taking care of other people. That’s an important element of the work that peer counselors have to be trained on.”

The survey found that 80 percent of peer counselors say they have received at least a fair amount of training, and nearly half said they received a “great deal” of training. Most—54 percent—received training through their campus counseling center, while 29 percent said they received peer counseling training through an outside program or resource, and 16 percent underwent a mix of on-campus and off-campus training.

Riba said the Jed Foundation recommends that institutions develop clear protocols and procedures around supervision—including oversight by licensed mental health professionals—and that peer counselors know how to respond to students who are in distress or at risk. She added that posting guidelines on the counseling center’s website detailing exactly what peer counselors are trained to do will help ensure that both peer counselors and students with mental health needs feel supported.

“There can exist many peer support, peer educator, peer counseling programs in higher ed,” Riba said. “But what Jed wants to be able to recommend is that there’s clear protocols for situations that may be urgent or life-threatening. For example, when sexual assault, suicide or homicide risks show up, what is the student supposed to do? And do they know how to get the support that they need?”

The Jed Foundation offers its own peer workshop, called You Can Help a Friend, to help students learn to recognize and respond to signs of distress in their peers. Riba said students are aware that the pandemic has increased mental health issues, and many have expressed interest in learning more about peer counseling.

According to the “Peer Counseling in College Mental Health” survey, 45 percent of peer counselors said they counsel because “it makes me feel good to help other students,” and 40 percent said that “peer counseling has been helpful to me, and I am paying it forward.”

Riba highlighted the University at Albany’s Middle Earth Peer Assistance program, which is directed by a licensed psychologist. The program offers a hotline, open from 1 p.m. to midnight Monday through Thursday and 24 hours a day on weekends when the university is in session. It also provides peer wellness ambassadors, who conduct presentations and workshops for sororities, fraternities, athletic teams and other campus groups about body image and eating, study skills and test anxiety, time management, and relationship concerns. Peer coaches, who are trained through the Middle Earth Peer Assistance program and must complete multiple semesters of supervised training, can also meet one-on-one with students to discuss mental health concerns and other wellness issues.

Ragouzeos said Brown University has a successful peer counseling network called Project LETS Peer Mental Health Advocates, which consists of trained students with “lived experience of mental illness and disability committed to supporting their fellow students navigate the process of self-advocacy.”

Through weekly meetings, mental health advocates at Brown work with fellow students to accomplish goals set by the student. The mental health advocates also create educational workshops, panels and discussions on different topics, including depression, family issues and eating disorders. Mental health advocates also lead “creative art therapy projects and alternative therapies” such as yoga and meditation, the organization states on its website.

Satisfaction with peer counseling is high, the survey found; nearly 60 percent of students who use the service called it helpful and 82 percent of students who have peer counseling at their institutions say it’s able to serve students of various backgrounds and identities.

Among different demographic groups, 59 percent of transgender students, 42 percent of LGBTQIA+ students, 42 percent of first-generation students and 40 percent of Black students said it is “very important” to find a peer counselor with similar identities or life experiences.

“Particular demographics of students, like Black students or students in the LGBTQ community, might consider peer counseling less stigmatizing,” Ragouzeos said. “And they might be able to connect with a student who holds the salient identities that they also hold in a way that perhaps they don’t see within their professional counseling services on their college campuses.”

Riba said having a peer counselor who understands what a student is going through goes a long way.

“When we have the space for peer-to-peer support, we have someone who’s on the other end, via a phone call or in person, that is hearing the story, hearing a student’s journey and can understand it,” Riba said. “That creates more openness, more connection, more understanding, and then the process of being heard and listened to further helps the relationship between the two peers.”

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