The college mental health crisis is forcing new ways of thinking about student wellbeing. With limited resources, high demand for services, and the continued challenge to reach those who are most at risk, peer-led mental health counseling is becoming wide-spread on campuses across the country.
Defined as “mental health support provided by a trained peer, not a friend,” peer counseling holds wide appeal for students for a number of reasons, including the fact it allows them to speak to someone they can relate to, often in a more immediate and less-stigmatizing way.
Peer-to-peer counseling also taps into a COVID-era sense of altruism among GenZ students, many who have undergone their own trauma and feel compelled to help others. Whether their motivation fills what they believe to be a void left by the inaction of their institutions is one of the many questions surrounding peer counseling. Other more practical concerns include the efficacy of the service and the liability on the college in engaging paraprofessionals in what has been a clinician’s domain.
A new survey from the Mary Christie Institute (MCI) and Born This Way Foundation seeks to shine light on how and why peer mental health counseling is being used on college campuses. The national, online survey of over 2,000 college students shows that peer mental health counseling is common and in demand, with one in five college students around the country saying they have used it. Usage is higher among Black, Transgender, and first-generation students, for whom the relatability factor is even more important. Of the 80% who do not use peer counseling, 62% are interested in doing so.
“We know this generation of students prioritizes their mental health and wants to help create solutions for themselves and their peers,” said Maya Smith, Executive Director of Born This Way Foundation. “Nearly half (45%) of the students who provide peer counseling said they do so to help others, which is a motivation that programs can encourage and support. It’s imperative – as non-profits, academic institutions and youth advocates – that we offer actionable resources to further support students and their mental wellness.”
Peer counseling services can be text-based, in-person or online and involve sessions with trained peers who conduct active listening. There are many different forms of peer support, often referred to as “coaching,” though the MCI/Born This Way survey asked specifically about services used for mental health only, not other issues such as academics or career advice. With 40% of those surveyed reporting it available at their school, peer counseling programs are now options for students who don’t want to wait weeks for an appointment or those who need help but are reluctant to seek it.
In open-ended comments, peer counseling was a familiar and welcome concept to many. A quarter of comments described peer counseling as a source of support and advice through talking with peers in a more structured context (24%). Some students described peer counseling in a group setting where they could share their challenges with fellow students (22%). Other comments focused on the help peer counseling allows them to give and receive (10%). And a handful of respondents specifically mentioned how peer counseling allows them to share with people of similar backgrounds or experiences (9%).
Peer-to-peer counseling also taps into a COVID-era sense of altruism among GenZ students, many who have undergone their own trauma and feel compelled to help others.
Those who have used peer counseling report high satisfaction, with nearly 80% calling it “easily available,” “confidential,” and “free” with an even higher percentage saying it is “able to serve students of various backgrounds and identities.” Interest in peer counseling is higher since COVID-19, with nearly half of students saying the disruption caused by the pandemic made them more likely to seek out peer counseling, including 20% who said it has made them “much more likely.” Notably, two thirds of all students surveyed said they have faced a mental health challenge in the past year.
Annie Harrigan is a senior at Harvard University and was an advisor to the survey. While she has not used peer counseling, Harrigan has many friends who do and understands their motivations. Harrigan spent her junior year as a campus education intern where she ran trainings and workshops for student groups and faculty who want to learn how to better support the LGBTQIA+ community on campus.
Harrigan sought counseling at the university but, as a person with a marginalized identity, she was quickly frustrated by the lack of diversity among the staff.
“I started seeing a clinician on our campus,” she said. “Ideally I wanted somebody who is of color but I didn’t get that. There were very few therapists of color and even fewer Black therapists. All the Black students request them and it’s impossible to get an appointment. So you’re starting out with that sense that, ‘culturally, this isn’t meshing.’”
Cultural sensitivity in clinical situations is Dr. Michael Gerard Mason’s specialty. Mason is an Associate Dean in student affairs at the University of Virginia and a multicultural expert at UVA’s counseling and psychological services center. For eleven years, Dr. Mason has directed Project Rise, a peer counseling project established by Black students for Black students. He also advised on the survey.
“When our peer counseling project started in ’05, our students were saying that the mental health support from the counseling center was not culturally sensitive enough,” he said. “They felt like when they began to seek help from these formalized channels, that something had to be wrong with them rather than the systems around them. And I think this is probably true for most minoritized or marginalized groups. They feel like they have to inappropriately bear the system’s pathology when they come into some of these very Western ways of seeking and receiving help. So for the black students, in particular, they began to figure out ways to become better equipped to be helpful to themselves. This motivation is especially true when they feel like the university isn’t able or willing to help them without making matters worse.”
Amy Gatto is a senior manager at Active Minds, a nonprofit organization supporting mental health awareness and education for young adults. She agrees with Dr. Mason, adding that cultural barriers often keep students who need help from seeking it and believes that peer support could bridge that gap. In an interview for the survey design, Gatto said, “I think peer counseling can be particularly helpful for harder to reach students, like international students, who are often afraid of seeking professional help. I think it really opens the door for students who can at least say ‘Okay, I just need to talk to someone about this.’”
While of particular appeal to certain student groups, the MCI/Born This Way survey showed that interest in peer counseling is high among all students. Of the 80% of students who do not already use the service, 62% said they would be interested in doing so, affirming what college counseling centers believe would be a promising option, if done well.
Dr. Zoe Ragouzeos is the Executive Director of Counseling and Wellness Services at New York University and the President of the Mary Christie Institute. Ragouzeos has a strong student health ambassador program at NYU and has, for many years, run the student-centered “Wellness Exchange,” which features a student-led production called “The Reality Show” that promotes the university’s counseling services, including a 24/7 crisis line. Since COVID, she has become more interested in how students could do more than just spread awareness.
“I am impressed by how involved students want to be in helping their peers with their mental health, particularly in this past year or so with the trauma of the pandemic and the stark racial injustices that were once again exposed. So we start with: ‘You want to help? We are going to help you do that,’” she said. “But there are many things I want to know will be in place with peer-to-peer programs such as adequate training, well understood protocols, and an assurance that those who are helping others are not burdening themselves and negatively affecting their own mental health.”
Like many of her counselor director peers, Ragouzeos said having a connection to the counseling center is important as peer-to-peer services can be used as a “step up” or a “step down” to more traditional therapy provided by the university or in the community.
Amy Gatto agrees, saying why students go to peer counseling is important to understand.
“I think at most schools, there’s a really strong emphasis on the fact that students are not trained mental health professionals and I think at a lot of campuses there’s a relationship between whoever’s providing peer coaching and the counseling services so there can be a warm handoff between the two,” said Gatto. “If you have a student who’s coming into the counseling center for procrastination, they should probably be referred to coaching. Same as if you have a student who’s really struggling with anxiety, they might need coaching, but they probably need some clinical treatment as well.”
The survey revealed that when deciding between seeking help from a peer counselor or a mental health professional, 86% said they consider how serious the problem is, while 85% consider the type of problem they face. This indicates students understand the degrees of severity that might encourage them to seek higher levels of support. But the survey also showed that the issues for which a student may seek peer counseling varied from the “day-to-day” to the more serious. The most common reasons for seeking peer counseling are stress, social life issues, and loneliness, but also include anxiety and depression, which are more serious disorders.
And while the survey findings paint a promising picture of peer counseling generally, they also raised some concerns about mental health training. While peer counseling training is common, it is not universal, with 16% of peer counselors reporting being unaware of an emergency protocol if they become worried for a student’s safety.
“Even a small percentage who are not trained in emergency protocol is too big a number,” said Ragouzeos.
Born This Way Foundation’s Maya Smith said the survey findings provide more support for wide-spread training for all students, citing that 36% of those surveyed said they would turn first to a friend or romantic partner when faced with a serious mental health concern. Born This Way Foundation endorses and promotes several programs, including teen Mental Health First Aid, a national program that teaches high school students what they can do to support their own mental health and help a friend who is struggling. It equips young people with the knowledge and skills they need to care for themselves and to support each other.
“We believe that young people are facing unprecedented challenges related to access, availability, cost, and stigma when it comes to supporting their mental health. It is with and for young people that we work to remove these barriers and increase access to tools and resources that support their mental health and that of their loved ones,” said Smith.
The survey, which asked about both seeking peer counseling and providing it, found that those who provide these services do so out of kindness. Nearly half of peer counselors (45%) said they serve because it makes them feel good to help other students. This was the top reason given, although a personal experience was also a common motivation. Some 40% of peer counselors said peer counseling has been helpful to them, and they are paying it forward. Another 36% said they have experienced mental health issues and know how it feels, thus making them want to be peer counselors themselves.
This is particularly true for Black students – 40% of those surveyed said they were doing so to help other Black students. Students who identify as LGBTQIA+ were not far behind, with 33% wanting to help students of similar backgrounds.
Satisfaction with providing peer counseling was reported to be very high with 92% saying they are satisfied with their experience as a peer counselor, including 61% who are “very satisfied.” Additionally, those who provide these services scored higher than average on the wellbeing scale, which may reassure administrators and clinicians who worry that those who help others may themselves be unwell, or may become so.
Dr. Mason believes that the welfare of the students he trains, as well as their understanding of their own limitations, is an ongoing concern.
“The biggest challenge in this work is balancing the tendency for us to burden our students with the acknowledgement that they are actually our greatest asset,” he said.