After the COVID-19 pandemic, tertiary students globally have continued to struggle with their mental health at alarming rates. Institutions struggle to respond adequately as the demand for professional counseling services continues to increase. Singapore’s higher education sector offers a number of insights, including innovative preventative approaches, an openness to piloting promising new technology, and the involvement of multiple institutional stakeholders.

Much has been written about mental health challenges plaguing higher education around the world. With high rates of anxiety and depression among students, administrators struggle to provide sufficient psychological services at a time when many institutions are facing budget constraints. Gone are the days of a pervasive stigma inhibiting students from seeking professional help, though studies indicate that some vulnerable groups are less likely to access resources. Demand for counseling at most institutions far outweighs supply.

The causes, percentages, and diagnoses likely vary somewhat between countries, but most administrators would put student mental health high on their list of concerns. Likewise, you would be hard-pressed to find an institution that is not struggling to respond adequately. The consequences of inadequate mental health support are dire for students and institutions, including higher rates of academic struggle and attrition.

Singapore is a good example of a country where mental health is receiving national attention, particularly in the higher education sector. A 2022 study using data at the height of COVID-19 restrictions revealed that three out of four students at Singapore’s flagship institution, the National University of Singapore (NUS), were at risk of depression, and over 83 percent cited high levels of stress. Recognizing that hiring additional mental health professionals is both cost prohibitive and only part of the solution, institutions in Singapore are implementing holistic approaches to addressing mental health.

Engaging Multiple Stakeholders

Sharing the responsibility for mental health support across an institution can reduce the burden on a university counseling center. Yale-NUS College, a residential liberal arts institution jointly established by Yale University and the National University of Singapore, utilizes trained student affairs staff and academic advisors to triage and manage lower-level mental health issues including mild forms of academic stress and social anxiety. Staff complete in-house training organized by counseling colleagues and some extend their education through external programs such as Mental Health First Aid.

In 2021, as an increasing number of teaching faculty encountered mental health struggles among their students, Yale-NUS introduced “gatekeeper training” that covered how to recognize signs of emotional distress, taught empathic and active listening skills, and explained the various resources available to students. Faculty and teaching assistants are often the first to recognize student mental health issues, since they engage with students regularly in the classroom, at advising appointments, and during office hours. Administrators should ensure faculty have access to and utilize an internal referral system that alerts the appropriate staff when professional follow-up is necessary.

NUS understood the importance of involving multiple stakeholders when they created the WellNUS© Mental Health Framework in 2021 to systematically map out the different aspects of well-being and identify the relevant initiatives and key stakeholders to provide support. The aim of the framework is to have a more holistic, structured, and sustainable approach towards student and staff well-being.

Proactive and Preventative

In 2021, Yale-NUS introduced a for-credit “Resilience and Success in College” elective course for first-year students in order to equip them with strategies to respond to the inevitable challenges and adversity that they will face during college. Example topics include finding purpose, utilizing strengths, practicing vulnerability, and developing positive interpersonal relationships. The course was later adapted for graduating seniors to help support them through the often stressful phase of transitioning out of college.

The six-week course was a collaborative effort between the student affairs division and psychology faculty with seminar-style classroom discussions and assignments that emphasized personal reflection and application. Students who completed the six-week course reported that they were better equipped to navigate future issues and understand what support resources are available to them.

Organizational Structure

In the United Kingdom, institutions are encouraged to focus on employee well-being through the University Mental Health Charter and the Education Staff Wellbeing Charter. The premise is that staff and student well-being are inextricably linked and supportive of the other. As such, a whole-university approach was called upon to better address mental health risks. Naturally, this requires a review of the organizational structure that cares for both student and staff populations. NUS has taken a similar path by devoting significant resources to staff well-being, including a dedicated in-house counseling team for university employees. Additionally, students and staff are recruited and trained to serve as “peer supporters” to provide basic emotional support and coping techniques to fellow students and colleagues in need.

NUS and another large Singaporean university, Nanyang Technology University, created well-being offices reporting directly to the university’s president and provost respectively, signalling a high-level commitment to address mental health risks. Both staff and student populations receive mental health support and experience the strategic program campaigns in a coordinated fashion from central wellness offices. This approach is different from the organizational structure in the United Kingdom and the United States, where mental health support is offered separately by human resources (often through an external insurance company) for staff and by the student affairs departments for students.

At NUS, the consolidation of staff and student mental well-being strategies and approaches has helped to drive consistent mental health campaign messages and resource awareness across the entire university community. In terms of impact, the NUS #AreuOK campaigns in 2021 and 2022 have reduced help-seeking stigma, increased awareness of mental health resources, and increased mental health service utilization among staff and students.

Innovations in Mental Health Services

Since the COVID-19 pandemic resulted in an increased demand for mental health services, overwhelming the existing counseling capacity in many universities, institutions should carefully consider promising new technology. For instance, AI-enabled chatbots and other types of online applications have gained traction in recent years, with thousands of mental health-related self-help apps in the marketplace. Evidence of effectiveness is nascent, though some promising studies have been published examining specific technology platforms. As innovative solutions are deployed, they should be viewed as a complement to existing well-established mental health solutions.

Other technology-based approaches are in the early phases. For example, digital phenotyping refers to passively tracking and actively requesting data through smart devices to assess and predict mental health risk. For example, students could opt-in to receive wellness-related questions via text messages providing mental health professionals with timely information predicting when students are at risk. An institution can then respond with appropriate interventions to prevent further mental health deterioration.

Taking this concept further, universities may be able to quantify student well-being based on measurements through digital devices such as sleep quantity or digital footprints (e.g., how orderly one navigates the learning management system). In turn, this would allow administrators to predict students’ mental health trajectories. This technology is still in its infancy but shows promise.

One obvious challenge is the invasive nature of personal data collection required for such approaches and all the related privacy concerns. Nevertheless, in forward-thinking Singapore, innovations like this are being evaluated as possible additional components of a holistic approach to mental health support at NUS and other local universities.

As the global mental health crisis in higher education persists, university counseling services will continue to face an insatiable demand. Singapore’s holistic and proactive approach of creating varied pathways to wellness and viewing mental health support as a collective responsibility across an entire institution provides a promising framework that can be applied elsewhere.

Dave Stanfield is vice president for student affairs and dean of students at Sarah Lawrence College, New York, United States, and former (2019–2023) vice president and dean of students at Yale-NUS College in Singapore. E-mail: [email protected].

Andrew Tay is director of health & well-being at the National University of Singapore. E-mail: [email protected].