The Impact of Representation in Mental Health Care for College Students

Colleges and universities are more diverse than ever. Forty-five percent of undergraduate students identify as people of color. And yet, healthcare disparities continue to exist. When students can’t find healthcare providers who resemble them, their beliefs, and their culture, the lack of diversity can keep them from getting the care they need.

Research shows that we trust people most like ourselves. Therefore, a diverse network of healthcare providers can reach a broader student demographic. Simply put, students feel more comfortable interacting with healthcare providers who have a similar background or identity (e.g., race, ethnicity, gender, and/or geography).

How lack of representation impacts student populations

Despite increasing rates of college admissions and enrollment among Black, Asian, Hispanic, and other ethnic groups, they’re still less likely to graduate. Students of color experience low rates of retention and high dropout rates. They also have the highest borrowing ratios and the most significant student debt burden. And among those who graduate, they have lower salaries and higher unemployment rates than their white counterparts.

Clay Center for Young Healthy Minds reports that “students of color are more likely to experience racism, discrimination, Islamophobia, cyberbullying, verbal and physical assaults, and micro-aggressions on campuses and within their college towns and communities—all of which can damage their mental health. These experiences can also lead to alienation, isolation, substance use, suicidal ideation, and loneliness, further compounding the negative impact on mental health.” The Clay Center goes on to report that compared with white students, college students of color report higher rates of loneliness and emotional stress, anxiety, depression, and hopelessness.

While mental illness is similar across all racial groups, a systematic review by a Boston University School of Public Health researcher, published in the Journal of Adolescent Health, found that students of color are less likely to be diagnosed and less likely to seek treatment. Barriers to treatment for young adults can be due to mental health stigma, lack of awareness of mental health services, and distrust of mental health professionals who lack cultural competence.

In contrast, the impact of mental health support for underrepresented students is overwhelmingly positive, according to Gallup and the Lumina Foundation’s report “Balancing Act: The Tradeoffs and Challenges Facing Black Students in Higher Education.” The report noted that 37% of Black bachelor’s students surveyed said that support from a school counselor or mental health professional was very important in being able to remain enrolled in their program. This is in comparison to 28% of all other students surveyed.

Discrimination is a major cause of mental health concerns in college as well. While already dealing with the challenges most college students experience—transitioning to a more independent life, managing classes, social pressures, and more—underrepresented students have to contend with biases from their peers, professors, and administrators. Also, Black, Indigenous, and people of color (BIPOC) college students are often victims of imposter syndrome, meaning they feel they aren’t supposed to be a part of the college community. All of this can lead to various mental health problems.

Barriers to care and support resources for underrepresented college students

There are a variety of barriers that underrepresented students face while in school, ranging from family and cultural barriers to lack of income or school resources, including these common treatment barriers:

• Being a first-generation student: Students who are the first in their families to attend college are less likely to live on campus than students who aren’t in this category. BIPOC learners are more likely to be first-generation than white students. This means mental health resources on campus are less accessible when students commute to campus and don’t have extra time to seek campus resources.
• Lack of health insurance: BIPOC, immigrants, and English language learners disproportionately lack health insurance, particularly in states where Medicaid hasn’t been expanded.
• Low-income backgrounds: Many underrepresented university students come from low-income backgrounds and often work while attending college, resulting in having to choose between work and medical or mental health visits.
• Professors and faculty who don’t understand their needs
• Religious and cultural taboos
• Issues with mental health services providers
  • Conscious and unconscious biases
  • Minimal training in culturally-responsive treatment: There are only a few providers from underrepresented backgrounds or who speak languages other than English. There are even fewer practitioners who identify as both BIPOC and LGBTQ+.
  • White physicians are less likely to recognize the severity of mental health issues in BIPOC students
• School mental health services: Non-white students are less likely to obtain mental health services within their schools before college.

Many organizations and colleges have developed programs to focus on college student mental health outcomes for students of color. These organizations include:

• Crisis Text Line: Nationwide crisis counselor support via text
• Kognito: Educating students and faculty about mental health and suicide prevention
• 7 Cups: Direct emotional support to students
• Young Black (YB) Men: Social media-based education for African American college students, a program to support young Black students
• Native American Cultural Center: Supporting the Native American student community

Mental health is one of the strongest predictors of students’ persistence and retention. So, initiatives like the ones above can help students prioritize their mental health and get the assistance they need—ultimately helping them graduate prepared for work, improving their social and economic standing, and empowering them to contribute to society.