Factors Affecting Mental Health Service Utilization Among California Public College and University Students

Published in: Psychiatric Services, 2016

Posted on RAND.org on April 21, 2016

by Lisa Sontag-Padilla, Michelle W. Woodbridge, Joshua Mendelsohn, Elizabeth J. D'Amico, Karen Chan Osilla, Lisa H. Jaycox, Nicole K. Eberhart, M. Audrey Burnam, Bradley D. Stein

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Research Questions

  1. To what extent do California college students experience serious psychological distress?
  2. What percentage of students experience academic impairment due to mental-health related issues?
  3. At what rate do students utilize mental health services? On-campus? Off-campus?
  4. What factors affect students' use of mental health services?

OBJECTIVE: Unmet need for mental health treatment among college students is a significant public health issue. Despite having access to campus mental health providers and insurance to cover services, many college students do not receive necessary services. This study examined factors influencing college students' use of mental health services. METHODS: Online survey data for 33,943 students and 14,018 staff and faculty at 39 college campuses in California were analyzed by using logistic regressions examining the association between students' use of mental health services and student characteristics, campus environment, and the presence of a formal network of campus mental health clinics. RESULTS: Nineteen percent of students reported current serious psychological distress in the past 30 days, and 11% reported significant mental health–related academic impairment in the past year. Twenty percent reported using mental health services while at their current college, 10% by using campus services and 10% off-campus services. Students on campuses with a formal network of mental health clinics were more likely than students at community colleges to receive mental health services (odds ratio [OR] range=1.68–1.69), particularly campus services (OR=3.47–5.72). Students on campuses that are supportive of mental health issues were more likely to receive mental health services (OR=1.22), particularly on campus (OR=1.65). Students with active (versus low) coping skills were consistently more likely to use mental health services. CONCLUSIONS: Establishing more campus mental health clinics, fostering supportive campus environments, and increasing students' coping skills may reduce unmet need for mental health services among college students.

Key Findings

  • Nearly one-fifth of students reported current serious psychological distress.
  • More than 10 percent of students reported that mental health problems impaired their academics.
  • Twenty percent of students reported using mental health services while attending their current college, with 10 percent using on-campus services and 10 percent using off-campus services.
  • Women, nonheterosexual, and white students were more likely than their peers to use mental health services.
  • Students with active coping skills were among the most likely to use mental health services.
  • Students on campuses with wide support for mental health were over 20 percent more likely to receive mental health services and 60 percent more likely to do so on-campus (as opposed to seeking services off campus).


Colleges and universities should consider the following to improve student access to mental health services: establish working relationships with providers in the community surrounding campus, help students develop strong coping skills to deal with stress, and reach out in a culturally sensitive manner to racial and ethnic minorities to address service use disparities.

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