A New Normal for Mental Health

At the University of the Incarnate Word in San Antonio, international students from Ukraine had to contend with an additional intercultural stressor on top of the conflict at home—chisme.

Spanish slang for “gossip,” chisme meant that well-intentioned peers were asking the Ukrainian students about developments in their home country in chatty, conversational ways.

“A lot of people are trying to show support, and sometimes they’re bringing up things they can’t help but think about,” says Sheena Connell, assistant director of international student and scholar services (ISSS) at the school.

In response, the ISSS office at Incarnate Word, a faith-based institution, distributed a two-page fact sheet highlighting how other students, faculty, and staff at the university could support international students from countries in conflict.

“The stressors haven’t changed—if anything they’ve increased."—Anastasia Fynn

“Students whose families are in an unsafe place are always thinking of them and do not need a reminder,” it states. “Instead, you can ask ‘How are you doing today’ or ‘We’re praying for your family’s safety’… it is respectful to wait until they feel ready to share and avoid asking them to relive the trauma they may be going through.”

Incarnate Word’s response to the struggles of its Ukrainian students highlights the fact that while the global shutdown caused by the COVID-19 pandemic centered the need to support students’ mental health and wellness, that need has remained high as mobility has resumed. Global conflicts, the ongoing impact of COVID-19, and perennial financial and immigration challenges have all intensified the difficulties many students face.

“The stressors haven’t changed—if anything they’ve increased,” says Anastasia Fynn, director of international student and scholar services at the University of Utah.

But there’s an upside: the massive shift to virtual platforms during the pandemic has helped chip away at longstanding cultural resistance and stigma to seeking help for mental health issues.

“There’s now room for virtual engagement for students seeking assistance,” Fynn says. “That has really changed the dynamic—especially for international students. The stigma still exists, but it isn’t as intense as when the only avenue was to physically go to the counseling center.”

International offices and their on- and off-campus partners have refined existing strategies by “continuing to add to their tool kits… and working closely with mental health and wellness professionals and other key stakeholders,” says Barbara Lindeman, director of international health, safety, and security at the University of Missouri. As staff members have become more knowledgeable about students' mental health struggles they have been able to more easily connect and work with them.

“We have better language on how to talk about it,” says Connell. “And the conversation starts earlier because it’s been more normalized.”

A New Normal, with Continuing Challenges

Mental wellness has long been a concern for international educators. Anonymous questionnaires from 686 U.S. study abroad students—mostly during the 2018–19 academic year—included reports of generalized and more severe anxiety, panic attacks, depression, bipolar disorder, and posttraumatic stress disorder, according to research by the Centers for Disease Control and Prevention presented during a session at the NAFSA 2023 Annual Conference & Expo.

Complicating matters, stressors on students that emerged during the pandemic have not yet abated. For example, in 2022 91 percent of students indicated that at least one area of their lives had been negatively affected by the pandemic, and nearly 69 percent indicated that their mental health had been affected, according to the Center for Collegiate Mental Health 2022 Annual Report.

“Some of the primary issues I’m seeing are an increase in anxiety, particularly social anxiety, as well as feelings of disconnection and difficulty with developing relationships,” says Scott Sokoloski, director of counseling and psychological services at Saint Joseph’s University in Philadelphia. “When you consider the additional factor of traveling to another country, this anxiety can be intensified, as students are away from the people, places, and things that help them to cope and feel grounded.”

International educators have seen these issues in turn impact program trends. For example, study abroad students appear more focused on traditional destinations such as Western Europe.

“Students seem less likely to take the road less traveled right now,” says Andrea Campbell Drake, director of international health, safety, and security and deputy Title IX coordinator at the University of Massachusetts-Amherst (UMass-Amherst). “Even though COVID doesn’t rule our lives and impact international travel as it once did, the lingering impact of such a large-scale event remains.”

Connell says she’s seen another anecdotal sign of lingering pandemic-related mental health issues: there’s been growth in the number of international students with emotional support animals on campus—a trend also seen in domestic students, she adds.

“Students seem less likely to take the road less traveled right now."—Andrea Campbell Drake

The stigma around mental health, however, has receded for all students. “My sense is that students are more likely to disclose mental health concerns since the pandemic. They are more willing to seek help, and [they are] more receptive to conversations around emotional well-being,” Drake says. “We were already on this trajectory with younger generations, but the pandemic expedited the process.”

Refining Strategies for Support

Many international offices and higher education institutions have focused on developing a tiered or stepped care approach that includes a broad range of interventions, ranging from social events and high-touch contacts to formal crisis response plans.

Some of these approaches include enlisting the broader campus community in ways that support all students. Some, for example, have developed “blue folders” that highlight potential warning signs, resources for support, and reporting procedures for students in crisis. Importantly, these documents are available to the public and prominently posted on campus websites, at times with language for specific stakeholders.

“The concept is the wider and finer the net, the smaller the holes will be."—Sheena Connell

”Having the tools to identify, address, and refer students appropriately is important as you interact with them,” states Columbia University’s blue folder for faculty and staff.

“The concept is the wider and finer the net, the smaller the holes will be,” says Connell. Drake agrees. “It starts with a university culture that supports student well-being, so students are getting the same support and encouragement from many different directions,” she says.

One key to casting a broader net is identifying gaps and new ways to support students. “Starting small and meeting student needs is always way better than reacting and coming up with plans to support students in crisis,” Fynn says.

Among possible avenues to consider:

Begin during orientation (or earlier).

Many international offices invite campus partners, including counselors, to introduce themselves during orientation. One recent shift, says Fynn, is emphasizing the availability of virtual counseling opportunities and other wellness programming.

Along with awareness, orientations and other predeparture or arrival activities can reinforce students’ sense of purpose and belonging. An institution with a strong expectation of community service, Incarnate Word focuses on helping students identify their gifts early on, as well as how they plan to contribute to their new community. “It’s a conversation that [reinforces] that you are important, cared for, and listened to,” Connell says.

In similar fashion, mental health has become a key part of predeparture orientations for study abroad students. “Each semester, we add more information about mental health, and we especially try to give students real-world examples,” Drake says. In particular, staff focus on highlighting in-country resources and the availability of online mental health counseling services from providers, insurance companies, and students’ home institutions, according to Lindeman.

Provide proactive resources—and publicize them.

Many institutions have developed “blue folders” that highlight potential mental health warning signs, resources for support, and reporting procedures for students in crisis. Importantly, these documents are available to the public and are prominently posted on campus websites, at times with language for specific stakeholders.

“Having the tools to identify, address, and refer students appropriately is important as you interact with them,” states Columbia University’s blue folder for faculty and staff.

Identify potential challenges.

There are many ways to help students be proactive when it comes to their mental health. For example, institutions can encourage students to consider health concerns—physical and mental—when choosing programs. Advisers, partner institutions, and providers often follow this approach for study abroad.

International offices can also encourage students to self-disclose physical and mental health issues, although they must develop responses that respect student privacy. At UMass-Amherst, for example, study abroad students complete a health evaluation form, which is sent without identifying information to the university’s health and counseling services departments. Students with significant challenges are flagged for follow-ups and “encouraged to create a health action plan with their providers,” Drake says.

At the University of Missouri, the international office sends a list of all students planning to study abroad to the university’s counseling center so staff there can “talk with any students who they may [already] be seeing about how best to manage their mental health abroad,” Lindeman says.

International offices can also encourage students to self-disclose physical and mental health issues, although they must develop responses that respect student privacy.

It’s also important to monitor wellness trends across all international or study abroad students, such as with anonymous surveys, focus groups, or feedback from peers and staff. At Incarnate Word, for example, 10 student assistants are “our temperature takers,” Connell says.

Collaborate with other departments—and beyond the institution.

While international offices have long worked closely with counseling departments, some are creating more structured systems for collaboration. “Increased collaboration and open discussion between departments is key and is one of the areas that I have seen change in the past few years,” Sokoloski says.

At the University of Utah, a dedicated counselor is assigned to the ISSS office to track trends, define needs, and identify gaps in services. “They may not work individually with all international students, but they lead the charge,” Fynn says.

Cross-institution care and crisis response teams are also evolving. While these teams are often reactive—responding when students reach out or are in crisis—they can also consider how to provide proactive care through the various offices represented on the team. Other departments besides international offices can also provide early warnings when international students are struggling. For example, the University of Utah’s basic needs office alerts ISSS staff when students are struggling financially.

"Increased collaboration and open discussion between departments is key."—Scott Sokoloski

Having close relationships with counseling services and other departments is also critical to ensure an international perspective is provided during crises—such as if a psychiatric hold is requested. It can also help at times when the international office must deliver bad news, such as terminating a student’s immigration status.

Study abroad partners and receiving institutions should be carefully vetted on a regular basis for the support they provide. According to Drake, it’s also important to set expectations that these partners alert offices of significant issues, within the constraints of privacy laws, which is an issue with all collaborative efforts.

One thing to keep in mind, Sokoloski says, is that collaboration may appear “one-sided” due to privacy issues. “We have limits to what we can say,” he says. “We talk with our partners in advance about the importance of confidentiality, but I recognize that this can be a source of frustration.”

Resources can also be found beyond the institution and its immediate partners. For example, San Antonio’s Charter for Compassion includes 80 regional organizations, including city police, and provides training that supports students and staff.

Create programming that emphasizes wellness and connection.

Cross-departmental collaboration can infuse mental wellness into different types of programming. At the University of Utah, the ISSS office and the counseling center collaborated to create a “global beverages hour” during which international students share coffee, tea, and snacks from around the world. The monthly gatherings are focused on themes like mental wellness, and counselors are available to talk with students. “Not tagging these as ‘mental health workshops’ helps,” Fynn says.

International offices should plan events around times when students are likely to be anxious—such as midterms, holidays during which they are accustomed to being with family, or financial deadlines. Programming need not focus specifically on wellness but can provide opportunities to discuss the challenges of these stressful times.

“Having students leading the charge drives more traffic, and students are more likely to attend."—Anastasia Fynn

It’s also helpful to have students lead events. At UMass-Amherst, former study abroad students serve as peer advisers and participate in predeparture orientations and other events. “Having students leading the charge drives more traffic, and students are more likely to attend,” Fynn agrees.

Remote spaces for events are also now nonnegotiable. For example, the University of Utah offers informal virtual “chai and chat” sessions that provide opportunities for group discussions of “anything that is confusing, difficult, challenging, or amusing,” according to a counseling center web page.

Consider internal changes.

As part of the restructuring of its ISSS office, the University of Utah plans to hire a case manager who will coordinate with the campus counseling center and “create spaces for students to be felt and heard and develop programming to help meet student needs,” Fynn says.

Even in the absence of dedicated counselor roles, open conversations with students are critical for all staff, says Sokoloski. “That doesn’t mean they should play the role of a therapist, but instead helping to identify areas of concern and making referrals to campus resources to work on them prior to their departure and as far in advance as possible,” he says.

At the University of Missouri, for example, those conversations involve asking “students to think through the strategies they currently use to manage stress, to anticipate mental health challenges they may face abroad, and to develop accessible self-care strategies before they go abroad,” says Lindeman. “In conjunction with this, we discuss the importance of having realistic expectations and being flexible.”

Don’t forget staff.

International educators face many of the same challenges as the students they serve—and can serve as models for them, according to Drake. “One thing I’ve noticed in the field is more of a tendency for international educators themselves to be transparent about their own mental health issues,” she says. “My colleagues and I try to emphasize our own experiences with mental health concerns… Everyone has ‘mental health,’ so if we approach it like physical health and therefore normalize the need to seek care or help, I think we could have a profound impact on our larger communities.”

Building a Culture of Support

In most cases, mental health challenges should not preclude participation in international experiences. “We emphasize that we have had many students go abroad who have self-disclosed significant mental health concerns, and the vast majority of them have great experiences,” Drake says. “Mental health concerns should rarely be considered a barrier to study abroad but instead just another part of the planning process.”

Institutionwide efforts to build a culture of support can support international students when their department participates, according to Sokoloski. “Everyone can and should be involved with and support these efforts,” he says. “How that culture of support is created depends on multiple factors which are specific to your university and community, but if we each accept that we have a role, however small, we can make a significant difference in the lives of students.”

“Mental health concerns should rarely be considered a barrier to study abroad but instead just another part of the planning process.”—Andrea Campbell Drake

And remember that addressing mental wellness, like international experiences themselves, can help students across their entire lives. “The more we can do to help set students up for the life skills of self-advocacy and resiliency, the better equipped they will be to handle challenges that arise,” Drake says.  •