Student-led programs are key mental health resources. But more research is needed.

There is strong interest on college campuses to increase peer support as a mental health resource for students. But more research is needed to establish guidelines for the programs — in light of concerns about liability, training and risks for students leading the effort.

That’s according to a new report from the Mary Christie Institute, a think tank focused on student well-being. The report was commissioned by the Institute and the Ruderman Family Foundation.

The report’s authors argue that peer support should be taken seriously as part of a public health approach to student mental health treatment, especially as college counseling centers struggle to meet the demand for services. The report, which is based on case studies, interviews with experts, a literature review and a survey of counseling center directors, calls on the higher education and philanthropic communities to initiate new research on what ideal peer support models should look like.

Peer support can take many forms, including peer education programs such as tabulation (making tables of mental health information); confidential sessions with a trained peer counselor; peer coaching; peer mental health hotlines; and anonymous online peer communities, such as those offered by TimelyMD and Togetherall.

The report follows research carried out this year by the institute which found that one in five students had used some form of peer support in the past year. Nearly 60 percent said it was helpful, and rates of use were higher among black, LGBTQ and first-generation students.

The new report includes findings from a July 2022 survey that asked college counseling directors about their views on peer support models. The survey was distributed to members of the Association of Directors of University and College Counseling Centers, and although the response rate was low, 95 percent of the 57 respondents indicated an interest in some type of peer support.

But there were significant differences in consulting directors’ interest in different types of support programs. Campus staff indicated that they were most interested in and likely to support peer tutoring programs that they considered easiest to implement. There was also strong interest in peer listening programs, short-term mental health coaching and support groups.

There were lower levels of interest — 30 percent — in peer counseling, which was defined as “confidential counseling by a trained peer” that helps students deal with mental and emotional issues, including depression, anxiety and suicidal thoughts.

Marcus Hotaling, director of the counseling center at Union College in New York and president of the Directors of Counseling Group, was among the experts interviewed for the report. Hotaling said The chronicle that he is concerned about peer support models that are more like traditional counseling, especially regarding supervision, training, and support for the students who conduct the sessions.

“I’m much more comfortable sitting at a table or having a mindfulness meditation group than students sitting around doing advice,” he said. “Not only are there potential ethical concerns, but students are already carrying a lot of stress.”

But Hotaling thinks it’s possible, with the right training and supervision, to run such programs well. He pointed to the University at Albany’s decades-old Middle Earth Peer Assistance Program, which includes a hotline, peer training and wellness workshops, as an example. The program at the State University of New York campus is student-led but supervised by professionals.

Zoe Raguseos, chief clinical officer of the Mary Christie Institute and an author of the report, said it underscores the need for standardized protocols and training for peer support efforts. Raguseos is also the executive director of Counseling and Wellness Services at NYU.

She hopes the report will prompt research into the effectiveness of different forms of peer support and which types of programs work best for specific student problems.

Although peer support cannot replace professional counseling, the report concludes that it should be pursued as a valuable part of a public health approach to student well-being. Peer support can help students cope with temporary problems, such as loneliness or homesickness, that are not the result of a mental health diagnosis. In some cases, it can be a bridge to more intensive care. And it can be especially helpful for students from certain identity groups who want to connect with peers they can relate to.

“But again, without data, you don’t know which students it’s actually working for,” Raguseos said.

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