The Mental Health Crisis in Higher Education: Insights from Singapore

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GLOBAL ISSUES | iNTERNATiONAL HigHER EDUCATiON

The Mental Health Crisis

in Higher Education:

Insights from Singapore

Dave Stanﬁeld and Andrew Tay

uch has been written about mental health challenges plaguing higher education

around the world. With high rates of anxiety and depression among students, ad-

ministrators struggle to provide sufﬁcient psychological services at a time when many

institutions are facing budget constraints. Gone are the days of a pervasive stigma in-

hibiting 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 re-

spond 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 nation-

al 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 depres-

sion, 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, insti-

tutions 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 in-

stitution jointly established by Yale University and the National University of Singapore,

utilizes trained student affairs staff and academic advisors to triage and manage low-

er-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 strug-

gles 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 stu-

dents regularly in the classroom, at advising appointments, and during ofﬁce hours. Ad-

ministrators 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 cre-

ated the WellNUS© Mental Health Framework in 2021 to systematically map out the dif-

ferent 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

Abstract

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 servic-

es continues to increase. Singa-

pore’s higher education sector

offers a number of insights, in-

cluding innovative preventative

approaches, an openness to pi-

loting promising new technology,

and the involvement of multiple

institutional stakeholders.

In 2021, as an increasing number

of teaching faculty encountered

mental health struggles among

their students, Yale-NUS intro-

duced “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.

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include ﬁnding purpose, utilizing strengths, practicing vulnerability, and developing pos-

itive 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 under-

stand 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, cre-

ated well-being ofﬁces reporting directly to the university’s president and provost re-

spectively, signalling a high-level commitment to address mental health risks. Both

staff and student populations receive mental health support and experience the stra-

tegic 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 de-

partments for students.

At NUS, the consolidation of staff and student mental well-being strategies and ap-

proaches 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 ser-

vices, 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 thou-

sands of mental health-related self-help apps in the marketplace. Evidence of effective-

ness 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 phe-

notyping 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 foot-

prints (e.g., how orderly one navigates the learning management system). In turn, this

would allow administrators to predict students’ mental health trajectories. This tech-

nology 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

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: dstan-

ﬁeld@sarahlawrence.edu.

Andrew Tay is director of health

and well-being at the National

University of Singapore.

E-mail: aet@nus.edu.sg.

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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.

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