Mental Health Equity in Higher Education: The Role of Policy, Policing, and Visible Inclusion

Abstract

The mental health of college students has become one of the top concerns in higher education. The number of students reporting psychological distress and seeking services has dramatically increased over the last two decades. Colleges are struggling to address longstanding mental health inequities such as those facing students of color (SOC) and transgender and gender diverse (TGGD) students. An accumulating body of research documents the scope of the problem and potential interventions. However, this literature has been siloed across a variety of academic fields and predominantly focused on individual student risk and protective factors while dedicating minimal attention to institutional opportunities for advancing mental health equity. This dissertation takes a socioecological approach and focuses on community, institutional, and policy-level factors to identify solutions that move beyond “fixing students” to help institutions become mental health promoting, not harming, environments. First, I conduct a multidisciplinary review of higher education interventions and policies shaping student mental health, with attention to multiple levels of influence (Study 1 | Chapter 2). This chapter provides the first comprehensive review of the evidence base pertaining to public health approaches to promote college student mental health, prevent mental health problems, and intervene with students who are already struggling. My scholarship lays crucial groundwork for a more evidence-informed approach to address the growing challenges of student mental health in higher education. Next, I advance research on two arenas of institutional practice—policing and TGGD-inclusive policies—relevant for enhancing mental health equity. Specifically, I use new data that I collected from 5379 students at a large Midwestern institution in partnership with the Healthy Minds Study to examine a) differing perceptions of and experiences with university police across race/ethnicity and gender identity and b) student perspectives on public safety policy-change opportunities to enhance mental health (Study 2 | Chapter 3). I take a novel intersectional approach that moves beyond binary conceptions of gender and considers the experiences of cisgender men, cisgender women, and TGGD students across multiple races/ethnicities. My results provide the first quantitative, representative understanding of student experiences with police at a large, public university. Findings reveal half of students reported encounters with police; with 24% experiencing unfair treatment. Attitudes about police presence were mixed, most students indicated one or more problems with campus police, and support for policy change was widespread. There were significant differences across race and gender. Last, I investigate the relationship between awareness and visibility of school TGGD-inclusion policies, psychosocial outcomes, and psychosocial inequities between TGGD and cisgender students using a survey that I designed and implemented at 28 institutions through the Healthy Minds Study (Study 3 | Chapter 4). This is the first research to examine the impact of higher education policy on psychosocial inequities between TGGD and cisgender students. I advance understanding of a novel and important construct: policy visibility. Multivariable results reveal higher visibility of inclusive nondiscrimination policies, gender inclusive restrooms, and pronoun options is associated with reduced psychosocial inequities for TGGD college students. The dissertation concludes with recommendations for colleges as we emerge from a global pandemic, which has further taxed student mental health. The culmination of the research suggests a more evidence-informed, policy-focused, equity-minded approach is needed to address the growing challenges of student mental health in higher education.