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

There is a strong interest on campuses in expanding peer support as a mental health resource for students. But more research is needed to define guidelines for the programs — in light of concerns about accountability, learning, and risks for students who lead the effort.

That’s according to a new report from the Mary Christie Institute, a think tank focused on college 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. Based on case studies, expert interviews, a literature review, and a survey of counseling center directors, the report 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 tabling (setting up mental health information boards); confidential sessions with a trained peer counselor; peer coaching; peer-staffed mental health hotlines; and anonymous peer-to-peer online communities such as those offered by TimelyMD and Togetherall.

The report follows a survey conducted this year by the institute, which found that one in five college students 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 results from a July 2022 survey of college counseling directors about their views on peer support models. The survey was distributed to members of the Association of College and University Counseling Directors, and although the response rate was low, 95 percent of the 57 respondents expressed an interest in some form of peer support.

But there were significant differences in the interests of counseling directors among different types of support programs. Campus officials indicated that they were most interested in and most likely to support peer-to-peer programs, which they believed were easiest to implement. There was also strong interest in peer listening programs, short-term mental health training and support groups.

There was a lower level of interest — 30 percent — in peer counseling, which was defined as “confidential counseling by trained peers” that helps students navigate 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 Counseling Directors Group, was among the experts interviewed for the report. Hotaling told Chronicle that he is concerned about peer support models that more closely resemble traditional counseling, particularly regarding the supervision, instruction, and support of students who lead classes.

“I’m much more comfortable sitting at a desk or doing a mindfulness meditation group than a student sitting and consulting,” he said. “Not only are there potential ethical issues, but students are already under a lot of stress.”

But Hotaling believes that with proper training and supervision, such programs can be done well. As an example, he cited the University at Albany’s decades-old Middle Earth Peer Assistance Program, which includes a hotline, peer mentoring and wellness workshops. The program on the State University of New York campus is student-centered but professionally supervised.

Zoe Raguzeas, chief clinical officer of the Mary Christie Institute and an author of the report, said she emphasizes the need for standardized protocols and training for peer support efforts. Raguzeas is also the executive director of NYU’s Counseling and Wellness Services.

She hopes the report will contribute to research on the effectiveness of different forms of peer support and what types of programs are best suited to specific student challenges.

While peer support cannot replace professional counselling, the report concludes, it should be seen as a valuable part of a public health approach to student wellbeing. 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 therapy. 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 really working for,” Raguzeas said.