Health Policy Perspectives—Realizing the Potential of Occupational Therapy in Supporting Postsecondary Student Mental Health and Success

What this Article Adds: This column highlights how occupational therapy practitioners can leverage the tenth anniversary of the Okanagan Charter: An International Charter for Health Promoting University and Colleges to advocate for a stronger role for occupational therapy in supporting student mental health in postsecondary settings.

Introduction

Around the world, the mental health of young people is declining (McGorry et al., 2024), constituting a significant and alarming global public health crisis (McGorry et al., 2025). Mental health disorders are “highly prevalent, disabling and often treatable” (Tarasenko et al., 2025, p. 1) with up to 75% starting by age 25 (Kessler et al., 2005) and a median age at onset of 18 years (Solmi et al., 2022). In the United States (Sappenfield et al., 2024) and Europe (World Health Organisation, 2025), around one in five adolescents are living with a mental health condition. Mental illnesses are “the largest and most rapidly growing cause of disability and lost human potential and productivity across the lifespan” (McGorry et al., 2024, p. 731). Responding to these persistently troubling data, in May 2025, the second Lancet Commission on Adolescent Health and Wellbeing (Baird et al., 2025) called for “loud and clear evidence-based advocacy, multisectoral actions, campaigning, and global solidarity” (The Lancet Editorial, 2025, p. 1883). In this column, we respond to this urgent call to action by advocating for a stronger role for occupational therapy in supporting adolescent (10–24 years) (Sawyer et al., 2018) and emerging adult (18–29 years) (Arnett, 2024) mental health in postsecondary settings through the enactment of the Okanagan Charter: An International Charter for Health Promoting University and Colleges (International Conference on Health Promoting Universities & Colleges, 2015).

Postsecondary Educational Settings

The postsecondary population in the United States reached approximately nine million individuals in the academic year 2023/2024 (College Board, 2024). With 80% to 90% of full-time undergraduate students at public 4-year institutions internationally under the age of 25 (College Board, 2024; Higher Education Authority, 2025a; National Center for Education Statistics, 2023), and therefore at a critical stage in life for the potential emergence of mental illness (Kessler et al., 2005; Solmi et al., 2022), it is no surprise that colleges and universities around the world are grappling with how best to respond to what is described as a crisis in student mental health (Bantjes et al., 2023; Hunt, 2026; Keptner et al., 2026). While college counseling centers traditionally play a central role in supporting the academic success of college students with mental health concerns (Center for Collegiate Mental Health, 2024), it is now well-recognized that promoting student mental health and emotional wellbeing on campus “requires more than a well-functioning counseling center” (Leshner, 2021, p. 1305) as “we cannot on its own counsel our way out of this problem” (Wessely, 2024, p. 245). New frameworks need to be adopted to support students’ current and future health during this important life stage (Dahl et al., 2018). Increasingly, tiered or stepped care models are recommended (Bantjes et al., 2023; Brown, 2018; Duffy et al., 2019; Hill et al., 2024; Smith, 2024) in the context of whole institution approaches that recognize the many and varied influences on student life and wellbeing (Wessely, 2024). In other words, “a more nuanced integrative public health approach” (Bantjes et al., 2023, p. 6) is required, one similarly recommended for occupational therapy services (Bazyk et al., 2016; Reitz et al., 2020).

Whole Institution Approaches Promoting Student Wellbeing and Success

The Okanagan Charter: An International Charter for Health Promoting Universities and Colleges was developed as an outcome of the 2015 International Conference on Health Promoting Universities and Colleges which took place in Okanagan, British Columbia, Canada. The tenth anniversary of the Okanagan Charter was celebrated during the Inaugural US Health Promoting Campuses Week in April 2025. The US Health Promoting Campuses Network led the celebrations, seeking to emphasize the importance of health in higher education and “reimagining higher education as a catalyst for human and planetary flourishing—on every campus, everywhere” (US Health Promoting Campuses Network, 2025). As of May 2026, there are more than 330 institutional members of the US Health Promoting Campuses Network, out of 3,722 degree-granting postsecondary institutions (National Center for Education Statistics, 2023). In addition, there is a growing trend among US postsecondary institutions to adopt the Okanagan Charter (Ginter et al., 2024), with 48 institutions now having formally adopted the Okanagan Charter. Institutional adoption of the Charter means mobilizing systemic and whole-campus action to infuse health into “everyday operations, business practices and academic mandates” (International Conference on Health Promoting Universities & Colleges, 2015, p. 2). In Ireland, the Okanagan Charter is enacted through the Higher Education Authority (HEA) Healthy Campus Charter and Framework (HEA, 2021). In June 2025, researchers, policymakers, and academic and professional services staff from around the world gathered in Limerick, Ireland, at the International Health Promoting Campuses Conference to explore strategies for healthier campus environments and communities. Alongside this, a charter renewal consultation took place to evaluate if the Okanagan Charter reflects health promotion goals and priorities in higher education today, resulting in the publication of the Limerick Framework for Action: Advancing the Global Health Promoting Campuses Agenda in December 2025 (International Health Promoting Campuses Network and University of Limerick, 2025). The Limerick Framework “provides a roadmap for collective, setting-based health promotion actions across the entire higher education system, driving systemic change” (p. 4) and presents 10 transformative actions through which higher education institutions can deliver the core calls of the Okanagan Charter. It is recognized that ongoing investment and collaborative leadership are required to deliver on the vision of the Okanagan Charter and achieve the vision of the Limerick Framework (Taylor et al., 2025).

Occupational Therapy in Postsecondary Settings

Ginter et al. (2024, p. 3) assert that “long-term, population-wide personal wellness solutions lie in addressing the broader concept of wellbeing—person, place, and planet, and not just focusing on strategies such as personal nutrition, exercise, and stress management.” In line with the paradigm shift presented in the Okanagan Charter, they advocate for an ecological model of campus health that recognizes upstream and downstream influences on wellbeing. Clearly, occupational therapy practitioners are exceptionally well placed to support higher education institutions in actualizing the vision of the Okanagan Charter and the Limerick Framework and delivering significant benefits for students, institutions, and society. With our professional expertise in supporting individuals, groups, and communities to overcome personal and environmental barriers to participation, we believe that occupational therapy plays a vital yet under-realized role in supporting postsecondary student mental health. The current renewed attention on the Okanagan Charter, alongside the US Occupational Therapy Mental Health Parity Act (Yeager, 2025), presents an ideal opportunity for the profession of occupational therapy to assert its value in postsecondary education and become a central support for postsecondary students, as it has become in primary and secondary education. Currently in the United States, approximately one-third of all occupational therapy practitioners work in public schools or early intervention programs, thanks to legislation including the Individuals with Disabilities in Education Act and the Every Students Succeeds Act (Saffer, 2025). School-based occupational therapy practice is also becoming more established internationally, including in Ireland, where the new National Council for Special Education (NCSE) policy Inclusive Education for an Inclusive Society (NCSE, 2024) commits to ensuring that all schools in the country have access to therapeutic supports, including occupational therapy through the establishment of the Educational Therapy Support Service.

Occupational therapy has a key role in primary and secondary education (Lynch et al., 2023; Pfirman et al., 2023; Saffer, 2024), providing value-for-money services to enable young people to achieve their potential. This mandated presence in primary and secondary schools in the United States and Ireland has allowed occupational therapy services to grow and develop as student population needs evolve, using a multi-tiered public health approach (Bazyk & Thomas, 2025). We believe that occupational therapy should be similarly mandated in postsecondary settings. However, to realize this vision, there is a need for more advocacy regarding the potential contribution of occupational therapy in postsecondary settings, more funding and reimbursement for occupational therapy services, and further research and development of innovative occupational therapy services. In the next section, we share examples of services from the United States and Ireland specifically addressing the growing mental health needs of postsecondary students; highlight advocacy efforts and international collaborations and offer suggestions for how occupational therapy practitioners can work to consolidate and expand this vibrant and necessary emergent practice area through the basic tenets of the Okanagan Charter.

Embedding Health Into All Aspects of Campus Culture—Selected Occupational Therapy Practice Examples

Occupational therapy practitioners are progressing the Okanagan Charter on campuses around the world, developing and delivering developmentally and ecologically sensitive occupation focused interventions (Eichler & Keptner, 2023; Hunt, 2021; Keptner & McCarthy, 2020; Keptner et al., 2026), at universal (beneficial for all), targeted (necessary for some), and intensive (essential for a few) (Reitz et al., 2020). In Ireland, a flagship event took place in June 2021, featuring a national HEA-funded seminar entitled “Showcasing a Tiered Public Health Occupational Therapy Approach to Supporting Student Participation, Health, Wellbeing and Success in Higher Education.” Eleven innovative occupational therapy-led interventions were presented to an audience of almost 100 staff from across the Irish higher education sector, spotlighting the significant role of occupational therapy, specifically in supporting students’ mental health and success. A free, publicly available companion compendium of practice-based case stories (Hunt, 2021) is a valuable advocacy resource for national and international university senior management, professional services units including student health, access and disability services, teaching, learning and academic support centers, as well as campus buildings and estates units. Complementing this important work by Irish occupational therapy practitioners, we now share selected practice innovations from campuses in the United States and Ireland to demonstrate the reach and impact of occupational therapy in postsecondary education.

Universal Interventions

Universal approaches are those which are considered beneficial for all students. Funded by the HEA National Forum for the Enhancement of Teaching and Learning in Higher Education, he first author collaborated with colleagues from neuroscience and psychology to create Brainpower (Hunt et al., 2021), an open access resource for university educators on how to harness the power and potential of adolescent brain and behavior for enhanced learning, wellbeing and student success in postsecondary settings (Staunton & Brennan, 2024), as well as a companion version for students called Your Brainpower (Hunt et al., 2022). Given that most undergraduate students are adolescents (College Board, 2024; Higher Education Authority, 2025a; National Center for Education Statistics, 2023), these programs offer scientific content on adolescent development to support educators in applying a developmental perspective to teaching and learning and to support students in better understanding themselves as they transition in and through postsecondary education. Also from Ireland, Everyday Matters: Healthy Habits for University Life^® (Hunt, 2026; Hunt & Coombes, 2024) is a free, online, asynchronous, co-curricular program now available to all students at University College Cork (UCC). Across eight self-paced online sessions, students are guided to reflect on their time use throughout the day and how it influences their health and wellbeing, for good or ill. Habits of mind are also explored, as their presence or absence can enrich or undermine daily experiences. Everyday Matters: Healthy Habits for University Life^® is typically offered once per semester to all UCC-registered students in partnership with the university's academic Skills Centre, situating this universal intervention within mainstream academic services rather than health/disability/therapeutic services, reducing stigma-related barriers and maximizing appeal. Building on the nationally recognized success of this program (HEA, 2024), the first author is now leading a 3-year Wellbeing and the Curriculum project in UCC supported by national HEA Mental Health funding allocated annually to Irish higher education institutions, which will see all 4000 + first-year UCC students receiving Jumpstart Your Success: Everyday Matters, a one-unit course supporting their transition into university, and the creation of a credit-bearing version of Everyday Matters: Healthy Habits for University Life^® for graduate students, among other work packages.

Other innovations that can benefit all postsecondary students include the development of new occupational therapy-based assessment tools to support participation and wellbeing. The Self-Assessment of Student Success (SASS) (Pérez & Grajo, 2025) is an occupational therapy strengths-based self-report assessment comprising 34 test items across five domains: resilience, stress management, social supports, quality of life, and study skills. The SASS enables undergraduate and graduate students to gain self-awareness, utilize their strengths to achieve goals, and address areas of limitation. It demonstrates initial content validity based on investigations with US-based experts, and future research will examine its construct validity and reliability.

Developed with financial support from the California Foundation for Occupational Therapy, the Occupations in Higher Education Transitions Inventory (OHETI) uses an occupational lens to explore student adaptation to daily life (Keptner et al., 2026). Using the Theory of Occupational Adaptation as a guide, students answer a series of questions about effectiveness, efficiency, and satisfaction in sleep, nutrition, physical activity, academics, social participation, caregiving, spirituality, leisure, health management, and work activities. This instrument demonstrated excellent content validity in clarity and relevance (CVI >0.95) during expert review (calculated by D. Martin, personal email communication, February 15, 2025). Pilot testing has been completed (N = 278), and the tool is undergoing construct validity to assess its fit within the Theory of Occupational Adaptation (Keptner et al., 2026).

Targeted Interventions

Students from traditionally underrepresented or marginalized communities or economically disadvantaged backgrounds, those whose parents did not complete postsecondary education, and/or those with disabilities, including mental illness, can face challenges in accessing and completing higher education and are identified priority groups for targeted supports to ensure accessible, supportive and inclusive higher education experiences (HEA, 2022; Negrea & Gartland, 2025). In the United States, targeted interventions have been designed and delivered by occupational therapy practitioners for groups of students who are considered to be “at-risk” of developing mental health challenges including autistic students (Schreier et al., 2020), students with learning differences (Nagata et al., 2022) and students who have aged out of the foster care system (Keptner et al., 2023); with different funding models including philanthropy and centralized university resources from campus academic success centers. The occupational therapy-led Greater Opportunity for Academic Learning and Living Successes (GOALS²) program uses a coaching approach to provide free-of-charge occupational therapy services to students with disabilities in one US postsecondary institution, through a collaboration between the institution's Dean of Students’ Office and the Department of Occupational Therapy (Harrington et al., 2021). In Ireland, the Trinity College Dublin (TCD) Sense Project (2024) was developed to make TCD more inclusive of neurodiverse users by reviewing and improving new and existing spaces, building sensory awareness, and providing specialist support to students and staff who experience barriers to managing and adapting to the university campus's sensory environments. Supported by HEA Access funding, this project was underpinned by an audit of student spaces at TCD, which identified that the university's learning and social environments needed to change to accommodate and enhance spaces for neurodiverse students (Nolan et al., 2022). Some of the outputs from the TCD Sense Project include a map of sensory spaces at TCD, a sensory environment self-evaluation tool, a Botanic Gardens sensory trail and the creation of designated TCD Sense Social, Study, Quiet and Outdoor Spaces across the campus.

Intensive Interventions

Intensive level supports are individualized for students who are experiencing more severe or enduring activity limitations or participation restrictions (AOTA, 2020). Schindler (2019) reports an occupational therapy-based Supported Education program for undergraduate college students with clinical diagnoses including attention deficit hyperactivity disorder, anxiety, and depression. Twice-weekly 1:1 mentoring sessions address the cognitive, social, and psychological challenges identified by students who were referred to the program by counselors in the university's Office for Students with Disabilities. Also in the United States, OT on Campus (Eichler, 2020) provides individualized services, supported by university student health funds, that include her signature “Sensory Packing,” integrating sensory preferences and awareness into strategies to support overall performance as adolescents and young adults navigate the transition to adulthood. In Ireland, a 1:1, individualized, occupation-focused intervention was developed at TCD to support students with significant mental health problems in their social and academic endeavors (Nolan & MacCobb, 2006). Part of the university's Disability Service, largely funded by the Irish national Fund for Students with Disabilities, the occupational therapy service, which now employs seven occupational therapy practitioners, focuses on supporting students in achieving their occupational goals as students. As part of this service, students complete an assessment of occupational performance, the Trinity Student Occupational Performance Profile (Lombard et al., 2022). This validated instrument enables students to identify personal, environmental, and occupational challenges to participation. It encourages collaborative goal setting, which, along with a self-management tool (Lewis, 2021), empowers students to manage their identified challenges. These initiatives are now fully integrated into needs assessments and the provision of reasonable accommodations for students registered with the university's Disability Service.

From Advocacy to Action

Sharing practice innovations and collaborating through research networks are vital to enabling practitioners to learn from one another (Smith, 2024). In the United States and internationally, occupational therapy practitioners are uniting in their commitment to supporting students’ wellbeing on campuses and are calling for further investment in this emerging and expanding area of practice. The OT-U International Collaborative, founded in 2019 by Eichler and Keptner, hosts an annual virtual Research and Practice Symposium showcasing OT practices across universal, targeted, and intensive service levels and promoting networking and identifying targeted research needs worldwide. In addition to the symposium, two members of the OT-U International Collaborative, Keptner and Adams (n.d.), are spearheading an open-access journal that promotes occupational therapy scholarship in higher education. The journal titled Journal of Academic Life: Health, Function, and Participation will have its inaugural issue in 2026.

In Ireland, the Association of Occupational Therapists of Ireland (AOTI) lobbied the Irish government for occupational therapy representation at national-level committees for policy development and student support in Irish higher education institutions. In 2024, after 3 years of lobbying government departments, AOTI secured membership of the newly formed HEA Student and Staff Health and Wellbeing Advisory Group, which is tasked with overseeing the implementation of the HEA Healthy Campus Charter and Framework and the HEA (2020) National Student Mental Health and Suicide Prevention Framework. In January 2025, an AOTI Working Group was established to advance the provision of occupational therapy services in universities in Ireland. Thirty-five occupational therapy practitioners across Ireland have joined this working group, which will map current service provision and develop best practice guidelines. This group made a formal submission outlining the current and potential role of occupational therapy in higher education in Ireland during the national consultations on the review of the National Student Mental Health and Suicide Prevention Framework (HEA, 2025b). Members of this group also hosted a symposium on occupational therapy in higher education at the International Health Promoting Campuses Conference in June 2025 (Hunt et al., 2025). They contributed to a panel on emerging areas of practice at the national AOTI annual conference in October 2025 (Hunt, 2025a). These are just some of the ways that occupational therapy practitioners are advocating for further expansion of services in postsecondary settings.

Our Call to Action for Occupational Therapy Practitioners

We believe that occupational therapy practitioners at all levels and stages of career development can assist in developing this practice area. We specifically recommend that occupational therapy practitioners:

Leverage their rich professional knowledge of lifespan and positive youth development to promote the application of a developmental perspective in teaching, learning, and student support in postsecondary settings, building on the valuable resources available for occupational therapy service provision in schools, early intervention, and community education (AOTA, n.d.; Hunt et al., 2021; National Council for Special Education, n.d.).

Conclusion

Postsecondary institutions around the world are struggling to respond to a reported crisis in student mental health with urgent calls for evidence-based advocacy and global action. In the United States and internationally, occupational therapy practitioners are supporting students’ wellbeing and are calling for stronger recognition of and investment in this expanding area of practice. Occupational therapy practitioners are well-positioned to deliver the vision of the Okanagan Charter: An International Charter for Health Promoting University and Colleges and Limerick Framework for Action: Advancing the Global Health Promoting Campuses Agenda as part of a whole university approach to student mental health and success. By sharing selected practice innovations from practitioners in the United States and Ireland, we demonstrate the reach and impact of occupational therapy in postsecondary education and outline ways by which occupational therapy practitioners at all stages of career development can assist in further developing this vibrant and vitally important practice area.