The typical age of onset for many severe psychotic disorders is late adolescence through early adulthood, an age range coinciding with the college population. Clearly, college counseling centers can play an important role in retention of students with severe mental disorders. This chapter presents a case example of how to make a referral. Due to the high-profile tragedies at Virginia Tech and other campuses, college counselors are under pressure to share concerns regarding students and to provide mandated counseling and assessment. The treatment of eating disorders continues to be very challenging for college counseling centers. College counselors have reported an increase in students presenting with self-injurious behaviors (SIBs) for some length of time. It has only been recently that college officials began to acknowledge students with autism and Asperger’s syndrome. Psychoeducational groups have become popular on virtually all college campuses.