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The field of college mental health is changing dramatically, and we are approaching a necessary paradigm shift in how "mental health" is defined and addressed. This paper will outline two primary forces impacting how we think about mental health and how a systems change perspective might help us understand what comes next. We will conclude with opportunities to integrate ways of thinking about mental health into the broader well-being and systems change work that higher education institutions have embarked on in recent years. The conclusion will include an overview of a project at the authors' home institution that is aligned with this worldview and holds the promise of a healthier, more sustainable path forward in college mental health.