As more college students face severe mental health issues, peer educators need effective communication skills and knowledge of campus counseling services to properly make referrals while continuing the peer relationship. This chapter presents an overview of current mental health issues in college students. These issues must be understood and considered by those planning, implementing, or supervising a peer education program. Four specific content areas for peer educator training are discussed: (1) effective communication skills needed to interact with students facing severe mental health issues; (2) effective referral practices, which include understanding the role of campus counselors and available counseling and the possible resistance a peer educator may encounter when trying to refer; (3) continuing peer educator-student relationships after referrals; and (4) supporting peer educators after they have dealt with students' challenging psychological issues.