For several decades, college counseling centers have struggled to meet a steady rise in demand for services. Research suggests that therapeutic advancements, including psychotropic medication, have led to an increase in students with serious mental illnesses who now represent a significant portion of this demand. Current strategies to meet the demand for treatment have fallen short, often resulting in students with serious mental illnesses withdrawing. This composite case study introduces the Next Step Program at Rutgers University, a new program designed specifically to treat students with serious mental illnesses on campus. Using a social ecological approach, this case study traces the development of changes implemented at the macro level of the university, the meso level of the college counseling center, and the micro level of a student receiving treatment at the Next Step Program. By highlighting how on-campus treatment removes common barriers to care and improves outcomes for both students with serious mental illnesses and the universities they attend, college counseling professionals and administrators will learn of the crucial positive impacts on-campus treatment can provide.