Psychological problems—from the most minor such as exams anxiety to the more severe such as personality disorders—are not rare in young adults. University Counselling Services often present the only opportunity for undergraduates to meet health professionals and to be confronted with their difficulties in a non‐clinical setting or—in cases of more severe psychopathology—to be referred to mental health services. Recent research attests to the increasing severity of psychological problems among undergraduate and graduate university students. The question necessarily arises as to whether this trend is replicated in the general population being referred to mental health services and, if such is the case, whether there are differences between the two populations. This paper analyses the change in the severity of self‐reported symptoms in a sample of 194 students attending a University Counselling Service over a course of 5 years (2010–2014). Clinical severity was assessed in both groups by Symptoms Check List 90‐Revised, Clinical Outcome in Routine Evaluation‐Outcome Measure, and Emotion Regulation Questionnaire scores. Results show a substantial stability in severity level across time, and a comparison with an age‐matched sample of patients referred to a public hospital clinical psychology service shows overlapping data with respect to disease severity level. As the mental health of university students is an important public health issue, the implications for the organization and structure of university counselling services and the connection with public mental health hospital centres are discussed. Key Practitioner Message The severity of distress and symptoms in Italian students who access psychological counselling service remained stable across a 5‐year period. The level of severity of distress and symptoms in students who access psychological counselling service was higher and similar to that of a mental health service. The results suggest to develop multilevel interventions to address the broader well‐being needs of university students providing both low‐ and high‐intensity interventions and develop a network with mental health services.