As student activism continues to roil campuses, concerns have arisen about the mental health costs associated with activist-oriented civic engagement. Drawing on in-depth interviews with 42 self-identifying student activists from across the United States, this study examines how activists describe the impact of their activism on their mental health. While just under one third of the respondents perceived a positive effect, 60% of the respondents noted adverse consequences to their psychological well-being. Nevertheless, these respondents remained committed to continuing their activism. Four factors surfaced in activists' reflections on their mental health, which, while not responsible for positive mental health outcomes, did help offset the stress, exhaustion, and guilt associated with activism. These four factors included social capital or connection to others, a sense of purpose, effecting change, and self-care and collective care. Respondents credited these factors with helping them to sustain the emotionally and physically difficult work of activism. Implications for higher education policy and practice are discussed.