A rapidly growing body of research spanning several scientific disciplines and countries converges to show that mental health problems among students are an increasing challenge for higher education institutions. Mental health problems among students threaten academic performance, degree completion and student well-being. Structural efforts aimed at building health-promoting, learning environments for all students are lacking in the literature. This study aims to identify and describe what is currently known about structural approaches to promote mental health or prevent mental health problems among students in higher educational settings. We conducted a scoping review of studies published in peer-reviewed journals between 2001 and 2021, which studied structural interventions to promote mental health or prevent mental health problems among students in higher educational settings. The search identified 8372 articles, and 27 were included in the final sample. Four broad categories of approach were identified: (1) inclusion and diversity approaches, (2) adaptations to the physical environment, (3) teaching health-related skills and behaviours and (4) adaptations to pedagogical practices and teaching approaches. The general finding from the studies reporting student perceptions was that students were favourable to the interventions to which they were exposed. Studies investigating pre- to post-test changes in well-being had mixed findings. Institutions aiming to support student mental health at the structural level should rigorously study and describe these approaches and their outcomes to advance our combined understanding of how we might design and deliver structural interventions to support students' mental health.