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Mental health (MH) disorders are highly prevalent among university students, with multi-level impacts. Although campus-based mental health services (CBMHS) are available, awareness and utilisation rates remain low. This study examined the awareness and utilisation of CBMHS among Zimbabwean tertiary students, including the barriers, facilitators, and preferences that influence their access to services. This descriptive cross-sectional study recruited 1070 students from five tertiary institutions in Harare, Zimbabwe. Participants completed questionnaires evaluating awareness, utilisation, preferences, and barriers to accessing CBMHS. Data were analysed using descriptive statistics and multivariate logistic regression. The mean age of the participants was 21.7 (SD = 2.7) years. 76.5% of students were aware of CBMHS. Awareness of MH services was associated with familial history of MH conditions [AOR = 1.35 (95% CI: 1.05; 1.83), p = .05] and personal experience of a MH condition [AOR = 0.71 (95% CI: 0.52; 0.97), p = .030]. Only 16.5% of students had utilised CBMHS. High utility of CBMHS was associated with drug and substance use [AOR = 2.388 (95% CI: 1.227; 4.644), p = 0.01], availability of a psychologist [AOR = 1.69 (95% CI: 1.10; 2.59), p = .017] and availability of campus-wide MH workshops [AOR = 1.62 (95% CI: 1.00; 2.60), p = .049]. Key barriers to MH service utilisation included lack of resident/institutional MH service providers [AOR = 2.02 (95% CI: 1.16; 3.51), p = .013], past MH experiences [AOR = 1.53 (95% CI: 1.16; 2.02), p = .002], and friend's history of MH condition [AOR = 1.44 (95% CI: 1.11; 1.86), p = .006]. Students preferred self-help services, individual therapy, and psychologists for MH support. Universities should promote MH awareness through effective awareness campaigns and workshops, provide tailored services that align with the students' preferences, and ultimately create a supportive environment that fosters students' overall MH service utilisation and well-being.