With the beginning of a new academic term a flurry of articles, think-pieces and reports has arrived. As usual there are voices describing young people as ‘snowflakes’ and wrongly assuming that the mental health of students reflects the rest of the UK population. Others suggest that mental health is best considered as part of more general wellbeing. However, as Aceijas et al (2016) noted, the health of the university students they researched raised concerns in general.
Whether you look specifically at student mental health or at holistic wellbeing overall, the picture is far from rosy. In its first year 2011, Mental Elf blogged on a report from Royal College of Psychiatrists stating that more mental health support was needed for students in higher education and current data suggests that we are seeing an explosion of need, so what’s going on?
- Demographics: As the 3 children in each classroom with a diagnosable mental health condition (Layard 2011) progress through the education system to university, the number of students presenting with mental distress increases. In addition, 75% of people with mental health issues have their first episode before turning 25 years old. It makes sense then that parts of society where this age group dominate should be expecting to face these issues.
- Widening participation: As the student population becomes more diverse it may also be that non-traditional students who are the first in their family to go to university are less prepared and supported. It is also likely that students with established experience of mental distress are accessing higher education in greater numbers than before.
- Decreasing stigma: There has been a 5 times increase in the number of students disclosing mental health issues to universities over the past 10 years. It may be that with decreased stigma people are more comfortable to access the services they are entitled to. A more cynical view is that the Equalities Act (2010) has forced institutions into being ‘slightly less awful’ to people with additional health and learning support needs!
- University experience: Many people fortunate enough to experience subsidised Higher Education from their youth would not recognise the current situation. Most students are working externally to their academic courses to survive and many are worried by spiralling debt as well as feeling the pressure to get a 2:1 and above for any prospect of a decent job. (It should be noted that carer’s responsibilities also fall within this remit of work external to study and are rarely appropriately waged or valued).
- Social media: It is impossible to have a list of factors that cause emotional distress without including social media – so here goes! There are suggestions that social media provides a ‘comfort blanket’ to homesick students away from their old social networks for the first time, offering a false sense of connection and discouraging them from braving Freshers week and making new friends. If things get tough, they then have less resource in their everyday lives to call on for practical and emotional support.
Is the huge increase in students disclosing mental health issues to universities a positive or a negative, or both?
Methods
The methodology for this recent IPPR report (Thorley, 2017) is only briefly described, although in fairness you would not expect a report to have complex detail on methodology. The mixed methods described appear robust, but it would have been a straightforward matter to link to more detail online.
The data was generated by:
- An in-depth literature review combining research, publications and media reports which was supplemented by analysis of data on student wellbeing from the Higher Education Statistics Agency (HESA), the Higher Education Funding Council for England (HEFCE), and data from Unite Students and Student Minds.
- There was also analysis of survey data from 58 Higher Education Institutions (HEIs) in England, Scotland and Wales. The survey was open to all higher education institutions in the UK (no responses were received from Northern Ireland).
- Qualitative data was gathered from six universities consisting of case studies, interviews with key stakeholders and a focus groups of students with experience of accessing their institution’s mental health and wellbeing services.
- The findings from these six case studies were supplemented by those from telephone interviews from a further eight institutions.
The key themes were generated using a framework analysis approach.
Results
This report makes a distinction between diagnosed mental illness and self-reported mental distress; noting data from HESA showed a 210% increase in students leaving university after experiencing mental health problems between 2009-10 and 2014-15 (the most recent data available). It is important that consideration is given to students whose distress impacts their wellbeing and academic performance, but who do not meet the threshold for a clinical diagnosis as they could be otherwise overlooked. The focus on undiagnosed mental distress is important in light of the number of students dying by suicide. Only a quarter of people to die by suicide in the UK were in contact with formal mental health services in the year before their death and the number of student suicides has increased by 79% between 2007 and 2015.
Data of this kind offers information that enables services to be responsive to the needs of student populations. For example, first-year students were more likely to disclose a mental health issue than any others and female students were more likely than their male counterparts. However, just under half of students who report experiencing a mental health condition chose not to disclose it to their university at all, stating they didn’t want other ‘students to think less of them’ (Equality Challenge Unit, 2014). This fear of stigma varied according to people’s expectations and backgrounds: non-UK and EU applicants were less likely to declare mental health needs as were students from more secure socioeconomic backgrounds.
In the face of this alarming picture the university sector is offering uneven support:
- Less than a third of HEIs had an explicit mental health and wellbeing strategy
- Only 43% design course content and delivery so as to support student mental health and wellbeing
- 29% do not monitor the attendance of all students
- Only 45% have a student medical practice (GP) based on site
- 67% do not provide students access to NHS mental health specialists who can deliver interventions on site
- Around a quarter of HEIs reported that they do not work well with either NHS mental health services or voluntary organisations.
Just under half of students who report experiencing a mental health condition chose not to disclose it to their university.
Conclusions
The higher education sector, university communities and the government share an interest in helping to improve the mental health and wellbeing of students. Universities should make the issue a strategic priority and there is currently too much variation in the response to students experiencing mental ill-health.
Implications for practice
Report recommendations
- Universities: should focus on student mental health and wellbeing as a priority issue and fund and develop their own ‘whole-university’ approaches, subject to audit and quality assurance, and which draw on best practice.
- The Government: should facilitate greater integration across the services through place-based coalitions, addressing the transition between child and adult services and by introducing a Student Health Fund to pilot mental health services in places with high student populations.
- Recognition of the unique health needs of student populations: GP practices with high proportions of student-patients could be supported by a Student Premium to top-up their funding; as students are likely to be disadvantaged from current funding arrangements. Student mobility could be addressed by a digital NHS Student Health Passport to link health services for students moving between home and university. The Adult Psychiatric Morbidity Survey (APMS) may also be updated to collect data on the prevalence of mental illness among students from 2021.
- Awareness and action: groups like Student Minds work to empower members of university communities to look after their own mental health, support others and create change. Do follow them on Twitter: @StudentMindsOrg
Universities should focus on student mental health and wellbeing as a priority issue.
Conflicts of interest
None for Nicky Lambert for writing this blog. The report itself was funded by Universities UK, Guy Baring, and the Mental Health and Wellbeing In Higher Education (MHWBHE) Group.
Links
Primary paper
Thorley C. (2017) Not by Degrees: Improving student mental health in the UK’s Universities, IPPR. http://www.ippr.org/research/publications/not-by-degrees
Other references
Aceijas, C., Waldhäusl, S., Lambert, N., Cassar, S. and Bello-Corassa, R., 2017. Determinants of health-related lifestyles among university students. Perspectives in public health, 137 (4), pp.227-236.
Equality Challenge Unit [ECU] (2014) Understanding adjustments: supporting staff and students who are experiencing mental health difficulties. http://www.ecu.ac.uk/wp-content/uploads/2015/02/ECU_Understanding-adjustments.pdf
Layard R (2011) ‘Time for Action’, New Scientist, 210(2808)
McManus S, Bebbington P, Jenkins R and Brugha T (eds) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014, NHS Digital. http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pdf
Royal College of Psychiatrists, (2011) College Report CR166, 30 Sep 2011 Mental health of students in higher education (PDF).
I wonder also how much impact there is as a result that this is the age at which young people with known mental health issues would be transitioning into adult services – and also the ‘hot potato effect’ we see where many young people report that both their home and their away (university) CCG want the other to fund / oversee their care – either way it is hard to ensure continuity when time is split between two different home bases.
I am not surprised – it’s depressing to see care fracturing down known fault-lines instead of working collaboratively in the best interests of the person needing services.
As with many of these national reports (Universities UK, IPPR, RCP, NUS, etc.) into student mental health, they very rarely focus on good quality evidence (in part, I think, that the UK is very poor at looking at what works, compared to colleagues on campuses in Australia and the USA). Yes, they speak to Universities counselling and wellbeing services, about individual campus practices, but very rarely have these practices been independently evaluated in a robust manner. Time for a practitioner research network, with counsellors, therapists, and mental health practitioners working alongside their academic colleagues, and with service user involvement, looking into what really does work!
[…] Mindfulness has become an increasingly popular intervention in universities (Barnes et al, 2017). With a growing number attending university, at a stage of their lives in which the onset of mental health issues is more likely (Kessler et al, 2007), there is a greater demand for student mental health services. […]
Great article ! Interesting read & very relevant