Just a few months ago, the United Kingdom (UK) government announced £3 million of funding to bridge gaps in mental health services for students in higher education (Gov.UK, 2022). Since there are 2.4 million students in UK universities, higher education institutions are a crucial platform to provide mental health support for young people. Student mental health services are especially important considering the endless challenges the university lifecycle comes with – from academic stress, and financial burdens, to forming new social relations. And the earlier we intervene, the more problems we can prevent.

However, when initiatives like this come up, how do we ensure that students experiencing social and mental health inequalities are once again, not “falling through the gaps”? (Gov.UK, 2022) Despite high engagement and participation, Black students are more likely to drop out, report lower student satisfaction, and face several structural inequalities placing them at higher risk for poorer mental health. For instance, Black students are among the most vulnerable to financial hardships and along with it, mental health difficulties and thoughts of dropping out (HEPI, 2022).

Stoll et al’s (2022) thematic synthesis reviews and brings together existing literature that has qualitatively explored factors affecting the mental well-being and health of Black students at UK universities.

Methods

A thematic synthesis – typically used within systematic reviews, compiles findings across several qualitative studies.

First, the authors reviewed a range of literature on Black students’ mental health in universities in the UK. The review included studies (written in English) with different methodological approaches such as qualitative, quantitative, mixed-method studies, and non-peer-reviewed articles. They searched four major databases including PubMed and also conducted a manual search. Considering the lack of research on this topic, the authors chose to be lenient with their inclusion criteria.

In their final selection, the authors decided to only include qualitative studies, and these were appraised using the CASP qualitative checklist. Then, they conducted a six-step thematic analysis (Braun & Clarke, 2006) to identify analytical themes across the twelve studies and synthesise their findings. They also used the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework to guide the reporting of this review (Tong et al., 2012). Notably, the research team included and was led by Black members.

Results

The following seven analytical themes emerged from the synthesis:

1. Academic pressure

Black students explained that a heavy academic workload contributed to their mental distress, especially for students who already reported poor mental health. Participants observed that as Black students, they faced more pressure from their families and community to succeed and do justice to their families’ sacrifices and hardships.

2. Learning environment

Their learning environment could be both liberating and frustrating. Lectures on race, diversity, and inclusion did have a positive impact on their well-being, but more commonly, Black students felt frustrated by White-majority staff, students, lecture materials, and racism in the classroom. In fact, many Black students constantly felt they had to walk on eggshells and be overly agreeable. This improved their academic relationships, but came at the cost of their mental well-being.

3. Black gendered experience

Black students’ experiences of racism often intersected with their gender. Narratives of hypermasculinity pushed Black male-identifying students to hide emotions and feel shame in seeking support. Black female students reported the struggle with their body image against a white body ideal.

4. Isolation and alienation

Black students constantly felt excluded by non-Black peers in both academic and non-academic spaces, which made them feel unmotivated and isolated. Some believed that academic staff could take more steps to create safe spaces for Black students. What helped students feel more comfortable and empowered was the sense of community amongst Black students – though this wasn’t always the case for Black international students.

5. Culture shock

From the shift in social networks to the high academic stress, moving to study in the UK was a big change for many Black international students – especially because of the stark contrast between UK’s individualistic culture and the strong social fabric in their home country.

6. Racism

Students reported that constant experiences of discrimination, and differential treatment from students and staff negatively impacted their social life, sense of belonging, and academic progress and therefore caused significant mental distress.

7. Support

Support from family and friends, Black-only spaces, religious organisations, and psychoeducational resources – all improved their mental health. Many students reported difficulties accessing university mental health services, but also choosing not to because of White-majority practitioners, a lack of trust, and perceived racial stereotyping. The stigma surrounding mental health also left Black students with less than supportive family members.

Conclusions

This review provides a sketch of several institutional and personal factors that impact the mental health of Black students in higher education in the UK, as per existing literature. Experiences of racism, exclusion, feeling unsupported, and the stigma around mental health have negatively affected the well-being of Black students as well as their likelihood of academic satisfaction and success. Efforts to create safe, inclusive spaces and communities within their social, learning, and living environment can positively contribute to their mental health. Yet, most students agree that institutions and policymakers need to do far more to create an environment that prioritises Black students’ mental health and improves education satisfaction and attainment.

Strengths and limitations

As the first study to systematically explore research on factors affecting Black students’ mental health in UK universities, this study paints a clear picture for stakeholders. The findings are also well-grounded in the context of the original studies’ participants. For example, while discussing the benefits of a sense of support from other Black students, the authors mention how this may not hold true for Black international students. In addition, by including factors that improved Black students’ well-being, the researchers offer a holistic report of students’ experiences instead of a ‘deficit narrative’ (Davis & Museus, 2019).

However, a major limitation of this review lies in its use of Braun and Clarke’s (2006) widely used six-step guide for thematic analysis. Since the thematic analysis was conceptualised to analyse primary research, a more appropriate method could be Thomas and Harden’s (2008) guide to the thematic synthesis of qualitative research. Though both are quite similar, Thomas and Harden’s method allows for participant accounts along with authors’ interpretations. Importantly, a thematic synthesis also involves a clear description of decision-making processes such as the selection of studies (Harden & Thomas, 2022). The authors could have detailed (in the PRISMA flow diagram) reasons why some studies were excluded, as also advised by the reporting framework (ENTREQ) the authors used (Tong et al., 2012). Transparency in decision-making is especially important here because these findings could inform policy decisions and initiatives. Following on from the need for transparency in thematic syntheses, the authors could have also highlighted general study and sample characteristics (e.g., method of data collection) and if these affected the findings in any way.

To vividly illustrate participants’ lived experiences, the researchers could have included quotations from participants or authors’ interpretations from the primary studies (Tong et al., 2012). While reporting patient and public involvement (PPI), the authors acknowledge their identity as Black university students, but don’t show any reflexivity. They could have involved an advisory group of Black university students to generate more representative and possibly less biased findings (Staley, 2009).

Implications for practice

The review highlights experiences that shape the well-being and lived experience of Black university students in the UK and offers a clear call to action for universities and policymakers.

Universities should make changes in their academic, social, and living spaces. As recognised by the authors, universities should ‘decolonise’ lessons, materials, and the classroom environment and provide race, racism, and inclusion training for staff (and mental health practitioners). The review also speaks to the overall state of mental health training and research, calling for their decolonisation. Universities should also improve the accessibility and nature of mental health services offered. While my experiences are not the same as that of Black students, as a South Asian student who moved to the UK a few months ago for my higher education, I related to the hesitation in using university mental health services. Despite hoping to potentially use these services, I wondered: will the practitioners understand my cultural context and background? How long will I have to wait? How do I even access these services? They need to employ Black and minoritised mental health practitioners, implement targeted mental health interventions (for example, a peer support group for Black international students) and improve knowledge of these services amongst students. The authors also suggest that universities could collaborate with religious organisations to provide support.

Young people from the Black community are already making strides toward empowering students and supporting their mental health. Black People Talk – an organisation co-founded by Stoll offers peer support groups and safe spaces for Black students. Another organisation – the BiPP Network offers a supportive space for Black and minority ethnic mental health professionals and students. In fact, I attended a workshop on the PhD application process hosted specifically for racial and ethnic minorities. The speakers and attendees were refreshingly relatable, and I found a space to safely address my concerns. Initiatives like these are key to creating support within and outside the community.

For wider changes to come together, however, we need legislative change. This may include increased funds and scholarships for Black students, policies to improve educational attainment and satisfaction, and targeted initiatives to improve Black students’ access to university mental health services.

Lastly, there are still major gaps in research on Black students’ experiences; especially surrounding the intersectionalities with gender, culture, religion, migration status, and more. There is much more to understand about the effect of mental health literacy, language, and narratives in Black communities. Although we have miles to go, this review by Stoll et al., is a great first step.

Statement of interests

No conflicts of interest to declare.

King’s MSc in Mental Health Studies

This blog has been written by a student on the Mental Health Studies MSc at King’s College London. A full list of blogs by King’s MSc students from can be found here, and you can follow the Mental Health Studies MSc team on Twitter.

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Links

Primary Paper

Stoll, N., Yalipende, Y., Byrom, N. C., Hatch, S. L., & Lempp, H. (2022). Mental health and mental well-being of Black students at UK universities: a review and thematic synthesis. BMJ open, 12(2), e050720.

Other References

BiPP Network. Black and Minority Ethnics in Psychiatry & Psychology Network C.I.C Limited, last accessed 7 Dec 2022.

Black People Talk. Black People Talk CIC, last accessed 7 Dec 2022.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology (PDF). Qualitative research in psychology, 3(2), 77-101.

Davis, L. P., & Museus, S. D. (2019). What is deficit thinking? An analysis of conceptualizations of deficit thinking and implications for scholarly research. NCID Currents, 1(1).

Gaps in student mental health services to be tackled. Gov.UK, 20 June 2022.

Harden, A., & Thomas, Thematic synthesis. Cochrane Training, February 2022.

Jones, A. Learning with the lights off: students and the cost of living crisis. Higher Education Policy Institute. 1 Nov 2022.

Staley, K. (2009). Exploring Impact: Public involvement in NHS, public health and social care research (PDF). Involve.

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC medical research methodology, 8(1), 1-10.

Tong, A., Flemming, K., McInnes, E., Oliver, S., & Craig, J. (2012). Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC medical research methodology, 12(1), 1-8.

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