Helen Whately is the Conservative MP for Faversham and Mid Kent. Alys Denby is Parliamentary Researcher for Helen Whately MP, she was previously a journalist at the Daily Mail and Evening Standard. This is one of the essays published today by the Centre for Policy Studies in the publication New Blue: Ideas for a New Generation.
University is presented to young people as “the best years of your life”. But for many, it’s stressful, lonely and unhappy – and occasionally deadly. In 2015, there were 134 student suicides, more than in any previous year. Bristol University has seen seven students take their own lives in less than 18 months.
These tragic deaths shine a cold light on the urgent need for better mental health support in universities. And for each student suicide, there are hundreds of students struggling with their mental health, suffering from anxiety and depression through to serious mental illnesses like psychosis and bi-polar disorder.
Such problems do not just inflict misery on those afflicted. They also blight lives, impacting on students’ studies and preventing them from making the most of their university experience.
Recently, there has been a welcome effort to improve mental health support in schools. The Five Year Forward View for Mental Health is leading to improvements on specific issues like eating disorders and early intervention for psychosis. So now it’s time to step up and focus on the mental health of students.
University provides a precious opportunity to intervene. It’s a stage of life when some mental health conditions develop or become apparent – including conditions like psychosis, where we know that early intervention can be the difference between a lifelong illness and recovery. And it’s an opportunity to help a huge proportion of the country’s young people – since nearly 50 per cent now go to university – learn how to look after their mental health.
The decisions you make, the experiences you have and the things you learn at university set you up for the rest of your life. Getting this right will help the next generation of scientists, teachers, engineers and business leaders be better equipped to cope with the ups and downs of a changing world.
Students are calling out for more help with their mental health
More UK students than ever before are coming forward to disclose mental health conditions – 15,395 in 2015, almost five times the number in 2006/7. And 94 per cent of higher education providers have reported an increase in demand for counselling services.
In 2015, a record number of students with mental health problems (1,180) dropped out of university, an increase of 210 per cent compared to 2009/10. It’s a large and growing problem – and a sad waste of potential.
Despite this, less than a third of universities have an explicit mental health and wellbeing strategy. Only 29 per cent of universities monitor student attendance – which means that students at the other two thirds could go missing for months and the university authorities would have no way of knowing.
While some universities have excellent systems in place, the picture varies enormously across the country. Students whose problems are not yet severe may not meet the threshold for NHS treatment, and if there’s no alternative provision at university they may get no help at all. And waiting times mean that those who do qualify for specialist treatment can fall through the gaps while moving between university and home.
Happier students will help build a healthier society
Almost 50 per cent of young people now go to university. That’s a student population of 2.3 million, plus 400,000 staff. With so many more people spending longer in education settings – where work, leisure, healthcare and social support are all focused in one place – there’s a real opportunity to catch health problems early. Providing better mental health support at university can break down stigma, help students learn how to manage their mental health and how to support peers, leading to a healthier society in years to come.
Students are told that a university education is about more than just grades – but those who are suffering from depression and anxiety can’t make the most of their time there. More support for mental health will help students to thrive.
The Government has recognised the need for better mental health care and the Prime Minister has committed to tackling the “burning injustice” of inadequate treatment. We are trialling four-week waiting times for access to specialist treatment and spending an addition £1.4 billion on young people’s mental health.
We have made great progress in tackling stigma and challenging the perception that mental illness – unlike physical disease – is untreatable, a life sentence. The emergence of many mental health conditions during childhood and the benefits of early intervention are now well understood, so the Departments of Health and Education have come together to produce their green paper on Transforming Children and Young People’s Mental Health.
Better support at university and in further education settings should be the next priority. We need more mental health training and awareness for all staff, continuity of care so that students can continue to receive treatment as they move between home and university, and more robust assessment of how universities promote the health and wellbeing of their students.
Britain’s universities are renowned across the world for the quality of the academic education they provide; with better mental health care they can provide an education for life.
Why are students struggling with their mental health?
Three quarters of adults with mental health problems experience their first symptoms before the age of 25, and mental health problems are more prevalent among people from tougher socio-economic backgrounds.
With widening access to university, the student population is coming to more accurately reflect society as a whole, so we would expect to see a greater proportion of students affected by mental ill health. However, there are certain aspects of student experience that can exacerbate conditions.
Students go through multiple transitions: leaving home for the first time, becoming financially self-reliant, meeting new people from very different backgrounds, learning new things, questioning old assumptions and seeking a purpose in life. These are all part of what makes university life so formative and exciting, but they can also be extremely challenging. The expectation that you will have “the best years of your life” can add to the stress if the reality does not live up to the promise.
For students with pre-existing mental health conditions, starting university and registering with a new GP can disrupt their care. There is often poor integration between the care they receive at university and at home, which creates difficulties accessing records.
Changes in routine can affect also self-management. For example, students with eating disorders may have to get used to cooking for themselves or eating communally in halls and shared houses.
Moving away from support networks of family and friends can leave students very isolated. International students are particularly vulnerable, as are students who are the first generation of their family to go to
university and may have less idea of what to expect.
Academic pressure is another factor. A student experience survey by the University Partnership Programme reported that 48 per cent of men and 67 per cent of women found the stress of studying difficult to cope with at
Moving from the structured, supportive environment of school to self-directed study with perhaps just eight contact hours a week can be a challenge. Many students get into unhealthy study patterns, staying up all night in the midst of an essay crisis.
In a report for Student Minds, one student said: “It is normalised at university to feel extremely stressed, or fearful, or not to be able to sleep, but then there can be a stigma surrounding those who seek help, as if they cannot cope with the pressure or ‘stress’ that everyone feels to some extent.”
Drugs and alcohol are often part of university culture and can have a significant impact on student mental health. The links between drugs, alcohol, addiction and poor mental health are well explored, but it’s not just the substances themselves that can have negative effects. Alcohol and drugs can lead to poor decision-making and affect students’ ability to concentrate on their work. Students with pre-existing conditions can use them to self-medicate. And students who abstain can struggle to make friends and become isolated.
The universities stepping up to the challenge
Many universities are already taking action. Bristol is spending an additional £1m on a new student wellbeing service and introducing course requirements beyond traditional subjects to improve students’ coping skills and foster a sense of community. It is also encouraging students to declare pre-existing mental health conditions before they arrive on campus, insisting that it will not jeopardise their admission. It has 13 fulltime counsellors and staff dedicated to students living in residence halls.
The University of Derby, which is in the top 20 universities in the UK for student well-being according to the Times Higher Education Student Experience Survey, invites students with mental health conditions and learning disabilities to pre-entry events so they can settle in early and make friends before the chaos of freshers’ week. It has also collaborated with Student Minds on research into the role of academics in supporting student mental health.
The next steps in improving student mental health
To truly change the experience of students struggling with their mental health, we need universities and the NHS to jointly embrace the challenge and the opportunity of supporting student mental health. Compared to the current patchy and often inadequate provision of mental health services to students, it’s time for a comprehensive and thought-through approach to student mental health, which identifies students’ mental health support needs, provides access to appropriate care and support dependent on need, and adapts the university environment itself to reduce the risks to students’ mental health.
These 10 proposals will move the various organisations involved in looking after students towards a comprehensive system of care that supports students in what really can be the best years of their lives.
- Introduce a whole-university approach to mental health by extending the recommendations in the recent green paper for whole-school approaches to mental health to higher and further education settings.
- Roll out mental health first-aid training systematically among both academic and non-academic university staff.
- Ensure that students have an appropriately-trained member of university staff providing support to them individually, who is unconnected with their academic work.
- On arrival at university, students should receive an induction with advice on what mental health support is available to them.
- Include measures of health and wellbeing in OfS assessment criteria for universities and in the National Student Survey.
- Universities should pilot surveying their students on admission to identify those who have a mental health problem or may be at risk.
- Enable students to register with two GPs, one at home and one at university, to ensure continuity of care – which would also benefit those with other health conditions.
- Facilitate better information-sharing between medical practitioners looking after students, for instance through a digital health passport.
- Expect universities and local NHS organisations to build strong links and develop services specifically for students.
- Where a region includes a student population, the regional NHS body should make specific provision for their mental health needs – and this should be required before their wider plans are signed off.
Responsibility for student wellbeing is often shared between academics, chaplains, GPs, counsellors and others. As a result, it’s too easy for it to become nobody’s problem.
Universities UK is encouraging university leaders to develop integrated, whole-university approaches to student mental health, through its StepChange framework.
Universities should review their curricula and the overall academic and pastoral environment to identify characteristics which are detrimental to student mental health and potential triggers for mental health crises.
The Departments for Education and Health and Social Care have recognised the need to promote whole-school approaches to mental health in their green paper, and should consider extending this to higher and further education settings as well.
Mental health first-aid training should be rolled out to university staff, as it is being to secondary schools. At present Mental Health First Aid offers training and resources for universities, but take-up is on a voluntary basis. Academics interviewed by Student Minds said that responding to mental health problems has become an inevitable part of their role. However, they receive little or no formal training.
At the same time, academics have a role in judging students’ work, and students say they worry that disclosing a problem could affect their grade. Others who have tried to talk about a mental health problem with their supervisor report not being taken seriously.
One suggestion is for students to have a member of university staff looking out for them who is unconnected with their academic work, with the aptitude and appropriate training to provide guidance.
As well as the right training for academics, non-academic university staff should be able to identify students who are struggling and signpost them to appropriate support. This should include out-of-hours staff, like porters, cleaners and security guards, who may be the first to encounter a student who is struggling – perhaps staying up night after night or locking themselves in their room.
All students should receive a thorough induction on arrival, with advice on what mental health support is available to them, how to navigate the system, and how to study healthily. Post-graduates must be given equal consideration in this process, as they tend to have even less supervision.
Students should have access to an individual, perhaps a mentor, who they know they can turn to for advice. And curriculums should be designed in a sensitive manner. For example, some medical courses teach students about suicide in their first term. Given this is when they are particularly vulnerable to mental health problems, that’s surely not the right time.
We mustn’t be too prescriptive. The independence of our universities is one of their greatest strengths, and students deserve to have the widest possible choice. But the Government does have a role, and can use regulation and transparency as powerful tools to drive improvement.
For example, the Office for Students should collect much more robust data. At present there is no national measurement of health and wellbeing at universities. Some universities have measured their own wellbeing
levels compared to national population figures published by the ONS and have found lower levels of wellbeing and a decline year on year.
Measures of health and wellbeing should be included in OfS assessment criteria for universities and in the National Student Survey. Universities should pilot surveying their students on admission to identify those who may be at risk. More research into suicides at university is also needed to identify gaps and best practice.
GPs are often the first port of call for people with mental health problems, but being registered with just one GP means that students can spend half the year without access to this trusted source of advice. Students should be able to register with two GPs, one at home and one at university, to ensure continuity of care. The funding they attract could be split between practices depending on how much time a student spent in each place.
Technology should be used to facilitate better information sharing between medical practitioners, for example via a digital health passport. And universities should build stronger links with local NHS organisations to help students get better access to the help they need. Where a region includes a student population, the regional NHS body (the Sustainability and Transformation Partnership) should make specific provision for their mental health needs and sign-off on its plans should depend on this.
To the extent that some of these proposals involve costs for universities, quite apart from the moral case, there is surely a business case for them to invest in the mental health and wellbeing of students. Some students drop out and abandon their courses as they struggle with their mental health. Others don’t get the results they should. And overall, if support for student mental health is assessed by the Office for Students and the National Student Survey, good performance will help attract students and conversely, poor performance will deter them.
Why strive for better student mental health?
Healthier students will get more out of university, both academically and socially. Healthier graduates will be able to contribute more to society and lead more fulfilling lives.
By taking both a medical and pastoral approach to students’ mental health and joining up the disparate elements of the system, we will improve, and in some cases save, so many lives.
Let’s not just expand students’ minds – let’s also help them with their mental health. In so doing, we can help more students have a university experience that meets their great expectations, and set them up to manage their mental health better for life.