Mental health care for students has evolved in the past decade or so, moving from singular mental health advisors in universities to complete pastoral teams and dedicated NHS services for young people. Accompanied by work in universities and wider society to counter mental health stigma, more is being done than ever to make sure students are supported throughout their courses.
Although services have improved, the numbers of students who report suffering from mental illness appears to have skyrocketed. There is a disparity between different studies which measure numbers of students who suffer from mental health issues. According to an APPG for Students survey conducted by NUS, 78% of students said that they suffered from a mental health issue during university (whether or not they were formally diagnosed). The Unite Students Insight Report 2016 found that 1 in 8 students had a diagnosed mental health condition. More robust research needs to be done to gauge the scale of mental health difficulties suffered by students, but we do know that the typical student demographic, aged between 18 and 25, is particularly vulnerable to developing mental illness. For those outside this core demographic – part-time and mature students – we know very little at all about the extent of mental illness and low wellbeing.
Students cite stress, relationships and the difficulty of living away from home as reasons why mental health issues flare up. However, there are other potential reasons for stress, anxiety and depression which have been hypothesised by a number of reports. It is commonly assumed that students’ experience has become more stressful as fees and the cost of living have risen, access to loans and grants has been constricted, and the competition to achieve high marks in a competitive graduate market has become even more important. But no firm causation has been proven. The NUS research highlighted perceived problems with the transition to university and moving away from home, whilst the Unite research focused on loneliness and isolation.
HEPI’s recent report on student mental health argued that university support systems for mental health difficulties have a number of weaknesses. The paper argues for a more seamless experience for students, including better training for staff on mental health issues, better signposting for students and a more robust review of current mental health provision. HEPI hosted roundtables in the subject at both the major party conferences – that attention is turning to mental health in the political arena is an important sign and may usher in a more practical dimension to handling student wellbeing. Jo Johnson even mentioned the issue in the Higher Education and Research Bill Committee:
It is vital that universities take full responsibility for the wellbeing of their students, towards whom they have a duty of care. Ensuring that students are supported throughout their studies, including during difficult periods relating to mental health or other issues that cause them to need counselling services, is an important part of a university’s overall pastoral role.
Lurking behind proposed solutions to address this challenge is the matter of funding. Financial obstacles have made meeting demands for mental health services more difficult, particularly as students mental wellbeing is the dual responsibility of institutions and the NHS, which has a tighter budget as a result of cuts. Mental health support in the UK as a whole is severely underfunded, receiving only 13% of the NHS budget despite being 28% of the burden of disease. The rising interest in student mental health seems to be linked to concerns about growing cuts in NHS services. According to HEPI, students who need specialised mental health services can take several months to be seen by their GPs. However, as many students move between university and home on a regular basis, they can be put to the back of the queue if they are not in the right place when a space opens ups. HEPI recommends that all students should have access to two GPs, one at home and one at university, so that students are covered all year round.
HEPI also recommends that some universities triple the amount they spend on mental health services, and the limited funding available was also addressed in a HEFCE report last year. HEFCE found that university funding for mental health services was not fully covered by the Disability Students Allowance, student opportunity disability funding (received from HEFCE) and universities’ central funding. Institutions noted that it was difficult to predict how much money would need to be set aside year on year, as the numbers reporting specific mental health conditions and demand for services varied. HEFCE recommended that universities should endeavour to ensure that students with mental illnesses, or those at risk, report them before they arrive at university. This would also make universities’ structured care plans for students more personal and appropriate for individual students’ needs, as well as improve budgeting and planning.
Concerns about retention rates inevitably inform the debate on student mental health. A recent report by the Social Market Foundation on student retention shows that universities still have work to do to ensure that the most vulnerable and disadvantaged students feel able to complete their courses. When students drop out, universities lose their fees; this is a cynical imperative for well-staffed mental health provision for students but nevertheless a real one. TEF, which will include assessment of retention rates, will also provide a new onus for providing sufficient support and services.
Besides practical matters of finance and retention, the extent of universities’ work in pastoral care is not without its critics. Whilst Sir Anthony Seldon, vice chancellor of the University of Buckingham, has advocated the role of schools and universities in teaching happiness and self-sufficiency to students, others are more cynical. Frank Furedi of Spiked Online (and many jaundiced newspaper columns) instead argues that students are responsible for their own happiness and wellbeing, and universities should play no part in directing it or interfering.
Furedi perhaps does hit on one more widely accepted insight: that self-sufficiency and resilience is crucial for ensuring that students are able to meet their academic potential and maintain their own wellbeing. The aforementioned Unite report found that students were likely to develop good mental health through developing confident feelings, a support network, emotional resilience and felt able to turn to university services for help. However, feeling able to turn to university services for assistance was the lowest priority of students when developing good mental health. Universities should endeavour to find out why, and how they can strengthen confidence in student services, but this finding perhaps suggests students’ determination to be self-supporting and self-reliant; a far cry from Furedi’s howls that today’s students are mere “snowflakes”.
Peer support projects are one area where universities are investing new resources. These student networks can act as a linchpin between informal and formal services. Peer support can take many forms, including mental health societies, buddy systems, and the Nightline service. A 2015 report by Student Minds and NUS recommended that informal peer networks should integrate into formal university student services, as well as provide signposting for the counselling service, GPs and other relevant professional forms of support.
Despite these recommendations to universities to better identify and support students with mental health issues with solid care plans, many current problems with mental health provision lie in funding. Without more funding made available, progress will be slow, and university leaders must consider whether support services should take priority over other pressing needs. Nonetheless, there are many cost-effective and innovative methods by which universities can engage more fruitfully with the student population and build a stronger relationship with those who are in need of help.