“More students than ever are reporting mental health conditions,” says the Office for Students (OfS), introducing its latest insight briefing on mental health.
The data in the report seems to bear out the claim: the proportion of full-time students declaring a mental health condition on entry to the university has more than doubled in five years, rising from 1.4 per cent in 2012/13 to 3.5 per cent in 2017/18.
These figures should be taken with a heavy pinch of salt: the nature of self-reporting, the timing of the collection, and the student population involved, combined with cultural beliefs around mental health and wellbeing that are in flux means the data could be under-reported due to stigma, or demographic bias.
But – and this is not considered – it could also be over-reported. Though OfS strives to differentiate between (diagnosable) mental health conditions and generalised mental ill health or distress, it’s not clear that students always make that distinction.
OfS is understandably concerned to ensure that universities take seriously their responsibility to facilitate access for students with diagnosed mental health conditions. The evidence presented supports the view that mental health conditions can interact with other circumstances such as socio-economic status, ethnicity and gender to put up additional barriers to student success.
This matters, and it’s something universities should take seriously. Conditions like bipolar disorder or eating disorders take great strength to live with every day, and the impact of mental health conditions on access to education, or their interaction with other forms of inequality, are still not sufficiently understood.
But although OfS data focuses on declared mental health conditions, it’s strongly implied that the growing pressure on university services is being driven not by students with mental health conditions, but by the rising incidence of mental ill-health in the student population.
Crisis of mislabelling
When only 16 per cent of undergraduates surveyed in the Hepi/AdvanceHE 2019 student academic experience survey were able to claim they have low levels of anxiety, and only 14 per cent of postgraduate researchers surveyed in PRES 2019 claim the same, we’re either talking about an epidemic of mental ill health on a scale the world has never seen, or a category error.
In June I bumped into Simon Wessely, professor at King’s College London and chair of the review of the Mental Health Act at a London Higher event. Tellingly, he characterised the so-called student mental health crisis as a “crisis of mislabelling”. Sir Simon is on record as warning of the risk of medicalising normal emotions in well-meaning but unfocused attempts to raise awareness of mental health issues.
The consequence is twofold. Universities and students’ unions invest more and more in student services, awareness and initiatives to support students experiencing mental ill health, risking squeezing out tailored support for students with clinical mental health conditions.
And students learn to characterise their distressing, difficult and unpleasant emotions as mental ill health. It’s a vicious circle, and it’s enormously disempowering for students and for the professionals who are striving to support them.
Emotional park runs
A comparison with physical ill health isn’t perfect, but it serves to make the point. When the evidence shows that we can improve our physical health by eating more fruit and vegetables, and jogging round the local park, powerful actors invest in publicity campaigns encouraging positive action.
We don’t collectively invest in the notion that everyone is just unhealthy now and there’s nothing to be done except update our thinking and manage the problem – we strive to change it, both through individual action on physical fitness and looking at the conditions that discourage good physical health in the first place.
If we took the same approach to emotional health we’d encourage individuals to take evidence-based action to develop their emotional “fitness” and ability to cope with and manage difficult emotions such as intrusive negative thoughts, social anxiety or loneliness.
These are vital life skills, contributing to personal, interpersonal and professional success, but it’s rare that these are considered as an aspect of of the university learning experience. We’d break this into manageable steps tailored for beginners, akin to a couch to 5k programme, rather than expecting people to exhibit highly emotionally developed behaviours all at once.
We’d also seek to challenge the conditions that contribute to mental ill-health. The recent Equality and Human Rights Commission report contained numerous stories of students experiencing mental ill-health as a result of racial harassment and exclusion. It self-evidently makes no sense to medicalise those students, when their problems are structural and cultural.
Universities UK’s Step Change framework on mental health has “prevention” of mental ill-health and promotion of healthy behaviours as one of its core elements. Though we’d endorse the principles of the framework and what it signals about the value university leaders are placing on mental health, I’d suggest it should go even further in considering the integration of emotional fitness into higher education curricula and active design of emotionally healthy campuses.
We don’t think students should be happy all the time. But we do think there’s a growing evidence base that coping with the challenge and rigour of a university education means exhibiting emotional fitness as well as intellectual prowess. If emotional fitness helps more students feel confident to navigate university life, and allows student services to focus attention on the areas of greatest need, that’s a win for everyone.
This article was published as part of a series exploring student wellbeing in association with Fika.