The announcement earlier this year that UK universities may be graded on their ability to deliver improved student mental health and wellbeing outcomes positions universities as providers of mental health care as well as providers of adult education. [1] However, there are implications of reframing universities as mental health care providers and we question whether or not such a model is feasible and indeed in the best interest of university students.
University can be a time of heightened stress and anxiety for students. [2, 3] For the majority of students, university is a time when they are also navigating early adulthood. For all students, it brings additional demands and challenges. These challenges are associated with students reporting high levels of psychological distress, but not higher rates of mental illness than their non-student peers. [4,5] While current university support services are designed to help distressed students, they are not designed to treat mental illness.
As the proportion of young people attending university increases so too do the demands placed on student counselling services. The majority of university student counselling and wellbeing services provide short-term support. When a student requires treatment for mental illness, students are referred to NHS services. Currently referring students to health services is not straightforward—NHS services are not set up to manage the atypical needs of the student population, such as their transient nature, or the ebb and flow of the academic year, with specific periods of heightened anxiety. Students routinely fall through the gaps and are lost to the system. [6] Like other members of the community, delays in treatment can leave students with mental illnesses without appropriate support, which can impact on their learning and functioning and lead to further psychological deterioration.
Universities are adult education providers. As providers of adult education, they design and implement healthy and supportive learning environments and promote activities that underpin learning, emotional, and psychological stability. For example, universities might offer advice on sleep, nutrition, physical activity, and stress management. Most universities aim to: a) provide counselling and other student support services; b) work to reduce the stigma of mental illness; c) make reasonable adjustments to support students with mental illness complete their studies; and d) where appropriate, refer students to specialist health services.
“Mental health” is not independent of healthy environments, responsive parenting, having a sense of belonging, healthy behaviours (sleep, exercise, nutrition), coping, resilience, and treatment of illness. [7] Many students face pressures that are situated outside of their university life including limited finances, inadequate accommodation, social problems, cultural complexities, history of traumatic childhoods that contribute to problems with interpersonal relationships, unhealthy coping strategies, or poor lifestyle behaviours. These can make it difficult for students to engage in and excel in university studies. It is simplistic to assign the responsibility for improving the mental health of young adults—who are also students—to adult education providers. It is unrealistic to expect adult education providers to become health care providers. They have neither the skilled health and social workforce or the funding to address the complex biological, psychological, and social factors associated with mental illness.
Attempting to alter the role of universities without appropriate infrastructure and governance frameworks will undermine the relationship universities have with their adult students. Part of the government proposal is that universities get blanket permission from students at enrolment for the university to contact students’ parents if and when universities deem it necessary. This arrangement is akin to what might be done when a child is in nursery, primary, or secondary education; here the difference being students are adults who legally have the right to confidentiality and self-determination. It is difficult to envisage ethically and legally obtaining blanket informed consent from students that may be used at some unspecified time in the future in response to some unspecified event. Health professionals, including counsellors, routinely use expertise to assess whether a person is at risk to themselves or others and connect the person with appropriate or more intensive support. To break confidentiality in any other circumstance is unethical and illegal and undermines the autonomy and self determination afforded to all other adults in the UK.
It is important that universities care for students by providing healthy learning environments, working with students to develop healthy coping strategies, and connecting students with specialist health services, as needed. Positioning universities as health care providers is not feasible nor in the best interest of university students. The needs of students will be best met by enabling universities to continue their role as promoters of health and wellbeing, enabling NHS services to adequately meet the mental health needs of students, and by facilitating increased collaboration and co-production of services between universities, the NHS, and other healthcare providers. Only with increased collaboration and government investment in student mental health services will the needs of the UK student population be met.
Helen Stallman is a clinical psychologist, hospital research foundation fellow, and director of the International Association for Student Health and Wellbeing. She is a specialist in the development and evaluation of interventions aimed to optimise health and wellbeing.
Bridgette Bewick is a associate professor and chartered psychologist, specialising in monitoring, managing, and modifying mental health and wellbeing of young people.
References:
- Department of Education. New package of measures announced on student mental health. Accessed 29 June 2018 https://www.gov.uk/government/news/new-package-of-measures-announced-on-student-mental-health. 2018.
- Bewick BM, Bill J, Mulhern B, Barkham M, Hill AJ. Using electronic surveying to assess pyshcological distress within the UK student population: a multi-site pilot investigation. E-Journal of Applied Psychology. 2008;4(2):1-5.
- Cooke R, Bewick BM, Barkham M, Bradley MM, Audin K. Measuring, monitoring and managing the psychological well-being of first year university students. British Journal of Guidance and Counselling. 2006;34(4):505-17.
- Stallman HM. Psychological distress in university students: A comparison with general population data. Australian Psychologist. 2010;45(4):249–57.
- Cvetkovski S, Reavley NJ, Jorm AF. The prevalence and correlates of psychological distress in Australian tertiary students compared to their community peers. Australian & New Zealand Journal of Psychiatry. 2012;46(5):457-67.
- Universities UK. Minding our future: Starting a conversation about the support of student mental health: Author; 2018.
- Stallman HM. Coping planning: A patient- and strengths-focused approach to suicide prevention training. Australasian Psychiatry. 2018;26(2):141-4.