Mental health of students in higher education

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IntroductionThere are a number of barriers on the pathways to care which areparticularly applicable to the student population. Some students, particularlyinternational students, may be sensitive to the fear of stigmatisation.There may be long waiting lists for services such as clinical psychology andpsychotherapy. Achieving access and maintaining continuity of care can bedifficult when students are in one place during term time and return homeor go elsewhere during vacations.We will discuss how the efforts of NHS services and those providedby higher education institutions might be better coordinated. Although theytend to focus on different parts of the spectrum of psychiatric disorder, thereis a large overlap between the activities of these services and considerablescope for improvements in collaborative working. There will be a need togive consideration to developing appropriate protocols for the sharing ofconfidential and sensitive information.Since the publication of the previous report in 2003, the concernshighlighted there have shown no sign of abating and in many respects havebecome more pressing. The demand for counselling and mental healthadvisor services continues to rise as the percentage of school leaversentering higher education increases. The student population is becomingincreasingly diverse and some of this diversity is creating new pressures oncounselling and mental health services. At the same time there have beenchanges in universities and other higher education institutions which havemade them less able to cope with mental disorders in students. Staff:studentratios have declined through failure to increase staff numbers in proportionto the increase in numbers of students. Academic staff are under constantpressure to maintain and improve research output as well as to develop theirteaching. It seems likely that pressure on public finances will exacerbatethese problems in the next few years.Traditional universities tended to be based on a single campus, withmost students living on campus or in close proximity to their institution.The majority of students lived away from home and were drawn from afairly homogeneous social background. In contrast, newer universitiesare often dispersed across multiple sites, often in large conurbations.Increasing proportions of students live at home and may have to commutelong distances to study. There is an increase in modular learning which canresult in students progressing through courses over differing timescales. Asa result, students may be less able to form stable relationships with theirpeers or academic staff. The personal tutor system, which used to play avery important role in offering personal and academic guidance to students,has been eroded in many higher education institutions.Students are subjected to the same risk factors for mental disorderthat apply to the general population of young people. Rates of familybreakdown have increased enormously over the past few decades. Whenparents separate, the resources of the family are more thinly spreadand there may be less financial support available for a young person atuniversity. Some students experience diminished family support followingparental separation as a result of the breakdown in the relationship betweenthe student and one or other parent.At the same time support for students from public finances hasdecreased drastically and student grants are largely being replaced byloans. Students often have to take part-time work in order to meet theirbasic needs. This detracts from the time and energy available for academicstudy and personal development and places some students at an unfairdisadvantage in relation to their more affluent peers. Students who areRoyal College of Psychiatrists17
College Report CR166managing mental health difficulties can experience financial disadvantageif they have to repeat modules or years of study. They may be less able tocope with the demands of both study and work.Students are at a stage of transition between dependence andindependence. Many have to cope with the stresses of moving from hometo university at an age when they are negotiating significant developmentalchanges. They may have to adjust to the change from an educationalcurriculum that is structured and closely supervised to one in which theymust take a more active role in managing time and planning their studies.On the plus side, there are new opportunities for developing friendshipsand pursuing social, recreational and sporting interests. The higher educationenvironment offers a wide range of easily accessible student supportservices. Students may be more able than others to benefit from psychiatricand psychological help, especially psychotherapy. They are usually bright,articulate and knowledgeable. They are more likely to be psychologicallyminded and curious about themselves. Times of change can presentopportunities for growth and maturation as well as presenting challenges.If attention is paid to ensuring that the higher education environment andrelationships are conducive to enhancing mental well-being, many difficultiescan be ameliorated. Higher education may offer benefits to students witha history of mental illness or psychological difficulties. It can provide newsources of self-esteem and opportunities for engagement with peers andthe wider society. Students are at a stage in life when the future is opento a range of possibilities. If problems that arise are caught early, it maybe possible to set someone on a path in life that is more positive and lessfraught with difficulties.We have attempted to produce a report that will be of practical helpto those who are attempting to improve the care and treatment of mentallytroubled and vulnerable students. We hope that the report will also assisthigher education institutions and others who are seeking to establish policiesand procedures for the prevention of mental disorders. To this end, we haveconsidered the need for professions to work collaboratively to ensure thatservices are efficient and effective. We have described the role of counsellingand mental health advisory services. A series of papers which describe arange of initiatives that have been developed across the country have beenappended. We hope that others will be inspired to emulate these.18 http://www.rcpsych.ac.uk
Page 1 and 2: Mental healthof studentsin higher e
Page 3 and 4: DisclaimerThis guidance (as updated
Page 5 and 6: Working groupPrincipal contributors
Page 7 and 8: AcronymsAMOSSHE, Association of Man
Page 9 and 10: College Report CR166Epidemiological
Page 11 and 12: College Report CR166Care pathwayThe
Page 13 and 14: College Report CR166Psychiatrists w
Page 15 and 16: College Report CR166Promotion of Me
Page 17: IntroductionThe purpose of this doc
Page 21 and 22: College Report CR166Students who ex
Page 23 and 24: College Report CR166Students must a
Page 25 and 26: College Report CR166of postgraduate
Page 27 and 28: College Report CR166alcohol use. Fo
Page 29 and 30: College Report CR166driving, unsafe
Page 31 and 32: College Report CR166the first, the
Page 33 and 34: College Report CR166ConclusionsWhen
Page 35 and 36: College Report CR166undergraduates
Page 37 and 38: College Report CR166and the Institu
Page 39 and 40: College Report CR166body. The EHRC
Page 41 and 42: College Report CR166and provision o
Page 43: College Report CR166consultation to
Page 46 and 47: Higher education contextConclusions
Page 48 and 49: Higher education contextMental heal
Page 50 and 51: Higher education contextHealthy Uni
Page 52 and 53: Higher education contextImproving h
Page 54 and 55: Pathways to psychiatric careIn coun
Page 56 and 57: Pathways to psychiatric careand is
Page 58 and 59: What to do if a psychiatric patient
Page 60 and 61: What to do if a psychiatric patient
Page 62 and 63: Mental health issues facedby intern
Page 64 and 65: Mental health issues faced by inter
Page 66 and 67: Medical and other healthcare studen
Page 68 and 69:
ReferencesAdams, T. & Moore, M. (20
Page 70 and 71:
ReferencesJumaian, A. (2001) Preval
Page 72 and 73:
ReferencesSocial Exclusion Unit (20
Page 74 and 75:
Appendix 1understanding of, student
Page 76 and 77:
Appendix 2Internal liaison within h
Page 78 and 79:
Appendix 3Different models of psych
Page 80 and 81:
Appendix 3see this as a step forwar
Page 82 and 83:
Appendix 4I have also been involved
Page 84 and 85:
Appendix 5University general practi
Page 86 and 87:
Appendix 6Initiatives from counsell
Page 88 and 89:
Appendix 6The Westminster mentoring
Page 90 and 91:
Appendix 6to the volunteer and then
Page 92 and 93:
Northampton Assessment CentreUniver
Page 94 and 95:
Appendix 8AimsThe aims of the MWBHE
Page 96 and 97:
Appendix 8Current projectsThe group
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Mental health of students in higher education

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