Mental health of students in higher education

College Report CR166International students’ attitudes to, and expectations of, mentalhealth services will reflect the diversity of experience that they bring fromtheir home countries. At one end of the spectrum, students from the USAwill often come to the UK on multiple medications for depression, ADHDand other psychiatric diagnoses. The threshold for medication use in suchconditions in the USA tends to be lower than in European countries (Zitoet al, 2008). A UK psychiatrist or GP will often come under considerablepressure to support continued prescription of these medications even if he/she doubts the wisdom of this. Students from North America may also haveextensive experience of counselling and therapy and expect that this will beeasily accessible. On the other hand, in other cultures there is sometimesa high level of stigmatisation associated with mental illness. Students maybe reluctant to admit to mental distress and to seek help. In some cases,psychological problems will lead to ‘somatisation’, that is the expression ofpsychological distress in the form of physical symptoms such as headaches,insomnia and gastrointestinal symptoms.International students will not usually be familiar with the workingsof UK mental health services. They may not have a clear understanding ofthe various roles of psychiatrists, psychologists, counsellors, communitypsychiatric nurses and others. They may also have misapprehensions abouthow to gain access to treatment.With regard to social relationships, international students are mostlikely to associate with students from their own country. Failing this, theytend to make friendships with other international students. They are leastlikely to associate with local students.There are four broad ways of relating to a majority culture:assimilation: the person becomes as much like the majorityculture as possibleintegration: adjustment to the majority culture and adoption ofsome of its aspects while retaining the attitudes and behaviour ofthe student’s culture of origintraditional approach: the student retains primary identificationwith his/her original culture and rejects the majority culturemarginalisation: the student becomes socially isolated, rejectingboth original and new cultures.There is some evidence that students do best with integration or thetraditional approach. Those who attempt to assimilate fully seem to do lesswell and those who become marginalised do worst of all.Students whose first language is not English can be at a disadvantagein relation to others. If English language proficiency is inadequate, this canlead to a range of problems. The most obvious of these is a detrimentaleffect on academic performance. Students may find it difficult to understandlectures, take notes and complete assignments such as essays. Theymay underperform in examinations. They can find it difficult to speak upin tutorials or to ask questions. A poor grasp of English can also make ithard for students to integrate into the host culture and to engage in socialinteractions.Vacations can create problems for students who are unable to returnhome. The Christmas vacation may be especially difficult. There may bedeadlines for examinations or course work. The international student maybe faced with cold, wintry weather and short days for the first time in his/62 http://www.rcpsych.ac.uk