When he started working at Brunel University London 19 years ago, Terry Vass, who is now head of security, recalls that most of his work involved breaking up drunken fights outside the bars and nightclub on campus. Over the two decades he has been in the job, he has noticed a shift. Now, an increasing number of calls are for mental health incidents.
The worst times are at the start of term, when students are adjusting to being away from home, or over the holidays, when the small number who remain on campus may feel lonely and isolated. Increasingly, Vass’s security team are called out to mental health emergencies, sometimes accompanying suicidal students to A&E and staying with them. “We spend as much time as it takes,” says Vass. On occasion, he has spent six hours with a student in distress.
British universities are experiencing a surge in student anxiety, mental breakdowns and depression. There has been a sharp rise in students dropping out – of the 2015 intake, 26,000 left in their first year, an increase for the third year running – and an alarming number of suicides. In the 12 months ending July 2017, the rate of suicide for university students in England and Wales was 4.7 deaths per 100,000 students, which equates to 95 suicides or about one death every four days.
The crisis in student mental health hit the news in 2017 after a high number of suicides at Bristol University. Over 18 months, starting in October 2016, 12 students are believed to have killed themselves. While the university tried to tackle the crisis, it struggled to keep up with the rising demand for help. In November 2018, a group of students gathered on a chilly Bristol street holding placards demanding better access to psychological support. The students told reporters that despite promises of more investment in student wellbeing, services were still badly overstretched.
Ruth Day, who helped organise the protest, had been suspended for eight weeks under a rule which says students can be sent home if they are considered unfit to study, or their presence poses a risk to themselves or others. Day said being suspended made her feel “terrified” and “hopeless”. Just a few months earlier, in April 2018, Natasha Abrahart, a 20-year-old physics student at Bristol who suffered from severe anxiety, killed herself on the day she was due to have an oral assessment. Her parents said they would take legal action against the university for failing to offer Natasha an alternative to the oral test, which she saw as an unbearable ordeal.
Students around the country feel their universities are failing them. On World Mental Health Day in October 2018, students at University College London disrupted an open day with a demonstration about waiting times for counselling. In March this year, Goldsmiths students occupied Deptford town hall, calling for better access to counselling for BAME students. Student protests and demands for better mental health services are frequently dismissed in the press. “We just can’t cope with essay deadlines, and tests stress us out, moan ‘snowflake’ students,” read a headline in the Daily Mail in November 2017. In September 2018, the Times described today’s students as “Generation Snowflake” and suggested that “helicopter parents” had “coddled the minds” of young people. Meanwhile, some university staff worry that teaching is having to come second to supporting students’ emotional needs.
“One of the most worrying phenomena that many of us have witnessed in recent years is the rise of chronic anxiety, that afflicts some students so deeply that they feel unable to come to the campus at all,” says William Davies, lecturer at Goldsmiths and author of The Happiness Industry, a book about the commercialisation of wellbeing. “Above all, a growing proportion just seem terrified of failure, and experience the whole process of learning and assessment as an unforgiving ordeal that offers no room for creativity or mistakes.”
Given that about half of young people in the UK now go to university, the number of students seeking help inevitably reflects a wider crisis in young people’s mental health. One study found that six times more young people in England (aged four to 24) have psychological problems today than a generation ago, in 1995. Budget cuts to social work, youth services, the NHS and state schools over the last decade mean that many young people experiencing problems do not get any help at all before they reach university, where they meet a new set of challenges.
“Universities are just a reflection of what goes on in the whole society,” says Irene Stone, a counsellor at Brunel University. “There are a lot of demands on young people today. The pressure is shifting on how we work – now we don’t just have one job, we juggle three. There are pressures of technology, managing social platforms, forming relationships. It can all cause a lot of anxiety and stress.”
The University of the West of England, Bristol, recently released a report into the deaths of the 14 students who took their own lives there between 2010 and 2018. It found that half of the suicides occurred between January and April, when students were preparing for exams.
In the drive to make universities profitable, there is a fundamental confusion about what they are for. As a result, there has been a shift from prizing learning as an end in itself to equipping graduates for the job market, in what for some can be a joyless environment.
Expectations have changed radically over the last two decades – not least because students paying thousands of pounds in fees expect a certain level of service in return. I spoke to academics around the country who expressed their own anxiety that they might miss a vital sign that one of their students is struggling. “It’s extremely stressful to have this extra responsibility that we aren’t really equipped for, especially when many of us are already operating in an atmosphere of uncertain working conditions,” said one academic.
Of course, universities have a duty of care to their students, but as the situation stands, we are expecting them to fill the role of parent and therapist as well as educator. These are institutions under terrible strain, striving to adapt to new demands. The question is not only whether they can fix the crisis in young people’s mental health, but whether it is their job to do so.
Ever since Tony Blair pledged in 1999 to get 50% of young people into university, “widening participation” has been a political priority. It has more or less been achieved: in 2017, official figures showed that 49% of people in England entered advanced studies by the age of 30. University degrees have become a requirement for many jobs which previously allowed people to start as school-leavers and work their way up.
At the same time as access to university was dramatically expanded, spending on public services was slashed: in the decade after the financial crash, day-to-day spending on public services as a share of GDP was at its lowest since the late 1930s. This meant savage cuts to local authorities, schools budgets and NHS mental health provision. Figures released in November 2017 showed that two-thirds of under-18s referred for specialist mental healthcare in England were not receiving treatment, while there had been a 30% fall in hospital beds available for acute mental health conditions since 2009.
In search of a cause for the dramatic increase in mental health problems among young people, studies have looked at the impact of social media, or lack of sleep caused by electronic devices, as well as the effects of an uncertain job market, personal debt and constricted public services. In his book Kids These Days: The Making of Millennials, Malcolm Harris argues that far from the stereotype of young people being entitled and narcissistic, millennials are harder working but poorer than their parents’ generation. Harris identifies the pressures of the labour market, rising student debt and a target-driven culture as contributing to steep increases in anxiety and depression among young people. “Young people feel – reasonably accurately – less in control of their lives than ever before,” he writes.
With about half of 18-year-olds now going to university, inevitably that population will follow the same patterns as the rest of society. “And some of their cases are very complex,” says Steve West, vice-chancellor of the University of the West of England and chair of the mental health working group for Universities UK (UUK), the steering body for British universities.
The Office for National Statistics produced a report on England and Wales last year which found that in the past, students were less likely than the general population to commit suicide, and that the recent spike had merely brought them more in line with the rest of the population aged under 24. If universities once provided a respite from the pressures of the world of work, they no longer do. Now they compete with one another for students and the hefty fees they pay.
In 1998, universal free higher education ended: fees of £1,000 per year were introduced, and maintenance grants were replaced with loans to be paid back when the student started earning more than £10,000 a year. Since then, costs have risen. In 2006, fees were raised to £3,000 a year. In 2012, this went up to £9,000. In 2017, the cap went up to £9,250, and is expected to keep rising. The average student now leaves university with about £50,000 of debt.
“Driving our universities to act like businesses doesn’t just cannibalise the joy of learning and the social utility of research and teaching; it also makes us ill,” wrote Mark Crawford, then a postgraduate student union officer at UCL, in a 2018 piece for Red Pepper magazine. When I spoke to Crawford, he reeled off a list of ways in which university, as it is structured, can worsen student mental health. “It’s self-worth being reduced to academic outcomes, support services being cut, the massive cost of housing,” he says.
When Crawford was working for the UCL student union – from 2016 to 2018 – it launched a petition for the university to improve mental health services, which got 2,000 signatures within a week. The campaign drew a direct link between the university’s large overall budgets and its low spending on mental health services. “Universities enact policies and a structure of learning that encourages poor mental health among students while at the same time underfunding services that could offset the consequences,” Crawford told me. After the students’ campaign, UCL agreed to hire three more counsellors.
But the problems cannot all be solved with more counsellors. William Leahy, Brunel’s deputy vice-chancellor, has been closely involved in his university’s efforts to improve mental health support. He points out that starting university might be the first time many students access any kind of psychological help. “We have seen unbelievable underfunding of secondary schools over many years – and not just schools but social services, youth clubs, all those services that used to be preventative, they’ve all gone.” This places an extra burden on universities to take on the responsibilities of the health or social services.
Successive prime ministers have urged more young people to go to university, with the promise of a better job at the end of it. But given the sluggish state of the economy since the 2008 crash, and the scarcity of graduate-level jobs, the connection is hardly clear. “The context of stagnating job markets can make university seem like a three-year job application,” says Crawford.
Many lecturers I spoke to noted that their students place intense pressure on themselves to get a first-class degree or to take on extra commitments so that they can stand out from the crowd. Some can’t keep it up. Dropout rates have increased every year since 2015, with high fees and lack of support for disadvantaged or troubled students cited as two possible reasons. At the worst affected universities one in five students drop out before the end of their first year.
“Clearly university and essay writing have always produced stress, but I do think something new has appeared since the fees and debt rose so sharply, which raise the stakes to a whole new level,” says Davies, the Goldsmiths lecturer. “Very few students respond to this as the government would like – as demanding consumers – and a large number simply shrink from the situation, or drop out altogether.”
Brunel University, on the outer edge of west London, is one institution where the shockwaves of government policy are felt. Built in the 1960s, it has been subject to all the drastic changes the university sector has undergone, but is not part of the elite Russell Group, so its student intake tends to be from a broader range of backgrounds, some with complex needs. Like other universities, it is struggling to deal with increasing mental health problems among students, and in the last few years it has been forced to rethink its mental health provisions, making it easier to access counselling and mentoring, and training lecturers and other staff in mental health first aid.
When Sean Cullen started at Brunel in 2014, he knew that he would need support: a serious motorcycle accident during his gap year meant that he could not walk. Before moving on to Brunel’s campus, he discussed wheelchair access with the university. “I was incredibly pleased,” he told me when we met at a bustling coffee shop on campus. “They had everything in place, so I didn’t need to worry.” He settled into university life, but the same day-to-day pressures that affected most of his peers – deadlines and money management – began to feel overwhelming.
“It was a combination of lots of different things at once,” he recalls. “Stress of studying, worry about the future. I found myself constantly feeling like I should be doing something, but the thought of doing any of those things made me stay doing nothing.” He tried to access the university counselling service, which at that point was run on a drop-in basis, so he could not make an appointment. There was a long queue and he wasn’t seen. In the end, despairing of seeing a counsellor face to face, he sought support from an online forum.
“Student terms are quite short,” says Lesley O’Keeffe, deputy director of academic and student services at Brunel. “If you’ve got a four- or five-week waiting list, it might not sound very long, but that’s half a term. The amount of living they can lose in that time is quite significant.”
Cullen, now 24, was struck by the contrast in the care he had received for his physical and mental health. “You can see physical disabilities, so it’s a lot easier to fix the symptoms. You’re in a wheelchair, you can’t climb stairs, so we’ll provide a lift: job done,” he says. “But if you’ve got anxiety and are struggling to go to classes – well, there’s no short answer.”
A greater number of young people arriving with more complex home situations, who have not managed to get help in the NHS, means that universities are facing a perfect storm. Joyce (not her real name) is 25, a second-year undergraduate student at Brunel. She is studying a science subject, which she likes partly because of the order it represents. “In life, you come across problems you can’t find a solution for, but when it comes to numbers and data, you normally always find a solution,” she told me when we met at Brunel on a snowy day in January.
In her own life, she has often experienced problems with no solution. Joyce, who grew up in London, had an abusive childhood, and is now completely estranged from her family. Undergraduate living has been challenging for her. At first, she moved on to campus, but found it intensely stressful living in halls, in close quarters to people in relationships, couples fighting, flatmates bickering – all the complications of cohabiting. “My adult brain had to deal with the childhood stuff that it had locked away,” she says.
Now she rents privately in the area. Her living costs are not covered by her termly maintenance loans, so she works several different part time jobs on zero-hours contracts. Added to the daily stress of exams and deadlines, this is a gruelling schedule. “At the moment, all I do is study and work,” she says.
Brunel, like most universities, has a range of social activities – from club nights to prayer groups. But over the last couple of years, Cullen and the rest of the student union staff have noticed a fall in participation. It’s getting harder to fill up events, most likely a symptom of the sharp increase in students living far away from campus to save money – over 50% of the student body now commute. Many opt to live with their parents, as much as two or three hours’ drive away, to save money. Others have limited time as they juggle studies with paid work. It is another sign of the pressure weighing on students that they allow themselves less time for fun.
Over the last two years, many universities have taken steps to reduce waiting time for counselling, launched courses on managing stress and anxiety, made support services easier to access, and tried to make students more aware of what is available – although Steve West at UUK acknowledges efforts are “variable”. Some, including Birmingham University and the London School of Economics, did not have a procedure for dealing with students’ mental health problems as late as last year. Some universities are increasing funding for wellbeing and counselling services: at Bristol, spending doubled from 2016 to 2017.
Counselling may be helpful for many people, but it can’t address the stresses built into university life, which can compound mental health problems or create new ones. For Cullen, money worries have been a grinding and ever-present aspect of his university experience. In addition to the £9,000 in tuition fee loans, he has received between £7,000 and £8,000 each year in maintenance loans for living costs. Generally, this just about covers the cost of rent, leaving little to live on. “You learn fast as a student what’s the bare minimum you can get away with,” he says. In his first year, he socialised more than he does now. But given that a single night out costs as much as a weekly food shop, he soon began to think twice about going out with friends. To complicate matters, the amount he receives from Student Finance England, the body responsible for student loans, changed year by year, with unpredictable amounts and repayment terms. “The financial aid is getting worse and worse, even though the cost of living is going up,” he says.
In 2017, Cullen was elected as the student union’s disability officer. As well as advocating for disabled students, this meant helping with the union’s Advice and Representation Centre, where students can come for advice on housing, mental health and academic or financial problems. He heard accounts of mental health problems from hundreds of other students, many of whose experiences chimed with his own. “I’ve not yet met a student that hasn’t experienced high levels of stress while studying, whether it’s because of deadlines, balancing paid work, or problems with housing,” he says.
While many students survive more or less on their overdrafts, Cullen has noticed that many have mental health problems in their final year. “Nowadays, getting a degree doesn’t necessarily guarantee you a job, or not a better job than without one,” he says.
According to a 2014 report, a significant number of students (45%) do paid part-time work alongside their studies, with 13% doing a 35-hour week. Inevitably, this has an impact not only on academic performance but on students’ ability to fully participate in university life. “We sometimes get students coming to lectures having just done a night shift, and we can see they’re tired and might not be in the best frame of mind to be learning,” says Michael Thomas, a lecturer in social work at Brunel.
Students exhausted from working while studying full time, and still struggling to cover their basic living costs, are bound to be more anxious about deadlines and exams. “It’s all the environmental stuff that makes it more stressful,” says Thomas. “If you’re tired, you haven’t had time to study, you have to make a long journey to university, it’s all cumulative.”
Some of the more attention-grabbing measures that universities have introduced do nothing to address these fundamental questions. This year Bristol University introduced a course in the science of happiness, a unit that, alongside lectures, will include happiness “exercises” to be practised for a week at a time, such as sleeping more, meditation, savouring enjoyment and performing random acts of kindness. It can count towards a degree. In the past few years, Cambridge, Brunel, London Metropolitan and Warwick, among many others, have organised “therapy pets” for exam periods – dogs, cats and guinea pigs that students can pet to ease their stress. To augment overstretched counselling services, many universities run free yoga or mindfulness courses.
“Often these measures are being done instead of properly funding mental health services,” says Crawford, the former UCL student. “Universities are competing for students. Therapy dogs look nice and are cost-effective. It’s insulting.”
Even if they are helpful for some people, such measures can only provide short-term relief, as Leahy, the Brunel deputy vice-chancellor, acknowledges. “In one sense, the system inherently pressurises people, while at the same time you’re saying, ‘chill out, relax, it’s all fine’.”
After the rise in suicides, in 2017 a national strategy was launched by UUK, giving out new guidelines to help universities improve the way they handle mental health. The guidance gave a boost to work that was already being done at Brunel. While two years earlier Cullen had found the system hard to navigate and slow, the process had been improved. “Our waiting lists are better, students can see the right person quicker, or multiple people if that’s what they need,” says O’Keeffe.
While Brunel has made a concerted effort to invest in student mental health services and reduce waiting times, across the UK this is patchy. Former health minister and mental health campaigner Norman Lamb recently gathered information from 110 universities, and found that many do not even record their counselling waiting lists or budgets for support services. He told the BBC: “If we are operating in a fog, if we have no idea how long students are waiting … this is putting students at risk. We know from the data that the longest waiting times could be over half a term for some students. We know also that there have been some tragedies among some student populations – students who have taken their own lives. If that happens while they are waiting for support, that’s utterly intolerable.”
When Leah (not her real name) started at Brunel in autumn 2018, she thought carefully about disclosing her history of bipolar disorder and anxiety. She was in her mid-30s and had spent much of the previous decade in and out of hospital. She had been sectioned more than once. Brunel, where she is studying for a postgraduate degree, was going to be a new start. “I don’t want to deal with other people’s prejudices as well,” she told me when we met in a quiet room on Brunel’s campus. “I’d rather just be accepted for who I am.”
This is not an uncommon dilemma: a key part of the new strategy is for universities to encourage students to disclose that they have a problem. Teachers and staff I interviewed said many of their students worry that telling the university about their condition might adversely affect their degree result. Leah, who rents a flat some distance from the campus, doesn’t talk to her peers about her condition, but she did disclose it to the university. When she started at Brunel, the new strategy for dealing with mental health had been in action for a year, and things went smoothly. She was set up with a counsellor and a mentor, who helps her manage her time and offers practical advice.
A few weeks after starting, Leah found herself sitting in the library, completely overwhelmed. Her mind was whirring: had she expected too much of herself by coming back to university? Should she quit? How would she bear the shame of telling her friends and family she couldn’t manage it? She spoke to her mentor, and in a very short space of time they had helped her to switch to a part-time master’s, meaning that her course would be spread over two years rather than completed in one. That also meant she could get a part-time job.
Leah’s problems first surfaced when she first went to university. She was younger then, and less sure about what help she needed or was entitled to. “It’s one thing needing the support, and another being aware that you need it,” she says. Although graduating was a triumph, the following eight years were often harrowing, with Leah in and out of hospital as she struggled to manage her condition.
Having decided to return to university, Leah was anxious about how she would cope with the stress – she likes to keep busy, but stress can trigger manic episodes. But she has been pleasantly surprised. It has actually been easier to access certain kinds of support than it was outside university. “There’s a lot of cuts in the community, and I’ve been on a waiting list for NHS counselling for years now,” she says. At Brunel, she sees a counsellor regularly.
When communication between university and health service works, it can provide valuable support. Leah is still supported by a mental health crisis team in her borough. The university is in touch with the team and can inform them if they have concerns about Leah, and vice versa. “No matter how well put together I am, that vulnerability is still there,” she says. “But I have a safety net to catch me if anything does go wrong.”
Everyone I spoke to in university administration around the country viewed mental health support as part of their duty to students, but they are struggling to meet the need. “We’re not residential care and we don’t have live-in staff,” says O’Keeffe at Brunel. “Sometimes there’s an expectation, even by our local services, that we can do more than we can do. We’re not here to give medical treatment or take the place of the NHS. Our aim is to get everyone to achieve the best they can. Everyone here at some point wanted to get a degree. If that desire is still in them, that’s what we try and work with them for.”
Yet even as university mental health provisions slowly improve, the particular stress of university life continues. “At the end of the day, it doesn’t matter what a counsellor says to you if you can’t afford to pay your rent,” says Crawford. “The way universities currently operate is manufacturing conditions that create poor mental health. So at the very least, they should invest some resources so that everyone can be seen and supported.”
In the UK and Ireland, Samaritans can be contacted on 116 123 or email [email protected] or [email protected] In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at www.befrienders.org
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