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In terms of neurological development, the transition from adolescence to adulthood happens throughout the years when most students are at university, and beyond. It is also a peak period for learning, given the plasticity of the brain. Neuroscience has shed light on some of the cognitive processes involved (Blakemore, 2016). It is also the age when people are most at risk of developing mental illness. For common mental disorders (CMD), this applies mainly to women. CMD include generalised anxiety disorder, depression, phobias, obsessive compulsive disorder and panic disorder. In 2014, women aged 16-24 were the most likely to experience CMD, while for men, the same age group were the least likely to experience CMD (Adult Psychiatric Morbidity Survey, 2014). Of course, the difference may be partly explained by men being less prepared to seek treatment. But this would apply less to severe mental illness, and in the 16-24 age group, combining 2007 and 2014 in the same survey, the prevalence of psychotic disorder was 2.5 times higher in women than in men. This is the peak period for developing schizophrenia. Therefore, effective treatment of young people with first episode psychosis will be an investment that will pay off as they get older – in terms of both their health and economics.
The psychological barriers to asking for help appear to be coming down: data available from a Freedom of Information Request show a large increase in students seeking mental health support between 2013-2014 and 2017-2018. Out of over 100 higher education institutions that were approached, 16 gave comparable figures, representing a wide range of universities. In 2013-2014, the mean was 865 (SD 465) students seeking mental health support. In 2017-2018, the figure was 1,332 (SD 650), an increase of 53 per cent. (The size of the standard deviation reflects the range of university size). Over the same time interval, based on 12 institutions giving comparable figures, their counselling services increased the number FTE (full-time equivalent) counsellors from a mean 4.3 (SD 2.27) to 5.3 (SD 2.82), a 23 per cent increase. It seems that as a result, students may receive shorter courses of counselling (there are few figures available). However, the waiting time for a first counselling session is very good at most universities, compared to the NHS: in 2016 the average was 16 days for university counselling services and 84 days in the NHS (Brown, 2016).
A wider range of therapy has become available. There has been a rise in mental health practitioners. Three universities in the Freedom of Information survey had a (part-time) psychiatrist available for students. Although, I have been informed by one such institution that the psychiatrist is not there to give treatment but to work with other therapists. Other initiatives include, for example, the University of East Anglia (UEA) offering physical activity as an adjunct to mental health support (UEA, 2018). UEA also has a buddy scheme, where first-year students can opt to be paired with a student who can offer guidance (UEA Students Union, 2019). Oxford has a Peer Support Programme. Both involve extensive training for the students giving the support.
While the provision of these services means that students have much shorter waiting times than in the National Health Service (NHS), if the university mental health service needs to refer a student for psychiatric care, the student generally finds they are in the same position as the general population, with some exceptions. Waiting times vary widely around the UK. One question on the Student Minds survey was to ask practitioners in university counselling services the top area of concern; it was inadequate NHS mental health provision (Student Minds, 2014).
If a student develops a severe mental illness, as with the general population, there is a risk that they may become one of the thousands each year given an out-of-area placement. The chronic shortage of NHS psychiatric beds means that patients are admitted in a completely different area. In August 2019, there were 701 inappropriate out-of-area placements (England) (NHS Digital, 2019), of which over 500 were to distance of over 100 km and 60 were over 300 km. Whereas students would benefit greatly either from the support of their friends at university, or from their family at home, they may find themselves a very long way from both. The Royal College of Psychiatrists recognises the problem:
The Royal College of Psychiatrists is calling for the NHS to urgently create hundreds of extra beds for people who are seriously mentally unwell in order to tackle a damaging shortage:
Cuts in the number of mental health beds have gone too far and patients and their families are suffering as a result,” said Prof Wendy Burn, the college’s president. “It is clear that some parts of England urgently need more properly funded and staffed beds. Hundreds more are needed.
Trusts struggling with dangerously high levels of bed occupancy are being forced to send seriously ill people hundreds of miles away from their homes for care. That must stop. (Campbell, 2019)
The same issue was reported in 1870:
“What can I do?” says one surgeon “I have a man subject to epileptic fits, violent, tearing up his bedclothes and requiring immediate admission to an asylum, and his admission is refused.”
“Indeed,” says the medical officer of Poplar, “it has become a perfectly hopeless matter to obtain admission for a pauper paralytic into any lunatic asylum in Middlesex, and many provincial asylums have also declined to take such patients.”[…] […].
[…] when the patient is taken several hundred miles away, he is practically consigned to a kind of living tomb […].
The journey of a lunatic to the North Riding of Yorkshire cannot be otherwise than injurious to the patient, and it removes him not only from the visitation of his friends, but also from that of the guardians. (Stallard, 1870)
Things have changed in 150 years: we no longer use the terms “pauper” and “lunatic”, but plus ça change, plus c’est la même chose.
Since the University of Al-Karaouine was founded in the ninth century, students have been facing all kinds of challenges, apart from academic ones. The twenty-first century brings more mental stress than previously; in response there is an increased provision of university and college mental health services. In recent decades, financial pressure has become more and more part of the picture, with living costs in university cities being particularly high. It is with this background that some of the articles in this issue are set: research on burnout in employed students, from a team in Ontario, Canada; the added stress of taking an accelerated, two-year degree, from the University of Lincoln; burnout in academics in Malaysia, which also has relevance to students, particularly graduate students. Stress can also be a factor in student alcohol consumption – the whole problem is examined in “Student drinking – Is change possible?” Our editor has interviewed Geraldine Dufour, Head of the University of Cambridge Counselling Service.
Appropriately, there are two contributions from students: Poppy Brown is a doctoral student in Psychiatry at Oxford; her item is on the current state of mental health research in UK universities, with reference to recent years. She was the author of a wide-ranging review, The invisible problem. Mental Health in UK Universities, in 2016, when she was an undergraduate. Tamara Sancho is a student mental health practitioner; her research looks at the barriers and facilitators affecting Afro-Caribbean students, regarding access to mental health services.
Adult psychiatric morbidity survey (2014), available at: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey (accessed 2 December 2019).
Blakemore, S.-J. (2016), “Inventing ourselves: the secret life of the teenage brain”.
Brown (2016), The Invisible Problem? Improving Students’ Mental Health, Higher Education Policy Institute, Oxford, p.13.
Campbell, D. (2019), “Hundreds of mental health beds needed to end ‘shameful’ out-of-area care”, The Guardian, 5 November, available at: www.theguardian.com/society/2019/nov/06/hundreds-of-mental-health-beds-needed-to-end-shameful-out-of-area-care (accessed 2 December 2019).
NHS Digital (2019), “Out of area placements in mental health services”, Report, August 2019 Published 14 November 2019.
Stallard, J.H. (1870), “Pauper lunatics and their treatment”, A Paper read at Bristol at the meeting of the National Association for the Promotion of Social Science; Longmans Green & Co, Bristol, London, 4 October 1869.
Student Minds (2014), “Grand challenges in student mental health”, available at: www.studentminds.org.uk/grandchallenges.html (accessed 2 December 2019).
UEA (2018), available at: www.uea.ac.uk/about/-/uea-tackles-student-mental-health-through-exercise (accessed 2 December 2019).
UEA Students Union (2019), available at: www.uea.su/opportunities/buddysu/ (accessed 2 December 2019).
Freedom of Information Request (2018), available at: www.whatdotheyknow.com/info_request_batch/544 (accessed 2 December 2019).
About the author
Julian Ashton is based at NIHR Research Design Service (SW), Paignton, UK.