‘I support students with safety, community, and connection’

The student in front of me had come to see our Wellbeing team at the University of Sunderland. She told me, in a strained voice, that she couldn't manage the way she was feeling anymore. She had moved up North for her studies, having previously been with Child and Adolescent Mental Health Services until she turned 18. Her discharge coincided with the huge transition of moving to a new city, alone, in a small apartment, trying to manage studies alongside a diagnosis of PTSD and OCD.

With no local GP she had come for support. As she was not attending classes we arranged a three-way meeting with her tutor, I supported her to register with a local GP who prescribed medication for her mood, and I referred her to the NHS talking therapies for further assessment and support. Our sessions offered a bridge of support until she was allocated a practitioner in the NHS talking therapies team.

My expectations of working in higher education had been that I would be offering a shoulder to cry on for students who were homesick, or managing anxiety related to exams or assignments. But this day-to-day work was a level above. My own University experience had been relatively plain sailing – naively, I never anticipated the challenges students would face while at university or the need for a mental health and wellbeing team for students. How wrong I was…

Mental health in higher education

According to the IPPR analysis of higher education statistics agency, the number of students disclosing a mental health condition to their higher education institution has increased from 9675 to 57,305 in a ten-year period (IPPR, 2017). We all hope this rise is due to an increased awareness of mental health difficulties and reduced stigma, meaning those who disclose feel able to do so. But while every generation of students can relate to academic pressures, concerns about future employment and issues with friends/family, it could be argued that there are a range of generational stressors which are impacting students more than ever.

These stressors include the cost of living, climate change, and the use of technology and social media. Jean Twenge, Jonathan Haidt and others have described 'Gen Z as being on the brink of the worst mental health crisis in decades' (Twenge, 2017) some of which can be traced back to their phones, and there are safety concerns: 86 per cent of 18–24-year-old women (prime student age) report having experienced sexual harassment in a public space (UN Women YouGov survey, 2021). This is something I have observed increase each academic year – taking first disclosures from student has sadly become something I am ever more familiar with.

Such stressors have major impacts. Between 2019-2020, 319 students in university died by suicide (ONS, 2022). Each loss, on average, is estimated to affect 135 people (Suicide-Safer Universities, 2022). University communities are small ecosystems: each student death is felt right across the university community, from lecturers to flatmates to support services. Recent media coverage (Telegraph, 2022) has made the point that universities need to do more to include trusted contacts when a student presents with suicidal behaviours, or disclose they are struggling significantly with studies. It is a complex ethical dilemma: support services are bound by data protection laws, and yet feel the tensions around involving family (which, on occasion students will not consent to).

Universities UK (UUK) which is an association of universities and higher education institutions in the UK, have moved towards a 'whole university approach' to preventing student suicides. It aims to develop universities as a compassionate community for staff and students, embedding mental health into each curriculum and encouraging early intervention with trusted contacts where appropriate (Universities UK, 2018). A previous role of mine was working within a community psychology framework in an assistant psychologist role, I am drawn to the concept of looking at why students are falling into the metaphorical river, rather than pulling students out one at a time. Watching out at the river banks must be a whole university approach- with a 492 per cent increase in disclosures of mental health at enrollment (UCAS, 2021) the whole university community must become invested in this vital work of supporting student mental health.

How I got here

I have always had an interest in mental health and knew this was the path I wanted to go down. As is typical for many psychology graduates the path became quite a journey.

After completing my undergraduate psychology degree I landed a job as an OT/physical therapy assistant in a busy stroke rehabilitation ward: a rewarding first job in the NHS. A Christmas mug from my mother that year read 'overstretched and underpaid – proud to work for the NHS'. That certainly encapsulated my own experience. Rewarding and demanding all at once. I remained with the NHS and went on to work as an Assistant Psychologist on a community psychology program, addressing another group of those who meet the overstretched and underpaid criteria – primary school teachers. My role entailed delivering a wellbeing and stress management course. Sometimes that felt like a sticking plaster, but I valued the role, grew in it and enjoyed working within a community psychology model.

I had been biding my time to apply for the golden Psychological Wellbeing Practitioner trainee role in my local NHS talking therapies service, and was successful in interview. A year after Improving Access to Psychological Therapies had launched I trained with 16 committed trainees, as we embarked on creating an IAPT team where none had been before. Integrating into a long-established primary care mental health team was an interesting experience. I spent a number of years working in the IAPT service before moving on after the birth of my second child, to the university in the same city, in the role of mental health advisor in the student wellbeing department.

The role

There is much variety in my role, each day can be different. Academic staff may bring up students in distress who have may have been triggered by lecture content, or who just feel under pressure to complete studies, we have had students drop in after having a panic attack in a pharmaceutical lab or who have received bad news while on campus. We will visit with students who have been placed under a section of the Mental Health Act in the local hospital, to support the transition back into studies. We are there to take calls from students who feel under strain, and staff who are seeking advice about a student. Alongside the responsive and risk support, I see students for assessment and follow up sessions. Sessions are goal-focused and led by the student's needs and presentations.

Golding (2012) proposed a pyramid of need for young people who have experienced developmental trauma. I see a lot of my role as supporting the student to tend those 'bottom' needs of safety, community, and connection with others. I can then refer on for the specialist trauma support that is often much needed for many of our students.

Helping students to navigate often complex NHS systems when they are miles away from home and parents has meant we have made strong professional relationships and referral pathways with local NHS teams such as psychiatric liaison, crisis team, EIP and eating disorder teams.

Much of my role involves using many of the skills I developed as a psychology undergraduate and the roles that followed. A deep understanding of different mental health difficulties has been essential including knowledge of causes and treatment options. With the average median age of onset for many disorders including anxiety disorders, eating disorders, OCD, personality and addiction disorders being between 19-25 (Solomi et al., 2022) it has been crucial to know what to look out for in assessment, the questions to ask and knowing the teams that can support these students.

A solid knowledge base of interventions and evidence-based treatment has allowed me to provide students with effective support and interventions grounded in research. A first-year paramedic student who struggled with traits of perfectionism found it intolerable not knowing her first grade from the first assignment she submitted. She had finished CBT around six months prior to commencing studies: our sessions were covering relapse prevention using the materials she had from her CBT sessions. She was able to remind herself of techniques to sit with uncertainty while she waited for results. Another student had completed a long-term course of Dialectical Behaviour Therapy to help him manage his diagnosis of Emotionally Unstable Personality Disorder: having an awareness and some training in DBT I was able to reinforce some of the key principles and messages when he was experiencing the ups and downs of student life with a diagnosis.

We also have a large population of international students, who need to not only adjust to life in higher education but do so in their second language in unfamiliar cities with different customs, currency and communities. These additional stressors can increase the risk of mental health difficulties emerging. We have designed psychoeducational workshops to develop a sense of belonging to a new community, along with sessions on supporting and looking after your own wellbeing as an international student. Active listening and the ability to communicate complex ideas in an accessible way has been beneficial in working with international students. It is a struggle often to open up about your own difficulties. Another layer to that is the concept, sometimes present, that opening up may bring shame to your family or community.

Challenges

University can be an amazing, enriching experience, making lifelong friends and transitioning into adulthood and the working world with a degree and life experiences behind you. However, in many ways it can also be a breeding ground for poor mental health; leaving home for the first time, feelings of inadequacy, financial pressures, a newfound independence, social pressures and new relationships.

And there are reasons to think that the challenges facing students are increasing all the time. A recent article in The Guardian (2023) highlighted a lack of statutory support services for children and young people, meaning that students arriving at university have not received appropriate support for existing mental health issues or are trying to complete studies with undiagnosed neurodivergence. We also continue to see the fallout from the changing face of hybrid education in students who have not had the pressures of exams since GCSE. It is not uncommon for us to get a call from a lecturer asking us to check in on a student who left an exam distressed, and unable to complete the assessment.

Being able to support a student to graduation and hear of their plans beyond university brings much satisfaction to the role, our university is proud to be a widening participation university with many students who have come from backgrounds that many would consider deprived. Knowing you have played some part in someone's journey to graduation makes working in student mental health a demanding, exhausting, but ultimately important and worthwhile role.

Key sources

APPG for UN Women. (2021) Prevalence and reporting of sexual harassment in UK public spaces. https://tinyurl.com/35ufpt3x 
Clarence-Smith, L. (2022, 6 October). Call a suicidal student's family even without consent, universities told. The Telegraph. 
Hall, R. (2023, 16 April). 'Buckling' NHS fails to treat 250,000 children with mental health problems. The Guardian. https://tinyurl.com/mwc2pkne
Golding, K.S., (2008) Nurturing Attachments: Supporting children who are fostered or adopted. Jessica Kingsley Publishers. London and Philadelphia
ONS (2022) Estimating suicide among higher education students, England and Wales: Experimental statistics. 
Solmi, M., Radua, J., Olivola, M. et al. (2022) Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27, 281–295.  
Thorley, C (2017). Institute of Public Policy Research. Not by degrees: Improving student mental health in the UK's Universities. London. https://tinyurl.com/4f33k35s
Twenge, J. (2017) Have Smart Phones Destroyed a Generation? The Atlantic. https://tinyurl.com/yc6v4w3k 
UCAS (2021). Starting the conversation. UCAS report on student mental health. Cheltenham
Universities UK & Papyrus (2018). Suicide-Safer Universities. London.