Student mental health - a public health challenge?
Half of young people in the UK now go to university. At the same time the number of students disclosing a mental health condition to their university has risen dramatically - with universities also reporting a significant increase in demand for counselling and mental health related disability services. So, what is happening and why?
Why has there been this reported increase?
Are today’s students facing unprecedented pressures, in an increasingly stressful and uncertain world? Is social media to blame? Has widening participation meant more students are finding the transition to university a challenge? Has safeguarding and increasing parental concern to protect their children had the unintended consequence of reducing their resilience and coping skills? Or are students interpreting negative feelings and emotions, which were once seen as a normal part of life, as symptoms of mental ill health? These are just some of the questions we’re exploring, to try to understand what seems to be a growing public health challenge.
The importance of what happens BEFORE university
The largest student mental health survey ever conducted in the UK found that 81% of students reporting personal, emotional, behavioural or mental health problems which they felt needed professional help, first experienced symptoms while still at school i.e. BEFORE going to university. That’s why much of our research is focusing on what is happening in this potentially formative period – in particular what has changed that might explain the increase. These potential factors include:
- Changes in the school system
- Changes in parenting
- The impact of social media
- The medicalisation of feelings and emotions
Changes that may be impacting on school children
Teachers and teaching unions report mental health difficulties in children of all ages and suggest this is due to:
- Schools turning into ‘exam factories’
- Family problems
- Social media
However, The Children’s Society reports a significant rise in reported happiness at school between 2004 and 2016 and with schoolwork between 1995 and 2016 and observes, ‘Children can be happy or unhappy with their lives whether or not they have emotional or behavioural difficulties’.
So, is what is happening in school making a difference?
That’s what Elizabeth Walters has been researching for us, focusing on the pressures children now face at school. She has considered evidence from teachers’ unions, changes in the education system and evidence from the Children’s Society – and concludes with four questions we need answers to if we’re to be clearer about the influence of schools on young people’s mental health. Here are her findings on whether pressure in schools help explain mental distress at university.
Meanwhile, Shelley Budgeon has explored whether differences between schools (such as co-educational versus single sex) are associated with different health outcomes.
While Anna Frey and Barbara Baker have researched what school-based initiatives are being taken to seek to protect pupils' mental health - and what evidence there is for their effectiveness.
Have changes in parenting had an effect?
Might well intentioned parents be increasing the risk of mental distress for their children by engaging in 'helicopter parenting', hovering over their children, ready to swoop in and protect them at the first sign of difficulty? Does this risk reducing their resilience and coping skills and leaving them more vulnerable to mental distress?
Michael Baber explains what helicopter parenting is, how it might influence young people’s mental health and what can be done to reduce the possible risks.
Rachael Stanton updates this analysis by considering possible economic factors behind helicopter parenting, including the rise in student debt following the shift from grants to loans, leading to rising levels of parental concern for their children's future prospects - as well as the impact of the COVID pandemic, both in itself and through the technological developments it accelerated, with Class Dojo for instance giving parents access even during the school day.
Or is social media more of a factor?
In a blog for the Royal Society for Public Health, Natasha Airey has looked in more detail at - Student mental health problems - the role of social media
She finds that teenagers themselves may sometimes have different perceptions of the influence of social media from researchers, schools and universities. She finds that some of the potential effects of social media are probably well known, from making it easier to connect with family and friends to online bullying and presenting an unrealistic picture of other’s lives.
However, other effects (such as possibly delaying adolescence and adulthood) are less well known and may mean today’s undergraduates are less independent and equipped with coping skills than their predecessors – which may leave them more vulnerable to mental distress.
Barbara Baker has researched evidence suggesting the influence of social media on eating disorders, including potentially increasing body dissatisfaction and the influence of 'thinspiration' and 'fitspiration' content .
Sophie Izzard has explored whether teen dramas (such as 13 Reasons Why) alongside a range of social media content may have romanticised suicide and suicidal ideation.
Lucy Doyle has researched whether the portrayal of anxiety and depression on TikTok and Instagram has become increasingly romanticised.
Taken together, this research into the depiction of mental health issues on film and television and in social media, suggests a misleading and often romanticised picture being presented to young people, with potentially adverse effects for mental health.
Have normal feelings and emotions been over-medicalised?
For centuries negative feelings and emotions have been a staple of literature and popular music. Take feelings of loneliness. Huckleberry Finn's statement 'I felt so lonesome I most wished I was dead’ in Mark Twain's book Tom Sawyer is very similar to Elvis Presley's lines, decades later, in his song Heartbreak Hotel ,'Well, I'm so lonely, I'll be so lonely, I could die.' Yet it is only in the 21st century that normal feelings and emotions (like worry, anxiety, stress and loneliness), natural responses to the challenges we sometimes face in life, have been categorised as symptoms of mental distress.
As Mikael Leidenhag and Michael Baber identify this has coincided with a combination of four further factors (the tendency to expand definitions of mental disorder; the risk of error in mental health diagnosis due to the limited diagnostic tools available; the trend towards medicalisation in the NHS more generally; and a lack of youth-friendly mental health services), potentially resulting in more young people now likely to receive the diagnosis that they have a mental health condition than in previous generations.
Our assessment is that the medicalisation of normal feelings and emotions is likely to have increased the incidence of students reporting mental health problems.
Can we learn from other countries?
With levels of reported student mental distress having risen sharply in the UK are there lessons we can learn from other countries, to seek to avoid this?
The Netherlands provides an interesting comparison, as a recent study found no evidence of an increase in student mental health problems there over the last ten years. William Bates' research suggests there are lessons we can learn from our Dutch counterparts.
Why is fear of failure at record levels?
Students in the UK have been enjoying higher levels of academic success than previous generations - at both school and university. Yet girls in the UK now rank fifth in the world when it comes to fear of failure.
Might it be that students have been so supported and protected in their school years that they are arriving at university 'failure deprived' and are finding it increasingly difficult to cope with the prospect of failure - and is this having detrimental effects for their mental health? Sophie Izzard explores initiatives to encourage students to experience, learn from and embrace failure.
Lindsey Stack takes this analysis further by considering whether schools should be teaching students how to fail and learn from failure, the value of extra-curricular activities and the potential of a growth mindset approach, as well as the influence of parent and teacher expectations.
Is 'spoonfeeding' at school part of the problem?
Despite A-level results improving steadily since the 1990s there has been a surge in reported levels of student mental distress at UK universities, often resulting from academic pressures. How can it be that students are leaving school with higher grades than ever, yet are struggling more at university, with knock on effects on their mental health?
One factor, explored here by William Bate, may be the phenomenon of ‘spoon-feeding’.
Tracy Scott builds on this initial analysis to consider how to move on from a spoon-feeding approach, including schools adopting a 'scaffolding' approach to enable a gradual transfer of responsibility from the teacher to the student, on a step by step basis. She also considers whether GCSEs and A Levels are fit for purpose in the modern world.
Do diet and physical activity make a difference?
It is often rightly said that what is good for the body is good for the brain. As the Romans put it, 'mens sana in corpore sano' (a healthy mind in a healthy body). Harrison Prince provides research findings suggesting that junk food increases the risk of mental health problems, while physical activity appears to reduce depression, anxiety, psychological distress and emotional disturbance in children. He notes that the impact of exercise on mental health has been suggested as being similar to that of cognitive behavioural therapy and emotion regulation.
Are widening participation students at particular risk of mental health problems?
More students are coming to university from non-traditional backgrounds, for example as the first person in their family to go to university. Does this make the passage to university more challenging and increase the risk of mental health problems - or might the effort required to gain a place have increased their resilience more than for other students?
In this article Elizabeth Walters considers the sometimes conflicting evidence, some factors that may be more influential than socio-economic status, and also some initiatives to seek to make the transition to university easier for widening participation students.
There has been debate as to whether or not today's students are less resilient than their predecessors - and if so, why this might be.
Here Michael Baber and Annie Borland consider whether well-intentioned action to protect young people from harm may unwittingly be reducing their resilience and making them more vulnerable to mental distress - suggesting that the 'safe spaces' young people need may be the space to experience and learn from both challenge and failure.
Meanwhile Sophie Izzard considers what initiatives universities are taking to seek to encourage student resilience, including initiatives at Edinburgh University, Imperial College, Bath University, Cambridge University and Leeds Becket University.
What about students on particularly pressurised courses?
Some students face additional pressures. For example, medical students have above average workloads, for at least five years (rather than the usual three). They may also encounter distressing situations while on hospital placements and may be more reluctant to seek help, for fear this will damage their career prospects.
In her article for Health Action Campaign, Lesley Hulmes, explains some of the challenges medical students face, what initiatives have been taken to reduce mental distress - and what more is still needed.
What other factors should we be considering?
We would welcome suggestions for other factors we might usefully research that are likely to influence student mental health.