Exam Factory schools

The scale of mental distress at university 

33.9% of university student respondents reported serious personal, emotional, behavioural or mental health problems which they felt required professional help, according to research from Rethink Mental Illness, published in 2019.1 

At first sight this presents a daunting picture. In practice the research relied on self-selection by a very small proportion of the UK’s university students. It may therefore overestimate the scale of the problem. It also bundles together personal, emotional, behavioural and mental health problems – making it difficult to separate out those students specifically reporting mental health issues (which are also self-reported rather than clinically diagnosed). This suggests it may not be as accurate a picture of student mental health in the UK as some media sources have suggested in their headlines. 

Mental distress starting BEFORE university 

However, if we assume that many of the students who responded were experiencing problems, including for some, mental health problems, and that these are students likely to seek support at university, then the research may be helpful in a different way. 4/5 of students reported that their symptoms first appeared when they were at school, compared with only 1/5 reporting they first appeared at university. If this were true of students more generally, it would suggest that problems start in the school years rather than at university. This would fit with the 2017 IPPR report Not by degrees which notes, ‘the vast majority of students who disclose a mental health condition to their HEI do so in their first year.’2 

This also fits with research from the NASUWT Teacher’s Union, where 96% of teachers surveyed say they have observed mental health difficulties in pupils of all ages. 14% report seeing mental distress in children as young as 4 or 5.3 The UK ranks fairly poorly for child mental wellbeing, being ranked at 11th and 14th in a sample of 15 countries.4 There is also a range of research which suggests that rates of mental distress increase with age throughout childhood, adolescence and into adulthood.5 

The importance of the school years 

If this is the case, then action in the school years is likely to prove more effective in reducing risk than action by universities, whose role would be largely support for those with pre-existing issues. However, what is it in the school years that is fuelling these problems. Is it the school experience itself?

In recent years there has debate as to whether schools are turning into ‘exam factories’ - spending too much time focusing on teaching to test children rather than teaching them to learn and grow.4 Research has suggested that 66% of school pupils report exams being one of the top causes of mental distress3, and there are also reports that the rising prevalence of ADHD is associated with increasing testing in schools.4 A report commissioned by the National Union of Teachers argues that current schooling methods are putting too much pressure on children from a young age, with not enough focus on creative teaching, play time or practical work. Even as early as Key Stage 2, children are being put through tests which are used to predict their GCSE grades. This makes teachers want to spend more time focussing on preparing children for their exams and puts pressure on the children to be high achievers early on in their education. It is further argued that the current patterns of testing children are not appropriate for their development, creating additional stress and anxiety early on in life. 

Additionally, recent changes to the GCSE system have made the exams the hardest they have been since they were introduced over 30 years ago.6 There has also been a move from course work to final exams at A Level, adding further pressure for some students.7 If school is when many university students report first displaying symptoms of mental distress, making school examinations even harder is likely to further increase mental distress – although one question perhaps worth researching further is whether exam related stress tends to be greater for less academic students than those who typically progress to university. 

More than just exam pressure 

However, in a survey by the NASUWT teachers’ union, although 66% of teachers identified exam pressure as the cause of mental health problems such as self-harming, eating disorders and OCD, 84% also identified family problems and 64% identified social media.3So, testing and exam pressure may be one factor but probably aren’t the only factors here. One Head Teacher commented, ‘By the age of 15 – 16 they (girls in particular) can get exhausted, not so much with GCSEs but with keeping up the pretence (the face they present to the world on social media versus the real them).

There has been an increasing focus on mental health in secondary schools in England and Wales within the last few years and a call for Ofsted to intervene and to measure a school’s approach to mental health and wellbeing, including it in in inspection framework to make sure pupils are getting the best support they can.8 Theresa May has also recently stated that she does not believe we should be accepting rising rates of poor mental health as inevitable and has called for teacher training to include teaching on how to identify children who have mental health problems and how to help pupils who are experiencing poor mental health, addressing issues such as self-harm.9 These developments can be seen as a positive step towards improving support for the mental health of school pupils. However, they focus primarily on providing support once mental distress has emerged, rather than tackling the underlying causes. 

Exaggerating the impact of emotional difficulties 

It must also be noted that according to The Children’s Society the overall level of happiness and wellbeing at school is 7.2/10 for children aged 10 to 17. Their report identifies a significant rise in reported happiness at school between 2004 and 2016 and with schoolwork between 1995 and 2016.8 Research by the OECD also found that 70% of children reported their school was ‘ideal’ for them.5 This suggests a more positive picture of the school experience, although the findings were from an earlier period, before the new and more rigorous GCSE and A Levels were introduced. As the report observes, ‘Children can be happy or unhappy with their lives whether or not they have emotional or behavioural difficulties.' This is a useful counterpoint to reports of rising mental health problems in schools, particularly at a time when emotional difficulties are increasingly being seen as symptoms of mental distress, which may be artificially inflating the prevalence of mental health issues. 

Questions we need to ask 

This suggests we need to consider: 

  • Is the increase in testing and exam pressure, which has been widely reported by teachers, affecting some students and are these students likely to go to university? 
  • Are family problems a factor and, if so, what kind of family problems, and are the students affected by family problems the ones likely to go to university? 
  • Is social media a factor and is this likely to affect students who will proceed to university? 
  • Are there other factors which haven’t been reported by teachers but which may, perhaps less visibly, be affecting students who will progress to university? 

When we have the answers to these questions we will be better placed to reduce mental distress in the school years and the risk of this mental distress being carried forward to university. 

Elizabeth Walters July 2019



  1. Rethink Mental Health, ‘Largest survey of its kind reveals extent of university students’ struggles with thoughts of self-harm, loneliness and anxiety’, 5th March 2019, Available at: https://www.rethink.org/news-and-stories/news/2019/mar/largest-survey-of-its-kind-reveals-extent-of-university-students-struggles-with-thoughts-of-self-harm-loneliness-and-anxiety/ 
  2. Thorley C, ‘Not By Degrees. Improving Student Mental Health in the UK’s Universities’, Institute for Policy Research, September 2017, Available at: https://www.ippr.org/files/2017-09/1504645674_not-by-degrees-170905.pdf 
  3. Busby E, ‘School mental health problems extend to primary-age pupils amid cuts to support’, The Independent, 2nd April 2019, Available at: https://www.independent.co.uk/news/education/education-news/mental-health-primary-school-sexual-harassment-bullying-pupils-nasuwt-union-a8283876.html 
  4. Hutchings M, ‘The impact of accountability measures on children and young people’, National Union of Teachers, June 2015, Available at: https://www.teachers.org.uk/files/exam-factories.pdf 
  5. Rees G & Main G, ‘Subjective Mental Wellbeing’, in J Bradshaw (ed) The well-being of children in the UK, 2016, (4th ed), Bristol: Policy Press 
  6. Weale S, ‘Stress and serious anxiety: how the new GCSE is affecting mental health’, The Guardian, 17th May 2018, Available at: https://www.theguardian.com/education/2018/may/17/stress-and-serious-anxiety-how-the-new-gcse-is-affecting-mental-health 
  7. GOV.UK, ‘Guidance. Get the facts: AS and A level reform’, January 2018, Available at: https://www.gov.uk/government/publications/get-the-facts-gcse-and-a-level-reform/get-the-facts-as-and-a-level-reform 
  8. The Children’s Society, ‘The Good Childhood Report 2018 Summary’, 2018, Available at: https://www.childrenssociety.org.uk/sites/default/files/the_good_childhood_summary_2018.pdf 
  9. Coughlan S, ‘Theresa May calls for mental health to be priority’, BBC News, 16th June 2019, Available at: https://www.bbc.co.uk/news/education-48658151