In September 2019, The Guardian headlined an article “‘The way universities are run is making us ill’: inside the student mental health crisis”.
We hear similar talk on all sides. Couched in the alarming vocabulary of “crisis” and “epidemic”, data presented at conferences, at staff training sessions and in the media create a sense of panic. Politicians have also embraced such claims. In September 2018, Sam Gyimah, then secretary of state for universities, science, research and innovation, wrote a letter to vice-chancellors stressing the importance of the issue and saying that “collectively, we must prioritise the wellbeing and mental health of our students – there is no negotiation on this”.
The government’s non-negotiable steer presaged high-profile research and development programmes. Working with the mental health charity Student Minds and led by King’s College London, SMaRteN is a national research network funded by UK Research and Innovation for the period 2018-22 to improve understanding of student mental health. In July 2019, the Office for Students (OfS) launched its own £14.5 million research programme. In December 2019, Student Minds issued the University Mental Health Charter. Backed by the government, the OfS and Universities UK, this calls for support services, accommodation, teaching and university bureaucracy to be geared towards students’ mental well-being and to “enable them to thrive”.
Such a goal may seem admirable and uncontentious. Yet behind the scenes many academics, administrators and support service managers are uneasy. Sparked by a workshop on curriculum, pedagogy and mental health that I ran with colleagues for SMaRteN in July 2019, as well as numerous comments I have heard over the past few years, I want to explore how talk about a student mental health crisis translates from policy injunctions into everyday institutional practices and why this has raised many concerns.
Many institutions are undertaking comprehensive development projects to promote well-being. The University of Cambridge, for example, is adopting a “public health approach” to all aspects of university life. As well as the perceived negative impact of course content, teaching and assessment, this includes tackling loneliness in halls of residence, and encouraging extracurricular activities and healthy relationships. According to Sara Weller, a member of the university’s council, this approach aims to “slow, and eventually reverse” the prevalence of mental health problems while building “a healthier culture and community where students have the personal psychological well-being to realise their fullest potential”.
Yet such initiatives are a response to intense political and institutional anxiety. This is generating what Alan Percy, head of counselling services at the University of Oxford and past chair of the Heads of University Counselling Services, sees as more “heat” than “light” in understanding what is happening and responding appropriately to a clearly defined problem. Alarming depictions of a “suicide epidemic” in universities, for example, are not supported by a report from the Office for National Statistics in 2018, which shows that the suicide rate among students is lower than for the same age group in the general population, and that it has more than halved since the early 1990s. Percy argues that the emotive, disproportionate picture painted by the media and campaigning groups fuels panic-driven reactions rather than considered responses.
It’s clearly vital that universities address a national spike in mental illness, reflected, as Hughes points out, in increased demand for support and the severity and complexity of problems. We are seeing more students admitted to hospital, engaging with crisis teams and being sectioned than in the past.
Yet a slippery terminology that elides “mental illness” with “issues”, “problems” and “difficulties” is rife, and this blurs the distinction between serious and everyday problems. Sir Simon Wessely, professor of psychological medicine at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, sees a danger that over-professionalising and/or medicalising routine difficulties means that “some of those now who tell me they have mental health disorders seem to be describing loneliness, exam stress or homesickness, which I as a psychiatrist would not classify as mental health disorders”.
One university registrar, who wished to remain anonymous, observed a strong “tendency to lump together all mental health issues as if they all have the same effect on students’ studies in a way that doesn’t happen with physical health”. In reality, he says, there’s a spectrum going all the way “from an enhanced sense of normal anxiety about assessment to very serious conditions at the other end of the scale”. Although it shows “a lack of proportion” not to take this into account, he thinks universities don’t have the expertise to do otherwise.
Academics and support service staff also report that vague, often casual, references to mental health compound this lack of proportion. It is commonplace to hear students describe assignments, lectures, material or content not seen as relevant to assessment and even lecturers as “really bad for my mental health”. This is combined with talk of being “totally stressed out”, traumatised, “needing a safe space”, and experiencing something as triggering or psychologically harmful. Beth Guilding, an academic at Goldsmiths, University of London, thinks mental health and well-being are increasingly coming to “mean everything and nothing”.
Given that the notion of mental (ill)health has been diluted in this way, it is not surprising that lecturers find it difficult to decide whether problems require specialist support, calm reassurance or, as one GP in a university medical centre put it, “benign neglect”, in the expectation that the problem in question will resolve itself.
Uncertainty and what Brendan Bartram, reader in education at the University of Wolverhampton, sees as “a culture that encourages invocations of vulnerability” can lead some students to engage in “emotional bargaining” to press lecturers for concessions. He argues that institutional climates highly sensitive to maintaining and monitoring students’ well-being turn declarations of a lack of support into a source of power and currency.
Using mental health as a lever isn’t confined to students: one social science lecturer, who wished to remain anonymous, reports that “we sometimes actively encourage good students who we think deserve another chance (because, for example, failing an assignment will mean them failing a whole year) to make up mental health problems”. She cites examples both where this happens in advance, in case someone fails a module, and afterwards, so that they’re allowed to go through anyway. “They have to provide evidence, of course,” she admits, “but this never seems to be a problem.”
Some academics and support service staff criticise the pursuit of satisfaction ratings and fear of media scrutiny that make managers too often inclined to accommodate requests or complaints, regardless of whether they’re valid or not. Linda Murdoch, director of the careers service at the University of Glasgow, reports that all decisions about academic matters “must account for impact on student well-being”.
There is also widespread concern that students in real need are not getting access to proper services. Despite recent student demonstrations demanding more counselling and emotional support, criticism of inadequate provision is perhaps too simplistic. Counsellors report growing difficulty in offering support to those most in need because of the strain on services imposed by students' tendency nowadays to seek an adult expert, rather than friends or family, for “a chat” about everyday stresses.
Murdoch notices a parallel marked change in how students use careers advice. “Students are returning time and again for ‘checking’ or ‘reaffirming’ appointments. It seems they lack confidence to act on advice offered at the first appointment. Nowadays a significant minority book two to five appointments. Some request significantly more. One colleague said she felt she was just being used as a crutch.”
Although there is widespread agreement that many students face a raft of life and educational adversities, and are often isolated and overwhelmed by challenges and existential doubts, Nicola Byrom, senior lecturer in psychology at King’s (and lead investigator for SMaRteN), observes that most aren’t looking for therapy or an expert but “a compassionate human who can help them make sense of things”. Yet opportunities for academics to relate to students authentically and compassionately, in ways that aren’t framed by mental health narratives, are under intense pressure from workloads, research targets, satisfaction ratings and the casualisation of academic work. Some universities require lecturers to take on 50 personal tutees. Others are making “mental health first aid” roles mandatory, often without releasing the people given such roles from other duties.
As China Mills, senior lecturer in public health at City, University of London, notes, senior managers rarely, if ever, address how structural factors undermine staff and student well-being but, “instead, they prioritise one-off ‘well-being events’” which are widely viewed as patronising and pointless.
Framing the need for support through the lens of mental health can have political repercussions. According to Lydia Lewis, a postdoctoral research fellow in the Faculty of Education, Health and Wellbeing at Wolverhampton, individualistic psychological understandings of problems that are actually rooted in socio-political relations “tempt students to shape their sense of self and self-label in ways that are unhelpful to them in the long run”. Crucially, this framing masks class, gender and race inequalities.
Psychological interpretations can also be used politically against particular groups. Mills reports cases where Muslim students fear (she thinks rightly) that staff in well-being services made to undertake mandatory Prevent training might interpret signs of distress or the accessing of support as indicators of potential radicalisation.
Perhaps the crucial issue, however, concerns the impact of the mental health narrative on education itself.
Broader interpretations of what count as mental health problems are generating large increases in the number of students granted “special arrangements” for assessment, including sitting exams on their own or being exempted from particular tasks. In Cambridge, for example, numbers have trebled in the past 10 years (and at Imperial College London, in the past five). There’s also an expansion of criteria for Learning Support Plans that enable “reasonable adjustments” to attendance, support, teaching and assessment.
According to King’s College London’s Byrom, incorporating such adjustments across the whole curriculum makes it more inclusive and empowering for everyone.
Yet some respondents doubt whether prioritising mental health is compatible with providing the kinds of challenge that good education should be about. Goldsmiths’ Guilding thinks that preoccupation with a psychologically vulnerable self changes the relationship between education and well-being. She doesn’t believe “in going back to the so-called ‘good old days’ of not talking about mental health” but thinks it now dominates an arena that should be about “growing minds and removing students from themselves to see the world differently, from infinite perspectives”.
In this vein, some counsellors and academics discern a creeping belief that there is some kind of polarisation between mental well-being and academic work. According to Oxford's Percy, “many students are presenting at counselling services saying they don’t know whether to prioritise taking care of their mental health or trying to do well academically and having to sacrifice their mental health. This comes from a very unhelpful, false narrative that the pursuit of academic achievement is, by definition, bad for your mental health.”
Other academics, such as Wolverhampton's Bartram, say that “engineering a profound change in how students see the role of universities, as institution[s] that should support their mental health” makes it harder to encourage students to overcome normal feelings of anxiety and realise that they can cope, do well and even enjoy being stretched beyond their comfort zone.
We also find academics striving to navigate a line between wanting to take students’ mental health seriously and accommodating the needs of individuals to a degree that over-protects them from reasonable expectations. Konstanze Spohrer, senior lecturer in education at Liverpool Hope University, worries that requests to avoid working with peers who students don’t know means that they don’t benefit from a wider range of perspectives or develop the ability to work with others.
Finally, claims that evidence should underpin mental health initiatives raise questions about their own evidence base. King’s College London’s Wessely observes, for example, that absence of scientific confirmation for the benefits of trigger warnings hasn’t hindered their widespread adoption. Similarly, official evaluations of psycho-emotional interventions in schools over the past 18 years show little evidence for any discernible short-term, let alone long-term, benefits. This hasn’t constrained a flourishing intervention industry and the prevalence of evaluations carried out by advocates committed to proving the benefits of a particular approach.
Other gaps in the evidence base are also significant. With universities now relying on commercial smartphone apps and frequent institutional surveys to incorporate well-being and mental health into their metrics, we don’t know whether constant probing and monitoring fosters hyper-sensitivity. There may be lessons here from behavioural programmes in primary and secondary school that sensitise participants to “uncomfortable feelings” and anxiety, and teach them “coping strategies”. Some heads of counselling and GPs in university medical services wonder whether such interventions, combined with a pervasive culture of risk-averse parenting, contribute to the pathologising of everyday difficulties and unpleasantness.
Disquiet about prioritising mental health in educational settings is rarely heard. There’s a tendency to dismiss reservations or criticism as elitist, out of date or insensitive to students’ problems. These charges did not apply to any of the respondents cited in this article.
While there is a good deal of unease off the record, there’s also apprehension about voicing it: some respondents worried that managers or media officers would regard publication of their views as “damaging” to institutional reputations. Others chose to be anonymous. In the face of high-profile enthusiasm for “mental health friendly” universities, caution needs to be replaced by much wider, more open, more nuanced debate than we have seen so far.
Kathryn Ecclestone is a retired professor of education and co-author of The Dangerous Rise of Therapeutic Education, published in 2008 and reissued in 2018 as part of Routledge’s Classics in Education series. She is a member of SMaRteN’s leadership team, contributing to its work on curricula, pedagogy and mental health.
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Print headline: Keeping things in perspective
