Are Rising Tuition Fees Causing An Increase In Female Student Suicides?

Female student suicides rose in 2016 for the fifth consecutive year, to new record levels. The news comes at a time when concerns have been raised about the mental health of adolescent girls and young women.

Although the female suicide rate in the general population increased in recent years, it remains approximately one third of the male rate. In 20-24 year olds, which represented the highest rate of suicide for women under 40, the ratio was slightly higher than one third at 37% compared to male. Amongst students specifically, a large proportion of whom fall within the 20-24 age category, female suicides in England & Wales were 54% that of male suicides, breaking from the broader population trend and suggesting that the student demographic may have unique features.

If we accept the conclusions of several studies and expert views examining student mental health, we might be quick to arrive at a culprit: the rise in tuition fees. While a study in 2015 claimed that the recent rise in tuition fees was not leading to worsening mental health amongst students, it only surveyed 390 students, and didn’t take suicide rates into consideration.

If we are going to suggest that the rise in tuition fees may be causing the suicide rate to increase, we have to consider why this seems to be affecting female students more than male. Although male student suicides have been at or near record levels during the past three years, the rate has been stable.

If we look at the relative suicide risk of being a student compared to the general population, female students have a suicide rate that is approximately equal to the broader rate amongst 20-24 year olds (based on HESA data; at 5 per 100,000), and higher than the adjacent age groups. When we factor in that a sizeable percentage of students fall outside of the 20-24 age group, this would put female students at greater risk of suicide than non-students for 2016. By contrast, male students had a lower rate of suicide than 20-24 year olds (at 11.8 per 100,000 compared to 14.1), suggesting that higher education may have provided a moderately protective effect against suicide in men (which one would expect in view of the inverse association between mental illness and socioeconomic status), but not for women.

As always, we have to be cautious in making conclusions based on limited data. However the rise in numbers of students attending counselling services may indicate both that mental health issues have risen, and also that anti-stigma campaigns may have had some effect. Many of these campaigns aim to challenge the ‘macho culture’ amongst young men, which may have had some effect in encouraging male students to seek help, preventing the suicide rate amongst men from moving higher.

It’s also possible that financial worries may affect female students more than male. A 2016 survey found that female students have lower expectations for graduate pay than male students, and a survey by NUS concluded that female students’ mental health may be more affected by financial worries than males’.

What happened to pastoral care?

This article was also published at HuffPost. 

We might be talking more about mental health at university, but there is a related concept, one more rooted within the tradition of higher education and yet crucial to any current discussion about mental health in education, that seems to have faded from view.

In an article for Times Higher Education last week, Anthony Seldon became the first university vice-chancellor to call out universities for not doing enough to protect students’ mental health. Those familiar with Dr. Seldon and his work on well-being at Wellington College and Action for Happiness will not have been surprised by what he had to say. But the article featured an expression that has been conspicuously absent from most of the conversations on mental health in higher education: ‘pastoral care’.

Over the past 10 years or so, usage of the expression has diminished. The Royal College of Psychiatrists’ 2011 95-page report on the ‘Mental health of students in higher education’ contains 290 references to ‘mental health’ and 56 for the word ‘well-being’, but just for 3 for ‘pastoral’ – with 2 of those referring to GP practices. By contrast, the previous report, published in 2003, was just 66 pages but contained 12 references to ‘pastoral’ – 2 more than ‘well-being’.

Part of the preference for ‘well-being’ over pastoral care can be attributed to the secularisation of university campuses. Wikipedia describes pastoral care as “emotional and spiritual support”. The idea of ‘spiritual support’ can seem old fashioned and unpopular, whereas well-being has been a popular subject of study amongst psychologists and economists.

Perhaps there is more to it than that. The Oxford Dictionary defines pastoral careas “relating to or denoting a teacher’s responsibility for the general well-being of pupils or students”. Central to this definition is the assumption that teachers (and educational institutions) have a responsibility for the well-being of students. Does the loss of the term ‘pastoral care’ reflect that we no longer tend to hold universities responsible for student welfare?

Widening access to higher education has brought sharp increases in the number of students. The effects of falling staff-student ratios on students have been compounded by pressure on academics to increase their research output. This isn’t how it’s meant to be. In the earliest days of western education, teachers might have had an entire week to devote to one or a handful of students. Today, students with a scattering of weekly classes can consider themselves fortunate if their lecturer even knows their name.

Some of the changes in higher education are inevitable. Most of us can’t afford to employ a private tutor. It’s unavoidable that giving more people the chance to attend university will mean sacrificing some of the small-group time between staff and students. But the disturbing thing is that we barely seem to have noticed this sacrifice.

Growing (and justified) criticism over inadequate funding for mental health services has overshadowed general wellbeing and support needs. And while university lobbying groups can argue that responsibility for treating those with mental illness largely rests with the NHS, the same cannot be said of general student well-being. There has always been an assumption that when a student arrives at university, their parents are handing over duty of care to the institution. In recent years, this assumption has become less and less justifiable.

There is a trend in academia towards distinguishing intellectual needs from emotional needs, and then trying to monopolise the former and dismiss the latter – something Dr. Seldon refers to as an “unhelpful divide”. This seems like an understatement. Intellectual development necessarily involves emotional upheaval. Good teaching helps steer us through that. As recent debates about trigger warnings and safe spaces show, if educational institutions ignore emotional needs then it’s not just our mental health that suffers, but also our intellectual growth.

If we acknowledge this as a problem, then it’s one that goes beyond the education sector, and dates back decades. The individualism championed under a Thatcher government tends to emphasise personal responsibility; the expansion of universities under a Blair government have made it harder for to provide individualised support, and the economics of higher education lead us to prioritise numbers before norms.

None of this means that pastoral care is doomed, and reinvigorating it doesn’t necessarily depend on reversing student numbers. Universities can prioritise (and monitor) personal tutoring, develop mentoring schemes and strengthen support services. But if we expect universities to take responsibility for the well-being of students then we need to tell them this. And, crucially, to recognise those that do it well.

A note on an article in The Lancet Psychiatry

The latest edition of The Lancet Psychiatry features an intriguing, if odd, article. Entitled ‘Rethinking the biopsychosocial formulation‘, its main premise is that, “to split the psychological and social from the biological is no longer scientifically tenable.” This is something I vigorously agree with and have discussed in criticism of the trendy political term, ‘parity of esteem’. As the authors imply, over-attachment to mind-body dualism is a major threat to improving healthcare. And yet, the conclusion that they appear to draw out of this premise is quite baffling.

As a precursor, I should say that my institution only allows me to access the first page of the article, but, assuming the authors don’t make a significant u-turn later on, the claim can speak for itself:

Screen Shot 2015-07-06 at 16.40.06

 

The authors seem to be concluding that problems with ‘splitting’ approaches to mental illness into three perspectives require us to discard of two of these perspectives – no surprises for which of the two the authors and psychiatrists wish to discard. It’s unclear how they expect to be able to favour a biological perspective without first ‘splitting’ it from the other two, an action they claim to oppose, or how this can possibly encourage the “integrative-approach” they apparently support.

Putting aside the contradictions, in suggesting a shift towards a more biological viewpoint they seem to be dismissing decades of scientific research and cultural progress that has moved us towards an integrated interpretation of mental illness that acknowledges the influence of social factors, environmental circumstances, and cognition. If nothing else, this is insulting to other mental health practitioners.

Thankfully another psychiatrist was quick to jump in and gently object to the point. After bringing the article to task for being “a little unfair” in its interpretation of the biopsychosocial model, Duncan Double, a ‘consultant psychiatrist and honorary senior lecturer’, discusses intellectual progress in psychiatry and the need for an integrated approach.

Dr. Double suggests that psychiatrists don’t need to be philosophers, but if they’re going to try and address the issue of dualism, they may do well to read up (here’s Stanford’s introduction). In contrast to their less labouring eastern counterparts, western philosophers have struggled with the mind-body problem since the time of Plato nearly 2500 years ago. Even in 400BC it was acknowledged that thoughts and feelings have a basis in the brain. But no sensible philosopher would go so far as to suggest that one should only view such things biologically – at least not until we can figure out consciousness and map out and biologically intervene in every thought and feeling. (That may take some time.)

Perhaps I’m being uncharitable towards the authors and the rest of the article is more nuanced; or perhaps they didn’t express themselves quite as intended? A quick search online and I see that the lead author of the article appears to have written a book on psychotherapy – which only adds to my puzzlement over the article. If those of us working towards joined-up approaches to mental health and healthcare can be a little sensitive about perceived threats to collaborative working, it’s only because we want to see the varying perspectives (biological, psychological and social) moving forward together. 

Deconstructing the First WHO Suicide Report

  • Over 800,000 people die by suicide each year, around one person every 40 seconds. 
  • 75% of suicides occur in low and middle income countries, although the actual rate of suicide is greater in high-income countries. 
  • Suicide is now the second leading cause of death in 15-29 year olds. 

In time for World Suicide Prevention Day, the World Health Organisation has released its first international suicide report, calling for large-scale strategic action to address a “global imperative”.

Its central advice is that all countries ought to have a national suicide strategy that focussed on restricting access to the ‘means for suicide’, equipping health services to better identify and respond to suicidal risk, and influencing culture to challenge stigma and increase ‘help-seeking behaviour’.

Perhaps surprisingly, given that the report divided nations by income, there is no substantial analysis around global socio-economic factors, or even why the suicide rate appears to be greater in high-income countries. Nor is there analysis of why so many young people should be suicidal.

The report steers clear of discussing current economic situations, unemployment levels, and global conflicts, despite each of these being strongly linked to suicide. Its recommendations are principally concerned with intervention at the point between suicidal ideation and the act of suicide, and not with prevention of suicidal ideation and related illnesses and conditions.

Necessarily, the report has to limit its focus. But in ignoring global events that may be increasing the risk of mental illness and suicide, the report seems to be in conflict with the whole-systems approach to health that the World Health Organisation has been advocating since the 1980s.

The rise of 'hapitalism', and what can be done

Hapitalism (hap-i-tal-ism)
noun (portmanteau of ‘happy’ and ‘capitalism’)
An economic system based on a state measuring collective happiness in a way that encourages a level of individual competition and inequality typical of unregulated, free-market capitalism.

Yesterday, I wrote something for the Huffington Post exploring the correlation between happiness and suicide rates in US states (and nations). In it, I raise concerns over a developing ‘hapitalism’ in which average happiness levels are raised by sacrificing the happiness, and, in some cases, lives, of a minority.

A central principle behind capitalism is that free markets allow for economic growth and that this benefits all of us on condition that interventions such as taxation and public services exist. In the same way, happiness advocates argue that an increase in gross national happiness will benefit us all. The problem is that, as the happiness-suicide correlate indicates, conditionals are also needed to ensure that a rise in GNH benefits all. I’ll look more at these conditionals shortly.

The importance of conditionals in a happiness economy risks being overlooked due to happiness being seen as an intrinsic moral good. On the surface, an increase in the happiness of a group seems like a good thing, but the problem is that an increase in average happiness can be attained even if one member of the group has come to find themselves in extreme suffering. The tendency to assume that we can draw conclusions about individuals from the condition of a group is known as an ecological fallacy.

The appropriateness of equating a capitalist economy with a happiness (‘hapitalist’?) economy depends on the way in which individual ‘growth’ occurs in the two types of economy.  In my blog post, I explore the idea that the happiness of some may be directly enhanced by the suffering of others, and that those who are suffering may feel worse by comparing themselves to happy people (hence a correlation between happiness and suicide)*. If this is an accurate description, then, just as capitalist societies tend to favour the wealthy and may widen inequalities of wealth and income, a happiness economy may widen the wellbeing gap between the happy and unhappy unless interventions are in place to help encourage the reverse.

Interventions

1. Improving happiness indicators
For happiness indicators to be a measure of the wellbeing of all, they need to focus on more than just aggregating individual happiness. The economist Sagar Shah suggests that this might be done by also looking at the ‘features of a society’, or by giving higher weight to those with ‘lower well-being’. Discrediting simplistic aggregated measures of happiness may also be an important step.

2. Improving communication
Those writing, speaking and teaching about happiness ought to appreciate the degree to which suffering is unavoidable, and to be mindful of the impact of their words on those who are suffering. Proponents of positive psychology tend to use Martin Seligman’s theories of learned helplessness and learned optimism to argue that we all have influence over our wellbeing. This can be a message of hope and encouragement to some, but it may also dishearten those with poor wellbeing. Whilst our perception of suffering may influence our ability to move on from the situation, the presence of suffering is often a normal and healthy reaction to adverse stimuli. (Try being happy when you’re repeatedly being subjected to electric shocks.) If we deny this, we risk stigmatising something that we will all experience at some point in our lives.

3. Improving policymaking
All official happiness policy should factor in public health principles, and any messages or interventions designed to boost collective happiness should consider implications for mental health and suicide-prevention. Economists and policymakers should be liaising with public health professionals — and also vice versa; as the World Health Organisation reminds us, “Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love.”

 

*This may only be the case for people, communities and societies that are driven by competition and comparison. In fact, research from Japan suggests that happier people are kinder.

Higher Education Propaganda: Bringing Lobbying Groups to Task

Originally published as ‘How Propagandists Manipulate the Facts to Sell the University Dream’ at HuffingtonPost.com.

It was the blog‘s lackadaisical attitude towards student wellbeing that got to me. The way it claims that higher education has “been shown” to benefit the ‘health and well-being’ of students, without providing a shred of evidence (and in the face of thisthis, and this). But it’s the misleading employment claims that show how far propagandists are prepared to go to sell university places.

For those that are unaware, Universities UK is a membership charity that (as you might guess from the name) acts on behalf of the majority of the UK’s universities. The aims of the organisation (which recently came under fire for its stance on gender segregation) include to “support universities in their primary aims of educating students, carrying out research and innovation, and strengthening civic society”.

The blog post in question was written by the Universities UK ‘Policy and Data Analyst’ and uses new ONS data to make a number of claims, including that those with a degree have a lower unemployment rate than those whose highest qualification is an A-level. Unfortunately that’s not what the data shows.

The first page of the ONS report states that the graduate figures refer to all those who have been through higher education, including recipients of diplomas and certificates typically awarded to those with professional experience. For instance, the Chartered Management Institute offers a Level 7 Award to senior managers. It’s not really surprising that for those with such an award unemployment should be low. We can assume, then, that had the unemployment figure only related to those with degrees, it might have been considerably higher. Of course, those casually reading the blog won’t know this. They’ll assume that the author of such an authoritative blog has got the facts right.

For an organisation that describes itself as “the voice of UK universities” it’s embarrassing that their official blog features such an obvious misuse of data. At best it’s carelessness, at worst, a deliberate attempt to foil the public. Let’s give them the benefit of the doubt.

Further claims in the blog relate to average salaries. Glancing at the impressive graph gives the illusion that graduates in their forties have average earnings twice as high as non-graduates, and that the data is a good prediction of what today’s graduates can expect in the future. Neither is true.

In his bestselling book, The Black Swan, statistician Nassim Taleb discusses the problems with using averages, warning, “don’t cross a river if it is four foot deep on average”. Those university candidates looking at average earnings data as an indicator of their future prospects should be just as wary – not only because of the issues with averages, but because of the changes in the jobs market over the past twenty years.

The highest earning university graduates, who are in their early-forties according to the graph, graduated at a time when the jobs market and economy were completely different. The proportion of the labour force with a degree has (according to the Guardian) doubled in twenty years, slashing the usefulness of a degree as a way of differentiating between job candidates. Additionally, economic turmoil and the shift towards a ‘knowledge economy‘ have created a skills gap that has forced almost half of graduates into non-graduate roles. The effect on average earnings is that, according to the same ONS report, 21-year-olds with an apprenticeship are earning more than 21-year-old graduates.

None of this is to say that university is not worthwhile for many. Of course it is. But to judge the value of a degree based on the success of those who graduated twenty years ago is like using a 1993 edition of the Financial Times to pick investments. Those considering university would do far better to ignore the propaganda and do their own research.

Is Higher Education an "Excellent Investment"?

In November, Universities UK, the higher education advocacy group, published a blog post entitled ‘Higher education is an excellent investment, even in an economic downturn’. The post is basically an advert for university, albeit with a number of questionable, and, at times, frankly, embarrassing claims.

Yesterday their social media team tweeted the post as the deadline for applications approaches, presumably aware that November applications were down on the previous year. I wouldn’t normally be critical of a blog post, but let’s take a look at its main arguments:

1. “Those with a degree are more protected from the recession than those without.”

The author refers to data from the ONS indicating that graduates enjoy a higher employment rate (87% versus 83%) and lower unemployment rate (4% versus 5%) as compared to those whose highest qualification is A level standard. Leaving aside the fact that the percentage differences seem pitifully small (particularly considering that graduates are more likely than non-graduates to have middle-class parents who are in a position to help them find work), a simple bit of background reading appears to show that the evidence doesn’t support the conclusion.

The ONS report clearly states on the first page that its definition of a graduate isn’t just those with degrees (as the author suggests) but also “those with higher education”, which covers all sorts of vocational awards and certificates that can be granted to those who are already established within a field. It’s not hard to get work after graduating if your employer is paying for the qualification.

Looking more closely at the ONS report, a crucial piece of information that the blog post doesn’t reveal is the nature of the employment. According to the ONS report, almost half of recent graduates were working in a non-graduate role (i.e. one that didn’t require higher education or a degree). They might, for example, be pushing trolleys in a warehouse. (Use of warehouse safety helmets is probably not the kind of “protection” the author wanted us to have in mind.)

2. “The profile of earnings for graduates is rising much more quickly than for non-graduates, and graduates are earning more than non-graduates over their lifetimes.”

The author displays the difference in earnings through an impressive adaption of the ONS’s chart, which – by narrowing the x-axis, starting the y-axis at £10,000, and removing apprenticeships from the chart altogether – makes it look as though graduates are very quickly earning more than twice as much as non-graduates annually. The problem with the graduate earnings data is that it’s largely meaningless. Not because it’s untrue, but because it’s based on the average earnings of graduates.

If there are four recent graduates in a room, each struggling on £10,000 a year, and a fifth graduate earning £110,000 a year walks in then the average earnings of the group will jump from £10,000 to £30,000.  This is unlikely to console them. As Fraser Nelson points out, the highest-earning professions – including law, medicine, and dentistry – tend to require degrees, skewing average earning figures for other graduates. Then there is the discrepancy between institutions, and the impact of unusually wealthy graduates.

The other reason why those thinking of applying to university should be extremely sceptical of the average and lifetime earnings data is that those at their peak earning age (of around 40) graduated in a completely different economic environment. University degrees were still relatively unusual, with 12% of the UK population having degrees in 1993, compared to 25% in 2010 (according to the Guardian) and only 19.3% of students participating in higher education in 1990 (according to this parliamentary report) compared to almost 50% today. The earnings data also doesn’t account for the negative impact of struggling to find work during a recession (which has been known as the ‘scarring effect‘). In short, the data is virtually useless as an indicator of what today’s graduates can expect their average earnings to be in twenty years.

The ONS’s average earnings data does have some use, though. It shows that a 21-year-old graduate earns on average less than a 21-year-old with an apprenticeship – a fact that’s unclear from the blog post’s chart due to it conveniently leaving out apprenticeships.

3. “There is personal benefit in attaining higher education, which has been shown for many aspects of life, including health, well-being and personal development.”

This is the part that really got to me. At least with the other claims, the author refers to some evidence rather than resorting to saying only that it has “been shown”. Let’s look at what’s been shown for a moment.

  • – Demand for support services has risen by nearly a third since 2008.
  • – Student suicides rose by 49% between 2007 and 2011.
  • – In an NUS survey of 1200 students last year, 80% reported feeling stressed and 13% claimed to have had suicidal thoughts.

Evidently the well-being benefits of higher education are not as clear-cut as the author might like to think.  The author’s half-hearted attempt to suggest otherwise, which reads more like an afterthought than a genuine point, is an indication that Universities UK does not see the wellbeing of students as a priority issue (despite its relevance to the ‘lost generation‘ claims that the author refers to).

Although Universities UK hosts a Working Group for Promotion of Well-being in Higher Education, the group receives no funding or advocacy support and is run by charitable university support staff in what little time they can find around very demanding university roles.

4. “Society as a whole also benefits by greater engagement through civic engagement, citizenship and lower crime rates, as described in the recent BIS report. It is clear that higher education is not only a good investment for those individuals who directly go to university, but it is a good investment for the UK’s economy and society too.”

Actually, most of this is probably true. Having more young people in university probably does increase ‘civic engagement’ and deter people from questioning authorities and institutions. And it probably does support the economy, at least in appearance (and until the next financial crisis).

But for those weighing up whether or not to go to university, these factors should be completely irrelevant. You should dismiss them, just as you should all the other misleading claims about higher education being a good investment. If you decide to go, go because it’s what you really want, not because you think it’s a safe option or that it’s expected of you. And certainly not because it will make you a ‘good citizen’.

For ideas about alternatives to university, take a look at www.notgoingtouni.co.uk

Edit
The Universities UK blog post was edited after this post was published, and now includes the following: “(chapter 3 of the supporting analysis for the higher education White Paper 2011 summarises some of the studies done on the wider benefits from higher education).” Unfortunately for Universities UK, the White Paper contains no evidence of the benefits to “health, well-being, and personal development” that the blog post claims have “been shown”. They have not responded to a requests for comment.

How China is addressing student wellbeing

The Chinese government has been taking major steps to protect the mental health of its students, an investigation has revealed.

Interviews with the Ministry of Education and a leading figure in student counselling have revealed that since 2011 all universities have been expected to start providing their students with compulsory mental health classes. The policy was introduced after more than a decade of lobbying from student support staff and ministry officials, and is aimed at helping students cope with academic pressures and to manage the transition into the working world during a period of global economic unrest.

In a story published in the China Daily earlier this year, Guirui Lin, Head of Counselling at Capital Normal University, raised concerns about the resources available to student counselling services. But a meeting in Beijing last month painted a more optimistic picture: “The majority of university students in China now have access to classes in mental health, and faculties are being trained to care for the psychological health of their students. Many students are also being trained to be peer counsellors, and every year on May 25th we hold a Mental Health Day which features a wide range of mental health education activities.”

At Guirui Lin’s institution, Capital Normal University, students are required to participate in 18 hours of mental health training per semester. Documents received by mwproject.org show that the classes cover a wide range of areas relating to student wellbeing including the Signs and Symptoms of Mental Illness, Managing Emotions, Adapting to College Life, Sexuality and Gender Issues, Dealing with Perfectionist Tendencies, Suicide Prevention, Healthy Relationships, Dealing with Setbacks, and Career Planning. Guirui Lin insisted that it was important that mental health classes be compulsory in order to reach all students and not just those with a pre-existing interest in the subject.

Wang Dinghua, China’s Director General for Basic Education, reiterated the importance that the government is placing on students’ mental health as part of reforms designed to shift emphasis away from standardised testing in schools: “We are providing funding and technical assistance to improve mental health in schools in 20 pilot areas…Within 5 years, we expect all schools to be providing mental health education.”

Canada: Huge survey into student mental health forces action

In a survey of more than 30,000 post-secondary school students in Canada, across 34 institutions, 9.5% of respondents stated that they had “seriously considered taking their own lives in the past year”, The Province and The Star reported. A guide has been released to help institutions take action.

The survey, which was led by the Canadian Organization of University and College Health, also indicated that 89% of respondents reported feeling overwhelmed by “all they had to do”, 54% reported feeling hopeless during the last 12 months, and 64% had felt lonely. The survey findings echo a similar survey from NUS in the United Kingdom, in which 13% of the 1,200 respondents reported having had suicidal thoughts.

Following the release of the survey, the Canadian Mental Health Association (CMHA) and the Canadian Association of Colleges and University Student Services (CACUSS) has launched a guide to help institutions take action to address student mental health using a “systemic” approach. The guide is based on three years of work, and input from hundreds of professionals and students.