Are universities less healthy than they used to be?

This post was originally published to Huffington Post.

A journalist called me during a morning meeting recently to ask if I thought university was “unhealthy”. The question caught me off guard. It is not one those of us working in higher education tend to ask.

The existence of universities is such a given, and their place in society so highly valued, that to ask if they are ‘unhealthy’ can seem almost blasphemous. And anyhow, universities are just places of study, how can we generalise about whether they are healthy or not?

My initial response to the question was to point out that each institution is different, with differing support provisions and varied programs of study, so we can’t make sweeping claims. But the words coming out of my mouth left me uneasy. While I suggested that we can’t generalise the university experience, I realised that this is precisely what higher education lobbyists do.

Ministers and lobbyists speak of the value of a university education and of the higher salary one can expect. In doing so, they use what statisticians call an ecological fallacy– where the average in a group is used to wrongly infer the likelihood of something occurring for an individual. Lobbyists rarely make reference to individual differences – between institutions, between programs, between what’s right for particular people. Perhaps, then, we are reasonable in employing the same sort of sweeping judgments when considering the healthiness of a university education.

To answer a question like that on numerical data alone is problematic. We are relying on case-control studies, pitting those that went to university against those that did not. Such studies are inherently flawed measures of causality because healthy, wealthy parents are likely to send their healthy, well-supported children to university. Just as those attending university tend to have a head-start in terms of wealth over their non-graduating peers, so too do they in regards to health. Quite simply, there is no suitable control group.

Another issue with case-control studies is that they draw their conclusions over extended periods of time. For a stable and standardised intervention, like a pharmaceutical drug, that’s not an issue. But universities, economies and working environments are so changeable that a university education is anything but standardised. Graduating 10 or 20 years ago could be, and probably is, completely different to graduating in 2015.

If we wanted to use health related data from previous years to infer something about universities today, we might draw worrying conclusions based on rising suicide ratesand demand for counselling. But to avoid making claims based on historic data that doesn’t necessarily apply to institutions today, we can also break a university education down into its characteristics and constituents, and consider these against evidence-based determinants of health. When we do that, things don’t look much better.

One of the most studied social determinants of health is social support. In going to university, most students are moving away from their family homes and childhood communities, removing themselves from their most sustaining support units, which offered food and shelter, emotional support and the preventive healthcare that tends to be offered by one’s parents. In its place, they have access to informal support from university staff and peers, as well as formal student support services. These services consist of specific advice and guidance for students, as well as counselling services. While all universities have counselling services, waiting lists tend to be lengthy, and services have had their funds stretched since the recession – even in spite of rising tuition fees and rising demand.

In a recent publication, the Chief Executive of Universities UK, Nicola Dandridge, seemed to downplay the obligation of universities to provide adequate counselling and mental health services, saying, “institutions are academic, not therapeutic, communities”.

This is troublesome for a number of reasons. Firstly, it’s all very well to suggest that students ought to use community health services, as Dandridge seems to be implying, but most students are spending up to 9 months away from the communities they are familiar with. If students are expected to transition to community services in their university town, who else is going to support that transition and facilitate access to community services if not the university? To deny responsibility for that seems to show both a disregard for any adverse health events students may suffer, as well as discriminating against those students bringing existing health conditions. When we reflect on recent concerns raised by Stephen Hawking, universities hardly seem to be the progressive institutions that we like to think.

Secondly, while we might accept the claim that universities are places for growth and learning, rather than for correcting health issues, the attempt by Dandridge to disconnect academic and pastoral aspects of study suggests a worrying ignorance of what it means to be human.

As much as places of higher learning might wish to imagine humans only as ‘thinking beings’ without emotions or bodies, the reality is that pushing ourselves in our studies often also means pushing our mental and physical states to their limits. Extended periods of study often demand, or are at least conducive to, late nights, isolation, limited sunlight, limited exercise and poor diets, not to mention the stress of potentially having one’s entire career come down to a 2 hour examination.

Support goes beyond formal services. It includes the informal support offered by professors and staff. One of the promises of a university education is access to leading academics that can provide both intellectual and emotional guidance. But where once the student-staff ratio averaged approximately 1 to 12, it’s now around 1 to 22. And then there are the greater research burdens on lecturers that limit the time they can spend with students – and the quality of that time. While students being assigned a staff member as their ‘tutor’ on arrival would seem to be of value, the burden of obligations felt by staff elsewhere tends to make it a tokenistic arrangement consisting of minor administrative duties at best.

Then there is the informal support offered by peers. Peer networks are invaluable sources of information, emotional support, and belonging. But it’s not always a good thing, as the contagion of obesity has shown. Social networks lead to social norms, and if our networks are engaging in poor lifestyles, fuelled by alcohol and late-night kebabs, we’re probably more likely to do the same – particularly when struggling to make friends and settle into a new environment. And if we don’t manage to fit in, we have social isolation waiting for us, with all of its ill effects. The great range of study and living options, particularly outside of collegiate institutions, are such that we can find ourselves without any particular identifiable group aside from being a member of a 30,000 strong university. For those coming from a small town or school of a few hundred, it can be a bewildering experience.

Many student unions and societies are working to address the lack of support through health promotion, but these are not core structural functions of a university education. They are not standardised for students; they serve a complementary role as fringe additions to the formalities, set up in recognition of university limitations. And the increasing attention shift by student unions away from political issues towards welfare issues shows the true extent of these limitations. For the government, that’s probably quite convenient – students addressing health crises through peer-support means fewer students fighting abuses of power; although, as some students are beginning to recognise, the two are closely related.

No one would be brazen enough to say that universities are ever going to be ideal environments for one’s health. Few would be brazen enough to expect that. But if our hospitals are places to reduce poor health, is it too much of a stretch to suggest that our universities ought to be places that protect good health?

In Praise Of Student Support Staff

At a Student Welfare event I was speaking at yesterday, I tried to catch a student support advisor after one of the sessions. She had left the room swiftly, and was on the phone in the corridor outside. There was a look of concern on her face, and at first I wondered if it was a logistics issue – perhaps a son or daughter that needed picking up from school, or some other personal matter. But it wasn’t anything like that. She was phoning to check on a student at her university that was having a particularly tough time.

I don’t often meet someone who shows this level of compassion and concern for others, but when I do, it’s invariably a member of student support staff. There has been an increase in the number of articles examining student mental health and questioning whether universities are doing enough, but very few of these have recognised the extraordinary work done by existing support staff.

One of the things I’m most proud of from my time at NUS-USI earlier this year was the groundwork we laid for an Open Your Mind awards programme. We wanted to recognise not just things done by students to promote mental health, but also the tireless work done by support staff to help thousands upon thousands of students every year. It wasn’t that we thought staff would want the recognition (they are too selfless for that) but we hoped maybe it would help others to see why student support is so valuable.

I don’t know why support staff don’t get more recognition. Maybe because they don’t make a fuss about things. Maybe because others think they are only ‘doing their job’. Anyone who has spent time with support staff will know that this is not the case, and that they give a huge amount to others. Nobody gets involved in student support for their own interests – they do it because they care, deeply.

University students to undergo psychological evaluation

According to the online news website Colombo Page, new students in Sri Lanka may soon be subjected to psychological evaluation. Sri Lanka has one of the highest suicide rates in the world, and the measure is thought to be being considered as a way of addressing mental health issues fuelled by increasing academic pressures.

Earlier today, Australian newspaper, The Age, reported on plans to introduce compulsive psychological testing at Australian university, RMIT. According to the report, the tests would form part of a ‘Fitness for Study Panel’ that would evaluate the health of students, and identify whether any students with health conditions were likely to display “behaviour of ‘serious risk’ to the student or others”.

Compulsory psychological evaluations are controversial. Proponents claim that it would help distressed students to receive proper treatment, but there are concerns that such tests undermines civil liberties, and could be used to discriminate unfairly.


USA students donate $50,000 to wellbeing services

Graduating students at the University of Washington have pledged $50,000 to their university’s mental health services in recognition of the pressures affecting students. The donation is part of a tradition in the United States in which leaving students offer their university a ‘senior class gift’.

The donation is the university’s largest ever senior gift, according to The Seattle Times. The money will go to the Student Counseling Center, and be used to develop mental health awareness campaigns and educational materials to help students look after themselves.

In a USA survey of more than 28,000 university students, half reported “overwhelming anxiety” and almost a third reported having experienced depression. Earlier this year, USA Today reported that roughly 2.2 million students had accessed counselling services during 2012, and that services have become increasingly stretched.

Referring Back To CR166 (And A Note For Journalists)

Blind Men And The Elephant
During the past few months, there have been articles about the mental health of students in the Guardian (here, here, here, here, and here), the Independent (here and here), Times Higher Education (here, here, and here), and now the BBC (here). It’s great to see the issue being covered, even if it’s because of tragic statistics and stories.

If there’s one issue with the coverage it’s that it tends to focus a lot on problems and not much on solutions. It’s important that those covering the subject don’t ignore the work that’s already been done to provide us with answers.

The Royal College of Psychiatrists’ report doesn’t have all the answers. It doesn’t even have all the questions. (It makes it clear that more research and data is needed – some of which has since become available thanks to the work of organisations such as NUS and the Equality Challenge Unit). But the report does give us a few clear guidelines and recommendations that can be acted on immediately. More than that, it’s the most comprehensive report on student mental health we have, with input from organisations across the higher education and mental health sectors. It gets us on the same page. We should all be referring to it.

When I get phone calls from journalists looking to cover student mental health, it’s usually immediately apparent that they are full of compassion and sensitivity for the subject. I enjoy talking with them. But I don’t think I’ve had a single journalist start by asking me what needs to be done. The focus has always been on what’s wrong, and why. I suppose that’s the nature of journalism, but hopefully it can begin to shift a little.

I wrote a review of the Royal College of Psychiatrists’ report after it’s publication, summarising key points and adding a few things that were omitted. I’ve now updated this paper, adding data and developments from the past 18 months. If you’re a journalist or policymaker looking to do something around the mental health of students, take a look.

Student suicide data, and what needs to be done

(Note: The issues discussed in this article may be distressing for those affected by suicide. You can find out more information about suicide at the Mental Health Foundation’s website, here. If anyone has been affected by the issues discussed in this post and needs to talk to someone immediately, you can call the Samaritans helpline and speak to someone confidentially, 24 hours a day, on this number: 08457 90 90 90.)

A report published by the Royal College of Psychiatrists last year warned that there was a “pressing need” to do more around student mental health. New figures released last week show what’s at stake. In 2011, 112 students in England and Wales took their own lives. Every suicide is tragic. But what makes this figure particularly concerning is that it is almost a 50% increase on 2007.

I was sent the data on Wednesday by the Office of National Statistics whilst researching for an article to mark the one year anniversary of the Royal College of Psychiatrists’ report (which I reviewed here). Having failed to find any up to date statistics, I contacted the ONS with a freedom of information request on Monday. The figures have been published to the ONS website here*, and are discussed in a Guardian article here.

Although the ONS officer I worked with urged caution about drawing conclusions due to the numbers involved, the increase corresponds with a BMJ study of the wider population that suggests the financial crisis may have caused a significant rise in suicides. It also corresponds with concerns raised in the Royal College of Psychiatrists’ report about the current pressures facing students: “Social changes such as the withdrawal of financial support, higher rates of family breakdown and, more recently, economic recession are all having an impact on the well-being of students and other young people.”

When I received the figures, I was writing an article about the lack of urgency around student mental health. These figures raise further questions about the higher education sector and about what institutions are doing to ensure their students have adequate support. It’s time for the sector to respond.

The Royal College of Psychiatrists’ report provides clear recommendations for institutions and policy-makers. Currently, it is difficult to know which institutions, if any, are making serious efforts to meet these recommendations. This needs to change;

  1. Institutions should guarantee a certain level of support for their students.
  2. Institutions should put in place an institution-wide mental health policy and make it publicly available through their website; the policy should be reviewed and updated regularly by an institution-wide mental health & wellbeing committee that meets several times a year.
  3. The sector should fund a national committee to recognise and promote good practice in student mental health.

It’s up to students, staff, parents, and all those with an interest in the welfare of young people, to demand that institutions and policy-makers prioritise student support.

*The figures are for students aged 18+. ONS data was only available for England and Wales. The number of students in full-time education has increased by 15% during the same period.
Resources:  Universities UK produced a guidance paper on Reducing the Risk of Student Suicide in 2002, available here.