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?

‘Employability, employability, employability’

In a 2001 speech, Tony Blair famously underlined his aim of getting more young people through higher education by listing his top three priorities for government as, “education, education, education”. Twelve years later, and with the recession having taken its toll on the ‘widening access’ agenda, political priorities for young people seem to be shifting.

The UK government has long sold the value of a university education on the evidence that graduates get paid more than non-graduates, but the figures have been criticised for being skewed by a small percentage of graduates that are on disproportionately high salaries.

It could also be argued that graduate salaries are higher due to factors outside of university; for instance, graduates may be more likely than non-graduates to have access to financial and professional support through their parents – something that can be particularly useful for breaking into certain industries, such as the media. The British public seems to agree that social status can be a key factor, with a recent poll indicating that almost two-thirds believe that ‘who you know’ matters more than ‘what you know’. 

Skepticism about graduate salary statistics, coupled with a rise in graduate unemployment, has driven the issue of employability into public consciousness, and, since 2007, Google searches for ’employability’ in the UK have doubled. There have been inevitable calls for more jobs to be created, but there has also been a growing argument – spurred by comments from recruiters – that educational institutions and their students need to focus on cultivating ‘soft skills’ such as those involving communication, teamwork, and assertiveness.

Last week, a Guardian live chat explored the ways in which the higher education sector is responding. According to the Work Foundation, the demand for soft skills is being ramped up by the shift towards a ‘knowledge-based’ economy. To address this, universities are increasingly looking to strengthen ties with businesses to create internship opportunities, promoting extra-curricular activities, and offering soft skills training and resources.

Entrepreneurship also continues to gain support within institutions, with recognition that, regardless of whether businesses are actually built, enterprise skills such as assertiveness and leadership are valuable to employers.

But as the employability agenda grows, there are some tensions. Whilst an emphasis on employability might benefit job prospects, there are concerns that the ‘corporatisation‘ of higher education will squeeze students down narrow career paths and detract from the pursuit of knowledge and personal development for its own sake.

Objections seem to be fading though, with Ferdinand von Prondzynski, Vice Chancellor for Robert Gordon University, recently writing on his blog that, “‘Knowledge for its own sake’ is no better as a pedagogical statement than ‘spinach for its own sake’ would be as a nutritional one”.

Resilient Youth: Using Psychology To Prevent A ‘Lost Generation’

This article was originally published with the Huffington Post.

Switching on the news last night, I heard a young graduate telling a reporter, “I’ve done everything that society told me to do, and I’m still not finding employment.” As his words trailed off, the despair in his voice seemed to capture a generation that’s feeling let down and unsure where to turn. Increasingly, recent surveys from NUS and The Prince’s Trust suggest, the blame seems to be turning inwards.

There is research showing that in previous periods of high youth unemployment, those affected continued to be hampered professionally and socially long after the recession ended – a phenomenon that has been described as the ‘scarring effect’. It’s data like this that gives some weight to the otherwise melodramatic claim that today’s young people will go down in history as a ‘lost generation’.

One explanation for the scarring effect is the psychological impact of unemployment. Research links unemployment with a perceived loss of control, and what some psychologists call ‘learned helplessness’ . Feelings of helplessness are a predictor of depression . They are also linked to decreased work performance – a correlation that exists not just in the western world, but globally .

There might be good reason for young people to feel helpless. 75 million young people around the world are out of work, the value of a degree has tumbled, and the so-called ‘scarring effect’ suggests that history isn’t on their side. But in the last recession psychological research and interventions were less developed. And what the latest research tells us is that helplessness is not inevitable and it can be reversed .

When a young american psychologist called Martin Seligman was researching depression in the late 1960’s, he found that if people were subjected to repeated and uncontrollable stressors then they would often come to resign themselves to their plight, remaining inactive even when opportunities to change their circumstances arose – a condition which he called ‘learned helplessness’. What he also found was that whilst some acquired this condition, others seemed to be more resistant. When he looked for distinctions between the two groups, he discovered that they had different ways of explaining the source of stress; those that were more resistant tended to see the stressor as confined and temporary.

The findings were consistent with assumptions underlying the emerging field of cognitive behavioural therapy, and Seligman hypothesised that if he could train people to develop a more optimistic ‘explanatory style’ using ideas from CBT then he could teach them to be more resilient to stress. His ideas gained support and helped establish a new field of research known as ‘positive psychology’, which argued that wellbeing is a legitimate focus for researchers and policymakers. This ‘wellbeing movement’ now spans psychology, economics, and politics, led by organisations such as Action for Happiness and the New Economics Foundation.

Governments and businesses have picked up on the science and are transforming it into policy and interventions. Wellbeing programs have been introduced in certain schools – Wellington College, for instance, holds wellbeing classes for its students, and school PSHE programs are teaching emotional skills. But despite graduate employers criticising a lack of soft skills, wellbeing programs have not (as Anthony Seldon of Wellington College notes) been rolled out for students in higher education.

Given that educational institutions are supposed to be at the cutting edge of science, it’s surprising that most seem to be so far behind the curve, with some members of academia (such as this Vice Chancellor) apparently not believing that learning has much to do with psychology at all.

Counselling services have increasingly taken it upon themselves to offer group sessions on topics such as mindfulness and stress management, but these are limited to the narrow financial and political confines of ‘student support’. Research links a perceived sense of control with job searching strategies , motivation at work , and entrepreneurial potential . As employability and enterprise agendas continue to grow, it’s time that applied psychology was recognised as being crucial not just to student support but to student development.

So how we do this? For starters, universities can work to strengthen ties between support services and careers centres, bringing together mutually-compatible expertise; careers centres can look to offer students psychological training, and the growing number of university programs encouraging extra-curricular personal development can promote and accredit initiatives that help build resilience. The evidence base is out there; let’s apply it.

I’m not suggesting that a focus on applied psychology is a substitute for social action; it won’t solve the issues of inflated tuition fees and struggling jobs markets. But if psychology can help young people to gain an advantage over the problems they are facing then it might be enough to give them a bit more hope for the future. And if we act now, just maybe when we look back in ten or twenty years the young people of today will be known not as a ‘lost’ generation but as a resilient one.

Lucas, R.E., Clark, A.E., Georgellis, Y., & Diener, E. (2004). Unemployment alters the set point for life satisfaction. Psychol Sci. 15(1), 8-13.
Baum, A., Fleming, R., Reddy, D.M. (1986). Unemployment stress: loss of control, reactance and learned helplessness. Soc Sci Med. 22 (5), 509-16.
Benassi, V.A., Sweeney, P.D., Dufour, C.L. (1988). Is there a relation between locus of control orientation and depression? Journal of Abnormal Psychology. 97(3), 357-367.
Ng T.W.H., Sorensen K.L., Eby, L.T. (2006) Locus of control at work: a meta-analysis. Journal of Organisational Behaviour. 27(8) 1057- 1087.
Spector, P.E., Cooper, C.L., Sanchez ,J.L., O’Driscoll, M., & Sparks, K. (2002). Locus of Control and Wellbeing at Work: How Generalizable Are Western Findings? The Academy of Management Journal 45(2), 453-466.
Buchanan, G.M., & Seligman, M.E.P. (1995) Explanatory style. Hillsdale, New Jersey: Lawrence Erlbaum Associates.
Caliendo, M., Cobb-Clark, D. and Uhlendorff, A. (2009) Locus of Control and Job Search Strategies. IZA Discussion Paper 4750, Bonn. Available at: http://ftp.iza.org/dp4750.pdf
Puthanpurayil R S. Personality traits and locus of control as predictors of work motivation. (2008) Available at: http://wiredspace.wits.ac.za/handle/10539/4751
Kaufmann, P.J., Welsh, D.H.B., & Bushmarin, N. (1995). Locus of control and entrepreneurship in the Russian Republic. Entrepreneurship Theory and Practice, 20(1), 43-56.

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.

 

University Mental Health Policies: Better Communication = Better Mental Health

In March I was part of an online discussion about the role of mental health policies in promoting students’ mental health – a subject brought to prominence by the Royal College of Psychiatrists. The starting point for the discussion was simple: should all universities have a mental health policy?

At first there seemed to be unanimous agreement from panelists: yes, all universities should have a mental health policy. Since all of the panelists were (to some degree) involved in supporting students’ mental health, this probably wasn’t surprising. Why would anyone not want to make it easier for students to access support, right? But the discussion grew more complex, and an opposing point was raised that I hadn’t anticipated. After reflection it became clear though that the disagreement was not based on a difference of views, but on an ambiguity found in the RPsych’s recommendations – one that I hope to clear up here.

The argument put forward by one of the panellists was that, whilst all universities should have mental health policy, it should not necessarily be based in a single ‘mental health policy’ document. The wider point that they alluded to was that, since the mental health of students is interrelated with other subject areas (such as disability issues and student services), it cannot be looked at in isolation; to expect universities to be able to extricate mental health policy from related policy areas and present it in a single uniform document risks oversimplifying the issues.

In some ways, this view aligns with the principles of the Healthy Universities project (based on the World Health Organisation’s settings-based approach), which recognizes that health and wellbeing is not a standalone issue but one that necessarily involves wider environmental factors. We know that social factors have a profound influence on mental health, therefore for universities to modernize and adopt settings-based approaches they need to recognize the links between mental health and wider campus issues – even those issues traditionally considered to be academic (as alien as this idea may be to certain VCs). The panellist was surely right, then: mental health policy must be embedded into wider institutional policy. And yet, the content of policy and the presentation of policy are not necessarily the same thing.

What the Royal College of Psychiatrists’ report fails to do is recognise the dual roles of a mental health policy. If we explore the definition of ‘policy’, we’re confronted by two interpretations. Whilst on the one hand policy exists to provide standards and guidelines for policy-makers and those policing policy, on the other hand, it exists as a public statement of intent – a contract between those with the power to implement policy, and those whom the policy affects. The former, we can think of as ‘policy‘ (or a number of related policies), the latter as ‘a policy‘ – which is about communicating ‘policy’ to stakeholders through a single document.

The reason I first got involved in mental health campaigning was not to address gaps in support, but gaps in communication. The Mind Matters Society was launched to ‘bring mental health out of the shadows on campus’ – by challenging stigma around mental health issues, but also by making information about mental health more available to students so that they could make their own choices. The latter of these goals (although not as topical as the former) is just as crucial. The sharing of good information necessarily reduces discrimination, but a reduction in discrimination does not necessarily lead to useful information being shared. As long as information about a university’s mental health and support provision remains impenetrable to students, mental health will be a subject difficult to grapple with. It’s for this reason that a formal statement outlining the university’s commitment to student mental health is so important.

The task for universities,therefore, is to provide a policy document on the subject of mental health that is accessible to those it affects, whilst also ensuring that policy on mental health remains embedded within its wider system. The dozens of university mental health policies already in place suggest that this is achievable.

If universities need to provide multiple policy documents then so be it, as long as there’s one starting document that sets out the university’s commitment to the mental health of students. As Chris Brill, the ECU’s policy advisor suggested during the discussion, irrespective of the complexity of policy, universities can offer a reference document that outlines the university’s position on mental health. It’s this that I believe the RPsych’s report is referring to it when it speaks of a ‘mental health policy’, and it’s this that I am campaigning around. Whether the title of this policy document contains the term ‘mental health’ is up to them, but  when ‘mental health’ is the universally used term to capture psychological issues and treatments, why complicate matters further by calling it anything else?

How We Can All Make A Difference on University Mental Health & Wellbeing Day

Note: This article was originally published on www.huffingtonpost.co.uk, here.

It seems like almost every day is an awareness day for something or other. There are a handful of awareness days, weeks, and months that get global attention and raise funds for vital causes. But then there are more obscure awareness days, not necessarily any less vital, perhaps, yet not quite managing to gain the same attention. There is, apparently, a National Pig Day, a Potato Awareness Week, and even a National Toilet Tank Repair Month – which, coincidentally, falls in the same month as National Pickled Peppers Month.

So it was with some trepidation that the idea of a University Mental Health & Wellbeing Day was put to me. Would it get lost in a sea of awareness days? Would the creation of yet another awareness day cause eyes to roll? I was unsure. But after thinking about it, I realised that an awareness day isn’t just about trying to squeeze a date into the diaries of those who would otherwise be uninterested. It’s also about aggregating the resources of those who are already involved with a cause – to get stuff done.

There are many people with an interest in university mental health; including university support staff, student unions, charities, and a growing number of student campaigners. But it’s hard to unite everyone. The issues are complex, and we have our own narrow remits and institutional issues to deal with. This is where University Mental Health & Wellbeing Day comes in. For one day of the year we can try and take a step back from the individual problems we’re working on, focus our resources on addressing the issues that exist across institutions, and know that there are others, all around the UK, who will be doing exactly the same.

Tomorrow is the second annual University Mental Health & Wellbeing Day, led by the University Mental Health Advisors Network (UMHAN). Amidst the campus events and activities aiming to raise awareness of mental health, there will be an opportunity to work towards accomplishing specific, shared goals. Goals that are unambiguous and worthy of broad support.

The most comprehensive guidance paper for university mental health is the Royal College of Psychiatrists’2011 report, which outlines a series of recommendations for how universities can improve the mental health of their members. In its recommendations, there is one that stands out for being relatively straightforward and achievable, and it’s this in particular that, in 2013, campaigners have an opportunity to push for. The recommendation reads as follows:

It is recommended that all higher education institutions have a formal mental health policy. This should ensure that they meet statutory obligations under disability legislation. It should also cover areas such as health promotion, the provision of advice and counselling services, student support and mentoring, and special arrangements for examinations (Universities UK/GuildHE Working Group for the Promotion of Mental Well-Being in Higher Education, 2006).”

It’s a precise recommendation, and when combined with guidelines on developing a mental health policy, available for download from the website for the Working Group for Promotion of Mental Well-being in Higher Education, there seems little room for ambiguity.

At its most basic, a mental health policy represents an institution’s commitment to supporting the mental health of its members. With it, staff and students can be familiar with the rights and opportunities offered to them, they can hold the institution accountable to its policy, and they can seek improvements to it when they deem it necessary. But it’s more than this. It provides a shared starting point from which the institution and its members can collectively identify and explore broader issues that go beyond the scope of the institution, such as cultural and political factors affecting the Higher Education sector at large.

For the policy to be meaningful it needs to be actively monitored, and reviewed and updated to reflect the needs of students and staff, as well as ongoing changes that affect universities. This is why each university should be encouraged to make their mental health policy publicly available through their website.

In December I wrote an article asking, ‘whose responsibility is student mental health?’ There was no easy answer to it. But on University Mental Health & Wellbeing Day, there is something we can all do. We can give our support to the range of activities taking place. We can champion great work by students, staff, and institutions. And we can push for each institution to have in place a formal, up to date, and publicly available mental health policy. It might not fix everything, but it’s a start.

Visit here to sign a petition urging the CEO of Universities UK – the representative body for 134 institutions – to encourage and support all of its member institutions in developing a mental health policy.

How We Can All Make A Difference on University Mental Health & Wellbeing Day

Note: This article was originally published on www.huffingtonpost.co.uk, here.

It seems like almost every day is an awareness day for something or other. There are a handful of awareness days, weeks, and months that get global attention and raise funds for vital causes. But then there are more obscure awareness days, not necessarily any less vital, perhaps, yet not quite managing to gain the same attention. There is, apparently, a National Pig Day, a Potato Awareness Week, and even a National Toilet Tank Repair Month – which, coincidentally, falls in the same month as National Pickled Peppers Month.

So it was with some trepidation that the idea of a University Mental Health & Wellbeing Day was put to me. Would it get lost in a sea of awareness days? Would the creation of yet another awareness day cause eyes to roll? I was unsure. But after thinking about it, I realised that an awareness day isn’t just about trying to squeeze a date into the diaries of those who would otherwise be uninterested. It’s also about aggregating the resources of those who are already involved with a cause – to get stuff done.

There are many people with an interest in university mental health; including university support staff, student unions, charities, and a growing number of student campaigners. But it’s hard to unite everyone. The issues are complex, and we have our own narrow remits and institutional issues to deal with. This is where University Mental Health & Wellbeing Day comes in. For one day of the year we can try and take a step back from the individual problems we’re working on, focus our resources on addressing the issues that exist across institutions, and know that there are others, all around the UK, who will be doing exactly the same.

Tomorrow is the second annual University Mental Health & Wellbeing Day, led by the University Mental Health Advisors Network (UMHAN). Amidst the campus events and activities aiming to raise awareness of mental health, there will be an opportunity to work towards accomplishing specific, shared goals. Goals that are unambiguous and worthy of broad support.

The most comprehensive guidance paper for university mental health is the Royal College of Psychiatrists’2011 report, which outlines a series of recommendations for how universities can improve the mental health of their members. In its recommendations, there is one that stands out for being relatively straightforward and achievable, and it’s this in particular that, in 2013, campaigners have an opportunity to push for. The recommendation reads as follows:

It is recommended that all higher education institutions have a formal mental health policy. This should ensure that they meet statutory obligations under disability legislation. It should also cover areas such as health promotion, the provision of advice and counselling services, student support and mentoring, and special arrangements for examinations (Universities UK/GuildHE Working Group for the Promotion of Mental Well-Being in Higher Education, 2006).”

It’s a precise recommendation, and when combined with guidelines on developing a mental health policy, available for download from the website for the Working Group for Promotion of Mental Well-being in Higher Education, there seems little room for ambiguity.

At its most basic, a mental health policy represents an institution’s commitment to supporting the mental health of its members. With it, staff and students can be familiar with the rights and opportunities offered to them, they can hold the institution accountable to its policy, and they can seek improvements to it when they deem it necessary. But it’s more than this. It provides a shared starting point from which the institution and its members can collectively identify and explore broader issues that go beyond the scope of the institution, such as cultural and political factors affecting the Higher Education sector at large.

For the policy to be meaningful it needs to be actively monitored, and reviewed and updated to reflect the needs of students and staff, as well as ongoing changes that affect universities. This is why each university should be encouraged to make their mental health policy publicly available through their website.

In December I wrote an article asking, ‘whose responsibility is student mental health?’ There was no easy answer to it. But on University Mental Health & Wellbeing Day, there is something we can all do. We can give our support to the range of activities taking place. We can champion great work by students, staff, and institutions. And we can push for each institution to have in place a formal, up to date, and publicly available mental health policy. It might not fix everything, but it’s a start.

Visit here to sign a petition urging the CEO of Universities UK – the representative body for 134 institutions – to encourage and support all of its member institutions in developing a mental health policy.