The Flourishing Student

Every tutor's guide to promoting mental health, well-being and resilience in Higher Education

Fabienne Vailes

• Publisher: Practical Inspiration Publishing
• Year: 2017
• Print ISBN: 9781910056592
• eBook ISBN: 9781910056783
• Topic: Education
• Subtopic: Education Theory & Practice

Aset of simple strategies to raise mental health awareness, improve knowledge around mental health issues and stress in academia and develop emotional resilience and mental well-being among students.

- PART I -

Gaining Understanding and Clarity

Chapter 1
Setting the scene

The current state of student mental health in the UK’s Higher Education

‘The noblest pleasure is the joy of understanding’ –
Leonardo Da Vinci

The general picture

To better understand the overall context surrounding the UK’s HE, here are some facts that you might find interesting drawn from Universities UK.

• 2.3 million students were studying in the UK at HE level in 2015/16. It is in fact a slight decrease and is less than in 2010 when there were 2.5 million students registered at various British HE institutions.² But it most definitely is a lot more than in the early 1960s when only about one in 20 young people were going into higher education.

• 56.2% were female and 43.8% male.

• Almost 40% of them were aged 20 and under, 5.52% were aged between 25 and 30 and 11.3% aged 30 to 59.

• The majority study in England (1.87 million) then Scotland (218,400), Wales (125,680) and finally Northern Ireland (52,650).

• Around 520,000 students lived in rented accommodation, 330,000 in accommodation maintained by the institutions, 327,000 lived at their parental/guardian home, 259,000 in their own accommodation and 118,000 in private sector halls.

What about student health?

The HE landscape – student epidemic or not… that is the question!

Mental health problems are a growing public health concern both in the UK and around the world. For example, the Mental Health Foundation states that around 12 million adults in the UK see their GP with mental health problems each year mostly for anxiety and depression and that one in four adults and one in ten children are likely to have a mental health problem in any year.³

Whether you have been working in the HE sector or not, I am sure you have become aware that over the last few years, the words ‘mental health’ and ‘mental health problems’ among students have been highlighted by the media. These articles have suggested that stress is much more prevalent than we think. A recent survey carried out by a private insurance company, in 2013 entitled ‘The Aviva Health of the Nation Index’⁴ reported that a lot more of our GPs’ time is spent dealing with mental health issues. It’s the most prevalent type of illnesses, with 84% of GPs seeing more patients than ever before suffering from stress and anxiety. The conversations carried out with a GP working at a Student Health Service confirmed this and they described their work as ‘trying to close the stable door after the horse has bolted’.

In 2013, the National Union of Students (NUS) published a survey of 1,200 students entitled ‘Mental Distress Survey’,⁵ of which 92% of respondents identified as having had feelings of mental distress, which often includes feeling down, stressed and demotivated. On average, respondents who experience feelings of mental distress experience them once a month or more (74%), and almost one third suffered mental distress every week.

The main causes provided were:

1. coursework for 65% of respondents

2. exams and study (54%)

3. financial difficulty (47%).

‘CRI66’, the report by the Royal College of Psychiatrists entitled Mental Health of Students in Higher Education published in January 2011 also provides insight into the research carried out around the mental health issues encountered by students. Bewick et al. (2008) carried out an Internet-based survey of mental distress in students in four UK Higher Education Institutions and found that 29% of students described clinical levels of psychological distress.

When I first started researching this topic and saw these figures, I was convinced that there was a real ‘crisis’ and that an increasing number of students were suffering from mental health ‘issues’.

Research has clearly shown that many of the major mental illnesses begin to appear during adolescence and early adulthood, so it is important to not only bring awareness to mental health and mental illnesses/disorders but also a clear understanding of what constitutes a mental disorder/illness so that everyone in education (staff, parents and students alike) has the right knowledge, competences and attitudes not only to help themselves, but also others, if need be.

What I didn’t immediately notice, however, was that newspapers are using surveys and data which don’t differentiate between self-reported and epidemiological data drawn from longitudinal cross-section studies for example or randomized control trials.

The interviews carried out with stress and anxiety specialists such as GPs, and practising counselling psychotherapists in the UK, Canada and the US made me aware of this fact and presented a different side to the coin which seemed to challenge the current narratives that mental health problems are massively increasing. According to several research studies (McMartin et al. 2014; Baxter 2014) on the epidemiological data over the last 50 years, it would appear that the incidence of mental health problems globally has remained steady.

Baxter (2014) recently tested the statements that common mental disorders have become more prevalent over the past two decades and found no evidence for an increased prevalence of anxiety disorders or Major Depressive Disorders (MDD). For example, the prevalence of anxiety disorders was estimated at 3.8% in 1990 and 4.0% in 2010. The prevalence of MDD was unchanged at 4.4% in 1990 and 2010. In his study whilst the crude number of cases increased by 36%, this can be explained by population growth previously mentioned and changing age structures.

The stark contrast, however, is that eight of the 11 General Health Questionnaire studies found a significant increase in psychological distress over time.

The conclusion is that the perceived ‘epidemic’ of common mental disorders is most likely explained by the increasing numbers of affected patients driven by increasing population sizes. Additional factors that may explain this perception include the higher rates of psychological distress as measured using symptom checklists, greater public awareness and the use of terms such as anxiety and depression in a context where they do not represent clinical disorders. (There will be more on this in Chapter 2 when we look at the different stages of mental health.)

McMartin et al. (2014) also decided to investigate trends in the prevalence of symptoms of mental health in a large population-based cohort of Canadian children and adolescents because they felt that existing research and media reports conveyed conflicting impressions of such trends.

They concluded that with the exception of hyperactivity, the prevalence of symptoms of mental illness in Canadian children and adolescents has remained relatively stable from 1994/95 to date. They also suggested that conflicting reports of escalating rates of mental illness in Canada may be explained by differing methodologies between studies, and increase in treatment.

Based on all the above information, what becomes significantly noticeable is the fact that the self-report of depressive symptoms/stress clearly has increased over time.

What might create the notion of increase in severity of anxiety, and stress in students across the world?

If we take a look at the various surveys and data mentioned in the first part of this section, it is obvious that they are based on self-reported symptoms. This is not to say that these symptoms are not real – far from it. I have no doubt that students are experiencing and showing signs of distress.

But when a researcher and non-expert in the field ask students questions such as ‘In the last six months have you felt depressed or anxious?’, participants tick yes and this creates the basis of self-reported data.

Based on this, the question we should therefore be asking is not: who is wrong or who is right in this debate, but to recognize that there IS a crisis of vulnerability and anxiety about having mental health problems among young people and students in education.

But instead of focusing on this ‘crisis’ it might be more productive to view it from a different perspective and to tackle this topic differently than we have done thus far.

Why are students reporting getting increasingly stressed?

The general labelling found in the media of university as being the best time of students’ lives may not be true for every student.

When I interviewed students, it became clear that many of them experience a real period of transition when they move to a new city and join a university for the first year of their degree. It is a transition between adolescence and adulthood. It is also a transition between dependence and independence, in a new environment, away from the safety and security of home. They consider the staff members in the departments/schools where they study as their main points of contact. They rely on us as adults to provide them with advice and guidance.

The ‘CR166’ report by the Royal College of Psychiatrists (2011) agrees with this statement too and recognizes that ‘Students are at a stage of transition between dependence and independence. Many have to cope with the stresses of moving from home to university at an age when they are negotiating significant developmental stages’ (p.18).

Have you ever wondered why so many of our students say that they are feeling stressed?

A lot of research is currently being carried out to understand the reasons behind this increased self-reported stress and anxiety among students. It is a rather complex and multifaceted issue and there is no single answer. One student I interviewed summarized it beautifully when she said:

There are problems everywhere. It’s a generation issue – where we are surrounded by problems with the media telling us that we should all be slimmer and what diet to follow – what degree to do to earn a lot of money, what to look like and how to succeed and even how to choose a boyfriend. Your job and your career says everything about you. It’s not the same values as one or two generations before. As a result, when you go to university, you are not just there to study, you are there to make friends, to be popular, to be known and so if those aren’t happening, you question yourself.

This statement clearly highlights the complexity of the issue and all the challenges, not only academic but also personal and social, that students are faced with when they join a HE institution and embark on their degree.

Below is a list of some of the specific points highlighted by students in previous research and drawn from my own interviews:

• Academic workload – many of my students regularly state that their number one stress is the workload. Research also seems to confirm this with large studies of the major stressors of the first year indicating that they cannot handle the academic work of university (Sax 1997). Yet, this workload has not changed and is not more demanding than in previous years.

• Concerns about the future – the ‘doom and gloom’ stories in the press, and social media about Brexit and Donald Trump for example. The uncertainty and the fear of something going wrong in the future. This will all contribute to the automatic nervous system kicking in (we will see more about this in Chapter 2 about stress).

• Exams and assessments. A survey called ‘Silently Stressed’ carried out by NUS Scotland found that 90% of 1,800 students from 19 FE colleges and 15 universities across Scotland reported that exams and assessments caused them more stress than anticipated and only 2% said they experienced no stress at all.⁶ This reported stress means that some of my tutees are unable to revise and they procrastinate and leave their work until the last minute, which creates even more stress for them as they get nearer the deadline and realize they will not be able to meet it.

• Extrinsic instead of intrinsic motivation. Several students mentioned the fact that they felt that they had chosen to come to university for ‘extrinsic’ reasons and that they were motivated to come to university to earn their degree (with a good classification) so that they could get a good job which is well paid and would help them to lead a comfortable life. One student in particular said to me ‘I am in my final year so I am not going to stop now but after having therapy and discussing my situation, I now realize that I shouldn’t have come to university because I didn’t have enough intrinsic motivation or an internal desire to engage and participate in university life fully because I found it personally rewarding or enjoyable. I did because that’s what my parents and teachers expected from me and encouraged me to do and I didn’t want to upset them. I was also worried that I would not be able to find a job otherwise.’ He added ‘Society says that young people need a degree to get a good job, earn good money and be happy but I am not sure that’s true.’

Of course, this is not suggesting that all students feel this way or that extrinsic motivation is bad as it can be beneficial in some situations. We will discuss the balance between intrinsic and extrinsic motivation further in Chapter 4 of the book.

• Financial worries. The increase in university fees and financial worries has featured regularly in the press. Students regularly mention the fact that they must pay £9,000 per year to attend university.

The impact of financial concerns on overall mental health has become a popular topic among researchers and practitioners. For example, Roberts et al. (2000) identified a link between adverse financial situations of college students and the negative impact on mental and physical health that translated into mental distress. Andrews and Wilding (2004) found that financial stressors were positively associated with increased anxiety and depression levels among college students in the United Kingdom.

• Future careers. In the same survey, over 75% of students reported that considering their future career prospects after graduation was reasonably or very stressful. Some students I interviewed said that it was linked to the pressure they feel about their exams and assessments, as they believe that they must perform and achieve to get the best job possible when they leave university. These feelings are also increased by stories in the media, which suggest that there are specific degrees that will help students to earn the largest amounts of money.

• Poor diet/reduced physical activity. We will see in Part II how important our physical health is for our overall well-being. Students I spoke to as part of our research highlighted the fact that they felt much better after doing some sport (as part of the numerous clubs offered in their institution) or if they went for a walk or a run. There is a growing body of evidence indicating that physical activity and fitness can benefit both the health and academic performance of students. Eating a healthy and balanced diet, which includes raw fruits, and fresh vegetables, for example, has long been known to be good for our health. Jacka et al.’s study (2011) confirms this and highlights the fact that there have been a number of published studies identifying an inverse association between diet quality and the common mental disorders, depression and anxiety, in adults. They also confirm the importance of diet in adolescence and its potential role in modifying mental health over the life course.

• Pressure to perform – get a 2:1 or a first. Students put a lot of pressure on themselves and have high expectations. They want to succeed and they think that it is important to gain a 2:1 or a first so that they can get a good job that pays well at the end of their studies and clear their debts. This is obvious for us as academic members of staff when we provide students with feedback or discuss points about exams as many students seem to be mainly driven and motivated by the mark rather than the feedback which will help them to improve and progress.

• Relationship difficulties. Some of the students I interviewed explained that whilst they mostly enjoy their relationships with their parents, friends, flatmates or their boyfriends/girlfriends, at times these relationships created some stress and anxiety because they sometimes ‘went wrong’. Neff and Karney’s (2009) study confirmed the common wisdom that the greater the stress in our lives, the more reactive we are to the normal ups and downs of our relationship. They explain that relationships exposed to high stress for a long amount of time are bound to falter. During such times, we are more likely to see the relationship as being negative, not realizing the impact the stress is having on the validity of our evaluation – it colours our perception of the relationship itself. Remove the stress, and people’s positive relationship skills can once again – and usually do – take over.

• Social media and use of technology. Social media and the use of technology have clearly improved our lives and have enabled us to connect with people on the other side of the planet. The Internet enables us to get information almost instantly and to raise awareness of political, an...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Introduction
• Part I – Gaining Understanding and Clarity
• Part II – The Implications for Education
• Part III – The Tutor’S Own Toolbox
• What next?
• References
• Index