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Mental Health: An Epidemic for Universities – II

How COVID Exacerbated Mental Health Demands

The pandemic, together with its unsettling transformation of the university experience, exacerbated mental wellbeing issues. [3] According to a survey by Active Minds, a national mental-health advocacy group, 80% of US college students said the COVID-19 crisis negatively affected their mental health, with 20% saying it significantly worsened. Conditions cited included 91% with stress or anxiety, 81% with disappointment, 80% with loneliness and 48% with financial setbacks. [8]

Similarly, in the UK, a survey of 2,000 students by the Office for National Statistics (ONS) highlighted the devastating impact of Covid-19 on students’ mental health in England, finding 57% reported a worsening in their mental health and wellbeing during the 2020 autumn term and 22% said their mental health was much worse. [3] Despite this, only a fifth had sought support. [35]

Unfortunately, COVID fostered a series of factors which exacerbated the mental health of hundreds of thousands of students worldwide, including fear, isolation, and uncertainty about the future.

Students Struggle with Social Isolation

For the first time in their generation, college students were bombarded with stories of the extreme contagiousness of COVID-19, and the drastic changes in behavior required for them to survive. Many of the prescribed behaviors to curb the spread of the virus culminated in extreme isolation, resulting in students living, eating and studying alone. The social life of most communities was either shut down or severely restricted and as a result students struggled to meet new people. Additionally, students lacked access to their friends, which meant diminished support to help one another work through the pressures of school, stunted relationships, and loneliness. In fact, 26% of students in the UK reported feeling lonely often or always. [23] In addition to friends, many students had to endure spending extending periods of time away from family, further exacerbating loneliness. And the ever-present mask requirements meant students began to develop a loss of identity with everyone hidden behind their mask.

 

Challenges with Releasing Stress

In addition to the isolation, the pandemic greatly eliminated or impaired many of the release mechanisms students typically use to cope with stress and tension. [32] Gone were the options to go out on the town with friends and share a meal or have a few drinks.  Likewise, the ability to vent frustrations at the gym was drastically restricted by the lack of access to gyms, and in some cases even outdoor spaces. [32]  In a Student Voice survey, conducted by Inside Higher Ed and College Pulse, 44% of students report getting less physical exercise than before the pandemic, with loss of motivation being the primary reason identified for one-third of that group. [33]

Additional Pressures for International Students

The first few months of COVID was particularly distressing for international students far from home and their families. These students often have language and cultural barriers which made it especially difficult to navigate complicated questions about whether to stay or leave their campus community, including if/when they would be allowed to return to campus, and how their decision would affect their prospects for completing their degrees. [21]

Uncertainty Plagued Students

For the vast majority of students, anxiety was ever-present and aggravated by a lack of certainty about the future. Students were uncertain of where they were going to live, when they could see and hang out with their friends, when they could return to campus, how COVID would impact their parents’ ability to fund their education, and of course, and how long the COVID shutdowns would last.

For some, this uncertainty led to idleness and apathy. Psychologists use the term “motivation paralysis,” said Jody Early, an associate professor in the School of Nursing and Health Studies at the University of Washington at Bothell. The term refers to a desire to act on something but being unable to do so. [33] This is often tied to the lack of normalcy in student’s lives i.e., lacking routines and schedules tied to their studies. “This ongoing sense of uncertainty can really have a toll on the body,” Early explained. [33]

Impacts of Mental Health on Students

Challenges with motivation and uncertainty act as stressors and can trigger students with mental health to experience physical, emotional or behavioral changes. For example, physical symptoms can manifest in stomach pain, headaches, and difficulty sleeping. Emotional impacts include anxiety, confusion, frustration, sadness or depression and can also impact a student’s ability to concentrate.

Economic Insecurities

Stress is compounded by economic insecurities tied to their attendance at university. Two-thirds of students said their financial situation had become more stressful because of the pandemic. [6] The majority of students surveyed — a sizeable 90% — cited student loan anxiety around their education debt as one of their top mental-health issues. [18]

The financial insecurities go beyond tuition, extending to those who were housing insecure and/or food insecure. A 2019 survey by the Hope Center for College, Community, and Justice found that 46% of students in the US were housing insecure at some time during the past year, and 39% had experienced food insecurity within 30 days of the survey.” [5]

Figure 6. Two-thirds of students said their financial situation had become more stressful because of the pandemic. Adapted from the Chronicle of Higher Education. https://www.chronicle.com/article/college-students-have-been-stressed-out-during-the-pandemic-heres-how-its-affected-their-mental-health?cid2=gen_login_refresh&cid=gen_sign_in&mkt_tok=OTMxLUVLQS0yMTgAAAF85rApsD5wS1xoaFG6ijDgB_4-BvtHLC-cKhWhR_dYRyqCrxEc3TM2aRDl3sf_cpgaMXVAXgBo3ov08KxyOcBwir4wUVXGZiMClF2mDOK46_Xy2A&cid2=gen_login_refresh&cid2=gen_login_refresh

Behavioral Changes

Many students attempt to cope with these stressors through behavioral changes which may include self-isolation, eating disorders, self-harm, stopping their medication and/or self-medicating. Self-medication is typically via drug-abuse or alcoholism. Interestingly, with most students not on campus and unable to socialize during COVID, binge drinking and substance abuse rates were notably lower, but depression rates rose from an already high 36% in Fall of 2019 to 41% in March-May of 2020. [7]

Academic Performance

Changes in behavior can also adversely affect performance in school. Research has found that mental health challenges can lead to low GPAs, decreased retention and engagement, and disruptions in academic progress [13]. As students struggle academically, they risk losing connection with the university and possibly being kicked out of school. In fact, research shows students with mental health challenges are more likely to experience disruption to their education through taking time off, attempting to continue their studies without the support they need, or dropping out altogether. [2]

The Elevated Risk of Suicide and Self-harm

Universities and colleges are now caught in a perfect storm comprised of thousands of students worldwide, searching for answers on how to cope with fear, isolation, and uncertainty tied to COVID. The large population of students struggling with mental health challenges has been exacerbated by students unwilling or uncertain how to access student wellbeing services and treatment.

And of course, when those with mental health challenges go untreated, they sometimes resort to more drastic coping mechanisms such as self-harm, including suicide. Overall, trends for the rate of self-harm and suicide are elevated. For example, in the UK, the number of girls and young women self-harming has tripled in the past 14 years. [40]

Alarming Number of Students Considering Suicide

A report released by the Centers for Disease Control and Prevention about the pandemic’s effect on mental health identified a disproportionate number of 18- to 24-year-olds — about one-quarter of those surveyed — had “seriously considered suicide” in the last 30 days. [44] Take 25% of the undergraduate enrollment of your university, and it provides an instant appreciation for the gravity of the challenges faced by higher education institutions.

Even before COVID, a 2018 study by Harvard Medical School found that one-fifth of all US students surveyed had considered suicide, with 9 percent reporting having attempted suicide and nearly 20% reporting self-injury. [50] In the US, approximately 24,000 college students attempt suicide each year, while 1,100 students succeed in their attempt, making suicide the second-leading cause of death among U.S. college students. [46]  And there are increased risks within certain demographics. For example, in the US, suicide is the leading cause of death among Asian American young adults age 15-24. [61] Likewise, among Australians between 15 and 24 years of age, suicide is the leading cause of death. [41]

Unfortunately, the high rates of suicide are not limited to higher education. In Colorado, Jena Hausmann, CEO of Children’s Colorado, said pediatric emergency departments and inpatient units are being “overrun with kids attempting suicide and suffering from other forms of major mental health illness.[30] And although the suicide rate has slightly declined in 2019 and 2020, the US saw a 35% increase in the national suicide rate from 1999 through 2018. [28]

Figure 7. Which of the following mental or emotional health challenges have you experienced in the past month? Adapted from the Jed Foundation. https://www.jedfoundation.org/survey-of-college-student-mental-health-in-2020/

A Global Challenge

Globally, it’s estimated that over 800,000 people die from suicide each year, representing an annual global suicide rate of 10.7 per 100,000 population [1] The suicide rate in the UK is 11.0/100,000, 11.8 for Australia (11.8) and 14.5 in the US, and in all three countries, the suicide rate is two to three times higher for males vs females.

In the UK, one student dies by suicide every four days and recently, one UK university recently had 11 students kill themselves over an 18-month period. [40] [43]

These alarmingly high rates of suicide have forced counselors and student wellbeing teams to be more proactive. Ged Flynn, CEO of the young suicide prevention charity PAPYRUS, said “Rather than expecting those who are experiencing thoughts of suicide to reach out, we encourage everyone to learn how to reach in, to ask about students’ well-being, to express concern if they see changes in behavior, to ask if suicide is on the cards.” [43]

The Impacts of Mental Health on Universities

In addition to the significant burdens students with mental health issues have to bear, there are far-reaching impacts on universities and colleges as well. First and foremost is the network of staff that typically counsel and support the students. Given the rising levels of casework, combined with anxiety among staff about returning to campus to provide services, and the sheer volume and intensity of the workload, it’s not uncommon for those on the front lines to also suffer from wellbeing issues.  This includes everyone from counselors, psychologists, doctors, and staff in Student Wellbeing, Student Services, Student Health & Services and Campus Police or Security.

Campus Police & Security Often Bear the Brunt

Although some administrators may underestimate the role campus police, safety, and security teams play in responding to calls from students with mental health issues, it’s actually quite significant. Most on-site provisions for mental health services are staffed Monday through Friday, 9-5 or 8-6.  In general, the only 24-hour organization on campus available to respond to incidents are the police and security resources. Thus, these security and campus police teams are the de facto first responders for individuals experiencing crises after hours. [29]

This is substantiated by the following: approximately one-third of individuals with severe mental illness have their first contact with mental health treatment through a law enforcement encounter. Law enforcement officers are thus now often on the front lines of psychiatric care, charged with responding to, handling and even preventing mental illness crisis situations.” [29]

Overall, reviews have found an inability by security and police forces to quantify the extent and impacts of mental health-related calls. However, research shows that 21% of total law enforcement staff time is spent responding to and transporting people with mental illness – so it’s certainly significant. [7] [29]

Preserving a University’s Reputation

In addition to impacts on staff, challenges with responding to and treating students with mental health issues can have significant impacts on the university’s reputation and brand. A university that is found to not fulfill its duty of care can result in negative press, fines from regulatory bodies, and can also diminish interest and enrollment from prospective students.

Student Drop-out Rates Already High

Rising mental health challenges can negatively impact student attrition, but those rates are already high.  The drop-out rate of students at colleges and universities varies quite a bit from one country to another.  In the UK, the drop-out rate is just 6.3%, while in Australia research has found 25% of students who start university drop out within eight years. [58] [59] And in the US, the rate jumps still higher with 30% of students dropping out in their first year.  Overall, higher attrition rates are seen among part-time students and those that do not live on or near campus. [60] Even more surprising is that only 11.6% of US students who drop out will end up transferring and getting their degrees elsewhere.

As one might anticipate, enrollment figures fell even further during COVID.  In the US, as higher education experienced the impact of COVID-19 related disruptions, there was a 3.5 percent decline in enrollment, representing 603,000 students – seven times worse than the decline a year earlier. [51]

Figure 8. Percentage of College Dropout by Age at Enrollment: 2-Year & 4-Year Institutions. Adapted from Admissionsly. https://admissionsly.com/college-dropout-rates/

Depression Jeopardizes Enrollment and University Objectives

Since research shows COVID increased the number of students who reported more challenges with mental health, it makes sense that enrollment numbers were adversely impacted. Studies show students at university with depression are more likely to drop out of school. [15] Sarah Ketchen Lipson, an assistant professor of health law, policy, and management at Boston University, said in a news release, “Our prior research has shown that mental-health problems such as depression are associated with a two-fold increase in the likelihood of dropping out of college.[6]

Sixty-two percent of students who withdrew from college cited mental health as the primary reason, with most suffering from depression, PTSD, or bipolar disorder. And 45% of students did not receive academic accommodations such as extensions on deadlines, lower course loads, tutoring or help communicating with professors. [52]

The Impacts on a University’s Resources and Objectives

In summary, it’s clear that students suffering from mental health challenges are more prone to struggle academically and socially, which leads to incremental drops in enrollment. Fewer students enrolled adversely impacts tuition, thereby reducing available funds and resources for universities to help students tackle their mental health challenges.  Furthermore, mental health support is starting to be featured in university rankings for prospective students and parents to consider how a university will support students. [62] Thus, the time to act is now, both for the mental health of your university community and secondarily, to protect the reputation and brand of your institution.

Moving Forward:

As we continue to explore mental health, our next article in this series will cover what to expect with the return to campus, blind spots universities need to address, and how SafeZone can help you address mental health challenges. We thank you for your interest in this topic and invite you to share this content with your peers as you prepare to tackle these challenges in the upcoming semester.

Endnotes

  1. Daniel Mansfield and Daniel Jones, “After the Crisis: A Co-Response Model for Follow-Up,” Police Chief Online, April 14, 2021.
  2. “Minding Our Future: Starting A conversation About the Support of Student Mental Health” Universities UK, May 11, 2018.
  3. “Student and staff wellbeing” Emerge Education; Jisc, January, 2021.
  4. “A commitment by Universities UK to students’ wellbeing” Universities UK, October 6 2020.
  5. Russell Lowery-Hart’ Madeline Pumariega, “Making the Most of $40 Billion” Inside Higher Ed, May 3, 2021.
  6. Audrey Williams June, “College Students Have Been Stressed Out During the Pandemic. Here’s How It’s Affected Their Mental Health.”, The Chronical of Higher Education, July 13, 2020.
  7. “The Impact of Covid-19 on Student Well-Being” The Healthy Minds Network/American College Health Association.
  8. “COVID-19 Impact on College Student Mental Health”, ActiveMinds, April 2020.
  9. Daniel Eisenberg, PhD; Sarah Ketchen Lipson, EdM, PhD; Justin Heinze, PhD; Sasha Zhou, PhD, MPH, MHSA; Amber Talaski, MPH; Akilah Patterson, MPH; Sarah Fogel; Paul Schulz; Lingxi Li, “The Healthy Minds Study”, Healthy Minds Network, February 2021.
  10. “Johns Hopkins University pilots new program pairing security officers with behavioral health team to handle campus safety and security calls” Security Magazine, May 20, 2021.
  11. Chi Chi Izundu; Dominic Bailey; Sandra Rodriguez Chillida, “Mental health: Can you tell if someone is struggling?” BBC News, May 10, 2021.
  12. Katie Neal, “TimelyMD Survey Finds 4 of 5 College Students Sill Stressed by COVID-19 After One Year”, TimelyMD, March 16, 2021.
  13. Doug Lederman, “Pandemic-Fueled Confidence for College Presidents” Inside Higher Ed, March 22, 2021.
  14. Sarah Ketchen Lipson, Sara Abelson, Peter Ceglarek, Megan Phillips, and Daniel Eisenberg, “Investing in Student Mental Health: Opportunities & Benefits for College Leadership” American Council on Education, 2019.
  15. “Students with depression twice as likely to drop out of college” Michigan News: University of Michigan, July 10, 2009.
  16. Ray Schroeder, “Wellness and Mental Health in 2020 Online Learning” Inside Higher Ed, October 1, 2020.
  17. Colleen Flaherty, “Burning Out” Inside Higher Ed, September 14, 2020.
  18. Elizabeth Gravier, “Student loans take a mental toll on millions of borrowers – here’s how you can cope” CNBC Select, May 16, 2021.
  19. James Higgins, “Seven in 10 students considered dropping out this year, survey suggests” University Business: The Business of Higher Education, May 10, 2021.
  20. Dodd, R.H.; Dadaczynski, K.; Okan, O.; McCaffery, K.J.; Pickles, K., “Psychological Wellbeing and Academic Experience of University Students in Australia during COVID-19.” J. Environ. Res. Public Health, 2021.
  21. “Survey finds majority of students struggling wuth mental health during COVID” ICEF Monitor, March 10, 2021.
  22. “Refreshed Student Mental Health Strategy 2018-2021” Victoria University, January 2021
  23. Mark Hamilton, “Coronavirus and higher education students: England, 19 February to 1 March 2021” Office for National Statistics, March 10, 2021.
  24. “NUS student survey sends clear message to government – invest in mental health now” National Union of Students, September 12, 2020.
  25. Amy Norton, “Making student mental health a priority” Office for Students, March 4, 2021.
  26. Rebecca Montacute; Erica Holt-White, “Covid-19 and the University Experience” The Sutton Trust, February 2021.
  27. Scott Jaschik, “Student Affairs Leaders on Mental Health, Race Relations, Free Speech and More” Inside Higher Ed, March 26, 2021.
  28. Robert Gebbia, “Written Testimony of Robert Gebbia” American Foundation for Suicide Prevention, May 13, 2021.
  29. “Road Runners: The Role and Impact of Law Enforcement in Transporting Individuals with Severe Mental Illness”, Treatment Advocacy Center, 2019.
  30. Morgan Haefner, “’Overrun with kids attempting suicide’: Children’s Colorado declares state of emergency” Becker’s Hospital Review, May 26, 2021.
  31. “Mental health facts and statistics” Mind, 2014.
  32. Louise Marshall, “Emerging evidence on COVID-19’s impact on mental health inequalities” The Health Foundation, June 18, 2020.
  33. Melissa Ezarik, “Health Habits: Emerging From the COVID Crush” Inside Higher Ed, May 27, 2021.
  34. “Survey of College Student Mental Health in 2020” The Jed Foundation, October 22, 2020, https://www.jedfoundation.org/survey-of-college-student-mental-health-in-2020/
  35. Sally Weale, “More than half of students polled report mental health slump” The Guardian, December 9, 2020.
  36. “About Student Space” Student Minds.
  37. “Policing and Mental Health: Picking up the Pieces”, Justice Inspectorates, November 2018.
  38. Denis Campbell, “Mental health patients ‘missed out on care’ during Covid” The Guardian, April 25, 2021.
  39. Peter LeViness, Ph.D.; Carolyn Bershad, Ph.D.; Kim Gorman, Ph.D., “The Association for University and College Counseling Center Director Annual Survey” AUCCCD, June 30, 2017.
  40. Gabriella Swerling, “Self-harm trebles among women in past 14 years amid calls for social media firms to protect vulnerable users” The Telegraph, June 4, 2019.
  41. Kinchin, Irina, and Christopher M Doran. “The Cost of Youth Suicide in Australia.” International journal of environmental research and public health 15,4 672. 4 Apr. 2018.
  42. World Health Organization, “Suicide rate estimates, age-standardized Estimates by country” World Health Organization, February 2, 2021.
  43. Belkis Megraoui, “One UK Student Dies By Suicide Every Four Days – And The Majority Are Male. Why?” QS Top Universities, April 4, 2021.
  44. Madeline St. Amour, “Pandemic Increasing Suicidal Ideation” Inside Higher Ed, August 17, 2020.
  45. Branka Vuleta, “27 Fascinating Facts About the US College Dropout Rate” What to Become, April 12, 2021.
  46. Wilcox, Holly C et al. “Prevalence and predictors of persistent suicide ideation, plans, and attempts during college.” Journal of affective disorders, May 14, 2010.
  47. Samira Shackle, “The way universities are run is making us ill’: inside the student mental health crisis” The Guardian, September 27, 2019.
  48. The University of Utah, “Community Services”, University of Utah.
  49. Jerilyn Stowe, “A place for healing and hope: Huntsman Mental Health Institute breaks ground on mental health crisis care center” University of Utah, May 26, 2021.
  50. Johanna Younghans, “College Stress: Study finds 1 in 5 students surveyed reported thoughts of suicide in last year” Harvard Medical School, September 10, 2018.
  51. Greta Anderson, “Mental Health Needs Rise With Pandemic”, Inside Higher Ed.
  52. Allie Grasgreen, “Students Rate Mental Health Services”, Inside Higher Ed.
  53. Darcy Gruttadaro and Dana Crudo, “College Students Speak: A Survey Report on Mental Health” National Alliance on Mental Illness.
  54. Elizabeth Redden, “Pandemic Hurts Student Mental Health”, Inside Higher Ed.
  55. “#RealCollege 2021: Basic Needs Insecurity During the Ongoing Pandemic” Hope4College.
  56. Mike Emery, “Mental Wellness Initiatives at UHD Supported by Nearly $300K SAMHSA Grant”, University of Houston Downtown.
  57. Michelle Roberts, “Universities With Highest and Lowest Dropout Rates”, What UNI?
  58. Paul Karp, “Will you drop out of university? Report reveals the Australian students at risk”, The Guardian
  59. Eye-Opening College Dropout Rates & Statistics – 2021, Admissionsly
  60. Amelia Noor-Oshiro, “Asian American young adults are the only racial group with suicide as their leading cause of death, so why is no one talking about this?”, The Conversation, April 23, 2021
  61. Chloe Lane, “73% of UK Students Unsatisfied With university Mental Health Support”, QS Top Universities, March 12, 2021

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