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mental health

Mental Health: An Epidemic for Universities – I

State of Mental Health in Higher Education

In this multi-part series, we explore the state of mental health in higher education, the contributing factors that lead to mental health challenges as well as how COVID-19 exacerbated the mental health crisis.  Future writings will cover the impact mental health challenges have on universities, on students, blind spots universities need to address and what to expect when students return to campus for the upcoming semester. Finally, we’ll explore success stories and best practices and examine how SafeZone® and other solutions can help universities better serve students who struggle with mental health. You will note this document is backed by comprehensive research and resources so you can further explore the content in greater detail.

Mental Health - Top Priority for University Executives

From 2020-2021, there has been a fundamental change in the way mental health and wellbeing is viewed and approached by universities. [3] In a March 2021 survey conducted by Inside Higher Ed, student mental health was the top priority for US university presidents, with 96% expressing concern about students and 94% expressing concern regarding the mental health of employees. [13]

 This is reinforced in an Inside Higher Ed survey of student affairs leaders, conducted by Gallup, in which university leaders said the top issues that dominate their time are student mental health (94%), and student well-being (91%). [27]

During COVID-19, the majority of college and university leaders placed the emphasis on physical health, with the priority of stopping the spread of COVID-19. “When we saw a physical health crisis, we did not respond to the mental health crisis running parallel”, said Marlene Tromp, President, Boise State University. [33]

That perspective has now largely changed with a greater emphasis on both mental health and physical health. Kevin Kruger, President of the Student Affairs Administrators in Higher Education said, “There is a clear understanding on campus that the long-term solutions must include population-level wellness and well-being initiatives in addition to therapeutic interventions.” [27]

Aligning Resources with Priorities

And this shift in priorities is reflected in the budgets of higher education institutions. In a survey by the American Council on Education, 35% of university presidents said they plan to invest more in mental-health services. [9]

To align with priorities, there is a growing understanding among university leaders that mental health issues cannot be handled by just one or two departments.  Not only is such an approach limited in effectiveness, but it also doesn’t scale well in the face of the rising volume of students who have mental health challenges.

Mental Health Issues on the Rise

According to the Association for University and College Counseling Center Directors, students today are mostly dealing with three major psychiatric conditions: anxiety (48%), stress (39%), and depression (34%). [39]

Unfortunately, there has been a significant increase in the number of students at university with a mental health condition – even before COVID. In 2017, the Institute for Public Policy Research (IPPR) reported that there had been a fivefold increase in the number of students who disclosed a mental health condition to their college or university over the past decade. IPPR research found that over the past five years, 94% of universities experienced a sharp increase in the number of people trying to access support services. [3]

Interestingly, the proportion of students saying their mental health had deteriorated rose in similar fashion across western countries, including 75% in the US, 70% in the UK, and 67% in AU. [21] One study found that six times more young people in England have psychological challenges today than a generation ago. [47] And in Australia, a survey of over 3,300 students across 40 universities and 30 TAFES undertaken by the National Union of Students in 2016 found that 67% of 16-25 year-olds rated their mental health as poor or fair. [22]

Overall, just 34.7% of Australian students reported a sufficient level of wellbeing. [20] Similarly in the US, 65% of university students rated their mental health as “fair” or “poor”, according to Inside Higher Ed’s recent Student Voice survey of college students. [18]

Academic Pressures Affecting Mental Health

When you consider the pressures students are under, it’s easy to understand why such a high proportion of students experience mental health challenges. First year students struggle with being away from home and coping with missing family and friends. These young adults are in an unfamiliar setting, looking to forge new friendships and relationships and face an unstructured environment, including widespread access to alcohol and drugs. [39]

As a result, many struggle to balance their personal life with the demands of school.

Students who were once in the top 10% of their class in high school or secondary school are now surrounded by other accomplished students and some struggle to adapt to professors’ elevated expectations and demands at university.  In addition, students face significant pressures from home to excel, especially given the significant investment in tuition and other expenses. This especially holds true for international students, whose families may have gone ‘all in’ on their investment in their child, assuming they will excel and succeed, in order to raise the social and economic strata of the entire family.

Achieving a high enough GPA to maintain scholarships, graduate, and qualify for further graduate level studies adds additional social and financial challenges. Beyond tuition, students struggle with how to afford adequate housing, healthcare, technology, and food. One survey of 195,000 students in the US found that 29% at four-year colleges experience food insecurity, and 48% of students experienced housing insecurity, including 14% affected by homelessness. [55]

Figure 1. Intersections of Food Insecurity, Housing Insecurity, and Homelessness Insecurity Among Survey Respondents by Sector. Adapted from Association of American Colleges & Universities: A VOICE AND A FORCE FOR LIBERAL EDUCATION. https://www.aacu.org/aacu-news/newsletter/majority-college-students-experience-food-insecurity-housing-insecurity-or

Like many medical conditionals, the stress tied to these circumstances exacerbates mental health and can lead to more severe bouts of depression and anxiety.

Access to Mental Health Treatment

William Leahy, Deputy Vice-Chancellor for Brunel’s University in London observed the first time many students access any kind of mental health treatment is when they start at university. “We have seen unbelievable underfunding of secondary schools over many years – and not just schools but social services, youth clubs, all those services that used to be preventative, they’ve all gone.” The result of this underfunding places an extra burden on universities to take on the responsibilities of the health or social services. [47]

Additionally, diagnosis of mental health conditions can be more challenging for new students, as the university does not know what constitutes a normal mood, disposition, and mental state for each individual. Furthermore, unless volunteered by the student, counselors don’t know if students were previously diagnosed with a condition and the scope of mental health counseling and treatment they’ve received prior to arriving at the university.

Of course, the quality of mental health treatment varies from one university to another. Unfortunately, students with more advanced conditions that require psychiatric services may not be able to access these services. For example, a survey of one the Association for University and College Counseling Center Directors (AUCCCD) found 35% of universities don’t offer psychiatric services on their campus. [39]

Most Students Not Seeking Help

Equally disturbing, is that few students who reported having mental health challenges, sought assistance. [3] In the UK, a survey carried out by Unite and the Higher Education Policy Institute (HEPI), reported that just over half of students told their university about their mental health condition. [25] And not all students who inform their university actually seek mental health support. In the UK, despite the difficulties students have been facing, only 20% sought mental health support. [24] Similarly, a National Union of Students survey found 52% of students reported their mental health was negatively impacted by COVID-19 but only 29% of those had looked for help.

Keep in mind that some students with mental health challenges have not yet been diagnosed as such. But for those that are self-aware, the following are among the more common reasons for which students do not seek treatment: 1) Negative stigma; 2) Uncertain How to Get Help; 3) Challenges with accessibility.

Frequently, students report they were embarrassed to admit they needed help and as a result, hesitant to ask for assistance. Despite campaigns by university student wellness teams, 45% of students said, “Most people would think less of someone who has received mental health treatment. [9] In addition, some students have anxiety or phobias tied to accessing mental health services which can stem from a range of issues including concerns of trusting and/or interacting with others in person, especially those they don’t know.

But for those students who recognize they need help and who are brave enough to seek counseling and treatment, there remain challenges tied to accessing treatment which include where to go to initially seek help and how to get plugged into these resources.

Students Uncertain How to Access Help

More than half of students said they would not know where to go if they or someone they knew needed professional mental health services right away, according to an Active Minds survey. [8]

Many universities rely on their websites to communicate what resources exist, yet when students were surveyed if their university’s websites included information about mental health, 64% responded “no” or “do not know.” [53]

Figure 4. Does your college’s website Include mental health information? Adapted from College Students Speak: A Survey Report on Mental Health. National Alliance on Mental Illness. https://www.nami.org/Support-Education/Publications-Reports/Survey-Reports/College-Students-Speak_A-Survey-Report-on-Mental-H

And for those that do know where to go for help, 60% of college students say the pandemic has made it harder to access mental health care, according to a survey on the impact of COVID-19 on student well-being. [54]

Challenges Accessing Mental Health

Even when students manage to navigate the pathways to access counseling resources on their campus, they often encounter challenges with accessing help ranging from waiting lists, caps in services provided, gaps in services available at home vs. at the university.

As demand for mental health resources peaks, rapid access to mental health services is a challenge for many universities with referrals and access to therapy taking increasingly longer. In the meantime, students struggle to carry on, often missing classes, falling behind in their courses, and struggling with their grades. [2] Unfortunately, many universities are unable to quantify wait times. UK-Former health minister Norman Lamb recently gathered information from 110 universities and found many do not even record their counselling waiting lists or budgets for support services. [47]

Once students do access counseling services, several have complained about limits on the number of times they can see a mental health professional on campus. For example, in the US, half of public universities and 46% of private universities have such limits.  [27]

Bridging the Gap with Virtual Treatment

During COVID, most universities used virtual treatment to bridge students’ lack of direct access to various mental health services.  And while this approach was deemed successful overall, challenges included more difficulty with assessing students’ state of mind and needs and achieving connectedness with students when physically separated. [3] According to a study by University College London, many patients experienced serious disruptions to their access to and quality of mental healthcare as a result of shifts in treatment from in-person to virtual support due to the pandemic. [38]

And while virtual treatment can scale better, it was not ubiquitous. In fact, some students faced gaps in resources in treatment and resources when transitioning from home to university or vice-versa. An American College Health Association survey in early April found that less than half of colleges and universities were able to virtually treat students regardless of where they were living. [8]

In some cases, licensing laws prohibited treatment across state lines in the US. [8]

Moving Forward

Given the prevalence of mental health challenges faced by universities, it’s understandable university executives are making this their top priority. As we continue to explore mental health, our next article in this series will cover how COVID has exacerbated mental health, the impact mental health challenges have on universities, students, the blind spots universities need to address, and how SafeZone can help you address them. We thank you for your interest in this topic and invite you to share this content with your peers as you prepare to tackle this head-on 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.

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