Universities may overmedicalise the usual emotions of young adults without always understanding a social component, argues Steve West, chair of the working group Universities UK: Mental Health and Wellbeing in Higher Education. This, he suggests, may render more harm than good.
Emotions such as loneliness, a common experience for students entering university often far from home, may be pathologised.
Other usual emotions include exam stress, particularly true where many people enter tertiary institutions directly from schools where independent thinking and learning has not been a strong focus.
Simply extending conventional mental healthcare services may not be the most effective way to manage the challenges universities are facing. Further, many interventions are not well researched nor yet shown to be effective. Some of the more “normal” yet distressing emotions, such as loneliness, may be better addressed through social connections.
Many South African students emanate from a context of poverty, educational disadvantage, poor social support, and yet have great expectations to fill. Many are first-time university students in their extended families. Language and culture present problems. Distractions abound.
Pressure to perform at universities increases because good marks count for residence admission, bursaries, re-admission into programmes and admission into higher postgraduate programmes.
The 2017 Student Confidence Index survey conducted by the Professional Provident Society revealed that less than 50% felt prepared for the transition from school to tertiary institutions. The question can be asked how that statistic links to the 48% of university students who do not complete their degrees, according to a 2015 report by the Department of Higher Education.
Universities accept students that they know are not university ready because they understand that the school system is struggling. To facilitate the transition to university standards, various types of foundation and assistance programmes are then generated. Come graduation time, some students have made up the gap‚ but many others have had a disillusioning experience and a poor understanding of broader options in their areas of interest.
Do we use these foundation programmes to really prepare students for the independent studies lying ahead of them? Or do we tightly hold their hands while focusing on getting them through?
Razia Mayet, (“Supporting At-Risk Learners at a Comprehensive University in South Africa”, Journal of Student Affairs in Africa) reminds us that the apartheid legacy, as well as ongoing economic inequalities, and continuing problems in the schooling systems promote student unpreparedness.
In the same journal, Mpho Jama points out in his article “Academic Guidance for Undergraduate Students in a South African Medical School: Can we guide them all?” that students’ socioeconomic background and harsh present realities may negatively affect academic performance. In turn, “poor academic performance can lead to an array of other social and psychological problems, such as the withdrawal of bursaries” and other ensuing psychological problems.
Do our study programmes integrate valuable life skills? Why are they often separated out and left to be caught up in modules and learning environments fragmented from their applications?
An analysis last year by the BBC of 83 universities in the United Kingdom stated that research indicated a 50% rise in mental health service demands at universities over the past five years.
University life is challenging because it breaks from an earlier developmental stage and, despite all the life orientation that goes on at schools, young people seem ill-prepared for independent life. This may not be surprising because learning about life seldom is effective when done out of a book.
Much can be achieved through resilience building. Helping young people to discover, mobilise and develop their inner resources can deliver life-long skills for managing commonplace human emotions.
Nonetheless, “real” psychopathology or psychiatric conditions often emerge in this developmental phase and this does need medical treatment: psychotherapy and prescription drugs.
This developmental period is typically associated with psychological and social challenges. During this phase, the part of the brain that plays a vital role in activities such as decision-making and planning, social interactions, understanding others and self, making judgments and impulse control is still being finely-tuned.
Neuropsychological researcher Sarah-Jayne Blakemore and developmental psychologist Uta Frith’s work on the developing brain of the adolescent (The Learning Brain: Lessons for Education) indicates that they are highly sensitive to reward-seeking behaviour, with poor impulse control. Students have to negotiate a number of potentially tricky transitions. When most start university they have entered young adulthood. Often they are dealing with changes in family and peer relationships. Some leave home and enter a new social context with an increased opportunity for risky behaviour such as substance misuse.
The stress of dealing with the transitions may contribute to poor psychological functioning and precipitate symptoms of psychopathology.
Prevalence and demand
It is always challenging to find accurate reporting on mental health prevalence. Healthcare professionals may find themselves over-diagnosing in a university context. This may be detrimental to the young person in the long run. The reading of statistics on mental health issues at tertiary institutions should bear this in mind.
The rise in the demand for mental health services is a global phenomenon. A study in the United States in 2017, conducted at 26 university campuses, showed that students experience a wide range of mental health problems. At least 17% suffered from depression, 4.1% had panic disorder, 7% had generalised anxiety, 6.3% had suicidal ideation and 15.3% reported non-suicidal self-injury.
In South Africa, research from 2013 by the University of Cape Town has suggested that up to 12% of students experience anything from moderate to severe symptoms of depression and15% report moderate to severe symptoms of anxiety. This same study found 24.5% of a large sample of South African students reported some form of suicidal ideation in the two weeks before they were interviewed.
Even in high-income countries there is a significant mental health treatment gap. It is estimated that about 24% of students in high-income countries receive the care they require. In low- and middle-income countries between 8% and 11% of students receive psychological care.
Some students are leaving home for the first time, leaving behind support structures and neglecting to take care of themselves properly. This could include overindulging in alcohol and drugs, failing to eat a balanced diet, or taking too little exercise.
Social media also plays a role in fuelling mental health issues. Apart from possible bullying and the competitive environment established by social media, there is also the easy and constant access to pornography and gambling.
In addition, the greater awareness about mental health issues might make some students more comfortable to ask for help. Academic staff are also more likely to refer students to the counselling units.
Who is responsible?
The responsibility seems to fall on tertiary institutions, possibly distracting from the core business. Are there partners in society who can help shoulder this important load? Should it be the department of health, parents or university administrators?
The responsibility is likely to lie shared across many shoulders. Corporates could take closer involvement in students earmarked for bursaries and professional roles. The divide between secondary and tertiary education levels can be reduced through co-operative attention to school curricula.
Another problem is that interventions at universities still predominantly rely on traditional approaches to psychotherapy. This is mainly one-on-one counselling. This is not suitable for all students. Researchers in Germany, the Netherlands and Canada have developed a number of internet based and e-interventions that could help students address problems. But these interventions still need to be tested in South Africa.
In the UK, information and self-help tools such as websites Mind; Time to Change; and Rethink Mental Illness provide some alternatives to addressing the problem.
Possibilities to draw on in order to address mental health challenges include a more stepped approach to help students, peer support systems, more online or cellphone-based interventions or preventative programmes.
The University of Pretoria has developed a number of programmes to move towards this approach. #UPliftUP provides peer-to-peer support in groups monitored by the South African Depression and Anxiety Group. A daily screening and emergency intake process attempts to capture crises as they arise. Mental health professionals are based at each of the five campuses.
Dr Linda Eskell Blokland is a clinical psychologist and academic. She is a founder of the University of Pretoria’s Itsoseng Community Psychology Clinic in Mamelodi.
This article first appeared in the Mail & Guardian on 11 October 2019.10.17