The following correction was printed in the Guardian's corrections and clarifications column Friday July 25 2003
The Royal Holloway College is no longer in north London, nor does it still bear the name. The merger between Royal Holloway College and Bedford College resulted in an institution now called Royal Holloway, University of London, which is situated in Egham, Surrey. ------------------------------------------------
When a student wrote "manic depressive" on her university application form she received a wide range of responses from outright rejection to being told that she would have to live in halls of residence for the physically disabled.
As well as being a great adventure, going to university can also be a time of great stress. Leaving home for the first time, coping with debt, forming new relationships and studying can create psychiatric problems for one in four students, according to the National Union of Students. With many of the common psychotic illnesses, such as schizophrenia and manic depression, first presenting between the ages of 18 and 21, universities are finally recognising that they must do more for students with mental-health problems.
Being away from home for the first time was the catalyst for Emma's illness. Despite falling into a deep depression that left her unable to leave her room or do any work, it was her mother who first saw the signs that she needed help.
"The university didn't have a clue. My mother got me to see a doctor and I was given antidepressants. After that, I started getting these grandiose delusions that I could start my own graphic design business. I even went to estate agents looking for offices to rent. I had these delusions that newspapers were writing about me but then being banned from publishing it."
She spent 14 days in hospital where manic depression - now more often referred to as bipolar disorder - was diagnosed. After six months of treatment, she was well enough to consider returning to full-time study in 2000. "My old college said I could come back but it had too many bad associations for me. I wrote 'manic depressive' on the Ucas form. I got some interesting replies - from totally not interested in me to others offering good support services.
"One college said that I had better have a place in specially adapted halls of residence for the physically disabled with call buttons for emergencies. I thought that was inappropriate. I chose Southampton and got excellent support. They told me I was eligible for the disabled student allowance, which paid for a mentor who helped me all through my three years. She is a trained counsellor and I saw her up to twice a week near exam times. I even had her mobile phone number so I could call her anytime up to midnight in emergencies."
Helen Gilburt didn't get the same levels of support. She was in the second year of her PhD in biology when a traumatic break-up with her boyfriend brought on a recurrence of the psychiatric problems she was only much later to discover were diagnosed as borderline personality disorder.
The condition brings on a marked tendency to act impulsively without thought for the consequences but can also bring feelings of emptiness and self-loathing that manifest in self-harm or even suicide. And a biology lab surrounded by scalpels and dissection kits was the ideal place for the PhD student to mutilate her arms and body. "The break-up was quite painful and I began to self-harm quite badly - to cut myself. I went to my GP but it took a long time to see a psychiatrist. They just talked to me really - I wasn't admitted to hospital. I carried on with my PhD but it wasn't really going very well."
Gilburt's condition deteriorated until she was sleeping in the laboratory overnight. Her supervisor was sympathetic but was due to leave for another job. After an overdose of tranquillisers and antidepressants she was hospitalised. "I was in for about a week when the psychiatrist said get out and start your normal life again - that is part of the treatment process."
She moved into a hostel, but drifted into sleeping rough and gradually went back to sleeping in the lab. "The supervisor found out and told me that this wasn't on, but that was about all. Nobody knew what to do for me - about the mental illness, about housing, anything. Luckily a friend took me in and I managed to complete my PhD - I don't know how I did it really."
Gilburt is now information officer with the mental-health charity Rethink. She says it is vital to get good support as fast as possible. "If you are worried about yourself or someone else, get in touch with the university counselling and support service. Tell your GP that you need help and they should make the appropriate referral. If you aren't getting help, talk to Mind or Rethink and they will help you get in touch with the right local people.'
The National Union of Students says universities need to do more to cope with increasing numbers of students with mental-health problems. Verity Coyle, vice president for welfare, says: "One in four people will experience a mental-health problem while at university and we want to reduce the stigma of these conditions. We want to raise understanding and awareness of mental illness in university admissions procedures but also ensure that better systems are in place when someone looks like they need help."
Dr Annie Grant, the director of the educational development and support centre at Leicester University, says attitudes are improving. "If we had an application from a student with manic depression it would be considered on academic merit alone, but we would also invite the student to meet us and talk about their needs. If we made an offer of, say, three Bs and the student got two Bs and a C, we would want to talk to them about the circumstances at the time of the exams.
"Where a student might miss some lectures we would want to ensure the right support was available for them to receive a copy of the lecture notes. The best interests of the student would be paramount."
Dr Grant says the university representative body Universities UK has just produced a new good practice guide to mental health and that her own university has produced a booklet for all staff called "Helping students in difficulty".
"In many cases, staff do want to help but ignorance and fear of mental illness can prevent that. We have also introduced awareness training for porters, secretaries and library staff. If someone doesn't leave their room for a couple of days I would like to think we have the right structures in place to know about it and get help."
The admissions policy at Royal Holloway College in north London has been praised for its sensitive approach. It uses a twin-track process by which applicants are judged by the academic tutor in terms of exam results but also on health needs. Applicants are asked to define any special needs using a coding system with categories for mental health, wheelchair use, physical disability and 'hidden illness' such as diabetes, epilepsy or heart disease. Applicants are assessed in terms of the extra support they might need and whether the college can provide appropriate care.
Academic registrar Phil McGeevor says: "We identified 270 applicants [out of a total of 11,000] with some special needs last year. That's not to say all of them went on to be students here, but to date we haven't said we can't support anyone because they have some special needs.
"In terms of the academic success of students with special needs, our surveys of exam results shows that they are doing as good as or better than the rest of the student body, so we must be doing something right."
· Mind helpline 0845 766 0163;
· Rethink: 0845 456 0455
