It can only be disturbing that the number of students arriving at university with pre-existing and often complex mental health problems is growing each year.
The reassuring thing is that their problems are arguably less severe than those among 18 to 25 year olds in society in general, with the bonus that the universities have dedicated counselling services that are, mostly, more efficient than those offered by the NHS.
Universities are also geared up to deal with the pressures of student life, with exam and modular testing timetables, with the pressures of separation from families and friends and with financial crises. They have a humanitarian as well as a business interest in happy students.
'It is in the institutions' financial and league-table interest to look after their students. Students dropping out is not what any of us want. There is not only a whole human emotional issue and a lot of pain for the individual students, but there also is a very considerable loss of income to the institution,' says Mark Phippen, head of counselling at Cambridge University, who is a former chair of the national co-ordinating body, the Heads of University Counselling Services (HUCS).
Ann Conlon, the head of student services at King's College, University of London and a founder of HUCS, agrees. She has been at King's as a clinical psychologist for 18 years and says, 'Universities are a microcosm of society.' She not only co-ordinates all her institution's welfare services, but also runs a clinical practice, so she is seeing the practical as well as the administrative problems.
'I would say the problems have become more serious. We do see a whole range of students, from those who have developmental problems related to their age and being away from home to those with borderline personality disorder problems,' she explains.
'Increasingly, there are more students coming with a pre-existing situation. The manifestation can be depression, suicidal tendencies, self-harm. The eating disorders have always been with us. Some people are more psychotic. But I do think one has to be aware that because of the nature of their age, students are very impulsive. They do not always stop and reflect. They feel things very intensely. They feel terrible one day and wonderful the next.'
Conlon is careful to point out that students with a serious problem remain a minority. In an institution such as hers, with 17,000 students, there are perhaps half a dozen a year who have severe problems.
Adopting a practice that is widespread across the universities, Conlon holds meetings with all the faculties at King's and provides literature and training programmes so that academic, housing and financial personnel recognise danger signs.
She believes that support services within each university should have one central co-ordinating body with links with the students' union. At King's, the counselling service takes the lead and other departments take it elsewhere. 'The important thing is that the services should work in co-operation and not competition. Competition can only be destructive.'
It is also important, she said, to create links with the NHS, with local doctors and with hospital accident and emergency services, so that they will refer students taken to hospital with such problems as overdoses back to the university.
The National Union of Students' estimates of the extent of mental health problems sound much more frightening. Verity Coyle, its vice-president responsible for welfare, said that one in four students would suffer mental illness and is highly critical of the services provided by universities.
However, the figure she gives, she says, covers the whole spectrum of mental ill-health, which can 'be anything from the occasional bad day, to intermittent depression, to depression that continues throughout university, to the extremes of suicidal tendencies and serious personality breakdown.'
The problems within the universities reflect those in society in general. Widening access means that more students with problems are getting to university and what is needed is a matching expansion of welfare provision. She says that the HUCS is doing excellent work, but is underfunded.
The aim of the NUS, she says, is to bring an improvement across the board. 'We want to reduce the stigma of mental health conditions in students. We want to raise awareness and understanding in university admissions procedures but also ensure that better systems are in place when someone looks like they need help.'
The universities have decades of experience of handling all kinds of problems, not just mental health issues, from homesickness to unhappiness with a chosen course.
The best-organised of them also have policies for handling parental concerns, which sometimes reflect poor relationships between the parents and their student children. Parents can be the ones to spot danger signals, although one common warning sign is something that many parents will find reassuring. The student who phones home constantly may be deeply miserable. The normal behaviour of a new undergraduate is to forget that parents exist. Counsellors have to tread a fine line, since undergraduates, being over 18, are legally adult and entitled to their privacy. However, parents' concerns have to be taken seriously.
Students' problems can vary, depending on their age, their home background and whether they are living at home or away. Those in halls are often best catered for, since they are integrated into the university welfare organisations. Often, postgraduate students get cheap living accommodation to be a watching but discreet presence. One of the difficulties is that the mentally ill will be reluctant to seek help.
Those living at home and the mature students may be the most difficult to help because their problems can be masked.
The widening of access to students from non-traditional university-going backgrounds has brought new problems. Their parents may be more anxious than those who have been to university themselves and understand first-term teething problems. Pressure on students from non-traditional backgrounds to succeed can be greater. They may feel that they must continue an unsuitable course to avoid disappointing parents. But the counsellors and the NUS agree that students of all ages and background can suffer.
The most important consideration is for those with problems to get appropriate help as fast as possible.
