Sian Davies thought things would change when she got to Bournemouth University. She had suffered from depression two years previously, at the age of 17. A suicide attempt was written off by doctors as a "teenage moment". She immersed herself in student life and the student union and made a solid circle of friends. But by the end of her second year she was tumbling back down her hole.
"It started when I couldn't get out of bed," she remembers. "I was a big drinker as well, which was a coping mechanism. I'd come home drunk and loud, but I wasn't happy. My friends and family were starting to worry. One [friend] said to me: 'We don't know whether you're going to come out of your room in the morning.'
"As I was a student living in shared accommodation, it inevitably impacted on my friends and flatmates. They wanted to know what had happened to the Sian they first met. They remembered the person with a love life, the president of rugby team, and they didn't recognise me. I'd put on three or four stone in a year, was self harming and, basically, had stopped enjoying life."
When she was warned that she was in danger of failing her degree (she had previously been predicted a 2:1 or a first) she took six months out. A doctor prescribed her anti-depressants and, more important she says, she got regular counselling from the university services. Eventually, she secured the degree in new media production she wanted, and four years later Davies is the National Union of Students' disabilities officer. Naturally, she has a particular interest in mental health issues.
"People say university is the best time of your life. It's very hard for someone to turn round and say, 'I'm not having the best days of my life, it's actually a rubbish time'."
Two years ago, a Royal College of Psychiatrists (RCP) report on student mental health and university services shook the sector. It found that more and more students were seeking help for mental health difficulties, ranging from what might be considered "the blues" to acute psychosis. For an explanation, it pointed to the government's widening participation strategy, which meant there were increasing numbers of students from more variable backgrounds.
Today 170 healthcare professionals and university representatives are to attend a conference organised by the Universities UK (UUK)/Standing Conference of Principals (Scop) student mental health committee, which was formed in the wake of the RCP report. It will continue a debate, started at a conference a year ago, about how to tackle the growing problem.
Among them will be Mark Phippen, head of counselling services at Cambridge University, which sees about 1,000 students a year - around 6% of the total student body. He says many freshers have unrealistic expectations of what student life will be like.
"The common notion of student life as being all about lazing about, lying in and drinking beer is unfortunately - or fortunately - very far from the truth," he says. "People work extremely hard, are usually poor and are trying, at the same time, to maintain a social life, have fun, earn money, maintain relationships with family and keep up the grades. It's a difficult balancing act."
According to new research into the impact of paid work on the lifestyles and academic attainment of students, the strain is starting to show. The survey of 1,500 students by South Bank University and the Open University, for UUK and the Higher Education Funding Council for England, found that 70% of students lose sleep because of the work they take on to pay the bills.
Nearly two-thirds said they were "constantly overloaded" by the combination of paid work and academic work. Four out of five said they spent less time relaxing because of their jobs and a third said they were less likely to do sports or other leisure activities. Another third said working stopped them seeing their families. Previous research has shown that the percentage of students doing term-time jobs shot up from 47% in 1998-99 to 58% in 2002-03.
Clare Callender, one of the authors of the research, which is yet to be published, says: "We have to look at the impact of student funding arrangements on the achievements and experiences of students once they get to university - not just the impact on whether they go at all. Getting students through the door is not enough. We need to understand their experience at university."
Fi Roxburgh was in her first year at the University of East Anglia when a relapse into ME and anorexia left her weighing six stone and swinging between bleak depression and fidgety psychosis. She tried to negotiate time out of her degree to get back on track, but the people she was told to contact at the university did not return her calls or emails. Nobody seemed to know the procedure to follow. She was vulnerable, stressed and definitely not thinking straight. Then she was told it was her fault - she'd gone about the process in the wrong way. "I felt that I'd done something wrong, or I should have known better, like I was a naughty little schoolgirl," she says.
"I felt very unsupported and let down by the administration side of the university. All universities seem to have quite a lot of administrative confusion, not just when it comes to health issues. But nobody seemed to know how to support me. It's a system that doesn't work. Different tutors have different reactions and I've now gauged which ones to confide in."
Roxburgh got her break from university, started a new degree, in English literature and philosophy, and took up a new passion: getting UEA to sort out its mental health policy and publicising the issue to other students. She approached the student union at the same time as the university itself was making student mental health a priority. Annie Grant, its dean of students, is now about to appoint a dedicated student mental health officer to tackle the problem head-on, and is in the process of introducing a mental health policy.
Grant says mental health issues are now a "major priority" of the university. Of Roxburgh's case she says: "We are always extremely keen to learn from students, both negative and positive. We're always sorry if something hasn't worked well and we take that seriously and use it as a basis to move forward."
Separate research by the UUK/Scop mental health committee, which is due to be published before the end of term, reveals that only 25% of universities have a student mental health policy. But, in a clear sign that nearly all universities now know they have to do something about the problem, a further 60% are currently developing one.
Les Ebdon, vice-chancellor of Luton University, is chairing today's conference. He says universities are increasingly waking up to their responsibilities when it comes to student mental health. "We know that if we aren't proactive the most terrible tragedies can happen. We're sensitised. We know students are away from home, under stress and experiencing new pressures. They are young adults just maturing; it's a time of vulnerability."
He adds: "Students who suffer from any health issue are also more likely to drop out, so, yes, there's an interest for us to keep our students healthy and happy."
Nigel Humphrys, head of the student counselling centre at the University of Leeds, says that as universities compete to recruit students, they will also have to compete to provide the best services for them. "Mental health services have to be a part of what a university does. They recruit, do admissions, but increasingly need to have good support systems - dare I say, the after care."
But the message from the conference today is that universities cannot do it alone. The theme is Joined Up Practice: Towards NHS/HE Collaboration in Mental Health, and the idea is to fill in the holes, so that there are fewer opportunities for students to slip through the gaps that exist between the various agencies they come into contact with, from lecturers to doctors.
In Leeds, for example, a university representative sits on the Primary Care Trust's mental health committee and the PCT has a dedicated student mental health adviser. In cities such as Leeds and Cambridge, where there are large student populations, the geography dictates that such focused provision makes sense.
However, as Ebdon is due to tell the conference today, he fears that recent trends within the NHS could leave students vulnerable. "We see a lot of students who have minor mental health problems. The NHS is very geared up for severe problems. Universities are worried students will be left in the cold. And with more targeting of vulnerable groups, such as the elderly, there could even be a cut for funding for health services in areas with a high population of young people."
Les McMinn, head of the student counselling centre at Surrey University and current chair of the Heads of Universities' Counselling Services group, says: "One of the reasons universities are building up expertise is because often the NHS provision isn't brilliant - it's totally variable throughout the UK. The university is often left to deal with the situation. If we don't provide support, there will be no support."
Back at the NUS, Davies says university mental health services are patchy, but where they do work, they can be a lifeline that doesn't exist in the "real" world. "Students might go into their GP and be told to wait three or four weeks for counselling. If there's a counselling service at university, you've got it better than in the real world."
