I am walking through Nottingham’s Arboretum park on a bright cold afternoon with 10 other people, all of us in complete silence. At first I find the whole thing so awkward I have to suppress an embarrassed laugh. But as we make our wordless way through the dappled shade, I feel an atmosphere of calm and thoughtfulness envelop us like a protective cloak.
The others in my group are undergraduate students, chaplains and other staff of Nottingham Trent University (NTU), all taking part in a mindfulness walk, intended to bring some space and quiet reflection into students’ hectic lives. Guided by the chaplains (who speak occasionally), we pause as a group to consider questions in the booklets we have been handed: “who am I?”, “where am I going in my life?” and “what brings me a sense of excitement?” Left to our silence, we note down our answers. Stopping by a rubbish bin, we ask, “What rubbish am I carrying with me in my life?” We tear off our answers and throw them in the bin. It sounds silly, but weeks later I still feel lighter for casting off that scribble on a scrap of paper.
Back in the bustling City Campus of NTU, students and staff weave their way around each other, a mass of hoodies and headscarves, skullcaps and backwards caps, hipster beards and hi-tops. Posters advertise a programme of free yoga, craft classes and eating-disorder information sessions: my visit coincides with Wellbeing Week, designed to raise awareness of mental health and encourage students who need help to seek it. This is just one part of NTU’s strategy to meet a dramatic rise in the need for support.
Last month, the Institute for Public Policy Research (IPPR) published a report revealing that nationally, the number of first-year students who disclose a mental health problem has risen fivefold in the past decade. A record number of students with mental health problems dropped out of university in 2015, the latest year for which figures are available. In the same year, 134 students killed themselves, the highest number on record. Similarly, the number of UK students seeking counselling has rocketed by 50% in the past five years, to more than 37,000, according to figures obtained by the Guardian. This trend is reflected at NTU: wellbeing services received 38% more referrals last year than in 2014/15.
There are many reasons mental health problems may arise at university. It is a time of transition: people are no longer living in the family home, but not yet fully independent either. Added to this, some might experience the big fish – small pond effect, where teenagers who are used to being recognised for their achievements find themselves in a more competitive yet more anonymous environment. Difficulties that have been repressed throughout school can bubble up when students leave their support network behind. As Glenn Baptiste, a mental health adviser at NTU says, “Sometimes it might look like it’s a problem that’s occurred within university, but that’s not always the case. If students come here with ongoing issues that they’ve not discussed, the university environment can make life difficult.”
Even students who have previously sought help may find the move to university makes access more complicated, as they move from adolescent to adult support services. According to a report by the Joint Commissioning Panel for Mental Health, a third of students who had access to child and adolescent mental health services (CAMHS) found their care was interrupted in the transition to university. Nearly a third more lost access to their support altogether.
Student Services manager Alison Bromberg says the most common mental health problems reported by NTU students are anxiety and depression. Bromberg can see how the challenges young people face today play their part in this rise - the burden of student debt, economic uncertainty, global political upheaval, apocalyptic climate change - “but,” she says, “I also think that a lot of work has happened and is still happening to reduce the stigma around discussing mental health and emotional needs. I think it’s making it more possible for people to come forward and ask for that support.”, global political upheaval, economic uncertainty, student debt
In a small office, Sam, a fourth-year student at NTU in her early 20s, sits twiddling a pen and jiggling her knee. She comes across as articulate but nervous, giggling occasionally after speaking. One day, she was in the kitchen of her shared student flat, chatting with her housemates, when out of the blue she felt as if she couldn’t breathe. The same thing happened again in a lecture, and again and again. Assuming it was linked to her existing health problems – migraines and a minor heart condition – Sam booked an appointment with her GP. It never crossed her mind that it might be psychological. “When he told me it was panic- and anxiety-related, it was a bit of a shock,” Sam says. At the same time, she noticed a problematic pattern in her studies: she would do well in the first term, but then stop going to lectures and end up failing her summer exams and having to resit them.
This year, however, she has managed to break that cycle with the help of Baptiste, who has a background in community mental health, counselling and cognitive behavioural therapy (CBT). An adviser rather than a therapist, Baptiste’s job is not so much to counsel Sam as to help her develop strategies to manage her mental health and studies. Sitting in on their session, I can see how his calm manner relaxes Sam as she listens to his practical advice. They work through her primary anxiety at the moment: an upcoming presentation. She fills in a worksheet that breaks down her fears into her core belief about the presentation (“I won’t be able to answer the questions”); her thoughts arising from that belief (“I will look stupid and get a bad grade”); the feelings provoked by those thoughts (“nervous, panicky”); and the physical reaction and behaviour that follow (“I’ll stutter and shake, and I’ll forget to breathe. Then I’ll want to leave”). At times, Sam tries to race ahead, to write a feeling in the box for thoughts, and Baptiste gently corrects her. Finally, he says, “We know these all feed into each other, so what do we need here in the core belief box? Something realistic and balanced: presentations are difficult for you, so accept that, but you know you have done them in the past. In the build-up, tell yourself this healthy core belief, and that will give you the ability to manage your thoughts, feelings and behaviour.”
For Sam, this CBT-style approach clearly works. She smiles with quiet pride as Baptiste points out that, according to her self-assessment forms, her mental wellbeing has drastically improved over the last five months, from a rating of 20% to 48%. He tells her that such an increase is, “of huge significance, and that’s down to you. Historically, in the last three years, this is the period when you drop out. We’re rewriting history. Well, you are.” The session is very practical, positive and solution-focused; there is no suggestion of delving below the surface and into her past to explore where these problems might stem from. Some students I spoke to wanted therapy to explore these deeper questions and find the meaning behind their issues; but Sam tells me she is not interested in therapy that might ask these sorts of questions: “I’m just interested in finding ways to deal with it, seeing if I can try to resolve it, rather than looking at why it started.”
Sam is one of more than 2,000 students who received help over the last academic year at NTU, an average of 80 a week; or more than 11 students every day. Student services manager Alison Bromberg says this is not just a problem for universities: “Whatever is happening in society will happen in university, so whatever you see here is reflected in the country.” The statistics back her up: in February, in a survey by the Association of Schools and College Leaders, 55% of schools reported an increase in stress and anxiety among their pupils. A 200,000-strong study found that young people in the UK have the poorest mental wellbeing in the world, with the exception of Japan.
Rosie Tressler, CEO of student mental health charity Student Minds, tells me, “The 2016 Student Academic Experience Survey provided strong evidence that [undergraduates] have lower levels of wellbeing than the rest of the population, with roughly one-third reporting psychological distress, and we know that the median age of higher education students overlaps the peak age of onset for mental health difficulties.” In other words, evidence suggests many people with mental health disorders first experience symptoms between the ages of 18 and 25.
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In September 2016, the thinktank the Higher Education Policy Institute (Hepi) published a report stating that some universities needed to treble what they spend on mental health support, warning that the number of student suicides was on the rise. ONS figures show that in the last 10 years, the number of student deaths by suicide has risen by more than 50%. This is not fear-mongering; it is a deeply serious problem, says Ged Flynn, CEO of Papyrus, a charity for the prevention of young suicide: “We hear daily from young people having suicidal thoughts and from those who are concerned about them. University life can add to the pressures that young people already experience these days.”
When I asked students around the country about their experiences of mental health, they talked about stressful deadlines, difficulties forming new relationships, balancing a job with studies, financial worries and social pressures. They also painted a picture of patchy provision: while some received prompt and effective help, others described underfunded services, excruciatingly long waiting times and dismissive attitudes. One student talked about desperately trying to get a counselling appointment when booking opened at 9am, only to find that all the slots had gone when she got through at 9.03am. A final-year student at another university wrote that she is experiencing increasing anxiety and can’t get help: “A good counsellor I saw in my first year has left, and they are not recruiting any more, so there are lots of students chasing very few appointments. They refer you on or offer leaflets. It seems very inadequate.”
Alex, 21, was a student at a Midlands university when she was diagnosed with bipolar disorder, anxiety and severe depression. She says services are able to deal only with the most seriously distressed students: “Because of the strain on the service, if you weren’t suicidal at the current time, you weren’t helped. You had to be five minutes from death or you had to wait weeks. You had to be at your worst.”
The counselling she was eventually offered was helpful, but she felt the eight-week wait was too long and the six weeks it lasted too short. For long-term therapy on the NHS, she was told she needed to wait a year, by which time she would have graduated and moved home. “So it’s kind of pointless,” she says. For others, such as George Watkins, 21, who is at Cardiff and has had anxiety and depression for eight years, the experience has been more positive: “It is since coming to university that I have made the most progress. I came off the crippling medication, came through suicidal patches and have now come more or less out the other side.” After having a breakdown around the time of his GCSEs, Watkins didn’t leave his house for six months, and then didn’t leave his small town in Dorset for three years.
“Going to university was the best thing that could ever have happened, but probably the hardest thing I will ever do, mentally,” he says. “All of a sudden, I didn’t have my support, I was surrounded by people, it was very intense. There is a massive prevalence of drink and drugs, and it’s hard not to feel a bit of an outcast if you don’t take part in all that.” Watkins benefited from a supportive mental health service, but says it is bursting at the seams. “The team here does a fantastic job, but there is not enough funding to meet the demand.” He points out that, if one in four people has a mental health problem, as a recent YouGov survey found, that equates to 7,500 of Cardiff’s 30,000 students: “That is far more than our services here could handle.” He has now been elected as the university’s mental health officer, and is campaigning for more funding. “I’m not going to kid myself that we’re going to have some kind of utopia. What I’d like to see is a good level of support that’s accessible to everyone. That’s the best we can do.”
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The 2016 Hepi report notes that in some institutions the funding for counselling services is less than £200,000. (The average pay for university vice-chancellors now exceeds £275,000.) However, it also notes that several institutions, including Imperial College London, the University of Leeds and Brunel are trialling new methods for dealing with the ever-growing need for better support. NTU’s work to develop specialist training is also mentioned.
Over the last two years, Alison Bromberg and her team have implemented a new system designed to make it easier for students to access help, starting with a single port of call for all inquiries. Crucially, it’s not just students who can get in touch: friends, family or staff members can alert support services if they think a student may need help. This change in policy was because “young people in transition don’t always find it easy to come forward”, explains Bromberg. A student, or someone concerned about a student, fills in a simple form on the wellbeing website. They then receive a call or email within two days and, where appropriate, then arrange a face-to-face meeting. For some students, that might mean accessing an online system that offers self-help modules on managing issues such as depression, anxiety and body image (this system is also used by the NHS). Students may also have the opportunity to work with an adviser such as Baptiste, receive counselling (usually up to six sessions) or work with a support officer who can liaise with academic staff. “It is distinct from a more therapeutic approach that some students get solely from counselling,” says Bromberg. “But we’re quite clear that they are distinctive offers.”
NTU has invested in three new members of staff on its wellbeing team, including adviser Rachael Sisson. I sit with her in a small room where large windows let in the sunshine. She works through the messages that have come through the online form, prioritising those most in need and phoning them first, making notes on her pad as she listens. She has a warm but professional style that I imagine would be a tonic for a student in distress.
Sisson phones and leaves a message for one student who is worried about his flatmate, whom he describes as being very emotionally volatile. She cannot contact the flatmate without his express permission, so, as with most third-party referrals, she will encourage his concerned friend to raise the issue directly. She reads about another student who has written to request counselling after experiencing issues for a few years. She makes some notes on her pad before she dials: GP? Academic staff? She introduces herself in an upbeat way and asks questions. “It sounds like you’re feeling a bit by yourself,” she says, gently, and offers him a wellbeing appointment – a 50-minute, face-to-face session.
This might be the first time these young people have ever spoken to anyone, and I’m glad that it is Sisson’s voice they hear on the end of the line. “I hope I come across as approachable and interested in their situation,” she says, “and through that I build a bit of a rapport. They’re in touch about really personal, sensitive issues, so I try to make that as easy as possible.” Sisson’s background in social work means she is well trained to talk about these kinds of problems; but Bromberg recognises that the whole university must be prepared to respond appropriately when faced with a student who is struggling. Her team has opened mental health first-aid training to all staff, to teach them how to listen calmly and hold silences for longer than feels comfortable. If universities can intervene at the right time, it can have a huge impact. Claudia de Campos, a child and adolescent psychotherapist and visiting lecturer at the Tavistock clinic in London, explains: “The things that we can’t talk about take on a life of their own, and seep through in ways we are not aware of. If something can be thought about and made sense of, spoken and elaborated, it loses its hold – and, depending on the nature of the problem, is less likely to get passed on to the next generation.”
For George Watkins at Cardiff, the stigma is exacerbated by so-called “lad culture”, where putting on a brave face pushes some to ignore their feelings. Things may be changing, but as Midlands student Alex says, with more than a hint of exasperation: “Reducing stigma is a huge deal, but even if we reduce it loads, it will be pointless if there is no money in any services to get anything done, and people who seek help are told, ‘Go and have a good sleep – see how you feel.’”
At NTU, Alison Bromberg still thinks there is cause to feel optimistic about the future. “I do. I actually do. It feels as if we’re embracing a much more holistic framework across the sector.” She cites proposed changes to the university curriculum, such as creating course content for all students on subjects such as coping with change and understanding stress and anxiety. “We’ve got to make sure mental health becomes everybody’s business. That’s the journey we’re on. And I think we’ve come a long way.”
Some names have been changed.
• In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at befrienders.org.
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