Drivers of demand

Although institutions have been growing in size, interviewees noted that the surge in demand cannot be explained by rising student numbers alone – although institutions with rapidly internationalising cohorts were experiencing larger numbers of such students requiring disability or mental health support. Several factors driving the nature of demand for institutional provision were therefore considered.

5.3.1 Change in culture

A strong consensus existed amongst staff at the case study institutions that, up to a certain point, societally there was a more open culture concerning mental health. It was felt individuals in the population were more widely encouraged to discuss mental health, so interviewees concluded this led to a greater willingness amongst the student community to seek formal and informal help, discuss their difficulties and diagnose conditions. Campaigns – both physical campaigns eg posters, and those using social media– were thought to raise the topic in a public forum, imbuing it with greater

prominence and contributing to reducing the stigma around mental health. However, some interviewees were careful to note that despite apparent increasing openness, certain students may still be reluctant to engage with the issue. Some may reject the mental illness label or question why they are being referred from counselling to a disability service as they do not consider themselves to be disabled. Additionally there may be particular trepidation amongst certain groups of international students,

potentially experiencing exacerbated anxiety and pressure to achieve. They may be at greater risk of not disclosing a mental health issue or a difficulty in coping with

academic/student life, and may conceivably feel more isolated than domestic students due to distance, time zones, the requirement to adapt to another language or culture, and for some overcome stigma associated with mental health problems which in some cultures is even greater than within our own. Therefore, interviewees contended there was still a lot of work to be done around normalising mental health problems.

‘I think that we have got a very high number of Chinese students and, I think, they have a lot of anxiety about asking for support and receiving support, so sometimes a student will come in and they’ve actually been referred by their academic advisor or by a tutor, but they’re very reluctant to take the course or to make any kind of formal acknowledgement of wanting support, so that number should be higher than it is, really because our suspicion is, actually, a lot of international students aren’t coming to [us], that we could be

supporting.’

‘There are increasing numbers of pressures and we do have a good reputation also amongst younger generations and there is less stigma – but people are worried about having diagnoses … The more severe forms: bi-polar, personality disorders, because of how they [are] seen, that label stays with you. There are students who don’t want to get the label, in case they get labelled in the workplace.’

One institution reported how they had introduced initiatives to attempt to normalise some of the transition issues incoming students may face.

Example of normalising transition issues: University of Lincoln

Staff at the University of Lincoln discussed the importance of ‘normalising’ certain issues such as initial homesickness, loneliness and attachment issues. One initiative offered sessions for international students which explained how feeling homesick was normal, and suggested strategies to draw on their own resources to get through this initial difficulty.

Interviewees explained such strategies were valuable for all students, and that it was important not to pathologise emotions immediately. Proactive strategies were viewed as

‘the best intervention’, and interviewees suggested that HEIs should do more to facilitate students’ self-awareness around their skills and resilience. Developing and fostering psychological strengths was perceived as a preventative strategy that would be valuable for all students.

‘If we can identify those strengths and get them working, that allows the whole community of the university to flourish’

5.3.2 Changes in the healthcare sector

Increased disclosures of disabilities or mental health needs were also connected to changes in the healthcare sector, both positive and negative. Diagnostic procedures were felt, by some, to have improved, producing more reliable diagnoses at much earlier stages of students’ lives. Better quality of care and treatment may also mean that individuals who would not previously have attended HEI are now studying in HE.

Additionally, experience of having engaged with mental health services – such as those provided in primary care – prior to HE may lead students to arrive with higher

expectations of the level or nature of help they will receive. Alternatively,

shortcomings in external statutory mental health provision, including barriers to referral and high NHS waiting lists, may mean HEIs are bearing the load as this provision recedes.

‘The big change I’ve seen is it feels like an increase in demand. There have been huge drives in the health care system to shift work out of secondary care and in to primary care and, at the bottom line, primary care hasn’t got any bigger. Primary care funding is something like eight per cent of the NHS budget and that has slipped back from much higher figures in the past.’

5.3.3 Success of widening participation

Alongside these two drivers which may partly explain increasing rates of diagnosis or disclosure, interviewees noted further factors which may influence the demographic profile of cohorts. Both factors were seen as having encouraged more people to view HE as a viable option. Firstly, support in school is better in terms of improved

awareness of mental health and access to counselling. This was thought to have

enhanced students’ knowledge that there is access to support. In addition, institutional engagement with widening participation has impacted on the profile of students now enrolling. It was viewed as very positive that people were transitioning to HE that may not have done so in the past, whilst at the same time there was recognition of the impact of taking vulnerable people away from personal support networks and into a situation of intense academic pressure.

5.3.4 Institutional factors

Whilst the above may be considered to apply across the HE sector, some institutional and disciplinary specificities were thought to influence the proportions of students with mental health problems on different courses and at different establishments.

Firstly, some interviewees explained that their institutional reputation played a key role. For example, students with recognised mental health problems may feel more inclined to apply to an institution seen as inclusive, small or friendly, with a more community feel or situated in a peaceful location. However in contrast, the same

features of a campus may be potentially limiting the number of students with multiple, complex physical disabilities, for whom accommodation or teaching spaces may not be

accessible. Alternatively, the nature of certain courses, disciplines and modes of assessment was felt to coincide with higher proportions of students with declared mental health problems or other difficulties. Particular examples included music technology, computer games and modelling which had high numbers of students with autistic spectrum disorder, and psychology which had high proportions of students with mental health problems. It was therefore felt that an institutional offer with higher proportions of humanities or creative courses or with more coursework than exams may increase the proportion of students with a declared disability or mental health problem.

Furthermore, institutional initiatives to engage students were felt to have increased disclosure, such as the promotion of the benefits of earlier disclosure during the admissions process. Efforts were also made to promote student support services.

Examples included rebranding student support under the wider and more inclusive rubrics of wellbeing or student life, promotion at open days and university events and the relocation of the service into a more prominent location so as to increase footfall (and therefore demand).

5.3.5 Greater pressures on students

Lastly, interviewees discussed a wide range of intensified individual pressures exerted on students which were exacerbating mental health problems. Some of these coalesced around finance. Finding the money to continue into higher or postgraduate education was a struggle for some students, and increasing fees, although not necessarily

dissuading people from entering HE, may be inciting fresh anxieties once studying.

This additionally translated into increasing pressure to succeed, whether in terms of family expectations or finding employment post-study. Furthermore, pressure to succeed was said to be particularly exacerbated at some more selective institutions in recent times, particularly as students adjust to their transition or compare their attainment to fellow students. Such concerns were somewhat tempered for some interviewees who contended that recent cohorts were less prepared in terms of their resilience to make the transition into HE. Identity issues formed a further pressure point that was raised. Increased body and image awareness coupled with decreased social interaction, was felt to stem from the advent of social media. Finally, there was some discussion of the dangers of very accessible and unpredictable legal highs, as well as the impact of incidences following overconsumption of alcohol.