Are universities encouraging students to believe hard study is bad for their mental health?

It is widely acknowledged that universities need to do more to support student mental health. Yet many academics and service staff are worried that well-intentioned initiatives pathologise ordinary anxieties and can do harm as well as good. Kathryn Ecclestone listens to their concerns

April 2, 2020
distorted reflection
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In September 2019, The Guardian headlined an article “‘The way universities are run is making us ill’: inside the student mental health crisis”.

We hear similar talk on all sides. Couched in the alarming vocabulary of “crisis” and “epidemic”, data presented at conferences, at staff training sessions and in the media create a sense of panic. Politicians have also embraced such claims. In September 2018, Sam Gyimah, then secretary of state for universities, science, research and innovation, wrote a letter to vice-chancellors stressing the importance of the issue and saying that “collectively, we must prioritise the wellbeing and mental health of our students – there is no negotiation on this”.

The government’s non-negotiable steer presaged high-profile research and development programmes. Working with the mental health charity Student Minds and led by King’s College London, SMaRteN is a national research network funded by UK Research and Innovation for the period 2018-22 to improve understanding of student mental health. In July 2019, the Office for Students (OfS) launched its own £14.5 million research programme. In December 2019, Student Minds issued the University Mental Health Charter. Backed by the government, the OfS and Universities UK, this calls for support services, accommodation, teaching and university bureaucracy to be geared towards students’ mental well-being and to “enable them to thrive”.

Such a goal may seem admirable and uncontentious. Yet behind the scenes many academics, administrators and support service managers are uneasy. Sparked by a workshop on curriculum, pedagogy and mental health that I ran with colleagues for SMaRteN in July 2019, as well as numerous comments I have heard over the past few years, I want to explore how talk about a student mental health crisis translates from policy injunctions into everyday institutional practices and why this has raised many concerns.

Many institutions are undertaking comprehensive development projects to promote well-being. The University of Cambridge, for example, is adopting a “public health approach” to all aspects of university life. As well as the perceived negative impact of course content, teaching and assessment, this includes tackling loneliness in halls of residence, and encouraging extracurricular activities and healthy relationships. According to Sara Weller, a member of the university’s council, this approach aims to “slow, and eventually reverse” the prevalence of mental health problems while building “a healthier culture and community where students have the personal psychological well-being to realise their fullest potential”.

Yet such initiatives are a response to intense political and institutional anxiety. This is generating what Alan Percy, head of counselling services at the University of Oxford and past chair of the Heads of University Counselling Services, sees as more “heat” than “light” in understanding what is happening and responding appropriately to a clearly defined problem. Alarming depictions of a “suicide epidemic” in universities, for example, are not supported by a report from the Office for National Statistics in 2018, which shows that the suicide rate among students is lower than for the same age group in the general population, and that it has more than halved since the early 1990s. Percy argues that the emotive, disproportionate picture painted by the media and campaigning groups fuels panic-driven reactions rather than considered responses.

It’s clearly vital that universities address a national spike in mental illness, reflected, as Hughes points out, in increased demand for support and the severity and complexity of problems. We are seeing more students admitted to hospital, engaging with crisis teams and being sectioned than in the past.

Yet a slippery terminology that elides “mental illness” with “issues”, “problems” and “difficulties” is rife, and this blurs the distinction between serious and everyday problems. Sir Simon Wessely, professor of psychological medicine at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, sees a danger that over-professionalising and/or medicalising routine difficulties means that “some of those now who tell me they have mental health disorders seem to be describing loneliness, exam stress or homesickness, which I as a psychiatrist would not classify as mental health disorders”.

One university registrar, who wished to remain anonymous, observed a strong “tendency to lump together all mental health issues as if they all have the same effect on students’ studies in a way that doesn’t happen with physical health”. In reality, he says, there’s a spectrum going all the way “from an enhanced sense of normal anxiety about assessment to very serious conditions at the other end of the scale”. Although it shows “a lack of proportion” not to take this into account, he thinks universities don’t have the expertise to do otherwise.  

Academics and support service staff also report that vague, often casual, references to mental health compound this lack of proportion. It is commonplace to hear students describe assignments, lectures, material or content not seen as relevant to assessment and even lecturers as “really bad for my mental health”. This is combined with talk of being “totally stressed out”, traumatised, “needing a safe space”, and experiencing something as triggering or psychologically harmful. Beth Guilding, an academic at Goldsmiths, University of London, thinks mental health and well-being are increasingly coming to “mean everything and nothing”.

Given that the notion of mental (ill)health has been diluted in this way, it is not surprising that lecturers find it difficult to decide whether problems require specialist support, calm reassurance or, as one GP in a university medical centre put it, “benign neglect”, in the expectation that the problem in question will resolve itself.

Uncertainty and what Brendan Bartram, reader in education at the University of Wolverhampton, sees as “a culture that encourages invocations of vulnerability” can lead some students to engage in “emotional bargaining” to press lecturers for concessions. He argues that institutional climates highly sensitive to maintaining and monitoring students’ well-being turn declarations of a lack of support into a source of power and currency.

Using mental health as a lever isn’t confined to students: one social science lecturer, who wished to remain anonymous, reports that “we sometimes actively encourage good students who we think deserve another chance (because, for example, failing an assignment will mean them failing a whole year) to make up mental health problems”. She cites examples both where this happens in advance, in case someone fails a module, and afterwards, so that they’re allowed to go through anyway. “They have to provide evidence, of course,” she admits, “but this never seems to be a problem.”

Some academics and support service staff criticise the pursuit of satisfaction ratings and fear of media scrutiny that make managers too often inclined to accommodate requests or complaints, regardless of whether they’re valid or not. Linda Murdoch, director of the careers service at the University of Glasgow, reports that all decisions about academic matters “must account for impact on student well-being”.

There is also widespread concern that students in real need are not getting access to proper services. Despite recent student demonstrations demanding more counselling and emotional support, criticism of inadequate provision is perhaps too simplistic. Counsellors report growing difficulty in offering support to those most in need because of the strain on services imposed by students' tendency nowadays to seek an adult expert, rather than friends or family, for “a chat” about everyday stresses.

Murdoch notices a parallel marked change in how students use careers advice. “Students are returning time and again for ‘checking’ or ‘reaffirming’ appointments. It seems they lack confidence to act on advice offered at the first appointment. Nowadays a significant minority book two to five appointments. Some request significantly more. One colleague said she felt she was just being used as a crutch.”

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Although there is widespread agreement that many students face a raft of life and educational adversities, and are often isolated and overwhelmed by challenges and existential doubts, Nicola Byrom, senior lecturer in psychology at King’s (and lead investigator for SMaRteN), observes that most aren’t looking for therapy or an expert but “a compassionate human who can help them make sense of things”. Yet opportunities for academics to relate to students authentically and compassionately, in ways that aren’t framed by mental health narratives, are under intense pressure from workloads, research targets, satisfaction ratings and the casualisation of academic work. Some universities require lecturers to take on 50 personal tutees. Others are making “mental health first aid” roles mandatory, often without releasing the people given such roles from other duties.

As China Mills, senior lecturer in public health at City, University of London, notes, senior managers rarely, if ever, address how structural factors undermine staff and student well-being but, “instead, they prioritise one-off ‘well-being events’” which are widely viewed as patronising and pointless.

Framing the need for support through the lens of mental health can have political repercussions. According to Lydia Lewis, a postdoctoral research fellow in the Faculty of Education, Health and Wellbeing at Wolverhampton, individualistic psychological understandings of problems that are actually rooted in socio-political relations “tempt students to shape their sense of self and self-label in ways that are unhelpful to them in the long run”. Crucially, this framing masks class, gender and race inequalities.

Psychological interpretations can also be used politically against particular groups. Mills reports cases where Muslim students fear (she thinks rightly) that staff in well-being services made to undertake mandatory Prevent training might interpret signs of distress or the accessing of support as indicators of potential radicalisation.

Perhaps the crucial issue, however, concerns the impact of the mental health narrative on education itself.

Broader interpretations of what count as mental health problems are generating large increases in the number of students granted “special arrangements” for assessment, including sitting exams on their own or being exempted from particular tasks. In Cambridge, for example, numbers have trebled in the past 10 years (and at Imperial College London, in the past five). There’s also an expansion of criteria for Learning Support Plans that enable “reasonable adjustments” to attendance, support, teaching and assessment.

According to King’s College London’s Byrom, incorporating such adjustments across the whole curriculum makes it more inclusive and empowering for everyone.

Yet some respondents doubt whether prioritising mental health is compatible with providing the kinds of challenge that good education should be about. Goldsmiths’ Guilding thinks that preoccupation with a psychologically vulnerable self changes the relationship between education and well-being. She doesn’t believe “in going back to the so-called ‘good old days’ of not talking about mental health” but thinks it now dominates an arena that should be about “growing minds and removing students from themselves to see the world differently, from infinite perspectives”.

In this vein, some counsellors and academics discern a creeping belief that there is some kind of polarisation between mental well-being and academic work. According to Oxford's Percy, “many students are presenting at counselling services saying they don’t know whether to prioritise taking care of their mental health or trying to do well academically and having to sacrifice their mental health. This comes from a very unhelpful, false narrative that the pursuit of academic achievement is, by definition, bad for your mental health.”

Other academics, such as Wolverhampton's Bartram, say that “engineering a profound change in how students see the role of universities, as institution[s] that should support their mental health” makes it harder to encourage students to overcome normal feelings of anxiety and realise that they can cope, do well and even enjoy being stretched beyond their comfort zone.

We also find academics striving to navigate a line between wanting to take students’ mental health seriously and accommodating the needs of individuals to a degree that over-protects them from reasonable expectations. Konstanze Spohrer, senior lecturer in education at Liverpool Hope University, worries that requests to avoid working with peers who students don’t know means that they don’t benefit from a wider range of perspectives or develop the ability to work with others.

Finally, claims that evidence should underpin mental health initiatives raise questions about their own evidence base. King’s College London’s Wessely observes, for example, that absence of scientific confirmation for the benefits of trigger warnings hasn’t hindered their widespread adoption. Similarly, official evaluations of psycho-emotional interventions in schools over the past 18 years show little evidence for any discernible short-term, let alone long-term, benefits. This hasn’t constrained a flourishing intervention industry and the prevalence of evaluations carried out by advocates committed to proving the benefits of a particular approach.

Other gaps in the evidence base are also significant. With universities now relying on commercial smartphone apps and frequent institutional surveys to incorporate well-being and mental health into their metrics, we don’t know whether constant probing and monitoring fosters hyper-sensitivity. There may be lessons here from behavioural programmes in primary and secondary school that sensitise participants to “uncomfortable feelings” and anxiety, and teach them “coping strategies”. Some heads of counselling and GPs in university medical services wonder whether such interventions, combined with a pervasive culture of risk-averse parenting, contribute to the pathologising of everyday difficulties and unpleasantness.

Disquiet about prioritising mental health in educational settings is rarely heard. There’s a tendency to dismiss reservations or criticism as elitist, out of date or insensitive to students’ problems. These charges did not apply to any of the respondents cited in this article.

While there is a good deal of unease off the record, there’s also apprehension about voicing it: some respondents worried that managers or media officers would regard publication of their views as “damaging” to institutional reputations. Others chose to be anonymous. In the face of high-profile enthusiasm for “mental health friendly” universities, caution needs to be replaced by much wider, more open, more nuanced debate than we have seen so far. 

Kathryn Ecclestone is a retired professor of education and co-author of The Dangerous Rise of Therapeutic Education, published in 2008 and reissued in 2018 as part of Routledge’s Classics in Education series. She is a member of SMaRteN’s leadership team, contributing to its work on curricula, pedagogy and mental health.

POSTSCRIPT:

Print headline: Keeping things in perspective

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Reader's comments (2)

Thank you for writing this! I totally agree with this - the lowering of the benchmark for what is a mental health issue has trivialised it to the extent that all regular run-of-the-mill daily stress are now regarded as 'traumatic'. Students are now 'traumatised' when answering questions about their academic stress(!). They are also stressed by academic deadlines and assignments(!). How are these clinically significant sources of stress?? GPs , healthcare services, and other student support services are now being abused by more and more students to obtain medical/health notes so that they can use it as evidence for their 'stress' to get exemptions and extensions for their academic work. Academics, pressured by policies such as the NSS, are now being asked to dumb down their academic programmes to make it less 'stressful'. A module that has three assessments (one mini multiple choice quiz, one midterm essay, and one final exam) is now asked to reduce the number of assessments so that it is more 'manageable' and less 'stressful' for students(!). Because, I am told, students have to take three module in one semester and if every module did the same, each student would had 9 assessments over a period of 3-4 months for a full time academic programme - oh, that is so much stress! Imagine having to do 2-3 assessments per month for a full time student! Even in the current covid-19 scenario, students who are not personally affected by it nor have any loved ones seriously affected by it, are considered 'stressed' by the situation to significantly require exceptions and extensions for their academic work. Hell, they get exceptions and extensions in the usual circumstances without covid-19. Current estimates of the fatality rate for covid-19 suggests at around the same rate for the common flu (~1%) - I don't see students being stressed by the death rates for the flu every winter? As your article points out, aren't we encouraging opportunistic behaviours among students?
Thank you for the article, which I read with interest. I do not hold a position within student well-being services but am an academic as well as a mindfulness teacher, and have collaborated with well-being services to some extent. I do not have a great deal of insight into how the services operate but I do know that such services across HE are often overwhelmed and that there is a waiting list for the likes of counselling etc. I also know that the issue discussed cuts across all stages of learning in HE up to PHD study, which has formed part of my recent research. There are a few issues here that I would like to highlight. Firstly, that the phrases, 'mental health' and 'mental ill-health' are perhaps to some extent problematic in themselves with regards what it means to be well, to struggle, and to achieve. Secondly, that support of student well-being is closely connected to staff well-being, or staff attitudes toward their own well-being. Thirdly, that the support of students is perhaps everyone's responsibility not just well-being services. That being said, I am highly supportive of the provision that is in place and believe that many issues are genuine for the majority of students. We should do all we can to help. In putting forward my responser, I will draw on my own expertises in mindfulness, which may offer a fresh perspective. The use of language and discourse around mental health may in some ways be contributing to the problems explored in the article. The phrasing, 'mental health' and 'mental ill-health' and the sub-categorisation of conditions that come with this, have perhaps not only become over-used and lost some of their meaning (at least from a student perspective), but may also mask a misconception about what it means to embody a sense of well-being, to flourish, to struggle, as well as to achieve. Such language may also provide a barrier to those who would like to declare how they are feeling, but prefer not to be labelled. The appropriation of labels that denote specific conditions may perhaps form an aspect of a student's schema about their own identity, mental states and general health and these may be used or abused. However, we must be cautious in making any claims either way, as it is very difficult to truly understand someone else's subjective experience. This is not to say that specialists in the field of well-being are mis-using categorisation of certain conditions; these are obviously extremely helpful in identifying real issues and targeting appropriate support. In the field of mindfulness, the atomistic categorisation of conditions is rarely used, at least in my experience of it. Yes, there are mental health experts who link mindfulness to such discourse, but generally, mindfulness provides a largely different perspective on what it means to be healthy in mind and body. To begin with, what we deem as mental ill-health is seen as a natural response to life and therefore not necessarily pathological in nature. For example, a perceived depressed state, may be due to a lack of connection with others and one's own essential nature; a resistance to change, and/or a lack of acceptance of the reality of one's experience. With the practice of mindfulness meditation we learn to observe the thoughts and feelings that are associated with this response to life with kindness and non-judgement; that is, we create a space for them, allow them to be there, rather that reject or block them out as if they should not be there. What is deemed as well-being and flourishing is just a re-balancing, a re-connection, and an acceptance of our experience, with an understanding that our experience changes from moment-to-moment and that our suffering will pass if we let it. Furthermore, a sense of flourishing does not necessarily mean we are constantly happy. We may simultaneously feel the pain and suffering in its full spectrum, but with an understanding that it is ok to feel that way - we embrace it all, and in doing so, reduce or eliminate potential for on-going suffering, as well as maintain a state of contentment. If we could teach our students to accept the ebb and flow of perceived difficult mental and physical states as a natural response and impermanent in nature, as well as an aspect rather than the whole of themelves, we may help them to understand that all of this is part of the learning journey. However, doing this with a helping hand and appropriate guidance would remain an essential part of this. Regarding my second point about the connection between student and staff well-being, I would suggest that staff attitudes toward their own well-being may form part of a hidden curriculum that may impact on how students see themselves, their well-being, and their future prospects. From my experience of teaching mindfulness, many people struggle to identify when their own well-being is being compromised. As such, they are conditioned to regularly transcend their own limitations and boundaries which can result in fatigue or exhaustion. They also struggle with being kind toward themselves, and may be rather self-critical. This may for example, manifest in academics working for too long, taking insufficient breaks, not giving sufficient time to social activity, cynicism about their roles, doubt about their abilities (e.g. imposter syndrome), or responding to emails at 1am, etc. This can form part of the hidden curriculum which refers to what is implicitly being learned by students (and perhaps other staff), such as the transmission of attitudes, values, etc. As such, we may be in danger of projecting that this is how life should be lived, at least in the academic field; for example, that the journey of getting where you want to be is inherently a struggle rather than a challenge and a joy; that when you get there you will need to compromise your life/work balance as well as your health, and that it doesn't necessarily get any easier even if you do succeed. This is not to generalise as such, but to highlight that we may all fall into such mentalities from time-to-time, especially when the pressure is on. Raised awareness of these potential components of the hidden curriculum may aid us in greater care for ourselves and a renewed appreciation of our privileged role in what is a great sector to work in. This may, in turn, highlight to students the equal privilege and joy of being a learner. Mindfulness meditation can certainly help us to be much more aware of when we fall into such thought patterns. Finally, in my experience as an academic, I see that I can play a role in providing optional services such as regular mindfulness drop-in sessions and courses that support the well-being of students but also of staff. With the right guidance and support, such practices can be embedded into the culture of the Academy, and offer additional well-being support. Thus, not only potentially easing the burden on formal well-being support services in the long-term, but normalising a culture of pro-actively looking after oneself and each other. Such preventative measures may come in a range of formats, not just mindfulness, but essentially demonstrate that together, we can provide a holistic culture of support for well-being across HE. Not all staff have such targeted expertise, but they do often have supporting roles, and can contribute whenever and wherever to a more enhanced culture of well-being.

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