Why student mental health is not (just) universities’ problem

Mental health is becoming more visible. It seems that finally mental health is a degree less stigmatised in society, allowing the previously taboo to be discussed. In the education world, this discussion has been particularly prominent within the higher education sector. 

We are often painted the picture of university students carefree and having the time of their lives: socialising, drinking, dancing, playing sport and attending the odd lecture as long as it’s not at 9am. In reality, there is a significant proportion of the student body for whom – even if they portray this image – it is not the case. HESA figures released last week revealed that 1,180 students left their courses early in 2014-2015 due to mental ill-health. This is reported as a 210 percent increase since 2009-10. Part of this increase could be due to better data collection or a greater tendency for students to report mental health problems now than before, but it remains a shocking figure. 

Contrary to much of the media around this issue, I think many universities do a pretty good job. I struggled to find statistics on the proportion of universities with a counselling service, but I also struggled to find a university that didn’t have one. Providing such a service is the skeleton of student welfare these days, and most universities go far beyond: pastoral tutors, mental health awareness weeks, student societies, campaigns, a dedicated SU mental health officer, workshops for exam stress, anxiety and depression. I am not excusing universities for times they should have done more, but many do a good job, particularly when we’re talking about dealing with adults. Students over the age of 18 can’t be forced to seek mental health advice, all universities can do is provide the offer. 

I think we need to do much more, much earlier. We need to educate young people in mental health, right from the start. 

For most young people, going to university is the first test of living away from home, dictating their own schedule, juggling finances and coping with day-to-day life without family around for support. At a psychological level, it is a unique environment full of unpredictable and novel experiences for all. Students need to be prepared for this. By the time they finish secondary school, young people should be equipped with a toolbox of strategies for dealing with the wider world. For some it will be simple and they’ll rarely have to use them. For others, they will draw on these strategies time and time again. So what should this look like? What should a curriculum of mental health involve? 

There are lots of different influences on mental health and wellbeing. To save a run through of all the psychological literature, I’m going to focus on two which have the greatest impact on wellbeing: social relationships and metacognition. 

Social Relationships

“Of all factors that influence happiness, relatedness is at or very near the top of the list...Loneliness is consistently negatively related to positive affect and life satisfaction.”

The above quote comes from Ryan and Deci (eminent psychologists in the wellbeing field) in their 2001 appraisal of the wellbeing literature. While the research has moved on, the basic tenet has not changed, and there is a wealth of literature evidencing the importance of strong social relationships for wellbeing.

Some children seem to need barely any education in making friendships at all, being social butterflies from an early age. For others it is evident from reception that social relationships will require rather more work. However, it is a vital skill for all. Even those social butterflies may come unstuck in a new location, feeling down and with none of their childhood friends or family around. What came easily in school may not always do so in the real world. 

Therefore we should encourage all children to take part in social activities from a young age whether this is through school sports, Duke of Edinburgh awards, volunteering or language clubs. By becoming involved in social clubs and societies, children not only learn how to work collaboratively with new individuals and build friendships, they also learn skills which will stay with them for life. Upon finding themselves needing to build a new friendship group later in life, picking up an old activity is a lot easier (psychologically and practically) than starting something completely new. 

Children need hobbies and interests outside of the national curriculum (after all, few relationships spring up over differential equations or subjunctive clauses) and teachers need to reinforce the importance of these. In practice this means: ensuring a school has ample opportunities on offer to appeal to a whole range of personalities; actively encouraging children’s participation; showing it is valued by taking the time to discuss and talk about what they have learnt and achieved; fostering a culture of proactive relationship-building where young people are encouraged (and sometimes forced) to work outside of their peer group. None of this is rocket-science and many schools do this already, but some could do more – particularly on the last point. 

Metacognition

Metacognition refers to the ability to think about and regulate your own thoughts; the ability to recognise you feel a negative emotion and stop that from escalating for example. There is rather less literature relating meta-cognition to well-being, but the association is still there. For example, a recent study showed that in a sample of 7-9 year olds, improvements in metacognitive abilities were related to improvements in wellbeing over the course of a mindfulness intervention[1]. The association also exists at the extreme end of the spectrum: poor metacognitive skills are related to severe mental health disorders in adults. 

Part of this association is because people with strong meta-cognitive skills are more likely to identify when they could make improvements to their mental health and act on it. A young person who is feeling sad and has strong metacognitive skills feeling sad would be competent in: a) recognising their emotions and b) rationalising that this feeling will pass and there are things they can do to make it better. A young person with strong metacognitive skills would likely select an activity they know to improve their wellbeing (e.g. seeking out the aforementioned social relationships) in order to make themselves feel better. On the contrary, a young person with poor metacognitive skills may not even recognise that they feel abnormal, but simply become accustomed to their new mental state. We should teach young people metacognitive skills so that they can identify, manage and take action to address their thoughts and emotions throughout their life. 

What does developing metacognitive skills look like in practice? There are a number of programmes targeted at improving metacognitive skills: mindfulness programmes and Philosophy 4 Children for example. Though these take time out of the school day, the benefits can be great – an independent evaluation of P4C has been shown it to have positive impacts on KS2 performance, speaking and listening skills, and self-esteem. There is also evidence linking metacognitive skills to long-term academic attainment.  

However, metacognitive skills can also be incorporated into the school day in other ways, for example through behaviour management.  Resolving conflicts in primary school is a valuable opportunity to teach metacognitive skills. Encouraging both parties to reflect on how they felt, why they said what they said or did what they did is facilitating metacognitive thinking. Asking the question “How did you feel when you hit each other?” encourages children to reflect on how their emotions relate to their behaviour. Providing alternative strategies such as “when you feel angry, turn around and walk away” is the next step in encouraging them to monitor their own mental states and manage them. In this way, teaching metacognitive skills does not need to be time consuming. It may just be a question of adapting existing interactions to encourage children to observe and regulate their own thoughts.

Social relationships and metacognition are two factors that have notable influence on wellbeing and can be incorporated in to primary and secondary school life. I will rarely call on teachers to do more, but I think it is relatively easy to build both of these into the school day, helping to promote young people’s mental health in the short-term and over a lifetime. As initially stated, I don’t want to imply that universities have no responsibility for student mental health - they do. But one role of school is to prepare young people for their next life transition. When such high proportions of university students are struggling with mental health, I think that part of the responsibility falls to schools to ensure that young people are prepared for this transition. In other words, student mental health is not just universities’ problem.   

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[1] Yes, it is plausible that the reverse direction of causation is also happening – wellbeing can influence meta-cognition. But there are also studies suggesting a predictive relationship of meta-cognition on wellbeing.