Published: 03 November 2021
Improving our understanding of how universities can better promote wellbeing and support students is both a research and intervention priority, argues Professor Ed Watkins, Director of the University of Exeter Sir Henry Wellcome Centre for Mood Disorders Research and Professor of Experimental and Applied Clinical Psychology.
University as a key window of opportunity
Because half of mental health problems start by age 15 and three-quarters start by age 24 and continue to cause young people distress, impaired functioning, and reduced productivity throughout their lives, we need to prioritise early interventions to prevent and improve poor mental health and its consequences in this age group.
This priority has become even more acute during the COVID-19 pandemic, with increasing rates of anxiety and depression generally and - the greatest rises amongst 14-24 year-olds. To promote better mental health, we need a portfolio of approaches across childhood and young people.
Promoting mental health and wellbeing at university is a key plank in such a portfolio. Over 50% of young people in the UK now go into higher education, so university-based interventions can reach many young people.
Moreover, the move to university is a high-risk period for the onset of poor mental health because it coincides with a critical developmental period for the brain and with major exposure to stressors such as leaving home, academic pressures, gaining independence, developing new friendships, and managing finances. Good mental health is central to flourishing and making the most of university and its opportunities.
Numerous surveys in the UK and internationally indicate that approximately a third of university students experience serious emotional and mental health difficulties, including anxiety and depression, but only 20-30% access treatment. And universities report a substantial increase in student demand for university-based mental health and wellbeing services, beyond the current capacity of these services. We therefore need to find better and more efficient ways to reach and help students.
Gaps in knowledge
Several important reports have examined the current delivery of student mental health services (examples include Duffy et al., 2019; a Universities UK report; and the Student Minds University Mental Health Charter). They all indicate key gaps in our knowledge:
- Models of service delivery vary between institutions, and none have been systematically evaluated in a rigorous way.
- Much of the research in university mental health has been limited to one or two universities and has been relatively small-scale.
- There are questions about the effectiveness of interventions, especially for wellbeing promotion and prevention of poor mental health.
- We need to better address barriers to receiving help due to structural, personal, and cultural inequalities.
- Related to the last point, we need to better understand what approaches work best for whom, across the rich diversity of the student population.
To address these gaps, a multidisciplinary team from six different universities - Exeter, Oxford, Cardiff, Newcastle, Southampton, King’s College London - building on existing networks within the NIHR Mental Health Translational Research Collaboration, is taking forward a £3.7 Million grant from UKRI Adolescence, Developing Minds and Mental Health scheme to develop and evaluate better service and wellbeing promotion models in universities.
We need an integrated whole university approach
Central to our approach is our belief that organising the delivery of care to students on a stepped care model will improve student mental health, although this needs to be formally tested, which is a major goal for our project.
A stepped care model is a system of delivering and monitoring interventions, so that the most effective, yet least resource intensive intervention is delivered first, and interventions are targeted to individuals based on their need. In the university context, this includes wellbeing promotion applied to all students, more targeted prevention interventions for more at-risk students, self-help interventions for students with milder difficulties, and improved pathways to counselling and therapy for students with more severe difficulties.
I also strongly believe in the idea of a whole university approach, wherein all aspects of the university including culture, curriculum, assessment, and formal services contribute to improved wellbeing, and where universities need to be responsible for promoting good mental health and flourishing in students. For example, we will explore how to make universities kinder, more supportive, and inclusive environments and see if this improves wellbeing for students.
Ultimately, we hope the lessons from this project will improve student mental health and help universities to take a lead in developing effective systems to promote wellbeing and life-long flourishing.
Professor Edward Watkins is the Director of the Mood Disorders Centre, University of Exeter and Professor of Experimental and Applied Clinical Psychology. He is the Chief Investigator of the UKRI funded “Developing and evaluating a stepped change whole-university approach for student wellbeing and mental health” project.