In Oxford there is a population of around 32,000 students in Higher Education of whom approximately 75% are full-time. There are approximately 16,000 students in Further Education of whom slightly less than 20% are full-time. The part time students vary in the extent to which being a student is a major role in their life. Putting these figures together, we could be looking at around 40,000 students within the scope of the OSMHN project. In order to predict the needs of these students, much of the first year was spent gathering evidence from three main sources:
- research data from other studies.
- a survey of 38 practitioners
- 71 face to face interviews with a range of staff and students
Whilst the survey generated useful data on some of the local services for students with mental health problems, a low response rate makes it difficult to generalise about the situation throughout Oxford. This report looks at some of our key findings.
How many students are affected by mental or emotional health problems?
Evidence from other Studies
Recent research in the UK indicates that 30% is a conservative estimate and that 50% is a generous but not unsubstantiated figure for the annual incidence of measurable mental health or psychological problems within student populations. Between these figures, 40% seems to be a reasonable rate nationally (Oxford may or may not be typical). Most are suffering from anxiety or depression, or both. In the case of the most severe forms of mental illness, some studies indicate that students may experience twice the national rate for clinical depression (students 10%) and for psychotic illnesses (students 1-2%).
Data from OSMHN’s Interviews
Whilst only a few students in each setting were described as displaying behaviour indicative of a psychotic illness, respondents indicated that there were many students with anxiety and depression. There were quite a few whose level of alcohol usage was a concern and a lesser but significant number with eating disorders and self-harming behaviours. Many respondents expressed the opinion that the number of students with mental health problems was increasing and that the severity of their problems was also increasing. There was also widespread agreement that the levels of stress were very high in the student population.
How many seek help?
Evidence from other Studies
Oxford students (1998) 63% felt there was stigma in seeking professional help.
Cambridge (2000) 35% of students with serious problems did not seek help.
Data from OSMHN’s Interviews
There was a perception that many students don’t seek professional help, either at all, or at least not until things have got pretty serious. This seems to be due to the stigma of mental health problems, the fear of being seen as weak or a sense that others would not find their problems serious enough.
Where do they seek help?
Evidence from other Studies
Students’ support preferences were found to be heavily weighted towards the social sector (Cambridge, Leicester, Nottingham and Dublin):
| Friends | 65 | 78% |
| Family | 46 | 65% |
| Tutor | 30 | 54% |
| Counsellor | 4 | 8% |
| Doctor | 4 | 6% |
| Chaplain | 2 | 3% |
If we take the highest of these figures for approaching doctors (6%), and if Goldberg and Huxley (1992) are right about the number of times that a GP recognises a MH problem (44%), then in our Oxford population we might predict the following figures:
| General population | Student population | |
|---|---|---|
| Size | 40,000 | 40,000 |
| Incidence of MH problems | 10,400 – 12,600 | 16,000 |
| Attend primary care | 9,200 | 2,600 |
| Recognised by doctor | 4,060 | 1,144 |
We don’t have sufficient local data to confirm these projections within Oxford, but it suggests that large number of students have significant emotional or psychological problems which are not addressed at a medical level.
Evidence from OSMHN’s Survey
Our findings in Oxford indicate that 1,490 students (3.7% of our 40,000) are using counselling. So counselling is picking up 9.3% of the possible total of 16,000 distressed students. All GPs and most College nurses indicated that up to 25% of their student clients had mental or emotional health problems.
Data from OSMHN’s Interviews
Friends and tutors were high on the list of support sought. The other sources such as counsellors, GPs and college nurses came further down the list and in some cases were approached when the friends or tutors had had enough.
Do they get the support they need?
Data from OSMHN’s Interviews
There was widespread frustration over the students who need more than the brief therapy normally offered by the counselling services, but who don’t meet the criteria required for emergency admission. These students are either not getting a service at all or are facing a wait of anything up to a year for an outpatient’s appointment. The result is that some students remain in distress for much longer than necessary and in many cases other people such as fellow students, tutors, counsellors, college nurses and GPs, administrative and residential staff operating a holding operation for these students. A number end up leaving or taking a year out.
What problems are caused by being a student?
Data from OSMHN’s Interviews
The student experience of today is very different to that experienced in the 1960’s, 70’s or 80’s. Factors include: student debt, greater material expectations, greater pressure on academic institutions and staff, and expansion of student numbers.
What triggers or amplifies any previously existing problems?
Data from OSMHN’s Interviews
Issues of transition came up very strongly. Leaving one’s family and making a new start elsewhere is stressful in itself, but it may also be amplified by unresolved and unconscious issues from earlier on, causing the student to experience much greater distress than they were expecting Or they may find that the distress has not gone away at a time when many others seem to be settling in and enjoying their time in education.
Many students place a great value on social and familial support. This is massively disrupted and it may take some time to find adequate substitutes (if at all).
The developmental stage that many of the students are at was seen to be significant. For many it could be seen as a sort of provisional adulthood, where relationships are being tried out and issues of self-identity and sexuality are being explored. Mature students may experience being taken back to an earlier developmental stage.
Many students have a sense of never being able to be “good enough”.
What issues arise for the students themselves and for those they are in contact with?
Data from OSMHN’s Interviews
There is much concern about the students who:
- are clearly disturbed but do not seek help
- have needs which require medical intervention but are not at crisis intervention point and so face long waiting lists or no offer of support
- need longer term counselling
- are referred to counselling when they have serious MH problems which are not being addressed by medical services
- are sent away from the institution without academic or counselling support
- are discharged into the care of the academic institution.
Although this paints a rather negative picture there were many examples of good practice in relation to offering extra support to, and adjusting the study patterns of, students with mental health problems. These provide a foundation on which to build. The presentation of this research at OSMHN’s end of year 1 event, provoked a lot of useful suggestions on how to improve the situation for students with a wide rang of mental health problems. The remaining two years of the project will look at how to carry these forward.
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