Degrees of difficulty: Growing numbers of students seek help for stress and anxiety
WHEN the class of 2017 arrive on campuses countrywide over the next weeks, they’ll face one of the biggest transitions of their lives. Instead of tightly-scheduled secondary school timetables and teachers demanding homework, they’ll find themselves in large, often anonymous, classes where lecturers don’t check attendance and nobody seems bothered whether they’re doing the work.
As they try to make friends and find their way around huge and often confusing campuses, many will be grappling with one of the biggest stressess life can throw at anyone: Moving house — living away from home for the first time and trying to find their feet with new flatmates. Small wonder some feel overwhelmed.
Starting college can be a wonderful, exciting experience, but it can also bring unique challenges, says Union of Students in Ireland (USI) president Michael Kerrigan. “Many students enjoy the intellectual challenge of study, opting for courses and subjects that match their interests. However, adapting to academic study and understanding what’s expected of you can be intimidating.”
Marian Browne, University College Cork’s acting head of student counselling and development, says these new college students are at a key developmental stage, moving from adolescence to young adulthood. “They’re negotiating the biggest change cycle in life. In adolescence, you’re negating everything, knocking everything. Whereas the young adult’s in a more creative phase — creating their own identity, life and future. They’re trying to find their path, asking ‘What’s my life going to be about?’ These are huge existential questions.”
For the first time, these young people are expected to be authority figures in their own lives. Referring to research, Browne says socially they worry about making friends, about how other students will perceive them, whether they’ll get on with their flatmates, how can they make space for new and old friends. “Some run for shelter and only meet the friends they knew at school. They don’t mingle [with college peers].”
They also have to manage their own boundaries. “They have to be authority figures for themselves — they find it very hard to manage. There’s no parent to say ‘hang on, you can’t go out tonight’, so if they’re not into drink or drugs there’s no one to hide behind.”
In August, USI released data showing 74% of students fear experiencing negative mental health in the future. And with almost 75% of all mental disorders emerging between ages 15 and 25, you can understand the fear.
“Even if you’re predisposed to a mental health difficulty but you’re in a familiar, positive place, you may well be fine,” says Browne. “However, in stressful and demanding situations, vulnerabilities can emerge.”
She says first years arriving at third level reflect the population as a whole — there will be “lots of very complex issues coming in”.
In this cohort, there may be students who’ve already been hospitalised for anything from depression to psychosis.
At the University of Limerick, clinical psychologist and head of counselling Dr Declan Aherne confirms 1,100 students used the service last year, representing 8%-10% of the on-campus population. “Eight years ago, it would have been 500. Numbers have more than doubled in the last eight years, yet numbers attending university haven’t doubled.”
UL pioneered the stepped care programme used by many colleges. Step one is psycho-education classes — for example, students are taught about stress-management. “We run 10 classes a week, at 1pm and 4pm daily during the academic year — any student can come.”
Step two is short-term: Six sessions of counselling. Step three is long-term counselling, up to 30 sessions a year, while step four is external referral to psychiatry/medical/specialist services, such as an eating disorder clinic.
With 23 people on the team (including two clinical psychologists on the core staff, senior professional counsellors, assistant psychologists and trainee psychotherapists), UL offers about 100 hours of counselling weekly.
“It’s very busy. Slots fill up quickly. Our door’s open everyday from 11am-12 and from 3pm-4pm. Clinics are full from day one. They come in with low mood — very common — anxiety, and stress,” says Aherne, who knows the service will get 60-70 students every week once term starts. “At the six-week point, we’ll start having a waiting list.”
Across third-level colleges, 15,000 young people attend counselling services annually. “All colleges have seen huge increases in the last 10 years. It tells us young people are ripe and ready and willing to talk about their problems,” says Aherne.
The major presenting issue is anxiety, at about 48%, says psychotherapist and chairperson of Psychological Counsellors in Higher Education Ireland (PCHEI) John Phillips. “Many students come in reporting panic attacks on a daily or weekly basis.”
Aside from the disorientation of suddenly having “all this personal autonomy”, where before they were
always “answerable to somebody”, Phillips says uncertainty feeds student anxiety.
“It’s not uncommon to find them presenting with personal development and sexual identity issues. But there also seems to be more uncertainty around — when it comes to future career, there’s less permanency, more requirement to move around, and significant competition for posts. Students may worry ‘have I chosen the right degree?’” And they’re meeting increased educational demands.
“A master’s degree is the new norm — before, an ordinary degree would get you into a company.”
For stressed students, 21st-century digital communication tools bring mixed blessings. Reachout.com, a PCHEI partner, can have a really positive impact on youth mental health, says Phillips. ReachOut.com is an internet service for young people that provides information, support and resources about mental health issues and enables them to develop resilience, increase coping skills and facilitate help-seeking behaviour.
And UCC, for example, has cognitive behavioural programmes on its website, www.ucc.ie/en/studentcounselling, covering anxiety, worry, coping with depression, improving self-esteem, procrastination, shyness, social anxiety, and assertiveness.
But social media has a flip side, says Browne. “A student might see a group of friends who’ve been out and s/he wasn’t invited. Or they might be keeping track of someone they’ve broken up with and see they’ve been out with someone else.”
Phillips says today’s technology means “events can’t happen and that’s the end of it” — there’s a record. “It’s held there. That can potentially increase anxiety.”
Students also risk isolating themselves on social media, spending overlong on their devices. “One of the few times students sit face-to-face with someone without an electronic device is when they’re in counselling.”
But they may have to wait for counselling. USI’s Michael Kerrigan says four- to six-week waiting lists exist in many colleges.
“Third-level colleges are completely autonomous — they decide on their own funding. Because of general cutbacks there have been cuts to mental health services.”
International best practice indicates counselling staff to student ratio should be one counsellor to 1,500 students. According to PCHEI, here it can vary from one to 2,000 or even 3,000 students — sometimes there’s just one counsellor to 3,500 students. USI is asking the Government to ringfence €3m a year for student counselling/supports to tackle mental health on campus. Such funding would make a real difference — 2014-15 PCHEI figures show 27% of students who used counselling services said it was a factor in their staying on at college.
AHEAD, the Association for Higher Education Access and Disability, works to promote full access to further/higher education for students with disabilities, including mental illness. For those with existing mental conditions, moving to third level can overwhelm them, says executive director Ann Heelan. “It can really sink them if they don’t talk to somebody.”
AHEAD’s 2016 report, Mental Health Matters — Mapping Best Practices in Higher Education, aimed to give a voice to students with mental health difficulties. “These students may need more individualised supports to identify the barriers and to achieve their potential,” says Heelan.
Some students interviewed for the report found giving oral presentations very challenging, for example. One first year described being a ‘nervous wreck’. “Getting up there — having to stand and being put on the spot, and what stops you is yourself, low self-esteem, feeling you haven’t got enough knowledge to know what you’re talking about.”
Heelan says when academic staff are open to new methods — students giving one-on-one presentations or recording themselves at home — it makes a real difference.
USI launched its National Student Mental Health Campaign in July. The project sees USI working with key stakeholders in mental health countrywide to jointly break stigmas, promote services, and train student leaders. “It’s started already,” says Kerrigan, who confirms 60 ‘student leaders’ from student unions all over Ireland have done one-day mental health first aid training, while 30 have done two-day applied suicide intervention skills training. “We plan to train college staff as well.”
USI has also got funding to hire a staff member to conduct research on students and mental health, while also running the national third level mental health campaign — ‘Chats for Change’, which will be launched in November.
“We want to ensure we bring forward evidence-based calls to action to alleviate mental health issues students are facing at third level,” explains Kerrigan.
The 2015 Reaching Out in College study found students overwhelmingly agreeing (87%) that ‘it’s reassuring knowing there’s a free college counselling service’. But one in four would prefer self-reliance (42%) or support from informal sources of help (40%) rather than accessing student counselling.
Colleges have been progressive in putting innovative, non-counselling-based stress-busting programmes in place. For example, UCC has Identifying & Responding to Distressed & At-Risk Students, a student mental health and suicide prevention programme. It trains frontline third-level staff to identify and provide informal support to students — and, where necessary, to link them to more formal supports. UCC also has Shelf Help, a library of self-help books covering a wide range of issues that affect students (http://libguides.ucc.ie/bibliotherapy).
University City Dublin’s Mind, Body, and Soul event is held around high-pressure exam time. “It aims to promote overall sense of well-being for students — showing them how to look after themselves mentally, physically and intellectually,” says Eoghan Mac Domhnaill, UCD Student Union welfare officer. Among the many events are ‘throw stuff’ with the Juggling Society and ‘Make Friends — Adult Ball Pit’.
Puppy cuddling is also a very popular event. “Puppies come in for two to three hours. Ten to 15 students at a time are thrown into a roomful of puppies — you’ve never seen a queue like it,” says Mac Domhnaill. The Tea Tent, he says, is like walking into a Middle Eastern palace, filled with rugs and cushions sourced from the Middle East.
“Last year, one veterinary
student arrived into the tent incredibly stressed. We gave her tea and a [mindfulness] colouring book and she ended up staying for four hours.”
But on the counselling front, UL’s Declan Aherne says third-level colleges represent the only community with an “embedded” counselling service, which is a good thing. “It’s primary mental health care and it doesn’t exist for the general public – they have to go first to their GP.”
But Aherne says more counsellors are needed on campus to allow students get the help they need as soon as possible. “We don’t want waiting lists. The academic year is short. If students don’t get to see you early, soon enough they’re facing [even more pressure with] exams.”
Visit ie.reachout.com/getting-help-2/minding-your-mental-health
