1. The Student Psychological Health Project: Research Findings from the University of Leicester Annie Grant Director, Educational Development and Support Centre © Annie Grant/University of Leicester 2002 Educational Development and Support Centre

2. Supporting Students with Mental Health Difficulties: Project Aims To identify the extent of mental health difficulties in the student population and the major causes of stress. To develop and improve provision for students with psychological or mental health difficulties. To increase the awareness, knowledge and skills of the whole university community. To produce training programmes, and information and support materials.

3. The context: the increasing concern being expressed about the possible increasing incidence of mental health difficulties amongst the student population The scope: the whole institution and not just those who were service users The focus: the learning/ HE environment, not the condition The funding: HEFCE grant to improve provision for students with disabilities

4. Evidence base: student survey Extensive biodata Wide ranging questions on stress factors (cf Columbia University) Drug and alcohol use Eating disorders Brief Symptom Inventory (BSI) Questions on help-seeking behaviour

5. Research methods Focus on second year undergraduates Survey administered in lectures with academic staff collaboration Spring of 1998 and 2001 2700 respondents, c. 80% response rate Focus groups Postal survey of full-time research students in 2001 (30% response rate, N = 118) Staff survey (all categories)

6. Student responses: issues having a significant impact on stress levels Adjustment (40 – 60%) –University life, housing, finance Academic and career concerns (51-66%) –Study skills, concentration, preparing for a job Personal development (30 – 50 %) –Self esteem, assertiveness, loneliness, friendship Psychological Health (23 – 40%) –Anxiety, depression

7. Group differences Higher levels of stress reported by: –International students –Students from ethnic minorities on almost every issue

8. Group differences: gender Higher levels of stress reported by women in respect of: –Getting used to university –Managing coursework –Exams, speaking in groups –Competition –Meeting and clarifying goals –Career preparation and finding a job –Sexual health practices –Weight control –Self-esteem and being assertive when necessary –Allowing themselves to have fun –Coping with loneliness –Managing anxiety and coping with sadness –Trusting friends and relating to friends –Needing parental approval

9. Group differences: gender Higher levels of stress reported by men in respect of: –Drug and alcohol use, smoking –Gambling –Excessive computer use –Sexually transmitted disease –Illness –Concerns about their religious belief –Coping with racism –Peer pressure –Finding love –Lack of sexual experience and sexual inadequacy –Sexual orientation

10. Group differences: age 22-25 year old students report higher levels of stress in respect of: –study skills –concentration –managing coursework –clarifying goals –coping with loneliness –trusting friends –parental approval –anxiety –suicidal thoughts

11. Group differences: age Students over 25 report higher levels of stress in respect of: –finance –anxieties about chronic illness –managing coursework –handling competition –managing time

12. Preoccupation with suicidal thoughts 11.5% of all undergraduate students reported this as very or crucially concerning (cf 8% postgraduates) Highest levels of stress reported by: –* those from families with no HE background (15% cf 9%; p = 0.015) – * male students (15% cf 11%; p = 0.011) –* 22-25 year olds (23% cf 13% (18-21) and 14% (25+) –Students from ethnic minorities (25% cf 12%) *Differences remain when controlled for ethnicity but at slightly lower levels of significance

13. Preoccupation with suicidal thoughts / 2 Amongst students from ethnic minorities, those with high levels of concern more likely to be working Significant correlation with high BSI scores for all students Much more likely to self-harm and binge eat More likely to have missed lectures through personal, financial or psychological problems (but not because they were physically ill or through alcohol or drug use)

14. BSI Global Severity Scores >2 2.4% of all students Higher percentages of female students: 2.9% cf 1.9% Higher percentages of students aged 22-25: 6.3% cf 1.9% (18-21) and 1.5% (26+) More likely to consult the Counselling Service (10.1% cf 2.1%) Less likely to be heavy drinkers

15. BSI sub-scale > 2 2 nd year UGs %Research students % Depression1310.5 Somatisation3.251 Hostility8.51 Social Comfort11.55.5 Obsessive- Compulsive 1312.5 Phobic Anxiety2.751

16. Alcohol Consumption 25% of male students drink over 30 units per week Female students drink less, but a higher proportion may be drinking at harmful levels Weekly binge drinking common (50% males and 25% females) 52% of students from ethnic minorities dont drink (cf 7% white students) Those who dont drink report the highest levels of stress in respect of peer pressure

17. Help-seeking behaviour Friends and family (65%) Personal tutors (54%) Other academic staff (35%) Careers Service (23%) Departmental secretaries (20%) Counselling Service (7%) Welfare Service (11%) Porters/cleaners etc. (3%)

18. ServiceAll studentsCrucially concerned by suicidal thoughts p Counselling720<0.001 Health Centre4135N/s Welfare Service11150.003 Nightline120.001 Personal Tutor56610.048 Friends and family6670N/s Percentages of students using services

19. Responses: development of study skills Wide range of leaflets on aspects of study freely available Workshops in departments and centrally Drop-in consultations, including Maths Help Revision workshops Students doing resits sent information on support available Specialised study support for students with disabilities and specific learning difficulties Stress on development and not remedial support

20. Responses: stress and psychological health difficulties Improved diagnosis, response and referral –Helping students in Difficulties – guide for all staff –Making Connections – sources of guidance given to all staff and students –targeted staff training sessions –guidance for Careers Advisers Student leaflets on exam stress, homesickness, depression and other concerns Information for peers and friends Mental health awareness campaigns

21. Responses: institutional Review of examination procedures Guidelines for invigilators Closer relationships between student services and admissions Strengthening of relationships with departments Mental health policy group

22. Future development: wish list Improvement of first year orientation programmes More contact hours in the first year Increased focus on formative assessment, especially in the first year Rethinking modular structure Radical approach to the development of the curriculum Further improvement of partnerships between departments and central services Strengthening and developing counselling and mental health provision Rewards for teaching and not just research A more diverse staff body

23. Conclusions Whole institutional approach essential –Integrated student services –Partnerships between departments and centre –Training for all categories of staff Holistic approach to student support beneficial –Resources developed across traditional boundaries –Focus on context not conditions –one size does not fit all Need for a rethinking of the academic curriculum and the assessment load

24. Challenges and future development Expansion of research base required What is cause and what is effect? Better integration of widening participation, learning and teaching, and student support strategies

25. Project team Paula Brady, Project Officer Matthew Davies, Project Statistician Annie Grant, Project Director Carol Whitehouse, Project Administrator Consultants: Nisha Dogra, Senior Lecturer in Child and Adolescent Psychiatry David Stretch, Lecturer in Mathematical Psychology Catriona Walker, Head of Counselling Service

26. References Derogatis, L. (1993) BSI Brief Symptom Inventory. Administration, Scoring and Procedures Manual (3 rd Edition). Mineapolis: National Computer Systems. Grant, A. (2000) Helping Students in Difficulties: a Guide for Personal Tutors and Other Staff. Leicester: University of Leicester. Grant, A. (2002): Identifying and responding to students concerns: a whole institutional approach. In N. Stanley and J. Manthorpe (eds) Students Mental Health Needs: Problems and Responses. London: Jessica King Publishers, 83-105. Hayes, J.A. (1997) What does the Brief Symptom Inventory measure in college and university counselling centre clients? Journal of Counselling Psychology 44, 1, 360-367. Student Psychological Health Project website: http://www.le.ac.uk/edsc/sphp/ http://www.le.ac.uk/edsc/sphp/