Around the world, the current pandemic is shifting the larger public discourse around improving access to public health resources, and rightly so. Within our immediate communities of family, friends, and neighbours, meanwhile, it has refocused our attention on vulnerable older people and those with physical illnesses who are most at risk. However, there is another kind of risk, less visible and in danger of being overlooked during a time of crisis – that of psychological vulnerability.
Even in the best of times it is estimated that one in four university students will be struggling with their mental health. Several high-profile student suicides in the UK have highlighted the need for universities to enhance the pastoral care and mental health support offered to students. A 2018 report by student mental health charity Student Minds identified a number of common concerns expressed by university staff, including overwhelmed student support services, waiting lists for students in difficulty, high referral thresholds, and faculty staff feeling unequipped to deal with the level of need they face. And this is pre-COVID-19.
In the midst of a global pandemic it is easy get distracted from problems we faced pre-crisis, but that doesn’t mean they’ve gone away simply because we’ve stopped paying attention them. In the case of mental health, unfortunately, it’s likely, at least in some cases, problems will get worse. For many students, the pandemic will represent a fundamental change in their learning environment, social lives, and living situations. For some, lockdown will mean Netflix parties and Zoom hangouts, but for others it deprives them of normal routines and social interactions and may lead to greater isolation.
All of this comes at a time when universities, like many other institutions, are undergoing tremendous upheaval, requiring rapid change to adapt to the new circumstances, making it even harder for faculty and staff to provide consistent and comprehensive pastoral care. The sudden move towards independent study and online learning is a major shift from the usual teacher-student relationship, adding to the challenge of identifying students in need and creating a distance that may discourage some from seeking help. When facing this still developing crisis, four issues immediately spring to mind:
- International students may be particularly at risk. The lockdown has forced these students to choose between remaining here in the UK or returning to their home countries with little to no advance warning. In either case, concerns for the wellbeing of their friends and loved ones overseas is being increased by distance and the insecurity of finding themselves caught up in a quickly developing global crisis. And unfortunately, we have also seen an increase in racist behaviour towards East Asians during COVID.
- People with depression are inclined to detach and isolate, and we frequently use ‘behavioural activation’ techniques to encourage daily routines, such as exercise, to motivate them to engage with self-care (looking inward) and socialise (directing their attention outward). This becomes much more difficult when people are alone or cannot do the things that would normally get them out of the house. This is unfortunately one of the reasons that online classes and, for those who are lucky enough to be able to work remotely, virtual meetings often prove a poor substitute for meeting face-to-face.
- Anxiety in a time of crisis is of course, only natural. We need to be careful however, not to let our anxiety become amplified by the 24-hour news cycle as well as the manifold ills of social media. For many of us (myself included) the experience of sharing worries with friends and colleagues is reassuring, but people suffering from anxiety disorders may be susceptible to contagious fear and selectively attend to information that confirms their worries, rather than soothes them. Isolation reduces our exposure to different sorts of information and means less opportunity to ‘reality check’ our perceptions and misconceptions.
- Finally, while online learning environments present a fantastic opportunity to embrace new technologies and offer continuity for many students, it’s possible that anyone already struggling academically will find remote study more of a challenge and academic support less accessible. We know that poor academic performance can be associated with mental health or social welfare issues, and it may be more difficult to tease this out remotely. Added to this, many students may feel uncomfortable discussing their mental health challenges with professionals who are officially affiliated with their universities.
For such students, it may be helpful to share some additional outside resources that are available:
- To help with every day challenges, my own institution, Maudsley Learning, has made some general mental health and wellbeing resources available here
- For more urgent concerns, many students may be unaware that Samaritans provide a phone-based service for anyone in crisis, available 24-hours a day, 7-days a week
- Shout provides a similar service as Samaritans via text, which some students may find preferable
- Mind is an excellent source of all things mental health
- Mindfulness apps such as Headspace are a great way to get into meditation and maintain regular practice
The scenarios I have presented here are partly based on published research and partly on my experience as a psychiatrist and educator working with university student support services. The truth is that, at this stage, we can only make educated guesses about the effects of this pandemic on the mental health of students, or anyone for that matter. Both as institutions and as professionals, we must strive to provide the highest quality of care, even in the most difficult of times.
Our capacity to create rapid and massive changes to our ways of working under extraordinary circumstances have been amply demonstrated over the last few months, but it’s important that we don’t become distracted by the novel and forget to tend to the challenges we have always faced. For universities, this means arming staff with the knowledge and skills to identify and respond to students in need and creating the infrastructure to provide care not only during the crisis as it unfolds, but also over the difficult months and years to follow as the magnitude of mental health impact becomes clearer.