Alice was in her second year of university when she attempted suicide.
She's struggled with anxiety and low mood for most of her life, and was finally diagnosed when she started a course in history at the University of Warwick. With her mental health “severely declining” not long after enrolment, Alice got in touch with the campus doctor. But after a hopeful start that included referrals to counselling services and IAPT, the NHS service designed to give people better access to psychological therapies, she soon realised that help was not on its way as quickly as she might have hoped. A month after her initial appointment, Alice was still waiting for her first CBT session; in early December, she tried to kill herself.
Alice is one of many students experiencing mental illness at university – and one of many who, stuck on waiting lists despite significant levels of distress, are having to lean on friends to get through crisis.
Zoe, another young undergraduate studying at Queen Mary University, London, found her chronic depression "re-emerging" when she started university. During her second year, her mental health problems manifested “very physically”; she also experienced mild psychosis. “The waiting lists were about as chronic as my depression at that point,” Zoe says. “University put a lot of emphasis on reaching out, but when I did finally reach out, services were lacking.” She also encountered problems with the university health services that had come to replace her hometown GP. “The counselling sessions were limited to four per academic year; when you’re dealing with a serious mental illness, that doesn’t really make a dent.”
Faced with this lack of help, Zoe leaned heavily on her uni friends – so much so, in fact, that she still finds it difficult to talk about. "It’s really hard because you don’t want to place the burden of your care on someone who isn’t qualified for it or capable of dealing with someone who is mentally ill,” she says. “I felt enormous guilt when I needed support from friends – when they cooked for me or let me stay with them to prevent self harm."
That doesn’t mean properly executed peer support can’t be a helpful tool for recovery. “It’s a very mutual thing,” she says. “I genuinely think that if I hadn’t had them to speak to this year, I wouldn’t be where I am now. They’re incredible; vital in keeping me afloat.”
As well as being uplifting, empowering and key to the recovery process, informal peer networks can often act as an important stepping stone to formal support. “People often come to us as the step before they go to counselling,” says Joanna, president of WellSoc, Edinburgh University’s Mental Health and Wellbeing Society. “And then there are the people who have tried the service but not really got what they wanted.”
“Students come to our events to learn how to support their friends,” adds Evan, WellSoc’s secretary. “We had a discussion recently with a psychotherapist on the panel; people were asking her how to look after their friends. People do want to help themselves and their friends and change the conversation on campus. But they have nowhere else to go to get help, so they come to these more informal places to work out how to start that conversation.”
Peer support is nothing new; research from the NUS in 2013 found that 64 percent of students were not using formal services for support, instead preferring to speak to friends or course mates about their frame of mind. Student Minds is a charity operating in the higher education space. One of the key parts of its ethos is a belief in working with these naturally occurring networks, teaching students how to be there for each other. “More often than not, students will talk to their friends, or the person they play sports with every week,” says Rosie Tressler, Students Minds’ CEO. “We felt it was really important to give people space to think about what it means to be a supporter and to look after someone else. Even if you have mental health treatment, it's inevitably likely to be a friend who sees more of you each week and knows what's going on."
As such, Student Minds has a network of student-run affiliated societies who are given training in active listening and effective campaigning. The charity also operates on a top-down, strategic level with universities, acknowledging that institutional change is also required for students to be supported effectively. One of their main focuses is transition points – when a student transitions from a home GP to a university one, for example, or from education to the workplace. This is an especially vulnerable time for students – and is exactly when sufferers can fall through the gaps, cut off from quick or effective treatment.
Execution, as Tressler points out, is key – formal support networks are not necessarily always going to be as beneficial as they could be. One King's College London student told me that a student-run “positive psychology intervention” left her feeling let down, the minimal training that facilitators had received not enough to cut through their own bias and insensitivities.
“It was run by students without much mental health training who openly talked about doing it just to put on their CV,” she says. “They also made the worst jokes I’ve ever heard about mental health. They’d casually say stuff like, ‘I’ve got so much coursework, I’m going to kill myself.’ We had one woman running it – who wanted to be an educational psychologist! – who said things like ‘Facebook is spazzing out.’ I was so concerned that people who were really vulnerable and didn’t have access to any other support would just be handed over to these 18-year-olds who didn’t really know what they were doing.”
Such workshops, even those formally affiliated with organisations like Student Minds, can also put strain on the students running them. I spoke to one student who volunteers his time to peers going through crisis – despite struggling with his own mental health and being on a months-long waiting list himself. Eva Crossan Jory, the NUS vice-president for welfare, says that there are clear benefits to peer-led support groups – but “when universities rely on unpaid volunteers to pick up the work, that’s not a good thing. Those students often don’t have anyone to speak to; if you’re going to a counsellor, they do have someone to speak to. We’re very much relying on the goodwill of these students.”
However, even when peer support networks are sensitively run or informal support networks bring mutual growth and comfort, mental health funding figures seem to suggest that the onus is likely to stay on students. Even when universities are investing in mental healthcare, as some SU staff say they are, problems in the NHS remain. Cuts to mental health services have been persistent and devastating – bed shortages sending patients hundreds of miles from home, austerity measures creating more and more distress. Figures released in October of 2018 found that some patients were waiting up to 13 years for treatment; Wendy Burn, president of the Royal College of Psychiatrists, rightly described it as a “total scandal”. The question of where students should go for help when wellbeing services signpost them away from institutional support is, as yet, unanswered.
Many students specifically point to the government cuts as a major factor in their management of their mental health. “The cuts are the reason I had to rely so heavily on my friends,” Alice says. “Their waiting list is so long, the phone is only manned by one person. Services could be much improved by more funding – and then I think people like me would be less affected.”
Those in charge of campus mental health services must be proactive in their attempts to provide proper care to their students, argues Crossan Jory. "Universities need to be lobbying for NHS funding," she says. “They have a duty of care to their students. Some universities use the excuse of an underfunded NHS to not really do much work, but I think they need to accept their responsibility and the part they have to play in the mental health crisis. It doesn't just come out of nowhere; a lot of the things enforced by them – fees, attainment gaps, cost of housing – all of those things are massive factors in poor mental health. They can't just pretend they have nothing to do with it.”
Indeed, Alice feels let down by her university. Campus security had been contacted to call an ambulance, so must have been aware of her situation. But when she went to the counselling services in late January, just a month after her suicide attempt, the first appointment available was on the 23rd of April. At time of writing, Alice has still not seen a counsellor. She does, however, acknowledge the help she has received – meetings with personal tutors, flexibility with extensions and mitigating circumstances. “I’ve had to ask for extensions previously due to poor mental health and they were really accommodating,” she says.
Still, “more needs to be done. After my attempted suicide, I received an email informing me of all the wellbeing services at Warwick,” she says. “But since then, there have been no catch-ups; nobody from the wellbeing service has attempted to contact me or check up on how I’m doing.” Thankfully, other students helped. “They made sure I wasn’t alone, they offered to let me sleep over at theirs, they checked in on me throughout the day.”
Peer support is clearly important; solidarity and community are often excluded from conversations on mental illness, and understanding exactly how people with mental health problems are living with their issues with the help of loved ones could be an important step away from the individualistic model of treatment so often pushed by the government and other institutions.
This doesn’t mean, however, that students should have to bear the brunt of the mental health crisis alone. Student Minds’ own documentation on peer support makes this clear: comprehensive training is “essential” for ensuring that peer support is delivered safely and effectively, as is ongoing support and supervision for those providing it. At the moment, this isn’t happening across the board – students are providing unstructured support that is often given to the detriment of their own mental health.
And no matter how good support from peers is, some of those going through crisis will need more structured help; psychological therapies, medication, meeting with psychiatrists. Relying on students to provide, essentially, the output of an entire medical team is not the answer to the mental health crisis.
Some names have been changed to protect identities.