Caring for our own

Seventy-five percent of mental ill health emerges before the age of 25. Alistair Kitchen asks if the University is doing enough.

img046

Art by Gillian Kayrooz

In memoriam C.P.

When the disastrous results of the Student Mental Health Survey were quietly released by the University of Sydney at the end of 2012, they went largely unnoticed by the student body.

The survey had been advertised to the entire student population as part of the Thrive Festival, a one-off campaign to encourage good health in students on campus. The questionnaire was included in mass emails, advertised online, and hosted in stalls along Eastern Avenue. In the end, nearly 4000 students participated.

The results, which were once publicly accessible, can no longer be found online, and many of the students who remember the study have already graduated. For all but a few key members of the University’s administration, the outcomes of the 2012 Student Mental Health Survey are unknown or forgotten.

The figures reflect widespread and severe mental ill health on campus. The majority of respondents to the 2012 Student Mental Health Survey described experiences indicative of mental illness.

Exactly 3,966 University of Sydney students fully completed the survey. Of these students, 49.8 per cent reported high to very high levels of psychological distress – a rate far higher than in the general population.

Separately, a full 21.2 per cent of participants reported levels of distress indicative of probable serious mental illness, and a further 59.4 per cent reported distress indicative of probable mild-moderate mental illness. Less than one in five students were “probably non cases” of mental illness.

The voluntary nature of the survey means the sample is not necessarily representative of the whole student body. If it were, the figures would suggest that nearly 25,000 University of Sydney students experienced significant mental ill health in 2012.

These numbers are cause for alarm, says Dr. Benjamin Veness, a former undergraduate Fellow of Senate and author of a new report into university student mental health.

“Even if, by some fluke, only the students that had a mental health problem had responded to that survey, that was still thousands of students at the University of Sydney who demonstrated alarmingly high levels of distress,” says Veness.

Specifically, the survey uncovered 1,975 individual students suffering from significant levels of distress.

“At a very minimum, that survey should have been an alarm bell to trigger some action in the University in direct and proportionate response.”

His report, called The Wicked Problem of Student Mental Health, investigates university mental health services around the developed world. As part of a Churchill Fellowship, Veness visited campuses across North America, the United Kingdom, China, and Singapore, in an effort to determine the best practices of tertiary education providers regarding their students’ mental wellbeing.

His conclusions suggest that universities in Australia, including the University of Sydney, are not doing enough to adequately care for their own.

“It’s fair to say that most overseas institutions that I visited demonstrated a much greater level of interest in, and what you might term responsibility for, their students’ health more broadly, but particularly their mental health,” says Veness.

******

If the University of Sydney hasn’t responded to the crisis of mental health as well as North American universities, it is at least aware of the problem.

The University began expressing a growing sense of responsibility for the mental health of its students back in 2011 when it released the Building Mental Health Capacity report, and has made gradual changes to its services since then.

Though USyd continues to lack a distinct student mental health policy (one of Veness’ key recommendations), a series of planning documents reflect an increasing awareness of the problem at an administrative level.

The most important of these is the 2013 Student Mental Health and Wellbeing Strategy (SMHWS). The SMHWS is the culmination of years of administrative discussion on the University’s role in student mental health, and now apparently represents the closest USyd has to a policy on its responsibilities towards the mental health of its students.

But the SMHWS is neither publicly available nor could be uncovered as part of this investigation. Director of Student Support Services Jordi Austin, who was given five working days’ notice, did not respond to two separate requests to provide the document. Similarly, a 2014 Student Services Report could not be found or accessed, even though the 2012 and 2013 Student Support Services Reports are currently hosted on the University’s website. These absences are in addition to that of the Student Mental Health Survey, which, for reasons unknown, is no longer available to the public.

The opaque processes of the University are cause for concern in an institution that claims to take the welfare of its students seriously.

Veness was disappointed and surprised by the inaccessibility of the documents.

“I’ve never heard of a student mental health strategy that a university has developed but not made public. When I looked at any of these leading universities overseas, who had often had a task force report in response to student suicides on campus, they were always publicly available.”

However, this investigation found a brief overview of the strategy in the 2013 Student Support Services Report, which cites the strategy document as an important step in the University’s response to poor mental health on campus. According to the report, the SMHWS aims to “create a starting point for the discussion of mental health” by shaping University mental health support services into three tiers.

Of particular note are the second tier and third tiers, which recommend creating “a coordinated, campus-wide system to enable early identification of students who may need support”; “1:1 treatment and timely access to assessment and referral as appropriate”; and finally, “in house access to psychiatric assessment and treatment.”

This three-tiered model suggests the beginnings of student mental health plan that would align with the recommendations made in The Wicked Problem of Student Mental Health.

But neither a “coordinated, campus-wide system to enable early identification of students who may need support”, nor substantial “in house access to psychiatric assessment and treatment” are features of the University’s current mental health support services.

And despite the reported existence of this strategy, and despite steady changes to the University’s attitude toward mental health, the University of Sydney clearly lags behind similar universities. Beyond a proliferation of strategy and planning documents, the University does not appear to have responded adequately to the demands of the 2012 Student Mental Health Survey.

******

The University of Sydney Mental Health Awareness and Support Society (MAHSoc) was founded in 2014 in response to a sense that not enough was being done to engage the issue of mental health on campus. The group works to increase the visibility of mental illness at the University and returns this year to restart a discussion about illness, stigma, and support systems.

“The original intention of MAHSoc was awareness and understanding,” says Mitchell Thomas, MAHSoc President for 2016.

“If you’re trying to juggle university and a mental health condition, it’s pretty hard, so I think having an understanding on campus is vital,” he says.

And though a great deal of stigma and ignorance remains, there are positive signs within the student body.

“What I found exciting when I first came to Sydney University was that there actually was interest in mental health,” says Camilo Zubiri, the treasurer of MAHSoc.

Thomas and Zubiri are men who have experienced the challenges and stigmas of mental illness firsthand, and want to use this opportunity to change institutions from the inside. They’re appreciative of any student mental health service provided by the University, but are hardly optimistic about the systems currently in place.

According to Zubiri, who works in mental health, both the University Counselling and Psychological Services (CAPS) and the public system in general are “heavily overcrowded and overstretched”. He’s had to move into the private sector to find adequate care.

“Particularly around a university, which is full of people between the ages of 17, 18, up to 30, mental health is a big consideration, because one-in-four young people will have a mental health condition at some point. And that’s a pretty overwhelming statistic,” says Thomas.

In fact, the numbers are even more severe than that: in any given year, 26 per cent of young people in the 18-24 age range experience mental ill health, and 50 per cent will have need for care at some point during the transition from childhood to adulthood.

In Australia, suicide is the number one cause of death in young Australians. It accounts for a quarter of deaths among 20-24 year olds, and a third of deaths among 20-24 year old men. It’s also preventable.

******

Despite its failings, the University has not been wholly inactive in tackling the prevalence of poor mental health on campus, and in recent years has developed a number of preventative care programs. In particular, CAPS has directed much of its attention to compiling a substantive mental health resource list.

Today the CAPS website hosts a variety of e-therapy tools, including videos, interactive programs, a monthly psychological challenge, guided exercises, and a range of accessible self-help e-books. These services are designed to provide support to students with low to medium levels of psychological distress by intervening early in the onset of mental illness. But the success of these resources relies entirely on student self-initiative and engagement, and the impact of these resources on the University of Sydney student body is currently unknown and unmeasured.

CAPS also runs a 6-week training program called Sidekicks, which, according to the CAPS website, is “dedicated to developing a stronger community on campus.” The training provided in Sidekicks helps students identify when their friends are in trouble and seeks to equip students with the skills to know what to say to someone in distress.

To the University’s credit, both these programs represent tangible efforts to ensure that University of Sydney students have access to resources before the onset of significant mental illness.

Where the University has failed, however, is in the adoption of substantial intervention and university-wide practices.

Specifically, the SMHWS recommendation that the University host “in house access to psychiatric assessment and treatment” has only partially been realised. CAPS first introduced a psychiatric service in April 2013 on a half-day per fortnight basis, and has gradually increased the frequency of that service. In 2016 CAPS will host a psychiatrist one day per week.

In comparison, University of California, Los Angeles (UCLA), hosted six full-time-equivalent psychiatrists in 2013, despite UCLA’s slightly smaller size.

Equally concerning is the University’s counsellor to student ratio. At 1 counsellor for every 4744 students, the University falls desperately short of the 1:3,000 itself cites as the recommended ratio. But even this goal is deeply inadequate by global standards. At UCLA, there are enough counsellors to successfully support the International Association of Counseling Services’ recommended ratio of 1:1,500.

The vast deficiency at USYD results in waitlists and backlogs, and CAPS routinely fails to meet demand during peak periods. These are barriers to the support of students already dealing with great mental distress. It takes initiative and strength to visit a counselling service for the first time, and yet at-risk students can be told to wait when at their most vulnerable.

******

But the counsellor-to-student ratio is not even “the first goal that I would aim for if I were looking at student mental health services as a university administrator,” says Veness.

What is missing, according to his report, is the right “tone from the top.”

“I don’t believe that any significant change will occur throughout an institution unless all the way from the Chancellor and Vice-Chancellor down, [university student mental health] is recognised as a fundamental enabler of the university’s performance.”

“Only at that point will other things start to happen. Universities have very complex structures and many competing aims, and it’s really difficult for one person, six levels down from the Vice-Chancellor, to effect a desperately-required systemic change.”

The type of change that Veness wants to see includes university-wide training for identifying students in distress.

“Helping students that are in trouble starts, obviously, with identifying those students,” he says. “So part of that is really a mandate for the university to go out and teach those people that are going to be in regular contact with students — and particularly those that are going to be in regular contact with the same students — what are the things to look out for.”

“So, so-called ‘gatekeeper’ training is necessary in the first instance, and then it’s a question of triage.”

Once students have been brought into the health system, Veness says, it’s up to the University to actively integrate their systems with healthcare providers.

“I thought that the University of Oxford did this quite well. Students that were admitted to the local hospital would come back to the University, to the doctor who treats the students in that college,” he explained.

“This way, the University was aware of the problems their student had encountered, and it wasn’t just as though this student turned back up on their doorstep completely cold as though they had just gone away for a semester or had a break for some other reason. There is actually a process by which Oxford takes an active interest in reintegrating students.”

******

Ultimately, there are structural reasons for the failure of Australian universities to properly embrace on-campus mental health initiatives.

In the United States, university students are covered by university health insurance schemes, which more clearly designate a duty of care to the university. At Oxford and Cambridge, the residential college system ensures a much closer relationship between student and institution. The result is that these universities experience a culture of pastoral care absent at the University of Sydney.

In Australia, the duty of care is blurred even further by the presence of both government and non-government health services. In fact, the 2012 Student Services Report explicitly notes that the University directs that CAPS “not duplicate existing government health services”. The view of the University seems to be that the mental health of its students is first and foremost the responsibility of the government.

The result of this diffusion of responsibility, it seems, is a failure from any party to adequately respond to the matters at hand. But even universities that don’t believe it is their responsibility to care for the mental health of their students have a reason to act: it’s for their own good.

According to Professor Patrick McGorry, Australian of the Year in 2010 and Professor of Youth Mental Health at the University of Melbourne, “the waste of creative, economic and productive potential is most dramatic when we consider the impact of preventable, untreated or poorly treated mental ill health in tertiary students.”

The economic and productive costs of failing tertiary students are born first and foremost by the University, which relies on research output for ranking and funding reasons. At a university, the student becomes both client and product.

These considerations are even noted in the conclusions of the 2012 Student Mental Health Survey: “[the type of distress reflected in the survey results] is likely to impact on students’ ability to attain their optimal level of academic excellence in addition to compromising their emotional and social well-being.”

“What I’m saying in this report is not only that universities need to take some responsibility for and ownership of their students’ mental health, but that they have a vested interest in doing so,” says Veness of this phenomenon, which he argues they could be doing in collaboration with government, so as to share both the responsibility, and the cost.

Students’ mental health is the cornerstone on which the University depends, he says. It’s up to the University to realise just how much is at stake if it continues to lag behind its overseas competitors.

******

There are no figures to describe how many members of the University community died by suicide in 2015. Instead, memories and grief linger to tell us that the student population was reduced by an unknown number last year.

Many of the leading university mental health policies in the US were written in the aftermath of student suicide. It is this writer’s sincere hope that no more students need die before we fully commit ourselves to caring for our own.

For help or information, call Lifeline, 131 114, or visit beyondblue.org.au.

To contact CAPS, call (02) 8627 8433 or 8627 8437, or visit http://sydney.edu.au/current_students/counselling/contact-us