The COVID-19 pandemic has emptied many university campuses, pushing more teaching online, cutting off access to laboratories and libraries, and changing the way staff and students interact. Amongst the many impacts yet to be fully understood are the implications of this period on student mental health. Students are navigating the threats and pressures of the crisis—such as health threats, financial instability, and the wellbeing impacts of isolation—while also dealing with major disruptions to their education. In this special feature, members of the WUN Working Group on Student Mental Health discuss the state of student mental health and share what their universities have been doing to support students in this extraordinary time.
One of the challenges in shaping support for student mental health during the coronavirus crisis is the lack of sustained evidence on which to base interventions. While some of the universities that have contributed to this feature have developed records regarding uptake of their services, systematic data on student mental health is lacking. As Dean McMillan, clinical psychologist at the University of York, put it, “there is not much in the way of rigorous evidence around the mental health difficulties of university students. This is something we need to work to address. We do, though, have very clear evidence across the sector of an increase in presentations to counselling services at universities and this predates COVID-19.”
Myles-Jay Linton, Vice Chancellor’s Fellow at the University of Bristol, identified three types of challenges interacting to affect student mental health: frequently changing external circumstances; the need to make personal adjustments to daily routine; and uncertainty about what the short-term (and long-term) future will look like. These challenges have been compounded by new stressors during the coronavirus crisis. As Dr Linton observed, “we are all needing to adapt to a changing educational environment, yet the need to be kind to ourselves and others has never been more important.”
Responding to the pandemic
When COVID-19 containment measures hit, “students and the universities they attend had to basically reinvent higher education almost overnight” said Ralph Manchester, Vice-Provost and Director of the University Health Service at the University of Rochester. Students have had to manage these changes and the uncertainty surrounding them, while dealing with the wider impacts of the crisis as well as pre-existing challenges. He praised the dedication of staff members striving to maintain and even increase levels of support despite “our first line of defence, to be able to sit down and talk with a student face-to-face, being pretty much off the table.”
Memory Muturiki, Director of the University of Cape Town’s Student Wellness Service, described how needs that were already complex increased as the pandemic unfolded. “Our telephonic and digital counselling services have been inundated by calls from students expressing high levels of anxiety and uncertainties,” she said, “regarding practising social distancing as young people, fear of isolation, ability to study online under different socio-economic circumstances and home environment, the stresses of living through the actual pandemic and having to adjust to a new normal.” In these circumstances, Muturiki indicated, “clear and regular communications to students is very important to alleviate some of the anxiety created by the pandemic and the rapidly changing trends.”
Linton also emphasised the importance of communication: “staff are working hard to explain that although student services may be remote and not identical to face-to-face support, the quality of support provided and understanding the needs of students remains a high priority.” Students who have returned to family homes may be feeling a loss of independence, Linton noted, and while academic study can bring pressure it can also be core to our sense of purpose and identity. “It is natural to feel adrift at the moment, but it is also worthwhile reminding ourselves of difficult situations in the past that did not last forever or were eventually overcome.”
The impact of uncertainty
Ziwei Xu, therapist in Renmin University of China’s Mental Health Centre, observed that requests for support have fluctuated as the emergency unfolded. Most students were at home for the Chinese New Year when public health measures were issued, meaning that they remained with family during stay-at-home orders. An early spike in demand for support was followed by a decline, which she believes corresponded to students learning to adjust.
As containment and distancing measures continued, however, demand rose again: “we found a kind of gradual depression among the majority in society is happening, with feelings of isolation and loss of connection. Sometimes classes are only a screen presenting the instructor alone and students are missing their interactions with peers.” In response to these concerns, Xu and colleagues at Renmin addressed an article to government with advice on policy approaches to mental health and COVID-19.
To address anxieties related to academic pressures, many universities have offered some form of concession in grades. For instance, some have given students the option of pass/fail results (without the grade contributing to their overall average) and others have determined that no student will be withdrawn from study due to results during the disrupted period. Universities have also increased their financial hardship support or waived certain fees.
Tools and technologies
Many universities already had online self-care guidance for students, such as apps and online tutorials to encourage mindfulness, productivity, and healthy sleeping habits, for example. Tailored support now also uses digital infrastructures, including counselling sessions via videoconferencing. As Manchester indicated, universities had to invest significantly to adapt, rolling out new software and hardware, additional training to ensure counsellors were equipped to provide telehealth services, and new systems for client consent.
The role of peer networks came out particularly strongly in a webinar on student mental health convened by the Worldwide Universities Network. Student leaders Lydia Borsi and George Bemrose, from the universities of Rochester and Bristol respectively, outlined how young people have been supporting each other, including peer health educators who raise awareness of services and student union-led social media forums that help to maintain a sense of community. Graduate students with counselling degrees have also contributed to UCT’s outreach prior to and during the pandemic.
These have also been a feature of responses at Renmin University of China, as Xu explained. The Student Affairs Division structures general support for all students, bridging a potential gap between collective academic forums and individual pastoral care. It also established a peer support scheme for students from Hubei province, where the virus broke out and was most severe, pairing them with students from around the country.
All the experts contacted agreed that universities need to be aware of at-risk students. Socio-economic inequalities and the digital divide affect students’ abilities to continue their education online. International students may face specific anxieties. For LGBTQ students, isolation may mean a decrease in positive social interactions and/or an increase in negative interactions. Students with caring responsibilities may be juggling study with home-schooling or other changes in care needs.
Given the reliance on remote counselling at a time when many have returned to family households, there are concerns that some students may have trouble finding the necessary privacy and space. Conversely, those in single households may risk feeling isolated. There are also concerns about whether treatment delivered remotely will be as effective. However, a recent systematic review to which McMillan contributed found that conducting counselling by telephone does not undermine the therapeutic relationship between counsellor and client (Irvine, McMillan et al 2020). He also pointed to solid evidence from a number of randomised trials, which suggested that treatment delivered over the telephone was as effective as face-to-face treatment.
McMillan pointed to another at-risk group: just-qualified nursing and medical students who have become part of the front-line response to the pandemic. “We are concerned about post-traumatic stress disorder,” he stated, “and the types of presentations we’re going to see in future may well shift due to COVID-19.”
The WUN working group
The WUN Working Group on Student Mental Health had been preparing a survey for WUN members and is revising its timelines with a renewed sense of purpose. “WUN was very forward-thinking to get students involved in the working groups along with professional staff and academic faculty,” observed Manchester. The WUN work builds on the WHO World Mental Health Surveys International College Student Project (WMH-ICS), which surveyed first-year university students about mental health. The World Health Organization project, however, has done limited work in low- and middle-income countries, a gap the WUN Working Group will tackle.