Why are so many university students struggling? This is the question I am often asked by faculty, staff and parents when I talk about my work as a psychiatrist with students confronting mental health and substance use issues. In my research – and as a long-time student, parent, staff and faculty member myself – I seek to understand and quantify these struggles and continue to search for answers which will lead to solutions, remedies or relief. I also like to respond with “What do you think?” as I suspect answers lie in surprising places or, perhaps, can be found right in front of us if enough of us are looking and talking.
Students, on the other hand, rarely ask this question. Perhaps some feel they have the answer, based on their experiences and observations, or they are too consumed by their own challenges and responsibilities in the moment to ask. But I think many students, whether they are stressed, distressed, or suffering from a mental illness or substance use problem or not, are seeking answers to different questions, like: “Where do I fit in?”, “Where is this taking me?” or sometimes, “What is the point?” or “Is it worth it if I’m struggling or suffering this much?” They also ask, “What happens if I’m not in school? Where will I go for help then?” These are even harder questions to answer.
It is important to recognize that, as more children with mental health problems and illnesses are being identified, supported and accommodated in primary and secondary schools, they are coming to university and expect and deserve ongoing care. On the other hand, many children and youth still struggle to access help in Canada, particularly marginalized youth and those living in rural and remote areas, and they often arrive at university with the hope that they can finally find care.
Increasingly, there are students with diverse gender, cultural and religious identities on campuses, with different experiences and understandings of mental health and illness, dis/ability, and help-seeking. There are more international students, many of whom come from countries and cultures in which mental health is more highly stigmatized and care has been less accessible and acceptable to them.
Some students are stressed, or distressed, dealing with the developmental challenges of emerging adulthood or with life circumstances that arise while at university, like sexual assault or the death of a loved one. Others face challenges that started much earlier, like exposure to adverse childhood experiences including abuse and neglect. Some are very ill or extremely distressed, sometimes with a first experience of psychosis, severe depression or obsessive-compulsive disorder. Others have milder anxiety or are suffering through their first break-up.
All of them, and others, line up for care on campus at health and counselling services, if it’s available. Each year, more are lining up, and this is not bad news. Stigma appears to be decreasing, more students are seeking help, earlier, and campus services are usually easy to find and typically more responsive and appealing to students. Determining who needs what, and when and where they can get it requires continuous navigation. Still, often the students who need the services most are the least likely to seek and find the care they need. Bottlenecks are common, given decades of under-funding of mental health and addiction services for children, youth and emerging adults at the federal and provincial level. Thus, students keep flowing in the doors to campus services, but only rarely and slowly flow out to other services, even if they have severe and persistent mental illness.
Suicide is a rare but tragic occurrence (at a rate of about one in 10,000 at this age and stage of life), although it is no more likely to occur among those pursuing postsecondary education. We should no longer be surprised, given the numbers attending our schools; given that by 25 years of age 75 percent of lifetime mental illnesses have had their onset, with the peak prevalence between 18 to 25 years of age; and given that care for mental illness and addictions remains as limited as it does. We must both prepare for and seek to prevent suicide and substance-related deaths among students. This cannot be done without engaging the entire campus, and institutions and the community beyond the campus.
Youth may attribute their struggles and problems to “mental health” or illness, rather than to life events and circumstances, more often than they did in the past. We all have a state of mental health, but we do not all have a mental illness. However, in the early stages and at this age, it can be difficult for students, parents, staff and faculty to determine the nature and severity of the problems, and it is not always straightforward for care providers either. There is no crystal ball.
Academic readiness, habits and coping skills, as well as grit and persistence in the face of academic difficulty, are also important factors to consider in relation to mental health. Have we, collectively, laid a sufficient foundation in childhood and adolescence that allows youth to survive and thrive in today’s universities and world? What if there’s a crack? Sometimes it can be difficult to determine if the crack began with an academic problem or a mental health one, but once initiated they can drive one another, and the crack can deepen.
Some parents hover, others are detached; most care and are trying their best to do what they know and what they can. What parents do not always do is what a student needs or wants when they are struggling. Asking “What’s going on?” or “What do you need from me?” can be more valuable than a mountain of advice, but then we must be prepared for the answers, which may not be what we want to hear.
Not everyone wants to be or will be a doctor, lawyer, engineer or university professor. Loneliness and perfectionism lurk around every corner on campus and in society, despite or related to our virtual connectivity. These problems are not unique to students, but when life is more precarious and uncertain, they can take hold in a toxic way. Substances and self-harm can feel like solutions. Success and meaning can be found along many paths, but the paths can be rough and winding. Some students have to face more barriers and hills, through no fault of their own. Sometimes the leader they’re following takes a wrong turn, or a path leads to a dead end. This does not mean a student cannot still build a meaningful, purposeful life.
Determining how best to provide efficient and effective care and support to students based on the evidence and individual needs, and conducting research among emerging adults is essential, but I suspect not all of the answers will be found there. If we really listen, often students will tell us. On an individual level, we must recognize that feeling better can be the result of many things – experiencing compassion and empathy, learning coping skills, the passage of time, taking medication, engaging in academic support or accommodations, starting to exercise, leaving a violent intimate relationship. Sometimes the answer is “none of the above” and sometimes it’s “all of the above.”
On a systems level, we must examine the educational and health systems and processes we are creating and maintaining on our campuses and in our communities and ask: are they helpful or harmful to mental health, and how resilient and flexible are they to the needs of youth? On all levels, it requires connecting with others and discovering opportunities for learning, health and growth. University is not just about developing minds. It is about opening up and opening ourselves to each other, and opening our eyes and our minds so that we can find relief and solutions to the challenges of the world we share.
Catharine Munn is lead psychiatrist in the Student Wellness Centre, and an associate clinical professor in the department of psychiatry and behavioural neurosciences, at McMaster University.