By Katie Rigg, Head of Safeguarding & Student Well-being Updated by Katie on 19 July 2019 with additional useful resources and insights.

Starting university can be a wonderful and exciting time for students as they acquire new knowledge, meet new people, learn about themselves and others, and form lasting friendships. It can also be layered with difficulties that can originate in the transition period as students leave one life behind and begin another. For international students arriving from another country, the difficulties can be even more acute. The way in which schools and universities manage this transition period can have a significant and long-lasting impact on students' mental health and well-being.

This blog sets the context to this issue and provides an overview of guidance and available resources. 

‘I have less support and do feel lonely because at school you had everyone every day … I can feel very lonely and depressed at times and if everything is going bad at the same time I break down and can’t seem to function properly. I’m in robot mode’ (student)¹

The transition from school to university can be challenging for any student—it is often the first time that they live away from home and are expected to look after their own basic needs. This can be accompanied by significant pressure to succeed academically while living up to the narrative of university being a time of intense social activity and enjoyment. Alcohol and peer pressure can also form integral parts of students’ early university experiences, making these other stresses harder to bear.

 

International students

‘It was kind of difficult to relate to the locals, I still find it a bit difficult sometimes ... because we have different experiences, we have different cultural knowledge and background’ (international student)²

International students can encounter the additional challenge of being in a new country surrounded by a different geographical and cultural context, without the protective factors and familiar normative controls and reference points of home. Challenges can include adjusting to a new social environment; practical, logistical and legal challenges related to issues such as insurance, immigration status and finances; culture-shock; language-barriers; difficulties finding friends who share their religion or background; homesickness; adjusting to a different climate; adjusting to different teaching methods and academic environment; financial or academic pressure; racial hostility or discrimination by peers and others on campus.

Student mental health

‘His worst thing was failure, he hated failure, and I suppose failing first year at uni[versity] was obviously a massive trigger’ (friend of student)³

Only 17% of people do not experience a diagnosable mental health issue at some stage during their life⁴

We know that living with a mental health condition can be devastating. We also know that early interventions and the right support can change the trajectory of a person’s life.  Schools and universities everywhere are ideally placed to provide this support and to transform people’s lives. 

International research suggests that the mental health of adolescents and university students has deteriorated over recent decades, with levels of distress, anxiety and depression on the rise.⁵ Transition to university can, if not managed well, be a significant risk factor for students’ mental health. Studies suggest that mental ill-health amongst first-year students is high. In one example, 10% of students involved in a study in Spain had suicidal thoughts in their first year and 30% suffered mental illness.⁶ Other studies demonstrate how the particular challenges that some international students face can exacerbate pre-existing mental ill-health and/or lead to low mood, anxiety and depression.⁷ Studies also indicate that some international students may be less likely to seek mental healthcare on campus, particularly those who come from cultures in which mental ill-health is particularly stigmatised. This reluctance may also be linked to being ill-equipped to recognise risk factors or mental illness or having concerns about meeting a counsellor who offers culturally relevant treatment.⁸

 

Six ways that schools and universities can support students through this transition

1. Prepare students from an early stage for practical and cultural changes. Also, talk with them about maintaining good mental health and seeking help when needed

Preparing students as early as possible, and well in advance of their move, is important. Some schools do this by holding student and parent sessions, and universities often arrange pre-orientation or summer school programs for international students. These often address practical issues like paying bills, registering for healthcare, preparing for cultural adjustment and changes in climate, and navigating differences in application processes. It is also important for these sessions to focus on issues like identity, resisting peer pressure, resilience in the face of adversity, maintaining good mental health and seeking help when needed. Although most schools and universities are doing something to prepare students for transition before they arrive at university, there is relatively little evidence on what good practice looks like, and although some institutions are doing excellent work in this area, examples of particularly good practice are often hard to find. Further work is needed to explore how both institutions can be more proactive in this preparation stage.

Resource tip:

- This Student Minds Know before you go toolkit helps students to anticipate, identify and navigate situations they will encounter when entering university.

 

2. Implement robust and effective transition programs and consider how to embed these throughout student life

Student orientation programs at university are critical and common-place. There is a wealth of guidance on how to build these programs, and although this guidance is helpful for supporting students with academic and practical issues, it does not always explore in sufficient depth the less tangible issues related to student mental health and well-being. Identifying resources that do address these is critical. There are fewer resources that focus specifically on supporting international students, but many universities that often include immigration and career planning workshops; host family programs; student mentorship program/ambassador program; cultural interaction programs connecting international students with local students; and courses for students helping them to build their resilience, manage their transition, and know themselves, their identity, race and culture.

As with the pre-arrival programs, more evidence is needed on what good practice looks like for international students, how to build orientation programs that genuinely support student well-being, and how to embed these programs throughout student life so that support and information is provided on an on-going basis, and not just in a students' first few weeks.

The transition from school to university is not the only transition that students will make and many institutions are now also looking at how they can support students who move from one school to another, take part in an exchange programme, and graduate from university.  When designing a transition program for international students, institutions draw on evidence of successful programs for students moving between international schools (see resource tips below).

Resource tips:

• This guide provides an overview of how to build student orientation programs
• This toolkit from Student Minds is for students to help them manage issues like identity, sexual activity, mental illness and addictions.
• The Massachusetts General Hospital Center for Cross-Cultural Student Emotional Wellness produced a number of publications and articles on how to promote good mental health amongst international students
• These are articles and cases for university students on relationships and sexuality.
• Initiatives like Stevenmentor support international students
• Programs developed by universities include Across Cultures, Conversation Partners, and Intercultural Activity Toolkit by NAFSA
• Safe Passage by Doug Ota looks at programs for students moving between international schools
• Sea Change Mentoring, founded by Ellen Mahoney, provides guidance and resources to international schools and their students
• The Global Nomad's Guide to University Transition by Tina Quick provides guidance to students to help them to manage their transition.
• This article on international student mental health includes guidance for advisers of international students.

 

3. Adopt a whole-school / university approach and involve your students in this approach

Focusing on transition is necessary but not nearly enough, and professionals in this field are increasingly urging institutions to take a whole-school or whole-university approach, by which they mean taking a holistic view, involving all members of the community and weaving prevention, identification and response throughout the fabric of the institution. Key to this is creating a culture of care or an eco-system in which students and staff support each other, every person feels able to be their true selves regardless of their background or health, and the culture of the institution is such that the experience of working or studying in it enhances, rather than diminishes, people’s lives.

‘Nothing about us without us'⁹

As a first step, always involve your students in these discussions and co-produce policies and resources with them. Involving and consulting with students in this way will provide valuable insight into the current weaknesses and strengths of an institution’s approach to well-being and how this can be improved in a way that best meets students’ actual needs. 

Adopting this approach involves looking not only at policies and practices related to mental health and well-being but also at policies related to issues like leave and mitigating circumstances requests, use of digital devices, equality, diversity and harassment. It requires institutions to look at how they organise advisory systems in schools and tutor or seminar systems in universities, what the impact of financial support is on students receiving it, how the curriculum addresses well-being, what it does to support staff and volunteers, how its governors, head, president and trustees lead on issues and how the institution supports social interactions.

This approach also requires institutions to review the way in which they respond to critical incidents such as suicide, which can have a significant impact on the culture of an organisation. Preparing for these incidents and developing response plans are key and will support on-going prevention work. It also requires partnerships and close cooperation with key local agencies so that students and staff can receive as integrated an experience as possible. This can be done, for example, by carrying out a local mapping exercise.

Considering how institutions can leverage technological advances, data and learning analytics could also help to strengthen its approach. For example, it could help institutions to diversity and improve access to services that can be delivered both digitally and in person, enhance risk assessments of individual students and enable the organisation to triangulate data and spot signs of distress at an early stage.

 

Resource tips:

• Universities UK's Step Change Framework advocates a whole institution approach to student mental health, including useful guidance on how to achieve this
• The JED Foundation encourages universities to take a holistic approach when building upon existing student mental health, substance abuse and suicide prevention efforts
• See what other universities are doing as showcased by the What Works Well-being Centre
• Learn how to develop a response plan to critical incidents relating to mental health, including suicide, from The Samaritans, and see this Protocol from the International Taskforce on Child Protection and Farrer & Co. for advice on how to address allegations of abuse and how to carry out a local mapping exercise
• Read this Student Minds Co-production guide for advice on how to co-produce mental health strategies for students in universities and take a look at their project developing a  Mental Health Charter for universities
• Check out Mind and Minds@work for guidance, training and resources related to staff mental health and well-being
• Take a look at this 360 degrees school programme by Young Minds for guidance on how to put well-being at the centre of your school

 

4. Develop the intercultural competence of your staff and strive for cultural diversity among your counsellors

It is important that staff in schools and universities are culturally aware and interculturally competent. Culture plays a central role in determining how students perceive their surroundings, how they understand issues like sexual assault and mental illness, how they deal with authority and perceive power, how they cope with challenges, and how they can develop resilience.

Without an understanding of the role of culture in student well-being, and how culture shock can impact on student mental health, staff will be less able to identify symptoms of distress, respond appropriately or provide effective support to students that originate from a culture that is different from their own. Intercultural competence is a feature of a number of international school accreditation frameworks including ours at CIS, The Council for the Advancement of Standards in Higher Education (CAS) also require faculty that interact with international students to receive regular and on-going training on the role of culture in mental health, and how to support students from different cultures.

Resource tips:

• A CIS Mental Health & Well-being Workshop includes training for both school and university staff on how to support students that are suffering from abuse or mental ill-health in a culturally competent way
• Universities UK intends to develop a toolkit to help universities co-create local responses to the needs of their international students

 

5. Provide opportunities for students to seek help at an early stage and strengthen your systems so that you can proactively identify students in need of support

“In a caring and compassionate organization, you are not only ill once you have filled out a form”¹⁰

Many universities provide excellent support to students who are proactive in seeking help. However, there is a concern that many students in need of support are not able to reach out proactively. These students often never come to the university’s attention or only do so once the risk has escalated to dangerous levels. We know, for example, that a significant proportion of students who commit suicide are not previously known to university student services.¹¹ Further work is needed to look at how schools and universities can make it easier for students to seek help. Efforts to do this should include building trusting relationships between staff and students, having a system where students have formal and regular one-to-one or small group sessions with (non-academic) advisors or tutors, putting in place visible, accessible, culturally-relevant and high-quality counselling services and helplines at university, offering multiple avenues for disclosure, using peer support programs, and removing the stigma around mental health. Reviewing the institution’s core values and these are communicated to students and staff is also key: for example, does the institution encourage young people to aspire to perfection, set unrealistic goals, or imply that an individual’s value is exclusively linked to their academic and professional success? Given the societal context in which we live, it can be easy to promote these messages without realising it, but these messages can make it harder for young people to seek help and admit that they are struggling. They can also make it much more difficult for young people to manage disappointment when they do not obtain the goals set for them. On the other hand, organisations that prioritise and place value on issues like individual well-being and the quality of relationships can foster protective relationships where students feel comfortable seeking help. Talking about how to identify and manage distressing emotions and having values such as equality and diversity, kindness and compassion run through the fabric of your institution can enhance these protections.

We also need to look at how schools and universities can proactively identify students who are not able to seek help or refer themselves to student services. Training for all staff (not just teaching staff) on spotting signs of mental ill-health, harm and abuse across cultures is also critical. Holding regular meetings with staff from different areas of your institution, including medical, safeguarding, academic, residential and support staff, to talk about individual students is another important way of triangulating information. Having in place clear and centralized reporting lines and recording systems that enable concerns to be triangulated and patterns to be spotted at an early stage, is key. Whilst schools are increasingly doing this through digital record-keeping systems, universities have to manage much larger quantities of data which they can struggle to centralise and triangulate. New developments in learning analytics have the potential to significantly change the way that universities record and analyse well-being data. Student focus groups and well-being surveys can also provide valuable insight, as can social events that enable staff to identify students who might be struggling and involving students in well-being committees and policy development.

Resource tips:

• Peer support programs: student mental health and Digital leaders program
• Remove the stigma around mental health - Place2Be and The Charlie Waller Memorial Trust  provide resources, training and guidance 
• Universities may want to draw on learning from early alert committees, tailoring these to focus on student well-being as much as academic success.
• Learn about how you can become a ‘suicide safer university’ with this guidance from Universities UK and Papyrus 
• Check out the following digital record keeping systems for schools: My Concern and Isams
• Learn how universities and apply learning analytics to improve student well-being and mental health with this JISC report and this article.

 

6. Strengthen connections between schools and universities

The more that schools and universities collaborate to address student well-being, the easier the transition will be for students. Discussions around this topic are too frequently limited either to just schools or to just universities. Including both groups can build connections, improve understanding of the other, generate new ideas and strengthen information sharing. For example, when a school needs to share information about a vulnerable student with a university, they often don't know who at the university they should share that information with, or how it will be stored or used. 

Greater cooperation between schools and universities will also increase the knowledge and understanding that each institution has of the other, which in turn will help to dispel unhelpful myths. It will also help schools to prepare students, let them know what to expect and encourage those with mental health needs to seek help from their university at an early stage. Current disclosure rates are low. Research suggests that in the UK, for example, only 37% of students disclose or intend to disclose mental health conditions to the universities to which they apply.¹² Schools and universities should set out clearly to students what the benefits are of disclosing and how that information is going to be shared.

Resource tips:

• This article outlines these issues in further detail
• This blog sets out the rights of students in the UK to disclose mental health conditions in their university application form, and this blog sets out the benefits of disclosure 

 

How is CIS supporting its members in this area?

We held our inaugural Student Well-being Workshop in November 2019 in Bilbao for universities and schools, which included sessions on mental health, digital well-being, intercultural competence, sexual abuse and violence, peer on peer abuse and transitions. 

We are gathering data from our membership to understand more about the specific challenges that students face and how our members can meet these. As part of this we are hosting a series of roundtables looking at supporting students in the transition to university, from which we will be publishing a series of case studies showcasing good practice in some of our member institutions. Finally, following a summit in London with global educational leaders, we will be forming a committee to focus on how CIS can help its members to strengthen student well-being throughout education, from early years through to university.

As you can see there’s a lot to cover on this subject and we are excited about the potential for our work to make a real difference to student safety and well-being. If anyone would like to know more about our work to address student safety and well-being or be involved, please contact Katie Rigg.

 

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References:

¹  Wrencha, A, Garretta, R and King, S, Guessing where the goal posts are: managing health and well-being during the transition to university studies, 2013

²  Belford, N, International Students from Melbourne Describing Their Cross-Cultural Transitions Experiences: Culture Shock, Social Interaction, and Friendship Development, 2017

³  Stanleya, N, Mallonb, S, Bellc, J and Manthorped, J, Trapped in transition: findings from a UK study of student suicide, 2009

⁴  Schaefer, Jonathan D; Caspi, Avshalom;  Belsky, Daniel W; Moffitt, Terrie E, Enduring Mental Health: Prevalence and Prediction, 2016

⁵  Twenge, J, Roger, M, Joiner, T, Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time, 2018; Collishaw, S, Maughan B, Natarajan L, Pickles A.Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart. et al., 2010; Stallman, University counselling services in Australia and New Zealand: Activities, changes, and challenges, 2012; Hunt, Eisenberg, Mental health problems and help-seeking behavior among college students, 2010, Papyrus and Universities UK, Suicide Safer Universities, 2018, Thorley, C, Not by degrees, Improving student mental health in UK universities, 2017

⁶  Blasco MJ, Vilagut G, Almenara J et al. Suicidal Thoughts and Behaviors: Prevalence and Association with Distal and Proximal Factors in Spanish University Students, 2008

⁷  Rosenthal, D., Russell, J., Thomson, G, The health and wellbeing of international students at an Australian university. Higher Education, 2008

⁸  Lee, M, Shedding Light on Asian American and Asian Students’ Mental Health Needs, 2018

⁹  Charlton J, Nothing about us without us, 2000

¹⁰  Anonymous

¹¹  Papyrus and Universities UK, Suicide Safer Universities, 2018

¹²  Thorley, C, Not by degrees, Improving student mental health in UK universities, 2017