Student mental health and well-being: Supporting students in transition from school to university

By Katie Rigg

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

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.4 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 (see references for others)5, 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 at university

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, is 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.

When designing a transition program for international students, universities can also draw on evidence of successful programs for students moving between international schools (see resource tips below). 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.

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

- This article on international student mental health includes guidance for advisers of international students.


3. 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:

- The CIS Leading Schools Interculturally course enables schools to strengthen their leadership’s intercultural skills and develop global citizenship in their school 

- A new CIS Student 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—find out more on their blog.


4. 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

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. Further work is needed to look at how schools and universities can make it easier for students to seek help. We also need to look at how these institutions can modify their training recording and reporting systems so that they are better able to proactively identify students who are not able to reach out themselves for support.  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 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. Training for all staff (not just teaching staff) on spotting signs of mental illness, harm and abuse across cultures is also critical, as is having in place clear and centralized reporting lines and a recording system that enables concerns to be triangulated and spotted at an early stage, student focus groups and surveys can provide insight into student mental health, plus holding 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

- Universities may want to draw on learning from early alert committees, tailoring these to focus on student well-being as much as academic success.


5. 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. Further work is needed to address wider questions around the extent to which schools can and should be sharing personal sensitive information with universities about students so that those universities can adequately support them

Resource tips:

- This article outlines these issues in further detail

- This blog highlights the importance of collaboration between schools and universities, with links to other resources.


6. Adopt a whole-school / university approach to student well-being and mental health

Focusing on transition is necessary but not enough, and discussions around this topic should naturally lead to questions about how schools and universities are keeping their students safe and supporting their well-being generally.

When seeking to answer these questions, professionals are increasingly talking about the importance of a whole-school or whole-university approach, by which people mean taking a holistic view, involving all members of the community from the directors and leaders to the students, and weaving prevention, identification and response throughout the fabric of student life. It involves looking not only at policies and procedures but also at student education, staff and volunteer training, background checks, governance and management systems to name a few.

Arguably the most important and least tangible aspect of this work involves reviewing and strengthening the culture within a school or university, and specifically creating a culture of care or an eco-system in which students and staff support each other and vulnerable students are identified and supported.

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

- Marcus Erooga’s work on Creating Safer Organisations, although focusing on abuse prevention, also contains important lessons about how to create positive and safe cultures within an organisation.


How is CIS supporting its members in this area?

We are leading a project designed to strengthen connections between schools and universities, specifically in the areas of global citizenship, the future of achievement and student well-being.

For student well-being, we are holding our inaugural Student Well-being Workshop in November in Bilbao. We are also 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. We are gathering data from our membership to understand more about the specific challenges that students face and how our members can meet these. 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.


Find out about our new Student Well-being Workshop

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 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

5 Ibid.

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

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