Overburdened and underfunded: The mental health crisis at Britain’s universities
In the first rankings of its kind, The Tab shines a light on institutions failing their students
Rebecca* was just weeks into her first term at the University of Glasgow when her mental health began to suffer. She was sent to the university’s counselling service in October 2014 by her university GP. She had been self-harming and was admitted to hospital almost every week.
“They sent me to the Counselling Service but I was told that there was a good chance I wouldn’t get a place as I wasn’t ‘ill enough’. Some days I was too ill to go into university and my advisor of studies basically thought I was making it up. It made me feel like he wanted proof that I wasn’t simply skiving like freshers sometimes do.
“In November, I was a little impromptu with him – when I spoke to him, I still had my fresh scars and bandages. Showing them to him soon changed his mind.”
Rebecca never went back to counselling – turned off by the attitude and the lack of support. British universities have a legal duty of care for their students. It’s why we have personal tutors to guide us through university, and it’s also why universities provide some level of mental health care. It’s also why Rebecca was able to turn to someone she could talk to independently and confidentially.
But Rebecca’s experience is the sad product of a decision every counselling service across the country has to make each day – does this person need our help as much or more than everyone else who applied? University counselling services are seeing unprecedented levels of demand. Tens of thousands of students are applying each year, often in desperate need of help, often directed to their university services by the overwhelmed NHS. Universities spend millions to cope, but all too often they have to prioritise cases, and this means turning away individuals who need help.
Where did it all go wrong?
12,000 people answered our survey on mental health in March this year. Through these results and data gathered through requests under the Freedom of Information Act, we have compiled this data to build the biggest mental health ranking of its kind. We have tried to investigate the epidemic unravelling at British universities in these rankings. The study is also published today in co-operation with the Sunday Times and their Young Minds campaign.
Mental health is being bumped up the priority list, but is it too late to recognise what can only be described as a problem of epidemic proportions? Can universities keep up?
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The table above shows 30 universities who responded and gave us data – the list of universities who refused is too big to include here. Those at the top are doing the best job at dealing with mental health, down to those doing the worst. This is based on several factors: how satisfied students are with the service, how much investment the service receives, and the universities’ outreach – this is how well used the service and how approachable students find it. It shows Kent at the top of the table, whereas York are at the bottom. You can find a more detailed explanation of the rankings here.
Of those who responded to our survey, 5,500 said they had a mental health problem. At the University of East Anglia, 51 per cent of respondents said they had depression. In 2011/12, an average of 892 students applied for counselling at each university, according to available figures. The most recent figures show that shooting up to 1,330.
Spending on mental health has increased by about 36 per cent across the board – yet that doesn’t reflect the reality of the changes. Demand for counselling at Cardiff and Birmingham more than doubled over five years, yet their counselling budgets have increased by only 20 and 32 per cent respectively in the same timeframe. Nationally, the money spent per student who seeks counselling has plummeted from over £415 to £344, even though universities are investing more. Essentially, the demand is outweighing the money being made available.
At Cardiff, demand for counselling sessions more than doubled from 1,131 in 2011/12, to nearly 2,500 this year. Our data shows that demand has increased over 40 per cent in just five years, but Edinburgh has seen an increase of nearly 90 per cent, and Birmingham of over 130 per cent. The Office for National Statistics has reported that student suicides are at a national high – up from 100 in 2013, to 134 in 2015. One in eight undergraduates is reporting a mental health condition of some kind, according to a new survey by YouGov and YouthSight.
But applying for help is only the first step. There are stories of students harming themselves, or committing suicide while they wait for an appointment. Some have waited for up to 10 months but the national average is 25 days. Glasgow’s average waiting time between assessment appointment and actual counselling appointment is 85 days. While Glasgow has nearly doubled their counselling budget since 2011/12, their previous spending – just £10 per student – was so insignificant that the university is still playing catch up.
Even when those in need do get care, it’s not always good quality. From our survey, we found 38 per cent of students speak positively about their experiences – but almost half weren’t satisfied with their treatment.
Jeremy Christey, who is the Project Director of Students Against Depression and works in the University of Sussex’s counselling service, explains: “Services have two priorities – they have to treat as many people as they can in a timely fashion for each individual, which involves assessing what people need, and they will also have to triage and offer more complex and acute support for a smaller proportion of individuals.
“All services work as hard as possible to keep their waiting lists down, but even the best services sometimes get surprised by sudden surges in demand. Different services operate in different ways, but it can be about mitigation and making sure people are seen in as few weeks as possible.”
For Rebecca at Glasgow, she can’t help but laugh: “I always end up laughing just at the sheer amazement that someone has got to actually see a counsellor. I’d tell them to take it in their stride as I’m sure it’s a great service, but maybe look into other places to go just in case they have to reapply – as they’ll be placed at the back of the queue again.”
A Glasgow spokesperson defended the service, highlighting how cases are fast-tracked, more students are seen, and the service is now award-winning. They say “welfare is one of the highest priorities” and that significant improvements have been made and students are aware of the options open to them.
It’s not just Glasgow
Services under pressure and on tight budgets are forced to prioritise – and as they do this, more and more students are being turned away or put off by the admin and insensitivity. Meg was struggling with depression and anxiety in her first term studying Politics at Birmingham, and went to see the counselling service after being referred by her doctor. There, she was told that her anti-depressant prescription wasn’t enough to qualify her for support and counselling, and she would need an official note from her doctor. After having to pay for her note, she sent it through to the counselling service, having been promised a response within the week. She never received a response. Birmingham say they have a variety of help at hand and they work hard to raise awareness and “lessen the stigma of mental health issues”.
Sophie pitched up to Goldsmiths’ counselling system earlier this year, preparing to talk about something she had never spoken about before, not to her friends, not even to her family: how she was raped.
“The counsellor asked me to describe the circumstances of my rape in some detail. They asked if I thought my sexuality [Sophie is gay] was due to my rape as a young adult. They also referred to my girlfriend as my boyfriend on one occasion. In retrospect I find both these things highly offensive, but at the time they just shook me and upset me.”
At the end of the session, Sophie was told that her counselling service could no longer help. “They could not offer me any support, as the maximum was five sessions and I clearly needed a lot more than that. They gave me a leaflet about childhood sexual violence – I was raped as an adult.” Goldsmiths wouldn’t comment on the case but said all their staff were highly trained and they work closely with the NHS to ensure students receive the help they need.
Cases of universities letting down students in need, or dealing with them insensitively, are far too common. Tutors might not be trained, but they often don’t know how to deal with students under pressure. Hayley was told to “do better” when her tutor at Nottingham heard how she was struggling. But what if someone’s mental health issues are so bad they try to take their own life. Are universities equipped to deal with someone who is ready to commit suicide?
One girl we spoke to went to York’s service feeling suicidal. She was told that as she hadn’t attempted suicide yet, she wasn’t worth their time. She said: “They pretty much said come back if you actually try and kill yourself.” She later ended up in hospital. York University said students should have access to quality services and they’re working with the NHS to achieve this. After our investigation, they have since invested £500,000 into their counselling service. In the financial year 2014/15, the university made £18million in profit.
It’s not just the counselling services that matter – students are often navigating healthcare services independently for the very first time, making them more vulnerable than they might already be. Tim* is at Nottingham and has struggled with depression, drug abuse and has attempted suicide. He didn’t know who to turn to: “It can feel very distant and often unclear about which route to take whether through the campus healthcare system or through other counselling systems. The biggest problem is knowing who to approach.”
What can be done?
For their part, universities say they are doing the best they can. When we contacted every university in the ranking, most said they offer a range of services and their counsellors are all highly trained. But the reality is that they’re stretched, overburdened and underfunded.
While getting the government to properly fund mental health care would be a start, the situation is unlikely to change soon. The reality is that university services will and should continue to support vulnerable students as best they can. A recent report by the Higher Education Policy Institute suggests allowing students to dual-register with GPs would allow them to receive consistent care over the summer and other holidays. The same report recommended counselling fundings be tripled across the board.
While throwing money at the problem isn’t a remedy, it’s crucial that mental health services get the funding they need. Christey of Students Against Depression says that mental health services are key investments: “Universities aren’t short of cash – we need to see more of that being directed towards embedded counselling services. They’re worth investing in, as it’s not only important for helping students to study, but universities gain from it too, studying is more effective, results increase and good management of mental health can benefit league table positions and ultimately the bottom line of the universities, as well as providing transferable skills to take to employment.
“There’s a move nationally to involve the entirety of the university in all aspects of student life, including mental health. This is not about making students feel fragile or mollycoddled, but helping people recognise their own resilience and to stand up to difficulties that they face. Part of the university-wide approach to mental health will include helping friends, academics helping students and everyone being able to acknowledge and manage difficulties and provide consistent signposting, identifying problems early, so universities can help students cope as realistically as possible.”
The head of the Brunel University counselling service estimates that she saves her university over £2.5 million a year from lost fees from students who drop out. Universities are multi million pound institutions, but throwing money at the problem isn’t the solution. Some universities are taking the right steps – Kent and UCL have both invested significant amounts over the past five years. However, as Christey says, it’s about institutionalising both a sympathetic and robust response to mental health issues at universities that’s not just the responsibility of the counsellors, but of tutors, lecturers and anyone involved in the student body.
Depression is the topic du jour of university life, and everyone knows someone who has experienced mental health issues – but few know how to deal with it. For some, it’s too late. Student suicides reached a historic high this year. Quite simply, people are dying. For others, they’re just doing the best they can to get on with their lives.
Meg never received a response – fortunately she’s now happy and relaxed, as her medication eventually kicked in, but when Meg needed help, it wasn’t there. Sophie* at Goldsmith’s still feels angry and betrayed: “It was a long time before I felt able to seek any kind of support again. I felt very violated and angered that I had given this counsellor so much personal information about myself, and not given any choice about it. I opened up in a way I never had before, leaving myself very vulnerable, and then was abruptly turned away.”
All the universities contacted refused to discuss individual cases, but asked those concerned to come forward.
Names have been changed, and quotes have been condensed and edited for clarity.
To see how we compiled the rankings, click here.