Research suggest that as many as 1 in 4 students are likely to experience mental health problems at some point in their academic career. Many of these will become unwell for the first time whilst at university.

Education and work are key factors in mental health - both as a contributory cause to mental health problems but also as an important part of promoting a person’s sense of well-being, identity and self worth. It is vital that all of us consider people with mental health needs, in order to provide an effective and timely response, and to enable students to continue to participate in all aspects of student life.

From September 2002 the Disability Discrimination Act was extended to higher education. Everyone has a duty to be mindful of the needs of students with disabilities.

As a member of the University population, either as a student or as a member of staff, it is possible that somebody may come to you for help and advice when they are experiencing problems either at university or at home.

This material aims to give a basic outline of some of the issues that may arise. It has been compiled jointly by the University of Exeter’s Disability Resource Centre and Workways, which provides help for people living in Exeter for whom mental health affects finding or staying in learning and work.

What is mental ill health?

Just like physical illness, mental ill health comes in many forms and with many different complaints. Often mental health problems involve feelings of depression, anxiety and confusion – all of which most people experience at some time in their life, especially after a distressing event, such as bereavement or divorce. But with mental health problems, these feelings occur to such an extent or for such a long period of time that they make it difficult for a person to cope with everyday life.

What causes mental health problems?

All of us have certain psychological strengths and weaknesses that are determined by our personalities, previous life experiences and probably some physical characteristics of our nervous systems. Most mental health problems seem to occur as a result of events that happen to us and our difficulty in coping with them at the time.

What causes stress?

In the student population these might include:

	· Feelings of isolation – often people are away from home and their support networks for the first time
	· Relationship difficulties or break down
	· Financial worries and concerns
	· Academic pressures and deadlines e.g. exams
	· Excessive use of drugs and alcohol
	· Problems with accommodation
	· Change, particularly change that is uncertain and unpredictable
	· The individual may have a reduced sense of control and poor understanding of their roles and others’ expectations

Signs of mental ill health

This list is not exhaustive, but indicators of mental ill health include:

	· Withdrawal and social isolation. Established relationships may break down or the person may have difficulty in making new interpersonal relationships. They may display unaccustomed irritability, mood changes or loss of commitment
	· Changes in appearance - for example weight loss, eccentric clothing or make up.
	· Changed sleep pattern - the person may wake early, sleep too little or too much.
	· Reduced productivity, concentration, judgement and motivation - people may work less effectively, have poor time keeping, miss deadlines or make faulty assessments or decisions.
	· Over-activity or apparent changes in mood - the person may be sad, elated, over enthusiastic, over talkative, talk and think in a negative way or be very quiet and withdrawn.
	· Threat of harm to self and others. Some people use self-harm as a way of coping with their distress.
	· Loss of contact with reality – for example confusion and speech content that does not make sense. Hearing and seeing things that are not experienced by others.

Other issues to consider:

	Have others expressed concern about this person?
	· Has the student been presenting in a different way for some time?
	· We all have the odd off day but are the changes ongoing?

A brief guide to mental health conditions

Feelings of depression, anxiety or confusion are normal responses to the ups and downs of modern life. A person is described as experiencing mental health problems when such feelings are so extreme s/he has difficulty carrying on everyday life.

Depression It is commonplace to talk about ‘being depressed’. But depression defined by a doctor as ‘clinical depression’ is a severe version of this. Depression covers a wide range of psychological distress, including lowered mood, making everything harder to do and seem less worthwhile. It can be life-threatening when very severe leading to thoughts of suicide.

Anxiety states These are described as having chronic fear, tension and panic attacks. The condition is defined as an illness when it becomes an individual’s main experience and stops them getting on with everyday activities. Obsessive Compulsive Disorder is a specific form of anxiety state, where people feel they have no control over their thoughts which keep coming back.

Eating disorders Starving to the extent of severe, sometimes life threatening slimness is diagnosed as ‘anorexia nervosa’. Compulsive eating and vomiting is known as ‘bulimia nervosa’. Both behaviour patterns are often a way of coping with psychological or emotional problems.

Psychosis Psychiatrists use the term ‘psychosis’ when someone is unable to distinguish clearly between what is real and what is imaginary, or what is external or internal to their own thought processes.

Schizophrenia The popular understanding of the term, as describing a Jekyll and Hyde split personality, is not true. Doctors use the term ‘schizophrenia’ to describe a state of mind in which people’s sense of their own identity, thoughts and perceptions go beyond the range of normal experience. People who hear voices, for example, or may describe themselves as feeling paranoid (e.g. believe they are being persecuted by other people) may be diagnosed as having schizophrenia.

Bi-Polar Disorder/Manic-depressive illness Some people experience profound changes in their mood, which can switch from depression and lethargy to periods of elation and overactivity. Doctors call this ‘bi-polar’ or ‘manic depression’. Some people may move from depression to elation and back in a week while others may go through this cycle once a year or less often.

How to offer support

Supporting somebody with mental health needs can be a lonely and emotional business. It is important to remember your own needs and your own limitations. It is also important to look after yourself too, consider what other help is available and to refer on to other services.

Here are some general pointers that may be helpful:

	Don’t avoid talking about the situation or pretend nothing is wrong.
	Simply asking somebody if they are all right might provide the opportunity they have been looking for to talk.
	If somebody chooses not to talk or disclose, respect this but give an open invitation to come back to you should they wish to in future.
	If they do disclose ask the person how you can help. Remember to do this in a private space and not when pushed for time.
	Be sensitive and open, listen to the person’s concerns. Do not make judgements or criticize their view.
	If you feel you can offer support be aware of what this might involve and be clear with the person about what you can and cannot offer within the remit of your role.
	Consider your limits and be clear and specific about these. What are your limits in terms of time? Can you offer instant or ongoing support? What happens when you are not around? What do you expect from the other person? What happens if they don’t turn up to an appointment or prearranged meeting? What will you do then?
	Confidentiality is an important issue. The person needs to be made aware that in some circumstances if you believe that they are a danger to themselves or others you will need to break confidentiality and share this information with someone else. Should this happen, try and get the person’s consent first and explain to them why you feel you need to tell someone.
	Avoid giving advice or jumping to solutions, acknowledge the person’s feelings and allow time and space for the person to voice their concerns. Avoid taking responsibility for the other person’s problems. Instead try to be responsive and help them to explore the options and make an informed choice.
	Have an awareness of available help or where to seek further advice.
	Ask the student to identify if there have been any factors that have been helpful or unhelpful in the past.

Supporting someone who’s distressed or angry

Remember there is usually a cause for distressed, angry or aggressive behaviour. It may not be instantly apparent but recognising the cause will be useful in preventing, predicting and managing the situation. Try to listen to what the person says the problem is, even if initially it does not make sense.

Causes of distress may be:

Physical – pain, headache, confusion, silence, sensory deprivation,

Psychological – difficulty in communicating, reduced ability to problem solve, inconsistency of approach or advice.

Social – feeling discriminated against or judged or ignored, some people may feel threatened in busy places or by aspects of the environment.

	· Do not get into an argument with someone who is angry. Stay calm, keep your voice lowered, be aware of using non-threatening body language and talk clearly using simple sentences.
	· Allow the person to have plenty of personal space and allow time for the person to become calmer. Perhaps offer them a drink (non-alcoholic) and a quiet place to sit for a while.
	· Be clear about what help you can offer and about what you feel you need to do in order to help e.g. call the doctor.
	· After the event it is really important that you have the opportunity to discuss what happened and talk things through with someone in a supportive way.

But do remember…

Most of us do our best in these difficult situations. It is easy to look back and blame yourself or others. It may be important to learn from these situations for the future but blaming just leads to greater anxiety and fear that may reduce our ability to cope in future. An awareness of what resources are available may be helpful in facilitating the person in getting the help or advice they require.

You are not expected to solve the person’s problem for them and there may be times when you can not see a way forward, the help you have offered does not seem to be working or you are left feeling worried. At these times, it would be appropriate to consult with staff from support services or to refer the person on to make contact with other services.

Retention and return to study

There a number of ways of enabling support to be put in place to help people start at the University, stay on a course or return to study after a period of time away.

Help in keeping on track with studies and participation in University life might include an assessment for the Disabled Students Allowance, assistance with note taking, a regular meeting with a support worker or mentor, working with problem solving or time management skills, study skills advice or supply and use of equipment to facilitate study.

Disabled Students Allowance and assessments are available through the Disability Resource Centre (DRC) at the Old Library. For further details, please contact the DRC on 01392 263880 or visit www.ex.ac.uk/disability

Sources of support

The stigma attached to mental ill health may prevent people form accessing or seeking help. The student’s GP practice should be contacted with urgent referrals or to gain medical advice and support in a crisis situation (see also ‘Out of hours services’ overleaf). NHS mental health services in Exeter are currently accessed via the G.P. Some useful resources are outlined below.

Streatham Campus:

Student Health Centre, Reed Mews. 01392 676606 or ext 4414

St Luke’s Campus:

The Heavitree Medical Practice, South Lawn Terrace 01392 211511

Student Counselling Service

Reed Hall, Hailey Wing, Streatham Drive 01392 264381

Student Advice Centre

1^st floor, Devonshire House 01392 263520

International Office

Room 167, Northcote House 01392 263041

Nightline - telephone listening service run by students 01392 674000/1

OUT OF HOURS SERVICES

Devon Doctors: on call G.P service out of working hours 01392 824600

NHS Direct 0845 4647

Nurse led telephone help line offering a confidential service with information and advice in relation to physical and mental health. Advisory staff have training in mental health issues and evaluating risk. Available 24/7.

Social Services Emergency Duty Team 0845 6000 388

Operates 5pm to 9am Monday to Thursday; 4pm on Fridays to 9am Monday and on bank holidays.

Chaplaincy 01392 263131 (office) 07739 232455 (mobile)

Available to offer support during the day, out of hours and in the event of a critical incident.

Streatham Campus: Room 217, Amory Building.

St Luke’s Campus: Room 109, Holnicote Building

Links for other religions and faiths: The International Office 01392 263041

Samaritans 0845 790 90 90

To search for other telephone helplines visit www.helplines.org.uk

LOCAL ORGANISATIONS

There are a number of voluntary organisations and other useful links that offer specific support and advice. Visit Exeter University Counselling Service website www.ex.ac.uk/counselling/resources.html

Depression & Anxiety Support Service 01392 259993

Exeter Drugs Project 01392 666711

Hearing Voices Network 01392 204495

MIND Exeter & East Devon 01392 204499

Workways provides information, advice, guidance and practical support relating to learning and work for people with mental health problems. Telephone 01392 208833

Written and compiled by the University of Exeter's Disability Resource Centre & Workways March 2004

Hard copies of booklet in A5 format available from the Disability Resource Centre

Includes material previously published by Berkshire for Mental Health, Lancaster University, MIND Exeter & East Devon, MIND, mind out for mental health, University of Leicester & Workways

Promoting mental health through learning and work