KABIR KHANNA
Dr Michael Spence
President & Provost’s Office
University College London
Gower Street
London WC1E6BT
United Kingdom
Mental Health on Campus: An Investment in Long-Term Mental Health is an Investment in Individual and Institution
Dear Dr Michael Spence,
I write this letter as one of the 40,000 people currently studying at UCL. Over the past two years, I have seen the pandemic wreak havoc on the lives of many of my friends here at university, mentally, physically and emotionally. I was heartened to see UCL join the University Mental Health Charter in July 2021 (UCL, 2021), enshrining student wellbeing at the forefront of the efforts to enhance the university experience. The charter calls for strong ties with local NHS services (Hughes and Spanner, 2019), a policy in line with UCL’s own stepped care approach to in-house mental health support. However, I believe that in its current state, hollowed out by years of austerity (Cummins, 2018) and hamstrung by the effects of the pandemic (Johnson et al., 2021), the NHS is not fulfilling its role in the provision of mental health care to students. Therefore, I urge you to use your power as provost of this university to introduce long-term mental health support here at UCL.
The Cost of Inaction
Over the last two years, we have seen the term “unprecedented times” tossed around ad nauseam. For the NHS mental health services, however, the pandemic represented an escalation of the status quo rather than a re-writing of the script. Before the pandemic, the waiting time to get regular sessions with a therapist was measured in months, not weeks, with one in six patients having to wait more than 90 days (Triggle, 2019). This figure has only grown as demand for mental health services surged during the pandemic, with 23% having to wait more than 3 months (Royal College of Psychiatrists, 2020).
The waitlists obscure real suffering as people struggle to manage their mental health conditions without the requisite interventions. As a peer supporter in the medical school, I’ve seen fellow classmates display their exasperation at the difficulty in receiving mental health support. I’ve seen close friends breaking down, feeling abandoned by the institutions and politicians that claim to care. It breaks my heart to see tasks like getting out of bed and cooking a healthy meal requiring herculean efforts for some of the brightest people I know, let alone fulfilling their immense potential.
Early intervention is a key cornerstone in modern day medicine, and this is no exception when it comes to mental health (Reavley and Jorm, 2009). Everyone who needs mental health support deserves to receive it – it is considered a human right by the UN (OHCHR, 2018). The main alternative to NHS mental health services and other affiliated services is private practice, which is prohibitively expensive for many. Fortunately, the issue of stigma arising from seeking support, whilst a pertinent and very real problem, is improving (Ebert et al., 2019). It is access to support that is the major barrier to mental health progress amongst the student populations (Salaheddin and Mason, 2016), exacerbated by the difficulty in receiving long-term support from the NHS.
This is where UCL can step in. The current strategy of providing short-term mental health support, followed by referrals onwards to the NHS or external services like iCope, is commendable but insufficient. Ethnographic research has found that the presumption that “low-intensity treatment is sufficient… shapes how young people assess their own experiences of distress” (Nichols and Lewington, 2021). When short-term treatment is the only option available, the individual’s perception of their mental illness can be fundamentally re-drawn. As a medical anthropology student, we’ve learnt to contextualise medical issues in the light of larger societal and cultural movements. A central function of anthropology in mental health is the highlighting of “socio-cultural, clinical and familial contexts… regarding emotional distress/mental illness” (Whitley, 2014). When attempted interventions face difficulty, such as in accessing therapy, there is an implicit message from society and those in power that their mental wellbeing is secondary in priority. There is a certain irony here, because although the cause of mental distress may be societal, the experience of it is profoundly individual.
As such, the neglect of people languishing as they wait for treatment is intimately felt, with this message being constantly reinforced throughout the wait, running counter to goals of intervening early. The renowned anthropologist Arthur Kleinman argues that mental illness can impair or severely curtail participation in the “networks of connection that form social life”, which he describes as a fundamental to the structure of the human lifestyle (2009). This incidentally provides an explanation for the challenges of living in a pandemic, when we were wrenched away from our social networks. Those with mental illnesses are more likely to be socially isolated, even before the pandemic (Harvey and Brophy, 2011). This non-participation has significant effects on social lives but, by extension, academic and extra-curricular activities too, with consequences for the success and progress of this university. A mentally healthier population is good for the university – culturally, socially but academically as well. With the NHS unable to address this issue, UCL should step in and fulfil its duty of care towards its students.
Why UCL Should Act
I believe that UCL, with its immense financial, political and academic leverage, is in a position to provide long-term therapy to students. Student Support and Wellbeing (SSW) do excellent work, with a wide variety of services on offer. The six free sessions of counselling are incredibly useful, as I can attest to. That said, people are still struggling with their mental health. The Students’ Union’s 2019 Wellbeing Report found that 11% of new students reported a mental health condition, a value that is thought to be an underestimate (2020). Students’ experiences with mental health are diverse, varying in cause, duration and sensation. The existing stepped-care clinical model, based on “evidence-based treatment of low intensity as a first step” (van Straten et al., 2015), is currently adopted by UCL in its wellbeing guidelines (UCL, 2019) in response to this variation. However, this is based on the assumption that intervention occurs at the start of their mental illness, which is often not the case. Of the new students who declared their mental illness, 95% said that they were experiencing an ongoing condition (Students’ Union UCL, 2020). I’m advocating for this stepped approach to include an additional step, in the form of long-term therapy, to be available to students with longer-term requirements to ensure that they are not left adrift after their six sessions of counselling.
UCL has a chance to become a strong ally of students in the pursuit of a mentally healthier campus. There is an attitude from universities, amongst students at least, that the “university is not a hospital”, as one Canadian student crudely put it (Nichols and Lewington, 2021). With 49% of new students opting not to declare their mental health condition to their university in the UK (UCAS, 2021), there is clearly more to be done to cultivate a “culture that prioritises mental health”, as stated in the goals of the University Mental Health Charter (Hughes and Spanner, 2019). I am not intending to diminish the wonderful work that SSW do, but committing to the provision of long-term therapy sends a rubber-stamped message that UCL really does care about the mental health of their students and is willing to engage with them throughout the duration of their mental health journey.
For many of the students, myself included, the university functions as the heart of our lives here. This obviously includes our academic journeys, but spans the social, romantic and extracurricular facets of our lives as well. However, there is a difference between what goes on at the university setting, and our relationship with the institution itself, especially one the size of UCL. The significance of taking mental healthcare seriously and into the university’s own hands strengthens the bond between institution and student. The ‘UCL Experience’ no longer becomes that of a consumer and provider. It becomes a relationship with a body that offers more than just academic enrichment, but life and health enrichment too. Strong identification with a university has a range of benefits, including higher levels of wellbeing (Bettencourt et al, 1999) and a better adjustment to university life (Amiot et al., 2010), creating a positive feedback loop that encourages a healthy and productive environment on campus.
This becomes an attraction for prospective students. With every one in six children between five and sixteen identified as having a probable mental health condition (NHS, 2021), becoming a leader in compassionate higher education will be an asset to the university. This can work concurrently with the NHS and external support providers. By adding this additional level to the stepped care approach, UCL is there for those who are slipping through the cracks. This would be a remarkable level of care displayed and a message sent to other higher education institutions that student wellbeing is not an afterthought.
The current mental health provision from the NHS is broken. You may not have the power to fix that, but you can protect the students under your care from languishing in a broken system. An Investment in long-term mental health is an investment in individual and institution. I urge you to use your power and put student wellbeing first.
Best wishes,
Kabir Khanna
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