Supporting students with their mental health

Welcome to Priory Bitesize, in which a mental health expert provides insights on mental health conditions to support your patient discussions.

For University Mental Health Day, we spoke to Jenna Sellis, a cognitive behavioural therapist at Priory Wellbeing Centre Birmingham, who discussed with us the mental health challenges faced by students and how they can be supported through this crucial time in their lives.

Supporting students with their mental health

Mental health difficulties are a growing concern amongst students and young people. The National Union of Students discovered that 20% of students consider themselves to have a mental health problem and 13% have suicidal thoughts.

Mental health diagnoses facing students are no different to the types of difficulties seen in later life, but can be exacerbated or triggered by a number of factors in the university setting. These can include:

• First experiences related to being away from home
• Social pressures and isolation
• Relationship problems
• Lack of routine
• Academic pressures

How GPs can help

Students may present at GP surgeries for support with these difficulties. As this is usually the first port of call, it is essential that it is a supportive experience in which the patient can openly discuss their feelings.

There are tools to aid GPs in measuring a patient’s mental health. They can be used as a guide rather than for gaining a definitive diagnosis:

• PHQ-9 questionnaire – a quick measure for low mood
• GAD-7 questionnaire – measures general anxiety
• EDE-Q – a useful measure for eating disorders

What treatment can be offered?

Cognitive behavioural therapy (CBT) provides evidence-based treatment for anxiety disorders and depression. It also has good evidence for the treatment of eating disorders.

Treatment can be given very quickly following referral and patients are often engaged in their first therapy session within a week of referral.

It is important to prevent the problem worsening to an extent where it can become more difficult to treat. It is often easier to treat a mental health problem if the person accesses therapy fairly soon after onset.

Supporting students with their mental health

Jenna Sellis, Cognitive Behavioural Therapist at Priory Wellbeing Centre Birmingham.

During my career as a cognitive behavioural therapist, I have worked with a number of students who have described that their mental health has worsened since starting university. The mental health diagnoses facing students are no different to the types of difficulties seen in later life, but can be exacerbated or triggered by a number of factors in the university setting.

First experiences related to being away from home

Being away from home for the first time brings extra responsibilities, including managing finances, home management and cooking. However, new responsibilities can also trigger or exacerbate certain mental health disorders, which may have been well-managed before university:

• Obsessive compulsive disorder (OCD) – a person who fears contamination may have managed this well at home, where their parents are responsible for cleanliness. Excessive cleaning or hand washing can start at university due to fear of contaminating themselves or others
• Eating disorders – difficulties such as anorexia nervosa, bulimia nervosa and binge eating disorder (BED) can become worse as the student becomes totally responsible for their own eating. Furthermore, not having people close to them observing/mentioning any concerning eating behaviours, can give them freedom to engage in disordered eating

Social pressures and isolation

Isolation can also be a particular problem with students, particularly those with social anxiety difficulties, depression, low self-esteem or confidence.

• More introverted students can find the university setting very intimidating and can become withdrawn
• People with social anxiety can find it more difficult to make friends. The pressures at university to get involved in a variety of different activities can be very overwhelming. Such individuals can become avoidant of social interactions and become at increasing risk of low mood and unhelpful or risky behaviours such as self-harm or drug misuse
• People can misuse drugs or alcohol as a way to feel more able to socialise in groups and to tolerate their anxiety in such situations
• Social pressures such as ‘fitting in’ can play a part in worsening eating disorders. A drive for thinness can be intensified by the desire to fit in, as people feel they will fit in better if they lose weight. This can therefore lead to an increase in restriction of food or purging
• Eating can also become more disordered due to the desire for control, in a phase of life where much can feel out of control

Relationship problems

It is common for people to have their first major relationship at university. This can be a very difficult experience if there are problems in the relationship or it breaks down. It is also common for people to be in a relationship before university and try to maintain a long distance relationship for some time. Any break up at university can be much more difficult, due to being away from close friends and family.

• Depression, anxiety, eating disorders and other difficulties can all be triggered by a relationship breakdown and potential isolation can make this feel worse
• Sexual orientation is often something which is explored more at university and hence, students may begin to suffer with low mood or anxiety around understanding, accepting or coming to terms with their sexuality

Lack of routine

Lack of routine is a further difficulty amongst students. It is common for students to have only a few hours of lectures per day and to lack a structure in terms of their sleep/wake cycle. Students often study in the same room as they sleep which can lead to associations between the bedroom and the stress of studying. The combination of this with a lack of routine can commonly lead to sleep problems. Furthermore, this lack of routine can contribute to low mood.

• One of the main treatments used in CBT for depression is behavioural activation, which encourages routine along with a range of activities, which help to give a sense of pleasure and achievement
• A lack of routine can lead to decreased motivation to do things which can result in a lack of positive reinforcement, increased rumination and isolation

Academic pressures

Academic pressure at university is one of the key factors which can trigger or bring to the surface a mental health problem. Stress can often occur and impact on some students’ functioning.

• It is common for university students to be highly perfectionistic. Perfectionism can sometimes be helpful in achieving highly, however setting unrelenting high standards can cause anxiety and self-criticism
• If goals are not achieved, higher ones are typically set and students can then be at risk of high stress levels as they cannot achieve a work/life balance. This can lead to burnout

How GPs can help

Students may present at GP surgeries for support with the above difficulties. There are tools to aid GPs in measuring a patient’s mental health. They can be used as a guide rather than for gaining a definitive diagnosis:

• PHQ-9 questionnaire – a quick measure for low mood
• GAD-7 questionnaire – measures general anxiety
• EDE-Q – a useful measure for eating disorders

In terms of the PHQ-9, I have known people to score high on this but there can be an underlying physical reason. Therefore, these questionnaires should be used to give further information, rather than be the sole assessment of a mental health problem. For eating disorders, the EDE-Q can be a useful measure. This assesses symptoms such as fear of weight gain, drive for thinness and behaviours such as restriction and bingeing/purging.

What can be done?

If a patient is suffering from a mental health difficulty, there are a lot of benefits that can be achieved from psychological therapy.

• CBT provides evidence-based treatment for depression and anxiety disorders. It also has good evidence for the treatment of eating disorders. It is often easier to treat a mental health problem if the person accesses therapy fairly soon after onset
• CBT is one of the most commonly used treatments at Priory, due to its evidence base and the use of National Institute for Health and Care Excellence (NICE) guidance for depression and anxiety. Treatment can be given very quickly following referral and patients are often engaged in their first therapy session within a week of referral. This prevents the problem worsening to an extent where it can become more difficult to treat
• CBT would focus on helping patients understand what maintains their problem and to begin to make small changes to their thoughts and behaviours. It is a very structured and goal-oriented therapy and patients will be set tasks to do outside of the sessions. Typically, CBT sessions last for one hour and are offered on a weekly basis
• Counselling can also be a useful treatment which can help move people towards acceptance of difficulties which are either out of their control or cannot be changed. For instance, difficulties such as bereavement, relationship problems and acceptance of sexual orientation can be worked with in counselling
• Eye movement desensitisation and re-processing (EMDR) is a further treatment which can be offered. This would most commonly be used for post-traumatic stress disorder (PTSD) but can also be used for the other diagnoses

Priory has a nationwide network of hospitals and wellbeing centres that are well placed to support your patients and offer fast access to therapy.