Half of all young people in the UK are now going to university – where the media tells us there is a growing mental health crisis. Is this a major public health issue? Here’s an alternative perspective.  

Heartbreak Hotel – what has changed?

Elvis Presley released Heartbreak Hotel in 1956. His song of youthful heartbreak went on to sell over a million records. However, if Heartbreak Hotel were released today it would probably be seen as a classic example of mental distress:

  • Heartbreak following a relationship breakup – tick
  • Loneliness and social isolation – tick
  • Possible suicidal thoughts – tick

So, what has changed that leads so many people to now perceive negative feelings and emotions as ‘mental distress?’ And why is this seen as a particular issue for university students? 

Mental distress

The first point to make is that rates of diagnosed mental health conditions among young people in the UK have remained relatively stable. The small reported increase coincides with an expansion of the ways ‘generalised anxiety disorder’ and ‘major depressive disorder’ have been defined. As a result, some people who wouldn’t previously have been diagnosed with a mental health condition are now being included. This follows publication of DSM-5 (the diagnostic bible for mental health professionals) by the American Psychiatric Association in 2013. As the NHS reported, DSM – 5 was criticised at the time for an increasing tendency to ‘medicalise’ patterns of behaviour and mood that are not considered to be particularly extreme. In fact, even before, as an article in the BMJ that year observed, depression had become more likely to be overdiagnosed than underdiagnosed in primary care.

This suggests that what has changed is definitions, rather than actual levels of mental illness, although there is some data suggesting that general levels of well-being and happiness in the country as a whole are decreasing.

What has increased is ‘mental distress’ i.e. self-reported mental health problems which have not been clinically diagnosed. This includes a range of negative feelings and emotions that might previously have been viewed as normal responses to the challenges everyday life can sometimes throw up – such as feeling stressed, anxious, panicky, worried, lonely, unsupported, overwhelmed, having problems sleeping or afraid of being judged.

It is mental distress we’re focusing on in this blog. 

Shouldn’t students be at lower risk?

One of the reasons we began researching student mental distress is that the media have reported a significant increase in recent years, yet students don’t fit the usual profile for mental health conditions. The risk is greater where children have experienced neglect or abuse or have grown up in dysfunctional families (including having parents with alcohol or drug dependency). In practice, despite initiatives to widen access, most university students are still coming from caring middle class families. As the Mental Health Foundation reported in 2015, there’s a significantly greater prevalence of mental health problems in children whose parent had no educational qualification compared to those with a degree level qualification. This suggests that, in general, university students have a below average risk of mental health conditions.

This doesn’t mean that university students are immune from diagnosed mental health conditions. Some will be coming to university with pre-existing conditions and some will develop mental health conditions while at university. In either case they need access to prompt treatment and support. What is at issue is the prevailing narrative of a growing mental health crisis among university students.

It is also worth noting that even where students are coming from disadvantaged backgrounds this doesn’t necessarily increase risk. As the Head of Counselling at a London university explained, ‘It isn’t necessarily the students you would expect, for instance not necessarily those theoretically vulnerable, perhaps because they have had to deal with problems before’. We also know, from the Office for National Statistics, that university students have a lower suicide rate than 18 – 24 year olds who don’t go to university. However, this fact has been obscured by media reports which suggest there is now a higher suicide rate for students - without explaining this is the figure for all students, including College students, as opposed to university students in particular.

So, how can we explain this increase in self-reported mental distress among students who have a below average risk of being diagnosed with a mental health condition? 

Might overprotective parents be a factor?

Might changes in parenting have made a difference? We know that poor parenting (neglecting or abusing children) increases the risk of mental health conditions. However, might excessive parenting, hovering over your children to protect them from any possible challenge (what American researchers have dubbed ‘helicopter parenting’) increase the risk of mental distress? This hasn’t been studied much in the UK but it has in the US. There, most research suggests helicopter parenting has harmful psychological effects. These include increased emotional problems; increased levels of anxiety, stress, depression and life satisfaction; neuroticism; dependency; sense of entitlement (the extent to which young adults believe others should solve their problems); and poorer coping skills.

Meanwhile, here in the UK, one Head Teacher we spoke with commented, ‘I’ve really noticed a change in parenting in recent years…They can be unwilling to let their children grow up.’ While a Healthy University Project Coordinator in Scotland noted, ‘reliance on parents until they leave home, for even the most basic things.’

Examples of helicopter parenting reported by schools include:

  • Regularly contesting their children’s grades throughout the year.
  • Explaining away late or uncompleted homework.
  • Blaming poor teaching for their children’s lack of focus or success.
  • Intervening constantly in friendship issues, expecting the school to mediate issues.
  • Editing or even writing their children’s homework.
  • Paying for tutors to help them understand and help with their children’s homework.
  • Monitoring phone calls, checking text messages and initiating communication several times a day to ‘check in’ on their children.

That this might increase the risk of mental distress is probably logical. As the children’s charity Barnardo’s reported as early as 2002, the more western countries have sought to protect children from harm, the less resilient and prone to psycho social ill health they have become. Coping skills are developed by experiencing and overcoming challenges. So, if those challenges are removed by parents then coping skills are presumably also reduced. Where parents are a constant buffer between their children and the outside world, children have less opportunity to experience cause and effect and to take on responsibility. They are also less likely to believe that anything might be their fault. Conversely, if they have never been allowed to experience and learn from failure they may find the prospect of failure particularly stressful. The growth of a safeguarding culture in the UK, while well intentioned, may be exacerbating the problem. It may also be leading to social pressure on parents to protect their children from all possible risks. One Head Teacher, for instance, reported that when she allowed her own children, aged eight and nine, to walk together to the corner shop without her, she was described by some of her friends as ‘feckless’. 

Are we medicalising feelings and emotions?

The way everyday language has evolved, may also be a factor here. For instance, performers used to talk about stage fright without this being seen as a mental health issue. Today, celebrity performers tend to talk instead about having an anxiety disorder and explicitly refer to it as a mental health issue. Again, for centuries it was seen as normal for people to sometimes feel sad or to grieve following a bereavement. Now, feeling sad and grieving following a bereavement may be diagnosed as symptoms of depression.

As Professor Frank Furedi commented in the Times Educational Supplement (TES) in 2016, 'Children have become socialised into interpreting their experience through the language of mental health deficits. That is why, unlike children who went to school 30 to 40 years ago, today's pupils readily communicate their problems through a psychological vocabulary and use words like "stress", "trauma" or "depression" to describe their feelings. Through medicalising children’s normal emotional upheavals, young people are trained to regard the challenges integral to growing up as a source of psychological distress.’

A further factor here is that a majority of university students are now female and female students are more likely to interpret feelings and emotions in psychological terms (as seen, for instance, by the fact that 80% of Psychology students are female, the biggest gender weighting for female students other than nursing). The mental health campaigner Natasha Devon has also observed, ‘Your chances of being able to speak about your mental health without being ostracised or judged are still much higher if you’re white, female and middle class (it’s for this reason that middle class girls consistently rank highest in polls about anxiety and depression - it’s not that they’re afflicted more, I don’t believe, they simply have more freedom to discuss it and are more likely to be heard and given a compassionate response when they do).  

The risk is heightened where students dramatize for effect, for example seeing it, as Professor Kathryn Ecclestone describes it, ‘as a badge of pride, a form of competitive identity, to say you are more stressed and anxious than anyone else.’ It is further heightened through emotional contagion. One university tutor described how, in her Hall of Residence, the number of panic attacks reported rose from 5 to 15 to 60 in just three years. It seems unlikely that objective reasons for panic would have risen twelve-fold in one university location in just three years. 

Normal human development?

Our brains are still developing until we’re in our mid twenties. As we go through adolescence and seek to develop our own individual identities we face a range of challenges (biological, social and psychological) in making a successful transition to adulthood. And there’s usually a fair amount of trial and error along the way. This is a normal developmental process for us as human beings. However, a combination of the pressure this places on adolescents and the increasing tendency to medicalise normal feelings and emotions may lead this normal developmental process to be interpreted as mental distress. 

Social Media

A further factor is the impact of social media, a relatively recent phenomenon, widely used by young people in particular and seen as beneficial by many. However, there can be potentially negative effects on mental health. In addition to malicious use of social media, for instance to bully, troll or harass, there are more subtle but potentially harmful effects for mental well being:

  • Encouraging a false sense of what everyone else is doing, which can undermine self-confidence. As a Clinical Psychologist observed, ‘a female student may come, saying, “all my friends are happy,” when you know some of their friends are also seeking help’.
  • Presenting an unrealistic visual picture of what it is like to be a young woman that can be mentally damaging – encouraging an unhealthy focus on body image; the need to create and curate their appearance online and then the exhausting process of keeping up that appearance; and the risk of eating disorders (as well as information on social media making it easier to hide eating disorders and self-harm). 

A 2019 study in the USA concluded, ‘there has been an increase in smartphone use, which has been found to be associated with lower grades, alcohol use disorders, anxiety and depression.’ 

This perhaps explains why the American researcher, Jean Twenge, who has been researching intergenerational differences for over 20 years, concludes, ‘There is compelling evidence that the devices we’re placing in young people’s hands are having profound effects on their lives – and making them seriously unhappy.’ She also observes that, in part because young people are spending more time on screen at home rather than out with friends, across a range of behaviours - drinking, dating, spending time unsupervised - 18-year-olds now act more like 15-year-olds used to. Because of social media, are today’s undergraduates less independent and equipped with coping skills than their predecessors? If so, this might also help explain the significant reported increase in student mental distress (stress, anxiety, panic, worry, loneliness, feeling unsupported and overwhelmed). 

Heartbreak Hotel revisited?

For centuries negative feelings and emotions have been a staple of literature and popular music and the adolescent years have been a time of challenge and development. Loneliness, for instance, was an issue for fictional characters from Jane Eyre (‘The trouble is not that I am single and likely to stay single but that I am lonely and likely to stay lonely.’) to Huckleberry Finn ('I felt so lonesome I most wished I was dead.’) However, it is only relatively recently that these negative feelings and emotions have been interpreted and reported as ‘mental distress.’ 

This has coincided with the rise of helicopter parenting and the potentially distorting effects of social media, which have combined to reduce the resilience and coping skills of young people. As a result, university students, the young people least likely to be at risk of mental health conditions have paradoxically become the most likely to report suffering from various forms of mental distress.

Fortunately, as we begin to understand the causes of 'mental distress' we become better placed to reverse the trend - and we'll be exploring in future blogs how this might be achieved, including the value of helping those young people whom some Harvard academics now describe as 'failure deprived' to experience and learn from failure, whether in their academic work or in their relationships.

 

Michael Baber and Nikita Sinclair   January 2020 

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