Student mental health across Europe: towards a public mental health approach
The emotional health of students in Europe is receiving increased attention. Here, Valérie Van Hees and Ronny Bruffaerts reflect on the existing European landscape and introduce a new project to support the implementation of sustainable policies across the EHEA.
Why prioritise student mental health?
Attending university can be stressful and involve significant lifestyle changes: adjusting to the demands of a new learning environment, interacting with a diverse range of new people and environments, and (coping with) being away from trusted support networks. Although sixty per cent of students navigate higher education without emotional problems, forty per cent experience mental health issues, and approximately one in five struggles with mental disorders. Manifestations such as binge drinking, eating disorders, and non-suicidal self-injury have steadily increased in recent years, suggesting that public authorities need to take bold action to prevent and treat students’ mental ill-health more effectively.
Indeed, at the Rome 2020 Ministerial Conference education ministers across the European Higher Education Area (EHEA) endorsed the “Principles and Guidelines to Strengthen the Social Dimension of Higher Education in the EHEA”. They thereby committed to develop policies enabling higher education institutions to ensure effective counselling and guidance, taking into account the specific needs of disadvantaged, under-represented and vulnerable students.
What is the situation across Europe regarding psychological counselling?
Although student mental health is receiving more attention, the impact of counselling is an under-researched area at European level. This is related to the complex range of very different guidance and counselling systems, as well as to the failure to prioritise mental well-being in general. The Eurydice report “Towards equity and inclusion in higher education in Europe” highlights that only around half of EHEA countries have a top-level legal requirement to provide psychological counselling services. In most countries, higher education institutions are the main providers. In 14 countries public authorities deliver these services, and in Belgium’s German-speaking Community, Denmark, Germany, and Slovakia they are the sole provider.
In most countries where public authorities provide psychological counselling, this happens in response to legal requirements. The exception is Germany, where services are organised by publicly funded student support organisations. Only a few jurisdictions, such as Belgium’s Flemish Community, Ireland, the Netherlands, and the UK, pursue specific national strategies or frameworks for the prevention and treatment of students’ mental health problems.
The quest for new approaches and treatments
Even in countries where counselling services and effective clinical interventions are widely available, the most crucial point is often overlooked: the vast majority of students with clinically significant mental disorders and suicidal thoughts go untreated because they do not believe that they need treatment. Other barriers include pressure of study workload and the fear of being stigmatised. Only between one fifth and one quarter of students effectively seek professional help for their emotional problems. Most students choose to deal with their problems on their own. Even so, counselling services are coming under increased pressure.
In this context, national authorities and universities should reflect upon current approaches and consider new ways of reaching vulnerable students. There is increasing evidence that courses of internet-based treatment, billed as self-help approaches and accessed privately, are more acceptable to students who are reluctant to seek help. In addition, international studies conclusively show that students who feel a sense of belonging to their institution and who maintain good relationships with tutors, lecturers and fellow students, are half as likely to suffer emotional problems. They tend to be more motivated and perform better academically.
A public mental health perspective for students
Against this background, the Flemish Community (Belgium) has rolled out a specific and sustainable student mental health strategy which takes a public mental health perspective as its starting point. The approach proceeds from scientific epidemiological data on the needs at the level of the whole student population and addresses both occurrence (prevalence) and prevention of mental health problems. Such an approach shifts the focus from high-risk students and mental disorders to the emotional health of the entire student population, and, accordingly, interventions that can improve the resilience of all students. Improving psychological resilience of the broad student population will as such decrease the number of students that progress to mental disorders when confronted with internal or external stresses. Such enhanced resilience skills act as a psychological safety net when students are confronted with exceptional risk factors, such as the Covid-19 pandemic.
The new policy has several strengths. Cross-sectional and longitudinal monitoring of students’ mental health is already undertaken through the WHO World Mental Health International College Student (WMH-ICS) initiative. A wide range of low-threshold e-health interventions free of charge to (international) students is available on the online MoodSpace platform. Going beyond these, the Flemish policy helps universities adopt a more proactive, preventive approach. Students are actively involved in the development and evaluation of interventions and policy implementation.
What’s next?
A new project, “Peer Learning Activities and Resources to Underpin the Principles and Guidelines for Social Dimension across the European Higher Education Area (EHEA)”, sets out – in cooperation with the Bologna Working Group on the Social Dimension – the organisation of peer-learning activities to deepen and sustain the exchange of good practices between EHEA countries at different stages of policy implementation. Based on identified needs, and working from a public mental health perspective, this project will develop a comprehensive action framework including a self-assessment tool and guidelines to support sustainable mental health strategies at national and institutional levels. In addition, the development of a central web portal on financial assistance and psychological counselling services will enable a Europe-wide network of cooperation, staff training and information-sharing.
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All views expressed in these articles are those of the authors and do not necessarily reflect those of EUA.
