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Osborn TG, Town R, Bawendi M, Stapley E, Saunders R, Fonagy P. University students' access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England. J Health Serv Res Policy 2024; 29:230-239. [PMID: 38414282 PMCID: PMC11346130 DOI: 10.1177/13558196241235877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. METHODS We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy - that is, how different needs are deemed deserving of health service attention - was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. RESULTS Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. CONCLUSIONS Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources.
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Affiliation(s)
- Tom G Osborn
- ARC Research Assistant, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rosa Town
- Digital Community Manager, The Tavistock and Portman NHS Foundation Trust, London, UK
| | - Majeed Bawendi
- MBBS Student, UCL Medical School, University College London, London, UK
| | - Emily Stapley
- Senior Research Fellow, Evidence Based Practice Unit, University College London, London, UK
| | - Rob Saunders
- Associate Professor, CORE Data Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Professor, Division of Psychology and Language Sciences, University College London, London, UK
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Tickell A, Fonagy P, Hajdú K, Obradović S, Pilling S. 'Am I really the priority here?': help-seeking experiences of university students who self-harmed. BJPsych Open 2024; 10:e40. [PMID: 38297500 PMCID: PMC10897682 DOI: 10.1192/bjo.2023.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Self-harm is a significant problem in university students because of its association with emotional distress, physical harm, broader mental health issues and potential suicidality. Research suggests that fewer than half of students who have self-harmed seek professional help when at university. AIMS This study aimed to explore the help-seeking journeys of university students who had engaged in self-harm, to identify perceived facilitators and barriers to securing both formal and informal support. METHOD Participants comprised 12 students who had self-harmed during their university tenure. Engaging in two semi-structured interviews over the academic year, they shared insights into their help-seeking behaviours and proposed enhancements to local services. Data underwent reflexive thematic analysis within a critical realist framework. RESULTS The analysis identified four themes: 'The initial university phase poses the greatest challenge', 'Perceived criteria for "valid" mental health problems', 'Evading external judgements, concerns and consequences' and 'The pivotal role of treatment options and flexibility in recovery'. CONCLUSIONS Students felt isolated and misunderstood, which amplified self-harming tendencies and diminished inclinations for help-seeking. A prevalent belief was that for self-harm to be deemed 'valid', it must manifest with a certain severity; however, concurrent fears existed around the ramifications of perceived excessive severity. Participants expressed a desire for streamlined pathways to mental health resources, encompassing both university and external mental health services. Insights from this study could guide future research and inform current service paradigms within academic and healthcare systems.
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Affiliation(s)
- Alice Tickell
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Katalin Hajdú
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Sandra Obradović
- School of Psychology and Counselling, Faculty of Arts and Social Sciences, The Open University, UK
| | - Stephen Pilling
- Department of Clinical, Educational and Health Psychology, University College London, UK
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Berry C, Phelan E, Michelson D. " Weird duality": learning from the experiences of students in university peer support roles during the COVID-19 pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37856416 DOI: 10.1080/07448481.2023.2253921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2023] [Indexed: 10/21/2023]
Abstract
Objectives: To explore university student peer supporter experiences in the pandemic context and with a specific focus on student mental health. Participants: The sample comprised 13 students from various peer support programs, providing academic, social and/or emotional support at a South-East England university. Methods: A two-phase qualitative design involved individual interviews and focus groups, followed by participant validation with a subset of participants. Results: Peer supporters identified an increased need peri-pandemic for mental health support. The accessibility was aided by students perceiving peer supporters to be approachable, but was undermined by concerns about peers' credibility. Supporter-supportee relationships were characterized by intimacy and mutuality, which were seen as conducive to authenticity, but caused challenges with respect to boundaries. Conclusions: Peer support is a complex activity, characterized by a sense of multiplicity and mutuality. Responsive supervision and dedicated training are necessary to manage these complexities amidst elevated student mental health needs.
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Affiliation(s)
- Clio Berry
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Emma Phelan
- School of Psychology, University of Sussex, Brighton, UK
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Osborn TG, Li S, Saunders R, Fonagy P. University students' use of mental health services: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:57. [PMID: 36527036 PMCID: PMC9758037 DOI: 10.1186/s13033-022-00569-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND International estimates suggest around a third of students arrives at university with symptoms indicative of a common mental disorder, many in late adolescence at a developmentally high-risk period for the emergence of mental disorder. Universities, as settings, represent an opportunity to contribute to the improvement of population mental health. We sought to understand what is known about the management of student mental health, and asked: (1) What proportion of students use mental health services when experiencing psychological distress? (2) Does use by students differ across health service types? METHODS A systematic review was conducted following PRISMA guidelines using a Context, Condition, Population framework (CoCoPop) with a protocol preregistered on Prospero (CRD42021238273). Electronic database searches in Medline, Embase, PsycINFO, ERIC and CINAHL Plus, key authors were contacted, citation searches were conducted, and the reference list of the WHO World Mental Health International College Student Initiative (WMH-ICS) was searched. Data extraction was performed using a pre-defined framework, and quality appraisal using the Joanna Briggs Institute tool. Data were synthesised narratively and meta-analyses at both the study and estimate level. RESULTS 7789 records were identified through the search strategies, with a total of 44 studies meeting inclusion criteria. The majority of included studies from the USA (n = 36), with remaining studies from Bangladesh, Brazil, Canada, China, Ethiopia and Italy. Overall, studies contained 123 estimates of mental health service use associated with a heterogeneous range of services, taking highly variable numbers of students across a variety of settings. DISCUSSION This is the first systematic quantitative survey of student mental health service use. The empirical literature to date is very limited in terms of a small number of international studies outside of the USA; studies of how services link together, and of student access. The significant variation we found in the proportions of students using services within and between studies across different settings and populations suggests the current services described in the literature are not meeting the needs of all students.
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Affiliation(s)
- T G Osborn
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, UCL, 26 Bedford Way, London, WC1H 0AP, UK.
| | - S Li
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, UCL, 26 Bedford Way, London, WC1H 0AP, UK
| | - R Saunders
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, UCL, 26 Bedford Way, London, WC1H 0AP, UK
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - P Fonagy
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, UCL, 26 Bedford Way, London, WC1H 0AP, UK
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Barnett P, Saunders R, Buckman JEJ, Cardoso A, Cirkovic M, Leibowitz J, Main N, Naqvi SA, Singh S, Stott J, Varsani L, Wheatly J, Pilling S. Are students less likely to respond to routinely delivered psychological treatment? A retrospective cohort analysis. Compr Psychiatry 2022; 119:152348. [PMID: 36191389 PMCID: PMC9760567 DOI: 10.1016/j.comppsych.2022.152348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Depression and anxiety disorders are increasingly prevalent among university students, making the provision of effective treatment in this population a priority. Whilst campus-based services provide some psychological treatments, many students are treated by routine adult psychological treatment services which have no focus or adaptations to treatment for student populations. We aimed to compare psychological treatment outcomes between university students and young adults (aged 18-25) in employment to explore whether routinely delivered psychological interventions are equally effective for these groups, or whether students report poorer outcomes. METHODS A retrospective cohort was formed of 19,707 patients treated by eight National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) services in England. Associations between student status (compared to same-age employed adults) and psychological treatment outcomes were explored using logistic regression models. Models were adjusted for important treatment, clinical and demographic characteristics, and propensity score matching was used to explore the robustness of effects. RESULTS Students and the employed comparison group were similar on baseline characteristics at assessment, but students were less likely to reliably recover (OR = 0.90 [95% CI = 0.83;0.96]) and reliably improve (OR = 0.91 [95% CI = 0.84;0.98]) by the end of treatment in fully adjusted models. Students and the employed group did not differ regarding the likelihood of deterioration (OR = 0.89 [95% CI = 0.78;1.02]) or treatment dropout (OR = 1.01 [95% CI = 0.93;1.11]). CONCLUSIONS Students appear at risk of poorer outcomes compared to employed younger adults when treated in routine psychological treatment services. Students may require additional support and treatment adaptations that account for student-specific stressors as this might improve psychological treatment outcomes.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK; iCope - Camden & Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Ana Cardoso
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Mirko Cirkovic
- Talk Changes: City & Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Judy Leibowitz
- iCope - Camden & Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Nicole Main
- Let's Talk IAPT-Barnet, Enfield & Haringey Psychological Therapies Service, Barnet, Enfield & Haringey Mental Health Trust, London, UK
| | - Syed A Naqvi
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Satwant Singh
- Waltham Forest Talking Therapies-North East London Foundation Trust, Thorne House, London E11 4HU, UK
| | - Joshua Stott
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK; Ageing, Dementia And Psychological Therapies (ADAPT) Lab, Research department of Clinical, Educational, & Health Psychology, University College London, UK
| | - Lila Varsani
- Let's Talk IAPT-Barnet, Enfield & Haringey Psychological Therapies Service, Barnet, Enfield & Haringey Mental Health Trust, London, UK
| | - Jon Wheatly
- Talk Changes: City & Hackney IAPT Service, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK; National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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