As the first university semester comes to an end, we can reflect on the short period since students arrived for the first time to embark on their university journeys. For some, they may have moved away from home, bringing new demands such as managing finances and building new relationships. While university offers a unique opportunity to grow and develop, this transition may be challenging.
In the last decade, university student mental health has received worldwide attention with increasing reports of poor wellbeing and psychological distress. University is a critical risk period for developing mental health difficulties, with more than half of the general population experiencing symptoms by their mid-20s worldwide. In recent years, the UK has seen a 450 per cent increase in the number of university students declaring a mental health condition. Student intake has also risen by 20 per cent between 2019 and 2022, with academics identifying university as a key time for mental health support. It is therefore unsurprising that demand on university support services continues to grow, unfortunately outweighing capacity.
To cope with psychological distress, individuals may engage in self-harm. Research in the US and UK suggests that up to one third of university students resort to self-harm. We know from previous studies that individuals who self-harm are more likely to approach friends and family for help, rather than professionals, with social connection crucial in reducing self-harm and suicidal thoughts. However, the voice of those offering support to students who self-harm is often missing from the literature. Identifying contexts where carers may be hidden or unrecognised is particularly important in allowing us to increase support to carers themselves.
In response, we conducted research to provide a space for these voices. Following a British Academy- and Sir Halley Stewart Trust-funded survey of those providing support for university students who self-harm, we interviewed 24 individuals, revealing a broad spectrum of care, from professionals to friends and family members, including students with their own personal experiences of self-harm. We found the support provided was diverse and many felt overwhelmed in these caring roles.
When we interviewed professionals and informal carers, we discovered that offering practical support for self-harm was common. For friends and family, this included distraction by spending time together, and help with accessing support to keep the individual safe. Participants often felt they had to be constantly available, for example accompanying the individual to emergency departments. When the individual did not wish to seek professional support, informal carers felt unsure about what to do next, and ‘out of their depth’.
Those in professional roles discussed limited funding for services, with low staff levels. Support offered to students was often short-term or involved signposting to services outside the university. However, NHS/community services frequently rejected referrals due to students not meeting certain criteria, while universities deemed the individual ‘too risky’. Students are falling through the cracks and not receiving the support they need.
As a result of these experiences, university carers reported poor health and wellbeing (e.g. exhaustion and sickness) and an impact on their personal and social lives. Many felt guilty about needing their own time as they did not want to let colleagues or students down. For students supporting housemates, it was particularly difficult to establish boundaries and personal space. Sadly, some friendships came to an end due to the amount of pressure felt by the supporting friend, especially if they were the main source of this support. Interviewees needed their own support with caring demands, raising questions of ‘What about me?’, yet limited provision for supporters was available.
Carers felt particularly overwhelmed by their limited knowledge of self-harm. Professionals raised concerns about students disclosing self-harm to personal tutors and lecturers with no experience of mental health, and reported feelings of stigma and rejection. Many felt that accessible resources (e.g. online) specific to self-harm were needed, such as information on why people self-harm, how to respond and when to advise medical attention. While those with their own experience of self-harm had this knowledge, some found that supporting others triggered a decline in their own mental health, or that they were being hypocritical in not following the advice they would give to others. In contrast, some found it cathartic and validating to know that others had similar experiences. Professionals felt knowledge of self-harm developed on the job, and had not always been covered in their training. They called for forums for sharing new ideas and research with other caring professionals across different universities.
So, what next? As a first step, we developed a website for those supporting students who self-harm, with resources and information about self-harm and self-care for individuals with varying experiences and skills. However, there is a clear need for development and growth in university support, given the increasing demands that we are already aware of, and the impact described in our study by those with lived experience. We can also see that university is an environment in which ‘hidden carers’, such as housemates, may be particularly present. Universities UK has recently introduced the ‘Stepchange: Mentally healthy universities’ policy, asking all universities to prioritise both student and staff mental health. Collaboration across institutions, and with NHS and charity organisations, as well as adaptation to specific university needs and cultures, are particularly important. While these initiatives offer hope for positive change in response to our findings, we need to be careful not to fall into the trap of initiating policies that are challenging to carry out on the ground. Support from government and funding bodies is essential to allow universities to meet the support needs of both students and staff, providing the opportunity to create mentally healthy universities.
The authors would like to thank all those individuals who participated in this study. This work was supported by the British Academy (grant ref SG163040) and the Sir Halley Stewart Trust (grant reference 767).
Laura Edwards-Bailey completed her PhD at the University of Westminster, London. Her research focused on self-harm amongst university students, and the role of those providing care and support for this group. As a result of these findings, Laura and her research team developed a website for those supporting students who self-harm. Laura is currently training to be a clinical psychologist at the University of Nottingham.
Nina Smyth is a Reader at the University of Westminster. Her research focuses on the impact of well-being and stress on health and illness, and the physiological pathways involved, and the design and evaluation of interventions to support health and well-being.
Tina Cartwright is a Reader at the University of Westminster and a Chartered Health Psychologist. Her research focuses on understanding people’s experiences of living with long-term physical and mental health conditions and designing interventions to support health and well-being.
Jay-Marie Mackenzie is a Reader at the University of Westminster. She specialises in research on understanding and preventing suicides in particular contexts or environments.
The spectrum of care within a university context: the differing roles of carers in supporting students who self-harm by Laura Edwards-Bailey, Nina Smyth, Tina Cartwright, and Jay-Marie Mackenzie for International Journal of Care and Caring is available on Bristol University Press Digital here.
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