23rd September 2021

Changing approaches to addressing academic mental health: current strategies, barriers and opportunities

23rd September 2021

This blog post is based on a talk I gave at the Minds Conference (23.09.21). Here, as in my talk, I want to focus on:

a brief history of how mental health has been approached in academia
the impact of Covid-19
what universities have been trying to do to address student and staff safety and wellbeing, and
whether these interventions have been effective

You will find this blog post useful if you are providing teaching, supervision, pastoral care, guidance, counselling or other support within academic spaces; if you’re trying to raise awareness around academic mental health; or if you are involved with a union or any role addressing workplace safety, and accessibility.

If you are someone seeking mental health support right now you may prefer to use the following resources and return to this blog post at a later time:
Understanding burnout
Ways to calm yourself if you’re feeling stressed or anxious
Practical help for you and your community in frightening and dangerous times
Ideas to give you hope
How to deliver Psychological First Aid
Mental health resources for Black people in need of care
Being Well In Academia: ways to feel stronger, safer and more connected

As you may expect, a post that focuses on mental health in academia will discuss a range of issues, some of which may be upsetting for you. A range of support organisations can be found here.

If you’re reading this because you are currently assisting others, or plan to do so, here is your timely reminder to ‘fit your own lifejacket first’. That means prioritising your own needs and boundaries, nourishing yourself and resting.

A bit of background – where we’ve been
Problems within universities are well documented (see the reading suggestions at the end of this post) and you will doubtless be familiar with many of them. Even if you haven’t directly been affected you may have seen others harmed by

competitiveness
precarity
bullying and harassment
institutional ableism, classism, racism, sexism and LGBTQ+ phobia
neoliberalism
managerialism
presenteeism
assessments and metrics
the pressure to publish
funding scarcity
employment uncertainty

Outside universities in many countries support services have been cut or defunded (particularly in mental and physical healthcare) – if they existed at all. Charities that offer additional support have closed, particularly smaller ones with localised expertise. And where charities have survived the shift to online, provision of information and a lack of face-to-face or telephone support has excluded many. For those that need it, counselling is costly and not always easy to access for practical and personal reasons. While for those who are now starting university direct from school or college the decline or absence of child and adolescent mental health care has resulted in their problems being neglected or ignored. Alongside this the previous decade (or longer in some countries) has seen increased poverty, political instability, unrest, housing problems, the impact of climate change, and rising levels of unemployment in many countries.

All of this means where universities previously could refer to in-house care or external mental health support, both are now limited, oversubscribed, or unavailable. In some countries there is limited or no mental health provision, particularly for chronic and severe mental illness. And accessing healthcare services is difficult due to distance, cost, transport barriers or minorities being vulnerable. For example LGBTQ+ people report feeling unable to safely access mental health care in countries where homosexuality is illegal; and disabled people may not be able to receive care if transport services and healthcare buildings are not accessible.

The impact of Covid-19
To a greater or lesser extent we’ve all been affected personally and/or professionally by the pandemic, perhaps in ways we are only just beginning to understand or have not experienced yet, or that we are already acutely aware of.

With the backdrop described above, universities were not well-placed to enter the pandemic. And so it proved with many institutions floundering to offer teaching, supervision, research support, adequate and pedagogically sound online learning, plus remote pastoral care.

Again, you may already know how this feels. Your research, teaching or learning might have been disrupted or even curtailed. Within academia the following groups (and all intersections of them) have been especially disadvantaged both by academia’s legacy (see above) and the collision of this with Covid-19:

undergraduates and postgraduates
precarious and low waged staff
those doing practical, field or lab work
parents/carers (particularly those overseeing home learning)
the lonely, isolated and/or estranged
disabled people
women
chronically sick (including those with Long Covid)
those shielding
anyone living through lockdowns
people living in countries that have struggled to respond effectively to the pandemic
people in abusive relationships
those in debt (particularly through having to pay for university accommodation)
part-time staff and students
self-funding students
those on placements
international staff and students
mature students
remote learners
people of the global majority
first generation students
Indigenous students and staff
LGBTQ+ (including non-binary folk) staff and students
neurodivergent staff and students
people working or studying in academic institutions in the global south
those with severe mental illness

Pause for a moment and consider for each of these what the possible implications of the pandemic (and past academic history) may be. If you are unsure the reading at the end of this post may help you. If you are in one or more of the categories listed above, how has the pandemic affected you? The sources of help at the start of this post may be reassuring.

In addition to the above the rapid shift to online learning, while a necessity, meant in many places all the pedagogies and practices developed within educational research and online learning expertise were dropped in favour of endless Zoom calls or Teams meetings. And a new phrase has entered our vocabulary – zoom fatigue. While some universities worked within a crisis to provide support, comfort and leadership, they were in a minority. In many cases management struggled, a ‘business as usual’ model was adapted, paying no heed to the effect of the pandemic on our personal and working lives. Digital surveillance meant some staff were required to check in early in the morning, regardless of their health or household circumstances; while students not appearing on camera, or appearing in casual clothing or sitting on a bed, were shamed and sanctioned. Because so much of this happened on screen, some situations ended up being shared on social media without people’s consent, amplifying their distress.

Where are we now?
As a consequence of all the above it will not surprise you to note how students and staff are reporting high levels of burnout, anger, fear and resentment. Things become harder the longer the pandemic affects us. None of this is a good way to return to face-to-face study which many campuses have adopted, and this has led to confusion over what kind of teaching models will be followed and who will be enabled, excluded, or potentially made unsafe or unwell by them. Particular concerns have been expressed over the effect providing care is having on staff offering pastoral support, and the rise in eating disorders, stress, isolation, and anxiety the pandemic has caused or worsened.

How have universities attempted to address Mental Health?
Historically, universities have not given student and staff mental health the attention, funding and facilities it deserves. This is particularly the case in institutions that are characterised by high levels of bulling and abuse, institutional prejudice to minoritised people, poor management, and underfunded institutions. Typically universities expected those struggling with mental distress to seek help off-campus (e.g. via their family doctor, a charity, or private counsellor). Or in some cases implied or stated that mental health problems were either a sign of weakness or an indication students or staff were not up to work or study. Predictably that led to fewer people asking for help or revealing difficulties for fear of repercussions, especially those in precarious positions, or from communities or countries where help seeking for mental health was already taboo.

This has left us with mental health care provision within academia that is varied and patchy. That could mean you might have one or more individual staff members doing their best; or have a good departmental approach; or an innovative programme run by the student union or chaplaincy, for example. But rarely is a whole-campus approach that puts addressing diverse mental health in inclusive ways at its core utilised. Universities are often loath to address mental health partly due to cost, but also because it requires them to accept their policies, practices and procedures cause or worsen mental illness. For this reason it is much more common for universities to host mental health weeks or days, share wellbeing webinars, or invite motivational speakers. All of which are relatively quick, cheap and easy to provide; allow publicity opportunities for the university; and are generally depoliticised and uncritical.

You may find as you continue to work in the area of academic mental health to ask my well-used phrase ‘who does this bring in? who does it leave out? Who might it help? Who might it harm?’ when you consider what is offered, and, more tellingly, what could be offered but is not.

Other areas where universities may offer support include:

training staff in Mental Health First Aid (sometimes referred to as Psychological First Aid)
mentoring programmes
pastoral care practitioners for departments or the whole university
guidance counsellors/teams
counselling services
student support services
occupational health
human resources
health and safety officers
influencers, speakers and trainers
multi-faith chaplaincy

Sometimes this care can be offered by external organisations or contracted individuals (e.g. therapists), while other times pastoral care and guidance may be part of an academic’s role. Although not necessarily with any training or recognition. Minoritised academics are much more likely to be given, or find themselves providing, pastoral care. This may be used against their career progression as while they will be expected to do this job, as it affects their ability to also undertake research and publish, they will miss out on other career opportunities. Burnout and distress is sadly very common here.

Where support is offered, it is generally well-intentioned. However that is not always the case as approaches such as ‘resilience’ ‘increasing productivity’ and ‘improving performance’ can easily be weaponised into pushing staff and students into enduring hostile or broken situations created or maintained by universities. And where mental health provision is made it is often presented by and for those that are white; straight; in relationships and/or have family support; are funded; have job security (and success); and who are not disabled or sick. With messages that are uncritically based on wellness, motivation, happiness and self-care that may be ableist, sexist, classist, oversimplified, commercialised, culturally appropriating and otherwise not fit for purpose.

As mental health becomes more of an issue raised by parents, students and staff there are increasing numbers of interventions, consultants, and programmes offering a variety of approaches to addressing mental health on campus (and online). While this can be seen as progress (and certainly is better than a decade ago where there was more opposition to both research and practice around mental health), these activities are often taken as impact in themselves. Meaning because a university is providing them, mental health has been addressed. Yet as provision is not evaluated for efficacy we have little idea what actually works and what could be described as window dressing.

What should we do?
The problem with offering criticisms of providing mental health care in academia as I’ve done here is it’s easy to list problems but harder to offer workable solutions that meet the diverse needs of academia.

As mentioned, we know a lot about what has gone wrong and why, who is enabled or excluded, and that many different activities are now taking place. What we don’t know is if these work, the volume and quality of what is being provided by universities (or that students and staff are creating or accessing externally). There is lots of anecdotal evidence, numerous complaints, and collated stories of struggle. We know what is broken, but not how to fix it. Or, more honestly, we do know how to fix it, but universities (and some students and staff) are highly resistant to this.

Below is a list of different ways that universities could approach addressing and improving campus wellbeing. They have been shared with me in workshops where we have talked about ways universities can address mental health. Which of the following do you consider to be important? How might they be tackled? Which appeal to you – and which do not? Do you have examples of good practice of any of these being used in the university where you work or study?

better working conditions
no fees (or reduced fees)
cancelling student debt
zero tolerance for bullying and abuse
more workplace rights
improved teaching/supervision, clarity and instruction
increased wages
financial support
fairer funding
collaborative practices
removing metrics
more training
Listening Services
Whole Campus approaches
pastoral care
counselling (if appropriate, not as default)
trauma informed teaching and care
guidance
Recovery Syllabus

Talking about our mental health
Contrary to idea that MH is too taboo to talk about, it is in many ways a hot topic now, particularly in universities in the Global North. This is partly driven by research and activism prior to the pandemic, and partly due to the impact of Covid-19 on work, study and personal lives.

The good news is there’s lots of research documenting problems in academia and how it impacts on students and staff. This contrasts with the recent and longer term past where there were significant barriers in undertaking research of this kind. There is also plenty of discussion, activity, PR and awareness programmes in and outside universities on our mental wellbeing and the importance of safety and personal care.

The bad news is much of what support is offered in academia is commercialised, culturally appropriating, with no quality control. Lots of problems within the self-care industry have passed into wellness and wellbeing training and support in universities. Few checks and balances are in place over who is providing training and support; their skills, supervision and qualification; or what they are offering.

For example, you may be familiar with academic organisations offering yoga or mindfulness sessions. These may be popular, and some people may really benefit from them. Yet as a solution to an institution that is poorly managed and inflicting harm on staff and students, a yoga session is either inadequate or offensive, potentially leading people to reject that and other forms of more appropriate care. And, crucially, both yoga and mindfulness when poorly taught can leave people feeling worse mentally (or cause physical harm in the case of yoga).

Moreover the shift towards ‘storytelling’ (which again is a well-established and powerful approach to education, activism and change) if not properly contextualised, analysed or presented, can cause damage too. Speakers who share their trauma with non-consenting audiences can trigger others. At best leaving them with sadness not solutions, but in some cases making people feel unsafe or unwell. And, due to the way academic mental health is addressed, people may either not know they can complain about poor provision, blame themselves, or feel unable to acknowledge what was offered did not help them. Or there may be a mistaken idea that the only way to participate in discussions on mental health and safety is to disclose personal things about yourself. Something that people may not wish to do, or that may be risky for them.

The competitive toxicity of academia risks becoming a feature of discussions of academic mental health, particularly on social media. While the side-effects of stress (impatience, mistrust, cynicism and hypercriticism) can mean that any attempt to provide care is met with resistance, even if it might be beneficial.

Who dominates the dialogue?
Participation in discussions about mental health in academia is not equal, particularly on social media and within funding bodies and research organisations. Currently the main contributors to the conversation tend to be white; in their twenties and thirties; studying or teaching STEM subjects; based in the UK or US; in funded, full-time student or newly qualified staff roles; with mild to moderate depression/anxiety.

Given many of the issues this cohort shares, particularly around lack of supervision, poor tuition, bullying and stress, there is a clear need for them to seek and receive help. But who does this leave out?

Basically everyone else that works or studies in academia (see the list above of those most likely to be affected by poor mental health in academia). This may be covert, as in diverse groups are simply not mentioned, with the default experiences and needs around mental health ascribed to the dominant groups (see above). But more often it is overt. For example, discussions about the needs of staff that only focus on those in full time academic (research or teaching) roles, rather than cleaners, administrators, caterers or caretakers. Or where panels discussing mental health and diversity do not feature any minoritised contributors. These things are not accidental, and it is vital that they are acknowledged and challenged, primarily by those in the dominant group who might be struggling with their wellbeing but also benefit from being in a position to speak on it – and frequently be heeded.

How is mental health positioned?
Alongside the conversations of mental health being occupied by particular dominant groups and voices, and the provision of mental health and wellbeing patchy, academic mental health operates on a very specific model of mental health. This includes a focus on:

anxiety and depression
mild/moderate symptoms
disease model favoured over situational and political explanations (e.g. that depression is primarily understood as a clinical problem rather than something caused or worsened by university policies and practices).
Western definitions of mental health and associated therapies are prioritised, and support offered is not culturally sensitive or diverse
short term interventions that are cheaper, quicker, and easier to deliver on or offline than other therapies (e.g. CBT)
rapid or one-off interventions that are not fit for purpose and often gimmicky or a PR opportunity are favoured over major change at all levels of the university organisation. For example a single visit from therapy pets, a one-off coffee morning, or wellbeing webinar, while not addressing job uncertainty or lack of supervision.
training that is provided in response to request and/or rising mental distress focus on maintaining the status quo and holding individuals responsible for personal change rather than the organisation
support and training, where offered, is imposed not solicited (so students and staff are not asked what they want to attend to their distress, or if they are asked, those requests are ignored)
interventions, advice or counselling is individualised – the model assumes a person has a problem, they need to fix it, and it isn’t linked to wider organisational structures and interpersonal harms
care tends to be delivered via university structures in official ways that may feel unsafe (e.g. directly through occupational health, HR or third parties hired by them).

Whose job is it to provide mental health support?
This remains a critical question that is not considered enough. Is it the role of the university to be providing mental health care that healthcare and charities should be delivering? If they aren’t available to help, what happens if academic spaces refuse to provide care? Where does the role of the university begin and end? At what point do university staff offering pastoral care or guidance need to refer to other services, and what happens if either the student or staff member receiving help doesn’t want to accept that, or if it is not available?

Growing awareness of mental health, particularly with the isolation and introspection brought by the pandemic, has led to a greater number of requests for mental health provision for students and staff. Parents, too, are adding their voices to these demands with the expectation that universities should play key a role in addressing mental health, representing a cultural shift from the recent past where this was not the case.

Some have argued that universities should not provide mental health care, but instead should focus on ensuring the things that cause or worsen distress – including poor supervision, competition, bullying and abuse, a lack of instruction, low pay, high fees, digital inequalities, and inadequate management. From this perspective the idea is that people would be far less stressed and unhappy within academic spaces, and anyone that does need assistance could get it from external services. Do you think this is a model that could work where you are?

Then there are the pragmatic questions about who gets care and when. Whose needs are prioritised? What happens to those who clearly need support but refuse it? How about the role of parents and families (where students or staff are young adults)? Issues of autonomy, confidentiality and safety are a priority here. Who offers care and who cares for the carers? What happens if mental health support has to be rationed? None of these are easy questions to answer, nor is it clear whose responsibility it would be within a university to address.

Pause for a moment and consider the challenges that the above issues create. How would you address them? Would you want to? What might be the demands and risks to those having to decide what care is provided and to whom? Ask yourself, who does it bring in or leave out? (A clue would be those who have no access to care; who come from cultures/communities where care’s stigmatised; who have experienced past abuse; that are mistrustful; lack the energy to access care; are afraid of repercussions; and who don’t want to seem ‘weak’ to name a few).

Next, reflect on what happens:

Where there is no affordable or accessible help?
Where there is too much conflicting advice or activity?
Where mental health initiatives reinforce or worsen inequalities?
When those delivering care are burned out and overwhelmed?
Who triages or decides who is most in need of help, particularly when help is rationed?

As with many aspects of mental health, there are no standard replies to the above questions. Much of this remains complex and tense. Expecting individuals to make these decisions or answer these questions alone is unrealistic. You may want to repeat the exercise above, this time talking to friends or colleagues. How do their solutions differ from yours? Where are you in agreement? What additional ideas do they have? In practice, you may find working in interdisciplinary groups within or across your university department/school, and including those who’re affected by mental distress, could prove much more productive and supportive than you taking responsibility for difficult choices alone.

What’s needed?
When people have attempted to bring change they talk about the following being helpful to them – do any of these also appeal to your experiences or practice? Are there other things you have tried or are aware of that could also be important?

Interventions for academic mental health need to be:

Practical – so suggestions will work in practice, not just in theory or for the duration of a wellness session

Agile – as needs and circumstances change rapidly, so must mental health provision

Robust – many pressures will be put on the provision of assistance and advice, alongside some opposition and criticism. Strong support programmes can withstand and/or respond to this

Ethical – interventions, care and support should not put people at risk, be based on unproven or unsafe recommendations, or be extractive or exploitative

Collaborative – avoiding silo working (where many people work on the same issue, just not together). Or rivalry, where varying practitioners, groups, influencers and universities compete to outdo each other on mental health provision or to prevent others from accessing funds or opportunities to improve and promote wellbeing

Something that does not perpetuate or worsen existing toxic problems in academia (e.g. a mental health spokesperson badmouthing another due to jealousy or professional competitiveness)

Trauma informed– both across the syllabi and within guidance, counselling and pastoral care

A joined up, multi disciplinary, whole campus approach – so there are neither gaps in care provision, or contradictions that undermine inclusive and responsive assistance

Driven by student and staff need – so not informed by what management think is wanted, or wish to provide for promotional purposes

Leaves nobody behind – so the most vulnerable are centred within any care offered

Ensures EDI/DIE (equality, diversity and inclusion) are meaningfully engaged with – rather than a box-ticking activity, and are led by minoritised experts and audiences

Supports those providing teaching, supervision, mentoring or pastoral care – ensuring people can work in boundaried, contemporary and thorough ways without being exploited, becoming burnt out, or placed at risk

Sustainable – meaning interventions or care provision continues to help or are funded on a long term basis.

As you reflect on this list, ask yourself what might get in the way of these factors? How might these compliment or contradict each other? If they might be used on your campus (on or offline) how might they work in practice? Perhaps you already have examples of successful programmes you’d like to share in the comments.

Who needs to try harder?
Arguably we could say mental health is everyone’s responsibility, and as an academic community we should care for one another. However, this could lead us to the situation we are currently in where those providing support and/or offering much-needed criticism and activism are bearing the burden of work, often at personal risk.

This may explain (without being disingenuous) why there’s lots of activity around academic mental health based on retelling and listing problems, with comparatively less action and impact. Those in power are unwilling to make changes, and in many cases institutional prejudice suggests change is unnecessary as those in crisis are either causing their own problems or are not up to study/work in academia.

If there is genuine commitment to academic mental health then research funding bodies, university management, unions, research and professional organisations and others working at senior levels need to demonstrate both an understanding, and commitment, and action. At present across the academic sector, worldwide, this has yet to be seen. There is a disconnect between those most disadvantaged that are making more effort than those who are less impacted or even the cause of harm.

Where next?
For you, the next step should be at least a cup of tea and a rest after reading this far! You might have found the above has told you nothing you don’t already know. Or now feel inspired to try to make more changes within your department, university, or wider academic spaces. Perhaps you would like to make things change but now feel overwhelmed.

Attending to academic mental health is not going to go away. It has always been an issue (even when we were much worse at addressing it). Even though the current focus on academic mental health may leave you feeling you must push yourself to stand out or keep up, the need for support, care, evolving advice and making all approaches to managing safety and wellbeing in academia inclusive is a long term job. There will be plenty of opportunities to assist if you wish to, or seek help if you need it. For now, rest.

Changing approaches to addressing academic mental health: current strategies, barriers and opportunities

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