ReachOut Ireland, in collaboration with the Health Service Executive’s National Office for Suicide Prevention (HSE NOSP) and the Irish Association of University and College Counsellors (IAUCC), recently published the report Reaching Out in College: Help-Seeking at Third Level in Ireland (Karwig et al, 2015). The study explored the most likely sources of information and support for student mental health and wellbeing, with a focus on both e-mental health (use of the internet and technology for mental health information and support), and current college supports and services.
A mixed-methods approach was undertaken for this study. An online survey was developed following a review of relevant literature and existing surveys, and a brief pilot phase; the survey link was subsequently circulated to students in participating colleges. The survey comprised 30 items across three sections: i) Demographics/basic information; (ii) Students’ views and use of various supports and services; and iii) Students’ mental health.
Additionally, four focus groups were hosted with students. To ensure representation of views from different student ‘types’, the groups were open to any gender, and separate groups were hosted for first-year and final-year students. Each group had a duration of approximately one and a half hours. The groups were audio-recorded and transcribed, following which the transcripts were coded using thematic analysis (Braun and Clarke, 2006).
In total, seventeen third level institutes participated in the online survey. Following omission of students who did not respond to any survey questions beyond the online consent form, the final survey sample included 5,556 students. The majority of respondents were female (61%), Irish (85%), and aged between 18 – 22 years (60%).
Attitudes towards e-mental health
Students were asked to indicate their level of agreement with statements reflecting various attitudes towards e-mental health. Table 1 presents results pertaining to the response options ‘agree’ and ’strongly agree’.
The results suggest that students hold diverse attitudes towards e-mental health. For example, while seven out of ten students agreed that there is a vast amount of valuable mental health information online, over half of students (54%) agreed that online information can be unreliable. Additionally, although the majority of students (81%) agreed that mental health discussions on online platforms can be harmful, a similar proportion (84%) also acknowledged that e-mental health can afford confidential and anonymous information and support.
Focus group results
Four focus groups were hosted with students, across two colleges (one university and one Institute of Technology). To ensure that the focus groups were representative of the student body, the groups were open to students of any gender and from any course, and separate groups were organised for first-year and final-year students within each college.
A total of 33 students participated across the four groups. The majority of participants were represented by females (27 students), Irish students (29 individuals), those aged between 18 and 22 years (27 students), and those studying at undergraduate level (31 students).
Following thematic analysis, two strong themes emerged: ‘mental health’ as a negative concept; and, ‘changing the narrative on mental health’.
Theme 1: ‘Mental health’ as a negative concept
Responses to the term ‘mental health’ during the word association exercises at the beginning of each focus group suggested that students’ understanding of mental health was predominantly deficit-based. Specifically, while a number of positive words were noted (including ‘universal’, ‘wellbeing’, ‘happiness’, ‘promotion’ and ‘awareness’), in addition to more neutral terms (such as ‘brain’, ‘thoughts’ and ‘mood’), focus group participants primarily reported words which were negative or which pertained to mental health problems. Indeed, one student noted that ‘mental health = a problem’, while others noted ‘people needing help’, ‘illness’, ‘difficulties’ and ‘disorder’. ‘Depression’ was the word most frequently reported during the exercise and was noted within three of the four focus groups, including seven students in one group alone. Additional negative words referred to particular mental health issues, such as ‘addiction’, ‘stress’, ‘anxiety’ and ‘suicide’; other words - ‘taboo’, ’sensitive’, ‘stigmatised’ and ‘discrimination’ - suggested that the topic of mental health is not openly discussed. References to ‘counselling’ and ‘therapy’ were also rooted in mental health as a negative concept.
Theme 2: Changing the narrative on ‘mental health’
Notwithstanding the somewhat narrow and negative conceptualisation of ‘mental health’ noted throughout the focus groups, students discussed the importance of increasing awareness of a broader understanding of mental health amongst the wider student population.
For example, when asked whether colleges should refrain from using the term ‘mental health’ when referring to or naming relevant events and campaigns on-campus, it was suggested that ‘mental health’ could be used – if colleges cultivated an awareness of a broad understanding of the term in parallel. As noted by one of the students (who had previously stated that mental health sounds like a negative term)
“rather than kind of keeping on using it [the term ‘mental health’, without clarification], you could do something that lets people know that mental health isn’t just about stopping depression and helping people with anxiety, it’s also just being happy… so just kind of clarifying it” (FG3).
The importance of increasing awareness of a broader (and more general) interpretation of mental health was emphasised by another focus group participant, who noted that she had previously equated the term ‘mental health’ with ‘mental illness’, by stating that
"it sounds silly but people don’t – like I didn’t even know myself, mental health or whatever, you’d
think of mental health as just mental illness so it wasn’t until I was doing Social Care myself that it was brought around that everyone has mental health, we all need to look after our mental health…" (FG4).
Recommendations and discussion of findings
Traditional support services on-campus are valued by students and should be appropriately staffed and resourced. This is evidenced by the following findings:
- The Student Counselling Service and Student Health Service represent the services on-campus most likely to be used by students (reported by 63% and 58% of survey respondents respectively). 87 percent of students also agreed that ‘it’s reassuring to know that there is a free counselling service in college’.
- The Student Counselling Service is trusted: students are significantly more likely to avail of online counselling if specifically offered by their counselling service on-campus and are more likely to avail of Student Counselling than seek help from an external counsellor off-campus.
Students should be regularly provided with visible, engaging mental health information.
This recommendation is supported by the following findings:
- Information should detail and explain the means to access the range of resources, supports and services available to students (on-campus, off campus and online). Information should also detail ways in which students can mind their own mental health and support others, given that 74% of students reported being likely to seek help from a friend.
- The vast majority of survey respondents (85%) reported being likely to go online when seeking information related to mental health and available supports and services; however, 54% also agreed that ‘mental health information on the internet can be unreliable’. Students should therefore be provided with quality mental health information online.
- Students in focus groups reported that online information provided/signposted by their college would be perceived as reliable. In particular, students suggested that the inclusion of an online mental health ‘section’ within their student portal would be valuable. Use of social media to provide mental health information in an engaging manner was also suggested, representing an opportunity for Students’ Unions to communicate information to students.
- Online mental health information that is provided to students within their college’s site should be user-tested, to ensure that they are likely to engage with the material.
Colleges should cultivate and promote a culture of positive mental health and help-seeking on-campus. The following findings elaborate this point:
- Mental health should be framed as an integral part of everyday life, and as a concept that does not pertain to mental health problems alone. As one student suggested, it is important that colleges ‘…make more awareness of even that term [mental health], that we all have a level of mental health, it’s not only then if you’re depressed or something’.
- Fostering a culture of positive mental health should encompass a whole-college approach to mental health promotion, with the provision of visible, engaging mental health information, hosting skills-based mental health workshops for students and, as suggested within focus groups, a lecture for all students on the topic of mental health and supports and services on-campus.
Colleges should audit and evaluate all resources and services currently being provided to students, including online resources.
- Evaluation should relate to the uptake and use of services, outcomes of service provision and satisfaction with service provision. Such information should be shared among colleges, to increase understanding of service provision at national level, and to inform future service development.
- Evaluation of resources and services provided on-campus is in keeping with Action 7.4.4. of Connecting for Life: Ireland’s National Strategy to Reduce Suicide 2015-2020 (Department of Health, 2015): ‘evaluate innovative approaches to suicide prevention, including online service provision and targeted approaches for appropriate priority groups’. This action specifically references ‘third level institutions’ as key partners.
Finally, colleges should consider developing a system for information provision and referral of students to appropriate supports on-campus. This could involve a comfortable drop-in space
on-campus or an online programme or screener that provides feedback to students on what to do or where to go. There is currently a gap between mental health need and knowledge as to how to access supports, despite a considerable range of supports being available. The findings of this study can support and inform practical strategies aimed at bridging that gap.
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