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Student mental health and well-being: are universities doing enough?
  1. David Barrett1,
  2. Alison Twycross2
  1. 1 Faculty of Health Sciences, University of Hull, Hull, UK
  2. 2 School of Health, Wellbeing and Social Care, Open University, Milton Keynes, Buckinghamshire, UK
  1. Correspondence to Dr David Barrett, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, UK; D.I.Barrett{at}

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There is increasing recognition that students in higher education are a population group at high risk of facing mental health challenges. Indeed, the Institute for Public Policy Research recently acknowledged that the level of mental illness and mental distress among UK university students is increasing, and is greater than other sections of the population.1 The prevalence of mental health issues among university students was highlighted by the results of a 2015 survey by the National Union of Students that found that in a sample of 1093 students:

  • Seventy-eight per cent reported facing mental health problems in the previous year.

  • Two-thirds of respondents reported having felt depressed in the last year.

  • The prevalence of suicidal thoughts in the previous 12 months (33%) was double that reported in the general population2 (although the rate of suicide among students has fallen substantially in the past 25 years, and is significantly lower than that of people of the same age within the general population).3

Internationally, a recent WHO survey of first-year college students across eight countries found that approximately one-third screened positive for at least one mental health disorder related to either anxiety, mood or substance use.4

For healthcare students, the pressures faced are arguably even greater, and the risks to mental well-being even higher. There is evidence that in comparison with the broader student population, student nurses report significantly higher levels of stress, anxiety and sleep disorders.5 In addition, these high levels of stress and anxiety in student nurses may be coupled with a tendency to adopt maladaptive coping strategies such as alcohol consumption.6

For students in general, it is recognised that the key factors that can impact on mental well-being are academic pressures, financial difficulties and the transition to a new stage of education that often requires leaving home for the first time.2 When seeking to identify why nursing and midwifery students report higher levels of stress and anxiety, we need to acknowledge the additional challenges of, for example, the requirement to undertake clinical placements in addition to completing academic work.7 Clinical placements often take place in short-staffed and highly pressured work environments. For some students, their practice placements will provide their first exposure to death and dying; students may witness (or even experience) violence and aggression in the workplace. Students may also feel added pressure knowing that their competence is being assessed while on clinical placements.7

So, what should universities be doing to ensure there is adequate support and guidance in place to support the mental well-being of students? Universities UK has a strategy called #stepchange. This strategy makes it clear that being proactive in supporting students’ mental health is fundamental to higher education and that a whole university approach is needed to drive and sustain improvements in student mental health. Buy-in and direction from senior leadership in the university is seen as the most important factor in helping improve student mental health and well-being.1 There are projects underway to develop and evaluate specific interventions that enhance students’ mental and social health. These include the provision of brief ‘drop-in’ therapeutic interventions for students in need, and the development of a peer education training programme in which older students support younger peers through the transition to higher education.3

Educators also have a role to play as individuals in enhancing the well-being of their students. As a minimum, educators need to be aware of the support available to students who are experiencing mental health issues or distress—this support may take the form of University services, or external resources such as the student minds website or the Samaritans in the UK.

All professionals interacting with students, peers, educators and practice supervisors/assessors have a responsibility to understand the causes of stress and anxiety in learners. We also need to identify evidence-based interventions for providing effective support for student mental health and well-being. This may include changes in curricula, use of reflection or introduction of robust support structures that may help to mitigate the particular challenges faced by student nurses and midwives. ‘Evidence Based Nursing’ will continue to source, summarise and commentate on research in this area, helping us to support the nursing and midwifery workforce of the future.



  • Twitter @barrett1972, @alitwy

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DB is an Associate Editor for EBN journal. AT is the Editor of EBN journal.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.