Picking up the Pieces
Are British universities providing enough mental health support to students? As Cardiff Uni signs the Time to Change pledge, Michael O’Connell-Davidson investigates.
This is a reposted version of Michael O’Connell-Davidson’s original piece, available here on our website.
Of all the problems facing our society, mental illness is perhaps the least understood. It is an inherently human problem, but not one that should be considered an inevitability. Yet with one in four people in the UK experiencing difficulties during their lifetime, mental health continues to be treated as a taboo subject. For the good of society — especially the one in four — it must not be.
Despite our long history, we have only recently begun to talk about it, but one wonders why we have waited so long. The effects of mental health problems are many and varied, but few are inconsequential. Anorexia, for example, drives people to severe malnourishment and often death; schizophrenia has an extremely difficult prognosis nobody talks about, with those on the road to recovery living with memories of things they never truly experienced; and depression has a way of making people not feel anything at all, replacing affinity and enmity with emotional phantom limbs. To complicate matters, that’s only really one type of depression — that description does not encompass post-natal depression, for example. And, indeed, what description could? Can anybody possibly convey the feeling of failing to bond with your child after nine months of pregnancy?
There are just over 2.3 million students in the United Kingdom right now, the majority of which are aged between 17 and 25. A Royal College of Psychiatrists study into mental disorder in higher education notes that this period coincides with when individuals are at the highest risk of developing schizophrenia and bipolar disorder; it also notes that alcohol problems are more prominent in student populations, and that approximately a fifth are troubled with anxiety at a clinically significant level.
Even in terms of lost productivity, mental health problems have a reach beyond what many realise. Yet despite offering courses which directly address global controversies — theology and climate science, for example — is the British higher education establishment willing to address problems closer to home?
I did not begin writing this feature with a hypothesis. As with many stories, I admit that I almost stumbled into it, circulating requests for those who have experienced mental health difficulties at university to get in touch with me. The response was unexpected; I have been presented with a cascade of information. So far, I have interviewed just around thirty students, but I continue to receive testimony from those who have surmounted the courage to get in touch as I write this.
Neither did I begin this feature anticipating what it would become. To commemorate the signing of Cardiff University’s ‘Time to Change’ pledge, and out of respect for all those who call for action, while writing this piece, my colleagues and I decided to spearhead a campaign to complement the pledge. As our legal advisor made plainly (and, as lawyers tend towards caution, surprisingly) clear, we cannot stop here; this piece marks the beginning.
And what better time to write a feature or start a campaign; Elliot Rodger, a British-born student in the United States, recently engaged in a spree killing. While it would be wholly irresponsible to attribute his actions entirely to any health problems, ‘mental illness’ was a motif that coursed through subsequent news reports. It’s clear that we need more clarity, and the recent ‘Time to Change’ pledge displays a commitment to that. The thrust of our campaign, then, will be to make sure that commitment does not go unfulfilled.
It is inevitable that this piece, and the pieces that follow, will have a focus on Cardiff University and the Students’ Union — the institutions that this magazine serves — because that’s where my colleagues and I work and study. It is also the signing at this university that kicked everything off, and the place where we are most able to judge the pledge’s impact. But students from across the country have shared their stories with myself and my colleagues, and I feel that, where possible, painting a broader picture than just this institution alone is important.
Some names have been changed.
I. Unwritten rules
Gareth developed an eating disorder during his second year of study. When the time came, he spoke to his course leader about the problems he was facing, and the impact it was having on his studies. “I tried to convey why I wasn’t coming in a lot, or doing very much.” Gareth was met with disbelief: “I explained that I was suffering from Anorexia, and my course leader countered with ‘but you’re a man!’” He dropped out shortly afterwards.
David, an associate at a leading drama school, told me that the head of their course spoke to them one day about an emerging pattern of absences. “We discussed the amount of time I was taking out, and we discussed why I was taking this time off.” The school had granted him extenuating circumstances that allowed him to take time away from his studies in the past, but both parties agreed that something would have to change for his training as an actor to remain viable.
My associate did not end up deferring; being depressed at university at least seemed better than putting his life on hold, and he had already taken one gap year. But they did tell me they’d stopped taking their medication to compensate.
“I know it’s stupid, and I know my head of course would think it was pretty stupid, too,” he said, “but I just don’t have time to go to the doctors anymore. Getting into college and attending all my classes takes up all of my energy.” He bears no ill will towards his institution, but continues to suffer from depression.
Despite the ‘typical student’ stereotype being grounded in Freshers’ Week propaganda and halls culture, postgraduate and distance students also suffer extensively, often experiencing exacerbated feelings of social isolation. Thom, a student currently undertaking a research degree, describes the course as an ‘invitation to depression.’
“For about two months, I didn’t leave the house. I wrote hardly anything.” He received counselling, and expects to complete his course later this year. “I don’t really blame my supervisors because it is not their job to hold my hand, but I just had this overwhelming feeling that nobody could care less whether or not I got out of bed and work, and so weeks went by.”
Despite purportedly offering a great deal of support for students, and sporting a name that confers accessibility, the Open University was repeatedly targeted by respondents as failing those it served where their welfare was concerned.
One student alleges that her bipolar disorder had led her to drop out of her studies so many times that she was barred from taking any more. She spoke to the OU about her ‘lifetime ban’ (after being originally told it was a three year ban), and alleges that the representative who talked to her to said that if her mental illness was such a problem, then it probably wasn’t such a bad thing that she wouldn’t be able to take a course anyway. She has vowed to fight for her right to education, and intends to apply again this year. Open University representatives informed me that while precluding students in this way does happen, it is “extremely rare,” and that mental health is taken into account by the Central Disciplinary Committee. Students are also invited to appeal if they believe there has been a mistake.
Lee, who also studied with the OU, suffered a depressive relapse during the course of their studies and missed an assessment deadline as a result. Having submitted evidence including a note from their GP, as well as confirmation from the Priory hospital that he had been under their care for a period of six weeks, he was confident this would be sufficient.
It was not. “In a perfect world, I would have contacted them before the submission date to tell them I was suffering depression, but in a perfect world I wouldn’t have fallen into depression in the first place.” He explained that depression wasn’t like that; the condition had made him wish that he was dead, and he had suicidal thoughts. “As you can appreciate, the last thing that was on my mind was contacting the OU.”
How did things resolve? “I got tired of arguing with them after three months, and it was starting to get me down so I just gave up. I also decided that I didn’t want to be associated with an organisation who treated people the way I’d been treated, and that I didn’t want to give them another penny in tuition fees.” To add insult to injury, “during that three month period, not once did they ask me how I was or if there was anything they could do to prevent this situation happening again. I was offered no support at all.”
I contacted the Open University about these stories and the support they offered students under their care. As is standard for institutions that support a wide range of clients, they could not comment on individual cases; they did invite anybody in this situation to contact them, and noted that it is not easy to predict how mental health will affect studies. They also added that all tutors and clerical staff who speak to students on a one to one basis are given “guidance and information” on how to support students with mental health difficulties.
Against the odds, I am an optimist, and I will assume that in some of the above cases (and many others that were brought to mine and my colleagues’ attention, but not included in this piece), the events described were the result of a simple misunderstanding. Actively displaying malice or giving in to discrimination is not good business sense. Yet when viewed in aggregate (I interviewed nearly thirty different people while putting this piece together, and am still receiving testimony via various channels at time of writing), the same narrative plays out over and over again: once they revealed their hand to their cohorts or their tutors, they either felt less understood, or no closer to getting better, despite whatever training the people they confided in had received.
II. A Deeper Understanding
Stonewall, an equal rights charity, provides an excellent list of universities friendly to the homosexual, lesbian and bisexual communities, with Cardiff ranking exceptionally well in this regard. But who holds institutions to account where mental health is concerned? Many people only realise the provisions available to them once they need to use them, and have no way to judge the quality of those services until they use them.
But for those with mental health difficulties, problems begin before you even enrol. Both Student Finance England and Student Finance Wales have been noted to ask for proof that you were mentally ill if you need to declare it as part of a loan application. This makes sense in that nothing should be a free pass to a full maintenance grant (and I say that as somebody who applied to university as an estranged student, and so was granted a maximum entitlement loan) if it has the potential to be easily exploited.
As has been repeated time and time again, however, mental illness is a sight unseen. Every person who has suffered from clinical depression lives with the fear that they might relapse, and many other conditions have high rates of recidivism. Can you truly prove when a condition has begun and when it has ended?
With a broken leg, it’s quite simple — all the signs are physiological, and there is a clear beginning and end point. But while those with mental health problems frequently enjoy a positive prognosis, patients are faced with challenges that differentiate their problems from more conventionally understood illnesses: that ‘broken leg’ can break again without warning.
I wrote earlier in the year that the potential of some mental illnesses to resurface is difficult even for people with long term mental health problems to parse: “It always starts with denial — No. This isn’t happening. I’m in the clear — which means I never seek help fast enough.” The lack of physiological symptoms can (and has) fooled even me.
Yet despite this, universities have been noted to have bizarre policies when it comes to relapses. Jasmine, a photography student at another of Cardiff’s universities, told me that she was given a warning that it would be “virtually impossible” for her to be granted extenuating circumstances a second time in case of a relapse. “I got the impression that in their opinion, after already having extenuating circumstances one time, that I should have learned, or somehow be able to deal with the depression should it ever get as bad as it currently is a second time.”
The fact that guidelines change so radically between institutions demonstrates a need to be able to understand them before you arrive. One point of interest is What Uni, a university review website affiliated with UCAS, which includes league tables that rank institutions based on eye candy — effectively, how attractive students are — yet makes no provision for student support. Indeed, this is something absent from basically every league table (such as The Guardian and The Times’ offerings), despite some students clearly needing more support than others.
Many of Cardiff’s mental health services are offered via the Students’ Union (a separately managed body). What Uni has a series of icons next to each of its ratings; the one for Students’ Unions is represented by a cocktail glasses. Supply and demand is such that this is perhaps a result of what its audience wants, but some of the above student stories suggest that people demand more than cheap pints and potential sexual partners.
I asked What Uni for comment, and editor Sam Haysom responded that the Eye Candy and Students’ Union categories were voted on by students reviewing their institutions, and only reflected their opinions. It must be noted, however, that their opinions can only be conveyed within the boundaries What Uni gives them; you cannot abstain from any category. Haysom did not offer any comment regarding social pressure to engage in recreational alcohol consumption at university, nor did he offer any comment regarding pressure placed on students to look good, despite being posed questions directly addressing both issues. In response to a question about whether or not he felt like the service he was affiliated with provided a good guide for those who may wish to select a university based on the support they gave students, he did not offer an opinion, but said that whatuni.com was “considering” adding a “student support” category. We will revisit What Uni later in our campaign to see to how these plans are progressing.
Britain’s social drinking culture is a problem for those on antidepressants (which manufacturers state should not be combined with alcohol) and many other types of medication, and nowhere is that culture more prevalent than within university populations. Our Students’ Union, despite taking a hard stance against ‘lad culture’, has decorated the pub with posters that seem to encourage it, displaying slogans such as “Beer is a right” (One, in the same style, which as of June this year has been removed, said“Save on heating, spend on pints”). I feel compelled to note that this is the same Union that has multiple photos of Manhattan pre-9/11 in one of its cafeterias; there are relics of bygone times littered everywhere.
University is not a world that makes particular allowances for those who have been tasked by their doctors to avoid alcohol. Against the odds, some university communities have developed strategies to address mental illness themselves within the boundaries of their institutions, although this might be less positive than it initially appears.
III: The Community Approach
A student at a leading drama school once described how he and his cohorts discussed mental health.
“We call it an avey,” he says. “If you’re going through a depressive episode, you’re having an avey. If you’re relying a bit too much on alcohol to get you through that week of classes, that’s an avey, too.” He boils it down: “No matter what’s wrong, an avey is an avey. So if you’re suicidal or just momentarily depressed, you’re having an avey.”
“I can’t work out whether or not it’s a good or bad thing. Most places you go, you can’t indicate that you’re depressed full stop, so in that sense, it’s great. But nobody’s interested in hearing that you’re suicidally depressed — you’re having an avey and that’s where the conversation ends.”
Is that enough? I don’t think so. I have learned more about this university’s various communities by actually talking to people for this article than I have from the university itself. Simply stopping at ‘aveys’ creates a different stigma altogether; a veritable “don’t ask, don’t tell” for a different place and time.
I appreciate the notion of stigma can be quite hard to understand for those who haven’t experienced it (I am purposefully avoiding the word ‘privilege’, here, because I find it unhelpful in these sorts of discussions), so I will do my best to explain:
Let’s say you really like Iron Maiden. You can’t help it — you just love Iron Maiden. It doesn’t hurt anyone, and it doesn’t really cause you to act any differently. Aces High is a rad song, and Brave New World is a great album. In secondary school, your friends called you Ryan Maiden (for the purposes of this thought experiment, your name is Ryan). Iron Maiden aren’t a popular band, but whatever. It’s part of you.
Imagine, then, turning up at your hall of residence, engaging in small talk, and finding that you get on fairly well with your new flatmates. “I like Iron Maiden,” you say, after getting comfortable, unaware that people in the flat have heard bad things about Iron Maiden. ‘Doesn’t listening to metal make you want to worship Satan?’ one —who we’ll call Housemate A — asks themselves. From there, Housemate A judges you through the lens of the Iron Maiden-listener you are. Absurd as it is, the sultry tones of Bruce Dickinson have, in Housemate A’s mind, placed a black mark on you that will last for as long as they know you. (Or until they’re properly educated.)
Say what you want about Iron Maiden, but we can all agree that stigma is absurd. It’s also pretty easy to see — and if you open your eyes, you’ll see it everywhere. It is a phenomenon experienced by minority communities across the country, and it is especially prevalent as far as mental health is concerned due to the poorly understood nature of even the most conditions.
I spoke to a Cardiff student called Tamar. “Where I differ from most people with depression is that I’m really open about it.” How was that, coming to university? “I regretted telling the people I lived with. There’s always this reaction you get from people when you tell them you suffer from depression; they pull away from you, their faces drop, and they act like you’re contagious.”
The day-to-day effects were immediately noticeable: “With the people I lived with, a lot of them would start to blame my depression for being grumpy, but they forgot that sometimes we all have bad days. I often heard ‘I know you’re depressed, but stop taking it out on me.’” She then says something I’ve thought frequently: “I just wanted to say, ‘well, stop being an asshole, and I won’t take it out on you!’”
Perhaps you haven’t experienced unwarranted stigma. But maybe if you’re a woman you’ve experienced a roughly similar phenomenon: have you ever had something blamed on you while someone insinuates that it must be your ‘time of the month’? It’s absurd. It’s unfair. And it’s a bit like that.
I empathised with Tamar when she told me this story. She’s come off her medication, and, by all accounts, she’s doing pretty well at the moment. But that means there’s more at stake, and she told me that the one thing she feared the most was relapsing. I’ve already discussed how problematic relapses are — but I’d like to ask you a question before we move on. Do you think it’s fair that Tamar experienced what she did when she was trying to put her depression behind her?
Let me put it another way: say you were grieving, but you were on the road to recovery. Do you think you’d stop mourning any sooner if the people you lived with said “Hey, I know your friend’s dead, but lighten up, eh?”
IV: Pledge or polish?
Universities and Students’ Unions take various measures to fight stigma on their own terms. To this end, Cardiff University and the Students’ Union signed the ‘Time to Change’ pledge on 2 June 2014. The pledge, described as a “public statement of aspiration,” is being undertaken specifically to combat stigma and increase mental health support and awareness. Both organisations and individuals can take the ‘Time to Change’ pledge, and organisations are required to submit an action plan that describes what they will do to achieve this goal. It is this pledge that inspired this campaign.
The university’s commitment to the pledge already appears disappointing. There was nothing sent out from the communications department, nor any posts on the Cardiff University news page; no press release in the archives, no nothing. This is the most well concealed photo opportunity I’ve ever (not) seen, and I’ve spent a long time using snapchat.
This entire process was initiated by Helen Dent, a sabbatical officer with the Welfare remit. When queried, Helen declined to offer any comment or information, including a copy of the action plan.
Rachel Jones, Cardiff Students’ Union’s outgoing Students With Disabilities officer (a part-time, non-sabbatical position) spoke to me about the pledge instead. She said that while the current level of mental health support available was “a mixed bag,” the pledge was a step in the right direction.
The student community previously voted on the pledge at the university’s Annual General Meeting, where a number of referenda are voted on by members of the student body. There, the measure was passed with an overwhelming majority; Dent had made a very compelling case to those in the audience, and I was among those who voted in favour of the motion. But now the signing has taken place, some students are starting to doubt the value of the pledge.
The signing was a public event, and students and staff were invited; one student I asked about this said “of course it’s fucking public,” calling it a “shallow public relations display.” “Beneath the rhetoric of change, there is nothing that will realistically improve the state of affairs for students with mental illness.”
On the whole, ‘Time to Change’ has been a successful initiative (led by Mind and Rethink Mental Illness), with a number of key signatories including Channel 4 and the Church of England. Yet in this instance, just signing the pledge took about six months (Jones ascribed this to persistent scheduling conflicts). While all students were invited to the signing, it took place early on a Monday morning, at a time when many had already returned home or were busy with exams.
Some have noted that Cardiff University’s pledge does not make specific allowances for subcontracted staff, who will be the responsibility of human resources departments outside of the university — a key issue during an earlier campaign for the Living Wage. Equally, the implementation of the pledge will take place long after the elected officers who wrote and approved the action plan have moved on to other positions.
And what if the action plan goes unfulfilled? I asked Jones what the repercussions for either organisation if they should fail to achieve their goals: would anybody be penalised? “No, no-one is penalised. I guess it’s because it’s something voluntarily undertaken, and it’s more about the statement they are making by doing so.” I disagree, and take the long view: statement or otherwise, if the Students’ Union and the university fail to achieve the goals of their action plan, then the entire student community are the ones who are penalised.
I feel as though this is a good moment to begin deconstructing the nature of the sabbatical officer system as it applies to this pledge and more generally, as both they and the part time officers are responsible for a great deal of this progress. For those unfamiliar, and it is an indictment of the system that many are, sabbatical officers are university students who are elected by the student body to serve them in a representative capacity.
This system is widely used by Students’ Unions across the country; at Cardiff, they are paid £19,495 a year, and are hired on single year contracts. During that time, they are elevated to directors of the union, and appointed to the board of trustees. Change is slow, and, because of their short time in office, many of their initiatives do not see the light of day until after they have left. At least as far as Cardiff is concerned, they are accountable to the student body that elected them, and can be removed from their post with a vote of no confidence.
The remit of the Welfare Officer is to communicate the welfare needs of students to the university. Helen has, during her time here, spoken a great deal about improving the mental health provisions available to students, including it in her manifesto when she initially stood for election, but the role involves more than just Mental Health support. Even so, the university has credited her as having a close relationship with the Counselling and Wellbeing team, having “worked successfully with [Helen] on student focused awareness campaigns.” These campaigns include ‘Mind Your Head’ week earlier in the year.
But gair rhydd, the Union’s student newspaper (and our sister publication) recently published a review of elected officers, and described Dent’s manifesto promises as being ‘largely unfulfilled.’ Now, I am not naive; manifesto pledges are manifesto pledges, and some are naturally sidelined as circumstances and budgets change. But it is somewhat dissonant with her work that Helen declined to offer any information for this article, particularly when interest in student politics is generally low. Why else do people don silly costumes and produce viral videos?
In terms of welfare, it is not immediately apparent how things have improved, and few students I have spoken to can point to any concrete examples; of those who approached me during the production of this piece, none were willing to go on the record and speak on Dent’s behalf (including some who were asked directly if they would do so). Certainly, the pledge has been signed, and nobody should dismiss the initiative before it has the chance to succeed, because if faced with negativity, then it never will — but I will forgive those who consider pledges to be cheap without action. Our generation of students has seen their tuition fees rise by nearly triple as a result of a broken pledge, so faith is hard to come by.
Whatever happens, Dent will no longer be here in 6 months, the time it took to sign the pledge in the first place. But her decisions will reverberate for a long time to come, both within the bounds of the pledge and without. While investigating the actions of relevant sabbatical officers for this piece, I spoke to Sophie, an anti-suicide charity worker and Cardiff University student, who claims she spoke to Dent about suicide prevention training for her and other staff. She forwarded me a document describing their correspondence.
“She turned down the opportunity to have her and other frontline staff — who deal with students on a day-to-day basis — trained in suicide prevention without any real explanation.” The reason given is that it was ‘not required at the time.’ But this is not a problem that the Cardiff academic community is immune to. “I was very surprised, because Cardiff has had a few issues with student suicides this year — that’s why I contacted her in the first place.”
Members of the Counselling and Wellbeing service were recently given training on managing suicidal thought, but there appears to have been no action taken in terms of the wider community of academic staff. In addition, when asked, a university representative who claimed they worked closely with Dent said that they were not made aware of this offer.
One of Dent’s manifesto pledges included increasing the mental health training students and staff received. I contacted her a second time, to confirm if this correspondence between her and Sophie took place, and if so, what her reasons were for declining the training. Once again, she declined to comment.
My intention here is not to single out a young person for perceived failures in a management position. No sabbatical officer has a perfect record, and directorships are typically very hard to come by — something most often awarded after years of experience in key positions. But when somebody champions an initiative so inherently public, with a view to encourage social change and open discussion, doesn’t it help the cause more to communicate than to remain silent?
V: After Dark
Student run services often fill in the gaps that Universities are unable to fill themselves. Student minds, for example, offers frequent group self-help sessions chaired by students. Another of these services is Nightline, which allows students to speak to somebody between 8pm and 8am about things that are bothering them.
Nightline is staffed by volunteer students. Unlike therapists or counselling professionals, they do not require any formal qualifications, and are given training according to the organisation’s principles. The minimum number of staff at any one Nightline branch is two — one to take the call, and another to support the person on the phone if they need any prompting or further information. One of these must be a senior Nightline listener, or a ‘veteran’. If the service lacks staff, then a recorded message is played advising callers about alternative services including the Samaritans, but this is very rare. Over the past academic year, Nightline has been available at all times it has advertised it would be, and those I spoke to have described the service as having massively improved.
Yet there is a disconnect between public perception of Nightline and what it is the service actually offers. Nightline staff aren’t allowed to identify themselves as such to their peers, but I came into contact with a volunteer who agreed to be interviewed on condition of anonymity. “I guess I got involved with Nightline because I bought into the idea that I’d be helping people at death’s door,” she told me. “I never did take a call from someone who was suicidal, however.”
“I joined just after a friend committed suicide. I knew three people who killed themselves, and he was the third in two years.” A year and a half, to be exact. She told me that she, and others she knew, had thought of — and in one case, attempted — suicide.
I asked her if she ever calls Nightline herself. “No,” she responded. “I don’t know if it would be effective, not now I know how it works.” That is not necessarily an indictment of the service, and she rushed to clarify that; indeed, plenty of NHS doctors choose to enrol themselves and their families on private healthcare.
However, speaking to her, I got the sense her thoughts ran deeper than that. “I never took that many calls, but I never felt satisfied putting the phone down after a stressful call.” Were you alone in thinking that? “No, I wasn’t.” She spoke of how powerless she sometimes felt. “We can’t call an ambulance unless we’re asked to, and we can’t put the phone down until they do. So if someone called and said they’d taken an overdose, and just wanted some company until they fell unconscious, we’d have to listen and wouldn’t be able to do anything.”
The trouble is that — outside of acting as a directory of services available to the person on the other end of the phone, and as a crumple zone to any immediate anxieties — Nightline staff really can’t do very much. The volunteer I spoke to told me she had trouble sleeping, but if the person on the other end of the phone said that they did too, she could not say she related to them. Perhaps this makes sense: after all, they’re student volunteers, not trained therapists, so they might end up doing more harm than good. I get the impression, however, that having somebody to talk to who could actively engage with what you were saying might be extraordinarily beneficial to some.
Equally, the implementation of this might appear negative to the uninitiated. We workshopped a few scenarios: what would you do if I told you I was going to kill myself? Could you advise me not to? “No,” she said. “I’d basically be able to ask why, but I couldn’t explicitly tell you not to kill yourself.”
While researching this article, I contacted Nightline, and put my source’s statements to them. I also requested copies of the training materials Nightline staff received — perhaps I could identify or convey the root of my source’s problems.
The central Nightline office declined to provide me with training materials, but the Cardiff Nightline was much more accommodating. Their response was to invite me to their operations base and see what they did for myself. I spoke to one of the service’s co-ordinators, and we agreed that there was sometimes a disconnect between what Nightline was perceived to do, and what Nightline actually does; posters are emblazoned with the words “Worried? Anxious? Stressed?” which are normally asked in a conciliatory tone, by those intending to counsel others. But counselling others is not Nightline’s job, nor its aim.
The Nightline office contains three beds, a Nintendo Wii, and ample supply of tea and coffee, as well as an intercom —considering the premises are unmarked, this is most useful when volunteers decide to order pizza. The service has its space and bills paid for by Cardiff University, and receives a very good amount of funding from both the Royal Welsh College and Cardiff University itself. The service is responsible for all universities in the city, except for Glamorgan, which is now a part of the University of South Wales and so served by the Newport branch.
The co-ordinator was happy to explain to me what general protocol was in some of the cases our source outlined. “We can’t advise anybody, as guided by our organisation’s core principles.” So, giving somebody guidance is off the cards. But she made a strong case for this: “I could spend weeks speaking to you, and never know the full story. Giving advice is not what we’re here for. We are a listening service.” Of course, counsellors can give advice. But counsellors spend long sessions getting to know their clients, and has a level of continuity that Nightline does not; Nightline protects the anonymity of callers and volunteers in order to protect both parties.
Cardiff Nightline receives 40-50 calls a month on average. “We get about four times as many listening calls than general information calls, one or two ‘heavy’ calls a month, and one or two crisis [suicide risk] calls a year.” They described to me profiles of ‘problem’ and ‘banned’ callers. “We occasionally get people masturbating down the phone.” (My commissioning editor, who also came to the interview, asked how listeners could tell; after a brief period of silence, neither I nor the co-ordinator volunteered any comment in response.)
The Samaritans once ran a phone service for these sorts of callers called the ‘Brenda-line’, which was shut down in 1987 after it was deemed too damaging to the mental states of volunteers. But while their phone service may have gone away, problem callers have not: “Some would call and ask us to repeat what they said — like it was a power thing — while others would describe sexual fantasies and other uncomfortable topics.” Incest was apparently popular. “When it comes to things like this, there is a line which some callers cross by mistake.” Nightline applies a ‘reasonable person’ test for fringe cases; even if the listener is not uncomfortable, if a reasonable person is likely to be offended, then callers are asked to change their mode of address for the sake of both parties.
The ‘thrust’ of Nightline’s services are to effectively act as a crumple zone; to absorb the impact of a shock, and allow an individual to offload negative thoughts so that they may be able to seek help later. To this end, offering any serious advice does not make sense. “We can point people towards services offered by their university, for example, but we can’t offer any concrete advice. There’s too much risk it would do more harm than good.” Nightline hopes to give callers the breathing space they need to figure out what works best for them, providing no more than a gentle nudge in the right direction.
The co-ordinator explained that relating to callers did not fit in with their organisational priorities (“We just don’t want to detract from their circumstances”), and that volunteers were able to put the phone down if subject to abuse or anything they were uncomfortable with.
When viewed through the lens of the most extreme cases, Nightline may appear to lack the protocol to properly deal with them, and it is for this reason that many new volunteers feel apprehensive when the time comes to pick up the phone. But as the above quoted statistics put across, only one or two suicide calls come in a year, so there is little value in viewing the service in these terms. Comparing the interview with my source and the co-ordinator who spoke to us makes one thing clear: approaching the service assuming that every caller will be in the worst case scenario is hardly representative of reality. How much value is there in engaging in improbable hypotheticals?
While the service has its scope and its limitations — as all services do — acknowledging this is not intended to discourage anybody who might benefit from Nightline’s services. I would like to restate that it is an excellent resource for those who need another person to speak to, who exists in the same demographic as them; somebody who understands, who also has essays due in, and also has grades to worry about. But if regarded as the only option — in the minds of some, including at least one person who has staffed it — the service is inadequate as a last resort. A crumple zone is of little value after an impact; where are those in crisis supposed to go? Even in a signposting capacity, it is completely unfair to place that burden on a student run service.
This is not to say that Nightline is somehow unfit for purpose, as it is exceptional at what it does. I have seen this for myself, and I am not ashamed to admit that I have used the service in the past. But it is not fit for a purpose that some find themselves using it for when they have nowhere else to turn. Both the co-ordinator and I agreed the gap between Nightline and A&E was too distant, and the services offered by the university and even the NHS are too frequently unavailable; it is unrealistic to expect Nightline to fill that void. This might also explain why our source found herself less than satisfied with her work.
But what else is there? It’s getting harder and harder to get an appointment with a GP. NHS Direct is an 0845 number in Wales; 111 is only available east of the border. The counselling service offers a drop-in session once a day for 45 minutes on the Park Place campus, and once a week on the Heath Park campus. In their own words, however, “it is not a psychological assessment or a therapeutic session.”
VI: Visions of Perfection
Part of the university’s ‘Time to Change’ pledge includes increasing the hours in which the university offers pastoral support. That this is a positive move is undeniable, but it is unlikely that this will extend to a full 24hr service.
Even if there was, the problem for many is that there is no continuity. As mentioned above, Nightline suffers from this problem too; you can phone up, call back, and speak to somebody with a completely different level of experience. While the university student support centre offers drop in sessions, these can be difficult to utilise without a pre-existing file on the system. (Equally, there is an unusual culture that surrounds the student support centre’s drop in service — one student I spoke to said that they didn’t use it irrespective of how much they required assistance, because it felt like they were “cutting line” if they already had an appointment later down the road).
I spoke to a student named Katie, who outlined some of the frustrations she encountered when dealing with the counselling service. Earlier in the year she experienced a situation that is probably familiar to a lot of people: “As a perfectionist, it’s in my nature to put a lot of pressure on myself. At the start of second year, I began working a lot of hours in the hope of building towards a First. On top of that I landed a part-time job, and then worked as a freelance writer. I quit smoking and drinking, and entered a cycle of non-stop work.” She admitted that this was unhealthy, and later described her descent into a “hellish” state — “beyond any previous comprehension of what it meant to be ill or unhappy.”
When she finally decided to approach counselling, she filled out a form and was told that it would be about four weeks until someone was able to see her. “By that time, I had already experienced a very real and very scary nervous breakdown. It was really demoralising to know that it would be so long before I saw anybody.” In an attempt to find out what was wrong, she began reading about types of mental illness online to the point of “obsession.” Four weeks is a long time. Panic attacks — which I think can be best as described as feeling like a heart attack without the physiological experience — can be over in moments. (Katie turned to a local volunteer led counselling service instead, Cardiff Concern, which she says was very helpful. She also noted that when she returned to the counselling service a second time, she only had to wait two weeks to be seen, and that they too were very helpful.)
Despite an exceptionally helpful tutor, Katie eventually ended up retaking the year. She is in a much better place mentally, now, but still had to repeat a year and forfeit the money that comes with taking an extra year of university; one wonders if this would be the case if someone saw her sooner.
Again, I do not doubt that Cardiff University’s staff do all they can, and would like to take this opportunity to express that the staff at the Student Support Centre are an exceptionally talented group of individuals. But the narrative at our university is the same as the narrative elsewhere — in the NHS, the public sector, everywhere — money is tight, and resources meagre. Talent costs money to hire, and while those who staff the SSC are talented indeed, there aren’t enough counsellors on staff to immediately deal with somebody experiencing something as debilitating as a nervous breakdown. (Statistics released by Cardiff University for this article note that the services provided by the Counselling and Wellbeing Team have been utilised by 1,300 students in the past year; there are seven full time equivalent counsellors shared between them.)
Katie described her experience with her tutor to me as unusual in standard (“she provided a very rare show of actual human interaction within my faculty”), and, indeed, part of the “mixed bag” Rachel Jones described above was the inconsistency in attitudes held by tutors: “I’ve had experiences of some being fantastic, and others telling people they just need to pull themselves together.”
The latter is more common than anybody would like to admit. A student from the Maths faculty said that they spoke to their tutor as a result of their anxieties, and their tutor plainly suggested that their circumstances should just “make them work harder,” and that they should be “used to stress at their age”. I suspect this is because many are blind to the damage their words can do, or, more specifically, that they are blind to the effects of mental illness more generally. (University representatives have stated that staff are provided with ample training and guidelines designed to help them manage risk.)
Part of the ‘Time to Change’ pledge intends to address this, by giving every member of staff mental health training. Both Rachel and the university at large are optimistic that this will be effective, although I can’t quite shake the feeling that it’s a little late — this institution has existed in various forms since the 1800s. That it took over a century and a half for the university to publicly state the intent to mental health training their staff shows just how pressing the work of mental health campaigners really is, and that their work is nowhere near complete.
VII: Angles
One of the people I spoke to is a step away from Cardiff and the demographic which most of my interviewees sit in. His name is Jacob, and he graduated from Cambridge about three decades ago. He seems to think that things have got worse since he was an undergraduate: “too much pressure to have pay for the course, too much pressure ‘to have fun’ all of the time, and who pays the bill?” He is referring to student grants, which have been the subject of unrelenting cuts in recent years. (Worth noting is the fact that during the time he was at university, there were no tuition fees.)
One thing he said in particular stuck out to me; he alluded to the fact that mental health care was neglected in all schooling, pushed back to later in life. In that sense, were universities forced to pick up the pieces?
At last year’s Mind Media Awards ceremony, host Scott Mills discussed an anxiety disorder which prevented him from attending school. It was not until he got involved in a local radio station that he found himself able to overcome his anxiety. This reminded me of my own experience; I, too, experienced extreme anxiety as a young person, missing huge chunks of secondary school and being demoted to lower academic sets as a result.
Despite having written the past 7000 words for publication, I received a D in one of my English GSCEs; my occasionally frail mental health has, for better or for worse, shaped my life.
At the time, the comprehensive I attended seemed unwilling to want to address this. They had established I had not been bullied, so they assumed that I was the victim of child abuse or another extra-curricular factor. My mental health never entered the equation, and it was not until I was diagnosed at 16 (a diagnosis prior to 18 is very rare) that I had considered that the reason might have been an enemy within.
In this sense, Universities making public statements about it being the ‘Time to Change’ is valuable. But my experience is by no means an exhaustive representation of how schools operate, and students are capable of falling through the cracks at university level. I spoke to Cari Davies, the departing Students’ Union President, who shared her own struggles with her mental health in the past.
Her head of year at school had identified her difficulties and initiated a process that led to regular visits from a mental health nurse at home. It is, in many ways, a success story — one that has enabled Cari to reach great heights at our university. But would the university alone be able to do so? “When all this happened, I had a strong support network around me who were able to make decisions and any necessary arrangements with me. The difference when you come to university is that that network no longer exists, or is at least not close by, and this changes everything.”
“If I’d first begun experiencing problems with my mental health at university, to the same degree that I had at School, I can’t imagine things happening in quite the same way. I’d have probably stopped going to lectures, but unlike at school, nobody would have chased me to ask why. I would have never spoken to my personal tutor, so there wouldn’t have been someone to point me in the right direction. I’d have stayed in my room on my own, and whilst my flatmates were great fun, they wouldn’t necessarily have had the knowledge or understanding to be able to recognise what was going on.”
“If one had directed me to the counselling service landing page and convinced me to fill out the form, I would be faced with a wait that was potentially six weeks long, and in that time would have managed to talk myself out of going. I don’t want to over dramatise things, but I just don’t believe I would have coped.”
This is coming from an exceptionally strong person — somebody who ran two successful political campaigns during her time at this university, for two separate positions with a large number of candidates (Cari was Athletic Union President for the 2012-2013 academic year). She is proof that mental health difficulties can afflict anybody, even those who are outwardly confident and outgoing, and is also proof that there is such a thing as a positive prognosis.
If schools did more to battle mental health stigma and help students fight hard battles early on, then perhaps we would have more stories like Cari’s. The education system shapes people from the moment they engage in formal teaching, and is perhaps one of the best places to address stigma, and to ingrain the fact that it is OK to talk about mental health into the minds of young people, while those minds are still malleable, and while they still have a support network surrounding them.
But it would be wrong to allow universities to absolve themselves of all blame simply because they are the last “part” of education; as many who I have spoken to have noted, Universities aren’t just about education. They’re about helping people grow into someone that is capable of using the degree they earn to do something great.
Cari believes that the ‘Time to Change’ pledge is a great step, but notes that it is important that what’s on paper translates into positive change for students. As with Helen Dent and the other sabbatical officers, Cari will have left her position in six months’ time, but is confident that the Union will continue to push forward with the action plan that Dent and her colleagues have set out.
Over the course of the last week, when this piece began to come together, my colleagues and I reached out to the university on numerous occasions. The principal respondent to our queries was Ben Lewis, who manages the Student Support and Wellbeing Service.
In response to suggestions that academic staff were not providing adequate support to students with mental health difficulties, he said that it was not the responsibility of tutors to be trained in mental health support, but their responsibility to “know the appropriate referral routes.” The university offers Mental Health First Aid as part of the Staff Development Unit, but it is unclear as to whether or not this training is mandatory.
He acknowledges that mental health is a massive issue facing our society, quoting the same figures I do in my opening paragraph; that one in four people develop mental health difficulties during their lifetimes. Yet he does not offer statistics regarding the prominence of mental health difficulties in student populations, which is a significantly different sample than the population at large. Ben tells us that counselling feedback is 99.9% positive, but it is unclear what this statistic refers to and how they define positivity — are they counting neutral feedback, or everything that isn’t negative? Such a high percentage would be considered a certainty by scientific standards, which is, for a service like this, totally unheard of. The Counselling and Wellbeing service saw about 350 students last year; one of my researchers points out this means that they would need to receive less than two feedback forms that were not positive over the course of three years.
It seems odd, then, that more than two people I spoke to while putting this article together told me they had negative experiences with counsellors. Neither could recall being presented with an opportunity to give feedback, and students who drop out of the service are unlikely to be asked, or be in a position to give it in the first place. I, myself, have used the counselling service, and while I have no complaints — indeed, it was a very positive experience — I have no recollection of providing feedback of my own.
Ben Lewis points out that many positive stories go unheard. He is most likely correct, and members of the research team who helped me produce this article agree that it has been much easier to find negative accounts than positive ones. Yet with many of the accounts I have been presented with, I have also been told that these stories have been told to nobody else, such as Gareth’s in the opening chapter. I have only really scratched the surface — suggesting that there are also a great number of negative stories that also pass without notice. There is no acknowledgement of this in Ben’s communications.
I understand that nobody can be expected to deal with problems they are not made aware of; indeed, if anybody was capable of reading minds, then we’d be a lot better at dealing with these problems. But during our correspondence, something struck me. I reviewed the university website, and I realised there was an total absence of the words “mental health” from all materials.
I spoke to a student while putting together the news piece announcing the signing of the pledge itself. She said that Cardiff does little to entrench stigma, but does equally little to foreground mental health issues and help students in need to self declare and connect with those around them. Student Support completely sidesteps these two words, constantly referring to student wellbeing, which does nothing to foster an environment of acceptance that would allow students to share these stories in the first place.
Fighting stigma is one thing, of course — but erasing the terms ‘mental health’ and ‘mental illness’ from materials entirely is quite another. In response to a question about what definition of mental health difficulties the university used, I was sent a link to a document. Worryingly, I did not have high enough security clearance to actually access the file. I assume this would be the case for all students, meaning likely none have access to the definition, meaning none have any information that would allow them to know when to seek help.
While the university clearly do have protocol in place to deal with mental health issues when these issues are presented to them by students, they are not foregrounded. Much of the policymaking regarding mental health at this institution takes place behind closed doors; despite posing questions about where the ‘Time to Change’ pledge will be displayed, so students can judge for themselves the progress of the action plan, I have still not received any response.
Ben Lewis informs me that the ‘Time to Change’ pledge will have its implementation managed by a working group that includes the Deputy Vice-Chancellor. The student support service staff will meet regularly with union staff — ‘student representatives’ — offering them an opportunity to convey any concerns they might have about the progress of the action plan associated with the pledge. But as noted earlier, the student representative charged with issues concerning student welfare did not respond or attempt to speak to me whatsoever during the production of this piece, with no explanation for the reticence.
So it is, then, that we are faced with a series of impermanent conclusions; there appears to be little protocol in place designed to actually communicate the progress of the pledge to the student body, and in some cases, there no desire to communicate at all. There are no repercussions for allowing the pledge’s many proposals to slip, and many are largely qualitative, promising the sort of progress that cannot be truly measured. Student led services such as Nightline do an excellent job of acting as a buffer, promising a degree of almost professional support on a totally voluntary basis when the university does not, but none are capable of providing students with advice, and the gap between A&E and these services is far too wide. No matter how many statements I read from the university, there seems to be little to suggest that I will stop hearing about tutors taking an unnecessarily hard or insensitive line against students under their care any time soon, and it does not appear that our university has a real plan to change that.
Mental health is an undoubtedly serious issue, and one that can be exacerbated when students leave home for the first time. This is combined with an host of other issues; dodgy landlords, the natural entropy of interpersonal relationships, dissertations and examinations that can never be retaken. Yet that those two words — mental health — are almost entirely absent from the university’s vernacular shows a certain lack of willingness to address issues that are of the utmost importance. It is not enough to sign a pledge that promises action: you have to create an environment that fosters open dialogue, that does not require those with health problems to ‘come out’, and that displays the routes available to those who might benefit from them. The actions of the LGBT+ association are such that Cardiff is recognised nationally for the culture of acceptance it has created (particularly the Students’ Union, which has achieved an exceptional amount). It remains to be seen if we can replicate that success for the wider student community grappling with mental health problems.
There is no doubt among us at Quench, the university, and the Students’ Union that the ‘Time to Change’ pledge is an important first step. But it needs to be followed by action and clear communication. This article, too, is only the first step, and both I as a writer and this magazine intend to push the spirit of the ‘Time to Change’ pledge as far forward as possible. In the short term, we are looking to examine the mental health provisions available to university staff — all of them, from the cleaning staff to academics — and in the long term, we intend to revisit the above themes in a year’s time to provide better assessment of the pledge’s impact. I hope it’s more than just polish.
Michael O’Connell-Davidson served as the writer and principal researcher for this piece. Special thanks to Sum Sze Tam, Gareth Evans, Jason Roberts and Tom Eden. For details on the Quench mental health campaign, see this page.
