Mental health of university students has been a recent issue of concern. The use of campus counseling and mental health services has increased dramatically over the past ten years. There has been a growing tendency, especially in students coming from the United States, for students to have received diagnoses, and medication, but to have received little proper care for their emotional difficulties. Of the 6,000 students treated at the McGill Mental Health Service over the past five years, less than 20% were deemed to have a clear diagnosis of a severe Axis I mental disorder, though most students did have serious symptoms of anxiety or depression. The reliance on quick diagnoses appears for the most part to be a reaction to limited treatment resources, and marketing ploys by pharmaceutical companies. It also appears fit with our society’s interest in quick fixes, rather than addressing underlying problems. From a student mental health perspective, it makes more sense to first think of students’ problems from an emotional wellness perspective, using DSM diagnoses secondly as a guideline.
The fundamental psychological needs that lead to emotional well-being are frequently weakened in many of the students appearing for emotional help. These needs may be as simple and common as proper sleep hygiene, or related to complex developmental issues. Often living on their own for the first time, many students have difficulty recognizing their psychological and health needs. Their desire to test their independence may leave them ignoring basic health requirements. As well, their desire to fit into their peer group may prevent them from attending to their personal needs. The lack of ability to balance these aspects of life will be more pronounced in students who have not felt well integrated into family and community life. From the time of birth, sufficient emotional responsiveness and structure, both at home and in the community, is required for an individual to grow up feeling secure and confident. When these aspects are present, a person will feel both a sense of their own worth, and a strong attachment to family, friends and community.
A major concern these days is the apparent weak attachment that many young people have to adult authority figures in their lives. Many young adults appear to see the adults in their lives as serving a functional, rather than an emotional role in their lives. This appears to be a reflection of the type of relationships that they have had with adult figures throughout their lives. Parents are often busy or overwhelmed these days, with the percentage of children growing up in traditional families falling. Only a minority of children or adolescents has regular dinners as a family. The time available for family members to emotionally connect appears to be diminished. At the same time, there has been heightened anxiety among parents about their children’s performance. Children tend to be signed up, transported, assessed, diagnosed, tutored, and pressured unlike any previous generation. This combination of less emotional connection and higher performance demands appears to lead to an anxious, functional view of life. The resultant sense that value in life is connected primarily to one’s continually reassessed performance, rather than to emotional attachment, results directly in fragile self-esteem. This fragility often surfaces in university, where competition rises, marks tend to drop, external relationships become more important, and the need for reliance on one’s ability to function emotionally increases. Weaker attachments, combined with a belief that even at relatively young ages one should be able to function with little support, often result in self-blame and depression when one begins to have difficulty in managing life. This self-blame is frequently expressed when students coming for help state, “I feel depressed for no reason”. This sense of having something fundamentally wrong with themselves, then often leads to a search for a diagnosis and medical treatment.
A lack of awareness of one’s fundamental emotional needs can also lead to confusion between traits and disorders. Every individual has certain personality traits that may be advantageous under certain conditions, but cause some difficulty in others. For example, some people are very good multi-taskers. They can switch quickly from one focus to another, but may be somewhat distractible when just having one aspect that needs attention. A student like this who also has poor sleep habits, frequently takes recreational drugs, and is feeling anxious, may appear as having a serious attention problem. Similarly, students who tend to be high-strung, may appear highly anxious if they are not getting adequate sleep and their normal support network is removed. It is crucial when working with students to understand, and help them understand, what are their normal traits and emotional needs.
In assessing emotional wellness in students one should start with the basics, assessing present lifestyle and habits, and looking at recent changes that may be causing difficulty. One then assesses the quality of present and past relationships with an emphasis on the nature of an individual’s attachments throughout their life. The effect of present relationships is generally important to a student’s sense of well-being. Identifying and validating emotional needs will frequently lead to a calming of the immediate upset.
Universities can have a significant impact on an individual’s emotional development. The university period is a time when students are consolidating their adult identity. It is crucial that universities envision themselves as institutions responsible for both intellectual and emotional development. From the moment a student first enters a university, it should be clear that the hallmarks of healthy family environments are embodied in the university atmosphere. Clear, consistent rules and expectations, along with strong support structures should be evident in orientation sessions and promoted in all aspects of university life. The development of strong mentoring relationships should be a priority for universities. No student should graduate without feeling that they were well known by at least one professor. Student Services should also play a strong role in providing both supportive and mentoring relationships. The availability of easily accessible psychological support is crucial in a university population. Ideally, psychological support should be available through multiple points of entry, such as Counselling and Mental Health services, as well as Residences, Deans’ offices, Health, Disability, Chaplaincy, First Year, Financial, Peer Support, and other specialized services. While there are many pressures facing students during their university years, this time should also be an oasis for students. It can provide an opportunity for individuals to consolidate strengths and to surmount emotional difficulties. As universities strive to emulate healthy, progressive societies, students can develop strong identities both as individuals and as members of their community.
Norman Hoffman, M.D., F.R.C.P.C