Much has been written about the mental health challenges plaguing higher education around the world. With high rates of anxiety and depression among students, administrators struggle to provide sufficient psychological services at a time when many institutions are facing budget constraints.
Gone are the days of a pervasive stigma inhibiting students from seeking professional help, though studies indicate that some vulnerable groups are less likely to access resources. Demand for counselling at most institutions far outweighs supply.
The causes, percentages and diagnoses likely vary somewhat between countries, but most administrators would put student mental health high on their list of concerns. Likewise, you would be hard-pressed to find an institution that is not struggling to respond adequately.
The consequences of inadequate mental health support are dire for students and institutions, including higher rates of academic struggle and attrition.
Singapore is a good example of a country where mental health is receiving national attention, particularly in the higher education sector.
A 2022 study using data at the height of the COVID-19 restrictions revealed that three out of four students at Singapore’s flagship institution, the National University of Singapore (NUS), were at risk of depression, and over 83% cited high levels of stress.
Recognising that hiring additional mental health professionals is both cost prohibitive and only part of the solution, institutions in Singapore are implementing holistic approaches to addressing mental health.
Engaging multiple stakeholders
Sharing the responsibility for mental health support across an institution can reduce the burden on a university counselling centre.
Yale-NUS College, a residential liberal arts institution jointly established by Yale University and the National University of Singapore, utilises trained student affairs staff and academic advisors to triage and manage lower-level mental health issues including mild forms of academic stress and social anxiety.
Staff complete in-house training organised by counselling colleagues and some extend their training through external programmes such as Mental Health First Aid.
In 2021, as an increasing number of teaching faculty encountered mental health struggles among their students, Yale-NUS introduced ‘gatekeeper training’ that covered how to recognise signs of emotional distress, taught empathic and active listening skills and explained the various resources available to students.
Faculty and teaching assistants are often the first to recognise student mental health issues since they engage with students regularly in the classroom, at advising appointments and during office hours. Administrators should ensure faculty have access to and utilise an internal referral system that alerts the appropriate staff when professional follow-up is necessary.
NUS understood the importance of involving multiple stakeholders when they created the WellNUS© Mental Health Framework in 2021 to systematically map out the different aspects of wellbeing and identify the relevant initiatives and key stakeholders that can provide support. The aim of the framework is to have a more holistic, structured and sustainable approach towards student and staff wellbeing.
In 2021, Yale-NUS introduced a for-credit “Resilience and Success in College” elective course for first-year students in order to equip them with strategies to respond to the inevitable challenges and adversity that they will face during college.
Example topics include finding purpose, utilising strengths, practising vulnerability and developing positive interpersonal relationships. The course was later adapted for graduating seniors to help support them through the often-stressful phase of transitioning out of college.
The six-week course was a collaborative effort between the student affairs division and the psychology faculty with seminar-style classroom discussions and assignments that emphasised personal reflection and application. Students who completed the six-week course reported that they were better equipped to navigate future issues and understand what support resources are available to them.
Organisational structure
In the United Kingdom, institutions are encouraged to focus on employee wellbeing through the University Mental Health Charter and the Education Staff Wellbeing Charter. The premise is that staff and student wellbeing are inextricably linked and supportive of the other. As such, a whole-university approach is needed to better address mental health risks.
Naturally, this requires a review of the organisational structure that cares for both student and staff populations. NUS has taken a similar path by devoting significant resources to staff wellbeing, including a dedicated in-house counselling team for university employees.
Additionally, students and staff are recruited and trained to serve as ‘peer supporters’ to provide basic emotional support and coping techniques to fellow students and colleagues in need.
NUS and another large Singaporean university, Nanyang Technological University, created wellbeing offices reporting directly to the university’s president and provost respectively, signalling a high-level commitment to address mental health risks. Both staff and student populations receive mental health support and experience the strategic programme campaigns in a coordinated fashion from central wellness offices.
This approach is different from the organisational structure in the United Kingdom and the United States, where mental health support is offered separately by human resources (often through an external insurance company) for staff and by the student affairs departments for students.
At NUS, the consolidation of staff and student mental wellbeing strategies and approaches has helped to drive consistent mental health campaign messages and resource awareness across the entire university community. In terms of impact, the NUS #AreuOK campaigns in 2021 and 2022 have reduced help-seeking stigma, increased awareness of mental health resources and increased mental health service use among staff and students.
New technology
Since the COVID-19 pandemic resulted in an increased demand for mental health services, overwhelming the existing counselling capacity in many universities, institutions should carefully consider promising new technology.
For instance, AI-enabled chatbots and other types of online applications have gained traction in recent years, with thousands of mental health-related self-help apps in the marketplace. Evidence of effectiveness is nascent, though some promising studies have been published examining specific technology platforms.
As innovative solutions are deployed, they should be viewed as a complement to existing well-established mental health solutions.
Other technology-based approaches are in the early phases. For example, digital phenotyping refers to passively tracking and actively requesting data through smart devices to assess and predict mental health risk.
Students could opt-in to receive wellness-related questions via text messages providing mental health professionals with timely information predicting when students are at risk. An institution can then respond with appropriate interventions to prevent further mental health deterioration.
Taking this concept further, universities may be able to quantify student wellbeing based on measurements through digital devices such as sleep quantity or digital footprints (for example, how orderly one navigates the learning management system). In turn, this would allow administrators to predict students’ mental health trajectories. This technology is still in its infancy but shows promise.
One obvious challenge is the invasive nature of personal data collection required for such approaches and all the related privacy concerns. Nevertheless, in forward-thinking Singapore, innovations like this are being evaluated as possible additional components of a holistic approach to mental health support at NUS and other local universities.
As the global mental health crisis in higher education persists, university counselling services will continue to face an insatiable demand. Singapore’s holistic and proactive approach of creating varied pathways to wellness and viewing mental health support as a collective responsibility across an entire institution provides a promising framework that can be applied elsewhere.
Dave Stanfield is vice-president for student affairs and dean of students at Sarah Lawrence College, New York, United States, and former (2019-23) vice president and dean of students at Yale-NUS College in Singapore. E-mail: dstanfield@sarahlawrence.edu. Andrew Tay is director of health and wellbeing at the National University of Singapore. E-mail: aet@nus.edu.sg. This article was first published in the current issue of International Higher Education.
University World News
