A promising framework for managing student mental health

SINGAPORE

Much has been written about the mental health challenges facing higher education around the world. High levels of anxiety and depression among students have left administrators struggling to provide adequate psychological services at a time when many institutions are facing budget constraints.

Gone are the days of pervasive stigma that discouraged students from seeking professional help, although research shows some vulnerable groups are less likely to access resources. The demand for guidance at most institutions is much greater than the supply.

The causes, rates and diagnoses likely vary somewhat from country to country, but most administrators would place student mental health high on their list of concerns. Likewise, you would be hard-pressed to find an institution that isn’t struggling to respond appropriately.

The consequences of inadequate mental health care are dire for students and institutions, including higher rates of academic problems and attrition.

Singapore is a good example of a country where mental health is receiving national attention, especially in the higher education sector.

A 2022 study, using data at the height of COVID-19 restrictions, found that three out of four students at Singapore’s flagship institution, the National University of Singapore (NUS), were at risk of a depression, and more than 83% cited high levels of stress. .

Recognizing that hiring additional mental health professionals is both prohibitively expensive and only part of the solution, institutions in Singapore are implementing holistic approaches to address mental health concerns.

Involving multiple stakeholders

Sharing responsibility for mental health care within an institution can reduce the burden on a university counseling center.

Yale-NUS College, a residential liberal arts institution jointly established by Yale University and the National University of Singapore, uses trained student affairs staff and academic advisors to assess and manage lower-level mental health problems, including mild forms of academic stress and social anxiety.

Staff undergo in-house training organized by colleagues, and some extend their training through external programs such as Mental Health First Aid.

In 2021, as more and more teachers faced mental health issues among their students, Yale-NUS introduced a ‘gatekeeper training’ that covered how to recognize signs of emotional distress, teach empathetic and active listening skills and explain the different resources that are available to students. .

Teachers and teaching assistants are often the first to identify student mental health issues because they regularly interact with students in the classroom, at counseling appointments, and during office hours. Administrators should ensure that teachers have access to and use an internal referral system that alerts appropriate personnel 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 the different aspects of wellbeing and identify the relevant initiatives and key stakeholders who can provide support. The aim of the framework is a more holistic, structured and sustainable approach to student and staff wellbeing.

In 2021, Yale-NUS introduced an elective “Resilience and Success at University” for first-year students to equip them with strategies to respond to the inevitable challenges and setbacks they will face during their studies.

Examples of topics include finding purpose, utilizing strengths, practicing vulnerability, and developing positive interpersonal relationships. The course was later adapted for graduating seniors to help them navigate the often stressful phase of transitioning from college.

The six-week course was a collaboration between the student affairs department and psychology faculty, featuring classroom discussions and seminar-style assignments that emphasized personal reflection and application. Students who completed the six-week course reported feeling better equipped to tackle future issues and understand what support resources are available to them.

Organization structure

In the UK, institutions are encouraged to focus on employee wellbeing through the University Mental Health Charter and the Education Staff Wellbeing Charter. The basic principle is that the well-being of staff and students are inextricably linked and support each other. Therefore, a university-based approach is needed to better address mental health risks.

Naturally, this requires a review of the organizational structure that takes care of both the student and staff populations. NUS has followed a similar path, dedicating significant resources to staff wellbeing, including a dedicated internal advisory team for university staff.

In addition, students and staff are recruited and trained to serve as peer supporters and provide basic emotional support and coping techniques to fellow students and colleagues in need.

NUS and another major Singaporean university, Nanyang Technology University, have established well-being offices reporting directly to the university’s president and provost respectively, signaling a high-level commitment to tackling mental health risks. Both staff and student populations receive mental health support and experience strategic program campaigns in a coordinated manner from central wellbeing offices.

This approach differs from the organizational structure in the United Kingdom and the United States, where mental health support is provided separately by human resources (often through an external insurance company) for staff and by student affairs departments for students.

At NUS, the consolidation of staff and student mental wellbeing strategies and approaches has helped drive consistent messages in mental health campaigns and awareness of resources across the university community. In terms of impact, the NUS #AreuOK campaigns in 2021 and 2022 reduced help-seeking stigma, raised mental health awareness and increased mental health uptake among staff and students.

New technology

As the COVID-19 pandemic has resulted in increased demand for mental health services, overwhelming existing counseling capacity at many universities, institutions should carefully consider promising new technology.

For example, AI-based chatbots and other types of online applications have gained popularity in recent years, with thousands of self-help mental health apps on the market. Evidence of effectiveness is still emerging, although some promising studies have been published examining specific technology platforms.

As innovative solutions are deployed, they should be seen as complementary to existing, established mental health solutions.

Other technology-based approaches are in their early stages. For example, digital phenotyping refers to the passive monitoring and active retrieval of data via smart devices to assess and predict mental health risk.

Students can sign up to receive wellness-related questions via text messages, ensuring that mental health professionals receive timely information about when students are at risk. An institution can then respond with appropriate interventions to prevent further deterioration of mental health.

Expanding on this concept, universities may be able to quantify student well-being based on digital device measurements, such as amount of sleep or digital footprints (e.g., how orderly one navigates the learning management system). This, in turn, would allow administrators to predict students’ mental health trajectories. This technology is still in its infancy, but it is promising.

An obvious challenge is the invasive nature of the personal data collection required by such approaches and any associated privacy concerns. Nevertheless, in progressive Singapore, these types of innovations are being evaluated as potential 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 continues, university counseling services will continue to face insatiable demand. Singapore’s holistic and proactive approach to creating diverse pathways to wellness and treating mental health care as a collective responsibility across an 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. Email: [email protected]. Andrew Tay is director of health and wellness at the National University of Singapore. Email: [email protected]. This article first appeared in the current issue of International higher education.