Degrees of Mental Illness

Cassandra Russell on the university students who game the system by self-diagnosing as psychologically unwell


Statistics, they say, are just lies cloaked in numbers. Well, try this one: in the academic year 2014/15, 33,000 students in the UK had a recorded “mental health condition”; four years later, in 2018/19, 82,000 did. But while mental illness has seen an alarming increase of 150 per cent, the number of students has risen by only 5 per cent. And when we turn to anonymised surveys, one in four students — more than half a million souls — report that they have had a mental health diagnosis. What truth do these numbers tell?

Four possibilities present themselves. First, that the world has deteriorated so dramatically in this period that it has pushed two-and-a-half people into mental illness for every one in the preceding student generation. Second, that there has been no change in young people’s mental health, but we are in a newly-accepting climate where students feel comfortable reporting genuine mental health conditions. Third, that their mental health remains the same, but the decreasing stigma and widespread debate about such issues have led students to misread the typical trials and traumas of teenagerhood through the medical lens of mental illness. Fourth, that many young people, aware that there are attendant benefits to reporting themselves mentally unwell, have found a foolproof way to game the system.

No one knows quite how these four explanations interact. Many academics are convinced that students are battling through a dreadful combination of the first two. But how exactly has the life of young people appreciably degenerated in the last five years, inside or outside university? Brexit, or the long lag of the financial crash, will hardly cut it. By contrast, the third possibility is often dismissed out of hand for trivialising young people’s experience: if they view their feelings as mental illness, then mental illness it is. The final possibility is deemed so appallingly offensive, so impossibly cynical, it cannot be voiced in public.

Well, here goes. I’m convinced that almost all of the increase can be chalked up to the last two explanations. A combination of student delusion and student opportunism is making a mockery of genuine and debilitating mental illness, conditions that blight a far smaller number. And, like all the truest taboos, this conclusion is publicly muzzled but privately acknowledged by many of my colleagues.

The development of the problem can be quickly sketched. As a student, your arrival at university proves a daunting experience: lecturers reveal that much of what you learned at school was a deliberate oversimplification, if not outright falsehood; peers emerge to be brighter, and perhaps more competitive, than anyone you encountered at school; friendship groups need building from scratch, reigniting playground anxieties about acceptance; and you now have to live alone, away from home, possibly for the first time. The business of adjusting to university is undeniably stressful and exacting.

That orgy of tours and inductions and drinks and clubs they call Freshers Week proves to be a blur. But you remember someone with a name like “Student Wellness and Experience Facilitator” making a song and dance about how the university is always there to help whenever you feel troubled: “The mental health of students always comes first at Wessex.” A cursory browse of the university website reveals how true that is.

While you bridle a little at reading that every mental health condition is treated as a disability, you are pleasantly surprised to see that you need not meet anyone to qualify. Of course, there is nothing to stop you visiting a GP off campus, expressing that you feel overwhelmed by the pressures of it all, and rapidly obtaining the required diagnosis from someone who really has no time to assess your case. Nor does the university have the staff to test robustly whether you are presenting actual mental illness. The university has in fact found that processing the paper-trail of mental health claims is beyond its ability: self-diagnosis, reported to an overstretched tutor, will suffice to tick the box. Perhaps you believe the stress has made you genuinely unwell.

Or perhaps not. But who would falsely consign themselves to this troubled category? There are certainly those for whom it’s not about the academic benefits but the consequent attention: universities have always had students who feel the need to announce their pronouns as “Me/Me”. But these are an infuriating minority. For the rest, there’s very little stigma attached to the process, since all information is entirely confidential. And it has its perks: in an environment where a mental condition is an acknowledged obstacle to learning, allowances automatically follow.

Extensions are routinely offered for essays and coursework; unsubmitted work can be pardoned for “personal issues”; exams can be sat on private computers, along with a generous extension of time. The result — for those not suffering in the genuine sense of the word — is a less stressful, and therefore easier, route through the course.

I wish it were the stuff of satire to allege that thousands of students, converted by social media into a cohort of narcissistic solipsists, are illegitimately flying the flag of mental illness for their own short-term benefit. Yet I have taught students who are as engaged, gregarious and outwardly stable as can be. But when the final exams arrive I learn that because of privately disclosed issues they have been awarded extensions, additional time, and examiner discretion.

The universities, terrified that their student satisfaction scores will suffer, have a simple response: increase the number of counsellors, so that no one can complain that provision was not there. But, faced with long waiting lists, students only blame the system for its inevitable insufficiencies. Several universities have tried creating their own “wellbeing apps”, in the hope that these untested and unscientific efforts can stave off the problem. Over-worked academics are asked to play the multiple roles of teacher, guardian and therapist, without even a day’s training.

A colleague reports how he is corralled by his Russell Group university to participate in “Wobble Week”. This widely-advertised initiative aims to address mental health by giving students a more inclusive experience: academics play board games with students, feeding them jelly babies intermittently. The teams in charge of these patronising sessions keep quiet about how much student tuition fees are funding their mandated playtime. Thankfully, most students realise the exercise is infantile nonsense.

In striving to bridge the gap between schools and universities, the latter now perpetuate the worst aspects of the former. Students need not evolve into more autonomous adults when quasi-parental care is available at every step. Independent living, and even independent learning, are increasingly risky ventures for the wellbeing team — those people keeping an eye not on academic quality but only the student experience. Oh, and an eye on ensuring that they don’t cure themselves out of a job.

A combination of student delusion and student opportunism is making a mockery of genuine and debilitating mental illness

But academic staff feel the rod that has been fashioned for them. Lecturers already wrap their teaching in the suffocating cellophane of trigger warnings and student opt-outs. Yet they are still faced with many students who refuse to speak in front of others because it’s too stressful to be judged by their peers. It’s no use countering that this is part of the point — that, although universities are not finishing schools for work, they should make students aware of what employers will expect. This basic duty is slowly fading from view, as the conveyor belt delivers vast cohorts of infantilised and insecure twentysomethings to an unimpressed world.

So here we are. Students continue to report increased anxiety year on year: last year only one in six students recorded their level of anxiety as “low”. The most worried students are white. And, of all students with mental disabilities, more than 70 per cent are female. I have found no explanation for why this should be, beyond the lazy conclusion that men are holding back from reporting their hidden mental illness.

All the while, circles of wellbeing advisers and desperate academics worry whether examinations are perhaps part of the problem. Is it right to test students in a pressurised atmosphere, rewarding their ability to think and recall information in an undeniably stressful scenario? Judging from their questionnaires, students do seem keener to increase the amount of written coursework: exams appeal only to the top and bottom of the cohort. And, when they are allowed to pose their own questions and tailor their assignments — invariably tied to their own limited life experience — the students are even happier.

Perhaps focus groups will find that they would be even happier to grade their efforts themselves without the invasive, objectifying assessment of others. Those who suggest that universities should provide an immersive, challenging and provocative experience, as much as a welcoming and nourishing one, are met with the withering glare of a Women’s Institute cake judge.

How will this all look after Covid-19 ceases to run amok? Will a global pandemic provide a useful benchmark for the student experience? Will the struggle to keep up with essay deadlines find its low and proper place in the hierarchy of humanity’s problems? Or will students point to their £9,000 tuition fees and remind us that the customer is always right? And if the customer wants to purchase an experience that puts personal serenity ahead of academic scrutiny, private comfort ahead of public debate, who is brave enough to turn them down?

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