Student Mental Health and What CAMH Professionals Need to Know

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TRIGGER WARNING: Please be aware that this podcast discusses personal experiences of self-harm and suicide.

This University Mental Health Day, we are joined by two students, Rhiannon Hawkins and Nathan Randles, to discuss student mental health and what CAMH professionals need to know.

Rhiannon currently studies Geography at the University of Oxford and Nathan is a medical student at Keele University. Both Rhiannon and Nathan are also Young Representatives for the Royal College of Psychiatrists.

Rhiannon and Nathan set the scene by providing insight into what University Mental Health Day is, why it is so important, and what the impact of the pandemic has been on student mental health.

Rhiannon and Nathan talk to us about their own personal history and experience around mental health. They discuss their own past experiences with child and adolescent mental health services (CAMHS), and whether this support is still available as a student. Rhiannon also explores whether there is still stigma around students using mental health services at university and why some students may not access support.

Whilst both Rhiannon and Nathan describe quite robust systems of support within their own universities, they share their views on what else universities should be doing to support the mental health of their students, what message they have for policy makers, and what mental health professionals need to know about student mental health.

Furthermore, Rhiannon and Nathan discuss what message CAMHS professionals should take from University Mental Health Day and share how CAMHS professionals can get involved.

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Rhiannon Hawkins
Rhiannon Hawkins

Rhiannon is a young person representative for the Royal College of Psychiatrists, a trustee at the Green Economics Institute and currently studies Geography at the University of Oxford. She has been involved in a variety of different Royal College eco distress projects, for example: planning conferences, doing press interviews and contributed to the College’s climate position statement. She has also written a debate piece within the ACAMH within their special COP26 issue. Rhiannon has also been a part of the Green Economics Institute’s delegation to COP26 and helps write magazine and book contributions for the Institute. She has strong interests in Climate Change, eco distress and intersectionality.

Nathan Randles
Nathan Randles

Nathan is a a young person representative to the Royal College of Psychiatrists on their Child and Adolescent executive committee and is currently a medical student at Keele University. He is also an ambassador for the charity The Mix UK, a hotline that offers support and counselling to young people under the age of 25. (Image from www.nathrand.com)

Transcript:

TRIGGER WARNING: Please be aware that this podcast discusses personal experiences of self-harm and suicide.

Jo Carlowe: Hello. Welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. March 3, 2022 is University Mental Health Day, and I have with me two students, Rhiannon Hawkins and Nathan Randles, who are going to talk about student mental health and what CAMH professionals need to know. Rhiannon is a young person representative for the Royal College of Psychiatrists and studies geography at the University of Oxford, and Nathan is a medical student at Keele University and an ambassador for the charity The Mix UK.

If you’re a fan of our In Conversation series, please subscribe on your preferred streaming platform and let us know how we did with a rating or review, and do share with friends and colleagues. Rhiannon and Nathan, welcome. Can you each start with a brief introduction?

Rhiannon Hawkins: My name’s Rhiannon and I’m a second-year geographer at the University of Oxford. My main speciality is in environmental justice. And I’m not only in my work with the Royal College of Psychiatrists, I also am a trustee at the Green Economics Institute, which specialises in climate justice and intersectionality. I’ve also visited COP26 in November with them, and I also do a lot of work with refugee rights and fundraising with the student charity SolidariTee.

Jo Carlowe: Thank you. And Nathan?

Nathan Randles: Yes. As you said before, I’m a medical student at Keele University. Like Rhiannon, I’m also a young person representative to the Royal College of Psychiatrists on their Child and Adolescent exec committee. And as you also mentioned, I’m an ambassador for The Mix, which is a hotline that offers support and counselling to young people under the age of 25.

Jo Carlowe: Now, the theme of the podcast is University Mental Health Day. What is University Mental Health Day and why is it so important?

Rhiannon Hawkins: Students currently in the 21st century are under immense pressure to be able to perform and succeed within society, not only in terms of academic potential, but also in terms of society through public opinion and through great issues which are currently facing society, such as climate change. So students are under an immense amount of pressure, and I think having psychiatrists aware of Student Mental Health Day is incredibly important to help assist their practises within the clinical area.

Nathan Randles: More often than not, the position that university students often find themselves in, it’s a new start and a new area and a time where there’s a huge amount of change going on in their individual lives, and a great deal of identity is built in that time. And so with that considered from the perspective of a post-COVID world as well, where we now have had some students who have had to remain effectively isolated in their accommodations, who have had difficulties accessing their education due to the shift to online, there’s a massive amount of variables that become in play now when it comes down to the mental health of university students, and students more generally, and so that is one facet as to why University Mental Health Day is so important.

Jo Carlowe: I’m wondering about the impact of the pandemic. I mean, as you say, students were stuck in their rooms. A lot of the tutoring happened online. What, in your view, has been the impact on student mental health?

Nathan Randles: I mean, it’s quite largely, I’d say, been a negative one. There’s been very few opportunities for young people to, and university students, be in a position to self-actualize during this pandemic. It’s been a case where they’ve been so stuck with whether it be a case of they are forced into a room where what is there better to do other than study, what would have been a time when they have access to societies, when they have access to clubs, hobbies, anything that’s recreational, was more or less just taken away from them.

And now when we see this move towards an increase in freedoms being brought back, a lot of young people now, at least in my position now as a student, it’s a case of, how do they respond to that? Because not only were young people scapegoated quite a lot during the pandemic, it’s also been a case of now that there’s this freedom, we don’t necessarily always have the right ideas on how we should actually take advantage of it now. There’s societies that have reopened, but they’re not necessarily as accessible as they may have once been.

Rhiannon Hawkins: Yeah. And going back onto that, I’d say, in terms of social isolation, there’s increased levels of people’s social anxiety and ability to communicate with each other. I know a lot of people in university who actually struggle to go out on social situations, into crowded spaces, because they’re extremely anxious about the fact that they’re worried about getting COVID because they don’t want to have to isolate in their rooms because university restrictions have been incredibly inhibited on movement and ability to socialise. So people don’t want to be able to isolate because of that reason, and also access to studies. People are paranoid about the fact that they miss lectures now because of the increased freedoms. Universities are starting to relax a bit on issuing online lectures, which means students are actually missing studying if they’re potentially isolating, or the quality of education they’re being offered is significantly lower compared to their peers who are able to attend in person.

Please be aware that in the next two questions, Rhiannon and Nathan will be talking about personal experiences of self-harm and suicide.

Jo Carlowe: If you don’t mind me asking, what is your personal history and experience around mental health?

Nathan Randles: I suppose, when it comes down to my own mental health, it began when I was about 12 years old. I haven’t necessarily always had a good outlook upon myself, but it began to get much worse when I was around about 12. I began self-harming. And over the course of the four years that I was in school, it became much more of a regular, vicious thing. It became very much part of the routine for me. And it became very much a coping mechanism, where I’d, due to my own negative self-perception, I would treat myself in a way where it was causing so much damage that I could feel a sense of retribution for everyone else around me because, in my own mind, I had pathologized my own existence.

It came to a head when I was about 16 years old, in the GCSE year, and I told another student who was in my year, and that person advised me to finally speak out about it. It got to a point where there was no other option for me, really. And so I told the teacher and that sort of started the dominoes to fall. And I wound up eventually going to A&E and then into having an emergency mental health appointment. And then two weeks later, I found myself in outpatient CAMHS. And so following that, it is what more or less started me on the journey to where I am today.

At the time, when I was 16– I’m 22 now– I didn’t do well in my GCSEs. I had no real sense of drive or ambition or want to go anywhere. I had no idea where I wanted to be when I was 10 years older from when I was. And so going into CAMHS, I received therapies, medications, to an extent, a lot of guidance as well. Irrespective of the medical and therapeutic aspects, it was a case of I went in there. And the most important thing that was in the room was my voice and how I was able to articulate it. And reflecting on the past years before that moment, I haven’t ever found an environment where I could speak and I’d never had a voice. And so after that point, things took a drastic turn for the positive. I was able to begin to use my voice. I was able to learn to talk, and I found myself able to actually develop myself and eventually get an apprenticeship, a career, and now I’ve left that to pursue medicine. And it’s been a fantastic journey to look back on because I can see the starting point. And if I ever had the chance to look back at the person I once was and just have a conversation with him, I think it’d be an incredible opportunity. But this is the path, and it’s been a fantastic one to walk down.

Jo Carlowe: Yeah, an amazing journey. Just sticking with you, Nathan, I’m just wondering, once you became a student, it sounds like you’d already had very good support through CAMHS. But if you needed that support as a student, was it still there?

Nathan Randles: It’s quite an interesting point to come on to. And as I did say, it’s been a massively positive upward turn, but it’s not been without its peaks and troughs. I’m now in the beginning of my second semester of my first year. And one thing that I did notice upon starting semester 1 is that I was taking a gradual but increasingly steep way downhill again. I wasn’t quite as bad as I once was, but I could see those negative thought patterns re-emerging and starting to reappear again. And so the first thing I did was, once I had registered with the GP on campus, I was then able to get an appointment relatively quickly. with occupational health, where I was able to have a place where I could talk. And I’d just say to everyone around me, this is what’s going on. Here’s the things that have helped in the past.

And then I got back onto some medications that would be helpful, and then I was given referrals to counselling and therapy organisations to see if I can get back to using those tools that once helped me so much. And so it’s been really good to know what is available, but mine is just one example from a university perspective. I’m very aware that there are other universes that have had very different approaches and different challenges to tackling these sorts of problems.

Jo Carlowe: Thank you for being so candid. Rhiannon, what about you? What’s your experience been?

Rhiannon Hawkins: When I was about 15/16, I attempted suicide. This is due to a long period of almost two years of being bullied, which led me to develop post-traumatic stress disorder and have low self-esteem and confidence, which then perpetuated me into wanting to commit suicide. Also, the combination of me attempting suicide was due to my lack of understanding of myself because, at the time, I didn’t actually realise that I was autistic. So by me actually attempting suicide, it allowed me to start from a baseline. So I got admitted to a mental health team, and they then put me in for an urgent referral for outpatient CAMHS. And then I had two years of CBT therapy because I found– I didn’t really understand counselling very well. It wasn’t the most effective therapy for me. But I had this one therapist, which I work with continuously for two years, which was really, really effective.

And then whilst I was at CAMHS I got my assessment for autism 14 months later, due to various delays and issues within hiccups within the system, not understanding autistic women fully or accepting certain triggers and things like that. But now we’ve come to the forefront, it’s OK. So yes, I worked through that. And despite the fact that I had so many mental illnesses, I still continued to study and I remained in education throughout my time in CAMHS. I managed to study my A-Levels at sixth form and managed to get two A* and two As at A-Level, which meant that I could apply to Oxford, which was really important to me because I needed to go to an environment which knew and understood me for who I was and accepted me for that position. But in that time between going to university, I took a gap year, and that provided with me a lot of support to be able to understand who I was through applying the treatments that I had at CAMHS. And it gave me a lot of self-confidence to be able to go to university and understand and know what triggered my illness and know what triggered my lack of confidence, and it allowed me to grow as an individual person.

Now at university, I have a lot of support through disabled students allowances. So that pays for study skills, but also mentoring, which I have once every two weeks, where I basically go and talk to kind of like a therapist about social situations and about my work, and it stops me from having to have to access counselling or having to go on medication. It’s like a buffer for me to try and access support, and it doesn’t mean that I’m ill. It keeps me well. It actually keeps me talking and keeps my mind focused, and it’s a really helpful tool and technique which the university offer.

I currently help support students in my college because we’re a collegiate university. So within my college, which is Mansfield, I’m the Disability and Mental Health Officer. And I help other students apply for mental health support within the counselling service, have access to it, medication, apply for GP appointments. And sometimes I actually go and take people to appointments and sit in the waiting room with them because they feel comfortable with me going with them because they know that I’ve had that same experience. And I think peer understanding of mental health and student mental health is so much better.

Now specifically with campaigns and actions by charities such as Mind have been really important in destigmatizing mental health problems amongst students. There is still a long way to go specifically in funding mental health places within the university and in terms of providing more counselling support and guidance. Specifically in a place like Oxford, the intensity of the workload is incredibly high. A lot of students are working 10-12 hour days, so it’s intense. But it is getting better now due to national campaigns and work by the government to try and normalise mental health support.

Jo Carlowe: I just want to pick up on something you said there, Rhiannon. You said that there is less stigma around using services at university now. I just wondered, is there still some stigma? Or are there students that wouldn’t access support?

Rhiannon Hawkins: I think so, but that’s because of their own fear. I know I felt this fear when I went to CAMHS myself because I was scared of the unknown of what was going to happen. And people fearing their parents’ reaction, because some people like to open out about that to their family members and friends, and they often struggle to do that. And people ask me a lot for advice on, how do I broach this with people who don’t quite understand what’s going on? And I think that that’s just a societal [INAUDIBLE] Unfortunately, we do have the societal pathologization of mental illness, and perceptions and representations of mental health support in public press and the media have often made it more difficult for young people to access support. And I think that’s why we’ve had such issues with young people coming forward in the past and continuing now, unfortunately. And I think, in terms of students now understanding that they can come forward, universities actually pushing for people to come forward is giving people the confidence to get the support and help they need.

Jo Carlowe: You’ve both described quite robust systems of support within your own universities. But I’m just wondering more generally, what else should universities be doing to support the mental health of their students?

Rhiannon Hawkins: Well, first of all, I would say, acknowledging people’s ability to work through their workload, like actually have more communication and dialogue between tutors and students in relation to trainings on recognising students who are struggling with mental health conditions, to be able to have those conversations on opening out about anxieties and pressures which they face in university, because, for example, the tutors and the lecturers are the first point of contact for a student.
It’s not necessarily the support systems, like the counselling service or the disability advisory service because they’re completely overwhelmed at the moment, because there’s not enough training within staff teams and not enough awareness within academic circles of the requirement to provide support. So I think more training amongst academic staff and welfare members would help provide a more informed approach of providing informal support so people who aren’t confident in accessing the main services, to be able to just have a chat.

Jo Carlowe: Nathan, anything to add?

Nathan Randles: I suppose from my perspective, it would be a case of, in some situations, the consideration of if it ain’t broke, don’t fix it, is quite valuable. I’m aware that in some universities, the way that they may offer their support from a counselling or from just any other general support perspective can vary from it being centralised to the university, or it could be from individual schools or faculties. One thing that I would say is that, for the sake of trying to streamline a service or to try and make something more efficient, you might be shooting yourself in the foot by creating a bigger problem, if it’s a case of trying to, say, you take one thing that was working quite well before and then you want to tweak it in such a way where it might run better for a system or for a software, it might be a case of, wait, why don’t you hang fire on that and actually check with some of the students, whether or not they’re actually happy with what there is and if they see room for improvement, rather than going in straight away.

Jo Carlowe: What about policy makers? What message do you have for them?

Nathan Randles: To me, it comes down to consultations and the consultation process itself. All too often, especially now it seems, where we’ve had to have so many rapid policies to be developed throughout COVID, there hasn’t been much in the way of robust consultation, particularly amongst university students, when it comes down to their mental health support and offerings. And so for me, what I would like to see going forward is a greater emphasis on that consultation process and a better feedback loop wherein those policy makers are continuously, but when necessary, keeping those students that they’ve consulted and potentially the wider student groups informed as to where the policy is going, where and how it might possibly impact them.

Jo Carlowe: Rhiannon?

Rhiannon Hawkins: Definitely consultation is key, like Nathan reiterated, because without understanding on the ground what is actually going on within the UK, policymakers have no idea because they’re stuck in the Westminster bubble. But also have awareness of other issues which could trigger mental health problems within the UK, like, for example, systemic issues surrounding poverty and inequality, or having understandings about climate change and its effect on communities in terms of mental health, but also in terms of just general day-to-day life.

Jo Carlowe: What does mental health professionals need to know about student mental health?

Nathan Randles: I’d be speaking quite very much so from a medical bubble, medical school bubble. I think those early years, at least from how it seems so far, mental health is more than just stress. A lot of the times, there can be some other issues that a school might be very well be unaware of. It’s the consideration of asking why rather than trying to actually undermine or question why someone is not achieving something or not turning up for something, or for whatever reason, there may be a negative. It’s the question of why and how can we support you to fix this, rather than, you need to do better.

When it comes down to mental health professionals more specifically, it’s definitely a case of, yes, student mental health has its own facets and variables that are very much niche when compared to other areas of mental health supports, and that’s perhaps turning your attention to them more often may actually help you to help you in your wider practise more generally.

Jo Carlowe: Rhiannon, anything that you want to add?

Rhiannon Hawkins: I would say, being aware of issues societal pressures which young people are currently facing, because these change all the time. And the way we communicate, the way we socialise, the way we move around is all rapidly changing all the time. And I think mental health professionals need to be aware of that because a lot of these pressures are being recently introduce, particularly
through social media. Had a lot of friends struggling with body dysmorphia and eating disorders, and that’s been triggered a lot by social media and societal pressure to look perfect. So those factions within online the merging of online and physical space and having understandings of how the digital is definitely enhancing and making students more vulnerable, but also understanding that accessing mental health services isn’t as easy as it should be. In terms of going to the GP, actually getting a GP appointment post-COVID is incredibly difficult. And a lot of people have actually given up trying to go to the GP to get a referral letter to go to a service which could support them because they don’t have the time to wait. They don’t have the time to sit down and ring up the GP practise continuously, asking for an appointment or filling out all the forms for mental health services and universities.

I think it’s really hard to get through those gates. It’s as if it’s like the floodgates are shut, and as soon as they open, people flood through them. And if the service was made more accessible, the level of flood on the other side of the floodgate will be far lower than the current situation we’re in at the moment, whereby having to wait for an appointment takes up to a year because of prior accessibility issues. Offering online support for CAMHS by CAMHS professionals, or even just a webchat, which aren’t actually registered patients, just to have a conversation with somebody, to get them known to the system, would save people’s lives.

Jo Carlowe: That’s a hugely important point. What message should CAMHS professionals take from University Mental Health Day, and how can they get involved?

Rhiannon Hawkins: In terms of message, acknowledge student issues at the current moment in time, and recognise that students will have different perceptions and experiences of their education. It can be the best time, but it can also be the worst time. Understanding that it’s a roller coaster of a journey, and people change a lot during university, and how they can support that is by recognising those changes and getting on board with speaking to young people out in the community about what they’re experiencing at the time.

Jo Carlowe: Nathan?

Nathan Randles: We have a lot of awareness days throughout the year, and I think there’s a lot under the mental health umbrella. And I think the main point that I would say to CAMHS professionals is that it’s great that many of them are checking in on them and making sure that those awareness days are recognised, but more often than not, University Mental Health Day seems a bit too niche for many CAMHS professionals. And what I would suggest and like to see going forward is a little bit more participation, a little bit more engagement for this day, because it’s just as important as every single other awareness day that is under the mental health umbrella.

Jo Carlowe: Rhiannon and Nathan, are there any particular topics or areas of mental health that you are especially passionate about?

Rhiannon Hawkins: I’m very passionate about climate change and the effects on mental health because not only in a psychological sense, but a physiological sense as well, the effects of CO2 particulates on brain and cognitive function is really interesting, but also how we can help empower young people in the future to make a great difference and change, about how a psychiatrists can support that. CAMHS professionals are really important within the community as health representatives. In most societies, health representatives are very well respected. And I think being willing to listen and to acknowledge young people’s opinions surrounding this issue will help activists get the right support they need, but also allow CAMHS professionals to connect better with young people as well, to integrate better policy strategy, because CAMHS professionals have the influence to be able to lobby governments, to be able to instigate change for young people, to help young people lay the path for their own future.

And I would also say another interest of mine is ASD and female research as well, and how autistic women need to be acknowledged within society as having, let’s say, a different condition from the typical male representations, which are portrayed in medicine, and how we understand place is very different to a neurotypical person, how those interactions could actually help improve how society functions and how cities function. It’s very interesting having the condition because it opens your mind to the world around you, and I think CAMHS professionals definitely need to use those understandings for their benefits to help support patients in the future.

Jo Carlowe: What about you, Nathan?

Nathan Randles: For me, it’s diversity in the Mental Health Acts. For people from the communities that are Black or minority ethnic, you are many more times likely to be arrested rather than sectioned, or treated negatively when a mental health crisis may manifest. I think psychiatry in general has quite a fair bit to answer for when it comes down to how we treat people from different cultural backgrounds. At the end of the day, psychiatry has been born out of a very European perspective, and the treatments that have been peddled mostly have been from that perspective and are very much biased in that perspective. And so what I’d like to see going forward is a greater acknowledgment of different cultural approaches that can still fit within the models of psychiatry, or whether or not we can actually adjust those models of psychiatry to better treat those people from different backgrounds so they’re not treated by the police because at the end of the day, that’s not where they should be. They should be in care and receiving help, and not being placed into cells.

Jo Carlowe: Is there anything else in the pipeline that either of you would like to mention?

Nathan Randles: I suppose for me, I’m quite happy to be able to say that I’m going to be speaking at the International Congress for the Royal College of Psychiatrists on a piece that’s been led by Dr. Tom Hewson on telepsychiatric interventions and the potential implications of them going forward in the future. So for anyone who’s interested, I would really recommend you reading his review on that.

Rhiannon Hawkins: In terms of work, I’m currently helping the Green Economics Institute write a book in pioneering mental health and climate distress, but I’ve also been working with ACAMH and wrote an article in the special issue surrounding COP26, which is published on their Wiley-based journal. So you can read that online, but I’m also doing work in an article surrounding student mental, not only at college but outside college as well.

Jo Carlowe: Finally, a question for both of you. What is your take-home message for those listening to our conversation?

Rhiannon Hawkins: Acknowledge and understand student experiences. Have a listen. There are many of them, so it makes it difficult, but be willing to sit and listen. And be willing to take on board what we have to say. A lot of us have lots of different opinions and experiences of society, and with those combined experiences we can learn to make the world a better place.

Nathan Randles: For me, well, thank you for all listening. University Mental Health Day is a big day for many, many students. And what I would say is that, if you know a student and if you are not necessarily someone who’s directly linked to university and maybe you don’t necessarily have direct access to the goings on of a university life or someone who is experiencing university life, maybe just have a chat with them. Have a conversation. See if you can maybe get a vague idea of how their experience is going for them. They might be having a fantastic time and are really, really enjoying it. But sometimes, they may be under the unique stresses that come with the university lifestyle. Maybe just check in, see how they’re doing.

Jo Carlowe: Do you think that’s an issue, that people assume that students are having the best time of their lives?

Nathan Randles: Absolutely. There’s a massive stigma when it comes down to students. There’s very much the association of, oh, they’re just students. They’ll be fine. And quite often they are given the short straw. We can look at the national insurance rise that’s going to affect students quite badly. We can look at the way the accommodation systems have been treating students, one in the pandemic, and two more generally. Private landlords can often have quite have a free rein with it, and it’s quite a problem. And students, although there’s student unions, there’s very little in the way of genuine support for how the real world can actually impact a student more systemically.

Jo Carlowe: Rhiannon and Nathan, thank you so much. It’s been really enlightening. For more details on University Mental Health Day, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelled A-C-A-M-H. Let us know if you enjoyed the podcast with a rating or review. And do share with friends and colleagues.

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