For most students, starting university is still about enjoying their freedom for the first time. Student health services, however, are finding that more and more are arriving at university already anxious and stressed. The suspected suicides of three first-year students at the University of Bristol last term?has only added to questions about whether this increase in mental health problems among freshers is being met with enough support.?

¡°I think [students now] are more anxious than previous generations of students,¡± says Ruth Caleb, chair of the Mental Wellbeing in Higher Education Working Group, and head of student counselling at Brunel University London.

¡°There are huge pressures to get good degrees, not just a degree. They come in very worried that they won¡¯t get a 2:1 or a first, and that is something we didn¡¯t used to see in first years¡­I think that they do carry the weight of the great deal of money they are investing in their future.¡±

While financial pressures push students to work longer hours to supplement their loans, social pressures ¨C such as finding accommodation ¨C and employment prospects are common concerns of students requesting counselling.

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¡°From when they first arrive some of them are already thinking about what their graduate prospects are like,¡± says Dominique Thompson, honorary secretary of the Student Health Association and director of the University of Bristol Students¡¯ Health Service.

¡°Twenty years ago, people did not even talk about it, they were just at university to get a degree, learn a few other skills, join a team or club and enjoy themselves.¡±

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The expectation that new students should be having the time of their lives on top of delivering good grades puts greater pressure on students.

¡°We hear many students struggle with loneliness at the start of college, and increased access to alcohol and other drugs with limited oversight can be a problem for many,¡± says Victor Schwartz, medical director of the JED Foundation, a US-based non-profit organisation that campaigns to prevent suicide among college students.

While financial, academic, social and cultural-specific pressures have the potential to cause anxiety or depression, the stress of transitioning to university is most detrimental for young people with existing mental health problems.

¡°Mental health conditions, generally speaking, have their onset between the ages of 15 and 25, and that¡¯s the age when people go to university,¡± says Thompson. ¡°When you put the two together ¨C their genetic tendency to develop something, plus all those other pressures ¨C that¡¯s when something is going to happen.¡±

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Widening participation, Thompson says, has created new burdens along with new opportunities. Young people with mental health conditions who previously may not have been able to attend university are stepping away from familiar support networks into environments that may not provide for their specific needs. Receiving support such as financial aid or mitigating circumstances requires attending appointments, filling out paperwork and ¨C for specialist therapies ¨C mental health assessments by a succession of strangers.

¡°Quite often by the time they get an appointment with psychiatric services ¨C if they¡¯re lucky enough ¨C that¡¯s the time they¡¯re going back for their vacation. So we need a system that fits students better and understands how students need to live,¡± says Caleb.

Despite well-intentioned gestures, such as references to "parity of esteem" between mental and physical health in government documents and the establishment of University Mental Health Day, mental health services are struggling to meet demand. Few universities have mental health strategies, and in the US, Schwartz says, there are no requirements for colleges to provide mental health services to college students.

To fill the gap, there have been countless initiatives set up to provide support for students, including advice websites, help lines, online counselling and an enormous number of apps, such as Mind¡¯s student app, Emoodji. On campuses, there are peer-to-peer support groups, "parenting" schemes for new students, while wardens and academic tutors are often expected to provide pastoral care.

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This type of support may be helpful ¨C particularly for students coping with less severe stress ¨C but it can be disparate, low priority or uncoordinated. Pastoral support provided by a faculty, for instance, might be given by untrained academics or administrators with other responsibilities.

Thompson describes a need for "central support services" to coordinate mental health support across academic departments, residences and student health centres, and to practically address problems that could induce stress, such as debt or accommodation. Access needs to be simple and well signposted, she says, particularly for new students unfamiliar with the services that their institution offers.

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¡°It¡¯s about making it as easy as possible for students,¡± says Caleb. ¡°I don¡¯t think there is any one model that is perfect for all universities. Some [universities] have many sites, some are very small, some are campus universities, some are spread around the cities, so it¡¯s impossible to give one modus operandi. But what we need is for universities to gather round the table to talk about how they¡¯re going to offer a service.¡±

hilary.lamb@tesglobal.com