Opinion article by Dr Munita Dunn-Coetzee, Director: Student Counselling and Development, University of the Free State.

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 October was Mental Health Awareness Month, and we have just commemorated it under the theme 'Make mental health and wellbeing for all a global priority’. The month provided us with even more opportunity to raise awareness about mental health challenges and advocate for a reduction in stigma as well as in the discrimination that people with mental health challenges are often subjected to. This ignites the conversation again, but does the conversation stop?

 

Mental health among students has increasingly been given a spotlight in popular and professional media. The increase in mental health issues is due to a myriad of reasons, some intrinsic, some due to the culture and increased use of social media, some due to the change in student profile, and some due to the changes in service scope of universities, among other reasons. Mental health challenges among student populations are a common occurrence globally. 

I spend my work day aiming to assist psychologists, counsellors and social workers at the University of the Free State’s (UFS) Department of Student Counselling and Development (SCD) to help students flourish and thrive. This is a fulfilling position, as I have the privilege of working with people and their deepest concerns. Unfortunately, the severity of mental health challenges with which students currently present has changed significantly over the years. Students tend to enroll at higher education institutions with already diagnosed psychiatric disorders. The adjustment to higher education can be intensified by societal trauma, crime, violence, poverty, health issues, and a lack of sufficient academic preparation for tertiary education. This has implications for the number of sessions of therapeutic intervention a student needs, increases the number of other medical professionals involved in managing the student’s health, and has implications for academic and student success. Where does this leave us with our conversation?

The global COVID-19 pandemic added another variable, as it has unfortunately heightened the risk factors generally associated with poor mental health – financial insecurity, unemployment, fear. Meanwhile, protective factors – social connection, employment and educational engagement, access to physical exercise, daily routine, access to health services – decreased dramatically. The pandemic has essentially impacted every facet of our lives. In my experience, students are struggling mostly with depressive tendencies, anxiety, challenging parental relationships, suicidal ideation (thinking about committing suicide), and substance abuse challenges. Over the past six months the SCD had more students present with suicidal ideation, suicide attempts, as well as psychotic episodes, than in the past few years. The levels of anxiety and depression among UFS students are high, and the COVID-19 experience highlighted the need for adequate mental health care.

In recent years, there has been increasing acknowledgement of the important role mental health plays in achieving global development goals, as illustrated by the inclusion of mental health in the UN’s Sustainable Development Goals. The World Health Organization (WHO) pleads for increased investment on all fronts – from increasing access to quality mental health care and effective treatments, to research and more mental health awareness campaigns. 

To adequately address our student population’s mental health challenges, a multi-faceted approach is needed, as highlighted by the WHO. This is a systemic intervention on a large scale. I believe that one should have a layered approach when offering services. The rationale behind the variety of online resources available for all UFS students is to foster the mental health of students and to assist them in building resilience during these times of uncertainty. Mental health self-help literature (articles, videos, and podcasts) was developed, designed, and distributed to each registered student on a weekly basis via email, and placed on Blackboard (the UFS academic platform), the UFS website, and social media.

The UFS Careline is exclusively available to registered UFS students, managed by the South African Depression and Anxiety Group (SADAG), operated by trained and registered counsellors, accessible 24 hours, seven days a week, and at no cost to students. It started in September 2020 and is still going strong. Currently about 70% of our students can be helped in this manner before therapeutic interventions are needed.

A physical trauma response from ER24 has been added since 1 October 2022, to assist SCD in responding to psychological emergencies, especially after hours and over weekends. This will be piloted for six months to evaluate effectiveness before long-term decisions can be made. This is a very exciting prospect! SCD is collaborating with Kovsie Health on this endeavour. 

We have trained a group of students on all three campuses – the ‘SCD Influencers’ – and they assist us with marketing, conversations, and spreading the word to students. They also act as a crucial link in our communication from students – ensuring we know what is going on in the student communities, what the trends are, and how students experience SCD. 

SCD also believes in building partnerships and engaging with different role-players on a frequent basis. SCD has a strong working relationship with the different entities in Student Affairs, the Residence Heads at the residences and day-residences, Protection Services, Kovsie Health, among others. I believe this is also the best way to address any challenges – to work in a team with different expertise. And the conversation continues…

I want to pause at the individual conversation. Within each system individuals are involved, and individuals have the power to influence a system significantly. Some of our students come from backgrounds where they had to fight for literally everything they wanted. Most of our students are first-generation university students and do not have the necessary social or parental support when attending university. This can significantly impact one’s mental health, and it can lead to mental health challenges. We also need to remember that mental health challenges do not discriminate – they occur everywhere. A poor socio-economic stance does not predict poor mental health. A dysfunctional system does not define you. Each one of us has been born with resilience, and I believe the way you use it can change our lives. The most important thing is to keep on trying, despite your circumstances, and believe in yourself. You choose. You CAN do this.

What do I mean by an individual conversation? We tend to forget ourselves and focus on others. Please make time for yourself, for what is important to you, and try to balance the different dimensions in your life. We need to be in conversation with all the dimensions in our life – from physical (running/ going to the gym) to spiritual (praying/ meditating) and mental health (practicing acceptance of yourself and others, practicing activities that mentally stimulate you, getting to know yourself and what might be possible mental triggers in a situation). Have you had your individual conversation today? Mental health is so much more than merely awareness raising during October – let’s continue the conversation all year round.