1. To analyse the key insights and reflections presented in this book regarding the experiences, challenges, and supports available to students with mental health difficulties in Irish universities.
2. To develop recommendations for reform for the inclusion and support of students with mental health difficulties in higher education and identify practical ways to integrate the knowledge gained from this book into educational and professional approaches.
This book was all about understanding. Its aim was to offer an insight into the lived experience of Irish university students with mental health difficulties so that readers might better be able to say “I understand”. It began by examining what understanding is, why it is important, and how it can be garnered and developed. Some context to the research was provided, with a particular focus on how we have understood and responded to the phenomenon of distress throughout Irish history and, more specifically, in the Irish higher education context. With orientation and context established, the body of this book was devoted to the experiences of students themselves. The transition to higher education, the provision of disability support, and the nature and meaning of higher education for students with mental health difficulties were each explored in turn.
This final chapter aims to offer some reflections based on the combination of the context (whole) of current provision for students with mental health difficulties in higher education, and the experiences (parts) shared by the 27 students who took part in this in-depth hermeneutic phenomenological research. These are simply that – reflections. They are neither conclusions nor hard “truths” but rather reflections from this particular hermeneutic cycle that may be used to inform knowledge, policy, and practice.
Supporting university students with mental health difficulties requires:
1. supporting transitions
2. re-examining the model of provision of support for students with mental health difficulties
3. financing widening participation
4. investing in people and relationships
5. celebrating and protecting the idea of a university
6. honouring the voice, experience, and wisdom of students.
Students with mental health difficulties are particularly vulnerable in the transition to higher education. Research suggests that students receiving treatment for their mental health are more likely to drop out of university in their first year than students not receiving mental health treatment (Zając et al., 2024). Suggested reasons for this increased attrition include “missed opportunities” at earlier stages of education, leaving students with mental health difficulties further behind upon entering university (Productivity Commission, 2020, p. 161). This, however, did not appear to be the case for the students who shared their experiences for this book. What the students in this study described was an acute sense of overwhelm and isolation which exacerbated existing vulnerabilities. Of the transition to university, Alicia said, “the whole thing was a major shock to me”. John said his “mental health fell apart” and spoke of the overwhelm and self-doubt that “would come into my head ‘I’m not intelligent’, ‘I’m not meant to be here’, ‘how did I get in here’ […] suicide kept crossing my mind and it came to a point where I wasn’t able to do my work”. Marie described how she “felt a little bit lost” while Ella said she “dropped off the grid”. The common theme for all these students who really struggled in the transition to university, and even dropped out to return at a later stage, was the absence of somewhere to turn to and someone to talk to. They found support later in their university journeys, but their accounts of this vulnerable transition period are marked by a lack of preparation, support, or connection. Students who transitioned to university via the DARE, disability route were encouraged to access additional supports in their transition to higher education. These include an additional orientation session where students had an opportunity to tour the campus, get to know the disability support service and meet their disability officer or advisor. For students such as Alicia, Marie, Ella, and John, who didn’t have the benefit of this additional orientation, they were significantly more vulnerable to overwhelm and dropping “off the grid” (Ella) in their first year. Ella, in particular, highlighted how the move to university, and away from the supports she had built up as a teenager, was especially detrimental. She described living away from home for the first time “with no help, trying to pretend it [her mental health difficulty] didn’t exist”. By January she had stopped going to university. While Ella managed to return to college the following year to begin a new course, what are notably absent from the data are the experiences of students who dropped out from university and did not return.
These experiences would suggest that all students, regardless of whether they have experienced distress, would benefit from somewhere to turn to and someone to talk to at intervals throughout their first year at university. While all students are offered some induction or orientation to their university, the stories of the students in this book remind us that transition is not something one completes in the first week or two of university but rather extends across the first year, if not further. Moreover, as was described by many students, when struggling it is often more challenging to ask for help. Scheduling one-to-one check-ins with tutors or advisors offers universities the opportunity to identify students at-risk of dropout and reduces the likelihood of a student “dropping off the grid” (Ella). Secondly, given that 15 per cent of students do not progress to their second year of university (Higher Education Authority, 2024c), the burden of paying full fees should they wish to return to higher education places a significant strain on the approximately 7,000 students who drop out each year. Given the challenges faced by all students at this critical transition point, and in particular students who struggle with their mental health, the opportunity to return to a different course, without the financial burden of full tuition fees, would be extremely beneficial for all students. Every student deserves a second chance.
The current model of support for students with mental health difficulties in Irish universities is predicated on a disability model. This means that students with significant mental health difficulties must have a diagnosis and be classified as disabled in order to access additional support. For many students, receiving a diagnosis is a positive experience. Sophie described how “it was nice to have that feeling of validation and acknowledgement”. John said he “didn’t care what he [psychiatrist] said to me, you know, I just wanted him to do something for me”. While, for these students, a psychiatric diagnosis offered validation and access to services such as Disability Support at university, these diagnoses are not always without repercussions. As discussed in Chapter 4, they can have long-term implications for a student’s ability to secure a visa, mortgage protection, or work in certain professions. Further, for those providing support to students with mental health difficulties in higher education, there is the question of whether this model is effectively reaching the students for whom it is intended. Students who can afford to pay for a private assessment and diagnosis have the advantage of availing themselves of the benefits of the DARE scheme, such as reduced points entry to university and additional time in exams, more readily than students who have to navigate the public system with its long waiting lists and administrative delays. This inequity of access is seen in the 70 per cent of those availing of DARE who come from affluent or advantaged backgrounds (Higher Education Authority, 2024a). Given that people with disabilities are known to be at higher risk of social exclusion and deprivation (Eurostat, 2022), this proportion raises the question of whether it is time to reassess the current model of provision. This question is made all the more pressing in a climate where the numbers of students with mental health difficulties deemed eligible for disability support is increasing rapidly (rising from 643 students in 2011/2012 (AHEAD, 2012) to 3,939 in 2021/2022 (AHEAD, 2023)), and funding for higher education remains debilitatingly low (Irish Universities Association, 2023).
A universal design for learning (UDL) approach to supporting students with mental health difficulties is posited as one solution to these challenges (Healy, Banks, and Ryder, 2023). It does this by addressing the barriers to inclusive and equitable higher education at the source rather than providing “reasonable accommodations” and resources to “eligible” students to overcome these barriers later downstream. It must be noted that the students who shared their experiences as part of this book spoke highly of their university’s disability support service and the support they received. They benefitted with help with “the practical stuff” (Mai) such as planning and breaking down assignments into manageable chunks but, primarily, students had the sense of reassurance of “just knowing that … if you really do need it, there is support there” (Millie). What is clear, however, is the current model of support is under significant strain from the twin demands of increasing numbers of students and under-resourcing. It is time to reassess the current approach to including and supporting students with mental health difficulties in higher education.
The Irish government has relied on a highly educated workforce to realise its economic and social ambitions since the 1960s. Government initiatives such as free second level education (1967) and the “Free Fees Initiative” (1996) succeeded in widening participation to such a degree that, as of now, 80 per cent of school leavers in Ireland progress to higher education (The Irish Times, 2023). However, from the early 2000s onwards successive governments have failed to adequately fund this widening participation strategy. Student “contribution charges” were introduced and, following the economic crash in 2008, increased to €3,000, making Ireland one of the most expensive places to go to university in the European Union (Citizens Information, 2023). Simultaneously, exchequer investment in higher education has dramatically decreased. Today it is estimated that the higher education sector in Ireland is underfunded by a total of €307 million per year (Irish Universities Association, 2023). This underfunding has significant consequences at every level of the university – from lecturers on short-term precarious contracts, to high student-staff ratios, to insufficient resourcing for essential services such as disability, counselling, and learning support services, resulting in long waiting lists and session limits. Underinvestment in higher education affects everyone. It undermines the government’s widening participation strategy, limits the resources available to universities to support student inclusion and engagement, and impacts individual student’s ability to achieve their higher education ambitions. It is clear that the effective and meaningful inclusion of students with mental health difficulties begins with adequate resourcing.
One of the effects of under financing and under resourcing is that, as the number of students with mental health difficulties registering with university disability services increases, individual staff members are faced with larger workloads. This means that they have less time to offer each student the support they need. This is true across student services, with student counselling services reporting long waiting lists and an according limit on the number of counselling sessions they can offer students (typically 6–8) (O’Brien, 2024). Students in this book spoke so clearly about the benefit of one-to-one support. John attributes his success in college “to the people around me”. Higher education, for John, presented an opportunity to move on from a past defined by “poverty”, “abuse”, and “deprivation”. To do this, John needed support that was tailored to his individual needs. He was highly complementary of the support he received and spoke about how his one-to-one academic writing support “makes a huge difference”, while his regular check in’s with the campus GP offered him a consistent form of support and encouragement. John spoke about each individual without whose time and individual investment “my life would fall apart within 24 hours”. He puts his successes in college “down to the people around me” as well as his own effort and determination: “I’m merely an individual that can’t function without the help of other people”. One-to-one interpersonal relationships with a trusted other have long been recognised as fundamental to supporting people who are struggling with their mental health (Block et al., 2022; Dooley and Fitzgerald, 2012; Dooley et al., 2019; Parker et al., 2015). These relationships require time and investment, and while it may be more cost-efficient to provide short-term automated alternatives such as mental health apps or online webinars, for those who are really struggling there is no replacement for a positive interpersonal relationship. These relationships do not always have to be professional, such as with a therapist or a disability officer. Peer support programmes have been shown to be effective for students experiencing distress (Pointon-Haas et al., 2023) as have student advisors and pastoral support (Sharp, Wray, and Maxwell, 2020). Some staff members in universities say they would benefit from specialist mental health awareness training (AHEAD, 2016), but students, when asked, speak not of the person’s awareness of mental health but rather the time, patience, and generosity they are shown. Adrianna said that “being able to see someone and actually develop that relationship was one of the most important things in my life”. Investing in the people, offering them the time and resources to build relationships with students in whatever their capacity, is one of the most important investments in student mental health on campus.
The meaning and value of higher education for students with mental health difficulties, as evidenced by the students in this book, is much greater than the sum of its credit, module, or accreditation parts. John, for example, viewed university as a way out of the abuse and deprivation of his childhood: “If you get your education nobody can take it away from you and that’s why I want to get it, I want to get something that nobody can take away from me”. For Leon, too, education offered him a way out of his early life circumstances. He described himself as “the black sheep” as a result of his early experience of schizophrenia. University offered him “the social acceptance of being a student” which has “helped my mental health as well, you know, because I have that social approval now”. Kate described how “I feel in my life I am to learn things intently”. Her anorexia nervosa had defined so much of her adolescence and early adulthood that, in returning to education, she “is trying to form a path of some type of understanding or knowledge […] I am going to see what I can learn. If over the years I have been so willing to let go of this life in an instant, well then I need to understand why I should be here”. For these three students, and many others, higher education is a significant and meaningful emancipatory experience.
Irish President Michael D. Higgins (2021) suggests we are “at what I believe to be a perilous juncture in the long history of the academy”. The very raison d’être of the university is under attack, according to Higgins (2021), from “market forces and the inexorable drive towards a utilitarian reductionism that is now so pervasive”. This pervasiveness is seen in the closure of university arts, humanities, and social science departments (The Guardian, 2023) and the prioritisation of courses that attend to the needs of the economy (Houses of the Oireachtas, 2023) – particularly those in Science Technology Engineering and Mathematics (STEM). Citing Max Weber, Higgins (2021) described universities as “an iron cage of bureaucracy within which conformity would be demanded”. Cardinal John Henry Newman (2009) in The Idea of a University stated that “if a practical end must be assigned to a University course, I say it is that of training good members of society”. The students who shared the meaning of their experiences as part of this book further demonstrate how this “training” can be truly life-changing. In a time when the prevailing emphasis is increasingly on employability as the chief measure of a university education’s value, the students in this book remind us of the purpose university has as a place to develop personal and intellectual virtues, such as curiosity, integrity, the ability and desire to seek knowledge, and to use it to be a better person and citizen. They remind us of the value of the university and how the idea of a university, as set out by Newman, Higgins, and others, needs to be celebrated and protected.
What makes this book unique is its emphasis on the experience and knowledge of students themselves. While literature is offered to create context to the students’ accounts, the voices and perspectives of students take centre stage. Policy makers, university administrators, and disability support providers are all notably absent, with their influence represented, primarily, through the students’ accounts. This book was not about comprehensively analysing or explaining, but rather understanding the experience as it is lived and representing this understanding for what it is – a valuable form of knowledge. In turning to the nature of lived experience, using the book’s hermeneutic phenomenological approach, the voices, experiences, and wisdom of students were brought to the fore. In doing so, this book sought to act as an example of just how valuable these experiences, this wisdom, are in developing understanding from which to develop policy or advance practice. So many of the students described how they “just want to use what I’ve learned to help other people” (Niamh). Engaging students, in a way that is meaningful, respectful, and protects their anonymity, is beneficial, not just for developing understanding, but for providing students with an opportunity to share the “different kind of understanding” (Adrianna) that comes with experience. Kingsley described how “huge experiences like that change you” and a mechanism to respectfully share, and openly receive, the understanding that comes through lived experience is beneficial to all.
Understanding, according to Heidegger (1927/1996), unfolds and develops ontologically within the hermeneutic circle. This book sought, in many ways, to emulate one hermeneutic circle. It began by exploring what we already know, the pre-understandings we hold about mental health, distress, and inclusion in higher education. These pre-understandings are themselves heavily influenced by our culture, assumptions, and our place in time and history. We then moved to the “parts” that are students’ experiences of university while experiencing distress. These parts included the experience of transition to higher education; the forms of support available to, and accessed by, students, and the nature and meaning of university for students struggling with their mental health. We then moved from the parts back to the whole in the reflections of this concluding chapter. However, it does not end there. Understanding does not have a conclusion but is rather a continuous journey. The hermeneutic circle never ends. We just re-enter it from a different starting point.
Irish University Students with Mental Health Difficulties
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