Mental Health Difficulties
What is a Mental Health Difficulty?
Mental health difficulty is a broad term used to describe a continuum between `relatively mild anxieties and frustration associated with everyday life, and severe problems affecting mood and the ability to think and communicate rationally´(IRISS Project, Students and Mental Health Resource Pack, Rethink/NUS, 1995). Everyone has times in their life when they feel depressed, anxious, or under stress. For some people these feelings become so overwhelming they produce physical or behavioural symptoms that affect an individual's ability to go about their day to day life.
Studying at University can be a stressful time. Factors such as academic, social, or financial pressure, lack of familiar surroundings, and drug or alcohol abuse can trigger the onset of mental health conditions in some people. Students with existing mental health conditions may also find themselves more severely affected than most by these pressures, which may exacerbate any existing symptoms.
How might a mental health difficulty impact upon the student and how can they be supported?
Below are some specific examples of barriers to learning which may be encountered by a student with mental health difficulties, alongside some potential adjustments which could be made to overcome them. These are solely intended to provide an overview of the nature and scope of requirements which staff may encounter, and to demonstrate some of the ways that a disadvantage incurred by mental health difficulty could be alleviated or removed. Above all else, it is important to note that staff being receptive and sympathetic to a student's requirements is paramount, and where appropriate an ongoing dialogue should be maintained with him or her regarding these.
In smaller teaching sessions, students with mental health difficulties may feel they are more conspicuous and that others will be aware of the difficulties they are experiencing. In an environment where contribution is expected from all, the fear of being asked to express an opinion in public or being questioned about an aspect of their work can lead to some students avoiding this type of teaching experience. If it is noted that a student struggles to or avoids contributing to discussions in a group, it is best to avoid directly addressing this in the group setting and finding another time to discuss with the student any concerns you may have. It may be that some students will not feel able to contribute to small group discussions during their time at University, and the knowledge that they will not be asked to can encourage them to attend rather than avoid such teaching sessions.
If a student experiences anxiety, particularly in the form of panic, large lecture theatres and the volume of people in transit to and from a venue can prevent an otherwise enthusiastic and motivated student from accessing this teaching resource. The ability to choose a seat in a lecture environment that allows a student to leave without drawing attention is preferred by many students who experience anxiety in large group lectures. Some students may need to leave lectures early or arrive late to avoid the busy changeover time at the beginning and end of the lecture. Ensuring that attention is not drawn to students who leave early or arrive late can help to build confidence in attending lectures rather than avoiding them altogether.
For many students with mental health difficulties, it is helpful for tutors to provide regular 1:1 tutorials rather than in a group setting as this allows private space to discuss problems the student may be having with academic work.
Delivery of teaching and learning
Mental health difficulties often have an impact upon concentration and energy levels leaving students less able to divide or maintain attention to verbal information or to listen and take this information down effectively. Students often describe being physically present in a teaching session, but not taking in information effectively and leaving without adequate notes; it may therefore be necessary for a student to be accompanied to teaching sessions by a note taker or (more frequently) to use a digital voice recorder to allow them to record teaching sessions, if Encore lecture capture is not available, so that they are able to review the information presented in a less stressful environment.
Explicit consent to use a recording device in teaching sessions is helpful in ensuring that the student is not anxious about using the device in case this is noted and commented upon during teaching sessions. Having copies of handouts and notes in advance can help a student to maintain focus and keep up when distracted. The act of adding to notes is far easier at times of difficulty than writing notes from scratch.
See the university policy on recording in lectures:
- Lecture Recording Policy (PDF)
Most students with mental health difficulties experience fluctuations in their mood and so it can be expected that there will be days when they may not be able to manage the demands of attendance at seminars or lectures. On these occasions it is helpful if tutors can provide access to any of the information that is used within missed teaching sessions so that the student can keep up with any learning they may have missed.
Coursework and Assessments
The submission of coursework is frequently a source of anxiety and distress for many students with a mental health difficulty. The combination of difficulties of focussing upon work and maintaining motivation in advance of deadlines means that work can be avoided until close to deadlines when the task of producing several pieces of work becomes insurmountable. Students will often work with a Support & Guidance Mentor to help them to structure time and to facilitate initiation of work and to break this into smaller chunks to avoid feeling overwhelmed.
This process is greatly helped where tutors are willing to meet with students to help them to understand what is expected from a piece of work and offer encouragement and direction in accessing resources that will help them to work effectively. This may involve providing more direction on a piece of work than for the student´s peers, but should be seen as a reasonable adjustment to the impact of mental health upon the initiation and confidence in self-directed learning.
For some students it may be necessary to allow extensions on submitted work or to consider the pattern of submission dates across the year so that clusters of hand in dates do not become a barrier to effective working. Experience has also shown that some students need to take up the option of non submission at the designated time with the option of submitting work over the summer period when the demands of attendance at University are reduced.
The focus on giving presentations or undertaking group work as part of teaching and learning and submission of assessed work is often cited as problematic for students with a mental health difficulty. The confidence and emotional energy required in effectively presenting information or negotiating with a group of peers can be a source of anxiety and avoidance for some students with mental health difficulties.
Where the assessment method becomes a barrier to effective assessment for students with mental health difficulties, it is helpful to consider whether the learning outcomes of a module can be met without the necessity for that element of assessment. For some modules this may not be possible (where the assessment method is a learning outcome), however on several occasions it has been possible for tutors to consider the learning outcomes of a module and negotiate an alternative form of assessment (such as presenting the information which would have been given in a presentation in a written format etc.) that allows the student to demonstrate their learning without necessitating that this is done by the original method.
Many students experience exams as stressful and the build up to exam time can be a time when a student who is coping fairly well with managing their mental health difficulty feels that they are no longer able to manage as effectively and may not be able to attend their exams. This method of assessment, whilst widespread and accepted throughout all elements of the education system, is likely to mean that some students with mental health difficulties are not able to competently demonstrate their understanding of a subject area because of their reaction to the exam environment.
Standard adjustments to exams can be put into place by the University to alleviate some of the additional stress that student´s with mental health difficulties may face in comparison to their peers. This may include rest breaks in exams, extra time or individual accommodation.
Requests to defer examinations to when the student may feel more stable should be considered where the student finds that they are unable to face the prospect of exams. Alternative forms of assessment should also be considered where students repeatedly underperform or fail because they are unable to manage exam conditions. Some students may undertake a time limited essay which they complete at home rather than sitting an exam. In some situations this may require the student to produce more written work than under exam conditions and should not be seen as an easy option as the additional work may be seen as reasonable in comparison to the disabling effects of exam stress.