Chapter 3 will address the challenges of the transition when the student has a pre-existing mental disorder. It is recommended that this chapter is read before Chapter 3. Both chapters may be considered alongside Chapters 14–16, which describe different mental conditions as they affect young students, and Chapter 18, which outlines mental health treatment services both within universities and in the NHS.

Schools and parents work hard to prepare young people for university life, and universities themselves have designed outreach and engagement programmes to attract students and promote retention and completion of courses. The beginning of university life is recognised as so important that there are learned journals devoted entirely to the first year. By the very nature of transition, neither school nor university can manage the whole process, nor even link up around each individual student to recognise their unique backgrounds and needs. Some reports and surveys on the topic have names that highlight both the liberation and daunting risks involved – Reality check (Unite Students & Higher Education Policy Institute, 2017), Betwixt spaces (Palmer et al., Reference Palmer, O’Kane and Owens2009) and Finding our own way (Harris, Reference Harris2019).

Students as ‘Transition Aged Youth’

The expression ‘transition aged youth’ originated in US health and foster-care systems to describe young people from 16 to 25 years old who were at risk of serious disturbance as a result of becoming too old for children’s services and having to make their way in the world as vulnerable adults. The term is now used more often to refer to everyone in the age range. It has taken on a similar meaning to the term ‘emerging adults’. However, emerging adulthood was the period of life from 19 to 29 years of age, proposed by Jeffrey Arnett (Reference Arnett2000) as a time young people experience a normal discrete developmental phase involving the exploration of life possibilities. Meanwhile, in her book The myth of maturity, Terri Apter (Reference Apter2002) coined the term ‘thresholders’ to describe this developmental phase, without setting any chronological age definitions upon it.

Whatever we call it, this is a time when we face more adult challenges without having yet mastered the tools and cognitive maturity of adulthood. Neuroimaging scan studies demonstrate that in this period of development there are changes in the structure, connectivity and function of brain tissue itself which extend well into our twenties (Giedd, Reference Giedd2008).

This chapter focusses on the most common route into university life: a young person in their late teens coming straight from school (or from a gap year), probably moving away from home to university accommodation, after attending a day school from the family home. International students may have the even greater challenges of a change of culture and of studying in a second language. Mature students may have already mastered many of the obvious tasks of youthful transition, but still have to manage change. Students from other minority groups, including those with pre-existing disorders and disabilities, will also face a different range of challenges. These challenges will be considered in more detail in later chapters.

The late adolescent brain is still experiencing the instability of accelerated development. This makes it more sensitive to psychosocial stressors, recreational drug and alcohol use and sleep disruption. Half of all mental disorders have emerged by early adulthood, and there are substantial delays in treatment provision. Untreated or inadequately treated mental illness is associated with progression to more chronic and complex disorders, self-destructive behaviours, addictions and drop out from education and work. An influential Lancet article (Duffy et al., Reference Duffy, Saunders and Malhi2019) points out that

Thinking about the Nature of Transition

Anthropology, sociology, psychotherapy and related disciplines have studied and reflected deeply on the nature of transition. One characteristic of transitions is their tendency to cluster, so that we generally face social, physiological, geographical and interpersonal changes all at once. This is a classic transition cluster, often played out against the background of parental transitions into menopause, retirement and ageing, and losses and bereavements in the grandparents’ generation. Individual students and whole family systems have adjustments to make.

Transitions are unavoidable and potentially refreshing milestones in life for everyone concerned. They are often marked with ceremonials and rituals that allow society to acknowledge, digest and celebrate the changes involved. Throughout the animal kingdom, one of the ways young creatures become adults is by challenging their elders to the point of retaliation. They are thrown out of the family den in exasperation, as ageing parents defend themselves against the growing dominance of the younger generation.

Some of this aggression between the generations persists in human initiation rites in which the new adults’ strength and courage are tested in almost sadistic challenges. Such instincts may still be with us alongside the urge to continue to nurture and protect our young. There’s a tension between the view that 18-year-olds should ‘learn the hard way’ and the alternative view that sees them as still essentially needy children.

Young people’s rates of progress may differ from one transitional area to another. For instance, social skills and confidence may develop at a different rate to the achievement of economic independence. Students need to take on new skills and responsibilities in self-care, group living and budget management and have to negotiate with a range of organisations and services as independent adults. They also have to adjust to new patterns of studying and learning and to a new social environment.

The move away from the family and local community offers freedom to explore new sexual and social roles, which can be thrilling but also worrying. Rejections are devastating without a secure network to cushion the blow. Ironically it is also difficult to return home and juggle the different expectations appropriate to home and university settings.

The founders of Interpersonal Psychotherapy (Klerman & Weissman, Reference Klerman and Weissman1994) observed that ‘transitions’ were among the most common triggers of major depression. Their model explores two aspects of the transition – the work of mourning what has been lost, and the reconstruction of a scaffolding of relationships that approximately substitutes for what has been lost, whilst also leaving behind relationships which were harmful or outgrown. This can be a helpful way to envisage the work of managing transitions. It certainly IS hard work. Students often need help in processing healthy grief and mourning, and in finding opportunities to form good new attachments. We also need to take care not to overburden those in transition with too many demands at the same time. The drunken, overcrammed ‘Freshers’ Week’ may have been replaced to some extent by more thoughtful, less intoxicated induction courses, but these are still overstuffed with information. It’s hard for students to recognise and store what might be relevant for future times of need.

At a societal level we facilitate transitional adjustments with ceremonials and observances that bring communities together for solidarity. In his 1909 work Les rites de passage, French anthropologist van Gennep (1909/Reference Van Gennep1960) writes of three phases to be negotiated: divestiture (separation and loss), liminality (being on the threshold with a foot in each camp) and investiture (settling in to a new sense of belonging). In practice, most of the well-recognised life transitions have an even earlier phase – that of anticipation and preparation, which is both constructive and anxiety-provoking. This anticipatory phase provides a unique context for each student. Previous experiences of navigating life changes are important, too. We seem a little hypnotised by societal expectations of going to university and forget that we have some control over when and how the process is managed. We are not obliged to send all the young people of the tribe out into the wilderness together at the magically appointed time to endure initiation rites. Readiness can be considered and nurtured.

This book urges not only a whole-university approach to the mental health of each individual student, but also a course-long, and even lifelong approach to the development of coping skills. For many young people, their whole university career represents the transitional stage between child-like dependency and the independence they are expected to assume on leaving higher education to make their way as adults in the world.

Preparation, Pacing, Practicalities and People

For all but the most sublimely resilient students, arrival at university is too late to start the process of preparation. Is going to university really a ‘leap’? A leap of faith, or an act of bravado? Are students ‘finding their own way’ like babes in the wood, rejected from their home and wandering in the wild? Such metaphors matter because it matters how we conceptualise going to university. Expectations are important when they drive self-fulfilling prophecies; if hopes are dashed and core beliefs shaken the trauma can be damaging. As in all of life, we are healthiest when our expectations and beliefs are a little skewed towards the positive side of reality.

One study (Denovan & Macaskill, Reference Denovan and Macaskill2016) explored a range of psychological strengths shown individually to influence stress and subjective well-being. Optimism emerged as a key factor for new students to adjust to university and buffered the impact of stress on well-being throughout the academic year. It is really hard, though, to tease out whether the students’ optimism was itself the determining factor, or whether it was rather a consequence of these individuals’ health and strength. The same study noted that ‘academic self-efficacy’ was another feature that corresponded with life satisfaction and positive affect. Perhaps the healthiest way to improve a student’s optimism is to help them find realistic causes for such optimism. Many of the effective interventions around student transitions to university seem to achieve precisely that. It’s a good start if the young person is actively choosing university rather than succumbing to pressure to follow the crowd. In today’s UK, about half of all young people and the majority of those who stay on at school after age 16 go to university. Sixth forms and higher examinations are all focussed on university entry. It can be tacitly assumed that everyone who gets good enough grades will apply, and that not doing so is a failure rather than a positive choice. But there are other options.

Schools, families and individuals themselves may form an idealised attachment even before attending a university open day, certainly before applying. If they then fail to get the grades needed, there’s an assumption they will feel humiliated and resentful. There’s even a myth that certain institutions are populated entirely by students who are bitter they didn’t get into Oxbridge (as the Universities of Oxford and Cambridge are collectively known). Research does not in fact find that students who entered their first choice of university are happier. An incidental finding from a study of student finance (Richardson et al., Reference Richardson, Elliott, Roberts and Jansen2017) was that those who got their first-choice university had more severe depression scores and greater alcohol misuse than those who got their back-up choice. Perhaps we’re not very good at identifying the universities that will allow us to thrive.

Teachers, parents and friends can all help the young person assess whether they are mature enough for university at this stage. It’s not a binary choice. There are other options in terms of both work and play, and within education there is also further education at college on either a part- or full-time basis, or the option of an extra year at school – or at a different school. Within the world of work there are apprenticeships, internships and vocational training posts, as well as voluntary work and a whole range of opportunities for gap years. University is often grasped with relief by students and their families alike as a way to postpone the world of work – or the world of not enough congenial, available, work – whilst the young person gains some maturity. For some young people, though, the university environment does not nurture their maturity, and in fact demands more of them than is yet possible.

For those who do opt for university, the question of which institution to apply for is too often a purely academic competition, with each student seeking to attend the most ‘prestigious’ to which their grades will grant entry. The process can seem almost political – some young people deliberately selecting less popular courses to gain entry to a prestigious university where their preferred subject is oversubscribed. Many schools, in both state and private sectors, offer extra mentoring and coaching for Oxbridge candidates only, and parents purchase tutoring if they have the money to do so. For some families this is a magnified repeat of the secondary school entrance competition, whilst for many in deprived areas it is an unaffordable or irrelevant process.

Many teachers are of course aware of specific universities that have delivered good pastoral and well-being support to their former students, or the reverse. The knowledge comes from personal experience and word of mouth. They pass on anecdotes about which universities display arrogance and lack of flexibility, and which are understanding and compassionate. One teacher described a bright student who had been in a secure mental health unit for a year before joining her school. She could have chosen to attend a Russell Group university, but opted for a less famous institution, which had reassured her of the accommodation and pastoral support she would receive. Another teacher praised a university which gave a student an extra 2 years to complete their degree in the context of mental health struggles.

Teachers and students confirm that for all concerned, there can be undue focus on high pressure academic competition, at the expense of balanced preparation of each individual to mature at their own pace in all dimensions of their life. The quest for academic excellence is entirely honourable and students who thrive on fast paced intellectual study need institutions where this is the norm. More balanced attention to psychosocial maturity and readiness, together with better matching of individuals to their working or learning environment could provide better academic results as well as healthier people.

We need better ways to compare universities on their approach to well-being and mental health, beyond specific anecdotes shared between teachers. Making a university’s track record on well-being and mental health more prominent in the university search, and supported by data collected on this issue, could empower better-informed decisions about where to study. The University Mental Health Charter, launched by Student Minds in 2018, could help with this. support this objective. It was co-produced with charities and higher education bodies to provide recognition to institutions that demonstrate good practice in student and staff mental health and well-being. This could particularly help young people with mental health issues and/or disabilities, and those who are sensitive, vulnerable or less socially confident, to make more informed decisions about where to study and live.

Throughout childhood and schooldays, written records and verbal information about the child are passed from adult to adult, without the child having much responsibility for this. Suddenly at age 18 the individual is expected to become the agent of responsibility. Only rarely will a schoolteacher have a counterpart in the university with whom they can share the profile of concerns and expectations of the student, and mental health clinicians may not have identified counterparts in adult services in other geographical areas who will communicate about mental disorders. Written records are less likely to be read in a large organisation where the student is a stranger, than in a small institution in which the child was already known.

Ideally, the move to independent living should be ‘piloted’ before leaving home. There are a range of ways to do this. The best schools change their teaching styles gradually so that by the sixth form they avoid ‘spoon-feeding’ to achieve higher grades. Instead, there is a move to showing the young person how to structure and carry out their own research, how to organise assignments rather than setting specific homework for one night, and encouragement of peer support in learning.

Socially, adult family members, friends and mentors can shift relationships between teenager and adult to a more equal footing, and of course the teenager can practise spending more time away from home. Within the home the young person can be expected to take on more financial responsibilities, household chores and work contributions.

Wise parents and teachers encourage affiliations to organisations that transcend the local level, whether they are political, musical, artistic, technical or voluntary groups. There’s particularly strong evidence for thriving of students with religious affiliations, and such groups often provide a sort of extended family when their members leave home. Holiday camp experiences, such as outward-bound adventures, build confidence in taking on new challenges and demonstrate that it is possible to bond with other people in a short time – useful to build social confidence, even though the group may not be going on to the same university as the young person.

Many young people plan a ‘gap year’ before, during or after studying for a degree. The individual can sample a variety of voluntary or paid activities, catching up on developmental tasks and sheltering for a while from academic and other stressors. However, ambitious long-haul travel projects can threaten the physical as well as psychosocial well-being of anyone who is already vulnerable to mental or physical disorder, particularly when foreign health systems are difficult to access or prohibitively expensive.

How Institutions Manage the Transition Process for Students

The sort of joint working that occurs between secondary schools and their ‘feeder’ primaries simply cannot apply to universities, which may welcome students from hundreds of different establishments. It may though be possible for representatives of an individual student to advocate for and support that individual from before the start of university and to then continue until they have made the adjustment to the new situation. Such supporters may be called mentors or transition coaches – there are a variety of role titles – and the role is often informal or else restricted to identified high risk students.

During the overlap period the student is supported to explore and explain the differences in the ways of working between the two environments and get to know key peers and members of staff. Then the student can be ‘weaned off’ the extra support. Most existing mentorship arrangements suffer from the drawback that they only move into action when the student has actually started at the university. Mental Health Mentorship is applied for in advance but the first meeting with the mentor is not until the first term has started. The ‘university families’ scheme, whereby each first-year student may be allocated a trained volunteer ‘parent student’ is also unlikely to start until the student arrives, and summer schools rarely reach so far back that they overlap with school.

School teachers tell researchers of their concern that universities will not meet their pupils’ needs for teaching and pastoral care. Senior school pupils are often invited to open days or special events mounted by universities. This sort of outreach attracts bright and interested pupils to apply to the specific institution. There is rarely a bridging role that can understand the young person’s situation while they are still at school and home, then reach forward to support the young person for a while – from a term to a year – as a new student.

The word ‘mentor’ has all manner of informal as well as official meanings. This makes it a useful non-stigmatising term, but also a confusing one. The ‘university parents’ idea is elegant in that it encourages students to seek and then deliver support on a peer-to-peer basis. This formalises and protects what can sometimes be a natural process and fosters maturity and kindness without too much regulation. Most ‘parents’ will have been at school themselves only recently and so understand the contemporary realities of transition. Groups of ‘university parents’ could usefully hold stalls for prospective students at open days to promote a philosophy of kindness and accessibility that transcends individuals.

Ideally, buddying or mentorship would be set up before the student arrives. As things are, the first face-to-face interpersonal contacts for most new university students are the peers they meet in halls and shared houses. Students will often have participated in social media groups before arrival, too. These first attachments are incredibly influential, bonding people together at a time of maximum vulnerability. Universities are missing a trick by allowing relatively random contacts to take precedence over considered induction. Immature peer-led induction can lead new students into high-risk cultures of substance misuse, scorn for diversity and difference, and gender-based disparagement.

Experience of using Zoom and similar platforms during Lockdown means that technological communication is no longer the preserve of students in their social time. One-to-one and group meetings can be held before students arrive in university accommodation. Staff can meet students to discuss their roles and expectation of students.

Living the Process: Feeling Homesick

Moving away from home to university brings additional stresses at the same time as taking away supportive people and structures. This is a recipe for anxiety. ‘Nostalgia’ – from the Greek word for home – and homesickness, are universal experiences. Even Odysseus, the great warrior, experienced homesickness. Modern soldiers, facing death and life-changing injury, yearn not for safety but for ‘home’. Bowlby (Reference Bowlby1969) and his contemporaries examined the consequences of the disordered attachments that occurred when young children were sent to hospital without their parents, or away to boarding schools. At the other end of life, old people in nursing homes grieve the loss of home and family.

Taking on new challenges can involve a ‘manic defence’ that also serves the purpose of distracting the new students from the less openly acknowledged business of mourning the passage of childhood. Even when the student is aware of their struggles, they may be too ashamed to acknowledge them. Whilst this is an almost universal painful experience, frequently self-limiting and part of a healthy adjustment process, we should not disqualify it as ‘just’ homesickness.

Some time ago, a longitudinal study examined the effects of the transition to university for students living on campus or at home (Fisher & Hood, Reference Fisher and Hood1987). All students experienced some increase in psychological disturbances and ‘absent‐mindedness’ but the symptoms were significantly worse for those who reported homesickness. In these days of electronic communication, we might expect a reduction in reports of homesickness, but there may also be a risk that when parents and students connect several times each day, this can diminish the student’s ability to engage fully in university life and to move on in their transition.

The more vulnerable the young person, the more important it is to respect the therapeutic value of a strong attachment in bridging transitions. When feelings are not acknowledged, maturity may be thwarted at this hurdle and the student damaged by unaddressed fear and isolation.

One key task in the transition to adulthood is that of developing close friendships and relationships to compensate for reduced emotional dependence on parents. The family left behind, especially parents and younger siblings, must also adjust to the loss of the new student. Healthy families can usually find their own compensations and progressions, so that the student feels there is a secure base they could still rely on, rather than a sense that bridges have been burned behind them. Where the student has been a young carer, the loss of practical and emotional care may be too great to tolerate. Transition may not be possible, and the student is split painfully.

Induction Strategies: Drawing the Student into the New Culture

The term ‘Welcome Week’ has widely replaced ‘Freshers Week’ to imply an experience that provides more structure, less alcohol, and a focus on making connections and exploring common interests, rather than partying. Induction courses and summer schools are more extended versions of Welcome Week, before the university term begins. These can usefully target prospective freshers identified as needing more information, skills and networks to flourish in university life. Vulnerable minorities such as ‘first generation’ students and those with pre-existing mental disorders are sometimes offered specific inductions. However, these miss the substantial proportion of students who haven’t disclosed – or even yet developed – a disorder.

Universities, unlike most primary and secondary schools, are the size of city states, with sub-groups such as faculties, courses, year groups, societies, residences, colleges and cohorts. Young adults pass through a sort of initiation from being relatively passive recipients of adult care, to being agents of their own well-being, subject to the supports of their chosen groups and to the rulings of the broader university councils and courts. As they emerge from adolescence into adult life, they are empowered to bring their own contributions to the structures that serve them. They can actually build the sense of their own belonging and participate in shaping the community in which they live.

Alternative approaches to either academic or social inductions are outdoor orientation programmes such as that reported by Hill (Reference Hill, Posey, Gomez and Shapiro2018) in the US, and similar in content to such courses offered by secondary and even primary schools in the UK. Residential outdoor expeditions can form an integral part of courses such as geography or archaeology, and often constitute part of the motivation for selecting such courses. Other disciplines have incorporated short trips to outdoor centres as part of ‘reading week’ or revision preparation before examinations. The mix of physical activity, immersion in nature, supportive company, and being provided with catering, is a powerful stress reducer.

Hill’s analysis identified major themes related to resilience, well-being and readiness for college. Even students who mostly disliked physical activity were enabled to develop connections, feel welcome in the university community, understand more about university life, and develop confidence in themselves and their abilities.

The Importance of Friends

The feeling of ‘belonging’ mediates student academic success and retention (Thomas, Reference Thomas2012). Interpersonal relations are generally essential for satisfying this need to belong, although the built environment has a role too, as does a university’s reputation and academic record Goodenow (Reference Goodenow1993) described belonging as ‘the sense of being accepted, valued, included, and encouraged by others (teacher and peers) in the academic classroom setting and of feeling oneself to be an important part of the life and activity of the class’.

The What works? projects (Advance HE, 2020) used retention rates as a pragmatic outcome measure, and found some interventions achieved 10% improvements through a focus on:

• supportive peer relations;

• meaningful interaction between staff and students;

• developing knowledge, confidence and identity as higher education learners;

• educational experiences relevant to interests and future goals.

In contrast with what students predicted, they found that the contribution of the academic experience in making students feel part of the university community was substantially more than that of the social experience. Effective interventions started pre-entry, with an emphasis on engagement and an overt academic purpose.

The situation is complex and dynamic, though. It may be that whilst an overt focus on academic matters is most effective, it is the beneficial social spin-off that mediates flourishing. A study of the outcomes of a pre-entry programme found that benefits for participants consisted of higher academic self-efficacy at the start of the academic year (Pennington, Reference Pennington, Bates, Kaye and Bolam2018). However, it was ‘in-group social identity’ that predicted satisfaction at the end of the academic year.

As Brown and Murphy (Reference Brown and Murphy2020) point out, finding new friendships is the main source of anxiety for new students. Their concern focuses primarily on new living companions rather than on academic course mates. Students felt that they would need to decide quite early on who they got on with, so they could plan who to live with in their second year of university. These concerns are realistic. The second year is indeed a time of immense challenge, not least because of the traditional move out of halls, and research also suggests many benefits for those who can make early friendships.

Most research into the first year is published in US journals drawing on US student samples so may not be directly applicable to UK students. However, over half of students surveyed in the United States and Canada reported feeling “very lonely” in the past 12 months (American College Health Association, 2016). A Canadian study examined the number of friendships reported by new students at a large university, without evaluating the quality or nature of those relationships (Klaiber et al., Reference Klaiber, Whillans and Chen2018). Three years later, students who made more friends in their first term reported healthier physical exercise and diet, as well as lower tobacco, alcohol and marijuana consumption. Good social integration had both direct and indirect influences on health. The students appeared to actively support each other in healthier behaviours, and to jointly set realistic healthy norms.

Klaiber et al. (Reference Klaiber, Whillans and Chen2018) point out that existing interventions to improve students’ health commonly focus on one specific health behaviour and are not strikingly effective. They suggest that interventions targeting students’ social adjustment, rather than any one specific health behaviour, may be more effective.

The realistic concern to create a new friendship group can be experienced as sheer desperation to ‘fit in’. Young students, even more than the rest of us, are keenly sensitive to the need to impress their peers as capable. When still at school they were able to confide worries and concerns to close friends. In the early weeks at university, though, they prefer to get support from staff instead of peers. Untested peers, they told researchers, might ‘ruin your social reputation’ by spreading the information to other students as gossip.

This demonstrates how uniquely vulnerable students feel in the first term, except for the minority who have come with an established friendship group. Some do use the strategy of turning back, through phone or other media, to parents or friends from home. This can feel safer, but too much reliance on previous supports risks retarding the formation of new relationships and even of preventing progress in transitioning.

How Do UK Students Cope? Alcohol Oils the Transition

The Canadian study (Kleiber et al., Reference Klaiber, Whillans and Chen2018) suggests that a wide friendship group can reduce alcohol consumption. In the UK, unfortunately, there is evidence that current norms and pressures of student culture actually increase the misuse of alcohol and other substances. Students use alcohol to relieve social anxiety and to fit into a culture where high levels of intoxication are normalised. Not drinking can result in social exclusion. The consequences of alcohol use for students’ mental health and well-being are discussed further in Chapter 6. Meanwhile it is important to be aware that the culture is anticipated even before arrival at university, and that individual interventions are limited and socially prejudicial to those individuals.

Even before arrival at university, students are exposed to social media expectations of ‘partying’, where social anxieties are numbed by intoxication and students feel pressured to plunge into the sex, drugs and rock and roll of student cliché. At present there is little evidence of real change at an institutional level. Attempts to change such behaviour at an individual level are rarely successful.

A qualitative study by Brown and Murphy (Reference Brown and Murphy2020) vividly illustrates the situation through analysis of detailed interviews with 23 first-year students. The students described their pre-arrival concern over new peer relationships and how this was subsequently relieved by drinking together. This experience confirmed their expectation that alcohol was beneficial, which in turn increased the behaviour. Drinking – or even the expectation of drinking – worked as a cure for anticipatory anxiety, then the act of drinking with peers reduced anxiety in the actual company of others. The rituals of drinking included going out or coming together in student accommodation, having a glass to hold and occupy one’s hands, and the act of drinking as a reason for being there. These seemed at least as important for some students as the experience of being intoxicated, but they didn’t appear to find communal tea drinking, for example, as an acceptable alternative.

For this group, alcohol felt like the ideal – or perhaps the only – solution for successful transition. Those who drank little or no alcohol said it was a real challenge to make social connections. They had to make careful plans and prepare avoidance tactics to try to both meet others and resist the pressure to drink. It was a distressing and lonely experience to be sober in a crowd of heavily intoxicated others.

The new students’ previous drinking experiences were highly variable, but the expectation of the centrality of alcohol to university social activity was universal. The official message from university authorities and student unions was that alcohol was not promoted, but local retailers were free to promote alcohol use, and drinking and ‘partying’ dominates the informal narrative of student leisure activities. Participants in this study seemed discount the risks of alcohol-related harms in the context of social benefits. They behaved as if the risks were entirely acceptable, much as we would expect to discount the risks to life and health of travelling on the roads, in the light of the desirability of getting around.

Regulation of student alcohol use in such a context seems futile. Staff told the researchers ‘there’s nothing you can do about that’. It may be true that there are limits to the effectiveness of interventions by individual staff members. Universities and even wider communities will need to work together at a systemic level.

Incomplete Transitions

Students’ first‐year experience is seen as a high‐priority research area, not least because of the consequences of student attrition and failure for university reputations and finances (Wilcox, 2005). Virtually all UK universities deploy interventions to help embed students, and enhance retention during the transitional period.

Retention and reduction of dropout are important for university finances but not necessarily good proxies for healthy connectedness. The loss of intellectually gifted but unhappy scholars is an academic and reputational loss to all, but we need to consider the best interests of an individual student. Sometimes there is a mismatch between the way of life demanded by a university or course, and the readiness of the student to engage with it, and they shouldn’t be coerced into living with the discomfort for three or four miserable and expensive years.

Students at highest risk, including the risk of suicide, include those who are obliged to leave their course in an unplanned way, a phenomenon uncomfortably described as ‘dropping out’. Whether this occurs because of financial breakdown, academic failure, mental or physical illness, family tragedy or some mixture of these, there is likely to be a huge emotional component to the experience. Even when there is a sense of relief, families as well as the student, are likely to experience disappointment, shame, embarrassment, a sense of loss and even despair.

When Does It All Settle Down?

Preparation and transition do not end with the arrival of the student on their new campus. Questions of readiness and pacing should be asked at each stage in higher education – some graduates rush straight into higher degree courses when they might be better served by taking a break from academia. Much is made of the challenges faced by older students, moving back into education after a gap, but in practice these individuals often thrive and relish the educational experience more than younger students, who are too preoccupied with day-to-day survival to truly enjoy their studies.

There is evidence that the acute stressors of the first term recede. Gall’s (Reference Gall, Evans and Bellerose2000) sample of 68 first-year students found that as time passed there was steady improvement in most aspects of adjustment. In this study, women showed greater vulnerability to the transition into university life, despite having more resources. A much larger study of over 4000 students at a UK university examined self-reported anxiety symptoms over the course of first year (Cooke et al., Reference Cooke, Bewick, Barkham, Bradley and Audin2006). Moving from home to university was associated with increased self-reported symptoms. Reported psychological well-being fluctuated throughout the year but did not return to pre-university levels.

Further transitions emerge too. It’s important not to focus so much on the first year that we overlook the needs of students returning to the second year. Andrews and Wilding (Reference Andrews and Wilding2004) assessed the mental health of UK undergraduates a month prior to starting university and in the middle of the second year. At the second assessment, 20% of students with no previous mental health symptoms had clinical levels of anxiety and 9% had clinical levels of depression. Financial difficulties made a significant independent contribution to depression, whilst relationship difficulties independently predicted anxiety.

Macaskill (Reference Macaskill2013) found that on admission, 13% of students had a mental health condition. The figure dropped a little by the end of first year but peaked in the middle of the second year to more than 23% of students before dropping to 19% for mid-third-year students. Student Minds (2014) highlighted the challenges of transitioning from living in university accommodation or in private, shared accommodation with other students, and fixed tenancy agreements make it hard for students to move elsewhere if they are unhappy living with their housemates. Also, for second-year students, the university induction and support systems are less structured than those for first-year students, their lecturers and support tutors may have changed, the novelty of university life may have worn off, they are accumulating student debt, and there is more pressure to perform academically, given that often the second and third years determine the degree grade.

It seems that the whole of university life is a continuous ‘transitional’ experience, or at least one of repeated transitions. In the third or final year, the transition into the wider world brings loss of ‘student’ role status, choices to be made about careers or further study, financial adjustments from living on loans to earning a salary and even repaying debts, and often further geographical moves.

An interesting 2012 study (Richardson et al., Reference Richardson, King, Garrett and Wrench2012) examined the well-being of Australian first-year students. It compared the characteristics of “thriving” students with those who described themselves as “just surviving”. Close social relationships, good time management and organisational skills, and effective coping strategies were the key differences. For instance, one ‘thriving’ student said she made a point of pairing something stressful, such as exam revision, with spending time with friends, in a study group. The healthier students tended to be much more focused on taking action to deal with the stress, allowing them to relax afterwards, whereas ‘just surviving’ students used passive and avoidant strategies, which left them feeling worse. One implication of this finding is that those who struggle may need to be approached with assertive help rather than expected to make use of available generic information that is available and to reach out for the support they need. ‘Just surviving’ students may not (yet) be experiencing a diagnosable mental disorder. They could benefit from straightforward skills: keeping a diary, attending some clubs and activities, combining friendship and study, and learning to recognise and manage feelings.

Practice Points