CORE-OM mental health norms of students attending university counselling services benchmarked against an age-matched primary care sample

Whilst concern has been expressed at the increasing severity of the mental health of students, there has been very little research on this growing population outside of small, single institution studies. The aims of this paper are to provide CORE Outcome Measure (CORE-OM) norms for the psychological health of students across multiple sites receiving university counselling, and benchmark these against an age-matched sample of people receiving treatment in NHS primary care settings. Results indicate that students using university counselling services show severity levels only marginally lower than young people presenting in primary care, with the differences being at a functional/relationship rather than a symptomatic level and with levels of risk to self being similar. This suggests that university counselling services deliver a service to people who closely resemble NHS primary care clients in terms of severity and risk to self.     

Cognitive counselling intervention: treatment effectiveness in an Italian university centre

Offering counselling to students is increasingly considered as a key academic service. However, the reduction of resources allocated to Italian universities emphasises the need to assess the quality of interventions. This paper presents data reporting the effectiveness of a university counselling service. A sample of 45 undergraduate students completed a cognitive-relational intervention at a counselling service in a University in the North of Italy. The project focused on the development of reappraisal skills and problem-solving strategies to manage difficult situations. The results showed a significant pre and post-intervention reduction in self-reported psychopathological symptoms (measured with Symptoms Check List 90-Revised) as well as in general levels of distress (measured with Clinical Outcome in Routine Evaluation-Outcome Measure). A significant increase in reappraisal levels, measured with the Emotion Regulation Questionnaire, was observed, which is a focal element of the counselling intervention. There were no detectable changes in the level of suppression.     

Exploration of counsellors' perceptions of the redesigned service pathways: a qualitative study of a UK university student counselling service

To address the mental health needs of students, UK universities offer bespoke student counselling services. Economic pressures have led services to find innovative ways of redesigning their service pathway. Few studies have investigated staff perceptions of these changes. The aim of this study was to investigate perceptions of staff employed as counsellors at a student counselling service at a UK university that underwent service delivery changes. Face-to-face interviews were conducted with counsellors (n = 5). Framework analysis was used to identify themes and meta-themes. Five meta-themes were identified: the overarching service ethos and service working style; change in the university context; impact of change on working practice; recording and perceived impact on confidentiality; acceptability and effectiveness. Changes to the service resulted in a more efficient service that is perceived to be more acceptable to students. Staff perceptions differed regarding how changes have affected their counselling practice. Despite these differences, the increase in workload was consistently expressed. Tensions remain as staff strive to maintain high standards of service in this changing context. Future research should investigate the process of developing and implementing change as student counselling services strive to evolve sustainable ways of working.     

Measuring, monitoring and managing the psychological well-being of first year university students

This paper profiles the psychological well-being of students in their initial year of university. There were three aims: to measure the impact of arrival at university on the psychological well-being of first year students, to monitor (i.e. profile) the shape of psychological well-being across the first year, and to investigate how students manage their well-being in relation to the use of university counselling services. Data were collected on four occasions, with 84% of all first year students at a UK university (4,699 students) completing the questionnaire on at least one occasion. Psychological well-being was assessed using the GP-CORE, a general population form of the CORE-OM. Results show that greater strain is placed on well-being once students start university compared to levels preceding entry. This strain rises and falls across the year but does not return to pre-university levels. Items tapping depression and anxiety suggest that the first year of university is a time of heightened anxiety but not a particularly depressive time. The findings are discussed in relation to students' experience of higher education and how to match student needs with university counselling service provision.     

University Counselling Services in Australia and New Zealand: Activities,Changes, and Challenges

The high prevalence of stress and psychological distress in university students highlights the need for adequate support services to enable students to achieve their goals. This study aimed to describe counselling services available to university students in Australia and New Zealand and to benchmark them against international services. Participants were five Australian and three New Zealand Counselling Services. Results showed that counselling services are using a variety of formats and e‐technologies to deliver services to students, but are hampered by limited resources compared with their international counterparts. These include very high counsellor student ratios, lower average number of consultations per student, and lower mental health qualifications of counsellors. This has even greater implications in the context of higher education reform in Australia that may further widen the gap between needs of students and available counselling services. Inadequate counselling support can negatively impact on students, universities, and the community through lost potential.     

Factors affecting self-referral to counselling services in the workplace: a qualitative study

The benefits of psychological support in the workplace (also known as workplace counselling) are well documented. Most large organisations in the UK have staff counselling schemes. However, it is unclear what, if any, factors affect employee decisions to use such schemes. This study has used a qualitative methodology to explore the reasons that make employees use workplace counselling. Eleven employees of a university in the north of England who had used the staff counselling service of their employer took part in the study. The employer had two schemes available: an internal staff counselling service and an external Employee Assistance Programme (EAP). A semi-structured interview was used with each participant and grounded theory techniques were used to analyse the interviews. The analysis resulted in the construction of a model of psychological help-seeking in the workplace. The main findings indicate that most participants were motivated to use their employer's counselling service by their prior positive experiences of similar or other type of mental health services. Other encouraging factors were: recommendation of service by others, a supportive environment and trust in the confidential ethos of the service. Conversely, negative preconceptions of psychological help-seeking and a perception of the employing environment as unsafe were shown to have been discouraging factors. The study concludes with suggestions for practice and for further research.     

The impact of psychological distress and university counselling on academic outcomes: Analysis of a routine practice-based dataset

Whole university approaches to student mental health and well-being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE-OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE-OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study.     

Characteristics of students receiving counselling services at the University of Cape Town, South Africa

The aim of the study was to document the correlates of receiving counselling services at the University of Cape Town, South Africa. The 932 students who received counselling over a 3-year period were compared with the other 23,158 students registered at the university. Data were obtained from the university computerised record system. Women, Black people and 20-24-year-olds were significantly more likely to receive counselling services. When adjusting for these demographic variables, non-English speakers, humanities students, undergraduates, first-year students, students who were eligible to receive financial assistance, and students from outside Cape Town were significantly more likely to receive counselling. New research is required to determine the reasons for these findings.     

Problem areas of students at a university psychological counselling centre: a 16-year analysis

This study examined the change in the problem areas of students who visited a university counselling centre for individual counselling over a period of 16 years. The findings showed that problem areas changed with the psychosocial and economic changes in the 16 years examined, and that the majority of students in the most recent period visited the centre with relationship problems. In addition, student problems through the different periods displayed great diversity, ranging from developmental problems to more severe psychological disorders.     

Differences in Beliefs About Psychological Services in the Relationship Between Sociorace and One's Social Network

The roles of previous psychological service use and social network variables in beliefs about psychological services were examined with 184 college students. Having friends and family members who used psychological services, being female, and having used psychological services positively related with beliefs about psychological services. Socioracial differences in the effects of previous use of psychological services and social network variables on students’ beliefs about psychological services were found. Suggestions for ways counselors can provide support to students are discussed.     

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups – frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months post-intervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.     

Evaluating the effectiveness of counselling intervention with final year undergraduates

This study explores the effectiveness of a short-term counselling intervention model, with final year students, in reducing psychological distress and increasing students' ability to complete their degree programmes successfully. A clinical sample (final year students who consulted he counselling Service) was monitored before and after intervention using the psychometric instrument Symptom Checklist-90-Revised (SCL-90-R) (Derogatis, 1977). A significant reduction in levels of psychological distress was demonstrated with this sample. In contrast a parallel control sample (final year students who did not consult the Counselling Service but whose initial SCL scores were in the same range) showed no significant change in levels of psychological distress over the same time period. The clinical and educational implications of these findings are discussed.     

At the border: reflections on psychoanalytically oriented counselling in an Italian university setting

This paper analyses the ‘border’ position of counselling services in Italian universities. The concept of ‘border’ has great relevance in the work of psychoanalytically oriented university students’ counsellors. Counselling is part of a continuum of interventions, from befriending to psychotherapy. This closeness encompasses the need for identifying specificities and differences among interventions. Moreover, a university counselling service occupies a ‘marginal’ position, continuously confronted with the risks of rejection and/or assimilation. The concept of ‘border’ is also useful to define the developmental phase of university students, crossing the border between late adolescence and young adulthood, as represented by Conrad's novel The shadow line (1917/1999), recently analysed by Green (2008) as the metaphoric demarcation line between youth and adulthood. Finally, most of the students referring to our counselling service come from families that for the first time crossed the border of university education.     

Willingness to seek counselling, and factors that facilitate and inhibit the seeking of counselling in Indonesian undergraduate students

This paper describes a study designed to investigate Indonesian undergraduates' attitudes to counselling. It focuses on the results derived from data analyses of a questionnaire measuring the level of willingness to seek counselling, factors inhibiting and facilitating the seeking of counselling in Indonesian students. The exploration was differentiated into professional counselling outside the university and the university counselling services. The self-administered questionnaire was distributed among 1,279 students. The results indicated that the level of willingness to seek counselling was low. The use of social networks was the most important discouraging factor. Wide dissemination of information about counselling services, efforts to enhance confidentiality in counselling and counsellors' understanding of students' world and ways of thinking were strongly suggested to encourage students to seek counselling.     

Students who self-harm: Coping style,Rumination and Alexithymia

Counsellors working with students or other young adults may encounter individuals who have self-harmed, either with suicidal or non-suicidal intent. Recent US studies reported rates of self-injury of up to 37% of the student population, but studies in the UK have focussed primarily on younger adolescents. This study examined reported self-harm incidents (scratching, cutting, poisoning, overdose etc) from a sample of 617 university students. A total of 27% reported at least one incident of self-harm, with almost 10% having harmed themselves while at university. Gender differences were not significant but psychology students reported significantly more self-harm than other students. Participants reporting self-harm scored significantly higher on maladaptive coping styles, rumination, and alexithymia (specifically difficulty in identifying emotions) and these differences were most marked for students reporting repetitive and recent self-harm. Rumination and Alexithymia factor 1 (difficulty identifying feelings) emerged as the most robust factors predicting self-harm status. Comments from students who self-harmed at university highlighted the importance of accessible services and academic staff support. The implications of these findings for counselling interventions are discussed, including challenging negative rumination tendencies and developing mindfulness skills.     

The effectiveness of UK student counselling services: an analysis using the CORE System

Despite concern surrounding the mental health of students, brought about by the government's policy of widening participation and increasing demands upon students, the effectiveness of student counselling has been a neglected research area. This study examines data from seven UK student counselling services using the CORE System in the routine evaluation of their services. Results indicate that counselling is effective, with 70% (service range 67% to 83%) of clients with outcome measures available showing reliable improvement on the CORE-OM from pre- to post-therapy. However, students who complete a course of counselling show significantly greater improvement, according to practitioner pre- and post-therapy severity ratings of depression and anxiety, than those clients who drop out or have an unplanned therapy ending (effect size 1.03, 0.85, respectively). The stage at which students drop out of therapy is important, with those students dropping out of therapy before the third session being the most vulnerable. The implications of these findings are discussed.     

The future of Canadian counselling psychology: Doctoral students

Little is known about the overall characteristics and beliefs of Canadian counselling psychology doctoral students. An online survey was administered to 43 doctoral students across all Canadian counselling psychology programmes, representing an approximate 26% response rate. Results indicated that the average age of doctoral students in the sample was about 32 years and that the majority were women (about 77% in the sample). Additionally, findings can be taken to suggest that participants were satisfied with their choice of counselling psychology as a career. The doctoral students sampled primarily practised from an integrationist theoretical standpoint and spent very little of their practice time providing formal psychological assessment services or career counselling. Participants generally intervened through individual counselling or psychotherapy and were focused on disorder treatment rather than preventative or developmental services. Curriculum changes that should be considered from the results of this study pertain to the topics of assessment, career counselling, advocacy/media skills, professional identity development and prevention/developmental interventions. The results of this study can also be taken to predict characteristics of the next generation of Canadian counselling psychologists and the future practice of counselling psychology in Canada.     

Frustration Intolerance Beliefs as Predictors of Emotional Problems in University Undergraduates

The present study examined the relationship between Frustration Intolerance Beliefs as suggested by the Rational Emotive Behavior Therapy framework and emotional problems. Data were collected from 332 university undergraduate students (age 19–26) who completed Demographic Information Sheet, Frustration Discomfort Scale and three subscales of Brief Symptom Inventory including depression, anxiety and hostility. The current findings confirmed the association between frustration intolerance and irrational beliefs and their respective roles in psychological distress among non-clinical student population. Results indicated that FDS subscales were differently related to specific emotions as entitlement and emotional intolerance sub-scales were significantly positively associated with depression, anxiety, and hostility while achievement was significantly negatively associated with hostility. The study has implications for counsellors, school psychologists and policy makers as it highlights the importance of rational group and individual counselling of rational ideas to reduce the emotional problems of students hindering their educational and personal growth.     

Relations of SARS-related stressors and coping to Chinese college students' psychological adjustment during the 2003 Beijing SARS epidemic

This study examined the main and interactive relations of stressors and coping related to severe acute respiratory syndrome (SARS) with Chinese college students' psychological adjustment (psychological symptoms, perceived general health, and life satisfaction) during the 2003 Beijing SARS epidemic. All the constructs were assessed by self-report in an anonymous survey during the final period of the outbreak. Results showed that the relations of stressors and coping to psychological adjustment varied by domain of adjustment. Regression analyses suggested that the number of stressors and use of avoidant coping strategies positively predicted psychological symptoms. Active coping positively predicted life satisfaction when controlling for stressors. Moreover, all types of coping served as a buffer against the negative impact of stressors on perceived general health. These findings hold implications for university counseling services during times of acute, large-scale stressors. In particular, effective screening procedures should be developed to identify students who experience a large number of stressors and thus are at high risk for developing mental health problems. Intervention efforts that target coping should be adapted to take account of the uncontrollability of stressors and clients' cultural preferences for certain coping strategies. A multidimensional battery of psychological adjustment should be used to monitor clients' psychological adjustment to stressors and evaluate the efficacy of intervention.     

Student mental health: how can psychiatrists better support the work of university medical centres and university counselling services?

Student psychiatric morbidity is rising. Whilst the influence of university counselling services is widely reported, NHS involvement by psychiatrists and general practitioners is not so well described. Counselling and mental health service providers for students at the University of Leeds were approached for numerical data and a university Group on Student Mental Health discussed the findings. The Student Counselling Centre, the University Medical Practice and a dedicated student psychiatric clinic have all seen a rise in referral rates. The University Medical Practice has also seen a rise in the prescribing of psychoactive medication. Collaborative links at the University of Leeds are explored and options for the future discussed. These include self-help over the internet, a research project to assess student mental health needs and the provision of a dedicated NHS psychiatric team for the university.