Development of the Uni Virtual Clinic: an online programme for improving the mental health of university students

ABSTRACT

There is growing recognition of the importance of addressing the mental health needs of young people attending university. Anonymous, scalable, and evidence-based online interventions can help to reduce burden on university services and increase access to care for marginalised or disconnected students. This paper reports the participatory design methods used to develop the Uni Virtual Clinic (UVC), a comprehensive online programme that was designed to prevent and treat mental health problems and related issues in university students. Data evaluating the participatory design process is also presented. The potential for the implementation of the UVC within university-based counselling services is strong, and has potential to reduce the prevalence of mental disorders in a high-risk group of young people.     

The mental health of university students in the United Kingdom

ABSTRACT

There are increasing concerns globally about the mental health of students. In the UK, the actual incidence of mental disturbance is unknown, although university counselling services report increased referrals. This study assesses the levels of mental illness in undergraduate students to examine whether widening participation in education has resulted in increases as hypothesised by the UK Royal College of Psychiatrists. Patterns of disturbance across years are compared to identify where problems arise. Students (N=1197) completed the General Health Questionnaire-28 either on the first day at university or midway through the academic year for first, second and third year students. Rates of mental illness in students equalled those of the general population but only 5.1% were currently receiving treatment. Second year students reported the most significant increases in psychiatric symptoms. Factors contributing to the problem are discussed.     

Action: a bridge between vocational and mental health counselling*

A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.     

Cyber-bullying: An investigation of the psychological profile of university student participants

The present study investigated the psychological profile of 430 Greek university students who reported cyber-bullying/victimization experiences. Participants completed a self-report questionnaire, measuring cyber-bullying, cyber-victimization, Internet frequency and use, personality characteristics, and psychological symptoms. Results indicated that 58.4% of the sample had participated in a cyber-bullying incident assuming any role. Cyber bully/victims, the most common participant role, endorsed more psychological symptoms, more psychopathic traits, and were high sensation seekers, compared to the rest of the groups, whereas cyber-victims scored higher on empathy. Cyber-bullying was predicted by callous/unemotional and impulsive/irresponsible traits, depression, Internet use, as well as lack of social skills. The latter four variables also predicted cyber-victimization along with gender. Findings are discussed in terms of prevention and intervention strategies.     

A systems analysis of a campus community mental health facility: A preliminary investigation

Faced with increasing demand and relatively static resources, community mental health facilities need to evaluate their functions in terms of time, cost, and performance effectiveness. For this study, the technology of systems analysis was applied to the functions of a progressive university counseling center. The systems analysis provided a management and information flow analysis and a time and cost analysis, as well as a performance analysis. This study focused on the preliminary results of the time, cost, and performance analysis.Gratitude is extended to the remainder of the systems analysis team for their assistance in the project, as well as the staff of The University of Texas Counseling-Psychological Services Center for their cooperation. This project was partially funded by National Science Foundation grant GJ 509X3, by the Counseling-Psychological Services Center, and by the Office of the Vice President for Student Affairs. Special acknowledgement is made of the support of Ronald M. Brown, Vice President for Student Affairs, The University of Texas at Austin. The systems analysis team included T. Bishop, C. Black, J. Byars, R. Byars, P. Caroom, J. Littlefield, A. Nutt, M. Rood, E. Salsbury, and C. Weinstein.     

Towards an evidence‐base for student wellbeing and mental health: Definitions,developmental transitions and data sets

Against a background of huge changes in the world of university and college students since the turn of the millennium, together with a multitude of reports on student mental health/wellbeing, this article argues that the field of student mental health is hampered by the imprecise use of terms, a rush to action by universities in the absence of a robust evidence‐base, and a lack of overall coordination and collaboration in the collection and use of data. In response, we argue for clearer and more consistent use of definitions of, as well as differentiations between, student wellbeing and mental health, for a longitudinal approach to the student body that captures their developmental transitions to and through university, and a strategic and systematic approach to the use of bona fide measures in the collection of data on wellbeing and on the process of outcomes in embedded university counselling services. Such a coordinated approach will provide the necessary evidence‐base upon which to develop and deliver appropriate support and interventions to underpin and enhance the quality of students’ lives and learning while at university or college.     

Exploring rates of transgender individuals and mental health concerns in an online sample

Background: Prevalence estimates of adults identifying as transgender are scarce, particularly in the United States. Method: The current study endeavored to estimate the prevalence of individuals identifying as transgender in a large online sample of adult U.S. residents (n = 6,727) and compare the prevalence of common mental health disorders (depression, anxiety, attention-deficit/hyperactivity disorder) and the age of onset for individuals identifying as men or women versus those identifying as transgender. Results: The prevalence estimate of individuals identifying as transgender was 0.8%. Individuals identifying as transgender were significantly more likely than individuals identifying as men or women to report having had a single diagnosis or co-occurring diagnoses for all three disorders examined. Additionally, transgender individuals were more likely than individuals identifying as men or women to receive a diagnosis of anxiety or depression at a younger age. Conclusion: Given the prevalence of transgender individuals and the associations with common mental health conditions, clinicians must be informed and competent to care for their clinical needs. This study introduces online crowdsourcing resources as a potentially fruitful option for reaching and researching gender diversity.     

Cultural competency for mental health practitioners: a selective narrative review

Cultural competency in the context of health services pertains to the appropriate provision of care to a diverse population. It is broadly recognised that this requires sensitivity at policy-making, organisational and individual levels. One specific focus in the literature has been the aptitudes required of practitioners to carry out psychological interventions with minority ethnic groups. A range of theoretical and practical perspectives have emerged on what such aptitudes should be and how to attain them. However, lack of clarity over definitions has resulted in a differential focus on sub-components of the cultural competency construct, namely awareness, knowledge and skills. The current review aimed to consolidate material dispersed across the literature, to create a narrative representation of what cultural competence means to the clinical practice of individuals delivering psychotherapeutic interventions. Limitations and implications of the cultural competency approach are discussed.     

Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions

With reports continually demonstrating increased demand and severity of student mental health needs, it is important to gain a fuller understanding of the impact on embedded student counselling services. The aims of this research were to identify (a) service similarities, (b) factors which impact on services, (c) characteristics of service users, and (d) the use of therapeutic technology (e.g. online self-help). An online survey was completed by 113 heads of UK student counselling services across Higher Education (HE), Further Education (FE), and Sixth Form Colleges (SFCs), to capture service data from the academic year 2013/14. Students predominantly received high-intensity support (e.g. counselling) and referrals increased over 3 years. Challenges to embedded counselling services and their implications for development are discussed.     

If you go down to the woods today you are in for a big surprise: seeing the wood for the trees in online delivery of career guidance

Arguments about online delivery of career development are too frequently couched in polarising terms setting traditional face-to-face guidance practice against online systems. The focus has been on the alleged dehumanising impact of technology and the speed, economy and efficiency of online systems. The possible synergies delivered by the appropriate integration of online systems into career development need exploring. The potential of eguidance, elearning, social media and online information and assessment systems has been insufficiently explored. The user experience has been overlooked, despite evidence that user-interface issues and usability are critical factors in the effectiveness of online systems. The application of artificial intelligence remains largely under-researched in career development. The potential for online systems to assist individuals respond to their chaotic careers has yet to be adequately addressed.     

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.     

Impact of play therapy on parent-child relationship stress at a mental health training setting

This study investigated the impact of Child-Centred Play Therapy (CCPT)/Non-Directive Play Therapy on parent-child relationship stress using archival data from 202 child clients divided into clinical behavioural groups over 3-74 sessions in a mental health training setting. Results demonstrated significant differences between pre and post testing on the Parenting Stress Index. CCPT appeared to be especially effective with children identified with clinical externalising behavioural problems, combined externalising and internalising behavioural problems, and children who were not categorised with clinical problem behaviours but whose parents sought counselling services for them. There were also significant differences determined by length of therapy. Results are discussed concerning implications for clinical practice and further research.     

Viewing oneself during synchronous online learning increases appearance anxiety and decreases memory for lecture content

In response to the COVID-19 pandemic, instructors began using online learning platforms to offer live remote instruction (e.g., Zoom), which allow students to view themselves in real-time (i.e., self-view). The present research examined whether having students keep their cameras on, relative to cameras off, during a live online lecture would increase anxiety and reduce learning. In both Experiment 1a (small group setting) and Experiment 1b (large group setting), students in the camera-on condition did not report greater state anxiety, nor was anxiety associated with lower performance on an immediate multiple-choice exam. Experiment 2 specifically examined the effect of self-view and if appearance anxiety (rather than state anxiety) might mediate the relationship between camera use and test performance. Results indicate that participants viewing themselves reported significantly higher appearance anxiety, and that higher appearance anxiety was related to decreased learning. These findings suggest that viewing oneself may uniquely contribute to heightened appearance anxiety and may reduce memory for content when learning synchronously online.     

Cultural aspects of mental health and mental health service delivery with a focus on Nigeria within a global community

With an endless range of subgroups and individual variations, culture bears upon what all people bring to the clinical setting. Culture could account for health-seeking behaviour, type of services and support system and variations in how people communicate their health concerns. Culture may underlie presentation of sets of symptoms that are peculiar to certain societies – culture-bound syndromes. Culture also influences the meanings that people impart to their illness and also stigma associated with such illnesses. Culture must be viewed from the patients, clinicians and health system dimensions. Changes in mental health service delivery in last few decades have yielded culturally competent mental health services. The aim of this paper was to discuss culture and mental health with a focus on Nigeria and from a global perspective.     

Making the grade: a pilot investigation of an e-intervention to increase mental health literacy and help-seeking intentions among international university students

ABSTRACT

International students may have less understanding and awareness of mental health issues and appear unlikely to seek help. The purpose of the current study was to construct and evaluate a brief online educational intervention designed to increase mental health literacy (MHL) and help-seeking among international tertiary students studying in Australia. The intervention was tested among 45 international tertiary students (undergraduate and postgraduate), who were randomly allocated to control and intervention conditions. The intervention led to significant improvements in help-seeking attitudes, particularly in stigmatising attitudes. No significant effects were found for MHL or help-seeking intentions. A brief educational intervention can improve help-seeking attitudes among international tertiary students. Future research may focus on establishing optimal intervention dosage.     

Leadership in community mutual support groups for mental health: A qualitative case study from the leaders' perspective

This study explores the experience of leadership of member‐led community‐based mental health mutual support groups. Recent research has documented factors that affect these groups, including leader well‐being, but little is known about the experience of leadership at the individual level. We aimed to understand more about the experience of leadership and how leading members conceptualise their roles. Individual semi‐structured interviews were conducted with 14 leaders of a community mental health mutual support group in England and thematically analysed. Three themes were identified through which leading members conceptualised their roles and group dynamics: (a) “It's a family”; (b) professional values; and (c) working as a team. These knowledge frameworks appeared to influence leaders' well‐being and conceptualisations of their role. The potential impact of this on group stability is discussed. Recommendations are made that group and individual‐level processes be considered together in future research in mental health mutual support contexts due to their interconnected nature.