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Young, vulnerable and isolated
Last Updated: 12:01am BST 23/04/2007Page 1 of 2
Following last week's campus massacre in Virginia, Cassandra Jardine
examines
the provision of care for the mentally unstable in our own
universities... and
finds it wanting
Exactly what medication Cho Seung-hui, the 23-year-old student who
killed 32 staff and fellow students at Virginia Tech, was taking is
not yet known.
Demand for student counselling services is soaring in UK universities
What we do know is that he was observed by a dorm-mate taking
prescription antidepressants; that he was briefly hospitalised for
mental health problems, then released; and that, despite concerns from
professors and fellow students, he became increasingly deluded and
deranged as he planned the massacre.
When his medication is identified, questions will be asked about
whether the drugs were alleviating or exacerbating his mental illness,
given that young people involved in similar shootings were also found
to be taking prescription drugs. Kip Kinkel, for example, the 15-year-
old who opened fire on his Oregon schoolmates in 1998, was taking
Prozac.
The drug's manufacturer, Eli Lilly, vehemently denies that Prozac can
generate suicidal or violent reactions. However, suicidal thoughts and
self-mutilation are listed among its side-effects and a large body of
anecdotal evidence now suggests that a wide range of drugs, an A-Z
that runs from antibiotics to the stop-smoking drug Zyban, can have
harmful effects on under-25s whose brains are still developing.
The medicalisation of childhood behavioural problems in the USA is
catching on in the UK. Some 30,000 to 40,000 children and teenagers
are already being prescribed antidepressants in Britain, according to
the Department of Health (DoH), and about half of those are treated
with fluoxetine, or Prozac. According to the DoH, there has been a
tenfold increase in prescriptions for the amphetamine-like drug
Ritalin to treat attention-deficit hyperactivity disorder (ADHD).
There is a serious problem of increasing mental ill-health among
adolescents, not just in America, where 8.5 per cent of students said
last year that they had seriously considered suicide.
Figures for child and adolescent mental health in the UK are also
increasing at an alarming rate with figures from the DoH indicating a
rise of 40 per cent in 2002-05.
Cho's doctors will have to answer questions about who prescribed his
medication and monitored his mental health, but in this country,
despite the creation in 2003 of a standing committee for student
health, led by Universities UK, there is still a worrying shortfall in
provision for students.
The UK mental health charity Young Minds, for example, says that it is
not possible to know how many young people are taking prescription
drugs for mental health reasons, as the figures are collected under
number of prescriptions, not individuals.
It is known, however, that demand for student counselling services is
soaring.
"In the last five years, the widening participation agenda has meant
an increasing number of students - with more serious and ingrained
problems - making calls on university welfare services," says Denise
Meyer, who has worked for 10 years as a counsellor at Royal Holloway
College and the University of Southampton.
University is stressful, the more so now as ever larger numbers are
being herded through. For those with little academic confidence or
poor social skills, who may also be living away from home for the
first time, it can be deeply stressful, even before the pressure of
exams turns the screw. "Lecturers," says Meyer, "have less time for
pastoral care these days because they are under pressure to produce
research to sustain a university's rating. They refer students to the
counselling services, as they don't have the time for tea and a chat,
but there hasn't been an increase in the resources put into
counselling."
Under the Disability Discrimination Act, provision must be made for
students with a declared and diagnosed mental health problem, but the
vast majority either play down their needs or don't make them known at
all, as they have lost touch with normality or are embarrassed by the
notion of mental illness. According to the National Institute for
Clinical Excellence, 50 per cent of those affected by depression do
not seek professional help.
"There is still a stigma, though it is better than it was," says Lady
(Rachel) Waller, whose son Charlie became depressed during his final
year at the University of Durham, but didn't seek help. Since his
suicide from depression in 1997, aged 28, the family has founded the
Charlie Waller Memorial Trust which, 18 months ago, set up a website,
www.studentdepression.org, to give young people a forum in which to
hear others' stories and get help themselves. "I believe it is making
mental illness more acceptable," says his mother.
But those who ask for help may not be in luck. What's available
depends on which university they attend. Alex Kemp, welfare officer
with the National Union of Students, is shocked not only by the
patchiness of provision but by its decline in recent years, which he
ascribes to the financial pressures on universities.
"In a good university, a classmate or tutor might pick up the signs -
sleeplessness, lethargy, self-harm, periods of mania - and encourage
someone to seek help or even refer the person for counselling. But a
counselling service doesn't always exist - and there is often a long
waiting list."
Research for a Channel 4 programme earlier this year highlighted the
wide disparity in welfare services among our colleges and
universities, which cater for the seven million students in further or
higher education. Of the 19 that responded to inquiries, the lowest
spender was the University of Bath, which spent just £5.92 per student
in 2005-06 - less than a sixth of the £37.38 outlay per student at the
University of London's School of Oriental and African Studies.
"There has to be a debate about whether universities have a
responsibility to provide pastoral care, or whether they are just
there to educate their students," says Kemp.
"And there needs to be a standardised procedure so that every student
can see a counsellor, have an assessment and access to a range of
services. Some colleges and universities offer only counselling,
others provide group therapy and cognitive behavioural therapy."
Most problems can be dealt with quite quickly by counselling, Denise
Meyer believes, "but it isn't the only thing needed. At Royal Holloway
we have a university health centre, staffed by doctors. Many
universities can only hand out a list of local GPs."
Those prone to mental illness are highly vulnerable at university,
especially in the initial weeks. Not only are they away from home and
their GP, but those who have been supported by the Child and
Adolescent Mental Health Service are moved to the adult psychiatric
service when they are 18.
Cut off from the consultant who knows them well, some could
potentially be a danger to themselves and others. UK universities are
now asking themselves whether a very unwell young man like Cho could
have slipped through their net with the same ease as he did at
Virginia Tech.
"If he was taking antidepressants a doctor would have been monitoring
him," says Meyer, "because there are concerns about a higher risk of
suicide and possible correlations with an increased risk of violence.
Increasingly, it is realised that in more serious cases of depression
and other mental health problems, it is not enough simply to prescribe
medication; there have to be support services alongside.
"It is also vital that students are not socially isolated, like Cho
Seung-hui. As universities get bigger, they need more than ever to
foster a sense of community, calling students together, telling them
where to go if they have concerns about themselves and others."
In Britain, where there is no enshrined right to bear arms, it may be
hard to imagine the equivalent of a Virginia Tech massacre. But with
inner-city shootings increasing, and Dunblane to remind us of the
unthinkable, it would be complacent to assume it could never happen
here.
And foolish, too, to miss this opportunity to repair the large holes
in our university safety nets.
***
Young, vulnerable and isolated
Last Updated: 12:01am BST 23/04/2007Page 1 of 2
Following last week's campus massacre in Virginia, Cassandra Jardine
examines
the provision of care for the mentally unstable in our own
universities... and
finds it wanting
Exactly what medication Cho Seung-hui, the 23-year-old student who
killed 32 staff and fellow students at Virginia Tech, was taking is
not yet known.
Demand for student counselling services is soaring in UK universities
What we do know is that he was observed by a dorm-mate taking
prescription antidepressants; that he was briefly hospitalised for
mental health problems, then released; and that, despite concerns from
professors and fellow students, he became increasingly deluded and
deranged as he planned the massacre.
When his medication is identified, questions will be asked about
whether the drugs were alleviating or exacerbating his mental illness,
given that young people involved in similar shootings were also found
to be taking prescription drugs. Kip Kinkel, for example, the 15-year-
old who opened fire on his Oregon schoolmates in 1998, was taking
Prozac.
The drug's manufacturer, Eli Lilly, vehemently denies that Prozac can
generate suicidal or violent reactions. However, suicidal thoughts and
self-mutilation are listed among its side-effects and a large body of
anecdotal evidence now suggests that a wide range of drugs, an A-Z
that runs from antibiotics to the stop-smoking drug Zyban, can have
harmful effects on under-25s whose brains are still developing.
The medicalisation of childhood behavioural problems in the USA is
catching on in the UK. Some 30,000 to 40,000 children and teenagers
are already being prescribed antidepressants in Britain, according to
the Department of Health (DoH), and about half of those are treated
with fluoxetine, or Prozac. According to the DoH, there has been a
tenfold increase in prescriptions for the amphetamine-like drug
Ritalin to treat attention-deficit hyperactivity disorder (ADHD).
There is a serious problem of increasing mental ill-health among
adolescents, not just in America, where 8.5 per cent of students said
last year that they had seriously considered suicide.
Figures for child and adolescent mental health in the UK are also
increasing at an alarming rate with figures from the DoH indicating a
rise of 40 per cent in 2002-05.
Cho's doctors will have to answer questions about who prescribed his
medication and monitored his mental health, but in this country,
despite the creation in 2003 of a standing committee for student
health, led by Universities UK, there is still a worrying shortfall in
provision for students.
The UK mental health charity Young Minds, for example, says that it is
not possible to know how many young people are taking prescription
drugs for mental health reasons, as the figures are collected under
number of prescriptions, not individuals.
It is known, however, that demand for student counselling services is
soaring.
"In the last five years, the widening participation agenda has meant
an increasing number of students - with more serious and ingrained
problems - making calls on university welfare services," says Denise
Meyer, who has worked for 10 years as a counsellor at Royal Holloway
College and the University of Southampton.
University is stressful, the more so now as ever larger numbers are
being herded through. For those with little academic confidence or
poor social skills, who may also be living away from home for the
first time, it can be deeply stressful, even before the pressure of
exams turns the screw. "Lecturers," says Meyer, "have less time for
pastoral care these days because they are under pressure to produce
research to sustain a university's rating. They refer students to the
counselling services, as they don't have the time for tea and a chat,
but there hasn't been an increase in the resources put into
counselling."
Under the Disability Discrimination Act, provision must be made for
students with a declared and diagnosed mental health problem, but the
vast majority either play down their needs or don't make them known at
all, as they have lost touch with normality or are embarrassed by the
notion of mental illness. According to the National Institute for
Clinical Excellence, 50 per cent of those affected by depression do
not seek professional help.
"There is still a stigma, though it is better than it was," says Lady
(Rachel) Waller, whose son Charlie became depressed during his final
year at the University of Durham, but didn't seek help. Since his
suicide from depression in 1997, aged 28, the family has founded the
Charlie Waller Memorial Trust which, 18 months ago, set up a website,
www.studentdepression.org, to give young people a forum in which to
hear others' stories and get help themselves. "I believe it is making
mental illness more acceptable," says his mother.
But those who ask for help may not be in luck. What's available
depends on which university they attend. Alex Kemp, welfare officer
with the National Union of Students, is shocked not only by the
patchiness of provision but by its decline in recent years, which he
ascribes to the financial pressures on universities.
"In a good university, a classmate or tutor might pick up the signs -
sleeplessness, lethargy, self-harm, periods of mania - and encourage
someone to seek help or even refer the person for counselling. But a
counselling service doesn't always exist - and there is often a long
waiting list."
Research for a Channel 4 programme earlier this year highlighted the
wide disparity in welfare services among our colleges and
universities, which cater for the seven million students in further or
higher education. Of the 19 that responded to inquiries, the lowest
spender was the University of Bath, which spent just £5.92 per student
in 2005-06 - less than a sixth of the £37.38 outlay per student at the
University of London's School of Oriental and African Studies.
"There has to be a debate about whether universities have a
responsibility to provide pastoral care, or whether they are just
there to educate their students," says Kemp.
"And there needs to be a standardised procedure so that every student
can see a counsellor, have an assessment and access to a range of
services. Some colleges and universities offer only counselling,
others provide group therapy and cognitive behavioural therapy."
Most problems can be dealt with quite quickly by counselling, Denise
Meyer believes, "but it isn't the only thing needed. At Royal Holloway
we have a university health centre, staffed by doctors. Many
universities can only hand out a list of local GPs."
Those prone to mental illness are highly vulnerable at university,
especially in the initial weeks. Not only are they away from home and
their GP, but those who have been supported by the Child and
Adolescent Mental Health Service are moved to the adult psychiatric
service when they are 18.
Cut off from the consultant who knows them well, some could
potentially be a danger to themselves and others. UK universities are
now asking themselves whether a very unwell young man like Cho could
have slipped through their net with the same ease as he did at
Virginia Tech.
"If he was taking antidepressants a doctor would have been monitoring
him," says Meyer, "because there are concerns about a higher risk of
suicide and possible correlations with an increased risk of violence.
Increasingly, it is realised that in more serious cases of depression
and other mental health problems, it is not enough simply to prescribe
medication; there have to be support services alongside.
"It is also vital that students are not socially isolated, like Cho
Seung-hui. As universities get bigger, they need more than ever to
foster a sense of community, calling students together, telling them
where to go if they have concerns about themselves and others."
In Britain, where there is no enshrined right to bear arms, it may be
hard to imagine the equivalent of a Virginia Tech massacre. But with
inner-city shootings increasing, and Dunblane to remind us of the
unthinkable, it would be complacent to assume it could never happen
here.
And foolish, too, to miss this opportunity to repair the large holes
in our university safety nets.
***