Studies in Higher Education

ISSN: 0307-5079 (Print) 1470-174X (Online) Journal homepage: https://www.tandfonline.com/loi/cshe20

A qualitative exploration of the unique barriers,

challenges and experiences encountered by
undergraduate psychology students with mental
health problems

Victoria G. Woof, Charlotte Hames, Susan Speer & Doron L. Cohen

To cite this article: Victoria G. Woof, Charlotte Hames, Susan Speer & Doron L. Cohen (2019):
A qualitative exploration of the unique barriers, challenges and experiences encountered by
undergraduate psychology students with mental health problems, Studies in Higher Education, DOI:
10.1080/03075079.2019.1652809

To link to this article: https://doi.org/10.1080/03075079.2019.1652809

Published online: 12 Aug 2019.

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STUDIES IN HIGHER EDUCATION
https://doi.org/10.1080/03075079.2019.1652809

A qualitative exploration of the unique barriers, challenges and

experiences encountered by undergraduate psychology students
with mental health problems
Victoria G. Woof , Charlotte Hames , Susan Speer and Doron L. Cohen
Division of Psychology and Mental Health, School of Health Sciences, Manchester Centre for Health Psychology,
The University of Manchester, Manchester, UK

ABSTRACT KEYWORDS
Research demonstrating student mental distress typically focuses on University students; mental
mental wellbeing by combining questionnaire responses from students health; help-seeking;
studying a variety of disciplines [see Ibrahim, A. K., S. J. Kelly, C. E. psychology; undergraduates
Adams, and C. Glazebrook. 2013. “A Systematic Review of Studies of
Depression Prevalence in University Students.” Journal of Psychiatric
Research 47 (3): 391–400; Bewick, B., G. Koutsopoulou, J. Miles, E. Slaa,
and M. Barkham. 2010. “Changes in Undergraduate Students’
Psychological Well-being as they Progress Through University.” Studies in
Higher Education 35 (6): 633–645]. Little is known about how student
mental health varies as a function of degree type. Psychology students
are of interest here, as Psychology is one of few degrees where mental
health is a topic of study. Semi-structured interviews were conducted
with 20 undergraduate psychology students with mental health
difficulties from a UK University. Thematic analysis showed that previous
mental health problems were a motivator for studying psychology. The
delivery of taught mental health content exacerbated pre-existing
symptoms, induced concern and challenged perceptions of treatments.
Students also experienced unique challenges when accessing a variety
of University support networks. Findings can be used to inform policy
changes to improve these students’ university experiences.

Introduction
The mental wellbeing of Higher Education students has become an area of increasing global concern.
Ibrahim et al. (2013) found that across a diverse range of countries (including the USA, Canada, Korea,
Sweden and Turkey), 30.6% of undergraduate students, on average, suffered depression at any one
time. In a large scale meta-analytic study covering 36 colleges from across Europe, Africa, Asia and
North America, 22.3% of students had experienced suicide-related thoughts, attempts or deaths
(Mortier et al. 2018). According to the UK’s Higher Education Statistics Agency (HESA), the number
of students disclosing a mental health condition in 2016/17 has increased to over 53,000 students
(HESA. 2018) compared to just under 45,000 in 2015/16. Meanwhile, the nature of the mental
health difficulties with which students present at University and College Counselling Services has
become increasingly complex and severe, with services struggling to meet the demands and expec-
tations of students (Benton et al. 2003; Eisenberg, Golberstein, and Gollust 2007; Smith et al. 2007;
Hunt and Eisenberg 2010; RCP 2011; Gallagher 2012, 2015; YouGov 2016).

CONTACT Victoria G. Woof victoria.woof@manchester.ac.uk Division of Psychology and Mental Health, School of Health
Sciences, The University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK
© 2019 Society for Research into Higher Education
2 V. G. WOOF ET AL.

To assess the developmental trajectory of students’ mental health problems over their degree, a
small number of studies have employed longitudinal designs that draw on self-report measures to
assess changes in mental wellbeing. Cooke et al. (2006) measured the mental health of undergradu-
ate students at a major UK University at four time points across their first year. They observed a wor-
sening in mental health following admission to the university and reported that mental wellbeing
scores did not return to pre-enrolment levels. However, research designs where single academic
years have been explored have been criticised for not providing a holistic picture of students’
mental wellbeing across the entirety of their degree (Bewick et al. 2010). Bewick et al. (2010) in a
large scale study of 24, 234 British students, found that after 3 years studying at undergraduate
level, mental wellbeing declined, with levels of distress measured throughout these 3 years being
consistently higher than those reported at enrolment. Taken collectively, this research appears to
indicate that the university experience may precipitate or worsen the onset of mental health
problems.
In an attempt to explain the high prevalence of mental health problems amongst the student
population, a number of psychosocial risk factors inherent in university and college life have been
identified (Scanlon, Rowling, and Weber 2010). Such factors include homesickness (Denovan and
Macaskill 2013), accommodation problems (Storrie, Ahern, and Tuckett 2010), pressure to succeed
academically (Beiter et al. 2015), financial stress (Benson-Egglenton 2018) and increased competition
for internships and graduate-level jobs (Robotham 2012). Collectively, these social, academic and
financial pressures not only precipitate the onset of mental health difficulties, but given that univer-
sity life typically coincides with the mean age of onset for a range of psychiatric disorders (Kessler
et al. 2007), may have a uniquely deleterious effect on wellbeing.
The consequences of poor student mental health are wide-reaching and associated with increased
risk of academic failure and underperformance (Andrews and Wilding 2004; Eisenberg, Golberstein,
and Hunt 2009; Bruffaerts et al. 2018), absenteeism (Blanco et al. 2008), drop out (Hartley 2010), self-
harm (Eisenberg, Hunt, and Speer 2013) and suicidal ideation (Mortier et al. 2018; Tang, Byrne, and
Qin 2018). Of greatest concern is the global increase in student suicides, particularly in the UK and
US where consistent rises in the number of students taking their own lives are reported annually
(Office for National Statistics UK [ONS] 2016; CollegeDegreeSearch.net. 2015).
Despite their usefulness in estimating the prevalence, causes and consequences of mental distress
in the student population, a major limitation of the epidemiological data is that they are typically
obtained via large scale surveys administered to students studying a wide range of courses. Conse-
quently, not only is relatively little known about the subjective, experiential nature of studying with a
mental health condition, but critically few studies have examined how mental wellbeing might vary
across students enrolled on particular degree courses.
Of the handful of studies that have examined the mental health of specific cohorts, the Health
Sciences (i.e. medicine, midwifery and nursing), where fitness-to-practice concerns can prevent
future progression, have received specific attention (Horgan et al. 2016; Puthran et al. 2016). This
research shows that healthcare students face additional stressors that impact on their wellbeing
with clinical placement experiences identified as unique factors contributing to the onset of
common mental health disorders (Cleary et al. 2012; Chernomas and Shapiro 2013). Evidence also
suggests that exposure to a variety of illnesses through taught content and clinical placements
can contribute to Medical Students’ Syndrome’ (MSS; Woods, Natterson, and Silverman 1966; Fergu-
son 1996; Baars 1997). This has been characterised as a form of temporary, low-grade, ‘hypochondria-
sis’ in which normal bodily sensations are misattributed as signs of serious illness (Azuri, Ackshota,
and Vinker 2010). Counterintuitively, healthcare students are reluctant to seek support for their
own mental health difficulties (Givens and Tjia 2002; Chew-Graham, Rogers, and Yassin 2003;
Deasy et al. 2016), often fearing that to do so would impact negatively on perceptions’ regarding
their fitness-to-practice (Chew-Graham, Rogers, and Yassin 2003).
Although a considerable proportion of psychology students are likely to, and do, become future
healthcare professionals, there appears to be no pedagogic or educational research to date that has
 STUDIES IN HIGHER EDUCATION 3

explored the unique experiences faced by psychology undergraduates with mental health difficulties.
Indeed, this reflects a general paucity of knowledge in the extant literature exploring the experiences
of psychology students throughout their degree. This lack of understanding of the mental wellbeing
of psychology students is a critical issue given that they, like other healthcare undergraduates, are
exposed to modules where syllabus content encompasses learning about mental health disorders.
Research is urgently needed to better understand how psychology students’ with poor mental
health make sense of their own conditions in light of their growing understanding of the causes,
treatments and nature of mental ill-health. By employing in-depth qualitative enquiry, this research
aims to explore the experiences of psychology students with mental ill-health as they navigate
through their degree.

Method
Sampling and recruitment
Participants were recruited using opportunity sampling from a three year Undergraduate Psychology
programme at a large UK Higher Education Institution. Participants were eligible for inclusion if they
had ever received a formal diagnosis from a medical professional regarding a mental health con-
dition. Individuals who, in the three months prior to data collection had attended a consultation
with a medical professional regarding concerns over their mental health were also eligible. A
study advertisement was placed on an online research participation portal accessible only to psychol-
ogy students. Interested students were sent a participant information sheet and if they wished to
proceed an interview was scheduled. Participants had the opportunity to ask questions about the
study ahead of data collection and written informed consent was obtained. If participants presented
as a risk to themselves or others during the interview they could be referred to a Clinical Psychologist
working on the project. Participants were provided with information for local support services that
they could contact in the event they required support after the interview.

Participants
Of the twenty-seven eligible participants that responded to the research advert, twenty were sub-
sequently interviewed. Twenty-five interviews were arranged however five either did not attend or
cancelled. Eight males and twelve females were interviewed, aged between 19 and 23, and were
at various stages of their three year undergraduate psychology degree.

Interviews
One-to-one semi-structured interviews were employed. An interview schedule comprising open-
ended questions and probes relating to the research question was applied flexibly throughout to
allow the interviewer and interviewees to explore points of interest naturally as they occurred
(Kvale 1996; Magnusson and Marecek 2015). To build rapport, each interview began with questions
broadly relating to the interviewees’ experiences of university and their course, before more sensitive
questions relating to their mental health were broached. Each interview lasted approximately one
hour. Interviews were recorded and transcribed verbatim. All identifiable information was anon-
ymised and participants allocated pseudonyms.

Analysis
The data was analysed in NVivo 11 using Thematic Analysis (TA). The theoretical position which
informed this TA was realism. A realist perspective was chosen to explicitly reflect interviewees’
experiences and realities (Braun and Clarke 2006). The analysis was conducted collaboratively by
4 V. G. WOOF ET AL.

two of the authors (VGW & DLC). First they read each transcript in turn and familiarised themselves
with the experiences inherent in the data. Following familiarisation, initial coding was applied. An
inductive-manifest approach to coding was adopted. This approach requires the researchers to
remain close to the data and represent the true experiences of the participants, free from the influ-
ences of previous theory and literature (Braun and Clarke 2006). This coding process was iterative,
with the researchers comparing and refining codes across transcripts. Data saturation was achieved
and recruitment stopped when no new codes were identified. The refining of codes led to the
identification of patterns, forming the initial themes and sub-themes. These themes were assessed
against the dataset to establish their representativeness (Braun and Clarke 2006). Following this
refinement process the final structure of themes and sub-themes was defined (see Table 1 for the-
matic structure).

Ethical approval
The University’s Research Ethics Committee (UREC) granted approval for this study.

Results
Thematic analysis
Thematic analysis identified three overarching themes regarding the experiences encountered by
undergraduate psychology students with mental health difficulties. These were: (i) mental ill-
health as motivation for pursuing psychology, (ii) adverse reactions to mental health content and
(iii) efficiency of university support networks. Within each of these themes a number of subthemes
were identified (see Table 1).

Theme 1: mental ill-health as motivation for pursuing psychology

Subtheme 1a: in pursuit of understanding. Most students had experienced mental health difficul-
ties prior to enrolling in University. Many explained that their primary motivation for pursuing a
degree in psychology was to discover more about themselves and, more specifically, about the
mental health disorders from which they suffer:
… I get really bad panic attacks and nausea and it’s horrific, like totally horrific and I wanted to know more about
people like me. (George)

Other students’ interest in studying psychology stemmed from a desire to construct meaning around,
and make sense of, the mental health difficulties of their relatives. This first hand contact with loved
ones with mental health or mental degenerative difficulties had typically been associated with con-
fusion and helplessness. The decision to study psychology appeared to offer a medium through
which to acquire knowledge to retrospectively make sense of these lived experiences:
… primarily it was because my grandparents both suffered with dementia, and I had been watching that happen
since I was 14, so I was always really interested in what was going on because at the time I didn’t know … . (Abby)

Subtheme 1b: in pursuit of self-help. Many of the students had initially believed that studying psy-
chology would equip them with the requisite skills and coping mechanisms to improve their own
psychological wellbeing:
… when I realised what this thing called psychology was, I was, I wanted to learn all about it. I wanted to, you
know, get better. (Sarah)

However, once enrolled on the course students soon realised that the course was not designed to
provide practical advice for the self-management of mental health conditions. Following this

Table 1. Table of themes and sub-themes.
Theme
1. Mental-ill health as
motivation for pursuing
psychology
2. Adverse reactions to
mental health content
3. Efficacy of university
support networks
realisation, students recognised that their initial reasons for studying psychology as a therapeutic
intervention were naïve with some appearing to regret their choice of degree:
I think looking back I’ve been a little simplistic I thought there would have been more about mental health but
there wasn’t. I thought this was almost like a self-help course but obviously it’s not. It’s not meant to be, but some-
times I think, did I do this for the right reasons? (Harry)
Subthemes
In pursuit of understanding
In pursuit of self-help
Desire to help comparable others
Trigging symptoms of mental
health conditions
Incongruity between experiential
knowledge and taught material
Questioning treatment efficacy
Variable appraisal of University
counselling
Anonymity of student-led support
service
Inconsistent staff support
STUDIES IN HIGHER EDUCATION 5
Description
Pre-existing mental health issues prior to enrolling at
university provided motivation to study psychology in
order for students to find out more about themselves and
the conditions they suffer from. Students were also
influenced to study psychology due to loved one’s mental
health experiences.
Students chose to study psychology as they believed they
would be provided with the techniques and mechanisms to
help themselves. However, students experienced
disappointment when this did not appear to be the case.
Students believed that studying psychology would enable
them to develop the requisite skills to help others like
themselves. Others expressed an explicit interest in
pursuing careers in therapy and counselling where they
could draw on their experiences and knowledge to help
others.
The mental health content taught on the course was
described as ‘symptom inducing’. Students described
experiencing symptoms of their pre-existing conditions
and ‘new’ conditions acutely as a result of taking part in
these sessions. Students also suggested that lecturers’
practical demonstrations of symptoms were particularly
distressing.
Most of the students interviewed described having mental
health issues before enrolling in University. As a result they
felt that they were already familiar with the mental health
content being taught. Equipped with this knowledge
students thought that taught content was
unrepresentative of the realities of living with a mental
health condition.
Students believed that lecture content regarding treatment
for mental health disorders was biased towards ‘talking
therapies’ such as CBT. This led some students to question
the effectiveness of their medications and in some
instances to abandon their medication.
Over half of the students interviewed described using or
trying to use the University’s counselling service. The
majority described the service as ineffective, with some
describing long waiting lists and limited sessions. However,
this was not the case for all, with a minority of students
describing positive experiences.
Nightline, a student-led overnight confidential listening and
information service is a widespread service across UK
universities and some US and Canadian Higher Education
Institutes. Despite students describing the service as
needed, many believed that it was closed off to them due
to the high volume of psychology students who volunteer
for the service. Students described being worried that they
may be recognised by the call-taker.
Students described receiving mixed support for their mental
health problems from academic staff. Some described staff
as disinterested whilst others described outstanding levels
of support. Specifically students described that changing
academic advisors year-on-year was difficult when
summoning the courage to open up to someone new,
believing this change to be unnecessary.
6 V. G. WOOF ET AL.

Subtheme 1c: desire to help comparable others. Some students acknowledged that a significant
factor for choosing psychology was to help others as well as themselves. As Julia stated: And I
wanted to help others and also myself a bit, I guess. They identified that having direct experiences
of chronic mental health problems inspired them to pursue a degree in psychology because they
wished to alleviate the suffering of others in an attempt to prevent them from experiencing
similar mental health problems. They also acknowledged that their first hand experiences provided
them with invaluable knowledge in order to support others:
… I want to push it a bit further and like help other people as well ‘cause I think it’s really valuable to have experi-
ence of the problems yourself. (Abby).

For some their goal was to acquire knowledge and skills from the course to specifically pursue careers
in counselling and clinical psychology, whereby they could provide professional support to those in
need:
I just wanted to be a clinical psychologist ‘cause I wanted to help people that are going through like a rough patch
like I was. (Sophie)

Theme 2: adverse reactions to mental health content

Subtheme 2a: triggering symptoms of mental health conditions. Many students identified that
exposure to content in clinical lectures triggered symptoms of their own pre-existing mental
health conditions. Students described that these sessions made them dwell on, and become more
aware of, their symptoms:
… you have to go into a lecture and then think about say, ‘intrusive thoughts’ and it’s like, that just sets off your
own thoughts and it’s a dangerous and vicious cycle. (Adam)

Some stated that the lecturer’s practical demonstrations of the conditions under discussion were par-
ticularly distressing and symptom-inducing. One student, who identified as struggling with anxiety
and depression, recalled a lecture about anxiety where the symptoms of the condition were demon-
strated, leading to discomfort:
And the lecturer was saying imagine this, imagine you’re anxious and you feel like your throat is starting to close
up, and it’s like saying that makes my throat close up. And then he’s like you can feel butterflies and the adrena-
line, and you’re actually becoming anxious because he is … what’s the word? Inducing it in you. (Harriet)

In addition, some students reported that learning about new and ‘frightening’ mental health dis-
orders was sufficient to induce symptoms of the condition being taught. Several students reported
that they spent the majority of these sessions in a heightened state of anxiety due to fears that they
would develop the underlying condition:
I found it a bit I guess distressing, just learning about symptoms of psychosis and like the typical anxiety part of
my brain, it’s like, oh my goodness, what if I’m going to develop it? (Rachel)

Some students even described visiting healthcare professionals to express concerns that they were
experiencing the conditions that they had learnt about in mental health sessions.

Subtheme 2b: incongruity between experiential knowledge and taught material. Given their pre-
vious mental health difficulties, many students viewed themselves as ‘extremely knowledgeable’
about the aetiology of mental health disorders and possible treatment options prior to embarking
on the course. Consequently, many of these students identified feelings of frustration that little
novel information was being delivered to them during taught clinical sessions:
I’ve had it for ages. I already know everything about it annoyingly, so a lot of the time it’s nothing I haven’t already
heard. (Paul)
 STUDIES IN HIGHER EDUCATION 7

Due to their lived experiences of mental health disorders, students overwhelmingly believed that
they were more knowledgeable about their conditions than the lecturers delivering the content,
… I know more than the lecturers, I am the expert. I live with the bloody condition (George). Some stu-
dents felt that lecturers’ descriptions of mental health disorders were overly-simplistic, often failing to
capture the experiential nature of ‘living with’ a specific psychiatric condition:
… I actually find it a bit upsetting, like how can they reduce me and my experiences to a couple of slides? […] I’m
more than just a slide and a theory. It’s more complicated than even the staff realise. (Harry)

Subtheme 2c: questioning treatment efficacy. Many students perceived that the content of mental
health sessions was a little biased, with therapeutic interventions being heralded as more effective
than medication, … they sort of indoctrinate you a bit and say like Psychology, talking therapies are
good and medication is bad (Sarah). Students explained that this bias led them to question the effec-
tiveness of the medications that they were being prescribed:
… my doctor gave me the beta-blockers but then we learn that talking and CBT is the way forwards in lectures, so
then I’m like so should I ditch the medication? Is this a plaster rather than a cure? (Julia)

In one case the relationship between learning about the side effects of treatments during taught ses-
sions led to non-compliance with prescribed medication:
I haven’t taken the antidepressants prescribed to me, I just won’t take it because as I said, I’ve got an addictive
personality but also I’ve like learnt about the side effects in lectures. (Ellie)

Theme 3: efficacy of university support networks

Subtheme 3a: variable appraisal of university counselling service. Over half of the students inter-
viewed said that they had used the university counselling service, highlighting its utility as a much
needed resource. Several reported having extremely positive encounters with informed and caring
university counsellors, I’m seeing one counsellor here, who’s one of my favourite people, she’s saved
me (Lauren). However, others reported more negative experiences. They identified that the long
wait between requesting an appointment and seeing a counsellor was problematic as they required
immediate advice, … they booked an appointment for like April [ … ] I was like that’s too late, like I need
advice now (Julia). Once receiving counselling, students described sessions as limited and, in some
cases appeared to devalue the role of the counsellor in favour of a more intensive and tailored treat-
ment plan delivered either by a psychologist or medical professional:
… the counselling wasn’t great I think I needed professional help from a psychologist who with maybe CBT and
tablets could help me. (Michael)

Subtheme 3b: anonymity of student-led support services. Students recognised the utility of Night-
line, a student-led overnight confidential listening and information service, but felt that in its current
form, it poses a number of barriers for psychology students. Many students reported avoiding Night-
line due to concerns over anonymity. They recognised that, given the high proportion of fellow psy-
chology students volunteering for the service to gain clinical experience, there was a considerable
risk that they would unwittingly disclose sensitive and confidential information about their condition
to course mates:
I learnt from a friend that loads of psychology students volunteer there, so now I feel like, shit, I can’t use them
again. (Julia)

Indeed, several students who had used the service described recognising the voice of the receiver,
leading to an abrupt termination of the call:
8 V. G. WOOF ET AL.

I rang up Nightline and somebody answered […] within two or three minutes I realised it was a student that I
knew, now that was awful because I just had to put the receiver down and it was embarrassing. (Michael)

Subtheme 3c: inconsistent staff support. Students reported a variety of experiences with regards to
staff support. Some students described receiving excellent pastoral support from academic staff
teaching on the Psychology degree course. However, other students provided a more negative nar-
rative in which staff appeared to invest little interest in student welfare, partially due to their high
workload, the staff are too busy and don’t really care that much (George). Students also found that
staff knowledge regarding mental health disorders was variable, causing a barrier in students receiv-
ing effective support:
… I guess a staff understanding of illnesses might be better just so you don’t feel like you’re having to teach
someone about your illness before you actually get the support. (Sarah)

Moreover, the University’s policy of changing students’ academic advisors at the start of each year
posed a unique challenge for those with mental health difficulties. Many students reported having
established a good relationship with their Academic Advisor in which they felt able to disclose
their mental health difficulties. However, they felt frustrated at having to self-disclose their conditions
to new members of staff each year:
I guess there is no need to actually keep changing Academic Advisor. If you disclose to someone that you have a
mental health problem, then that should be enough. (Harry)

Similarly, other students felt unable to contact their previous advisor with whom they had established
an excellent relationship as they perceived they were no longer the advisor’s responsibility:
I did feel like I could talk to my first year academic advisor. But I felt–, I don’t know, because they weren’t my
academic advisor any more it was like well I’m not your student so, it felt a bit strange for me to be like oh
can I come and talk to you please? (Olivia)

Discussion
This study represents the first tentative steps to exploring the barriers, challenges and experiences
faced by undergraduate psychology students with mental health problems. The findings are of con-
siderable value for better understanding the lived experiences of those with mental ill-health in the
context of studying for a degree in which psychological distress is a topic of interest in its own right.
As well as the social, academic and financial pressures associated with university life (Scanlon,
Rowling, and Weber 2010; Storrie, Ahern, and Tuckett 2010; Macaskill 2013; Beiter et al. 2015;
Benson-Egglenton 2018), this research demonstrates that psychology students with mental health
problems experience specific challenges arising from the content and nature of their degree.
Pre-existing mental health difficulties prior to enrolling in university were significant motivating
factors in students’ decisions to undertake a psychology degree. Participants frequently described
wanting to learn more about themselves and apply this specialist knowledge to facilitate their
own recovery. Our findings support previous research that has shown that prior personal difficulties
are a significant predictor of students electing to study psychology, as well as the desire to help
others and become future healthcare professionals (e.g. a Clinical Psychologist) (Marrs, Barb, and Rug-
giero 2007). This research shows that a small proportion of psychology students, like medical stu-
dents, are motivated to embark on medical careers due to personal experiences of illness or loss
prior to starting their degree (Pagnin et al. 2013; Whyte et al. 2013).
Students were occasionally resistant to accepting lecturers’ ‘expert knowledge’ of mental illness,
choosing instead to position themselves as the ‘real experts’ in terms of having to deal with the day-
to-day management of their often debilitating conditions. The study reveals that these students
encounter a unique set of challenges as they reconcile their first-hand experience of managing
 STUDIES IN HIGHER EDUCATION 9

psychological ill-health with the often distressing content of the programme’s taught material.
Perhaps counter-intuitively, given that the majority of these students elected to study psychology
because they were interested in clinical practice, many stated that studying the aetiology and treat-
ment of psychiatric disorders exacerbated their conditions, and in some cases, led to feelings of acute
hypochondriasis. This is analogous to Medical Students’ Syndrome (MSS), where, after having learnt
about serious and potentially distressing physical illnesses, students develop a sense of ‘paranoia’ in
which they start to ‘acquire’ symptoms of the condition (Woods, Natterson, and Silverman 1966; Fer-
guson 1996; Baars 1997). It is likely that the same underling mechanisms account for the phenom-
enon described by participants in the current study.
Students in this study showed positive help-seeking behaviours, utilising many University support
networks, with over half having attended appointments with the University Counselling Service. This
finding differs to the present body of literature, whereby students on programmes allied to medicine
demonstrate poor levels of help-seeking behaviour for mental health (Givens and Tjia 2002; Chew-
Graham, Rogers, and Yassin 2003; Deasy et al. 2016), citing stigmatisation and concerns over their
fitness to practice as common barriers. Levels of mental health literacy have been linked to an
increase in student help-seeking for mental health difficulties. Consequently, the high levels of
mental health literacy amongst psychology students could begin to explain the positive help-
seeking behaviours observed in this study (Gorczynski et al. 2017).
Although many students in the present study reported that university counselling was an invalu-
able resource, one frequently cited complaint centred on the often unacceptably long waiting times
for a limited number of sessions. The efficacy of student counselling services has been widely
debated in the literature. Variability in student satisfaction has been linked to differences in the
quality of the support and treatment provided (Eisenberg, Golberstein, and Gollust 2007; YouGov.
2016). Given the financial cuts that university counselling services have been subject to over the
past decade (Benton et al. 2003; RCP. 2011), the lack of available appointments likely reflects the
on-going underfunding of this vital resource.
A further area of potential concern is that some psychology students, presumably because they
have high levels of mental health literacy, expressed a strong preference to be treated by a Clinical
Psychologist rather than a Counsellor. This is because they tended to characterise Clinical Psycholo-
gists as occupying a higher professional status than University Counsellors. These findings extend
that of Cleary et al.’s (2012) conclusions regarding the efficacy of counselling for medical students,
whereby psychology students could also be described as a unique group with an informed view
on mental health practices, and, consequently might require a more tailored approach to treatment.
The ‘anonymity’ of the University’s student-led call-in service (Nightline) was a significant barrier to
help-seeking. Students highlighted that they had been, or were anxious about being, recognised by
fellow psychology students volunteering for the service and therefore disclosing sensitive infor-
mation to their peers. Existing research suggests a link between stigmatisation and mental ill
health, with higher education students particularly concerned about disclosing their difficulties to
friends, course mates and staff for fear of being judged (Martin 2010; Markoulakis and Kirsh 2013;
Mackenzie et al. 2014; Wynaden et al. 2014). Our study shows that student-led call-in services
appear to heighten this concern for psychology students due to the disproportionate number of
course mates who volunteer for the service, creating a unique barrier to its utilisation.
Despite concerns associated with disclosing mental health difficulties to staff (Martin 2010; Mar-
koulakis and Kirsh 2013), many students reported regularly approaching their academic advisors
for support. However, the help students received was described as inconsistent. It is likely that
some non-clinical staff may feel ill-equipped to manage students with mental health problems
(McAllister et al. 2014) and prefer to refer students to specialised support services. Moreover, due
to occupational pressures, academic staff across universities worldwide suffer from high levels of
stress and burnout (Abouserie 1996; Watts and Robertson 2011), potentially affecting their emotional
and mental capacity to effectively support students’ wellbeing. Universities UK (2015; a UK-based
advisory organisation representing and supporting Universities to deliver educational excellence)
10 V. G. WOOF ET AL.

has recommended that Higher Education Institutions should provide staff with regular training to
identify and manage student mental health problems, as well as personal support to enable them
to better advise students.

Recommendations
For students to feel more included and represented in taught mental health sessions, we recommend
asking students to share their experiences of living with a mental health condition with lecturers via
an anonymous online depository prior to taught sessions. Their anonymous views and experiences
could then be shared at relevant junctures in the lecture. From a pedagogical perspective, such an
intervention would not only provide students with a richer insight into what it is like to live with
the condition under discussion, but would also foster a sense of inclusivity where students
become active participants in shaping aspects of the curriculum (Morton 2009).
When considering the impact that mental health taught content may have on students, we advise
that ‘trigger warnings’ prior to mental health lectures should be given. Recent research has indicated
that ‘Abnormal Psychology’ instructors often fail to consistently provide students with ‘trigger warn-
ings’, with some clinical staff deeming them unnecessary (Boysen, Wells, and Dawson 2016). This is
particularly problematic where multiple staff, with differing attitudes towards the use of trigger warn-
ings, teach across a single module. We suggest that some lecturers who deliver mental health content
need to be more consistent in providing ‘trigger warnings’, as well as more cognisant of the potential
distress that this content might have, not only on students with mental health difficulties but on all
students more generally.
Given psychology students’ high mental health literacy around the causes and treatment options
for psychological disorders, we suggest that Counselling Services acknowledge the unique position
of these students in order to provide them with more targeted and effective interventions. Counsel-
lors working with psychology students might, for instance, stress the underlying evidence-base for
specific treatment options at the outset of consultations, as well as the psychological mechanisms
implicated in the management of the condition (see Rowland and Goss 2013).
With regards to issues of anonymity and fear of stigmatisation, student-led call in services could
provide students with alternative online support forums. Such interventions have been successful in
the US for providing effective and anonymous support to students in crisis (Horgan, McCarthy, and
Sweeney 2013). As the current sample was taken from a single UK University, future research could
aim to explore psychology students’ views of Nightline from across its different international sites
(including the US and Canada). If similar findings were reported at a national or worldwide level,
student-led call in services could provide support to alternate universities to increase anonymity.

Conclusion
Through fine-grained qualitative enquiry this study is the first (to our knowledge) to identify a
number of specific barriers and challenges, which could be modified to improve the university experi-
ence of psychology students with mental distress. The present study represents the views and experi-
ences of only 20 undergraduate psychology students from a single UK University, which may limit its
theoretical and practical reach. We welcome further research that shifts away from a consideration of
student mental health on ‘aggregate’ in favour of qualitative exploration of the challenges encoun-
tered by students as a function of their degree. While the current study offers the first steps to achiev-
ing this goal, very few studies have examined whether students enrolled on specific degree courses
share similar lived experiences, values or personality traits that impact on mental wellbeing (but see
Vedel 2016). Given that research shows the overall demand for higher education is continually
increasing worldwide (UNESCO 2017), universities have a window of opportunity for effecting posi-
tive change in mental health. To best achieve this goal, more subject-specific exploration of the
 STUDIES IN HIGHER EDUCATION 11

unique difficulties encountered by individual cohorts of students is urgently needed to inform sys-
temic course and institutional level changes.

Acknowledgements
We would like to acknowledge the students who participated and Dr Filippo Varese, the Clinical Psychologist employed
on the project for student’s welfare.

Author contributions
DLC and SS conceived the idea for, and gained funding to support the study. DLC, SS and VGW
refined the study design and gained ethics approval. CH and VGW recruited participants. CH inter-
viewed the participants. VGW conducted primary data analysis under DLC’s supervision. VGW led
the writing of the manuscript. DLC, SS and CH provided feedback and edits to the manuscript. All
authors read and approved the final manuscript sent for publication.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This work was supported by a University of Manchester, School of Psychological Sciences ‘Teaching and Learning’ fund.

ORCID
Victoria G. Woof http://orcid.org/0000-0003-4069-5188
Charlotte Hames http://orcid.org/0000-0002-6772-5052
Susan Speer http://orcid.org/0000-0002-3048-2851
Doron L. Cohen http://orcid.org/0000-0002-6540-8264

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