Peter Wilson – Mental Health – Whose Business Is It Anyway?
Peter W. began by stressing that in his view ‘we are all mental’ in the sense that everyone depended on internal mental processes and that there were not firm boundaries between mental health and distress and went on …
…There is a notion now, isn’t there, that the whole university should develop a culture that is tuned into the mental health of young people. I keep going back to children, partly because I see a lot of young students as being children still which I may come to later on, and partly because I do come from predominantly from a child and adolescent field and I see these young people tottering their way up into Higher Education.
In the child field over the last 10 years, and it’s still a relatively new concept, is the concept of the whole school - the whole school policy – and it really came from some very good research done by Peter Smith in Sheffield looking into bullying in schools. Bullying had never been a subject of interest or of research until about 1988. Before then, you know, ‘That’s the way the cookie crumbles - you get bullied? – tough’. He did some research, figured out and found out in Sheffield that bullying and the incidence of bullying varied enormously from one school to another and a lot depended on the culture of the school. In other words, schools would develop an attitude, a view about certain kinds of behaviour, which they thought were wrong. From governor to dinner lady, or from the dinner lady down to the governor, whichever way, everybody had a part to play in it. Now you are never going to eradicate bullying entirely because it is something perverse in the human spirit that enjoys tormenting people and being tormented. But you can significantly reduce its incidence by everybody taking a part in making sure that it is disapproved of, that people are helped not to do it and not be victims of it and so on.
So, that’s really where the idea of the whole school approach emerged and then it’s been developed into other areas, so that we have the idea of an organisational culture with value and mission and what matters and what doesn’t matter and what part every member of that organisation has to play in that. You can see it in industry; in the large companies everybody is committed to maximising profits and reducing costs, improving efficiency. That is the major competitive economic culture that prevails and everybody is to sign up in it. Everybody. Well, I guess simply I’m saying that if we can take on board this broad definition of mental health, then we all have a part to play in it, individually, and an organisation, the university, has a responsibility to value it highly.
I think actually, I would agree with the Minister on one instance and disagree with the Vice Chancellor on the other side about the main thing that gets in the way of student retention is financial. I rather take her point, you know it’s no bad thing to rough and tumble a bit. . You know, take on a bit of edge of the real world and that sort of thing, earn a couple of bob for yourself and it’s tough and it’s hard, but OK. Obviously a lot of students are having to do it far, far too much but I’m not convinced finance is the main issue. I think that people who cannot respond and deal with that kind of challenge are people who are suffering from mental health problems. The issue is a mental health problem, not a financial problem and I think if one can take that on board, there are some young people who will rise to it, say for example "I will do a waitressing job”, and get something from it. They are enlivened by it, they can organise their time, they can still get a good degree and they have actually profited from the experience. I know that because I do a lot, and have done a lot, of recruitment into the large companies over the last 20 years and you see people who have actually almost come alive with the experience of working. But I do know, too, that there are some young people who just do not have those capacities. For one reason or another they cannot rise to that kind of challenge. They cannot organise their time, they feel depressed, they feel frightened of whatever it may be in their lives and they cannot meet it. And I think we need to be addressing the mental health issue, which is really the key issue above all else.
I shall be focusing in my talk on that large bulk of young people between, let’s say, 18 and 30 and I take the Vice Chancellor’s comments about there being a very diverse population now and we have to think of the population in a very different way. But still the majority is this group of young people and I am very taken, really, by this segment of the population that is in the process of growing up and trying to be adult and I want to talk a bit about that a little more in a while.
I do talk, of course, largely from being so preoccupied in my day to day life with children and adolescent mental health and I do think, of course, that if more resource was put into that area you would have much more robust students coming into your universities. There is an awful lot that’s been going in those 18 years and if we can improve the resourcing of that and start to prevent some of the mental health problems that some young people develop during those first 1,2,3,4 years of life, through their school years, we can do an enormous amount to resource the universities with much greater capability than we have now. And I know this is not the centre of our agenda today, but if you just think of how you are going to improve retention rates, the Minister and the joint ministerial groupings are going to have to make a connection there. People don’t come into university off the moon, they come out of 18 years of, often, very difficult and demanding and ravaging lives. More of those with difficult histories will be coming into the universities with this 50% target, whereas before they were not coming in. So I think you are going to get more young people coming in who have particular difficulties with themselves and their relationships and so on. I take the point entirely that there is no correlation between mental health problems and academic ability, but I think there is a correlation between mental health problems and the capacity to learn and for those on the margins, that capacity can be severely limited.
We know a lot about the factors that get in the way of children and young people growing up to develop positive mental health. It has been very well documented over the last four or five years and we know that there are factors within the child; we know that there are factors within the family; we know that there are factors within the community. All these contribute one way or another to producing young people with differing degrees of mental health robustness. They are risk factors, they are not predictive factors, but they are risk factors and you can see that some children and young people are really against the odds in attaining a readiness and a capacity to have the mental health capacities that I have spoken about. What comes through in all of these studies on risk factors, apart from inherent factors that may be within the child, is the importance of continuity and commitment in relationship. That’s what comes through in all of the factors. A parent, a teacher, a tutor, a friend, an aunt, somewhere in that life there has been an element of significant commitment and attachment that has enabled that young person to feel that he or she is worthwhile and is thought about and has him or herself in someone else’s mind, and that really does matter a great deal.
I think you can translate that too into communities. A lot of children are at risk of developing mental health problems because their neighbourhoods are in some sort of frantic transitional state – people moving, people going, people living in isolated bedsits, nobody communicating with each other, no real sense of parish life, if you like, no real sense of community, nobody knows anybody. Parents don’t know anybody. So it seems to me that the community and the sense of interrelatedness and knowing each other, which is at the heart of a good community, is enormously important and there again I think about the role of universities. How far can a university create a sense of community? No easy task. I mean, you go back to your university days, as I go back to mine. I went to Nottingham University and when I went to Nottingham there were 2,000 students – before which war is up to you to guess! Now it’s got 29,000 students. Of course Halls of Residence have helped out. How do you create a university that is somehow or other in its ethos, in its mission, in its way in which it webs its staff together, the way in which it organises itself so that one department can speak to another and know what’s going on and deal with these sorts of rivalries so that you create a place where young people can come and feel they are going to be connected up, they are going to get through the freshers’ week and still be connected up and have some place in that community? How can you organise that? That seems to me to be of vital importance.
We get rather mesmerised by the labels. (Shows slide) I have been trying to talk about mental health in its broad sense. Within the population the numbers are BIG, much bigger than I believe our ministers really have taken on board yet. Within that we have people with mental health problems, mental disorders and mental illnesses and Eileen rather helpfully put up that slide which hopefully meant something to you. We all have problems along a continuum. Some of us are depressed on Sundays, it can just be Sundays or it might be a Monday, or it could last for a couple of weeks, or it could last for months. Others can be in a constantly anxious state and sometimes it disappears. Others of us are totally confused and bewildered by what’s going on in life at certain times and those who are most ill suffer the delusional state over a sustained period of time. We are all in this together. This is my other point. We all have mental health problems. There is nobody here who does not have some experience of feeling frightened, angry, anxious, mistrustful, disturbed, unsettled mentally, in their minds. If there is, please have the courage to stand up and tell us how – the secret of life. The fact is, we are all in this together. But we do like to say “Oh, no, no, no. There is a disorder over there. There’s a disorder over there and therefore I am in good shape”. And I rather like this one here. Can you see it? You probably can’t. It’s at a party. I think it must be a psychiatrist’s party and it says at the door at a party, “Why do you insist on labelling everybody?” And we’ve got ‘Borderline psychotic’. ‘Mildly neurotic’, ‘Hysterical’, ‘Obsessive compulsive’, ‘Schizo’, and the rather unfortunately lady up there at the top left has something called ‘Anal elusive’, or ‘ulsive’.
This is all by way of saying that problems come in all different kinds of forms. Amongst children and young people some children internalise them – there are the eating disorders, there are obsessive-compulsive thoughts, there are the suicidal, depressive young people, kids who lock themselves in their room and don’t come out. At the other end of the spectrum there are those who deal with their stress and their mental health problems in criminal behaviour. It is no surprise that 90% of young people in young offender institutes have a diagnosable mental disorder. They are in the wrong place. They are mentally unwell and yet they are being punished. We don’t make that connection between mental health difficulty and crime and youth offending, disruptive behaviour, conduct disorder and so on.
I thought Myra Woolfson’s guidelines were excellent because in about 3 or 4 pages, on identifying and responding to students in difficulty she describes the sort of signs that we all need to be alert to. Not completing work, doing too much or too little, missing classes, is it clear why? Is there anything odd or unpredictable about their behaviour? Are they tense, sad, miserable, unkempt, flat, agitated, very loud, very quiet, housemates telling you something that’s not right? It just seems to be a rather useful summary of the kind of signs of problems which you would have at university. There is a campaign, actually, being run by the Department of Health at the moment called ‘Read the Signs’. It’s all part of their anti-stigma campaign. It’s coming out next February. ‘Read the Signs’ suggests: Be open to these, try and understand them, talk about them with your colleagues if you’re worried about them. Don’t just label, say, ADHD, or whatever it is. Reflect, think about them, see where you can in your system refer these people with problems. I thought that was very helpful indeed.
Now I want to come to numbers and I am just going to put one overhead on that. I want you to get a sense of how big this problem is. Overall it’s a major challenge to deal with and promote the mental health of young people and students at university. I think we have to take on board that there a lot of young people who are struggling. I have been impressed by the Department of Health over the last 5 or 6 years in how far they have tried to actually get to grips with what the extent of the problem is. You see, actually, public health in the field of mental health, particularly children’s mental health, young people’s mental health, has not been very well advanced and we actually haven’t known what the prevalency rates of children have been. There was a study in 1976, but since them we haven’t really had an up to date study. The office of National Statistics last year came out with some prevalency rates of mental disorders in children based on a sample of something like 14,000. Very well conducted, very rigorously conducted, you have to pay attention to it. I’ll just give you the gist of it in this slide. 10% - 1 in 10 – children 5-15 - One in ten of those have a mental disorder at any given time. One in ten. What does mental disorder mean? Well, it means that these children are in a state of anxiety, of tension, of fear, of mistrust and they are behaving in ways which are disruptive and destructive to themselves and to others, it goes on over time, it persists, it’s a pain in the neck or a pain of worry to other people and it interferes significantly with their behaviour. In other words, these are not young people just with a passing mood or the passing upset or whatever. These kids have mental disorders. They are not mentally ill in the sense that they are not delusional or are not hallucinating, but they do have a real problem in their lives. One in ten. Take the population of people in the UK aged 10 to 19, you have got seven and half million young people. If you take the population of young people aged 20 to 24 in the UK, you’ve got three and half million people, so you’ve got about 11 million people we can just play around with, more or less, in a comparable age group. You don’t have to be too fussy about this. The point is you come up with about 1 million young people who have a mental disorder.
We also know from very good research from New Zealand that prevalency rates actually increase from later childhood through mid to late adolescence to young adulthood. Problems get worse during this period of time. We know that psychosis kicks in around 14, 15, 16 and unless it’s treated early it really becomes a major problem. So we are talking about a lot of young people who are in a state. Just to highlight the lack of provision, we know - again from another Department of Health study – that for adolescents between the ages of 12 and 18 there are but 900 adolescent in-patient beds. There are 80 units and 900 adolescent beds. If you actually try to think about extrapolating from the research you are really thinking of something like 50,000 young people who probably need in-patient treatment. Where are they? Well, I’ve already given you one indication – they are in the prisons.
I’m not going to bedazzle you any more with these sorts of figures. I am just trying to say that we can’t be complacent. I think the Government’s aspirations are laudable, I think a lot of the things that they have done in my field, in child and adolescent mental health, have been excellent in many ways. But, my God, there is a long way to go and I think when we start looking at those prevalency figures, you have to take on board that in your universities, whatever they are – twenty to thirty thousand in size, there are going to be several thousand young people who are not well at all. Who are not well at all. And a substantial proportion of those, not all, will be having major problems in studying, let alone in growing up.
The costs are very difficult to determine. The best study that we have in the field of child and adolescent mental health is looking at the cost of a conduct disorder, not the most beautiful term to call anybody. “Good morning, you’re a conduct disorder”. Not very nice. It simply means kids who are going all over the place, disruptive, stealing, fighting, just a pain in the neck to themselves and to everybody else. And Martin Knapp who is a very good health economist has calculated really, that between the ages of 10 and 28, young people with a conduct disorder EACH cost over £100,000 more in services than those without a conduct disorder. But I think the more you are going to bring in a more diverse range of people from different sorts of backgrounds, the chances are you will have more young people with conduct disorders or as they are called in adult vernacular, personality disorders. And they are not easy to deal with.
The problems, of course, have been increasing considerably over the years and we know this with very good evidence, particularly from Michael Rutter and David Smith, two very distinguished, very sceptical, very dry, very essential academics who looked critically at trends across Europe and the Western world over the 50 years and the signs are clear that there is more crime – 10 times more crime – in this country in the last 50 years, much more drug and alcohol abuse, more depression, more suicide, particularly suicide in recent years and probably eating disorders have increased as well. There are 1001 different reasons for this and I think some of them have been mentioned before. But I think a major factor has been the change in family life, the divorce rate increased 6-fold in the 30 years and if you look at the studies and add them up, they do indicate that it does lead as an aggregate to greater difficulties in young people growing up feeling well and able to learn. Not all, a great deal depends on how the divorce is handled. But certainly family life has been a major factor. And we could list many others. Poverty has increased over this time in families. I think the media MUST have had an effect on the minds of young people. We don’t know exactly what or how, but it must have done. We all live with September 11th. I could go on. There is much, much greater competitiveness, I think, in society generally. We have heard already that there is going to be a higher premium on qualifications, which means that those who don’t get the qualifications are going to be significantly marginalized and those who are trying to get the qualifications are going to come under greater pressure and we have heard that point already this morning. So one could go on at some length about this.
The point I am trying to make is that universities are the place where young people are thresholders. That’s a term that I am taking from a book called ‘The Myth of Maturity’ by somebody called Terry Apter. It’s an interesting book, it’s not the best book and the lady in the second row gave it to me – just remembered! But it is very well written – it’s got very good points. The myth of maturity, that we are sort of beguiled by the idea that simply because young people have a legal status of adulthood, that they are, in fact, adults. And I want to dwell on this thing for a moment, about what is an adult? Because it seems to me that universities have a responsibility for enabling the young of its society to grow into adults through its education, through its facilitations, through its supports, through its community. It is by and large dealing with children and young people moving beyond the orbit of their neighbourhoods and homes and becoming adults. And I think it raises the question, really, about what is an adult. And I’ll just throw a few questions at you. I’ll ask you, “any adults about?” would be the question. How adaptable and creative are you as an individual? How self-reflective are you as an adult? How aware are you of other people’s motivations and values? How adept are you at dealing with uncertainty, disappointment, pressure, pain and so on? How readily do you work in different organisational settings, in new jobs? How able are you to build knowledge from learning, to integrate diverse experiences and make links and make and take effective decisions? How many? I thought you were going to put your hand up, for a minute. So it just got that far.
They are rather heavy, tall questions, but actually when you start looking at what we expect of adults, people in our society it does start to raise questions about how able you are to do these things. In other words, if you like the terminology of the nineties and now, how emotionally intelligent are you? How emotionally literate are you? How able are you to enter into relationships, to enter into significant and growth-full partnerships? How able are you to deal with those rivalries between your professional groups and departments? How able are you to actually move forward and be creative in your work and actually produce a university that works together in the interests of its students?
Now it seems to me that these are rather pressing questions and I would suggest that, albeit that many young people are very bright and able and physically strong and this, that and the other, they are still trying to figure out how to become an adult and to have those sorts of qualities which expect of them. I think we expect of them more than just high academic qualifications. I think we expect them to go out and, at whatever level of society activity, to be effective and be adaptable. This is an extraordinary, crazy world we’re living in. We’re going to have to embrace diversity within our own country, across the world. We’re going to have to deal with difference. How well are we equipping our young people to do that? Now I think that is an emotional, mental health issue and it is a responsibility of the university to be addressing that. So I hope I am half succeeding in trying to bring this notion of the mental experience of students really into the middle of the road agenda, rather than seeing it as something that is marginal, that can be left to anybody’s whims over there, if they like. This is, it seems to me, very central.
I’ll just quote, if I may, from Terry Apter, because I think she just has a way with words, which I’d like to share with you.
This myth of maturity. She says “It’s taking longer and longer to prepare for the adult world. Education and training are now intensive. Leaving home is not a single event, but a prolonged process. Leaving home is a stop-start transition and does not mark true independence from parents, either emotionally or financially”. Young people who leave for college, or a job, or to marry are in her words “incompletely launched young adults” and I think the strain is there to see. The suicide statistics always give us some indication of what is at stake for those who are struggling the most. And as I understand it, although there was some levelling off, there is a considerable and significant increase in suicides, particularly amongst young men and I think that’s an indicator that something is over straining in the process of growing up in today’s society.
So I’m going to come to an end and show you a few more of my cartoons. I do apologise for that, but I have a penchant for cartoons.
So, mental health, whose business is it anyway? Well, I’ve tried to make a big point that think it’s a lot of people’s business. I was also impressed by Annie Grant’s presentation who has done lots of interesting work in Leicester, including asking who do young people seek help from? Friends and Family are top of the list. Personal Tutors second. Other academics staff next. Departmental secretaries. Welfare Service. Then at the bottom, counselling services, porters and cleaners. I’ve got that right - the author is here. Right?
(Annie Grant demurs)
Oh, I know, but I just threw that in for a joke, really. One mustn’t be too particular, you know (laughter). I’m not knocking the counselling services; I’m going to come back to that in a minute. The point is that here we have everybody; it’s everybody’s business. It just seemed to me it was expressed very clearly and that really matters a great deal. That must be fostered. What they are doing in those moments when students talk and seek help is crucial and they need to be helped to know how to do it the better. Some of them may be just naturally very good at it, others could maybe do it better, others may disastrous and we need to attend to that, to think about how we are going to cultivate the attitude.
But I also want to also argue for counselling services per se. I am very conscious from the field particularly in which I work which is the Child and Adolescent Mental Health Services that we have now greater recognition of the prevalence of the problems, of the extent of the difficulties, we look at the specialists, we see that they simply haven’t the capacity to meet it, some of these specialists don’t even have the attitude to want to get out to deal with it and so they are maligned and marginalized. I have to say that I do sit on the National Service framework for Child and Adolescent Mental Health and I think one of the emerging findings from the study is that we want to actually consolidate and develop the core service. Maybe it’s a different kind of service from the way it’s traditionally been, but you have to have, it seems to us, whether it’s in any particular kind of local authority area, or whether it’s in a university, a core service that holds in mind the importance of all the things that we are saying. We are there to deal with these very, very difficult problems and very severely disturbed young people that you have and will increasingly in your midst, and to actually move out and to offer and to work with and to provide support to the other services, the other support services, the teaching staff and so on.
You see, I think the problem is that we are only waking up to this problem now. And of course what would be great would be to get rid of the problem straight away. Let’s get the happy pill and be done with it. But we have already heard this morning that medication doesn’t work for a lot of people with problems. But there’s kind of pressure – ‘give us a quick fix, get through it, cut costs.’ I think there is a pressure on counsellors to get desperate.
(Shows cartoon) Here’s the psychiatrist. He’s saying “OK, buster. Talk” The people in the door are saying “In my opinion he’s got a rather unfortunate manner”. But he’s trying to move the thing on.
(Shows another cartoon)
Here’s a psychiatrist trying to get through 5 patients on a trolley all at once. Performance related high output; fine throughput.
A Social market foundation has just come up with a new trend, or discovered a new trend. It’s called ‘Lifelong parenting’. The fact is that two thirds of twenty year olds who have left home rely on their parents for financial help and the chances are – well it’s certainly the fact, too, that many of them still live at home. So, if you are thinking of having a child, any of you, today. It’s going to go on for thirty years. I used to think it would stop at sixteen, but it doesn’t. I make this point because families are important too. I don’t know how much universities think about families. We think about them all the time when we deal with children. Adult society doesn’t think about families at all when they are seeing adolescents and I wonder how much you take them into account as well. Because according to who they turn to they do turn to their friends and family whilst they are at university. How much help are you giving to parents?
(Shows cartoon)
You have to translate in this one – it’s not the dog, it’s the young person we are thinking about. Here are the parents, there’s the dog. “We spoil that dog”.
Am I arguing that we spoil our students? Shouldn’t we be toughening them up? To hell with all this mental stuff? They’ve got to grow up one day! And so on. I think not. I think these problems are immensely entrenched. I think they cause an enormous amount of suffering. I think they are enormously, highly responsible for your student retention issue. It is a mental health issue and everybody has a part to play and you have got to fortify your student support services and your counselling services if you
(a) want to ensure that they grow and learn and become adults and
(b) stay with you and give decent results.
Amen
Questions
My name is Andrew Varley. I work at Liverpool John Moores University as a student counsellor. I want to go back to what you were saying and the title of your talk, which was ‘Whose Business is it?’ and the idea of that notional spectrum of mental problems from one end of maybe mild anxiety to psychosis or heavyweight personality disorders at the other end. What do you think is the place of counselling services and what is it their business to deal with on that spectrum, if not the spectrum as a whole? I say that partly because of an argument that heavyweight cases, which aren’t to do with academic problems (as though they could be separated in some way), aren’t the business of counselling services and should be for other resources wherever they may be.
P.W. Well, I think there is a danger of course that, let’s call them heavy weight cases – we know what we are talking about - very distressed, unsettled young people who have got some kind of difficulty in their personality. Let’s try and get away from personality disorder because everybody thinks they are dangerous or murderers. There are a lot of very unintegrated young people about who are very difficult to make sense of and who move around and cause unsettlement where they go. Or we’re thinking about psychosis or severe anorexia or some of the severe obsessional-compulsive disorders. That would the heavy-duty end, as it were.
Well, I think it’s a bit of myth that there are magical psychiatrists who can deal with these. First of all, the services are limited, secondly I’m not entirely convinced, with great respect to adult psychiatrists, whether they are sufficiently well trained or have the right kind of attitude to work with young people of this age. Some are and clearly some of those severe conditions require medication, that’s for sure. But there is a wide band, I’d say 5% of that 1 in 10 that I gave you, who are very confused, very troubled. I think the origins of their difficulties lie in their experiences of abuse or neglect, one thing or another and I think they are the business of counselling services. I think the counselling service is the kind of core service within the university. Now, the counselling services need to be well resourced and trained to deal with these kind of disturbing young people and I believe- and this exactly what we are saying with Child and Adolescent Mental Services on the National Service framework - that these services have to have a critical mass. You need to have a body of people who are well trained and who can support each other and who can, not cure these young people, but what you try to do in good counselling, to enable them to cope that little bit better. The worry about counselling services is that they can be marginalized and they are down the corridor and far away and they are not part of the mainstream and all of this that was being talked about this morning. If you are under critical mass you can’t possibly get into the mainstream. I do think it is the responsibility of a counselling service to get out of its offices, to actually work with teachers, whatever system or structure you have. It is your job, it should be part of the job description, it should be part of the service specification. You should vary your work. There is a limit to how far I think it is good for you to be just seeing young people all the time. I think staff need support as well. And leave time for evaluation of course, so that one can get the feedback that is so necessary for your work. I know from my experience that there are a lot of very disturbed young people who don’t get anywhere near a psychiatrist and if they did he wouldn’t be much help. Again, I am not an anti psychiatry person, particularly. But they need someone who has the awareness of what their life means to them, how they are groping with these issues of becoming an adult. I think a lot of them do have problems in studying. Of actually taking the information in. Of actually acknowledging that they don’t know everything. They’re omnipotent, they don’t need to listen, or whatever. Who become very anxious that they are going to fail unless they do something perfect. There are thousands of reasons why people have difficulty studying and that should be the business of the university to concern itself with. It should be there to help people study, to learn to become academic. I think a lot of these problems do get in the way of that. It’s not easy, if you just think how hard it is for any of you to learn something new. All of these different sorts of tensions come into it, which are mental health issues as far as I am concerned. So I think counselling services do have a part to play. But you do need to be well resourced, you do need to be of an optimum size in my view. Not just two or three hidden away somewhere on your own. In my experience it is not a good idea to be seeing some of these young people on your own. You need the backup of a well-tuned and interested psychiatrist and you do need to get out and be meeting people in your institution. But I do think these young people are your business.
Hullo Peter. My name is Penny Hayman and I am a counsellor at Nottingham Trent University. I think I would like to ask you to comment a bit further about a point that you made at the beginning of your talk – you said that there was not necessarily a link between academic ability and mental health problems and then you went on to say, but having a mental health problem always affects the capacity to learn. I suppose what that brought up in me was an awareness of people who have been to traditional schools who have learned how to learn, who have learned to be academic in a traditional way, which many students from non traditional backgrounds just haven’t at all. So that was my thinking about it really, but I wonder if you have anything more that you could say about that.
P.W. Well, it was three things really, it was academic ability, capacity to learn and mental health problems and how that triangle maybe fits together.
Well, I was springing off something Geoffrey said this morning, that there is no clear correlation between mental health problems and academic ability. I think they were your words and I think that’s right. Some young people, regardless of the state they’re in, just simply do have the wit or the skill or the style or the sheer intelligence to do well in exams. We have to acknowledge that as a fact and in a way, thank God they can do it, because it gives them a sense of esteem and it gives them a sense of strength to deal with other areas of their life, which are in greater disarray. So I think one has to separate that out. But that is some people. Other young people don’t quite have what I prefer to call the wit, some kind of combination of know-how and intelligence factor. Perhaps if you’d like to say it’s some kind of academic competence that they have. Some kids seem to be able to do it better than others. But there are others who don’t do it so well and I think their vulnerability, their emotional frailty, their preoccupations, their anxieties do really interfere with that capacity to learn, to process, to take in, to digest, to produce, to find. All kinds of obsessionalities can come in. All kinds of doubts about one’s being, by virtue of the fact that you can’t get some essay in on time. These issues start to cloud the learning process, so that in that sense I think these mental health difficulties, you may just be too depressed, you may not think you are worthwhile enough, you maybe feel that anything you produce is crap. I mean you people in this audience know this better than I do and in that sense I think there is a relationship between mental health problems and the capacity to learn and it does interfere with academic results.
Elsa Bell from Oxford. I was just thinking about what you were saying and the question that Penny had posed to you, because I was thinking about students who do well very academically and still have quite severe mental health problems or conduct disorder. Thinking about how the actual process of being a student puts a frame and a structure around their mental health problem, which then allows them to deal with it in a much better way. I am constantly surprised by this and I shouldn’t be because I’ve been doing this for long enough to know, but even this week talking to someone who is a private psychotherapist who had seen a student who was also referred to our service and her concern about the level of disturbance in this student and then when that person presented to us, that level of disturbance was there, but the capacity of the counsellor who saw him, to use the framework of the academic study as a therapeutic tool was really quite significant. And I think sometimes we forget that that’s one of the great benefit of the expertise that we carry, that we can actually use the structure, they move in and out, so the structure helps us and we help the structure and I think we ought not to lose sight of that.
P.W. May I just say that I think that’s really very interesting in itself. It speaks for very well qualified counsellors, because you could easily pathologise this individual and just see the pathology and not really be able to use the structure as you say, or indeed to recognise the strength that this young person has at this point in his life. It may be that disturbance will emerge later on, but there is a limit to what you can deal with at any given time. So I think that capacity to know the institution that you are in and to know what it can offer and provide and facilitate within that, is extremely important.
E.S. I think at that point – a rather more cheerful point, perhaps – we need to stop for this morning.