What assists postgraduate students with a mental health conditions succeed at university

1. What assists postgraduate students with a mental health conditions succeed at university Dr Naomi Blake

2. Overview of Lecture • Presence/incidence of students with mental health concerns within University • Education at University • Triggers for students with Mental Health concerns in general & within the university environment • Other issues around mental wellbeing that may impact upon their success at university • PhD research into success for postgraduate students at UniSA • Strategies to facilitate success

3. Presence/Incidence • Around 1 in 5 adults in the general community (Aust Bureau of Stats) • Individuals with mental illnesses have educational potential (Collins & Mowbray 2005) and are supported with their studies through various legislation worldwide (McLean & Andrews 1999) • In Australia students are supported through legislation, standards and policies on disability, education and mental health (Martin 2010). This includes the UN convention on the Rights of Persons with Disabilities – ratified 17 July 2008.http://www.ag.gov.au/www/agd/agd.nsf/Page/Humanrightsandanti-discrimination_UnitedNationsConventionontheRightsofPersonswithDisabilities • Students entering further education rather than university do not have fewer incidence than those at university (Warwick et al 2008) • Estimated between 10 & 20% of university students have mental illnesses – research in USA (Collins & Mowbray 2005), despite earlier research indicating that young people are unlikely to enrol in higher education (Megivern et al. 2003)

4. Presence/Incidence Cont’d • Out of those, some students have pre-existing mental health concerns, where as others may have their first episodes during their time at university (Martin 2010) – especially if they are school leavers as... • ¾ of initial onset of mental illnesses is between 16 & 25 years old (Mcgivern et al 2003 & McLean & Andrews 1999) • UniSA: Number who made contact with me through my online survey – 120 students – therefore there are students at this university studying with mental health concerns – it is around you!

5. Education at University • Major change in delivery and focus of your learning (Lu 1994; Biggs 2003) • Adult learning • Responsibility for learning shifts to the individual student • Few contact hours • Attendance is usually not compulsory • This becomes even more prevalent with post-graduate studies and research only studies

6. Education at University – cont’d • Other areas that can also change in conjunction with change to university studies (particularly if you are a school leaver entering university) • Housing • Employment • Also, international students have to contend with a different culture and for some a new/different language as well as being away from familial & other supports (Biggs 2003) • In general, transition to university is a major life change & fits within stressful life events research (Lu 1994; Thoits 1982)

7. Impact on the Individual CHANGE & UNI EDUCATION OFTEN LEADS TO..... STRESS • impacts on any individual, both home and international, with a strong link to psychological distress and also links to risk & resiliency theory (Lu 1994; Collins 2001; Halamandaris & Power 1999) • for students with a predisposition to mental health concerns or those who already have mental health concerns, this can lead to attrition (Martin 2010; Tennant 2002; Surtees et al 2002; McLaren & Andrews 1999) • Appropriate supports are required to reduce that attrition

8. Impact of Psychiatric Disabilities & University Education • Thinking, behaviour, perception of reality, affects and judgement & insight • Effects of medication impact learning and increased around change/withdrawal of medication • This impaired functioning includes the areas of cognition, emotions, psychological and social. • Grief & Loss of their mental illness experience – future oriented loss (Baker, Procter & Gibbons 2009) UniSA research

9. Other issues around mental health wellbeing & uni education • Benefits of university education • increasing self-esteem (Coleman & Hagell 2007) • community engagement (Martin 2010, Humphrey 2004 & Kohn 1994) • In the University community: through meaningful and purposeful engagement in order to achieve study goals, and • In the wider community: through employment and other engagement to achieve life goals • Decreased hospitalisations, increased self-confidence & empowerment - if appropriate support is utilised • My research explored ways to maximise student potential within higher education and its flow on into the wider community despite the hurdles that present

10. One of my Key theories - Resilience • Definition: • a multi-theoretical approach to understanding how people maintain well-being despite adversity, which is learnt (nurture) rather than something you are born with (nature) (Greene 2009; Fergus & Zimmerman 2005) • Ability to bounce back from or overcome adversity & stressors • See table 12.2 in reading from Greene (2009)

11. Resilience, cont’d • How it relates to students with mental health concerns • As mentioned changes to learning at university and assessments can be significant stressors, particularly for students with mental health concerns • Dealing with the stress is necessary to provide an environment where success is possible

12. Resilience – Cont’d • How it can facilitate student success and engagement within the university and wider community. • It promotes the development of protective factors to reduce the risk of stressors • Protective factors can be either internal (personal) or viable support networks that modify the risk from life events stress including uni education(Greene p, 321; Thoits 1982; Warwick et al 2008). • Assistance through LTU and other means, both inside and outside the university, are important in the provision of support services/networks

13. Positive Psychology • Positive psychology is focused on the wellbeing of individuals and mental wellness rather than just the absence of mental illness. • It links to resilience and strengths based approaches in working to achieve goals. • Often referred to as the wellness model • Originated as an opposing viewpoint to learned helplessness as put forward by Martin Seligman. (Seligman 2011a; Seligman 2011b; ; Seligman 1992; Seligman & Csikszentmihalyi 2000)

14. Positive Psychology - PERMA • Positive Emotion • Engagement • Relationships • Meaning • Accomplishment

15. Help Seeking Behaviour...or lack of it! • The positive impact of help seeking behaviour • Increased success (as mentioned earlier) • Reasons those with mental health concerns may avoid seeking help and the impact of this on their university educational success and university experience (Martin 2010) • Stigma ( & link to empowerment) • Hidden nature of the disability • Nature of the disability being a fluctuating condition • Nature of the illness – characterised by withdrawal • Need people they can connect with when they are in need • However, to aid students in the pursuit of their studies, universities need to ensure that their support provision is responsive and effective (Surtees et al 2002; Thoits 1982)

16. My PhD Research Success for University Students with Mental Illness: Building Resilience and Positive Emotion, Engagement, Relationships, Meaning and Accomplishment [Conferred August 2014] (Blake 2014)

17. Sample/Responses

18. Ways students indicated that success could be improved • Self-initiated strategies, but the focus is on University initiated strategies here • Resilience focused strategies will be first discussed and then those around Positive Psychology’s PERMA

19. University Facilitated improvements - Resilience • Workshops on self-esteem and positive outlooks for students • Student participation in campus programs such as mentoring • Provision of flexibility and assistance • LTU staff being available • More encouragement given • More assignment feedback • LTU staff having more time to provide services • Provision of information to students about services such as information packs pointing out that mental illness is part of disability services

20. University Facilitated Improvements - PERMA • Support Group • Consolidated Student Information Packs or staff guiding them through options • Case Management (Higher Degree supervisors could help manage this or provide some brochures to help direct to appropriate services) • Staff trained in MHFA (Mental Health First Aid)

21. Ways postgraduate students indicated already assisted success • Allowing resubmissions within reason • Understanding that Academics have a lot of pressures and providing more administrative support to free them up to respond more speedily to emails and help-seeking • Being willing to explain information a number or times, possibly in a number of different ways

22. More ways postgraduate students indicated already assisted success • Understanding, approaching and treating mental illnesses as physical illnesses • Promoting, confidence to even out the self-doubt, particularly in the first 6 months around the research proposal as this grounds the student in an experience and understanding that they can and are achieving • Engaging in the provided postgraduate gatherings either for academic or social reasons

23. New ways to improve success for postgraduate students • Access to information and provision of information about services to access outside of university, including alternative approaches • Holistic approaches • Enshrining bio-psycho-social approaches – not just reliant on referrals to doctors for medication

24. Three key findings of the research • Only around ½ students disclose to staff and then only ½ of those seek help through DAPs • Students are often confused around the terminology and could be assisted further by staff, particularly those undertaking higher degrees • Not all students have a positive experience of disclosure and perceptions of students with mental illnesses going into professions can be negative

25. References • Australian Bureau of Statistics (2007) National Survey of Mental Health and Wellbeing: Summary of Results. Vol. 4326.0 Canberra: Australian Bureau of Statistics. • Aneshensel, C. (1992) “Social Stress: Theory and Research” Annual Review of Sociology 18: 15-38 • Baker, A., Procter, N. & Gibbons, T. (2009) “Dimensions of Loss from Mental Illness” Journal of Sociology & Social Welfare 36, pp. 25-52 • Bentley, K. (2002) Social Work Practice in Mental Health: Dontemporary Roles, Tasks, and Techniques Brooks/Cole Thomson Learning: Canada • Biggs, J. (2003) “Teaching for Quality Learning at University: what the student does” in Teaching International students, (2nd Ed) Society for Research in Higher Education: Buckingham, Philadelphia, Chapter 7 • Coleman, J. & Hagell, A. (2007) Adolescence Risk and Resilience: Against the Odds John Wiley & Sons Ltd: Sussex, England

26. References Cont’d • Biggs, John B. and Society for Research into Higher Education (2003) Teaching for Quality Learning at University: What the Student does. Buckingham; Philadelphia: Society for Research into Higher Education. • Blake, Naomi (2014) Success for University Students with Mental Illness: Building Resilience and Positive Emotion, Engagement, Relationships, Meaning and Accomplishment PhD Thesis, University of SA, Adelaide • Coleman, John and Ann Hagell (2007) Adolescence Risk and Resilience: Against the Odds. West Sussex, England: John Wiley & Sons Ltd. • Collins, M (2001) “Transition to Adulthood for Vulnerable Youth: a review of research and implications of Policy” The Social Service Review 75(2): 271-291 • Collins, M. & Mowbray, C. (2005) “Higher Education and Psychiatric Disabilities: National Survey of Campus Disability Services” American Journal of Orthopsychiatry 75 (2): 304-315

27. References – Cont’d • Fergus, S. & Zimmerman, M. (2005) “Adolescent Resilience: A Framework for Understanding Healthy Development in the Face of Risk” Annual Review of Public Health Vol. 26, pp. 399-419 • Fredrickson, B. L. and Losada, M. F. (2005) Positive Affect and the Complex Dynamics of Human Flourishing. American Psychologist 60:678-86. • Gable, Shelly L. and Jonathan Haidt. (2005) What (and Why) is Positive Psychology? Review of General Psychology 9:103-10. • Grigg, Margaret, Bruce Singh and Graham Meadows. (2007) Mental Health in Australia : Collaborative Community Practice. Melbourne, Vic.: Oxford University Press. • Greene, R. (2009) “Risk and Resilience Theory: A Social Work Perspective” in R. Greene (ed) Human Behavior Theory & Social Work Practice (3rd Ed.) Transaction Publishers: New Jersey, Chapter 12

28. References – Cont’d • Halamandaris, K. & Power, K. (1999) “Individual Differences, Social Support and Coping with the Examination Stress: A study of the psychosocial and academic adjustment of first year home students” Personality and Individual Differences 26: 665-685 • Humphrey, N. (2004) “The Death of the Feel-Good Factor: Self-Esteem in the Educational Context” School Psychology International Vol 25, pp. 347-360 • Kohn, A. (1994) “The Truth About Self-Esteem” Phi Delta Kappan 76 (4) • Langer, E. (2002)Well-being: Mindfulness Versus Positive Emotion. Pages 214 in Handbook of Positive Psychology [Electronic Resource]. Oxford England ;New York: Oxford University Press. • Lazarus, Richard S. (2003a) Does the Positive Psychology Movement have Legs? Psychological Inquiry 14:93-109.

29. References – Cont’d • Lopez, S. J. (2008a) Positive Psychology: Exploring the Best in People - Capitalizing on Emotional Experiences. Vol. 2 USA: Praeger Publishers. • Lopez, S. J. (2008b) Positive Psychology: Exploring the Best in People - Discovering Human Strengths. Vol. 1 USA: Praeger Publishers. • Lu, L. (1994) “University Transition: major and minor life stressors, personality characteristics and mental health” Psychological Medicine Vol.24, pp. 81-87 • Maddux, J. (2005) Stopping the "Madness": Positive Psychology and the Deconstruction of the Illness Ideology and the DSM. Pages 13-25 in Handbook of Positive Psychology. Edited by C. R. Snyder and S. J. Lopez. Oxford: Oxford Univeristy Press • Maddux, J. (2002) Self-Efficacy: The Power of Believing You can. Handbook of Positive Psychology. Edited by Shane J. Lopez and C. R. Snyder. Vol. 2. Oxford: Oxford University Press.

30. References – Cont’d • Martin, J. (2010) “Sigma and Student Mental Health in Higher Education” Higher Education Research & Development 29(3): 259-274 • Masten, Ann S. and M. Reed. 2002. Resilience in Development. Handbook of Positive Psychology. Edited by Shane J. Lopez and C. R. Snyder. Vol. 2. Oxford: Oxford University Press. • McLean, P. & Andrews, J. (1999) The Learning Support Needs of Students with Psychiatric Disabilities in Australian Post-Secondary Institutions Adelaide: National Centre for Vocational Education Research • Meadows, G., Singh, B. & Grigg, M. (2007) Mental Health in Australia Oxford University Press: Melbourne • Megivern, D., Pellerito, S. & Mowbray, C. (2003) “Barriers to Higher Education for Individuals with Psychiatric Disabilities” Psychiatric Rehabilitation Journal 26 (3): 217-231

31. References – Cont’d • Oades, L., P. Robinson, S. Green and G. Spence. (2011) Towards a Positive University. The Journal of Positive Psychology 6:432-9. • Peterson, Christopher. (2006) A Primer in Positive Psychology. New York: Oxford University Press. • Seligman, Martin E. P. (2011a) Authentic Happiness. North Sydney: Random House Australia. • Seligman, Martin E. P.(2011b) Flourish : A Visionary New Understanding of Happiness and Well-being. London: Nicholas Brealey Publishing. • Seligman, Martin E. P.(1992) Learned Optimism. Milsons Point, N.S.W.: Random House Australia. • Seligman, Martin E. P. and Csikszentmihalyi, M. (2000) Positive Psychology: An Introduction. American Psychologist 55:5-14.

32. References – Cont’d • Seligman, Martin E. P., Steen, Tracy A., Park, Nansook and Peterson, Christopher. (2005) Positive Psychology Progress: Empirical Validation of Interventions. American Psychologist 60:410-21. • Snyder, C. R. and Lopez, S. J. (2005) Handbook of Positive Psychology. Oxford: Oxford University Press. • Surtees, P., Wainwright, N. & Pharoah, P. (2002) “Psychosocial Factors and Sex Differences in High Academic Attainment at Cambridge University” Oxford Review of Education 28(1): 21-38 • Tennant, C. (2002) “Life Events, Stress and Depression: a review of recent findings” Australian and New Zealand Journal of Psychiatry Vol.36, pp. 173-182 • Thoits, P. (1982) “Conceptual, Methodological and Theoretical Problems in Studying Social Support as a Buffer Against Life Stress” Journal of health and Social Behavior 23(2): 145-159

33. References – Cont’d • Warwick, I., Maxwell, C., Statham, J., Aggleton, P. & Simon, A. (2008) “Supporting Mental Health and Emotional Well-being Among Younger Students in Further Education” Journal of Further and Higher Education 32(1): 1-13