Student mental health issues in South Africa are escalating; but who should be providing the necessary care and treatment – universities or government – and what else can be done to address this growing problem?

Counselling psychologist Charl Davids (below), Director at the Centre for Student Counselling and Development at Stellenbosch University (SU), believes student mental health has reached crisis point due to the sheer volume of those seeking help.

“We’ve definitely seen a rise in the numbers of students reaching out for support and accessing available mental health services, particularly after the CoViD-19 pandemic. However, what is particularly disturbing is the increasing severity of the presenting problems. This year, SU has had to hospitalise more students than we’ve done in the past three years due to severe anxiety and depression as well as substance (such as cannabis) induced psychosis. Tragically, we’ve had two successful suicides.”

He had one caveat, however: “When I speak to psychologists in private practice, it’s not different to what we also see in the general population. So, universities are a microcosm of general society.”

Professor Teboho Moja (left), Clinical Professor of Higher Education at New York University (NYU), reiterated the fact that student mental health is a growing global concern.

“The figures in the US show that one in four students could be suffering from mental health issues and the CoViD-19 pandemic has definitely exacerbated this. Younger students are also more vulnerable as they move into adulthood and are transitioning to university life, which, in itself, is stressful.”

Said Professor Jason Bantjes, Department of Global Health, Faculty of Medicine and Health Sciences at SU:  “Globally there’s concern about the mental health of university students – a series of surveys of first year students in 19 universities across eight countries, including South Africa, reported that 31 percent of students screened positive for at least one common mental disorder (depression and anxiety are high on the list) in the preceding 12 months, which is higher than the prevalence typically observed in the general population.”

However, there were important differences in terms of the South African context so possible solutions, he said, should not simply “be cut and pasted” from the Global North.

Professor Bantjies (right) said he was ambivalent about framing it as ‘a mental health crisis’: “When it comes to conversations around student mental health, it is called a crisis with questions raised as to whether there is an epidemic of depression and suicide among university students. I think it’s potentially unhelpful because it may create the impression that all students are in crisis and it may create an impression that it’s normal for students to have mental health problems. However, the discourse of crisis helps to mobilise action and make resources available.”

The three scholars were leading discussions in Mental Health and Self-Care in the Academy as part of last week’s 2022 HELM (Higher Education Leadership and Management) Summit, whose aim was to explore developing leadership for sustainability and change in higher education, globally. The Summit attracted up to 500 delegates from around the world.

Professor Bantjes explained that mental health in South Africa is a highly politicised subject for a range of different reasons. “It was central to the #FeesMustFall student protests between 2015 and 2017, and one of the three demands that students made as part of the protest; but it has also become a way of students signalling the extent to which universities support and look after them. And so, this discourse of providing student mental health care is an important part of the context and the lack of provision of those services is seen as a political injustice.”

He continued: “There are increasing tendencies to frame any difficulties that students have in South Africa – from housing and food insecurity to struggling with an academic workload or the breakup of a romantic relationship – under the banner of mental health. While it broadens the conversation about mental health there is a flip side; talking about it so loosely means what might be considered as normal developmental challenges are now perceived as mental health.”

The professor referred to some of the findings of one of the largest student mental health surveys ever undertaken in the world – which was launched in April 2020, initiated by Universities South Africa (USAf) and funded by the South African Medical Research Council (SAMRC) – which focused on mental health at South Africa’s universities with 29 000 students completing the survey.

“We can’t forget that apartheid has created divides and inequalities which persist in universities in South Africa. There are still significant differences between the historically white institutions and the historically disadvantaged institutions and this has a range of implications for student wellbeing but also to the extent in which a university can respond to the needs of its students.

“South Africa’s political history has also left other scars including high rates of trauma, violence and crime. It’s not only concerns about students’ physical safety on university campuses but also on their journey to and from the institution and other traumas they may have experienced. And so, while the conversation in the Global North often focuses on depression and anxiety, post-traumatic stress disorder (PTSD) is a greater problem in South Africa than mood and anxiety disorders,” he revealed.

Continued Professor Bantjes: “What we predicted with PTSD rates was much higher in South Africa than we would expect to see in other countries. We’re not that out of line with what we see in the general population of South Africa but there is a high proportion of students suffering from attention difficulties in universities so we need to identify and support them. We also screened for other disorders, notably eating disorders and social anxiety, and found very high rates of these. Body image issues are also what we should be having conversations about when it comes to student mental health.”

He thinks that there’s another gap regarding alcohol and cannabis use as the national survey did not deal with these: ”We know that there are huge problems in South Africa with the way alcohol is consumed and we have yet to unpack the impact of cannabis use, now that legislation has changed.”

He continued: “The prevalence rates of anxiety disorders are consistently higher at historically white institutions with these students reporting much higher levels of distress. The survey also indicated that black students at historically white institutions were at much higher risk of mental disorders compared to white students. Unisa has the lowest proportion of individuals who would meet a criteria for a psychiatric disorder. That makes sense given that a large number of students at Unisa are over the age of 35.”

Charl Davids also dealt with the sociological, economic and political problems facing South African students: “Look at what has happened at SU recently around racism and the link between race and class. It is the reason why we also see more black students in historically white universities seeking mental health services because of issues they face.”

While universities have some responsibility to respond to students’ needs, at the very least by creating an environment which is conducive to their psychological well-being, to what extent universities can and should provide services is an open question. 

Said Professor Bantjes: “The absence of adolescent mental health services in this country as well as a health care system that is overburdened and under-resourced leads to an implicit assumption that universities should be the ones to solve the ‘problem’ and provide care — responsibilities that, in other countries, might be assumed by the healthcare system.

Davids does not believe that universities should be healthcare providers: “I think that’s a government responsibility. However, due to socio-economic factors, universities have to fill the gap. It can take months to see a state psychologist.”

However, this leads to problems of its own.

Professor Bantjes explained: “It’s all very well to say that universities have some responsibility to provide mental health services for students. But, the moment we move into that territory, we have to acknowledge that we’re in ethically thorny territory because we move into debates about people’s rights to privacy and autonomy.”

Davids was in full agreement: “We need further conversations when it comes to a balance between duty of care and students’ rights to confidentiality and this is an extremely complex and ethical issue. For an example, a student may not want their parents to know about the mental health issues they are facing and won’t allow us to speak to them but what happens if they are psychotic or have attempted suicide? If we take them to hospital, the hospital stops talking to us and contacts their parents who then hold the university responsible because we did not keep them informed.”

Mental health doesn’t only affect students

Professor Moja said she thinks it is vital that the focus is not only on students but on all university staff as well as those who work in the mental health arena: “Due to the high workload and demand, they are also under stress, with mental health workers leaving their jobs en masse. While other industries are also experiencing turnover, mental health workers are particularly vulnerable to leaving their jobs in today’s environment. And we cannot forget university staff and lecturers who are burnt out and also struggling. They also need help and support.

“I also need to underscore the point that mental health issues are not just an institutional responsibility but should be regarded as a national responsibility, similar to other societal issues such as gender based violence.”

So what are some possible solutions, and what next?

Mr Davids: “Universities should create either ‘courageous spaces or safe spaces’ where students can have conversations as opposed to psychological interventions. We do provide mental health literacy programmes to try and ensure that students know where to get help while also allowing students mental leave. But then again you see the stigma with either the student or parent not wanting to take us up on this offer. More conversations are needed between the universities and students for best practice guidelines as well as peer counselling and peer education programmes.”

Professor Moja: “Universities need to provide a platform for dialogue, which helps remove the stigma that often surrounds the subject of mental health. We have to help normalise it as we do other health issues. We need to allow students to take medical leave for a semester if they need to.”

Professor Bantjes: “The crisis, for me, concerns the students who cannot access the care or treatment they require. Universities have some responsibility to step into the gap and that requires engagement around ethical issues and what universities can reasonably be expected to take responsibility for.”

Close to 40 delegates from across the globe attended this session of the virtual HELM Summit 2022, that was convened to explore innovative leadership development strategies in the context of disruption, complexity, change, and the global pursuit of the Engaged University. 

Janine Greenleaf Walker is a contract writer for Universities South Africa.