Lifestyle

Many students feel stressed or depressed for one of a multitude of possible reasons at some stage during their time at University, and an increasing number of these seek some form of counselling. The causes of mental health problems are not conclusively known, but there are certain factors that are believed to contribute. Some problems are clearly caused by stress, social pressures, and racial or other prejudice. It would seem that some people are genetically predisposed to mental health problems. It has been argued that drugs and alcohol can be a cause of such difficulties, although others argue that drug and alcohol misuse are more likely to be a consequence of an existing problem, with the individual using them to relieve symptoms.

The fact that many people in Britain suffer some form of mental health problem at some point in their life does not mean that mental illness has become as accepted as physical illness. It simply tries to raise awareness of the prevalence of mental health problems both among students and in the community at large.

All universities, and many colleges, have in-house counselling services staffed by trained and experienced people. Unsurprisingly, the main cause of stress among students is financial worries, although academic concerns and worries about future employment are also a factor. The beginning of the first year at university is also a time of great stress for new students, and some suffer from bouts of depression. One study has suggested that 61% of freshers feel depressed at some time and 12% were estimated as feeling suicidal, although only 1% actually attempted it.

Another critical time for depression can be when first years return to college following their first Christmas vacation. This is often caused by the fact that the student has just discovered that their parents are breaking up. Studies suggest that parents often wait until children have left home to go to college before ending their relationship, which can be very traumatic.

Students are often reluctant to approach institutional counselling and other help agencies with any mental health problems because they are afraid that this might have an adverse affect on their future studies. At some colleges there have been reports of counsellors being told to inform teaching staff if a student approaches the service more than once with a mental health problem.

The suicide rate for those at college is lower than the UK average for the 15-25 age group. However, the rate of student suicides between 1983/4 and 1993/4 rose by 400%. Of these, male students were three times more likely to take their own life and the most vulnerable category were mature students, with nearly half of the suicides being students aged 25 or over.

One of the most common mental health problems among students is depression. The condition may be temporary, in response to pressures at University, in a job, at home or in the person's social life. It may be manifested as a pathological sense of hopelessness or helplessness, which in its extreme may provoke threats of or attempts at suicide (threats of suicide should always be treated seriously).

Depression may also be a symptom or side effect of some other condition or illness, for example, cancer or chronic pain problems. It may appear as apathy, disinterest, inattention, impaired concentration, irritability, or as fatigue or other physical symptoms, resulting from changes in eating, sleeping or other living patterns.

Anxiety is also prevalent among students and may also be the transient reaction to stress. Mild anxiety, in fact, may promote learning and improve student's functioning. Severe anxiety, however, may reduce concentration, distort perception and weaken the learning process.

Anxiety may manifest itself as withdrawal, constant talking, complaining, joking or crying, fantasising, or extreme fear, sometimes to the point of panic. Bodily symptoms might include episodes of light-headedness or hyperventilation.

Some students who are undergoing treatment take prescription medication to help control disturbing feelings, ideas and behaviour. This medication might cause side effects such as drowsiness, disorientation and lack of motivation. For many students who have mental health problems the stressful nature of participating in the learning situation itself will pose problems. This will be particularly so when undergoing formal assessment and when giving oral or group presentations. It is imperative to consult the student with sensitivity on issues that may cause stress.

Nearly everyone has times when they feel sad and lonely. Sometimes it can feel as if no one really likes us, that we are a failure, that we just upset people and that no one would care if we were dead. We may feel angry but unable to say so, or feel hopeless about the future. It is feelings like these that make some young people try to kill themselves. Often, several upsetting things have happened over a short time and one more upset or rejection is the 'last straw'. An argument with parents is a common example. Another is breaking up with a friend, or being in trouble. Young people who try to kill themselves are often trying to cope independently with very upset feelings or difficult problems for the first time. They don't know how to solve their problems or lack the support they need to cope with a big upset. They feel overwhelmed and see no other way out. At the time, many people just want their problems to disappear, and have no idea how to get help. They feel as if the only way out is to kill themselves.

Nowadays, it is common for hospitals to see young people who have tried to kill themselves because they have been feeling desperate and unhappy. In most cases the young person soon regrets it. Sometimes, they don't really want to die, but want to do something to show their distress and 'make people care'. Any attempt should always be taken very seriously. The young person needs someone to understand what he or she has been feeling, although they might find it hard to put into words. They need someone to give constructive help.

Suicide is rarely a spur of the moment decision. In the days and hours before people kill themselves, there are usually clues and warning signs. The strongest and most disturbing signs are verbal "I can't go on," "Nothing matters any more" or even "I'm thinking of ending it all." Such remarks should always be taken seriously.

Other common warning signs include:

• Becoming depressed or withdrawn
• Behaving recklessly
• Getting affairs in order and giving away valued possessions
• Showing a marked change in behaviour, attitudes or appearance
• Abusing drugs or alcohol
• Suffering a major loss or life change

The following list gives more examples, all of which can be signs that somebody is contemplating suicide. Of course, in most cases these situations do not lead to suicide. Generally, the more signs a person displays, the higher the risk of suicide.

• Family history of suicide or violence
• Sexual or physical abuse
• Death of a close friend or family member
• Divorce or separation, ending a relationship
• Failing academic performance, impending exams, exam results
• Job loss, problems at work
• Impending legal action
• Recent imprisonment or upcoming release

• Crying
• Fighting
• Breaking the law
• Impulsiveness
• Self-mutilation
• Writing about death and suicide
• Previous suicidal behaviour
• Extremes of behaviour
• Changes in behaviour

• Lack of energy
• Disturbed sleep patterns - sleeping too much or too little
• Loss of appetite
• Sudden weight gain or loss
• Increase in minor illnesses
• Change of sexual interest
• Sudden change in appearance
• Lack of interest in appearance

• Thoughts of suicide
• Loneliness - lack of support from family and friends
• Rejection
• Deep sadness or guilt
• Unable to see beyond a narrow focus
• Daydreaming
• Anxiety and stress
• Helplessness
• Loss of self-worth

There are three main groups:

• In about 1 in 5 cases, the young person will have shown no previous sign of emotional or behavioural difficulties. They are upset by common problems with friends or parents, under stress from exams, or have suffered rejection or bereavement. If the young person is able to talk about their problems and get help, they are unlikely to repeat the attempt.
• In about 3 in 5 cases, the young person has been showing signs of emotional or behavioural problems for months before the attempt, and has not been able to find help. These young people usually need specialist help such as counselling or psychiatric treatment for depression or other mental health problems.
• In about 1 in 5 cases, the person has had serious problems (e.g. with the police, their family, school, college or university) for a long time. These are the young people who are most at risk of further attempts. Some will already be seeing a counsellor, psychiatrist or social worker. Others have refused normal forms of help and appear to be trying to run away from their problems. Some seek an escape through drugs or alcohol. Young people who are misusing drugs or alcohol have the highest risk of death by suicide.

In recent years there has been a lot of research into the incidence of suicide among gay and lesbian people. The findings of these studies have not been consistent, but most researchers do agree on one point - gay and lesbian people are at far higher risk of suicide than people who are heterosexual. There are many reasons for this. One is that homosexual activity is illegal or considered wrong in many countries, and this can cause gay and lesbian people to feel isolated and become depressed.

It is important to remember, though, that there are millions of gay and lesbian people all over the world, living happy and fulfilled lives. Many have felt depressed at some time but have come through their difficulties. People who are gay or lesbian can find it helpful to talk to someone about their sexuality and feelings. This is particularly true for young gay and lesbian people, and for people who are isolated and do not have gay and lesbian friends.

Bullying can happen to anyone at any age, in any walk of life. It is, unfortunately, very common. Not all bullies use physical violence - bullying can be name-calling, sarcasm, being put down or even being ignored. Whatever form the bullying takes, it can have a devastating effect upon a person's life.

People who are being bullied can find it helpful to talk to someone about the situation, particularly where bullying has left them feeling isolated, unconfident and helpless.

Bullied children can feel frightened and alone. They may not feel they can tell school friends or a teacher, and most children have few, if any friends outside their school. Bullied children may also find it difficult to talk to parents and family about the situation. This may be because they fear being branded a tale-tell; or perhaps they fear that their concerns will either not be taken seriously or will cause anxiety to those they care about. Bullied children may also worry that the bully may be confronted against their wishes, and that the situation may worsen.

Bullying in the workplace is not always obvious. It can occur through a series of small incidents, where a person is perhaps undermined, belittled, patronised or criticised. When taken in isolation each incident may seem trivial so, often, this behaviour is not recognised as bullying and is accepted as "normal".

However, bullying can damage a person's health and self-esteem, affecting their happiness and performance both inside and outside the workplace. The bullied person may not feel confident enough to deal with the situation within the workplace, or may fear that he or she is risking his or her job by doing so. Colleagues may seem unsupportive or too afraid themselves to speak out.

If someone is feeling depressed or suicidal, our first response is to try to help. We offer advice, share our own experiences, and try to find solutions. We'd do better to be quiet and listen. People who feel suicidal don't want answers or solutions. They want a safe place to express their fears and anxieties, to be themselves.

Listening - really listening - is not easy. We must control the urge to say something, to make a comment, add to a story or offer advice. We need to listen not just to the facts that the person is telling us but to the feelings that lie behind them. We need to understand things from their perspective, not ours.

Here are some points to remember if you are helping a person who feels suicidal.

• Someone to listen - Someone who will take time to really listen to them. Someone who won't judge, or give advice or opinions, but will give their undivided attention.
• Someone to trust - Someone who will respect them and won't try to take charge. Someone who will treat everything in complete confidence.
• Someone to care - Someone, who will make him or herself available, put the person at ease and speaks calmly. Someone, who will reassure, accepts and believes.

• To be alone - Rejection can make the problem seem ten times worse. Having someone to turn to makes all the difference. Just listen.
• To be advised - Lectures don't help. Neither does a suggestion to "cheer up", or an easy assurance that "everything will be okay." Don't analyse, compare, categorise or criticise. Just listen.
• To be interrogated - Don't change the subject, don't pity or patronise. Talking about feelings is difficult. People who feel suicidal don't want to be rushed or put on the defensive. Just listen.

Notice when your loved one seems upset, withdrawn or irritable. Encourage them to talk about their worries. Show them you care by listening and helping them to find their own solutions to problems. Buy blister packs of drugs in small amounts. This helps prevent impulsive suicides after a row or upset. Getting pills out of a blister pack takes longer than swallowing them straight from a bottle. It may be long enough to make someone stop and think about what they are doing.

Everyone who has tried to kill themselves or taken an overdose needs an urgent assessment by a doctor as soon as possible even if they look OK. The harmful effects can sometimes be delayed. Even small amounts of some medication can be fatal.

All young people who attempt suicide or harm themselves should have a specialist mental health assessment before leaving the hospital. The aim is to discover the causes of the problems and to prevent repetition. This makes it easier to understand the background to what has happened, and to work out together whether help is needed after the young person leaves hospital.

Treatment can make all the difference. A lot of young people make another attempt if they do not receive the help they need. Usually, treatment will involve individual or family work for a small number of sessions. A very small number of young people who try to kill themselves really do still want to die. Often, they are suffering from depression or another treatable mental health problem. They may need specialist help over a longer period of time.

The World Health Organisation (WHO) estimated that in the year 2000 approximately one million people would die from suicide. A global mortality rate of 16 per 100,000. One death every 40 seconds. The WHO further reports that:

• In the last 45 years suicide rates have increased by 60% world-wide. Suicide is now among the three leading causes of death among those aged 15-44 (both sexes). Suicide attempts are up to 20 times more frequent than completed suicides.
• Although suicide rates have traditionally been highest among elderly males, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of all countries.
• Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide. However, suicide results from many complex sociocultural factors and is more likely to occur during periods of socioeconomic, family and individual crisis (e.g. loss of a loved one, employment).

We are born with the ability to take our own lives. Each year a million people make that choice. Even in societies where suicide is illegal or taboo, people still kill themselves. For many people who feel suicidal, there seems to be no other way out. Death describes their world at that moment and the strength of their suicidal feelings should not be under-estimated - they are real and powerful and immediate. There are no magic cures.

It is also true that suicide is often a permanent solution to a temporary problem. When we are depressed, we tend to see things through the very narrow perspective of the present moment. A week or a month later, things may look completely different. Most people who once thought about killing themselves are now glad to be alive. They say they didn't want to end their lives - they just wanted to stop the pain. The most important step is to talk to someone. People who feel suicidal should not try to cope alone. They should seek help now.

Organisations which can help:

• Department of Health, Richmond House, 79 Whitehall, London, SW1A 2NL, United Kingdom. Tel: + 44 (0) 20 7210 4850 (10am - 12.30pm and 2pm - 5pm Monday to Friday). Minicom: + 44 (0) 20 7210 5025. Email: dhmail@doh.gsi.gov.uk Website: Department of Health Produces a series of booklets which offer additional general information about mental health problems and ways of finding help, including 'Mental Health: A Better Understanding' (available in various languages). For free copies of these booklets call the Health Literature line on + 44 (0) 800 555777.
• Department of Work and Pensions. Provides information about benefits and social security issues. The Benefits Enquiry Line on + 44 (0) 800 882200 provides free information about the benefits you are entitled to. Freeline Social Security on + 44 (0) 800 666555 provides free information on social security issues. Website: Department Of Social Security
• Health Service Ombudsman, 11th Floor, Millbank Tower, Millbank, London SW1 4QP, United Kingdom. Tel: + 44 (0) 845 0154033. Website: Health Service Ombudsman Investigates complaints about failures in the National Health Service.
• Mental Health Act Commission (England and Wales), 2nd Floor, Maid Marian House, 56 Hounds Gate, Nottingham NG1 6BG, United Kingdom. Tel: + 44 (0) 115 943 7100. Website: Mental Health Act Commission Investigates complaints about treatment from anyone who has been detained under the Mental Health Act.
• The Mental Health Foundation, 7th Floor, 83 Victoria Street, London SW1H 0HW, United Kingdom. Tel: + 44 (0) 20 7802 0300. Website: Mental Health Foundation Undertakes ground-breaking research into mental health issues and provides a number of information services including a dial and listen service on + 44 (0) 8456 10 50 50 and Connects, the Mental Health and Learning Disabilities Portal. Runs the Crisis initiative which is helping to develop alternatives to hospital for people in a mental health crisis, with an emphasis on developing the contribution of the voluntary and user sectors, and improve partnership working.
• Mental Welfare Commission for Scotland, K Floor, Argyll House, 3 Lady Lawson Street, Edinburgh, EH3 9SH, United Kingdom. Tel: + 44 (0) 131 222 6111. Website: Mental Welfare Commission for Scotland Investigates complaints about treatment from anyone who has been detained under the Mental Health (Scotland) Act 1984.
• Mind, Granta House, 15-19 Broadway, London E15 4BQ, United Kingdom. Tel: + 44 (0) 20 8519 2122. Mind Information Line: + 44 (0) 20 8522 1728 if you live in Greater London or + 44 (0) 8457 660 163 if you live elsewhere (9.15am-4.45pm Mon, Wed & Thur). Email: contact@mind.org.uk Website: Mind Covers all aspects of mental health including legal matters for service users, carers, family and friends, researchers, students, service providers and the public.
• National Association of Citizens Advice Bureaux. Tel: + 44 (0) 20 7833 2181. Website: National Association of Citizens Advice Bureaux Gives information and advice about benefits, debt problems, legal issues and local services.
• NHS Direct, Tel: + 44 (0) 845 4647. Website: NHS Direct A 24 hour nurse-led telephone advice and information service, part of the National Health Service.
• Northern Ireland Association for Mental Health, 80 University Street, Belfast BT7 1HE, United Kingdom. Tel: + 44 (0) 1232 328 474, Email: anne.niamh@dnet.co.uk. Voluntary organisation providing services for people with mental health needs, including residential, day care, counselling, information, education and training. Range of information on mental health service provision, treatment, use and research issues.
• Patients Charter, Freepost NEA959, Wetherby, West Yorkshire, LS23 6YY, United Kingdom. Tel: + 44 (0) 800 555777. Provides free copies of the Patient's Charter. Please see 'Your Guide to the NHS' if you live in England.
• Rethink, Head Office, 30 Tabernacle Street, London EC2A 4DD, United Kingdom. Tel: + 44 (0) 20 7330 9100/01 (Office). Email: info@rethink.org National Advice Line Tel: + 44 (0) 20 8974 6814 (open between 10am and 3pm Monday to Friday) Email: advice@rethink.org Website: Rethink Rethink is the new operating name for the National Schizophrenia Fellowship. They exist to improve the lives of everyone affected by schizophrenia and other severe mental illnesses by providing quality support, services and information and by influencing local, regional and national policies.
• SANE, 1st Floor, Cityside House, 40 Adler Street, London E1 1EE, United Kingdom. Saneline: + 44 (0) 845 767 8000 (open from 12 noon until 2am every day of the year) National helpline, calls charged at local rate. Website: Sane Gives information and support to anyone coping with mental illness.
• Scottish Association for Mental Health, Cumbrae House, 15 Carlton Court, Glasgow G5 9JP, United Kingdom. Tel: + 44 (0) 141 568 7000 (11.30am-4.30pm Mon-Fri) Email: enquire@samh.org.uk Website: Scottish Association for Mental Health Campaigns and provides services for people with mental health problems. Publications and "Know your Rights" leaflet available.

Your GP, health centre, pharmacist and practice nurse can also be of help.