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Mental Health, Higher Education, and the Year Abroad: Challenges and Recommendations

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Anne-Charlotte Husson
School of Modern Languages, Newcastle University

Damien Hall
School of Modern Languages, Newcastle University

 ABSTRACT
In this article, after a brief discussion of the changing landscape around student mental health in universities, and the particular challenges that may be posed by a Year Abroad for language and cultural immersion, we present a series of mental health challenges arising from the Year Abroad, and make recommendations for overcoming them. We examine both issues that students may face when they are abroad, and the ways in which staff at universities can help those students. These challenges and recommendations arise from a workshop under this title which the authors led at Year Abroad Conference 2019.

KEYWORDS: Year Abroad, mental health, training, students, resources 

INTRODUCTION
In the UK, mental health has become part of everyday discourse, but also political and institutional discourses. It has recently been at the centre of many news items, often in relation to education. Following the deaths of eleven students by suicide, the University of Bristol launched in October 2018 an opt-in ‘Science of Happiness’ course, the first of its kind in the UK. Lighter news coverage includes the rise of therapy dogs on campus, whose job is to provide psychological support to students. Other recent, more systemic, responses to the issue have come from a variety of actors, from Universities UK’s Minding Our Future report (UUK 2018) and ‘#stepchange’ framework (UUK n.d.),[1] to Student Minds’ University Mental Health Charter (Hughes and Spanner 2019) and Co-Producing Mental Health Strategies with Students (Piper and Emmanuel 2019).

Student mental health has recently become a prevalent concern in British Higher Education Institutions (HEIs) and in the public sphere (even though there are debates around whether the prevalence of mental health difficulties among young people in HEIs is increasing, or whether difficulties that were always present are now simply more visible). The authors’ experience in the School of Modern Languages at Newcastle University suggests that the compulsory Year Abroad (YA) can be a particular cause of mental health difficulties for our students, or at least that it can bring out previously latent difficulties. This is why we proposed a workshop on mental health and the Year Abroad for the Year Abroad Conference 2019 (YAC2019). This article presents a series of recommendations for universities helping students to deal with these problems, based on workshopped reactions to case studies (which are given in the Appendix to this article).

Figures from Newcastle University certainly suggest that students’ use of university-provided healthcare is high. In calendar year 2019, 55% of YA students across all subjects were known to Student Health and Wellbeing Services; by the end of March 2020, three months into the year, 46% of YA students were already known to them. These figures include all areas of wellbeing, so not all students known to these services have mental health concerns; disaggregated figures are not available. Nevertheless, these overall figures do seem surprisingly high, and we do not think they are peculiar to Newcastle.

Wolff (2020) hopes to see in the 2020s ‘better student mental health care’ to answer ‘the need for more and speedier action’, while a survey conducted by an ‘emotional fitness app’ revealed that 95% of the students who were polled ‘want universities to teach them how to look after their mental health and wellbeing’ (Hall R. 2019). However, the idea that HEIs should include mental health care among their duties is not necessarily self-evident to the academics and others to whom students in difficulty turn for help. In generational terms, the students are often Generation Z, while HEI staff are usually millennials or older, not used to such a lot of help being available, and certainly unqualified to provide it. Most importantly, academic roles in the neoliberal university are in constant flux, as workloads keep increasing and duties evolving (UUK 2015, Piper and Emmanuel 2019). Academics often feel a lack of control regarding such changes, which they may not necessarily understand, accept, or keep up with. This feeling of lack of control and understanding can be a contributing factor to mental health difficulties for university staff themselves (Gill 2010, Berg and Gutzon 2016, Analogue University 2019). Anecdotal evidence in the authors’ own university suggests that such difficulties are more prevalent now than they were, and that the university is also taking more account of them (for example, by advertising a counselling service in staff lavatories).

MENTAL HEALTH AND THE YEAR ABROAD 
The authors have both taken part in administering the academic side of the compulsory YA in the School of Modern Languages at Newcastle (Husson as Year Abroad Officer responsible for our students in francophone countries; Hall in that role, and then as Year Abroad Director, with overall responsibility for all our students abroad).  Our experience certainly shows that the YA can bring out problems for students who, in a more familiar context, might have been able to cope with them better. We link this to reports of increasing mental health difficulties for young people in general, as discussed above. It is not that the YA itself is becoming harder, but students seem to be starting from a lower mental health base, as it were. If young people’s mental health is more often fragile in general, there are correspondingly more latent difficulties that the YA could bring out.

While we must be careful not to overgeneralise (because there are many students for whom the YA goes without a hitch), our intuition about increasing YA-related mental health problems was confirmed by attenders at YAC 2018. As a consequence, helping each individual student with their particular difficulty (because problems are rightly individual and require tailored solutions) is taking up more and more time. This is true not only for dedicated professional services such as Newcastle University’s Student Health and Wellbeing Service and its analogues in other HEIs (see the 2019 and 2020 Newcastle figures cited earlier, which seemed to indicate increased use of welfare services in 2020); it is also especially true for the lecturers and administrators who must administer the academic side of students’ YA, and who are often the first point of contact when life becomes difficult.

For this reason, we proposed for YAC 2019 a workshop on Mental Health and the Year Abroad, on the model of the excellent workshop ‘Managing Year Abroad Crises: lessons learned’ put on by Ian Foster and Edith Li Ross (U. Bristol) at YAC 2018. In our workshop, participants were asked to divide into four groups; each group was given a difficult YA student situation to consider (fictional, but based on real cases dealt with by the authors). Each situation included a general description followed by an escalation. The groups were asked to make two types of suggestion:

  • practical courses of action for the particular students in the fictional situations, and for those helping them (‘situational advice’)
  • more generic advice about institutional provisions that could be considered, to make YA administration more responsive to the increasing importance of mental health, and to make it easier not to ‘reinvent the wheel’ for each difficulty, while always bearing in mind the need to treat individual situations individually (‘procedural advice’).

In this article, therefore, we will set out and motivate a series of recommendations for good practice in dealing with mental health difficulties related to the YA. We have formulated these recommendations as a result of discussions at our YAC2019 workshop. In these recommendations, the procedural and situational points of view are integrated in order to put forward some general principles which we suggest should guide our view of the relationship between mental health and the YA. 

MENTAL HEALTH CHALLENGES AND THE MODERN YEAR ABROAD
Three main challenges emerge from the situations presented in the workshop (see appendices).

Challenge 1
HEI staff who deal with the YA (whether academic or administrative staff) are increasingly likely to be confronted with one mental health-related condition or another as part of dealing with students. As discussed above, there are challenges in the increasing quantity and range of mental health care needs among students; also, staff are not trained to respond to these needs. Although staff are not expected to act as mental health practitioners, their ability to leave mental health to the experts, so to speak, is increasingly challenged by the central role given to mental health in HE. For this reason, we chose to include anxiety, depression and self-harm, as well as autism, among the situations considered at our workshop. Mixed anxiety and depression is the most common disorder in the UK, ‘with 7.8% of people meeting criteria for diagnosis’ (Mental Health Foundation 2016). Self-harm in young adults is also highly prevalent (Bailey, Wright and Kemp 2017). Although autism is regarded not as a mental illness but as a developmental disorder, it often goes hand in hand with anxiety (White et al. 2009). It affects one in a hundred British adults.

Challenge 2
Concerns the relationships of care established between the student, the YA support officer(s) and the home university’s mental health and wellbeing team. Lees (2020) emphasises the necessity of a balanced relationship between YA students and university staff, in which students are actors in their own mental health care instead of merely passive; but it is also  crucial to note that relationships established in the home country can be challenged or overhauled while the student is abroad, which means that the basis of this balanced relationship can change after the student has left for their YA. Students who had been able to negotiate university life reasonably independently when studying in the UK can find that life abroad presents challenges that they do not feel prepared for, and thus they can come to contact staff from their home university much more when abroad than they did when they were at home, and to rely much more on these contacts. The difficulties they encounter can run from dealing with familiar situations but in a foreign language to dealing with situations they had never encountered in any language (e.g. because they had never had to live quite so independently, dealing with bills and so on).

All in all, when talking about mental health and the YA, context is crucial, and staff who know a student and are then ‘left at home’ when a student departs for their YA should be aware that there can be changes in the way the student perceives their relationship with staff, once the YA has begun. Staff should be aware that this shift in student perception of them may be likely (depending on what they know of a particular student from before their Year Abroad), and the challenge is then for staff to help students maintain the balance, encouraging them to be active partners in their own mental health care, while not denying them university help if appropriate.

Challenge 3
Is also linked to the context in which the YA is happening, this time from a cultural point of view. Not only do some students abroad find it difficult to deal with cultural differences, but if and when the need for mental health care arises, culture-infused perceptions of mental health and the availability of care can themselves become an issue.

All three challenges put a spotlight on the changing role of YA academic officers, YA administrative officers and personal tutors, and on the response they can put in place to potential crises. This is why we offer in what follows a series of recommendations which, we hope, will help to anticipate and address such issues. Our recommendations should therefore make possible quick and effective reactions to potential crisis situations, based on good practice.

PREPARING THE YEAR ABROAD 
What students can and cannot prepare for
One popular wellbeing tool among mental health professionals, which has spread more widely to the wellbeing community, is the formulation of a ‘self-care plan’. This is a process which the academic YA officer is not qualified to guide; student wellbeing services are of course much better suited to this, though YA officers can of course assist. For young people presenting a history of mental health issues, a self-care plan may figure in the strategies they put in place before leaving for their YA (with or without the university’s knowledge), strategies on which they are expected to rely once on their YA. Here is how the charity Mindful describes the self-care plan in its magazine:

A Self-Care Plan is an intervention tool that keeps you from being completely sucked into the vortex, saving you when you find yourself standing on the precipice gazing into the dark abyss. It’s a fail-safe, created by you, and filled with your favorite self-care activities, important reminders, and ways to activate your self-care community.
(Tygielski 2019)

The rationale of the plan is therefore that it is a pre-made set of tools for moments of crisis. Taken at face value, this seems like an excellent way to help students become fully actors in their own care, instead of merely being on the receiving end of help from others. Such a shift is recommended by Lees (2020), who observed that post-YA students whose mental health made for a difficult experience abroad tended to blame their home institution, whereas students who reported a positive experience saw this as a personal success. However, planning for a mental health crisis cannot really take context into account, especially when it comes to the reality of life abroad, because the context might well be unknown in advance. In other words, the context in which the crisis emerges is key. Relying on a strategy framed as a ‘failsafe’ might compromise the student’s ability to adapt to a new context, unless this strategy is regularly updated during the YA.

Recommendation #1: When preparing for the YA, students who present a history of mental health issues should be aware of the unpredictability of living abroad. Where wellbeing support is offered by the university, YA officers may want to work with such services in order to determine how to strike the right balance between alarmism and realism, and if necessary to adapt such discourses to individual situations by providing specific examples or advice.

Cultural contexts
The cultural context of the YA is crucial. (We define culture and cultural informally here, as ‘(relating to) a set of distinct social norms, which may be associated with a particular country, nation, or sub-national group’.) Discourses around mental health vary considerably between countries and cultures, as does the availability of mental health provision. While most UK home students are used to mental health being a normal part of everyday discourse, including in HEIs, they are often not aware of cultural differences in this respect.

 Recommendation #2: Students should be made aware that attitudes to mental health difficulties differ around the world—especially students going to regions where mental health remains mostly taboo, such as the Arab world or East Asia. More importantly, cultural differences with regard to mental health should be discussed in detail with every student declaring a history of mental health issues. Although planning for medical care provision is important, it should always be done with an awareness of the general discourse around mental health in the foreign country in question.

Recommendation #3: Not all YA officers might have current, specific knowledge on this topic. One way to remedy this would be to include culture-specific knowledge in the training provided to all YA officers (see also recommendation #4). This could be done through the provision of culture-specific situations, like the ones in the Appendix to this article, for new YA officers to work through as training for the role.
THE ROLE OF THE YEAR ABROAD ACADEMIC OFFICER 
The need for a well-defined, stable role
Recommendation #4: is that it is crucial for a YA officer to be able to take on the role for a reasonable period of time - say, at least three years. This might be a difficult recommendation to implement, and it is certainly a recurring issue at Newcastle when it comes to academic officers, although stability can often be provided by support staff. Beyond the recurring problem of the amount of information that a new officer has to learn, we believe that a stable, well-defined role can have a positive impact in at least three ways.

Benefits of long-term investment in the role
It is crucial for a YA officer to be able to invest themselves fully in the role, which takes time - precious workload time, but also, simply, the time needed to develop expert knowledge regarding the YA in a specific country. The need for stability is exemplified below by the transmission of knowledge regarding previous cases, which should constitute an essential part of the training of new YA officers. It is also crucial with regard to the relations established with partner institutions. Here at Newcastle University, the YA officer responsible for students going to China has been in that role for 20 years, and has thus been able to establish personal relations with a variety of actors in China, as well as a list of possible mental health professionals for students seeking help. This has proven essential in a country where mental illness is very stigmatised and universities might not offer any support.

The need for a well-defined role
Another aspect of this recommendation is one we are working on at Newcastle: the need to provide a full, clear description of the role of YA officer within their academic unit. This is less easy than it sounds, and one major reason is the way mental health issues tend to blur the lines between academic, pastoral, and medical support within the university. What is more, the YA officer role has grown ‘organically’ in the past few years, and now concerns many issues including mental health. It is tempting to say this is because of the evolving needs and expectations of students. Therefore, not only would a clear definition help new YA officers learn about their role, but it would also enable them to maintain clear professional and personal boundaries when student mental health issues arise.

Personal boundaries
The expansion of the YA officer role also has an impact on personal boundaries and the emotional investment which can be put into this work. Although academics are always strongly encouraged to leave mental health matters to the experts, it is not necessarily easy or possible to do so when you fear for the safety of a young person who is suicidal, or more generally when you are aware of the difficult circumstances of someone you feel in charge of. If a YA officer knows their exact place within a network of support, and has a clear sense of what their role does and does not entail, it could help preserve their own mental health.

The YA officer, one actor within a diverse support network
Recommendation #5: When it comes to mental health and wellbeing, the YA officer is necessarily one link in a long chain spanning home, visited country, partner academic institutions and YA employers, and involving administrative and academic staff, as well as in- or sometimes out-of-university wellbeing professionals. Besides knowing their role within this chain (recommendation #4), YA officers should when possible maintain direct relations with other actors in the possible mental health care chain in their regions of responsibility. Most importantly, they should keep up personal relations with actors based in partner institutions.

This implies knowledge of what kind of support is available to students abroad - an aspect that should be covered in prior training (see recommendation #6). The British Council, for instance, is able to offer very limited direct support for their language assistants. As for partner universities, support varies widely according to institutions and countries. While some limited support can be available in some European partner universities, this is not the case for instance in many Chinese universities, where mental illness is strongly stigmatised. As mentioned before, it is possible for a YA officer for China to find local help and build an address book over the years. Such relations might need to exclude some Chinese partner universities, who may not accept students with a history of mental health issues.

The network of support around students doing their YA should never, in our opinion, include other students. Emotional peer support while on the YA has proven to have possibly deleterious consequences for the mental health of those students supporting a peer. However, we do recommend facilitating informal contact among students already abroad, among students preparing to go, and between these two groups. Microsoft Teams is one useful tool to enable such contacts while preventing users’ data from being sold to third parties. The YA team at Newcastle University’s School of Modern Languages facilitates a Teams group which links students preparing for their YA, and one which links these students with students preparing for their YA; staff only intervene, however, if a question remains unanswered or to correct erroneous information.

Training for YA officers
Recommendation #6:    Participants in the workshop emphasised the need for basic mental health training for new YA officers. Although academics may have to deal with mental health-related issues in a variety of roles, including that of personal tutor, the YA presents its own set of issues. Distance, in particular, changes pastoral care in possibly challenging ways. We want to make it clear here that, if a student is having mental health difficulties, appropriate professionals in student health services should guide the care of that student as much as possible and as soon as possible. Academics and university administrative staff arguably already have too great a workload, and it is much more varied than ‘what they signed up for’. However, it emerges from everything that precedes, that academics and administrative staff in students’ home universities are often the first point of contact when a student is in difficulty. At a very basic level, therefore, these people, who are not mental health professionals, need to know what to say when that phone-call or e-mail arrives. Furthermore, since the YA is a very specific academic situation, it is almost always true that there are aspects of it where only the academic or administrative staff dealing with a student’s degree can advise, and therefore it is these staff who will be asked for advice, not the mental health professionals. University-based mental health practitioners simply do not have the requisite knowledge of the YA, from either an academic or a practical point of view.

Our YAC 2019 workshop could serve as a basis for the basic mental health training that YA officers need, provided that mental health specialists can contribute to the workshop. The training should at least include:

  • legal requirements regarding confidentiality
  • templates based on previous cases (see Appendix)
  • culture-specific knowledge of mental health discourse and provision in the assigned country or countries
  • knowledge of who to contact for help within the home university, as well as available resources concerning disability, counselling, and international relations.

 

THE ROLE OF THE YEAR ABROAD IN THE DEGREE 
Recommendation #7:  Our last recommendation might also be the most controversial. It concerns the role granted by the unit/institution to the YA in a given degree. We suggest that, for students in real difficulty, the YA should not always be compulsory, even in Modern Languages degrees where it is woven into the very fabric of the degree.

We have come to this recommendation because, in the case of many students like Carys (situation 5 in the Appendix) or Kate (situation 4), the question of fitness to undertake a YA, and/or to study at all, arises. It can be very difficult to deal with students’ perceptions of such situations - for example, Carys resents what she perceives as attempts to bar her from doing a YA, yet ends up self-harming in China. For a student like Kate, who found herself paralysed by anxiety, unable to do any paperwork, and therefore having to suspend her studies for a year, the question should also be asked whether a YA is the best option for her.

Many factors are involved here, including the home institution’s safety and liability requirements. We want to emphasise that no student should be barred from doing their YA simply because of a history of mental illness; in any case, this would implicate too many students nowadays. However, at Newcastle, we have chosen to offer the possibility of a 3-year instead of 4-year pathway for all our Modern Languages degrees. In the School of Modern Languages the YA is usually compulsory, and this is made clear from the outset. However, if a student’s mental or physical health in the year before their YA is such that a YA would be harmful, risky or extremely impractical, the Personal Extenuating Circumstances Committee can agree to a request to skip the YA and go straight to final year. This change of degree is permitted if medical and/or psychological evidence is satisfactory. The option was requested, for instance, by a survivor of sexual assault whose care team argued that a YA would set her back in her recovery (needless to say, the PEC Committee agreed).

CONCLUSION
Looking at the advice suggested for all YA mental-health situations considered at the workshop, it is apparent that good practice involves both addressing each problematic situation individually, and having in place a set of procedures making fast, efficient decisions easier. Obviously, administrative procedures are always partly based on situations that have occurred, and the need to react to them. But procedures should only be partly based on exact situations, since anything that follows a particular situation too closely will be less useful for other situations that are similar but different.

Although focussed solely on mental health, we hope these recommendations will help HEIs put into place better frameworks for the YA, and help YA officers in performing this challenging and constantly-evolving role.

Addresses for correspondence: achusson@gmail.com, damien.hall@newcastle.ac.uk

REFERENCES

Analogue University (The). 2019. Correlation in the Data University. ACME: An International Journal for Critical Geographies. 18(6), pp.1184-1206.

Bailey, D., Wright, N. and Kemp, L. 2017. Self-harm in young people: a challenge for general practice. British Journal of General Practice. 67, pp.542-543.

Berg, H. and Gutzon, L. 2016. Producing Anxiety in the Neoliberal University. The Canadian Geographer / Le Géographe canadien. 60(2), pp.168-180.

Gill, R. 2010. Breaking the Silence: The Hidden Injuries of the Neoliberal University. In: Ryan-Flood, R. ed. Secrecy and Silence in the Research Process: Feminist Reflections. London: Routledge, pp.228-244.

Hall, R. 2019. Teach us how to look after our mental health, say university students. The Guardian. [Online]. 3 October. [Accessed 28 February 2020]. Available from: https://www.theguardian.com/education/2019/oct/03/teach-us-how-to-look-after-our-mental-health-say-university-students

Hughes, G. and Spanner, L. 2019. The University Mental Health Charter. [Online]. [Accessed 28 February 2020]. Available from: https://www.studentminds.org.uk/charter.html

Lees, D. 2020. An examination of student experiences of wellbeing during the Year Abroad. In: Salin, S., Hall, D. and Hampton, C. eds. Perspectives on the Year Abroad: a selection of papers from YAC2018. Voillans: research-publishing.net, pp.11-21.

Mental Health Foundation (The). 2016. Fundamental Facts about mental health 2016. [Online]. [Accessed 28 February 2020]. Available from: https://www.mentalhealth.org.uk/publications/fundamental-facts-about-mental-health-2016

Piper, R. and Emmanuel, T. 2019. Co-producing Mental Health Strategies with Students: A Guide for the Higher Education Sector. [Online]. Student Minds. [Accessed 28 February 2020]. Available from: https://www.studentminds.org.uk/uploads/3/7/8/4/3784584/cpdn_document_artwork.pdf

Tygielski, S. 2019. Why you need a self-care plan. Mindful. [Online]. 20 February 2019. [Accessed 24 July 2020]. Available from: https://www.mindful.org/why-you-need-a-self-care-plan/

Universities UK. 2015. Student mental wellbeing in higher education: good practice guide. [Online]. [Accessed 28 February 2020]. Available from: https://www.universitiesuk.ac.uk/policy-and-analysis/reports/Documents/2015/student-mental-wellbeing-in-he.pdf

Universities UK. 2018. Minding Our Future. Starting a conversation about the support of student mental health. [Online]. [Accessed 28 February 2020]. Available from: https://www.universitiesuk.ac.uk/policy-and-analysis/reports/Documents/2018/minding-our-future-starting-conversation-student-mental-health.pdf

Universities UK. 2020. Stepchange: Mentally Healthy Universities. [Online]. [Accessed 24 July 2020]. Available from: https://www.universitiesuk.ac.uk/stepchange-mhu

Universities UK. n.d. #stepchange: Mental Health in Higher Education.  [Online]. [Accessed 28 February 2020]. Available from: https://www.universitiesuk.ac.uk/stepchange

White, S., Oswald, D., Ollendick, T. and Scahill, L. 2009. Anxiety in children and adolescents with autism spectrum disorders. Clinical psychology review. 29(3), pp.216–229.

Wolff, Jonathan. 2020. In the 2020s, universities need to step up as a central pillar of civil society. The Guardian. [Online]. 7 January. [Accessed 28 February 2020]. Available from: https://www.theguardian.com/education/2020/jan/07/2020s-universities-need-to-step-up-central-pillar-civil-society
 

APPENDIX
Situations presented to the groups

Situation 1: Maya, France
Maya is in the second year of her degree in French. As Year Abroad officer for francophone countries, you are aware that she is on the autism spectrum. More precisely, she has Asperger syndrome, which means that she has difficulties with social interactions and nonverbal cues, and suffers from considerable anxiety.

Maya comes to see you early in semester 1 to express her concerns regarding her Year Abroad. She is particularly worried that she might need to go home suddenly to Darlington (in the North of England, not particularly easy to get to from France), and that she might be too isolated in France, without her usual support network.

Your university offers 3 types of placements: study, work, and British Council assistantship. Maya would like to teach in a French school, but is reluctant to choose a BC assistantship, because she is aware that she would not necessarily have a choice about the size of town she was based in.

Escalation: It is now April. Maya had found a work placement in a private school but it has fallen through. She is now panicking. She has a mental health advisor from Student Services, who has been following her since her first year. This advisor is concerned about Maya’s wellbeing and would like to organise a three-way meeting to help her.

 

Situation 2: Alberto, Brazilian student in the UK
You are your School’s YA Officer responsible for Latin America. Alberto is a student from one of your Brazilian partner universities, spending a whole year at your university. He had no problems until at least the end of Semester 1, but, in early April, your YA administrative team e-mails you to say that he has not been attending lectures for a few weeks. They have written him a couple of e-mails about it, but he has not answered. You therefore schedule a meeting between you and Alberto to discuss the situation, and you let him know, but he does not reply and does not turn up. You reschedule the meeting and let Alberto know, but he still does not answer and does not come to the rescheduled meeting.

Escalation: Since the events above, the Easter vacation has passed. As there has been no word from Alberto at all, you have written to his home university asking whether they know anything, and they have replied that, as far as they know, he should be at your institution.

 

Situation 3: Nick, Germany
Nick is a student preparing to go to Düsseldorf for a semester-long work placement. He has a history of mental health problems, and has occasionally self-harmed in the past. He has been helped by your university’s Student Health and Wellbeing Services. Now, he is anxious about his Year Abroad, and you and Student Services are worried that this anxiety may cause him to self-harm again. You are going to have a three-way meeting (Nick, you and Student Services), specifically to discuss his Year Abroad.

Escalation: Nick is now in Düsseldorf, and the first few weeks of his placement seemed to go well, but he has now started to self-harm fairly regularly. His employer has come to know about it, and has been very supportive. Nick himself is also in touch with you occasionally, but is still in Germany.

 

Situation 4: Kate, Spain
You are your School’s YA administrator for outgoing students. Kate, a very introverted, non-communicative student, is registered as doing a Year Abroad at the University of Salamanca (Spain). She has not filled in any paperwork regarding the YA and there has been no contact over the summer, despite multiple reminders from you. You are trying to find out whether Kate has actually gone to Spain at all. Nothing had been flagged previously.

On the 20th of October, you finally receive an email from Kate, informing you that she is still at home and hasn’t prepared any of the necessary paperwork for the YA. She asks your advice on how to proceed. She doesn’t give any further explanation.

Escalation: You have replied to Kate, asking for further information as to why she is still at home, as the YA team had been unaware of any specific issues (beyond knowing what Kate is like generally). Kate replies that she has been feeling very anxious about the YA for the last year and has found the application process so confusing and stressful that she avoided doing it. She also explains that she had felt so overwhelmed at the prospect of living abroad that she hadn’t wanted to seek help.

 

Situation 5: Carys, China
You are your School’s YA Officer responsible for China. Carys is a student preparing to go to China for a year of study, who has declared that she has a long-standing diagnosis of anxiety and depression. In China, there is little easily-available mental health care, which is of course not the situation Carys is used to in the West. Because of this, you call a three-way meeting between Student Services, Carys and yourself, to discuss how we can make sure that her Year Abroad goes as well as possible. Carys is very reluctant to engage with these attempts to help, though; she comes to the meeting, but is resentful because she feels that the university is trying to stop her having the same experiences as everyone else. She does not feel that counselling has helped her in the past.

Escalation: After the meeting with Carys, you have written to her with some advice about things she could do if she did start to feel bad in China, and also with some details about professionals who are available to talk to there (not on the scale of the West, but something as opposed to nothing). Carys has agreed to the conditions in your letter, including regular e-mail check-ins with people at your university, and letting you know by certain deadlines that she has got details of the emergency care services she could use in China. However, two of Carys’ fellow students in China have got in touch to say that she has self-harmed while there, and has told them about it.

[1] Revised in May 2020 and republished as Stepchange: Mentally Healthy Universities (UUK 2020).