Tailored mental health approach may be what HE students need

Attending lectures and focusing on his books should have been easy. Levian had done it throughout his first year. But, when he returned to campus for his second year in 2021 after a break of more than a year – induced by the coronavirus – things were not the same.

“I could not concentrate, even on the simplest of tasks,” said the student of mathematics at Mbarara University of Science and Technology in Uganda. “I had headaches. My head felt heavier and crowded. I was distressed. Suddenly, I didn’t want to go to class.”

Levian, who preferred anonymity, went to the hospital. Doctors said he was depressed and prescribed antidepressants.

But experts say a new mental health approach may be just what Levian and many other students in African higher education institutions (HEIs) who are battling depression and anxiety issues need.

Stepped Care draws inspiration from the World Health Organization’s tools to manage mental health, such as Problem Management Plus and Self Help Plus and customises them to fit individual learner needs. Initially, the approach encourages students to eat a balanced diet, sleep seven to eight hours a night, meditate and participate in 30 minutes of moderate to vigorous physical activity per day to stop worry, anxiety and stress.

Then, it engages the learners in peer-to-peer programmes and off-campus referrals where they learn several psychosocial skills such as deep breathing, self-awareness and empathy and how to break big problems into smaller ones (so they do not seem overwhelming) and stay motivated. It supports students who are facing challenges to talk to family and friends or other trusted peer mentors so they can be helped or ‘stepped up’ to more intensive services.

Intensity of support differs

“You can say Stepped Care is a tailored approach to mental health,” said Adam Brown, who designed the approach. Brown is an associate professor of psychology and vice provost for research at the New School for Social Research, New York City. “It assumes that every student needs support, but not every student will need the same intensity of support for the kind of challenges they are experiencing.”

As the prevalence of students who are battling mental health issues continues to rise, experts believe the intervention can be a game-changer, especially in Africa, where many HEIs lack resources and services to help learners who need care. The programme trains personnel who are not psychologists or mental health specialists in basic psychosocial skills to support students dealing with mental issues.

“The idea is that these persons — who include students — will then pass on these skills to more persons and bridge this gap (of inadequate mental health services) in HE communities,” Brown said in an interview with University World News. “This also creates a group of people who are knowledgeable about mental health in our HEIs and can support learners who need care.”

According to Brown, “Stepped Care aims at creating higher education environments where students are fully aware of mental health — what it is, its triggers and symptoms — and can freely talk about it,” he said.

“When students are aware of mental health and can freely talk about it, they are more likely to seek help or refer fellow students with symptoms to care. This can reduce the stigma associated with mental health, increase the quality of life and help students to develop coping mechanisms and heal faster.”

Concern about the situation in Africa

So far, Brown and others have implemented the strategy at the New School for Social Research and at Bard and Vassar Colleges in the USA. They are piloting the intervention in central Asia and are seeking partners in Africa.

As in much of the world, mental health difficulties among higher education students in Africa were on the rise even before COVID-19. The pandemic only intensified the uncertainty.

For instance, a 2016 study among students (a sample of 1,337) in South African HEIs showed that 12% experience moderate to severe symptoms of depression, while 15% have moderate to severe symptoms of anxiety and 24% report suicidal ideation.

A study conducted in 2020 among 1,135 undergraduate students in Ethiopia showed that at least three in every 10 were battling some form of mental distress.

The same tendency was found in Kenya. The global Mental Health Innovation Network reported high levels of depression and anxiety among HE students, especially from poorer backgrounds.

Joseph Musalo, a counselling psychologist at Uganda Christian University, said many students are worried about their academics — whether they will pass or not and whether they will get jobs after university.

“They are stressed over financial challenges,” said the psychologist. “And others are fighting challenges related to social connection and cohesion.” Unfortunately, several HEIs in Africa do not have adequate personnel and resources to help the students.

Lack of resources at HEIs a barrier

“Many of them don’t have functional counselling departments that can help students,” said Musalo. “There is a lack of awareness and accurate information about mental illnesses. People here still relate mental health to witchcraft and call persons with mental issues names such as ‘haywire’. There is stigma.

“All this stops students who need care from coming out,” Musalo said. “So, when students can’t sleep or are depressed and can’t focus, rather than seek help, they resort to alcohol and drug abuse.”

But alcohol never solves anything. Instead, it worsens things.

As a result, Musalo said, anxiety, depression, and substance use have been associated with poor student scores and dropout rates in African HEIs, while suicide has become the second-leading cause of death among college-age students.

However, Stepped Care can help. The approach does not only equip students with essential psychosocial skills to solve complex challenges and lessen stress and anxiety, but it also encourages supportive relationships among students, as does the ‘Mindful Living Movement’ [a Canadian wellness programme] and ‘To Write Love on Her Arms’ [a US non-profit organisation].

Stepped Care helps students to take charge of their mental health, Brown said. And it is cost-effective.

Mental sharpness also gets a boost

It integrates with existing education structures to give educators and staff sustainable models to support students with mental health issues. The approach would help African HEIs that lack adequate resources to train staff and students in simple psychosocial skills to support learners with mental health issues and subsidise the cost of mental health services.

Musalo said the programme could help the institutions to develop mental health policies and integrate them into campus curriculums.

“We have been calling for mental health policies that can introduce students to mental health education in our universities. Such an intervention would help,” he said. Training HE students about mental health helps them to be better at detecting distress and to seek help and listen to people in pain and connect them to services. It also helps university leaders and academic staff to learn simple psychosocial skills to help students who need care.

Musalo said encouraging students to participate in physical activity does not only improve students’ mental health, but it also helps to improve their sharpness and stave off other non-communicable diseases such as hypertension and diabetes. Skills such as problem-solving, empathy and critical thinking can help students avert stress and anxiety.

But Brown said HEIs couldn’t just copy and paste the approach. “We have to think creatively how we can adapt it to different cultures and contexts to make it fit within their university environment because there may be things that work well in New York City but would have to be changed for Ethiopia or other countries.”

He said: “So, if we are to work with a college for instance, we might have to spend a couple of weeks first meeting with the administrators, staff, students and faculty to teach them about what we are trying to do. We might review the training with them. We will talk to them about who may be the best people to train on campus.” Training material might also be amended to adapt to the specific context and translated where necessary.