HE needs to safeguard international student mental health

The social, political and educational decisions made during the COVID-19 pandemic have had repercussions on international students’ mental health. As higher education returns to ‘business as usual’, it is time to revisit its duty of care to these students. Learnings from the pandemic period must inform strategies to support international student well-being as they re-engage with their studies in their chosen host country.

The pandemic and university student mental health

The constant change and uncertainty experienced by higher education students during the pandemic have had a significant impact on university student mental health. ‘Alarming’ levels of anxiety and stress have been reported, with mental health crisis helplines receiving a significant rise in calls from university students.

Despite pre-pandemic reports of disproportionately high levels of mental health issues among international students, research within this student group during the pandemic has been limited.

International students who remained in their host country during the pandemic experienced significant distress, with host nation public health regulations exacerbating their isolation, loneliness and financial difficulties.

At the same time, cultural perceptions of mental health and associated stigma, as well as unfamiliarity with mental health support services, have prevented help seeking.

Routine data on student suicide is not collected in many of the countries that most commonly host international students, including Australia, the United Kingdom and the United States; however, a 2021 study by One Voice Canada revealed a spike in suicide, attempted suicide and suicidal ideation among the international students in Canada during the pandemic.

International students who began or continued to study from their home country during the pandemic also experienced poor mental health. Reports of hopelessness, uncertainty about the future and difficulty in adapting to a new and unfamiliar academic system from their home base were common.

A 2022 survey of these students found 95% felt their mental health had been significantly impacted by this experience.

This evidence supports the assertion that some international students are returning to study this year with unresolved mental health issues that may affect their ability to study and their overall well-being.

Concerns about inferior learning

The sudden, mandatory move to exclusive online learning during the pandemic represented an intense period of effort and a steep learning curve for academics and students alike. While this shift in delivery offered ongoing educational access, it was also an isolating and, for some students, inferior learning experience.

For international students residing in their host country, online learning severely limited opportunities to make new social and academic networks that are so crucial for opportunities to engage, belong and thrive.

A study with those students who took up the offer to study online from their home country as an interim measure reported an overall negative learning experience, with 42% of respondents very dissatisfied and 26% dissatisfied.

This unhappiness was primarily associated with a lack of interaction with peers and tutors, the impact of time zone differences on scheduled online classes and the inability to complete practical components of the degree. Perceived academic incompetence and unfamiliarity with online technology contributed to an overall feeling of doubt in the quality of the course students had invested in as well as disconnection from the university.

Vilification of international students

Although an existing issue, media reports of racism against international students intensified during the pandemic, with Asian students the target of ongoing vilification.

The situation was arguably inflamed by then president Donald Trump’s 2020 “Chinese virus” tweet that placed blame for the pandemic squarely at China’s door and prompted an outbreak of attacks on Asian students across the US and Australia.

The January 2023 travel restrictions imposed on Chinese individuals by four of the five top international student host nations (Australia, the UK, the US and Canada) may deepen societal racism, and with it, international students’ experiences of being unsafe and unwelcome in their chosen host country.

Financial distress

Governmental fiscal decisions had a major impact on the experiences of international students during the pandemic. Those ‘trapped’ in host countries due to flight restrictions, lack of finances and fears of being unable to return to study once the pandemic was over reported extreme financial stress as the casual work they relied on dried up.

Unlike their domestic peers, these students were excluded from government financial strategies to support those unable to work.

The first half of 2020 saw numerous media reports of international students struggling to meet rental payments and relying on goodwill from sympathetic community groups. The same reports told of students’ distress, disappointment and feelings of abandonment.

Similarly, a 2021 survey by the Council of International Students Australia of overseas students prevented by COVID restrictions from leaving their home country reported similar experiences of financial stress, with these students facing payment demands for university course fees during a time of rising job losses and unemployment.

Additional financial burdens included storage fees and rental or break lease payments on top of living expenses in their home county.

For many international students, family members have provided financial support to enable their overseas tertiary education, often at great personal risk and cost. This knowledge, and the expectation from family to succeed academically, have added to the distress of students struggling with unfamiliar online academic systems and a loss of income.

At the same time, cultural perceptions of mental health and associated stigma have led to feelings of shame, hopelessness and despondency.

Where to go from here?

It is apparent that, for international students, the pandemic has represented a period of intense and continued financial stress, isolation and distress, with individuals disenfranchised and disillusioned with their educational provider.

While the longer-term impact of this period on international student mental health is as yet unknown, higher education cannot be complacent and assume that the return to ‘business as usual’ means these issues have gone away. Now more than ever, a university-wide approach is required that understands, acknowledges and safeguards international student mental health.

To be effective, a tailored approach is required that understands the disparate and complex experiences of these students, including racism, financial distress, academic challenges, social isolation, familial expectations and cultural dissonance around acknowledging mental health and well-being issues.

While universities are to be commended for their efforts to support student mental health in recent years, efforts are needed to ensure these resources are relevant and accessible to international students. For example, the excellent UK Suicide Safe University guidance, published in 2018, would benefit greatly from the inclusion of international student issues, as would the more recent AdvanceHE’s Education for Mental Health Toolkit.

Student engagement and belonging

Efforts to re-engage with international students academically and socially, and to encourage networking within and outside campus, are crucial to mental health, study success and future employment.

Welcoming and orienting students from induction onwards can help with acculturation and the navigation of unfamiliar systems. Topics should include safe housing and neighbourhoods, transport, the health system, financial support groups and local cultural community networks.

While online teaching technology and teaching skills have improved since the start of the pandemic, strategies to support engagement and belonging need further attention through innovative pedagogical approaches.

More widely, meaningful communications from the university are required that acknowledge and react to cultural and social issues of concern for international students. At the time of writing, this includes floods in Pakistan and anti-government protests in Iran.

Mental health literacy

Raising staff and student mental health literacy is a prerequisite of any mental health strategy. Mental Health First Aid Australia student training and longer accredited trainer courses can form a basis for this literacy as well as signposting students to appropriate online resources, such as Head to Health.

International student mental health literacy strategies must be informed by an understanding of the structural and cultural factors that influence university experiences and help seeking. This understanding is particularly important for university counselling services that work with students in mental health crises.

Service uptake can be improved through the normalisation of mental health issues in class discussions, on campus and online, as can the explicit promotion of support services, their cost and confidentiality.

The call for data

Finally, understanding the longer-term impact of the pandemic on international student mental health and the effectiveness of mental health interventions in general depends on reliable and consistent data on student disclosure, service uptake and suicide at university and at the national level.

An approach that captures trends and patterns is required, supplemented by studies that capture the student perspective and the proactive measures necessary to support their well-being. Calls for governments and individual universities to take responsibility for this monitoring and reporting must be answered so that a baseline of understanding can be achieved on which to build proactive strategies of support.

Dr Lesley Andrew is a senior lecturer, AdvanceHE fellow and deputy director of the Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice at Edith Cowan University, Australia.