by Linda Krajčovičová

The topic of mental health has enjoyed a significant rise in popularity in recent years, which is slowly resulting in people’s improved and more profound understanding of the matter. Struggles with mental wellbeing are experienced by people from various spheres of life, at various ages, and to various degrees, and university students are no exception. Despite the impression that young people are generally “healthier” than the older generations, being young poses its own threats which can have a huge impact on people’s mental health. This article looks primarily at the United States and the Czech Republic, and compares the state and the development of university students’ mental health in recent years. It also tries to see whether the role universities in these two countries play in helping students who struggle mentally is sufficient or not. 

Mental Health in General

According to the World Health Organization (WHO), the number of people who are affected by mental health issues has been growing for many years everywhere. And yet, the response of people in power has been relatively inadequate as there still are numerous problems connected to either the availability of treatment for those who need it, or to the prejudices which these people face. The WHO estimates that 20 percent of young people worldwide are suffering from some kind of mental illness and claims that a significant part of them is at risk of suicide. 

Mental Health Atlas 2020 shows a few differences in data concerning mental wellbeing of the citizens of the Czech Republic and the United States. Firstly, there is a higher rate of mental health promotion and prevention programmes in the US, with the country’s suicide prevention policy, National Strategy for Suicide Prevention, introduced in 2012. The Czech Republic, on the other hand, introduced National Action Plan for Suicide Prevention only two years ago, despite the fact that three people take their own life each day on average in the country. Secondly, while statistics concerning suicide mortality rate per 100,000 citizens in the Atlas show that the number is falling in the Czech Republic, the percentage is rising in the United States.

Even though the data suggest an increase in the initiatives on the part of most of the member states, the organization also indicates that more should be done to make help available to those who need it. Mental Health Atlas 2020 states that there are “significant gaps globally between the existence of policies, plans and laws and the implementation and monitoring of these and the allocation of resources”. It remains to be seen whether in less than ten years, WHO’s Comprehensive mental health action plan 2013-2030 aim “to promote mental health and well-being for all”, will be successful or not.

University Years

Attending a university is a privilege that not everyone enjoys. However, the demands academia makes on students can have far-reaching and negative effects on their lives, not just relating to school, but also to other aspects like their relationships or their emotional stability. Authors of a study based in Pakistan introduce their research by claiming that this period affects everyone in a relatively similar way, no matter the culture or region. Saleem and Mahmood state that: “the university years of an individual are emotionally and intellectually more demanding than almost any other stage of education” and therefore support the argument that this truly is a global issue.

Currently, according to official data, there are over 304,000 university students enrolled in the Czech Republic, and over 19.4 million in the United States.  Sarah Ketchen Lipson, a researcher at Boston University, states that rising numbers of university students struggling mentally have been a “continuation of [a] troubling trend”, rather than a new development. According to her research, there was a 50 percent upsurge in the number of students who faced some kind of mental condition in the academic year 2021 compared to the academic year 2013, meaning that more than 60 percent of students needed treatment for at least one mental problem nationwide. Other research has also supported this claim, and some even suggest that the issues university students are experiencing mentally are growing “in number as well as in severity”. Despite this relatively long-standing development, it is fair to emphasize that the last two years have been significantly marked by the covid-19 pandemic, which has caused new challenges to university students’ mental health that still affect many now.  As Pavel Žára mentions on behalf of Masaryk University, the number of students seeking help from university psychologists has doubled in March 2021 compared to previous years. The issues discussed in the sessions have been most commonly associated with anxiety, stress, and the lack of face-to-face contact.

There are various factors at play for the development of a mental condition in an individual, ranging from biological predispositions to social circumstances. University students and their mental wellbeing, however, can be significantly affected by other common aspects associated with academic life. Firstly, the environments to which young adults are exposed to in high school and at university are extremely different, and the transition can be an uncomfortably challenging experience. Not only are they expected to be more responsible and independent, they are also expected to find new people to rely on because their families and friends from home are not as close to them as before. Although the primary shock from these demands usually slowly disappears in the first few months after enrolling at university, there are other issues which continually negatively affect students, long after their first encounter with university, including “stress from academic pressures…growing up to adulthood, the demands impending practical life and other extraneous factors”. These are often closely linked to academic organizations themselves, and may include, for instance, various challenges concerning finances (although generally more associated with the United States than with the Czech Republic), lack of information about the availability of help at university, or even lack of professionals on campus who could help students. In fact, both the Czech Republic and the United States have been recording higher demand for counseling services at universities for many years, and, subsequently, also insufficient supply of professionals able to help. So, even if a student decides to talk to someone, there is a large chance that they will not be able to see the counselor they have chosen, or that they will have to wait a long time before they will be able to see any of the professionals on campus. The decision to seek help is not an easy one and the lack of immediate guidance could not only worsen students’ mental states but even prevent them from seeking help again in the future. 

Research Findings

Much research has been done on mental health of university students worldwide in the last few decades, which serves as an important source for comparison of the data with newer research. One study proposes that it was only in the last decade of the twentieth century that the most common issue which made students at American universities seek help changed. While the topic of relationships dominated the causes for visiting a counselor before, since 1994, stress and anxiety have been reported to be the primary reasons for such visits. That same study also suggests that university students are more vulnerable to suffer mentally than the rest of society. As Benton et al. point out: “compared with the general population, overall student health is poor and their emotional health is a greater problem than their physical health”. In research, from 2018, Harrer et al. states that: “12 – 46% of all university students are affected by mental health disorders in any given year” which is an arguably highly troubling statistic. 

Yearly surveys examining the mental health of university students in the United States are also conducted by the Association for University and College Counseling Center Directors (AUCCCD). It is an organization dedicated to raising awareness of mental health at universities and to improving the quality and accessibility of help on campuses throughout the country. Its latest survey looks at the academic year 2020/2021 and concludes that the top five issues that encourage students to seek help include anxiety, stress, depression, family concerns, and academic performance difficulties, with the number of students suffering from anxiety being approximately 61 percent. Other issues include for instance relationship problems, loneliness, sleep difficulties, body image concerns, or suicidal thoughts.

Several articles have also looked at the situation in the Czech Republic and the data do not differ very much. It is, again, anxiety with stress and depression which are the leading problems with which university students struggle. Although the existence of counseling at Czech universities is embedded in law, the reality often is that students do not have sufficient information about the help available, or there are other obstacles to getting the help they need, such as bad communication or, again, lack of counselors. 

As already stated, mental distress is something that affects students everywhere in the world, and the data available support the argument that the topic of mental health at universities deserves to be discussed openly. Anyone who is a university student, a professor, or a loved one of either of these, most probably has some idea about the pressures connected to pursuing higher education and can understand how significantly the stress from the demands put on students can influence their emotional stability. While it is true that such an environment can, to a certain extent, motivate students to be better and work harder, it has, more often than not, the opposite effect where it makes it extremely difficult for them to learn. As Macaskill states: “students need to be psychologically healthy if they are to get the most out of their education and move confidently into employment” which is almost impossible unless something changes.

Medical Students

Few would probably find it surprising that students who are among the most prone to experience mental health struggles are aspiring doctors. Much research has supported the argument that studying medicine is associated with high levels of student stress. Over 60 percent of medical students in the United States have reported experiences with mental struggles, mainly with stress, anxiety, and depression. What is more, they have disclosed fear of and concern about how these challenges to their mental wellbeing would affect their abilities to be successful doctors. Roberts et al. suggest: “we should seek to reshape the culture of medical training at each institution to allow students to be who they are: individuals whose fundamental humanity and proven strengths will allow them to be empathetic, and perhaps healthier, physicians in their care of patients in coming generations”. Instead of seeing these experiences as a weakness, they propose seeing it as a strength that has the potential to improve their careers.

Data concerning medical students in the Czech Republic are equally troubling. A survey (Čeští medici v (ne)pohodě 2021) conducted by organization Po medině looks at the eight medical universities in the country and compares the mental health of their students. Over sixty percent of students claim they strongly agree that studying medicine is, overall, very stressful, and the majority of correspondents states that the main sources of stress are exams. What is more concerning, though, is the number of students who strongly agree that the excessive stress leads them to find comfort in alcohol or antidepressants. The survey also included open-ended questions to look at the specific causes of stress for the students. Although the answers slightly vary, they all more or less arise from the pressure that is put on the students, including feelings of guilt for not dedicating enough time and effort to studying, unclear requirements from the professors and their lack of objectivity during exams, a disproportion in the amount of information students are expected to learn and the time available to do that, and lack of connection between theory and practical application. 

The aim of this section is in no way to undermine the pressures university students of any discipline have to face, but rather to emphasize that the path to one of the most responsible professions is set in a way that can lead to students’ loss of passion for the field they once have felt, or even to the false conviction that they are not good enough to pursue such career, either because they are told so by the faculty or because the pressure becomes too much and they lose confidence. It is highly ironic that those who are expected to be able to help others after university are among the ones who need help the most while they are just at the beginning of their journey. 

Path to Improvement

The question of what can be done to improve the situation is a difficult one because the answer also includes the necessity for a change that universities alone do not have the capacity to ensure. Nevertheless, there are ways in which they can play a huge role in improving their students’ mental health. For instance, by introducing basic courses on this topic available to all students, or by adjusting the system so that it would not put so much pressure on excellent academic results. The belief that grades are a highly telling indicator is still here and while they surely disclose something about students’ abilities, they are not everything. As stated by Lipson in “Depression, Anxiety, Loneliness Are Peaking in College Students”: “[a] faculty need[s] to be flexible with deadlines and remind students that their talent is not solely demonstrated by their ability to get a top grade during one challenging semester”. Also, establishing a good system of professional counselors on campus available to immediately help students who need it would be a great step. As Novotney points out: “investing in mental health services for college students can help keep them from dropping out”, meaning that such a system would, in the long run, help universities even acquire more money. 

Closely connected to this is also the necessity to educate people about what is still healthy and what is not, as the lines may be quite blurry for the majority of the population. Not only would it ensure that more people would get help, it would also lessen the stigma by “aligning it with overall healthy living” as Holland points out. Masaryk University, for instance, promotes mental wellbeing through its campaign Jsme jedno ucho, which tries to reach students from all backgrounds and educate them about mental health and help them with whatever struggles they experience throughout their studies.

What is more, as Lipson notes in the above-mentioned study, more than ninety percent of students “wouldn’t judge someone for seeking out help for mental health”. However, the reality is that this topic is generally still surrounded by much stigma which causes people to perceive mental health struggles as shameful and as a proof of weakness.

It is understandable that to be great at whatever one chooses requires sacrifices and it is not easy, however, there should always be balance. This article shows that such balance is virtually non-existent in various groups of students worldwide. Mental health is equally important as physical health and spreading awareness of this fact at educational institutions like universities has the potential to help many. If universities fail to make good mental health of their students a bigger priority, there is a chance that the consequences will be that either less people will graduate from college, or even if they do, they will not be in a good place mentally that would allow them to do well in a job after they earn their degrees. It would be a shame to see talented people fail to fully succeed because the institution that inherently promises their growth did not take proper care of them. Hopefully, the conversation about emotional health will improve globally so that it will be considered completely normal to prioritize one’s mental wellbeing.