This blog is part of our Mental Health And University series.
Starting university can be an overwhelming time for any young person. Beginning a new life, often in a new city, is no small task, and for those who are in their adolescence, the changes can feel extreme. In addition, moving from a secondary to a post-secondary educational structure is a big shift, and it can be extremely difficult to know how to prepare.
These challenges are often even greater for young people facing mental health difficulties. Individuals who have been in treatment or recovery programmes for their mental health may find the additional stress of the changes required by the move to university too much to cope with. According to research conducted in the UK, young people with mental health conditions may be less likely to attend university altogether. 
Over the past few weeks, we have been exploring some of the challenges young people struggling with a mental health condition might face as they embark on the beginning of their university journey. In our last post, we examined how transitioning into a university setting – choosing a programme and a school, for example – can present particular difficulty for those in treatment for depression, anxiety, PTSD, an eating disorder, or another mental health condition.
This week we will examine the start of the university experience: what young people entering a post-secondary educational environment are likely to face and how it is likely to affect those who are struggling with a mental health condition. We will provide a brief overview of what the first year at university entails and how those concerned for their mental health can prepare to navigate this challenging but extremely rewarding time.
New Structures, New Systems
Primary and secondary schools are designed to provide young people with a rounded skill set in specific subjects such as maths, history, and language and further equip them with basic social and life skills like cooperation and independence. On the other hand, universities are founded to produce knowledge at a high level through an intense research process.
This difference in structure is reflected in almost every aspect of life at these two educational stages. In primary and secondary school, for example, teachers are very familiar with the pupils and frequently see each individual across various activities, classes, and school events. Each pupil develops close relationships with certain teachers over the years, and teachers often take on a pastoral role by looking out for the well-being of students outside of their academic performance.
By contrast, university lectures and classes often have hundreds of students in attendance each week. Professors do not often get to know their students personally; there are times when lectures are so big that professors will not even be able to put names to students’ faces. This is partly because professors are not there specifically to teach – most professors are skilled researchers employed by the university primarily to conduct studies in their specialist teams. They teach as a part of their research role, not the other way around.
For young people, this can be one of the more startling and upsetting things to adjust to in the first year. Used to being surrounded by adults – such as teachers, guidance counsellors, teaching assistants, and peripatetic specialists – who are engaged, present, concerned about their well-being, and focused on their success, many young people find themselves feeling isolated and forgotten during the first year attending university. This is particularly true for young people who were previously in treatment and are used to having therapists and coaches as well as teachers and school staff to attend to their well-being.
Understanding that the structure of the university is different from that of a secondary or primary school before attending – or even applying – is key to managing this startling shift in the social dynamic. It is also helpful to understand where there is adult support through the university structure; pastoral care is not absent in the post-secondary setting; it’s just site-specific. That is, there are often departments and teams at the university dedicated to student well-being and support. Knowing where to access those departments before beginning to study can help ease the transition immensely.
New Lifestyles, New Risks
Outside of the alarming structural differences which become apparent once a young person has started attending university, there are certain lifestyle differences brought about by the transition, which can present an entirely different type of risk. For many, the start of university marks the start of life away from the supervision of family. Many young people move cities – or even countries – to attend university, which places them far beyond the reach of their parents, siblings, grandparents, or other family members’ supervision. But even young people who attend university in the same city as their families find the newfound freedoms allowed by university remove them in large part from the expectations and routines they previously lived by at home.
Therefore, the first year of university is also a challenge for many as they learn to navigate the need to look after themselves in an environment where there are very few rules to follow and many opportunities to try new things. Without a family member around to remind you to go to bed, for example, you may end up staying up far later than you ever had before but still have to get up for class the next morning. And without a curfew to keep you coming home at a particular hour, it becomes possible to spend the entire night out at bars, clubs, or parties, the consequences of which must be dealt with alone the following day.
Striking a balance between the newfound personal freedom of university with the newly acquired personal responsibilities proves too challenging for some. Nearly one in ten people in the UK don’t make it past their first year of university, and at least some who drop out are forced to quit their programmes because they couldn’t successfully manage their lifestyle during the first year and either partied too much or never left their rooms.
These risks are especially pronounced for young people struggling with a mental health condition that already affects their ability to make decisions and set boundaries for themselves. Removing all structure and consequence can be extremely dangerous, for example, for someone who is struggling with bipolar disorder and is unable to regulate their moods or someone who has experienced an eating disorder and needs structured days and mealtimes to support their recovery.
Getting involved with set activities and groups is an excellent way to mitigate some of the intensity of these lifestyle decisions. Having a series of weekly evening events that are structured and interest-driven can help add a sense of purpose to the first year that often feels alarmingly free of constraints for many. Developing firm friendships based on mutual respect and trust outside of class can also help to create the boundaries required to make balanced decisions during the first year of uni.
To learn more about the transition from school to university and its intersections with mental health in young people, read the rest of our Mental Health and University series here. And to learn more about The Wave clinic, visit our website: https://thewaveclinic.com
 Lewis, G, (2021). Higher education and mental health: analyses of the LSYPE cohorts. Department for Education. Government Social Research. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/996975/Higher_education_and_mental_health__analyses_of_the_LSYPE_cohorts.pdf