Mental Health and Disability at Third Level: Findings from a national study on student mental health

Introduction

In 2018 the Union of Students in Ireland (USI) undertook a study to provide an overview of students’ mental health experience in third level education across the island of Ireland (Price, A. and Smith, HA. 2019). The objectives of USI’s study were to describe and explore the: demographics of students in third level education in Ireland, in particular:

• the proportion of third level students that report mental health distress and ill health;
• gain information on the mental health of specific groups;
• explore the availability and usage of mental health support services for third level students.

One of the groups that the USI study focused on was students that identified as having a mental and/or physical disability. The purpose of this paper is to summarise the key findings, from the USI study, that are specific to third level students with disabilities. The paper will conclude with disability policy recommendations for third level education settings.

Methodology

The full methodology undertaken for USI’s study on the mental health of students in third level education is freely available to download. Briefly, the study design was a point prevalence anonymised survey. The questionnaire contained both open (qualitative) and closed (quantitative) questions and was developed in-house (literature review followed by consultation with mental health professional, academics and students). The one inclusion criteria was that all participants had to be a third level student on the island of Ireland. The survey was distributed from January to the end of April 2018 through local Students’ Unions attached to third level education settings (this includes Universities, Institutes of Technology, Art Colleges and Further Education settings). 

The survey asked all respondents demographic data and used the validated Depression, Anxiety and Stress Scale (DASS-21) (Lovibond, SH. and Lovibond, PF. 1995). The section of the survey specific to disability included questions on the type of disability (self-reported or formal diagnosis) and how respondents felt disability impacted on their mental health and access to services. The survey also asked respondents if they had registered with the disability office and disclosed their disability to academic staff. A further analysis looked at the use of on-campus services, including counselling, by students with disabilities. Questions on the use of on-campus services to support mental health were open ended and this is where the qualitative data was drawn from.

Findings

Respondents

In total 3,340 students took part in the study. The majority of those that returned the survey were female (73.5%, n=2455), aged 18-24 (82.7%, n=2763) and in undergraduate education (88.3%, n=2950). Over one quarter 28.1% (n=939) respondents said they had at least one disability.

Out of the 939 respondents with a disability most (74.0%, n=695) were female, 80.3% (n=754) were aged between 18-24 years and the majority (89.4%, n=839) were studying for an undergraduate degree, Table 1a,b,c,d.

Table 1a,b,c,d: Demographics of Study Population.

The majority (74.7%, n=701) identified as having one disability. One fifth (20.2%, n=190) reporting have two disabilities and the remaining 48 (5.1%) had three to five disabilities. The three most reported disabilities were: mental health difficulties (76.1%, n=715), specific learning disability (15.3%, n=144) and significant ongoing physical illness (11.7%, n=110), Table 2.

The Student Experience

Disability was found to impact on students’ mental health with over a third saying that it effected them often (34.4%, n=323). Four percent (n=38) said that their disability did not have an impact on them at all, Table 3.

Table 3: Disability’s Negative Impact on Mental Health.

Just under half (42.3%, n=397) of students who identified as having a disability had used the counselling service. Close to a third (32.9%, n=309) of respondents said that their disability did not affect their ability at all to access mental health services. However, 6.9% (n=65) of students did indicate that their disabilities impacted on their ability to access support services all of the time and a further 14.1% said their disability often impacted them accessing support services.  Two hundred and seventy-two (29.0%) respondents stated that they used services other than counselling to support their mental health, Table 4.

More students had disclosed their disability to academic staff (48.7%, n=457) than had registered with the disability services (40.1%, n=377). When asked about disclosing their disability when they had completed college and were entering the workforce most students (51.5%, n=483) were unsure followed by 35.1% (n=330) stating that they did not plan to tell their employer of their disability. Only 13.4% (n=126) said they would be informing their employer of their disability.

Depression, Anxiety and Stress Scale

Just under half (46.4%, n=436) of students with disabilities were extremely severely depressed. Those who were blind or visually impaired had the highest rates of extremely severely depressed (56.3%, n=9/16) compared to other groups of disability. The highest proportion of respondents within the normal range of depression were students with physical and mobility related issues (27.5%, n=19/69).

Over half (58.7%, n=551) of students with disabilities were at the extremely severe end of the anxiety scale, with only 13.1% (n=123) within normal range. Out of the 22 students who were deaf and hard of hearing 72.2% (n=16) had particularly high rates of anxiety when compared to other groups of disabilities. Respondents with the highest proportion in the normal range were those with physical or mobility related disabilities (26.1%, n=18/69). 

Extremely severe or severe stress was reported by 29.3% (n=275) and 29.0% (n=272) respondents, respectively. Students with ADD or ADHD were the most likely grouping to be severely stressed at 34.0% (n=17/50). Those with physical or mobility related disabilities had the highest proportion in the normal range (31.9%, n=22/69).

Overall, students registered with the disability office, or who had disclosed their disability to academic staff, were more likely to be within normal ranges and less likely to extremely severely anxious, depressed and stressed compared to those who had not registered. 

Students Views on Disability Support Services

Satisfaction with overall service

Students felt supported and satisfied with the service, one said ‘I feel very supported by the disability service’. Students spoke about the service being approachable should their level of need change, one student said ‘I have been supported with extra time and supervised rest breaks for exams. I have not been offered any additional help to cope with my studies, but I am coping okay and feel that I could ask if I did need it’. Another spoke about how they the service was helpful in dealing with logistics around exam administration and accommodations ‘they were very helpful in organising deferrals/dealing with college administration which is extremely complicated and stress-inducing. They were able to provide smaller-centre exams and rest breaks during exams which was useful’.

Dissatisfaction with overall service

Students had difficulty accessing the service, one student said it was ‘really quite awful. I experienced a lack of information regarding how to register with the service’. Another respondent spoke about the delay in registration with the disability service ‘I was referred to disability support service September 2017, had first appointment February 2018. I've 8 weeks left of final year... it's a bit late in the year, I really needed the occupational therapy from day 1 as I’m a final year student’. Another student said that it wasn’t until their case got ‘worse’ that the service was helpful to them ‘the disability services was not initially helpful as I don’t think they took my case too seriously and it was difficult to register.  In my second year when things got worse, they then were helpful and now in my final year they check in on me a couple of times a semester and make sure I’m doing okay’.

Occupational Therapy

Where available, students found occupational therapy to a very helpful resource and feedback included how it helped them ‘in giving concrete plans and short and long-term solutions’. One student said ‘I have had nothing but good experiences with the service at my college. I can't speak highly enough for this service, if it was not for service, I would have dropped out of college long ago’. Another echoed this saying ‘I can honestly say that if it were not for the service in my college, I would have dropped out of college on many occasions. I cannot praise my occupational therapist from service enough, if the academic staff were half as good as him, college would be a much more positive experience for me’. Students spoke about the occupational therapy service providing them with specific strategies to deal with, one student said ‘the OT has taught me some strategies to try and ease my anxiety’.

Conclusions

Students with disabilities experience high levels of self-reported and clinical distress. Interestingly those registered with the disability services, and/or disclosure to academic staff, had better mental health than those who did not. Disability was found to impact on students’ mental health with over a third saying that it effected them often. Less than half of students with disabilities used the student counselling services to support their mental health.  Mental health specific support such as an occupational therapy service (only offered in some of the third level institutions) was highlighted as an important service by the students themselves. The high rates of distress among students with disabilities is something to bear in mind considering the current COVID19 restrictions and accessibility of lectures and assessments as well as support services to those with disabilities.

This paper has summarised the key findings from the USI national study on the mental health of third level students that are specific to those with disabilities (Price, A. and Smith, HA. 2019). We are working towards a greater, more in-depth, analysis of the data to explore the current mental health and what supports are needed for subgroups with the population of students with disabilities. The current information from the survey provides the opportunity to produce policy recommendations to enhance and protect the overall mental health of students with disabilities in third level education.

Policy Recommendations

• Specific disability support for mental health including occupational therapy is essential to many student’s success at third level. This is a service that should be available in all third level settings and where investment is required.

• Those who registered with the disability support services had better mental health than those who didn’t. Strongly suggest students are encouraged to register with the disability support prior to entering third level as well as throughout.

• Many students had disclosed their disabilities to academic staff, and it is important that staff have a good understanding of the support services available to students with disabilities. It would be useful to have a disability link in each school or department that can advise on these matters.

• Students with disabilities use the free student counselling services on campus, and this should continue to be supported and funded. More investment is needed to meet the growing demand for services. 
• Research needs to be prioritised. There should be a commitment to improve quality data on mental health and wellbeing regarding disability. This could effectively be integrated into the Irish Survey of Student Engagement and should be adequately resourced.

Read the full mental health report. If you would like to learn more about the report, Aoife can be contacted at aoife.price@edf-fepf.org.