29% of university students have mental illnesses.
78% think they have had a mental problem at some point.
1.5% disclose to HEIs.
75% disclose their mental health conditions to fellow students.
(UMHAN, 2017)
Warning signs of student distress:
- Changes in mood e.g. elevated or decreased mood, increased anxiety
- Irritability or tearfulness
- Restlessness
- Reduced appetite and weight loss
- Reduced concentration and memory
- Loss of initiative or desire to participate
- Decrease or increase in speech speed
- Increased difficulty making decisions
- Placement non-attendance e.g. unexplained absence or sick leave
- Reduced communication or withdrawal
- Changes in presentation and cleanliness
- Reduced performance
- Poor organisation and time management
- Changes in ability to think logically.
(UMHAN, 2017)
© Matthew Tizzard
Issues of non-disclosure
- Fear they will not get in; stigma/fear of being judged
(UMHAN, 2017)
- Cultural differences: Reliance on prayer or faith healers; belief that it is a Jinn possession or Evil Eye
(Ahmed, 2012)
- Source of shame; distrust of the medical profession.
Additional risks for international students
- High expectations
- Lack of familiarity
- Restrictive conditions
- Home ways of learning don’t fit
- Course selection mismatch
- Pride hides vulnerability; stops help seeking
- Working psychological over-time to fit in.
(UKCISA)
‘The move to a new environment is one of the most traumatic events in a person’s life and in most sojourners some degree of culture shock is inevitable’
(Brown and Holloway, 2008:33)
Symptoms associated with culture shock:
Low self-esteem | Bitterness | Depression | Helplessness |
Low morale Social isolation Dissatisfaction with life | Home- sickness Disorient- ation Anxiety | Role strain Identity conflict Self-doubt | Personality dis- integration Irritability Fear |
(Brown and Brown, 2013:396)
A key trigger
- Real or supposed attacks on national identity.
(Brown and Brown, 2013:397)

© Matthew Tizzard
What to do:
- ‘Perhaps the most important thing we ever give each other is our attention.’ (Remen, ISHI)
- Listen with ‘unconditional positive regard’ (Carl Rogers);
- Be aware of when you are moving out of your area of competence;
- Encourage students to see one of the counsellors (through Gateway). If necessary, help them to organise an appointment;
- If they are in university accommodation, ensure accommodation staff know of your concern;
- Recognise that they may have cultural reasons for refusing help;
- Suggest they go to the Listening Post.

© Matthew Tizzard
For international students:
- Take your time and listen;
- Consider the impact of culture shock;
- Consult with colleagues or relevant professionals;
- Consider using ‘cultural interpreters’;
- Pay attention to your gut feelings;
- Remember the impact on other students;
- Do understand that a student might refuse help.
- (UKCISA training: ‘Frontline skills in responding to mental health issues for international students’ 6 June 2017)
Further reading:
Ahmed, K. (2012) Feeling Stressed? A leaflet for Muslims at: http://www.rcpsych.ac.uk/info
Brown, J. and Brown, L. (2013) ‘The international student sojourn: identity conflict and threats to well-being’ in: British Journal of Guidance & Counselling 41:4, pp.395-413
Brown, L. and Holloway, I. (2008) ‘The initial stage of the international sojourn: excitement or culture shock?’ in: British Journal of Guidance & Counselling 36:1, pp.33-49 UK Council for International Student Affairs (UKCISA)