This chapter considers the support of staff mental health in the context of their changing roles and the consequences of increased responsibility for student wellbeing. 5% income is lost to the sector through staff ill health. Academic and teaching staff are far less likely than students to ‘disclose’ a diagnosable mental condition. Guarantees of more secure career pathways from graduation and postdoctoral research to tenured lectureship could improve wellbeing. The nature of the work itself also contributes to burnout. Administrative overload is a priority for review. Structures are needed to allow mental illness to be flagged up through compassionate and supportive rather than disciplinary pathways. Staff should be able to identify mental health problems, without fear of negative consequences for their career. Formal university policies should ensure academic and teaching staff don’t have disproportionate responsibility for student wellbeing. University policies, appraisers and job planners could better reward pastoral support financially and in terms of status and recognition. Student support and university mental health staff are best placed to design and deliver mandatory mental health training for staff. This should prioritise mental wellbeing of staff themselves and build good links between academic and support staff.

There are high levels of alcohol in the UK population, with a particularly damaging pattern of ‘binge drinking’. Extreme alcohol use remains embedded in university culture. Since COVID and lockdown, male students, postgraduates and academic staff are likely to have increased their alcohol consumption. Starting university marks a rise in alcohol intake, to reduce social anxiety and ‘belong’ to the prevailing culture. High risk sexual behaviours rise significantly when alcohol is taken. Death by suicide, and deliberate self-harming, are associated with alcohol use. This is an important modifiable risk factor in addressing sexual violence and suicide. Mental disorders are strongly associated in complex interactions with alcohol use. Heavy alcohol use may be associated with other substance misuse and addictive behaviours. Abstaining from alcohol may result in striking improvements in mental health and academic performance. The rights and wellbeing of non-drinkers need to be acknowledged too. Information campaigns and paying lip service to disapproval do not work. The student age group tends to be less risk-averse than older groups. It falls to university authorities in partnership with local communities to control high risk alcohol intake.

This final chapter summarises themes which recur repeatedly when considering mental health in UK universities. It identifies seven key issues in determining the overall mental health of university communities in the UK: transitions, the need to belong, finance, routine and structure, social media, mental illness and intoxication. The rest of the chapter considers their importance and their interactions in the context of many significant changes in both the nature of universities themselves and in current attitudes to the nature of mental health and disorder. It is emphasised that the wellbeing and mental health of staff is also of concern and must be addressed if universities are to achieve their aspirations. The book concludes with a call for thoughtful action, rather than suggesting ‘quick fixes’, and appreciates the potential for mental well-being and human development in university communities.

This wide ranging chapter examines the relationship of mental health with physical aspects of behaviour such as exercise, eating and sleeping and the consequences of dysregulation for both academic success and mental health. The loss of home and school structures at a time of continued physical and brain development puts the student age group at high risk of dysregulation-related disorders, including the so-called ‘eating disorders’. The author discusses benefits of restoring institutional structures such as canteens and adolescent-friendly timetabling. Physical activity, including outdoor activity is important for physical and mental health of all students and staff, and not just a competitive activity for the prestige of an institution. Universities will inevitably host many young people with eating disorders, given the demographic involved. The UK is underprovided with specialist eating disorders services, so that universities may need to develop expertise to support young adults in association with NHS clinics. However, eating disorders can affect people of any age or gender. Staff as well as students may experience these conditions and should be offered services where their privacy is protected.

Universities should recognise neurodiversity as conferring risk for mental health conditions and suicide. Evidence-based support and monitoring can reduce the risk of these occurring and can also reduce dropout and improve academic and psychosocial outcomes for these students and staff members. Staff training in recognition and management of neurodiverse conditions should be delivered at levels appropriate to staff roles. Despite growing interest in both ASD and ADHD in adults, many people who could benefit from diagnosis have not received it. Professionals need to be aware of underdiagnosis of both ASD and ADHD in girls and probably in ethnic and other minority groups. Lack of recognition deprives these vulnerable people of the supports universities can offer to people with neurodiversity. Lay people who take on caring or ‘buddying’ roles for people with neurodiversity need to be well-supported within a helping community rather than expected to shoulder responsibility alone. Waiting lists at many NHS clinics are too long to provide timely assessment for students. University mental health staff may be able to create recognised training programmes and negotiate agreements about diagnosis and prescribing with local GPs.

This, the first of two chapters on the transition from school and home to university, addresses general principles of the nature of transitions. All significant transitions involve normal healthy grieving what is lost (‘homesickness’), alongside rebuilding helpful structures and finding new relationships. Concepts of ‘thresholders’ and ‘transition aged youth’ are discussed alongside growing evidence that dynamic changes in the adolescent brain and mind continue longer than previously thought. Other life transitions are considered from an interpersonal perspective, acknowledging that parents and other family members simultaneously experience disruptive role transitions when a student leaves the family. Individual differences and diverse backgrounds make it difficult to know how much adult capacity can be realistically expected of new students. A list of ‘readiness skills’ is provided for consideration, without the expectation that these will all be mastered before leaving home and school. The author suggests that university need not be the automatic immediate option for school leavers and discusses benefits of using wider criteria than the purely academic to choose a university. Finally induction courses, summer schools and other ways of preparing for university are discussed. These include the peer expectation of using alcohol to manage the inevitable social challenges.