Journal of Student Affairs in Africa | Volume 6(2) 2018, 121–127  |  2307-6267  |  DOI: 10.24085/jsaa.v6i2.3318   121

www.jsaa.ac.za

Campus report

Mental Health at Universities: Universities are Not In Loco 
Parentis – Students are Active Partners in Mental Health
Birgit Schreiber*

*     Dr Birgit Schreiber is Senior Director of Student Affairs at Stellenbosch University, South Africa. She is the 
Book Review editor and a member of the JSAA Editorial Executive. Email: birgitschreiber@sun.ac.za

Mental Health in the Spotlight 
Mental health is currently in the national and international and African spotlight 
(Jacaranda, 2018; Mabasa, 2018). Recently, the South African higher education mourned 
losses at Wits University, Stellenbosch University, as well as other institutions of higher 
learning (Mabasa, 2018). The U.K. media featured an article in The Guardian, quoting the 
U.K. minister of higher education as saying that higher education institutions risk “failing 
an entire generation of students” (Adams, 2018). 

This article takes position on the emerging discourse around mental health in 
higher education. It discusses the extent of the problem and reveals the challenges in our 
understanding in terms of the absolute measures and highlights that particularly female 
students are at risk (Lochner et al., 2018). This article emphasises that constructions of 
students as active partners in higher education opens the opportunity to enlist students as 
active partners in creating conditions conducive to health and healthy choices that promote 
mental health. 

Hyperbolic responses like Bristol University’s call for all academics to go on suicide 
watch training and the BBC’s suggestion for students choosing the ‘opt-in’ service 
(Adams,  2018; BBC,  2018) and blame-discourses focusing on higher education are 
unconsidered, reductionist and simplistic. These positions deepen the myth that there is one 
pathogen that causes mental ill-health and one solution that forestalls it. 

The ecosystemic and multi-etiological framework of mental health is far more useful 
in illuminating factors that impact mental health. The most critical factors which need to 
be emphasised include multiple sociocultural contextual factors including gender violence, 
the ‘always on’   Y-Generation, promoting help seeking enablers and putting pressure on the 
public health and school system to respond during early adolescence which is onset for 
most mental health issues. 

Student Affairs in higher education institutions needs to focus on ecosystemic 
interventions, working towards a caring and engaging institutional context, and focus on 
promoting help-seeking behaviours as well as doing targeted intervention focusing on at 
risk groups. Specific at risk groups include high alcohol users, female students with history 
of self-harm and students with low social embeddedness. 

https://doi.org/10.24085/jsaa.v6i2.3318
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122   Journal of Student Affairs in Africa | Volume 6(2) 2018, 121–127  |  2307-6267  |  DOI: 10.24085/jsaa.v6i2.3318

Extent of Problem
The Official Journal of the World Psychiatric Association collects data on life time prevalence 
and projected lifetime risk of mental disorders via the WHO’s World Mental Health 
Survey of young adults (Kessler et al., 2007). Seventeen countries across the world are 
compared (n = 85 052) and very useful and reliable data emerges. The highest prevalence 
of anxiety and mood disorder are reported in the U.S. and Columbia. According to the 
WHO study, the South African figures for anxiety and mood disorders are much lower 
than these and lower compared to The Netherlands, Mexico, Germany and Italy (Kessler 
et al., 2007). Figures from Nigeria suggest that prevalence of mental illness there is much 
lower than South Africa (Kessler et al., 2007). These figures suggest that the causality is 
much more complex. The simplistic leap to blaming socioeconomic status of students and 
the performance focus of higher education is unhelpful. 

To examine the data on the South African student population, the recent ‘Caring 
University Project’ has gathered data on mental health from 18 universities in 8 countries 
across the continent (Lochner et al., 2018). It emerges that 24,68% of students reported at 
least one lifetime Major Depressive Disorder and 20,8% a Generalised Anxiety Disorder 
(Lochner et al., 2018). The onset of mental illness is around 14 years of age and the most 
vulnerable group appears to be females (Lochner et al., 2018). Amongst the students in 
this study, race, first generation, or financial vulnerability did not emerge as a risk factor 
(Lochner et al., 2018). 

In a meta-analysis examining sixty-one studies that explored hopelessness as correlators 
of mood disorders, Lester (2013) found that there was only small increase in hopelessness 
since 1978, with American undergraduate students scoring significantly better than students 
from other nations. Twenge (2015) reviewed research on incidence of mental illness and 
found that there has been a steady increase in mental health issues for the past decade. 

We see a decline of suicidality since the 1990, and while this may be an indication 
that there has been an improvement of mental illness, this may be related to the increased 
prescription of antidepressants and more readily accessed mental health care services 
(Twenge, 2015). 

It is evident, that the research on increase in reporting and/or incidence of mental 
illness is not conclusive. There are questions on what exactly is measured: Increase in 
reporting? Increase in availability of mental health care services? Increase in accessing 
services? A reduction of stigma (Lochner et al., 2018) and thus a breaking of the silence 
around mental health? Are students more psychologised and thus quicker to identify 
symptoms and seek help more readily (Koppetsch, 2018)? Is there a cultural shift towards 
a higher demand on subjective wellness? Is there a quicker leap from distress to disorder?  
Or do we indeed see an increase in depression and anxiety in our student population? 

These are questions that are not fully explored. 

Constructions of Students – Active Partners in Mental Health 
Mental health issues are not going to be addressed by focusing on higher education 
institutions as the curartive driver.  This focus on higher education as the responsible agent 

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B. Schreiber: Mental Health at Universities: Universities are Not In Loco Parentis: Students are Active Partners …   123

is regressive and reminds of the in loco parentis model of higher education. It positions 
higher education in a paternalistic role and reduces students to helpless minors and 
vulnerable victims.  The focus, at least in part, needs to be on students as active collaborators 
in the fight against mental health issues. 

South African higher education and the larger part of Africa is currently in the throes 
of de-colonialisation, reconceptualisation of the curriculum, considering higher education 
practice and principles, and examining its own raison d’être (Le Grange, 2016). The guiding 
framework for this renewal borrows from socially just pedagogies and liberation education. 
Within social pedagogies students are conceptualised as active partners in education; and 
within socially just pedagogies, students are constructed as active agents and collaborators in 
addressing conditions that perpetuate social inequalities.  Students are active partner within 
the system of education and they cannot be treated “as the unfortunate” (Freire, 1970, p.  54). 
So, too, are students active partners in considering issues around mental health. 

Martín-Baró (1989), a scholar of Freire, who applied liberation education principles to 
psychology maintains that “psychotherapy must aim directly at … shaping a new identity 
for people as members of a human community” (1994, p.  43). Martín-Baró (1989) thus 
argues that students need to be enlisted to address issues that perpetuate ill-health and are 
active agents of promoting conditions that are conducive to mental health.

This article argues that the basic stance of any Psychological and Counselling Service 
within Student Affairs in current African higher education should be aligned to the tenets 
of socially just pedagogies. Students are part of Martín-Baró’s ‘human community’ and are 
part of efforts to improve mental health. 

The construction of the active and engaged student as a key collaborator in successful 
education is akin to the notion of agency in psychotherapy. These are important 
constructions of the student-patient, as participation, agency, subjective engagement and 
active involvement is a key predictor for therapeutic success (Orlinsk et al., 2004). In a 
meta-analysis of  27 therapeutic outcomes, it appeared that patients’ therapeutic agency leads 
to improved therapeutic outcomes (Bohart & Wade, 2013; Coleman & Neimeyer, 2015). 

Students as active partners is not only a conceptual argument aligned to liberation 
education and social justice, but also an established tenet of successful psychological and 
medical treatment. 

Hyperbolic and Alarmist Responses Deepen Erroneous Myths
The idea that suicidality and mental ill-health can be ‘addressed’ or ‘dealt with’ in the higher 
education sector by general university staff, academics and management – as argued by 
Adams in The Guardian based on Bristol University’s and the Universities U.K.’s report 
(Adams, 2018) and the reveals a lack of knowledge of mental illness, is simplifying the 
interacting causal aspects of precipitating and predisposing factors, fudges the scope of 
higher education, and furthermore, and perhaps the most sinisterly, implies that higher 
education is the central caretaker responsible for the prevention of and treatment on 
suicidality, anxiety and depression. 



124   Journal of Student Affairs in Africa | Volume 6(2) 2018, 121–127  |  2307-6267  |  DOI: 10.24085/jsaa.v6i2.3318

The idea that academics should “intervene when students get into difficulties” (Adams, 
2018, p.  2) is counter to what academia is about. Students indeed need to be challenged 
and some of these challenges are uncomfortable, unsettling and confront the status quo. 
To sanitise the higher education experience of challenges is absurd. 

As recent as 2015/2016 the #Fallist student movement reminded the world that 
students are indeed adults who engage with adult issues and can take on oppressive and 
unjust systems. We have empowered and vocal students who can make conscious choices. 

Suicide, as part of a range of mental illnesses, premised on psychological dysfunctions 
such as impaired impulse control and mood disorder cannot be contained by general 
university staff as suggested by the The Guardian (2018) and Naledi Pandor (UWN, 2018). 
While ‘gatekeeper programmes’ (Lochner et al., 2018) are useful, these need to include 
students to make them effective. 

Universities need to create inclusive environments of care and compassion and support 
the outliers and courageous thinkers and student leaders. The ‘alert system to detect patterns 
of difficulty’ proposed by Bristol University (Adam, 2018, p.  2) is akin to Big Brother 
watching, premised on homogenous and uniform behaviour patterns. Any such alert system 
stifles free expression, original behaviour and curbs free thinking. Only a narrow band of 
normative behaviour and conformist thought can survive such watchful alert systems. 

A Look at Scope and Role 
There are at least six reasons why the implicit suggestion that higher education holds the 
key,  the responsibility or blame, for student mental health is unhelpful. 

1. By focusing on universities, one lets the real culprit off the hook: the public 
health care system and the secondary school system is responsible to address 
mental health issues. The onset of mental health issues is around age 14 (Lochner 
et al., 2018; WHO, 2011) and it is at that point – and prior to that – that effective 
services need to be provided. 

2. Role clarity is essential: Staff in higher education should teach socially just 
curricula and facilitate relevant co-curricular programmes which are inclusive 
and caring, which promote healthy choices and active global citizens, and develop 
empowered graduates who are active agents of sustainable change towards social 
justice and towards conditions that are conducive to mental health. 

3. Students in higher education should risk being challenged and engage with new 
ideas and indeed push their boundaries. Higher education’s role is to challenge 
students, not cocoon in comfortable narratives premised on assumptions of 
students’ psychological fragility. 

4. Students need to make healthy choices. Lifestyle choices of the ‘always on’ 
millennials and ‘Generation Y’, who engage in pervasive hypercritical self-
evaluations, make this generation of students more ambitious, more vulnerable 
and less self-reliant than previous generations (Koppetsch, 2018). The misuse of 
performance enhancers, such as the illicit overuse of Ritalin, the misuse of alcohol 

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B. Schreiber: Mental Health at Universities: Universities are Not In Loco Parentis: Students are Active Partners …   125

and substances in an attempt to enhance performance are choices that students 
need to consciously manage. For instance, the National Institutes of Health (NIH) 
warns that almost 40% of students in the U.S. engage in binge-drinking once 
per month (NIH, 2018). These are choices that students make and while mental 
ill-health and insidious social factors are contributors and precipitants, students do 
need to realise their agency within this and make conscious choices that promote 
health rather than ill-health. 

5. By focusing on ‘how universities deal with mental health problems’ (Adam, 2018), 
the author somehow implies that universities are in a paternalistic caretaker role – 
in loco parentis – and that the students are passive bystanders vis-à-vis their own 
mental health. 

The narrative of students as helpless minors has long gone and was finally 
dispelled by the 2015/2016 student unrest which displayed the immense student 
power, decisiveness and leadership that precipitated wide change across the 
affected countries, especially South Africa, Canada and the U.S.

Indeed, in late adolescence and early adulthood, in this prolonged 
developmental moratorium, students may oscillate between regression and 
precociousness but to reduce them to vulnerable victims that rely on universities 
for mental health interventions is miss-constructing the student–university 
relationship and corrupts the teaching–learning process. It is not a binary: at times, 
students may indeed be vulnerable but also have internal locus of control that 
enables them to be competent partners in mental health promotion. 

The treatments for mental health rely most centrally on the patient and not 
on the university. He and she, the student, has to report, has to engage, make 
choices, seek help, comply with treatment, reach out, and be a collaborative and 
active partner in treatment. The depressed and vulnerable student, paradoxically, 
needs to be positioned as the central partner in any intervention. When 
universities position themselves as the saviours, it deepens the sense of patient 
victimhood, promotes welfarism and social disempowerment discourses.

September (2018) rightly points out that universities need to enable accessible 
services, accessible to the vulnerable and disenfranchised, but it is a three-way 
partnership of the adult student and the compassionate institution and functioning 
public health care system that will shift the status of mental health. 

6. The mental health care professionals, the psychologists, social workers, psychiatrists 
and psychiatric nurses are the best trained and most insightful group of 
professionals who are equipped to diagnose and treat. It is ill-guided to appoint 
well-meaning academics and benevolent university managers as caretakers and 
mental health experts who should monitor students for self-harm risk and 
give alerts (UWN, 2018). The training for such interventions is not done over 
a weekend short course and minimises the risks associated with assessments 
for self-harm. 



126   Journal of Student Affairs in Africa | Volume 6(2) 2018, 121–127  |  2307-6267  |  DOI: 10.24085/jsaa.v6i2.3318

The risks of such naïve plans, like the one proposed by Bristol University 
(Adam,  2018), are not only for the staff who need to live with the burden of 
ever-scanning students for suicide risks and living with the guilt when they fail. 
But also, such a system would narrow the spectrum of behaviours and be akin to 
Big Brother watching any behavioural outliers and reporting these to the mental 
health police. 

This call made by the Universities U.K. (Adams, 2018) to train all staff 
in suicide prevention is absurd. The reductionist approach encapsulated in 
their ‘checklist of steps that university leaders can take to prevent suicides’ 
(Adams, 2018) minimises the contributing and multiple factors, neglects the 
biomedical aspect of mental health, disempowers the vulnerable, and wrongly 
allocates agency to university leaders while absolving each and everyone of us 
of the responsibility to contribute towards a healthier society. 

We must remember that suicide and suicidal behaviours peek during late 
adolescence and early adulthood and again around retirement. And let us also 
remember that “the rate of suicides among students is significantly lower than 
among the general population” (Adams, 2018). 

Capacitation and Outsourcing
The current trend by universities based in part on reduced government funding, to reduce 
mental health care staff, to outsource or to establish free emergency telephone or e-services 
to deal with spiking mental health issues is compounding the issues around mental health 
(UWN, 2018). Responses tend to be crisis and emergency driven, rather than preventative 
and proactive, and systemically integrated and articulated to teaching and learning. The 
splitting off of mental health care as a short-term treatment outside of the daily lived 
experience does not assist in addressing systemic factors that are causally implicated in 
mental health. 

South African Minister of Higher Education, Naledi Pandor, announced in 
November 2018 that ZAR 900  million (60 million Euro) will be invested in “university 
capacity development in order to support universities in developing programs around issues 
of mental health and support to students that face gender-based violence” (DHET,  2018). 
This reveals profound understanding that violence, especially gender-based violence as 
a social-cultural systemic issue, is linked to mental health. Capacitation and support for 
universities is essential and it appears that South African Minister Pandor is impacting this 
very positively. 

Conclusion 
The concern for students’ well-being is indeed a just, urgent and relevant one. But 
universities must not narcissistically appoint themselves as the only saviour, nor should 
students be robbed of their role in mental health or be limited in their spectrum of 
expressions by pathologising the outliers. 

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B. Schreiber: Mental Health at Universities: Universities are Not In Loco Parentis: Students are Active Partners …   127

It takes a community to create conditions that instil hope and self-care in students. 
To isolate universities as the hotspot for suicide and then to add that universities ought to 
do something about it deepens the myths that universities are the centre of the universe 
and can save us all. 

References
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How to cite:
Schreiber, B. (2018). Mental Health at Universities: Universities are Not In Loco Parentis – Students 

are Active Partners in Mental Health. Journal of Student Affairs in Africa,  6(2), 121–127. DOI: 
10.24085/jsaa.v6i2.3318

https://www.bbc.com/news/education-44635474
https://pubs.niaaa.nih.gov/publications/CollegeFactSheet/Collegefactsheet.pdf
https://pubs.niaaa.nih.gov/publications/CollegeFactSheet/Collegefactsheet.pdf
http://www.psychologytoday.com/us/out-chaning-culture/201510/
http://www.psychologytoday.com/us/out-chaning-culture/201510/
http://www.universityworldnews.com/article.php?story=20180630063328382
http://www.universityworldnews.com/article.php?story=20180630063328382
https://doi.org/10.24085/jsaa.v6i2.3318

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