The World Health Organization (WHO) (2011a) estimates that 15 per cent of the global population live with a disability, which equates to more than a billion people. Residents of the UK who are included in this group are an estimated 11 million people. Due to the widening participation agenda (DfES, 2003; NHS, 2010) and equality legislation (HMSO, 2010), it can be argued that the student population may be more representative of the diverse general population than in the past. Therefore it is not surprising that the number of disabled students known to the university sector has
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increased (Riddell and Weedon, 2014) year on year, and over the duration of the last five years the number has doubled within the UK (HESA, 2016a). The disability statistics from the university under investigation (The University, 2016) and a further seven studies suggest students labelled dyslexic are significantly higher in comparison to other disabilities (Konur, 2002; Morris and Turnbull, 2006; Murphy, 2009; HESA, 2016a). Tinklin et al. (2004) posit that the number of students who have disclosed a dyslexia label or have acquired such a label during their time at university has doubled. The literature tells us that this is not exclusive to the UK. For instance, Sweden (Berggren et al., 2016) and Australia (Cummings et al., 2013) have reported similarities, whereby dyslexia is the most frequent disability within higher education. In contrast, the majority of students who have a disability in the US are known to have a mental health label (Berggren et al., 2016). It is therefore comprehensible why the majority of student disability studies and discussion papers have focused predominantly on dyslexia, both within health professional programmes (Ijiri and Kudzma, 2000; Selekman, 2002; Sanderson-Mann and McCandless, 2006; White, 2007; Murphy, 2009; 2011; Evans, 2014; Howlin, 2014b) and within higher education as a whole (Madriaga, 2007; Mortimore, 2013).
However, it can be argued that the statistical data should be examined with some caution as the estimates are dependent on disclosure of students who identify with a disability label and intend to access reasonable adjustments (Selekman, 2002). Students who do not identify with the disability label or do not wish to proceed with an assessment for adjustments are excluded from this data. Despite this, Rose (2006) estimates that one in six students is covered by the legislative disability definition. The prevalence of data of disability among the student population can be attributed to a number of factors. For instance it can be argued that universities are becoming a more inclusive environment (Morris and Turnbull, 2006; Murphy, 2009) which has enabled more students to study (Equality Challenge Unit, 2010). Students may be feeling more confident and safe to disclose a disability. However, this is unknown as an equally
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viable explanation is the increase of disabled students generally. Despite this, the number of students with disabilities is disproportionately low on courses which result in a professional qualification (Riddell et al., 2004). Furthermore, students with disabilities are still more likely than non-disabled peers to discontinue their higher education courses and less likely to achieve a first or upper second class degree (Department for Business Innovation and Skills, 2016). Therefore it can be argued that the need to work toward inclusivity and equality requires further development (Healey et al., 2006). To contribute, it is paramount to investigate if educators’ and students’ understanding of mental ill health, reasonable adjustments and NMC fitness requirements influence the successfulness of nursing and midwifery students with a mental health label.
2.10.1 Student mental health
Student mental ill health comes under the disability definition as stated in the Equality Act (HMSO, 2010) but similar to statistics of disabled students as a whole, the numbers of students diagnosed with a mental health condition is equally unknown. However, studies have revealed extensive data suggesting student mental health is on the increase (Kitzrow, 2003; Blanco et al., 2008; Mowbray et al., 2006; Equality Challenge Unit, 2010; Royal College of Psychiatrists, 2011; American College Health Association, 2015). The number of students with disabilities known to have a mental health condition has doubled from the academic year 2009/10 to 2014/15 (HESA, 2016a). It can be argued that the increase may be attributed to more people being open about experiencing mental distress than in previous generations, rather than an increase in mental ill health per se. The diagnoses involved in this study and highlighted within the literature review typically include depression, anxiety disorders, bipolar disorder, schizophrenia (Kitzrow, 2003; Hunt and Eisenberg, 2010) and post- traumatic distress disorder (PTSD). This is not an exhaustive list of mental health conditions, but is arguably relevant to this study.
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Whatever the reason, evidence would suggest the prevalence of mental ill health among the student population is a cause for concern, especially if students are more likely to experience mental ill health than their non- student peers (Brown, 2016). This is a view supported by Bewick et al. (2008) who conducted an online survey of mental distress within a UK university and found that 29 per cent of undergraduates acknowledged clinical levels of psychological distress. A further study conducted by Bewick et al. (2010) also found the levels of distress did not reduce throughout the course. Another UK survey, which questioned 1093 students in both further and higher education, conducted by the NUS (2013) found 92 per cent of respondents felt they had experienced mental distress. The research also documented that a third said they had had suicidal ideation over the past year. This figure increased to 55 per cent for those who did not identify as heterosexual. Since 2010, the university under investigation has also experienced an increase in students known to have a mental health condition. The academic year 2014/2015 saw a slight reduction owing to the decrease in undergraduates as a whole. However, mental ill health still remains to be the second most frequent disability after specific learning difficulties including dyslexia (The University, 2016). Despite a slight reduction in the last reported academic year, the number of students accessing the mental health advisor has continued to rise (The University, 2016).
The majority of epidemiological studies have been conducted in the United States and the findings suggest high mental ill health among the student population and its effect on education (Mowbray et al., 2006) is not exclusive to the UK. Zivin et al. (2009) conducted an online survey of 2843 US college students and found that 15 per cent of undergraduates were considered positive for depression or anxiety disorders. The study also reported that over a two year period, students diagnosed with mental ill health increased their rates of suicidal ideation, anxiety and self-harm. Similar findings from a survey representing 302 counselling services within university settings found that 80 per cent of students were known to have
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depression (Gallagher, 2009). Blanco et al. (2008) found that almost half of the students met the DSM-IV criteria for at least one mental health condition in the previous year. Also in the US, a study conducted at one university found that 15.6 per cent of undergraduates met the criteria for depression or anxiety and that 44 per cent said that their experience of mental ill health affected their academic success (Eisenberg et al., 2007). More recently the American College Health Association (2015) reported 16 per cent of undergraduates found it difficult to function due to depression in the previous 12 months and 20 per cent felt overwhelmed by anxiety.
An increase in mental ill health among the student population has been reported across the globe. For example Bayram and Bilgel (2008) from a study of Turkish university students and Nerdrum et al. (2006) from a study of Norwegian first year undergraduates found a high prevalence of mental ill health. Stallman, (2010) conducted a survey of 6479 students from two large Australian universities and found psychological distress experienced by students was significantly higher than amongst the general population. In contrast, Blanco et al. (2008) used data from a US National Epidemiological Survey to examine the prevalence of mental health labels of college students and their non-college peers. While they found mental ill health across both groups to be equal, they did find bipolar disorder to be less common among the student population.
The literature tells us little about the extent of mental health labels among students studying healthcare subjects, compared to other higher education courses and disabilities. However, Shrewsbury (2015) does acknowledge that disabilities as a whole are under-represented in medical education. There are no studies which suggest that the occurrence of mental health conditions among students studying nursing and midwifery programmes are any higher or lower than the general student population. However, research both in the UK (Cleary et al., 2012; RCN, 2013) and internationally (Ahmadi et al., 2004; Mowbray et al., 2006) have reported high numbers of nursing and midwifery students experiences of stress and mental ill health. Nursing
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and midwifery students may start their education with anxiety and/or depression, eating disorders and substance use disorders (Mowbray et al., 2006; Cleary et al., 2012). Students may also experience mental distress for the first time during their nursing and midwifery education (Cleary et al., 2012; Riddell and Weedon, 2014).