Developing a student mental health policy for a South African university: Consultation, contestation and compromise

  • D. Kaminer University of Cape Town
  • N. Shabalala

Abstract

Given high rates of student mental health difficulties globally, the need for universities to have a student mental health policy has been increasingly recognised. In the South African context, such policies must not only balance the mental health needs of students with the realistic constraints of university resources in a time of austerity, but also engage with complexities posed by the Global North foundations of the fields of psychology and psychiatry and the systemic determinants of mental health. This article describes the development of a student mental health policy at a South African university, with a focus on points of contestation that emerged out of a broad-based institutional consultation process. Areas of contestation included the scope of university support for student mental health, defining mental health difficulties, the use of a disability framework for mental health, and processes of verification. All of these were embedded within a broader tension between health and social justice discourses. The compromises that were designed to balance these complexities within the student mental health policy are discussed, and reflections are offered that may inform the development of student mental health policies at other South African universities.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5). Washington, D.C.: American Psychiatric Association.

Auerbach, R. P., Alonso, J., Axinn, W., Cuijpers, P., Ebert, D., Green, J., . . . Mortier, P. (2016). Mental disorders among college students in the World Health Organization world mental health surveys. Psychological Medicine,46(14), 2955-2970.

Bantjes, J. R., Kagee, A., McGowan, T., & Steel, H. (2016). Symptoms of posttraumatic stress, depression, and anxiety as predictors of suicidal ideation among South African university students. Journal of American College Health, 64(6), 429–437. doi:10.1080/07448481.2016.1178120

Bion, W. R. (2018). Second thoughts: Selected papers on psychoanalysis. London: Routledge.

Bozzoli, B. (2015) Behind the university funding crisis. Retrieved from http://www.politicsweb.co.za/news-and-analysis/behind-the-university-funding-crisis on 3rd May 2019.

Bracken, P., Giller, J., & Summerfield, D. (2016). Primum non nocere. The case for a critical approach to global mental. Epidemiology and Psychiatric Sciences, 25, 506-510.

Brooks, E. (2019). Criminalising students who protest(ed)- do we care? A student affairs practitioner’s perspective. Paper presented at the University of Cape Town Teaching and Learning Conference, University of Cape Town, July 2019.

Brown, J. S. L. (2018) Student mental health: Some answers and more questions, Journal of Mental Health, 27(3), 193-196. doi:10.1080/09638237.2018.1470319

Bulhan, H. (2015). Stages of colonialism in Africa: From occupation of land to occupation of being. Journal of Social and Political Psychology, 3(1), 239-256. doi:10.5964/jspp.v3i1.143

Constitution of the Republic of South Africa, 10 December 1996. Retrieved from http://www.justice.gov.za/legislation/constitution/SAConstitution-web-eng.pdf on 7th May 2019.

Cornell, J., & Kessi, S. (2017). Black students’ experiences of transformation at a previously “white only” university: A photovoice study. Ethnic and Racial Studies, 40(11), 1882-1899. doi: 10.1080/01419870.2016.1206586

Dolmage, J. T. (2017). Academic ableism: Disability and higher education. Ann Arbor, MI: University of Michigan Press.

Eisenberg, D., Golberstein, E., & Hunt, J. B. (2009). Mental health and academic success in college. The B. E. Journal of Economic Analysis and Policy, 9(1), Article 40. doi:10.2202/1935-1682.2191

Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534-542. doi:10.1037/0002-9432.77.4.534

Employment Equity Act Revised Draft code of Good Practice for the Employment of Persons with Disabilities (12th June 2015). Retrieved from http://www.labour.gov.za/DOL/downloads/legislation/Codes%20of%20Good%20Practice/employment-equity/Code%20of%20Good%20Practice%20on%20Key%20Aspects%20on%20the%20Employment%20of%20People%20with%20Disabilities.pdf on 7th May 2019.

Evans,T. M., Bira, L., Gastelum, J. B., Weiss,L. T., & Vanderford, N. L. (2018). Evidence for a mental health crisis in graduate education. Nature Biotechnology, 36(3), 282-284.

Faculty of Health Science Students (2016). Demands made by the students of the Faculty of Health Sciences on Tuesday, 20th September 2016. Retrieved from https://vula.uct.ac.za/access/content/group/25f04c1d-1bf4-497a-bdb5-e12357b066ef/Test/1.%20Undergraduate%20Health%20Science%20Faculty%20Student%20Demands.pdf on 19th May 2019.

Fanon, F. (1991). Black skin, white masks. New York: Grove Weidenfeld.

Frances, A. (2013). Saving normal: An insider's revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life. New York: Willaim Morrow.

Frances, A. J. & Widiger, T. (2012). Psychiatric diagnosis: Lessons from the DSM-IV past and cautions for the DSM-5 future. Annual Review of Clinical Psychology, 8, 109-130. doi: 0.1146/annurev-clinpsy-032511-143102

Gallagher, R. (2014). National survey of counseling center directors. Alexandria, VA: National Association of Counseling Services. Retrieved from http://d-scholarship.pitt.edu/28178/1/survey_2014.pdf on 3rd May 2019.

Goodley, D. (2018). Understanding disability: Biopsychology, biopolitics, and an in-between-all politics. Adapted Physical Activity Quarterly, 35(3), 308-319. doi:10.1123/apaq.2017-009

Grech, S. (2015). Decolonising Eurocentric disability studies: Why colonialism matters in the disability and global South debate. Social Identities, 21(1), 6-21. doi:10.1080/13504630.2014.995347

Institutional Reconciliation and Transformation Commission (IRTC) of the University of Cape Town (2019, March). Final Report. Retrieved from https://www.news.uct.ac.za/downloads/irtc/IRTC_Final_Report_2019.pdf on 13th May 2019.

Insel T. (2013, 29th April). Director’s blog: Transforming diagnosis. Retrieved from www.nimh.nih.gov/about /director/2013 /transforming-diagnosis.shtml on 13th May 2019.

Kirmayer, L., & Gold, I. (2012). Re-socializing psychiatry: Critical neuroscience and the limits of reductionism. In S. Choudhury & J. Slaby (Eds.): Critical neuroscience: A handbook of the social and cultural contexts of neuroscience (pp. 307–330).Wiley-Blackwell: Chichester

Kirmayer, L. J., & Pedersen, D. (2014). Toward a new architecture for global mental health. Transcultural Psychiatry 51, 759–776. doi:10.1177/1363461514557202

Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27, 99-110.

LaFrance, M. N. & McKenzie-Mohr, S. (2013). The DSM and its lure of legitimacy. Feminism and Psychology, 23(1), 119-140. doi:10.1177/0959353512467974

Lopez, M. F., Compton, W. M., Grant, B. F., & Beiling, J. P. (2007). Dimensional approaches in diagnostic classification: A critical appraisal. International Journal of Methods in Psychiatric Research, 16(S1): S6–S7. doi:10.1002/mpr.213

Lund, C., Kleintjes, S., Kakuma, R., & Flisher, A. J. (2010). Public sector mental health systems in South Africa: Inter-provincial comparisons and policy implications. Social Psychiatry and Psychiatric Epidemiology, 45(393), 393-404. doi:10.1007/s00127-009-0078-5

Lund, C., Myer, L., Stein, D. J., Williams, D. R., & Flisher, A. J. (2013). Mental illness and lost income among adult South Africans. Social Psychiatry and Psychiatric Epidemiology, 48(1), 845–851. doi:10.1007/s00127-012-0587-5

Mabasa, N. (2018, October 28). Suicide on campuses: Spate of deaths raises alarm. Retrieved from https://www.google.co.za/amp/s/www.dailymaverick.co.za/article/2018-10-28-suicide-on-campus-spate-of-deaths-raises-alarm/amp/ on 19th May 2019.

Martín-Baró, I. (1994). Writings for a liberation psychology. Cambridge, MA: Harvard University Press.

Murphy, D. (2015). "Deviant deviance": Cultural diversity in DSM-5. In S. Demazeux & P. Singy (Eds.), History, philosophy and theory of the life sciences: Vol. 10. The DSM-5 in perspective: Philosophical reflections on the psychiatric Babel (pp. 97-110). New York, NY, US: Springer Science + Business Media.

Mills, C. (2015). The psychiatrization of poverty: Rethinking the mental health-poverty nexus. Social and Personality Psychology Compass, 9(5), 213-222. doi:10.1111/spc3.12168

Ngubane, P. (2019). Mental health difficulties associated with re-admission appeal applications at the University of Cape Town. Unpublished masters dissertation.

Oxford University (2017, December). Student mental health policy. Retrieved from http://www.ox.ac.uk/sites/files/oxford/field/field_document/Student%20Mental%20Health%20Policy%20-%20PDF%20Version.pdf ) on July 18th 2016.

Patel, V. (2012). Global mental health: From science to action. Harvard Review of Psychiatry, 20, 6–12. doi:10.3109/10673229.2012.649108

Patel, V. (2014). Why mental health matters to global health. Transcultural Psychiatry, 51, 777–789. doi:10.1177/1363461514524473

Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., …van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370, 991–1005. doi:10.1016/S0140-6736(07)61240-9

Prince, M. J., Rahman, A., Mayston, R., & Weobong, B. (2014). Mental health and the global health and development agenda. In: V. Patel, H. Minas, A. Cohen, & M. J. Prince (Eds.), Global mental health: Principles and practice (pp. 102-115). New York: Oxford University Press.

Promotion of Equality and Prevention of Unfair Discrimination Act, 2 February 2000. Retrieved from http://www.justice.gov.za/legislation/acts/2000-004.pdf on 7th May 2019.

Rhodes Must Fall Movement (RMF; 2015). UCT Rhodes Must Fall mission statement. Retrieved from http://www.jwtc.org.za/resources/docs/salon-volume-9/RMF_Combined.pdf on 8th May 2019.

Samuels, E. (2014). Fantasies of identification: Disability, gender, race. New York: New York Univesity Press.

Shifrer, D. (2013). Stigma of a label: Educational expectations for high school students labeled with learning disabilities. Journal of Health and Social Behavior, 54(4), 462-480. doi:10.1177/0022146513503346

Orem, S., & Simpkins, N. (2015, December 16). “Weepy rhetoric, trigger warnings, and the work of making mental illness visible in the writing classroom.” Retrieved from http://enculturation.net/weepy-rhetoric on May 13, 2019.

Strategic Policy Framework on Disability for the Post-School Education and Training System (March, 2018). Retrieved from http://www.dhet.gov.za/SiteAssets/Gazettes/Approved%20Strategic%20Disability%20Policy%20Framework%20Layout220518.pdf on 7th May 2019.

Summerfield, D. (2002). ICD and DSM are contemporary cultural documents. British Medical Journal, 324, 914. doi:10.1136/bmj.324.7342.914/b

Swartz, S., Mahali, A., Moletsane, R., Arogundade, E., Khalema, E. N., Cooper, A., & Groenwwald. C. (2018). Studying while black: Race, education and emancipation in South African universities. Cape Town: HSRC Press.

Thomas, C. (2007). Sociologies of disability, ‘impairment’, and chronic illness: Ideas in disability studies and medical sociology. London: Palgrave.

Titchkosky, T., & Aubrecht, K.(2009). The anguish of power: Remapping mental diversity with an anticolonial compass. In A. Kempf (Ed.), Breaching the colonial contract: Anti-colonialism in the US and Canada (pp. 179-199). Dordrecht: Springer.

Tol, W. A. (2015). Stemming the tide: Promoting mental health and preventing mental disorders in low- and middle-income countries. Global Mental Health, 2(11). doi:10.1017/gmh.2015.9

United Nations General Assembly (2007). Convention on the Rights of Persons with Disabilities : resolution / adopted by the General Assembly, 24 January 2007, A/RES/61/106. Retrieved from https://www.refworld.org/docid/45f973632.html on 7th May 2019.

Universities UK (2015). Student mental well-being in higher education: Good practice guide. Retrieved from https://www.universitiesuk.ac.uk/policy-and-analysis/reports/Documents/2015/student-mental-wellbeing-in-he.pdf on 15 May 2019.

University of Calgary (n.d.). Campus mental health strategy. Retrieved from https://www.ucalgary.ca/provost/files/provost/15-unv-018-mental_health_strategy_final.pdf on 19th July 2016.

University of Cape Town (2018). Transformation report 2018. Retrieved from https://www.news.uct.ac.za/images/userfiles/downloads/media/2018-UCT-Transformation-Report.pdf on 3rd May 2019.

University of Western Australia (2015). University policy on mental health. Retrieved from http://www.hr.uwa.edu.au/policies/policies/equity/mental-health on 19th July 2016.

Watters, E. (2010). Crazy like us: The globalisation of the American psyche. New York: Free Press.

Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V., & Vos, T. (2015) The global burden of mental, neurological and substance use disorders: An analysis from the Global Burden of Disease Study 2010. PLoS ONE 10(2): e0116820. doi:10.1371/journal.pone.0116820

Whitley, R. (2015). Global mental health: Concepts, conflicts, controversies. Epidemiology and Psychiatric Services, 24, 285-291. doi:10.1017/S2045796015000451

World Health Organization (2002). Prevention and promotion in mental health. Geneva: World Health Organization.

World Health Organisation (2005). Mental health: Facing the challenges, building solutions. Report from the WHO European Ministerial Conference. Copenhagen, Denmark: WHO Regional Office for Europe.

World Health Organization (2010). mhGAP intervention guide for

mental, neurological and substance use disorders in non-specialized health settings. Geneva, Switzerland.

World Health Organization (2013). Mental health action plan 2013–2020. WHO: Geneva, Switzerland.

Xiao, H., Carney, D. M., Joun, S. J., Janis, R. A., Castonguay, L. G., Hayes, J. A., & Locke, B. D. (2017). Are we in crisis? National mental health and treatment trends in college counseling centers. Psychological Services, 14(4), 407-415. doi: 10.1037/ser0000130

Published
2019-11-26
How to Cite
Kaminer, D., and N. Shabalala. 2019. “Developing a Student Mental Health Policy for a South African University: Consultation, Contestation and Compromise”. South African Journal of Higher Education 33 (5), 196-212. https://doi.org/10.20853/33-5-3597.