South African Journal of Psychology 1–12 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav https://doi.org/ DOI: 10.1177/0081246317731958 journals.sagepub.com/home/sap
Contested meanings of mental health and well-being among university students
Article
Vinitha Jithoo
Abstract Emerging adults are an important group not only because their opinions and knowledge will determine future attitudes but also because of the emergence of mental health problems during young adulthood. In order to provide relevant support, academics, health care providers as well as policy makers need to be more cognisant of how emerging adults make meaning of their psycho-social developmental context. The objective of the study was to explore how a cohort of 150 university students made meaning of emotional well-being and mental illness, the causes of mental health problems, the negative connotations associated with mental ill health, help-seeking behaviours, and how culture was used as a lens through which mental well-being was understood. The main findings indicate that students struggle to fully understand these concepts mainly because it is shrouded in mystery and complexity and not engaged with freely because of stigma and stereotypical attitudes, and while culture provides a lens to understand the causes and interventions, emerging adults often adopt a level of scepticism and are beginning to vacillate between tradition and modernity. Emerging adults face many barriers to accessing health care services including limited knowledge and stigma related to services, lack of confidentiality, fear of mistreatment, location of facilities, and the high cost of services. Universities and government should actively engage with research evidence to inform policies and programmes to improve the health and well-being of emerging adults. Keywords Emerging adults, emotional well-being, help-seeking, mental health, stigma.
Department of Psychology, School of Human and Community Development, University of Witwatersrand, Johannesburg, South Africa Corresponding author: Vinitha Jithoo, Department of Psychology, School of Human and Community Development, University of Witwatersrand, Johannesburg, Private Bag 3, Wits, 2050 Johannesburg, South Africa. Email:
[email protected]
2
South African Journal of Psychology 0(0)
Kabiru, Izugbara, and Beguy (2013) argue that while youth in sub-Saharan Africa are growing up in challenging contexts, not enough is known about health seeking and health utilisation behaviours; hence, research is needed to understand the issues which confront emerging adults in order to provide programmes and policies to improve their health. Emerging adults are an important group not only because their opinions and knowledge will determine future attitudes but also because of the high prevalence of mental health problems in childhood and adolescence (Smith, 2002). A longitudinal study conducted by Copeland, Shanahan, Costello, and Angold (2011) found that by their 21st birthday, three out of five young adults meet the criteria for a well-specified psychiatric disorder. Hunt and Eisenberg (2010) contend that despite university students having a privileged status, they are not immune from the suffering and disability of mental illness. They report that male undergraduates are at a higher risk for suicide, while females tend to have a higher prevalence of depression and anxiety disorders. Whitlock, Eckenrode, and Silverman (2006) examined the prevalence, forms, and demographic and mental health correlates of self-injurious behaviours in a representative college sample and found that a substantial number of students reported self-injurious behaviours in their lifetimes, which was correlated with a history of abuse and comorbid adverse health conditions. Academic stressors have typically included examinations, time management, and adjustment to the university environment, but Andrews and Wilding (2004) found that while university life had a positive impact on some students with pre-existing conditions, they also confirmed that financial and other difficulties contributed to increased levels of anxiety and depression among British students. These difficulties had a negative impact on academic performance. A study by Letseka and Breier (2008) found that student poverty was the highest ranked reason for dropping out of university by Black South African students. They reasoned that in the context of historical social and political factors, lack of finances should be considered a major stress factor among disadvantaged students in South Africa. There is substantial and growing evidence that developing social and emotional capabilities in young adults supports the achievement of positive life outcomes, including educational attainment, employment, and health (Andrews & Wilding, 2004; Hunt & Eisenberg, 2010). Most mental health problems, although treatable, are usually not timeously identified or formally diagnosed (Hunt & Eisenberg, 2010). Health promotion specialists need to be sensitive to lay beliefs and meanings of health and illness and the complex interplay between health and culture (Mehrotra, Tripathi, & Elias, 2013). University campuses by their scholarly nature can play a pivotal role in health promotion. Patel, Flisher, Hetrick, and McGorry (2007) describe young people as emerging adults between 12 and 24 years who are sexually mature, in the final stages of their educational career, or in the early stages of their employment career and embarking on several socially accepted adult pursuits, including finding and keeping a job, romantic relationships, and in some cultures using alcohol and tobacco, thus they contend that well-being is generally based on the perceived successes and difficulties in negotiating the developmental tasks of this period. Patel et al. (2007) suggest that mental health and substance use disorders are the major health problems of emerging adults, which account for most of their disability. However, the use of mental health services is generally very low (Vanheusden et al., 2008). Arnett, Žukauskienė, and Sugimura (2014, p. 569), p. 569), p. 569) contend that it is a useful heuristic for clinicians and mental health service providers to distinguish emerging adulthood from adolescence because treating these ‘individuals as adolescents underestimates their capacities for self-direction, self-reflection and independent living’. They describe this unsettled phase as characterised by identity explorations, self-focus, feeling in-between, and possibilities or optimism. Arnett et al. (2014) found that depression and anxiety often occurred during this phase and was generally associated with identity explorations which may have been daunting
Jithoo 3 and confusing especially for individuals who felt that their choices in love relationships and work was unattainable. Instability in love, work, and living independently also reduced social support and increased reliance on virtual support; and feeling in-between, namely those individuals who believed that they should feel more adult at their age than they actually were. Schulenberg, Bryant, and O’Malley (2004) examined continuity and discontinuity of normal developmental tasks during the transition to adulthood. They assert that the transition is associated with new roles and opportunities to flourish, in contrast to the sometimes stifling experiences of high school, but there is discontinuity in the form of reversals which occur in some emerging adults who may have been functioning well during adolescence. The changing ecology of childhood and family relationships (divorce; single-parent households, redefined gender roles, a more individualistic outlook on life); socio-demographic changes (parental unemployment and joblessness; poverty); health issues (such as HIV and AIDS, hypertension, and cardiovascular diseases); substance abuse; the incarceration of young mothers and fathers; trauma and violence are significantly associated with well-being and mental health of young people (Jithoo & Bakker, 2011). Therefore, emerging adults are living, learning, and negotiating transitions to adulthood and independence in an increasingly complex and challenging world, in which they face ever increasing levels of choice and opportunity, but also unprecedented uncertainty and risk. This calls for empowered, resilient young people, who play an active role in navigating these paths. Hunt and Eisenberg (2010) assert that mental health among college students represents not only a growing concern but also an opportunity, because of the large number of people who could be reached during an important period of their life.
Method This qualitative study adopts a contextualist method and draws on the phenomenological approach to privilege university students’ subjective meanings and experiences about mental health and emotional well-being. According to Cresswell (2007), the transcendental or psychological phenomenology approach developed by Moustakas in 1994 entails the inquirer collecting data from persons who have experienced the phenomena in order to develop a composite description of the essence of the experience for all the individuals. The phenomena of interest at university level is to ascertain students’ understandings, attitudes, and beliefs about mental health and mental illness because this will provide a lens into how they experience and express their own psychological distress and how they disclose these symptoms and manage them. The objective of the study was to explore how a cohort of 150 university students made meaning of emotional well-being and mental illness, the causes of mental health problems, the negative connotations associated with mental ill health, help-seeking behaviours, and how culture was used as a lens through which mental well-being was understood. Such insights will assist academics and mental health professionals to rethink and reframe strategies to address their potential support needs.
Participants A total of 182 students, who were registered for a third year module in Child and Adolescent Psychology at the University of Witwatersrand, were given the brief to interview a fellow student from any faculty between the ages of 18 and 21 years. They were specifically asked to refrain from interviewing family members and fellow students who were currently registered for a psychology module. This was to elicit lay meanings without the benefit of theoretical exposure to the field of Psychology. Of the 182 interviews conducted, only 150 were used in the study, with 32
4
South African Journal of Psychology 0(0)
interviews having to be excluded, as those interviewers failed to adhere to the guidelines provided. The recruitment of participants was only influenced by their willingness to participate and their availability. The final sample comprised 90 females and 60 males and ranged in age from 19 to 21 years (mean age, 20.7 years). Many of the students were Black (64%) and endorsed a range of religious and ethnic affiliations. Interestingly, the majority (88%) of students were also in their third year of study for an undergraduate degree.
Instruments A semi-structured interview schedule based on a literature review was used and included following questions: What comes to mind when you hear about ‘mental health’ or ‘emotional well-being’? How do you understand the causes or contributors of mental health and ill health? What resources currently exist to address problems? Who would you consult if you had a problem? What prevents people from seeking help? What negative attitudes exist about mental illness? How is mental illness understood from a cultural perspective?
Procedure This study was limited to exploring the lay meanings of mental health and well-being in a sample of South African university students. Role playing and class discussions (prior to and after the interviews) were used as training methods to ensure all students adhered to the same interview schedule and recording format. The majority of these students were very enthusiastic and enjoyed performing the task. They felt that this had given them a snapshot into the applied psychology domain. The obvious advantages of being interviewed by one’s peers were that it allowed an exploration of personal experiences and attitudes in greater privacy; the conversation was uninhibited and flowed fairly easily and participants did not feel anxious about revealing their honest attitudes and perceptions about the topic, their stereotypes, and how they experienced other adults. All interviews were recorded verbatim, transcribed, and subject to analysis.
Ethical considerations Ethical clearance was obtained from the University of Witwatersrand and all parts of the research complied with these ethical standards. Participation in the study was voluntary, with the option to withdraw at any stage and written informed consent was sought from each participant prior to data collection. Student interviewers explained the purpose of the project and the boundaries of confidentiality were agreed.
Data analysis The interviews were recorded and transcribed verbatim. All the audio recordings and transcripts were checked to ensure that the data were trustworthy and conformed to the guidelines. The procedures for data collection and reduction identified by Moustakas consist of identifying a phenomenon to study, bracketing out one’s experiences, analysis of the data by reducing it to statements
Jithoo 5 or quotes, combining statements into themes, developing a textual description, developing a structural description, and a combination of textual and structural description to convey the essence (Cresswell, 2007).
Results The data analysis revealed some interconnectedness between making meaning of positive and negative emotions and behaviours, psychological risk taking and self-soothing as a means of coping, the strong influence of stereotypes and stigma, and difficulty in accepting and accessing appropriate emotional support. The main findings are condensed as follows: Unpacking mental health; It’s too complicated; Who can be trusted.
Theme 1: unpacking mental health The study found that most participants conflated the concepts ‘mental health’ and ‘mental illness’ and consistently used them interchangeably. Mental health was seen on a continuum, with the major emphasis on the polar ends. Many of the participants focussed solely on the word ‘mental’ and associated it with ‘mental illnesses’ – with the causes of mental illness being understood as emanating from brain dysfunction either during birth or from trauma to the head later in life, as well as being inherited. There was a strong belief that mental illness is a phenomenon rooted in physiology with long-term negative implications. Mental illness was described as being characterised by sudden changes in mood, poor decision-making skills, living in poverty, and irrationality and impulsivity. Some participants defined it as the opposite of mental illness with the capacity to be rational, to make good decisions, and to have good physical and psychological balance. A few participants felt that these terms were confusing, linguistically problematic and resulted in associative thinking that signalled pathology. Some students also felt that the colloquialisms such as ‘you must be crazy’ and ‘moron’ played a role in developing negative attitudes towards people with mental illness and learning disabilities: They have a chemical imbalance and split personalities, something went wrong in the brain, or radiation and pollution, a bad living environment, living in dirty areas, an unstable mind, unable to make logical decisions, things change from happy to something completely different such as anger, upset or depression, bullying and sometimes physical damage to the body can sometimes cause it. (Participant 4)
A range of jargon commonly used by the biomedical models to label psychopathology was identified including schizophrenia, bipolar affective disorder, depression, anorexia, bulimia, and attention-deficit hyperactivity disorder. Emerging adults living in South Africa are acutely aware of traumatic stress associated with crime, rape, and violence as many students have either been victims or had family members who had fallen victim to such incidents. Interestingly, the dominant narrative was that this is ‘normal’, transitory, and more acceptable than any other emotional difficulties. Many participants reported that there were fewer stigmas attached to receiving psychological assistance for trauma-related emotional difficulties. There was a common misconception that mental illness impacted mainly adolescents and geriatrics during periods of transition. Adolescence is viewed as a challenging period for many
6
South African Journal of Psychology 0(0)
teenagers, characterised by emotional difficulties during their quest for individuation and identity development. Old age was considered to be characterised by cognitive decline, disorientation, and dementia resulting from brain pathology associated with ageing. The linear understanding exhibited by most students either reflects their attempt to be concrete in communicating about a topic they felt ill equipped to handle or a genuine struggle with depth of the topic: The teenage period is the time teenagers want to be in relationships and want to go out a lot, they want to experiment, but when it goes wrong they feel hurt, sad and rejected, and it leads to mental disorders, . . . well old people, their brain cells die and they do some funny things. (Participant 44)
Ironically, the challenges (careers, financial independence, settling into relationships, etc.) associated with the transition to adulthood were not conceptualised as potential adjustment difficulties that may require professional support. It was believed that engaging in academic endeavours acted as a buffer against possible emotional upheaval. The use of substances, especially alcohol, was constructed as one of the main coping resources to ease the strain of emotional difficulties associated with an increased workload and greater independence. Mental illness was considered to be masked and hidden. Students struggled with the intangible and illusory nature of mental health. This resulted in mystery and misunderstanding. For many students, it aroused a deep sense of fear and uncertainty. Many felt that it was difficult to identify before it reached crisis proportions; it often felt that there was a linear relationship between depression and suicide; there was also a sense of contagion by association and the most terrifying aspect was that this signalled a catastrophic demise of a premorbid lifestyle. Thus, the perception that recovery and a ‘normal’ lifestyle were impossible. The disease model is very strongly perpetuated by students. Accordingly, mental health or ill health was difficult to appreciate especially in the absence of an identifiable infection and overt injury: Mental illness is treated like a contagious disease; it’s a disease without a voice. Mental illness is one Goliath that no one wants to tackle. (Participant 27)
The aetiology and treatment of mental health problems was also discussed in a dichotomised manner with physical, economical, and psycho-social factors being clustered together and cultural factors seen as independent and unique. From a cultural perspective, mental health problems were understood to occur when the ancestors were communicating unhappiness and displeasure (often problems in children was a sign that a parental figure had caused a problem) or as a result the practice of demonism and witchcraft or the calling to be a healer. The intervention would then entail the ritual sacrifice of an animal and a prayer, drinking of traditional medicine or muti, and repentance. Although many emerging adults shared the same ethnicity as their parents, they adopted a more critical stance and questioned many customary practices. While there was a strong awareness of cultural rituals, the majority of the students felt that they could no longer subscribe to these understandings and disputed those healing methods: They believe you are possessed by evil spirits; I think that there is a level of irrationality, it has never been proven that witchcraft exists, it’s a very complex concept, education gets you out of the woods with regards to religion, I feel like demons are invented by pastors. (Participant 32)
Jithoo 7
Theme 2: this is too complicated During young adulthood, introspection and insight development does not appear to take precedence over one’s identity and social location. Thus, many students admitted to being too embarrassed to admit something was wrong. In the face of emotional turmoil, denial was often a frequently employed defence mechanism. This obviously worked in the short term, but the long-term ramifications were not considered. Ego development was further expressed through gender disparities. Most male students held a stereotypical conception of masculinity and therefore any form of emotional vulnerability was constructed as a sign of weakness: . . . being a guy, I would not consult anyone due to feelings of failure, being seen as incompetent and loosing pride, it is easier to ignore one’s issues, the prospect of discrimination, social isolation and other stigmas that go along with mental health, . . . psychiatry is a joke, seeking help from a professional compromises manhood. (Participant 7)
Female students, on the other hand, had mixed feelings about seeking psychological help, but were more willing than their male counterparts to receive professional services if the need arose. The majority were resistant, again because of the fear of stigma and social exclusion from peer groups. Interestingly, having an emotional problem was also seen as tarnishing one’s beauty. There was a very strong conception that admitting to emotional difficulties also depreciates the self-concept and lowers the social worth of an individual. Most students struggled with empathy and not only subscribed to but also perpetuated the stigmas towards people in need of psychological help. Alienation and discrimination was the most common reaction towards people who were considered mentally ‘unhealthy’: I know a lot of people, even my friends and family who will point at and make degrading comments about people with mental disorders, these people won’t even start a conversation if they thought someone was weird in that way, so they will definitely not be friends. (Participant 42)
Many students also reported that the stigma of having a mentally and sometimes physically disabled person in their family resulted in strong ostracism and social exclusion. Thus, as a coping mechanism, these family members were hidden from the public gaze: For many Black families a huge stigma is attached if they have a child with a disability. In my hometown, individuals with mental problems are built a small cottage at the back of the house; they are left to stay there as they are a threat to society, an embarrassment to the home and capable of harming members of the house. (Participant 11)
Theme 3: who can be trusted? While many students had some knowledge of mental health, they felt unsure and often insecure discussing this topic. This was largely attributable to their sources of knowledge not being as trustworthy and an absence of mental health awareness campaigns reaching young adults. Although students were aware of campus resources, most of them were convinced that these services were only appropriate for serious mental health issues: . . . there is no public awareness, we are a 3rd world country, the government doesn’t care, in London and America people go to psychologists and psychiatrists and its ok, maybe our government thinks by having
8
South African Journal of Psychology 0(0) awareness campaigns, more people will come forward, they did the same thing with condoms, they didn’t want to promote it to school children because they thought it will make them more active. I don’t think that many resources exist here, even books, magazines and just educating the youth where to go for help, are not readily available here. (Participant 52)
. . . when I see those pamphlets on campus advertising, I conclude in my head that they are meant for people who are unable to deal with stress, people who are on the edge of being crazy, I simply think about lunatics and insanity. (Participant 68) The major sources of information were from movies and documentaries, very few students had encountered friends or family who were clinically diagnosed, and even fewer admitted to experiencing trauma, episodic depression, or an anxiety disorder. Hence, most university students have a negative conception of mental health and stereotypes and stigma seem to play a role in shaping these ideas: In the movies mentally ill people are always the ones who are suffering, isolated, have no friends, their family disown them, they can’t hold a job, they are outcasts of society, they cannot love someone, and they are prone to becoming serial killers, rapists, and deviants in society, as they are not 100% in their brain. (Participant 26)
Trust and confidentiality were considerations when it came to help-seeking behaviours. Many emerging adults felt that divulging emotional pain may be very sensitive and hence they would require assurances that information which had the potential to damage their self-concept and lower their self-esteem will be protected. This issue was a possible source of conflict and neither family nor friends came with the necessary ethical obligations of confidentiality. Some friendships have an expiry date and once this bond was severed there were no guarantees. The general attitude was that many adults, by virtue of their adult status, lacked understanding and compassion in respect of issues pertaining to this life stage and could not be trusted. Some students had negative experiences with campus health staff and felt they were judged, especially when they consulted on matters pertaining to sexual health. These attitudes left many emerging adults to their own resources to work out adjustment difficulties. Students expressed some anxiety about consulting psychologists and psychiatrists mainly because of the stigmas perpetuated by society and very importantly because they felt that these services required individuals to relinquish complete control of their personhood. However, those students who had been exposed to the helping professions either personally or through secondary exposure had positive experiences and would not hesitate to seek help if the need arose: . . . even friends can’t be trusted with confidentiality, especially when you fall out or fight. (Participant 13)
. . . if I had a problem I would definitely keep it to myself, youth are not comfortable talking to adults because they are always being pushed away . . . youth struggle with trust issues as we are all so self-conscious and care too much what others think of us. (Participant 10) There was a definite desire for more accurate information and the normalisation of mental health, especially within the home context. Mental health discourses were at times reduced to narrow conceptualisations and overgeneralisations based on racial affiliation, with some students attributing the poor mental health literacy in their homes to a level of ignorance, a sign of weakness, or a cultural narrative which makes meaning of it either a gift or a curse:
Jithoo 9 Black people are not open to the idea of having mental illnesses . . . if a white family had a problem child they would immediately take them to a doctor and have a psychological test done, whereas Black parenting styles are a lot sterner. It’s like you are acting out, you get a hiding, and ‘man up’ and carry on, White people are very whiny, in my circle of White friends many of them have bipolar and depression and these different kinds of illness. (Participant 45)
As a consequence, most students would only consult their parents for support when all their other resources such as friends, peers, and professionals were completely exhausted: I will definitely not go to my parents again, for them issues such as depression do not exist, in my community mental illness is looked at in a very harsh and ignorant way . . . people jumping to conclusions that they are unaware and naive about, mental illness is never addressed but a figment of your imagination. (Participant 23)
. . . not a lot of people have a relationship with their parents where you can tell them everything, you can’t discuss every element of life and struggles with them as some topics are censored, they also do nothing to show me that I have their support, they say to me, you should go see a doctor. (Participant 1) There was also the perception that psychologists and psychiatrists were mainly there to service White people as many students had not seen these professional services located in their residential areas. There is a common belief that township youth give vent to their emotional turmoil by gravitating towards criminality and substance abuse and that the lack of appropriate psychological services may be responsible for some of the deviant behaviour in these communities. This further perpetuates the linear causality between poverty, crime, and deviance. The legacy of apartheid and population stratification and the limited accessibility of health care services especially in townships are still being experienced in South Africa two decades after democracy. Many students felt that mental health care was very expensive and not easily accessible unless they belonged to a medical health insurance scheme and could access it privately: . . . before varsity, I thought psychologists were only for White people. Black people are going through so much real suffering and psychologists are dealing with White people who are sad over a divorce. (Participant 54)
My brother lives in Diepsloot, and during my vacation in that community I have never come across a centre or group designed to help people deal with their life stressors, instead if one feels overwhelmed their first resort is alcohol or tobacco, the youth are engaging in criminal activities and nyaope. (Participant 44) In contrast, the visibility of Jewish mental health services in some communities was acknowledged as helping to normalise and accept mental health difficulties and contributed to mental health literacy for some students: I don’t think that White upper class Jews have a bad perception of mental health issues . . . they’re all neurotic and understand anxiety, Jewish youth understand anxiety as there is a lot a pressure for privately educated kids to do brilliantly at everything. (Participant 27)
In the Jewish community people look out for their society, we have structured support such as a home for the mentally challenged, an orphanage and a school for children with special needs. I am
10
South African Journal of Psychology 0(0)
involved in a group called ‘Friendship Circle’, twice a week we visit our friend, but there is still a weird vibe going to these places or even talking about them. (Participant 11)
Discussion Consistent with this study, Hinshaw (2005) found that the media played a role in conveying negative messages about mental health problems and these serve as a primary source of information for emerging adults. Hence, from theme 1, it is apparent that students struggled to consistently distinguish between mental health and mental illness and thus a general culture of silence exists around these topics. Hinshaw (2005) argues that the science of some areas of mental health appears to be conceptually very confusing and imprecise, hence most students viewed mental health from a biomedical perspective and neglected the more holistic and contemporary definitions which include subjective well-being, environmental mastery, and emotional regulation. The gaze on mental illness served to distract students away from mental health. They thus struggled to conceptualise the transactional relationships between individuals and other contextual and environmental factors. It is evident from theme 1 that the conceptualisation and expression of mental distress varied across the student cohort; it is possible that these views may have been instrumental in shaping students ideas about the coping resources and appropriate services. Consistent with the current findings, Armstrong, Hill, and Secker (2000) confirmed that most students used unsophisticated mechanisms such as substance abuse, internalising feelings or bottling them up in the hope that they will go away to deal with negative emotions. Hunt and Eisenberg (2010) report that fewer than half of the students who screened positive for depression and anxiety disorders received treatment and that students with alcohol and drug use disorders were less likely than non-college-attending peers to seek treatment. Resiliency was believed to be a skill that one learns from denying, meeting, or overcoming challenges. Ignorance, stigma, and community attitudes and beliefs play an important role in help-seeking behaviour. Some societies have struggled with the impact of mental illness and faced rejection and avoidance, especially when there are alternative explanations for mental health problems. Stigma is a complex phenomenon, which can only be modified if the cultural and contextual factors facilitate these changes. It is likely that a greater variation exists between university students and their families and reflects socio-cultural transformations that challenge traditional norms and values. Emerging adults in South Africa display a mix of continuity and change reflected in the constant renegotiation with modernity and tradition. Changing beliefs and behaviours is difficult and complex and cannot be accomplished merely by imparting information, which tends to be the focus of many existing awareness campaigns. University students feared being stigmatised but also actively were the stigmatisers. The descriptions provided in theme 2 indicated that the stigma associated with mental illness was pervasive and emerged as a major challenge to one’s sense of self and humanity. Participants preferred to avoid disclosure as they feared discrimination, isolation, and a sense of shame and as a consequence most people would not seek help. Theme 3 highlights the lack of trust and poor uptake of mental health services which Vanheusden et al. (2008) attribute to the following: emerging adults not having frequent contact with a doctor because they enjoy good physical health; parental control is not as strong during this phase of life; they have limited knowledge of the signs of mental health problems in themselves and others and may therefore not personally recognise it when they are having mental health problems; and they often lack the perception that they need treatment and think that their problems will get better without intervention. In addition, mental health services are not sufficiently tailored for young adults. The other barriers to help-seeking among students include lack of time, emotional openness, being unaware of services, and scepticism about treatment effectiveness (Hunt & Eisenberg, 2010).
Jithoo 11 Gender differences have been recognised in the experience mental distress and help-seeking with female students being more willing to report mental health problems than their male counterparts. Vanheusden et al. (2008) found that young adult males were particularly likely to deny having problems, as men are less likely to translate symptoms of mental health problems into a conscious recognition of having a mental health problem. They suggest that the greater denial of problems for men may reflect different socialisation experiences with maleness characterised by independence, control, and invulnerability, thereby making it difficult to acknowledge mental health problems. It is therefore vital to address the gender differences in both mental health education and services. This study highlighted the difficulty that adults experience in providing emotional and physical safety and support. Parents were not always considered as the primary support system for emerging adults in emotional turmoil, as adults were not always empathic and tended to be dismissive and trivialise their problems. The dilemma of trust also extended to professional services. Armstrong et al. (2000) found that such an attitude may have a detrimental effect on well-being and prevented them from getting help at an early stage.
Conclusion Mehrotra et al. (2013) assert that uncovering of lay meanings provides a window of opportunity to understand what is desired and valued in a given culture or subculture. The psycho-social components of well-being are conspicuous by their absence in this study. This raises several issues worthy of further research as also a concerted attention to mental health education. Emerging adults face many barriers to accessing health care services: limited knowledge and stigma related to services, lack of confidentiality, fear of mistreatment, location of facilities, and high cost of services. Universities and government should actively engage with research evidence to inform policies and programmes to improve the health and well-being of emerging adults. Processes and health care access pathways need to be user-friendly, easily understandable, and appropriately resourced. The findings of this study provide some insights that could be used in integrating both physical and mental health promotion to deal with misconceptions, stereotypes, and stigma. Dialogue with adults needs to take cognisance of emerging adults’ understanding of concepts and support should be given irrespective of how trivial or unimportant the issues may be. Mehrotra et al. (2013, p. 296), p. 296), p. 296) suggest that using the concept of ‘fitness’ in mental health promotive programmes might have an appeal for stakeholders and reduce stigma as it may signal that such services are geared to enhance competencies and functioning. The limitation of this study is that it was conducted in one university so the findings may not be generalisable across other campuses. Given that mental health and well-being are important ingredients in academic success, universities offer a promising venue for prevention and treatment as well as greater psychoeducational efforts which could be infused in curricula. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References Andrews, B., & Wilding, J. M. (2004). The relation of depression and anxiety to life-stress and achievement in students. British Journal of Psychology, 95, 509–521. Armstrong, C., Hill, M., & Secker, J. (2000). Young people’s perceptions of mental health. Children & Society, 14, 60–72.
12
South African Journal of Psychology 0(0)
Arnett, J. J., Žukauskienė, R., & Sugimura, K. (2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1, 569–576. Copeland, W., Shanahan, L., Costello, E. J., & Angold, A. (2011). Cumulative prevalence of psychiatric disorders by young adulthood: A prospective cohort analysis from the Great Smoky Mountains Study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 252–261. Cresswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches. Washington, DC: SAGE. Hinshaw, S. P. (2005). The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 46, 714–734. Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46, 3–10. Jithoo, V., & Bakker, T. (2011). Family therapy within the African context. In Mpofu, E. (Ed.), Counselling People of African Ancestry: (pp. 142–154). New York, NY: Cambridge University Press. Kabiru, C. W., Izugbara, C. O., & Beguy, D. (2013). The health and wellbeing of emerging adults in sub-Saharan Africa: An under-researched area? BMC Internal Health and Human Rights, 13(11). Retrieved from http://www.biomedcentral.com/1472-698X/13/11 Letseka, M., & Breier, M. (2008). Student poverty in higher education: The impact of higher education dropout on poverty. In Maile, S. (Ed.), Education and poverty reduction strategies: Issues of policy coherence: Colloquium proceedings (pp. 83–101). Cape Town, South Africa: HSRC Press. Mehrotra, S., Tripathi, R., & Elias, J. K. (2013). Lay meanings of mental health in urban Indian college youth: Insights for mental health promotion. Journal of Community & Applied Social Psychology, 23, 286–299. Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: A global public-health challenge. The Lancet, 369, 1302–1313. Schulenberg, J. E., Bryant, A. L., & O’Malley, P. M. (2004). Taking hold of some kind of life: How developmental tasks relate to trajectories of well-being during the transition to adulthood. Development and Psychopathology, 16, 1119–1140. Smith, M. (2002). Stigma. Advances in Psychiatric Treatment, 8, 317–325. Vanheusden, K., Mulder, C. L., van der Ende, J., van Lenthe, F. J., Mackenbach, J. P., & Verhulst, F. C. (2008). Young adults face major barriers to seeking help from mental health services. Patient Education and , 73, 97–104. Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939–1948.
