Occupational Medicine & Health Affairs
Open Access

Mental health; Jamaica; Stress; Final year students

According to Manwell et al., mental health is the absence of mental illness as well as the condition of one's body, mind and social environment. Others have noted that mental health should include a person's "ability to adapt and to self-manage" in response to challenges, while others have defined mental health as the capacity to cope with typical life stresses and having "a state of complete wellbeing’’.

Studies have shown that up to 75% of individuals affected by mental health issues experience symptoms before 24 years of age. Thirteen thousand nine hundred eighty-four (13,948) first-year students from 19 institutions in eight different countries were surveyed as part of the World Health Organization's World Mental Health-International College Student Initiative. According to this study's findings, 4.3% of students have tried suicide at some point in their lives, 35% of first-year students express symptoms suggestive of a lifetime mental condition and 31.4% report symptoms in the past year. This represents a large portion of societies and can also be seen in America, where university students are said to make up the largest group of young people suffering from mental health problems such as anxiety and suicidal attempts due to academic stress, financial issues and career ambitions [1].

The healthy minds study found that 56% of respondents of from a sample of 62,171 college students in the United States received mental health therapy/counselling and/or psychiatric medication for depression or anxiety. Financial challenges, familial stresses, curriculum, examination and coursework demands among others, have been identified as the causes of mental health disorders in students. College students experience anxiety, tension, burnout and other problems. Students believe that there are barriers to seeking help, including a lack of support, self-stigma, ignorance, the cost of mental health care, discrimination and confidence [2]. Global research widely recognises the academic performance of students has been proven to be impacted by mental health disorders. Final-year students are a portion of this and are too affected by mental health issues. Fort students, this is a time of intense change that is crucial for university students’ transition to the world of work. As such, a significant percentage of undergraduate students have difficulties during this time.

Williams iterates that despite pressing symptoms by many young people (15-19 years), many report that they would not seek help for illnesses outside of serious ones such as schizophrenia. This reluctance is largely due to poor mental health literacy and high rates of stigma and discrimination in Jamaica. This stigmatization is also seen in mental health nursing students who associate mental illness with fear, danger and violence. It is often ignored that mental health problems affect young people's lives, especially academics, which is a big part of one’s life at that age. Many college students report that mental health difficulties impact their studies, reducing their quality of life and academic achievement [3]. This is reiterated by the American College Health Association Survey, which identifies that mental health problems negatively impact academic performance. Similarly, university students in the UK identify that one in five university students has been diagnosed with a mental health illness.

In the context of Jamaica, revealed that 40% of Jamaicans suffer from some mental health problem and Jamaica is faced with a mental health epidemic. In a study with postgraduate nursing students in Jamaica, the researchers discovered that 50% of participants reported moderate levels of stress linked to their study program, including workload, tests and the curriculum. Numerous pressures plague students throughout their academic careers, but notably in their final year. With these findings, it is important that more be done in Jamaica and other countries to curb the impact of mental health on students and provide greater support [4]. It is important to understand where on the spectrum of academic performance and mental health, final-year university students lie. As well as exploring the importance of mental health in Jamaica can help to clarify how mental health problems affect them.

Importance of study

Mental health is a crucial part of one’s overall being, especially as a student. This study is, therefore, primarily important because it opens empirical discussion on the relationship between mental health and final-year undergraduate students. Assessing the relationship between the variables identified is significant as, to the knowledge of the researcher, no study seeks to analyze the relationship between academic performance and mental health in the capacity of final-year university students in Jamaica [5]. There are limited empirical data on all matters pertaining to mental illness in Jamaica, but what little there is suggests significant levels of stigmatization exist. This study may enable university stakeholders and regulators to develop programs and policies that are geared to addressing gaps found. By highlighting this relationship and the gaps present, the findings can help to identify how the relationship may be improved, thereby improving how future generations view their mental health and improving the culture of mental health and the stigma placed on the subject.

Statement of the problem

The prevalence of mental health and illnesses is a growing public health concern; it's an important aspect of one’s health. Therefore, the researcher sought to ascertain the relationship that exists between final-year students and mental health in the context of Jamaica, where the subject is so heavily stigmatized. The researcher chose to undertake this study because while there has been growing extensive research on the impacts and importance of mental health for students, there has been little focus on final-year students in Jamaica [6]. Accounting for individuals, the majority of which are about to leave the educational system and enter the world of work, is imperative and provides key insights for the graduates entering the workforce. As such, it is the researcher's view uncovering the mental health issues that exist and the impact that this has on students’ academic performance is necessary.

Purpose of the study

In the societal context of the people of the country, putting a focus on student mental health is crucial. The researcher’s aim was to add valuable insight to the mental health literature in order to fill the gaps present in research. By studying how mental health affects these students, this research produced findings that can improve the knowledge of mental health in Jamaica for youths, as well as aid decision-makers, school regulators and private and public sector employers for knowledge purposes. This ranged from the stigma of mental illness in Jamaica and how that perpetuates in the younger generation. All these have rationalized the necessity of empirically documenting how mental health affects final-year students [7].

Research questions

• What is the impact of mental health issues on the academic performance of students?
• How does the college/university engage students who have mental health issues?
• What is the administration's perception of the effectiveness of the current mental health intervention strategies?

Delimitations

• This study is delimited to the country of Jamaica.
• This study is delimited to one specific university-The Mico University.
• This study is delimited to final-year undergraduate students.

Limitations

Mental health is very sensitive and Jamaicans don't readily speak on the issue, which may impact participants' level of openness which may possibly affect the depth of the data collected. Another constraint that might affect the research is time. The research's scope must fall within the parameters of a master's degree research paper.

Assumptions

The researcher assumed that a relationship exists between final-year students and mental health.

Summary

The chapter identifies that mental health issues are key problems affecting young people's lives. This study opens empirical discussion on the relationship between mental health and final-year undergraduate students, as there is limited empirical data on all matters pertaining to mental illness in Jamaica. However, what little there is suggests significant levels of stigmatization exist. The researcher sought to fill the gaps present in the research by answering the three research questions detailed above. The delimitations, limitations and assumptions of the study were also identified.

Mental health

According to the World Health Organization, mental health is a state of complete well-being. Research on mental health, over the years, has increasingly become prevalent in efforts to understand its many components and impacts on individuals. Mental health is a crucial contributor to the global disease burden and is expected to increase annually over the next decades. According to estimates by the WHO, mental health illnesses account for 30% of the nonfatal disease burden worldwide and 10% of the overall disease burden, including death and disability [8].

Traditionally, the general public has failed to understand mental health, its importance and its implications. This has long resulted in poor attitudes toward persons’ mental health, with significant stigmatization. This is evident in the Caribbean, as a Caribbean country spends an average of only 4.3% of its healthcare budget on mental health. Mental health is left severely underdeveloped and further shows the lack of importance that many places on it [9]. There is a combination of cultural, economic, social and political reasons which explain why mental health has long been neglected in the Caribbean region. The socio-economic situation has allowed for poverty, income inequality and unemployment to become deeply rooted in degrading mental health.

Mental health-The Jamaican perspective

The long standing colonial system of managing mental illness in Jamaica was evident in the latter decades of the 20th century. The first place to start when examining the progression of mental illness treatment is what happened during slavery. The slave owners were in charge of looking after the slaves' health. Gibson and Hickling assert that it was likely for slave owners to "put down" violent, mentally ill slaves at this time. According to some sources, throughout the early part of the eighteenth century, slaves who were considered to be mentally ill were imprisoned in dungeons or "hot houses" on plantations. The Kingston Public Hospital was where Jamaica's first lunatic asylum was founded in 1776 [10]. The main elements of the public policy measures for the care of the mentally ill in Jamaica and the West Indies were involuntary commitment and custodialization.

In preparation for slavery's abolition and liberation, the colonial government began to take responsibility for the care of mentally ill slaves with the establishment of the asylum at the Kingston public hospital. Following this, a new mental health hospital was built in 1862. The system then underwent a change in 1972 that deinstitutionalized it by providing care in local communities. However, prior to this, it provided the only inpatient mental health care available. In 1947, the name was changed to Bellevue mental hospital. According to Hickling and Paisley's research, the mental hospital was the primary institutional construct that contributed to the development of the stigma associated with mental illness. This occurred as a result of the extreme fear and scorn attached to going there [11]. According to the mental health services report by the Auditor General of Jamaica, the hospital was initially built to accommodate 1500 patients but was later reduced to 800 beds, 795 of which were occupied in 2016. At this time, 673 of these patients were stable based on clinical assessments and could be discharged to return to their homes. This is an ongoing struggle for the institution, as many patients are left at the institution due to family neglect. It is also revealed that the majority of patients admitted suffer from schizophrenia, while others have bipolar disorders and depression.

In addition to the stigma attached to Bellevue Hospital, Jamaican culture has also added other elements. This includes some people's convictions that various forms of psychological disorder have supernatural roots. Therefore, traditional therapeutic methods are more likely to be utilized to treat mental illness, such as obeah, a belief system that is based on spirituality and emphasizes the strength and healing capabilities of the supernatural. Another widely held view in Jamaica is that mental illness is a punishment for bad conduct committed in the past, the outcome of a character flaw or personality weakness or both. According to Abdullah and Brown, there is a widespread misconception that moral failings, the possession of evil spirits or punishment cause mental health issues. The stigma attached to mental illness is worsened by the perception that it is a sign of inactivity, laziness, egoism and irresponsibility.

Hickling and Paisley highlight that despite this culture, the stigma is said to have diminished as a result of deinstitutionalisation and the inclusion of mental health services in local communities. Another finding of this study was that there had been a shift in how the public views those who are mentally ill, from one of dread to one of care. However, preceding studies reveal that people have a perception of the mentally ill as being dangerous and unpredictable, particularly those who have been diagnosed with schizophrenia. Research by Gibson, et al., on how families view loved ones with mental illness found that 43.8% of a sample of 1306 people were afraid of their mentally ill relatives. Jamaicans have a long history of being stigmatized and therefore not seek professional mental health care and instead turn to religious leaders when they need it or they rely on themselves [12]. Many Jamaicans are struggling with mental health concerns but aren't seeking treatment, which reinforces that some citizens of Jamaica and the larger English-speaking Caribbean have a long-standing stigma towards mental health which has been a significant problem. Many individuals require comprehensive mental illness treatment from an institution like Bellevue and are unable to access such due to individuals who are able to leave not leaving due to societal issues and family neglect. This happened on 494 occasions between the period of 2013 to 2016.

This long stand stigma and culture have trickled into the minds of adolescents as they too are suffering. According to Lipps and colleagues, 7 out of 10 adolescents show signs of depression [13]. Other studies have revealed that hurdles to obtaining help may include low mental health literacy, ignorance of services and a preference for independence. Recent research supports similar viewpoints, emphasising that this stigma persists when youth express worries about confidentiality and doubts about the efficacy of available resources. Despite this, evidence indicates that the stigma associated with mental conditions has significantly decreased. According to literature, "familiarity" with mental illness lessens prejudice. Other literature highlights in a similar manner that familiarity and social backgrounds impact how adolescents view and interact with the mentally challenged. According to Jackson, et al., young individuals from lower socioeconomic backgrounds were more accustomed to seeing persons with mental illnesses and were less discriminatory due to this.

Mental illnesses make up a part of global diseases and have become more and more prevalent in discussions today. The neglect of mental health in the Caribbean is a result of cultural, economic and societal factors. For Jamaica, history starts with slavery and the cruel treatment individuals who experienced it endured. It took some time before a facility specifically designed to care for the mentally sick was established. With its disdain and shame, this facility can be cited as one of the causes of the stigma associated with mental illness. The main conditions treated include schizophrenia, bipolar disorder and depression [14]. Space constraint is an issue faced by the hospital and due to family neglect, people who are able to leave are unable to and take up space for persons who also need treatment. The notion that mental illness has supernatural origins and results from bad behaviour or moral flaws is indicative of cultural factors. The stigmatizing culture has been discovered to prevent many people from seeking treatment and it has partially trickled down to the younger generation; however, the stigma has decreased.

Mental health issues affecting undergraduate students

In 1961, Alexander Mair argued that mental illness is a known issue that university students are particularly vulnerable to. According to Mair, a high failure rate in the future may have to be explained in psychological terms rather than based on intellectual incapacity [15]. He argued that both physical and mental health were essential to good academic performance. Furthermore, many studies on the health and well-being of college students internationally have largely focused on students' self-reported risky health behaviours, such as smoking, using drugs or alcohol and engaging in unsafe sexual activity. Similar research on drug use among undergraduates has been done in Jamaica, highlighting the poor well-being of many Jamaican students. Williams and Brands noted that there is a negative impact of drug use on academic performance and for youths living at home, the social support reduces the likelihood of them engaging in such activities.

According to statistics from the global burden of disease research, mental disorders and mental illness, respectively, accounted for four and five out of the top ten global causes of Disability-Adjusted Life Years (DALYs) in people aged 20 to 24 and 15 to 19 years. Students may experience a great deal of stress at this period due to the academic, financial and social pressures involved with a university. It is emphasized that several studies have identified student stress as a significant issue. The many difficulties of academic life frequently result in excessive stress, melancholy and anxiety, which have an adverse effect on both physical and psychological health. Earlier studies like Saleem, Mahmood and Naz focused on Pakistani university students aged 19 to 26. Revealing that 31% and 16% of students in the survey sample of 1850 suffer from "severe" and "very severely" respectively to issues of dysfunction, loss of confidence, lack of self-regulation and anxiety proneness [16].

Lipson et al., study included survey data from 350,000 students at 373 campuses in the US and found that in the year 2020/2021, over 60% of students reported having one or more mental health problems. These issues included depression, anxiety and suicidal ideation. However, more recent studies in Jamaica have also shown that college students experience high levels of stress and anxiety. Ethnic allegiance affects Jamaican students' academic performance and levels of stress with cultural demands to do well, according to a study of Jamaican immigrant college students. According to a cross-sectional survey of university students in Jamaica and 26 other countries, 6.1% of students experience sleeping difficulties, which have an impact on stress levels, mental health, academic performance and social support. Graham, et al., noted that 47.2% of participants noted financial difficulties as their main source of stress, whilst other reasons included family, clinical setting and school.

Burnout: One of the common mental health issues that university students deal with is burnout. It is a syndrome marked by diminished personal accomplishment, depersonalization and emotional tiredness. Researchers' focus has gradually migrated from professionals to undergraduates in recent years as they have focused on burnout, particularly among medical undergraduates. Over 50% of medical students in America are in danger of burnout, according to a prior study. Academic burnout can have detrimental effects, including thoughts of dropping out, alcohol misuse or dependence and even suicidal thinking, according to numerous other research.

Data from the healthy minds study, an annual web-based survey that paints a thorough picture of mental health and related issues in college student populations. The 2018–2019 report, which was based on data from a sample of 62,171 college students in the United States, showed that the majority of participants are experiencing some degree of depression, while some reported moderate to severe anxiety and stress. Similar studies in Jamaica show that students' primary concerns are stress and depression [17].

Factors that associate with poor mental health in undergraduate students

The following constitutes a variety of factors that result in poor mental health among undergraduate students:

Perceived social support and mental health: Higher academic aspirations have been linked with commitment and loyalty to family. According to other studies, higher academic motivation and fewer university dropouts are related to the need to support one’s family, emotional ties and support from one’s family. The parenting practices of Mexicans have a good impact on their academic progress, according to a study by Dumka, et al. Similarly, a number of academics have looked into how immigrant Asians' academic success in America is impacted by comparable family expectations. The need to perform well is said to take a toll on the mental health of these students. Furthermore, one study highlighted that despite first-generation college students coping with various stresses like finances and psychologically not seeking help on the basis of being self-reliant and emotionally tough. In this instance, though the support may be available, it's not utilised in part due to relational concerns.

According to a review of recent literature, university students who felt supported reported less severe psychological issues, while those who felt a lack of support from family displayed mental health distress, such as depression, loneliness and anxiety. Additionally, Vungkhanching, et al., study found that 45% of students' depression and anxiety were at a moderate level or higher and the social support received by peers has a positive effect on it. This review of recent literature supports that, for undergraduates, having sources of support from the social environment lowers the chances of poor mental health, while having little or no support increases those risks. According to a study by Onuoha and Idemudia, social support can improve the mental health of undergraduate students who are employed full-time by creating supportive conditions at work and in the classroom. Other studies also support this finding highlighting in a similar manner that when students feel supported, their mental health is improved [18].

Academic demands and mental health: Academic accomplishment is the defining factor used to evaluate students and plays a significant role in their life. Academic success and mental health have a positive association; according to the literature, the better a student’s academics the better their mental health. They both have a significant impact on one another because it is well-recognized in the literature that individuals with mental health issues or disabilities, whether they receive treatment or not, tend to have lower Grade Point Averages (GPAs). Additionally, a student's coursework is fairly substantial, undergraduate students are under even greater stress due to the intensified and extremely demanding nature of university curricula.

Students are under pressure from a variety of factors in higher institutions, including short course duration, frequent exams, fast-paced environments and high expectations. Students are under strain as a result of these obligations resulting in them being under pressure to do well, often leading to feeling even more anxious. College students who procrastinate and perform poorly are more likely to experience sadness, low self-esteem and anxiety. Additionally, problems with one's mental health have an impact on academic achievement. The article by Onuoha and Idemudia adds to the body of literature on mental health by emphasising how full-time students who work are also susceptible to mental health problems because of the rigours of both employment and education.

Transitions: Researchers have focused on transitions and offer insights into the pivotal phases of a person's life, such as becoming a teenager or becoming a mother. The move from high school or community college to the university setting as well as the transition from the university to the working world, are all times that are accompanied by difficulties. An increase in negative impacts connected to anxiety and depression is likely to occur during the difficult first year of university. First-year university students likewise experienced the same results in several studies. In comparison to the general population, the first year of university is linked to high levels of anxiety, physical health issues, drug and alcohol misuse and a poorer level of wellbeing. Overall, the data point to the first year of college as a difficult time. The findings of Cobo-Rendon, et al., are similar to other research conclusions that university students experience unpleasant emotions like anxiety and depressive symptoms.

There is also the change from a student life to a working one. As a final-year student, there are many things to think about that could be stressful for one's mental health. Many people who have never worked before or who have only recently started an internship will start to experience the challenges of being entirely responsible for themselves. These are mentioned as concerns alongside careers, potential future employment and student debt. These are but a few of the factors that many place into consideration at this final stage of formal education unless they so choose to go for higher education. The mental strain that comes with being on the final lap is put into perspective by Raj, et al., study on the quality of life among fourth-year medical students. Patient care obligations, "on-call” times, starting a new job and applying to residency programs are all factors that contribute to this stress. Additionally, it is noted that the final year is becoming increasingly stressful and there is a broad perception that this stress causes alterations in vital parameters in final-year medical students. Doygun and Gulec study highlighted that students are plagued with worries of unemployment, the future and worry surrounding whether the education they take at university will be sufficient in their working lives. Furthermore, the literature demonstrates that one's mental health is impacted by learning to adapt to a new environment and culture and becoming a contributing member of society at large, which students would soon have to do [19].

COVID-19 mental health impact on students

All nations have been affected by the COVID-19 pandemic, which has largely interrupted daily life. Studies on its psychological effects on various populations have been produced by researchers all over the world. Studies from 2020 to 2022 relate the epidemic to emotional problems in people in isolation, even going so far as to give vulnerable populations the tendency to commit suicide, a lingering impact on mood and wellness, despair and anxiety. In the Philippines, a study analysing the psychological effects of COVID-19 during its early phase in 2020 with 1,879 respondents was published. According to the findings, 1 in 4 respondents reported having moderate to severe anxiety and 1 in 6 reported having moderate to severe depression. It is crucial to consider the effects that a significant shock like the coronavirus might have had on students when examining mental health issues. The effect the novel Corona had on academic performance has been examined in numerous studies. Yang, et al., found that undergrad students had significant levels of stress, were depressed and overslept throughout the day due to their isolation and academic burnout.

In a study of 4,972 college students, it was found that the covid-19 impact was positively associated with poor mental health problems, including moderate to severe depression, alcohol abuse/dependence, excessive daytime sleepiness and high perceived stress. Since remote learning may lessen communication between educators and students, research findings have shown that modifications in learning patterns during the COVID-19 pandemic have heightened the risk of academic burnout and affected academic performance.

According to several earlier studies, undergraduates may experience mental health issues as a result of prolonged home isolation, decreased face-to-face interactions, excessive screen and smart device use, a lack of social support and academic stress. Given that the students continued to experience academic stress and excessive screen time after returning to university, the increased frequency of mental health issues during the pandemic's mitigation period may be a reflection of the ongoing psychological harm caused by COVID-19. Similar to other studies, COVID further highlights mental health issues among students. A survey of 489 undergraduate students between the ages of 18 and 25 found that 81.6% reported having at least one of the symptoms of mental illness, which include hopelessness, loneliness, sadness, anxiety, sadness and anger.

Impacts of poor mental health

According to studies, mental health issues have a negative effect on university students' performance. A study conducted involving 540 university students revealed that, at Pakistani universities, students' academic performance declines when there is an increase in mental health problems. Similar findings from other studies, such as Drum, et al., study, included a survey of 26,000 students from 70 colleges and universities, which found that mental health issues affect students both personally and professionally. Students that perform poorly in school exhibit dishonesty, drug usage and poor physical condition on a personal level as well.

University life may be a particularly difficult period for students due to the academic, financial and social hurdles involved. These issues may negatively impact a student's academic performance. A 2021 study of 540 final-year university students in Pakistan between the ages of 20-35 years found that a 1% increase in mental health problems reduces a student’s academic performance by 8.4%. This is also consistent with earlier studies, as a longitudinal examination of 198 post-secondary institutions revealed that 46% of students who failed to complete their degree were due to mental health issues. According to Kenny, et al., study of 1254 first-year students living on campus at a single university, mental health interacted with perceptions to predict past-month drinking outcomes. Specifically, higher levels of anxiety and perceptions that peers drink heavily were linked to higher levels of alcohol consumption and consequences, while higher levels of depression and perceptions were linked to higher levels of alcohol consumption and frequent heavy drinking. In students with higher levels of depression, attitudes that peers approve of heavy drinking were linked to more drinks taken and heavier drinking frequency.

School administration’s role in engaging students with mental health issues

According to Williams' research on adolescents in Jamaica and their access to psychological care, there is a serious issue with the stigma attached to seeking mental health care in Jamaica. The survey found that students typically turn to guidance counsellors and teachers as the last choice when they need assistance. A study of 107 participants aimed to find out how rural and urban populations respond to digital mental health services also found that stigma, shame and embarrassment prevent young people from obtaining formal professional care when problems like substance misuse arise. Maloney, et al., also found that 78.5% thought that online mental health resources that one could do on their own would be beneficial.

College students are increasingly utilizing mental health services due to the influence of stress on rising rates of anxiety and despair. According to a study by Lipson, Lattie and Eisenberg, the percentage of students who used mental health services in the US rose from 19% in 2007 to 34% in 2017. Mental health services used by students who were diagnosed with depression were being used more frequently, going from 42% in 2007 to 53% in 2017. All of this emphasizes the rise in mental health issues and illnesses on college campuses as well as the mounting pressure on student health services. In light of this, Petruzzello and Box have recommended that administrators at schools encourage students to engage in more physical activity in order to enhance their mental health. Hook and Markus emphasize that while maintaining one's physical and mental well-being is the duty of the student, institutions of higher education must work to establish the "cultural cycle" in order to make health and wellness feasible. Studies have also proposed that during the orientation week of universities, students should also expose students to psychological counselling and guidance services to help newly-coming to university.

A university-based online platform with the potential to complement traditional face-to-face services and more effectively and efficiently address student mental health issues is highlighted in the literature. Online services may increase their cost-effectiveness and scalability. This idea has been put up in light of young people's increasing use of technology and the internet. Other academics emphasise the value of using technologically assisted methods. A mental health chatbot is a modern remedy that is gaining popularity in the mental health care industry. A chatbot is a computer software that mimics human interaction and can give the impression that it is intelligent. Chatbots are mostly employed to deliver cognitive behavioural therapy in a university context.

Online life-crafting intervention is recommended by Dekker, et al. This is made up of a number of cohesive elements that are constructed using a variety of scientifically tested techniques to help people reflect on their current and future lives, set goals and make plans and take actions that are consistent with their values. Despite this evidence stating that e-mental health services can be effective, other studies have shown that most persons would rather have face-to-face help. However, it can also be seen, in a 2014 study by Kauer and colleagues, that young people aged 14-25 regularly used and are satisfied with digital mental health services. Studies done in Jamaica have also focused on digital mental health services as an avenue. Maloney, Abel and McLeod study reveals that adolescents in Jamaica are plagued by stigma and embarrassment to reach out for help despite it being done digitally.

In research conducted in Pakistan, Zada further emphasises that the complicated educational system is the primary cause of the rise in mental illness among students. The educational system in the nation does not prepare its students for having to deal with difficult situations. Students struggle to make the switch from community colleges/high schools to universities as a result. The results were intended to assist school administration in developing intervention methods to counteract those results.

In research conducted in Pakistan, Zada further emphasises that the complicated educational system is the primary cause of the rise in mental illness among students. The educational system in the nation does not prepare its students for having to deal with difficult situations. Students struggle to make the switch from community colleges/high schools to universities as a result. The results were intended to assist school administration in developing intervention methods to counteract those results.

Summary

The literature reviewed emphasizes the connection between undergraduate students' academic success and mental health. The researcher discovered that this is a widespread problem throughout the world, one that is highlighted in adolescence and early adulthood. The majority of the literature on mental health and academic performance in Jamaica focused on adolescents and the researcher discovered a knowledge gap about how final-year students' mental health difficulties affect their academic performance. According to the literature, stigma is a key factor that keeps many young people from seeking mental health care. In Jamaica, this stigma is deeply ingrained in both history and society. The mental health issues identified to be affecting students include burnout and other issues. The research also iterated that perceived family support, life transitions and academic pressures are the main factors surrounding mental health issues for final-year students. This has harmful effects on students, chief among them low academic performance, which will be the main focus of this study. In the end, the study characterizes the relationship's nature in the Jamaican context and offer recommendations based on these findings.

Theoretical framework

Life course developmental theory: The idea that lives change along developmental trajectories is explained by Elder's work on the life course developmental theory. Elder’s study focused on how social change, life paths and personal growth can be used to explain behavioural continuity and evolution. These paths allude to the social trajectories of family, employment and education that people and groups in every aspect of society pursue. He places emphasis on the idea that theories of human development should be applicable to all life activities. Since the 1960s, life course theory has developed as a result of deliberate efforts to deal with similar problems. In order to understand how experiences inside the individual, the environment and the interactions of the individual environment contribute to outcomes in terms of mental health, Kellam's work on life course development was developed from Elder's approach. Individuals were tracked at various stages throughout their lives and their mental health was evaluated. Results alluded that mental health among people was connected with domains particular to different age groups. Other academics have used developmental theory to study the connection between mental health and academic success. This is vital for this study because it aims to pinpoint a crucial problem affecting these particular people at a pivotal moment in their lives and the variables that affect the subsequent change. For this study, the crucial time is transforming from a university student to a working adult.

Modified labeling theory: According to the modified labelling theory of mental disease, when an individual is given a mental illness diagnosis, cultural stereotypes of people with mental illnesses become personally relevant and encourage unfavourable self-evaluations. Researchers investigate the impact of the psychiatric diagnosis on this procedure. It aims to balance the meanings attached to self-identities "myself as I really am" and reflected assessments "myself as others view me" with respect to stigma feelings. Studies about mental health and the stigma attached to it have utilised the modified labelling theory. Mehdi studied how epilepsy-related stigma affects the lives of women with the condition. The data was analysed from a sociological standpoint using the Modified Labelling Theory. Similar methods have been employed in other studies to mediate the relationships between the variables rejection, stigma management and social support.

The modified labelling theory was created to explore the impact of stigma resulting from mental illness. Still, the structure of the theory has been adapted to other negatively stereotyped ideas that could lead people to adopt stigma management methods. The theory has thus been used to explain behaviour in groups such as those living with HIV/AIDS smokers and parents of children living with disabilities.

This chapter highlights the research design that was used, the methodology and the methods of data collection. Also discussed are the methods of sampling, methods of data analysis, issues of ethics and the reliability and validity of the study.

Research design

The research employed the exploratory research design. Mouton notes that exploratory research designs are focused on the establishment of facts, the collection of new data and the determination of meaningful themes or patterns in a particular research area that is relatively unknown in order to gather new or further insights into the phenomenon. In this study, literature has produced varying information on the relationship between the academic performance of undergraduate students and mental health. However, there is still not much known in the context of Jamaica, especially regarding final-year students; hence, the exploratory design is ideal for gaining an understanding of this relationship. This design was also chosen in order to gain in-depth knowledge that a descriptive approach would not have provided. Furthermore, exploratory studies are often conducted to gather answers to 'how' and 'what’ questions, which this study explored.

Methodology

The researcher utilized the single case holistic case study version of Yin’s case study methodology, which encapsulates having only one study of a single unit of analysis conducted. This study was single case and holistic because the unit of analysis and the case (Mico University final year students' mental health issues) are the same. This methodology was utilized because this study can be considered a representative case as though the study was conducted on Mico University final-year students, these lessons were assumed to be informative about the experiences of the average final-year student across Jamaica. Overall, the objective was to capture the circumstances and mental health conditions of a typical final-year student.

The single case holistic case study was designed to aid in the research of a phenomenon within a specific context using a number of methods. It also explored the phenomenon via a range of lenses to show the phenomenon's many facets. Due to the complexity of the research problem, it necessitates the analysis of the data using a variety of methods; hence the researcher used this methodology. Additionally, it enabled close collaboration between the researcher and the participant to build trust further in order to combat any unease that may arise due to the sensitivity of the subject of mental health. It also enabled the researcher to see the relationship between the phenomena, context and people.

Methods of data collection

The researcher utilized three methods of data collection, which included interviews, document analysis and focus groups.

Interviews (describe the interview schedule, how many questions, closed or open ended questions etc.): Interviews are a means of gathering data that is used to examine people's opinions, past experiences, beliefs and/or motivations about particular issues. Since there is limited information available regarding the phenomenon in Jamaica, this approach was helpful. Additionally, this was especially suitable for a sensitive matter like this, where it could be tough to speak up in a group situation. The researcher deemed this method fit as it enabled a deeper analysis that would not have been possible with a quantitative approach, such as a questionnaire, due to its enormous complexity. Interviews were conducted by the researcher with 5 administrative/academic personnel, 5 students and 3 subject matter specialists, such as psychologists and psychiatrists. Interviewing students provided rich data and truly captured the experiences of the students. The researcher also saw it fit to interview experts as it was to provide in-depth conversations that would fill the research gaps.

Document analysis: Fraenkel and Wallen posited that document analysis involves "defining as precisely as possible those aspects of a document’s contents that the researcher wants to investigate and then formulating relevant categories". In order to draw conclusions about the message being given, the researcher used this method to evaluate the meanings of specific words and concepts. Utilizing documents in this study was especially beneficial because it enabled a thorough examination of data from the literature to contextualist the research findings further. For an issue such as mental health in Jamaica, this enabled the researcher to highlight how the past impacts the present. Thereby analyzing how the current generation views mental health and the utilisation of current resources in comparison to studies done in the past in a similar context. Additionally, given the scope of the problem at hand and its many intricacies, an earlier study may point forth specific indicators to look for when examining interview responses. Therefore, the researcher examined 10 documents that generally depict the phenomenon, as well as specific documents that gave data related to university students locally, as well as those specific to The Mico University. The documents ranged from university annual reports, local newspaper articles, university policy documents and scholarly works from Google Scholar, this is depicted in Appendix Table 1.

Focus groups (what tool was used to facilitate the group session, describe the tool, also how long were these discussions): Focus groups were a suitable fit for this study because they provided the opportunity for the researcher to facilitate a group discussion between participants and not between the researcher and the participants. This allowed participants to share with each other and encourage each other to be open, as one individual's openness may influence another. For a subject that many find difficult to speak on, this would have been beneficial in opening up since others may face similar issues as themselves. To achieve this, two focus group discussions were conducted by the researcher with 7 students. The students were informed of the purpose of the research and consented to participate.

Method of sampling

Purposive sampling was used by the researcher to select interview and focus group subjects. Purposive sampling is a sampling approach that enables the researcher to use subjects or cases that have relevant information in relation to the study's goals. This technique was used to collect data from best-fit participants who were informed on the topic. It was beneficial for this research since it would have allowed the researchers to speak with people who were knowledgeable about and had personal experience with mental health issues. For document analysis, the researcher used the document sampling method. Searching for keywords linked with the research topic was used to acquire papers that were pertinent to the current study. These were examined while keeping context and relevance in mind. To make sure that the documents acquired were pertinent to the ongoing research.

Method of data analysis

Thematic analysis is a type of qualitative analysis that can be applied to classify data and display themes (patterns) that are connected to it. It presented the information in great depth and used interpretations to discuss a variety of topics. It added a methodical component to data analysis. The researcher deemed it fit as it enabled the researcher to link a frequency analysis of a theme to a content study of the entire text. In order to establish a credible and logical chain of evidence, the procedure involved coding, categorization and recording patterns, which would make provision for various levels of themes. The highlighted sentences were then broken into smaller segments or themes. The researcher chose this approach because it helped draw connections between various data points and because the sheer volume of data would make it simpler to spot responses that differ or may be alike.

Issues of ethics

The researcher applied the appropriate ethical principles while conducting the study to prevent harm to respondents. Participants’ confidentiality and anonymity would be protected as their identities and names would not be revealed during the data analysis and data presentation phases of the study. The researcher also ensured informed consent and respondents were fully informed of the interview process, what was expected of them and the potential outcomes of the study. Respondents were only identified by their preferred pseudonym, all responses were anonymized and data was presented on the aggregate level. Potential risks of harm included psychological risks, which included the production of negative affective states such as anxiety and depression. The researcher mitigated this by adequately informing participants of the engagement and their right to pull out at any point in time.

Trustworthiness

According to Lincoln and Guba, a research study's trustworthiness is crucial for determining its value. While quantitative studies focus on the use of jargon such as reliability and validity, qualitative research “trustworthiness” is the comparable measure of good quality research. Establishing credibility, transferability, confirmability and dependability was necessary for trustworthiness. Credibility, which is the degree of trust in the veracity of the results, was determined in this study by the process of method triangulation. In order to check if the results were consistent across the approaches, the researcher triangulated the results using document analysis, interviews and focus groups. Through source triangulation, the researcher determined confirmability or the level of neutrality. This was achieved through the use of numerous sources, including students, academic personnel, psychiatrists and psychologists, who were interviewed and discussed within focus groups. The researcher also guaranteed transferability by providing detailed descriptions of the phenomenon to assess how broadly applicable the conclusions are to different situations and individuals. In order to assure dependability, the findings, interpretations and conclusions will be subjected to an external audit.

Validity determines whether the research measures what it was intended to measure. The researcher ensured content validity by utilising the conceptual definitions found in the literature as well as overall information to guide how interview questions were created, ensuring that they would capture all-around details on mental health issues faced by final-year students, in addition to using the literature to inform what questions to ask to get the most information relevant to the study. The use of appropriate sampling methods to select the sample was also used to ensure validity in this study. This study utilized purposive sampling, which is based on the premise of selecting individuals who are "information-rich" and have relevant information to answer the research question. This ensured that the results would be valid.

Joppe describes reliability as the extent to which results are an accurate representation of the population and can be replicated. The researcher ensured reliability by having carefully carried out interviews, wherein each interviewee was asked the question in a similar manner. This would have ensured that no variables were omitted and the methods applied consistently, which was done to reduce the influence of outside factors, creating a variety of results. Furthermore, in interviews and focus group discussions, the physical and psychological environment was maintained so that all participants felt comfortable. This was also to reduce external factors that may affect the results [20].

The research design that will be utilized for this study is the exploratory research design, using the qualitative case study methodology, Yin’s single case holistic case study version. To gather the data for the research, the methods will be interviews and focus groups, which will be sampled using purposive sampling, and document analysis, which will be sampled using document sampling. Furthermore, the data gathered from respondents will be analyzed thoroughly using thematic analysis. Additionally, the various issues of ethics will be taken into consideration as well as ensuring trustworthiness through credibility, transferability, confirmability and dependability.

Presentation of findings

This section focuses on the presentation of findings from interviews, focus groups and document analysis. The findings from these methods were examined using the qualitative data analysis matrix. Participants in the interviews were students and members of the school's administration, as well as a psychiatrist and psychologists. The matrix illustrated the coding process and responses broken into themes. To illustrate the responses pertaining to each research question, the themes will be presented using smart arts. The chapter will flow in the following manner:

• Presentation of the findings from the interviews sectioned by the research questions.
• Presentation of the findings from the focus groups, sectioned by the research questions.
• Presentation of the findings from the document analysis, sectioned by the research questions.
• A synthesized/overall presentation of the findings sectioned by research questions.

Presentation of findings from interviews

What is the impact of mental health issues on the academic performance of students?: As shown in Figure 1, the main themes highlighted by respondents reflected poor academic performance. This was due to depression, anxiety, stress and feeling overwhelmed. As a result of poor mental health, academic performance suffers. Students reflected on feeling fearful of the future, the requirements of the final year being burdensome and the impending transitions. Students also express experiencing a lack of focus, being zoned out and not being motivated.

 

Figure 1: Impact of mental health issues on the academic performance of students from interviews.

How does the college/university engage students who have mental health issues?: The themes from interviews conducted included seminars and discussions, mentorship, guidance counsellor support, peer-to-peer counselling and social gatherings, as shown in Figure 2. Some respondents highlighted that they are unaware of strategies being employed; however, some respondents highlighted the presence of seminars and discussions conducted, even though they do not occur frequently. Persons also mentioned the presence of guidance counsellors at the institutions. Another major theme highlighted is social gatherings such as lymes and fetes that are in the university space, used to allow students to take a break. Peer-to-peer counselling was also highlighted as a strategy.

 

Figure 2: College/university engagement of students who have mental health issues from interviews.

What is the administration's perception of the effectiveness of the current mental health intervention strategies?: As shown in Figure 3, the major themes from the interviews are ‘effective vs. ineffective’, the need for improvement in strategies, support of students in transition and the effectiveness of the counselling centre. There were generally mixed responses in terms of the effectiveness of the strategies employed. It was found that some administrators believed that the strategies, such as the personal development course and counselling centre, were effective, while others highlighted that strategies were non-existent or needed improvement.

 

Figure 3: Administration's perception of the effectiveness of the current mental health intervention strategies from interviews.

Presentation of findings from focus group

What is the impact of mental health issues on the academic performance of students?: Figure 4 shows that the main themes from the focus group discussion included online to face to face challenges, the challenge of final year, culture shock in transitioning to the classroom and lack of effective communication impacted students’ mental health. These challenges negatively impacted their academic performance as those factors led to poor lesson plans, poor concentration levels during teaching, anxiety and lack of motivation. In terms of the transition from online learning to face to face, students were faced with the challenge of conducting their teaching practicum in face to face classes after learning online and using online tools. This posed a challenge in adapting to the classroom setting. The challenges of final year included having to complete hours of Teaching Practicum (TP) as well as classes at the school.

 

Figure 4: Impact of mental health issues on the academic performance of students from focus group.

How does the college/university engage students who have mental health issues?: Respondents highlighted several initiatives that they believed aided towards addressing mental health issues. The major themes were guild advocacy, counselling services, seminars and a lack of awareness of any initiatives for final-year students, as shown in Figure 5. This included advocacy from the guild office on issues that are affecting students that must be addressed. Additionally, respondents highlighted the seminars that take place occasionally and counselling services available as other means. Of the 7 students in the focus group, 5 highlighted that they were unaware of any strategies for final-year students.

 

Figure 5: College/university engagement of students who have mental health issues from focus group.

Presentation of findings from document analysis

What is the impact of mental health issues on the academic performance of students?: The findings from the document analysis highlight the themes of mental health issues: Depression, anxiety and ADD/ADHD, which are a result of the challenges students face. As shown in Figure 6, the findings noted that the complexities and demands of the curriculum, personal life, COVID 19 and financial issues are some of the major struggles faced by students.

 

Figure 6: Impact of mental health issues on the academic performance of students from document analysis.

How does the college/university engage students who have mental health issues?: Figure 7 shows the strategies implemented by various institutions and have been recommended by these documents, including counselling services, health centres, group therapy, peer counselling, and telehealth. It is recommended that institutions create a culture of wellness.

 

Figure 7: College/university engagement of students who have mental health issues from document analysis.

What is the administration's perception of the effectiveness of the current mental health intervention strategies?: The effectiveness of the strategies to improve students' mental health has been mixed. The themes garnered and shown in Figure 8 suggest that students are increasingly benefiting from counselling as the stigma reduces, as well as the use of online resources to reach students, such as telehealth. On the other hand, it is also suggested that traditional counselling centres are ill-equipped and that more can be done to assist students.

 

Figure 8: Administration's perception of the effectiveness of the current mental health intervention strategies from document analysis.

Presentation of overall findings

What is the impact of mental health issues on the academic performance of students?: The findings of this study as shown in Figure 9, revealed that there are mental health issues such as stress, anxiety, burnout and depression being faced by students. These issues are caused by a culture shock of the realities of the classroom, the requirements of the final year being burdensome, impending transitions after university and challenges from switching to online learning. Students express zoning out during teaching, not being motivated, as well as writing poor lesson plans. These struggles ultimately result in poor performance, as it becomes hard to do well.

 

Figure 9: Impact of mental health issues on the academic performance of students.

How does the college/university engage students who have mental health issues?: The findings shown in Figure 10 highlight that the university conducts occasional seminars to engage students and give tips on how to perform well. It was also highlighted that guidance counsellor support is available to students. Other forms of strategies highlighted include the promotion of peer-to-peer counselling, guild advocacy and social gatherings for students. Many students, however, highlighted that they were unaware of strategies being used to cater to final-year students. Furthermore, the findings of the document analysis highlighted that counselling and peer counselling are viable options, as well as group therapy and telehealth.

 

Figure 10: College/university engagement of students who have mental health issues.

What is the administration's perception of the effectiveness of the current mental health intervention strategies?: The success of the counselling centre and the effectiveness of effective versus ineffective tactics are the main takeaways from the interviews with office administrators. There were typically conflicting opinions regarding the success of the applied tactics. It was discovered that some administrators thought that some tactics, including the counselling centre and personal development course, were successful, while others said that strategies weren't there or needed to be improved. The results of the document analysis point to a lack of consistency in the tactics used to promote students' mental health. The patterns identified show that as stigma diminishes, students are increasingly benefiting from counselling and from the use of online services like telehealth to reach them. However, it is also said that conventional counselling facilities lack the necessary resources and that more may be done to help kids (Figure 11).

 

Figure 11: Administration's perception of the effectiveness of the current mental health intervention strategies.

The discussion of findings is divided into three sections to answer the research questions. A triangulated approach was used to analyze the various perspectives from the interviews, focus groups, document analysis and previous literature and theories.

Impact of mental health issues on the academic performance of students

Academic performance plays a vital role in the trajectory of a student and is considered very important. Mental health is another critical factor in one’s life; being well in this area is as pivotal as the others. Experiencing mental issues, no doubt has an impact on many other facets of one’s life, including their academics. According to students' responses, poor mental health has impacted their academic performance. Students express zoning out during teaching, not being motivated and writing poor lesson plans, affecting their performance during their final semester. These factors have been attributed to the requirements of the final year being burdensome, the culture shock of the realities of the classroom, challenges from switching to online learning and impending transitions after university.

A significant challenge expressed by students during focus group discussions was the pressures of the final-year curriculum stipulated by the university. According to the responses, students must complete teaching practicum, a programme designed to give teachers training experience in teaching, a course and a research paper for some. One participant highlighted, “being on teaching practice, doing lesson plans, trying to complete 14 hours, also doing different assignments, attending JTC meetings, different webinars, there’s a lot of pressure.” This is mentally draining for students and can impact how they perform in the classes when out in practice. Another student highlighted, “when you reach this semester where we are out on TP. Our mental health is drained, people are on the breaking point and I am literally holding on by a thread.” These findings are consistent with that of Cant, which found that the curriculum and requirements of many university programmes can be draining mentally for students.

Furthermore, respondents generally agreed that mental health issues can affect their academic performance, “I believe that for persons with mental health issues, how it affects their academic performance is that they will not have the motivation.” Another respondent noted,” yes I believe it affects our academic performance. It also affects our concentration level.” As a result of such stressful experiences, many have opted to take time off as they recognize that they are struggling and are unable to manage, “15 or 16 students who decided that due to issues that they are facing mentally, decided to retract themselves from practicum until a later year.” One administrator also expressed that many leave the system permanently or temporarily, “you find persons dropping out and finding persons asking for leave of absence”, as they cannot cope.

These findings agree with that of earlier studies, which note that academic burnout causes students to have thoughts of dropping out. Furthermore, the Modified Labeling Theory can be used to understand the concept of students taking a leave of absence. The theory suggests that individuals stigmatized or labelled by society, including themselves, as having mental health issues may experience negative consequences, such as reduced self-esteem, limited opportunities and decreased social support. The label of having a mental health issue can influence how others, including educators, perceive and interact with the student. Negative stereotypes and biases may result in lower expectations and reduced support, resulting in wanting to leave the school system.

Another major challenge students identify is the culture shock they experience once they enter the classroom. One respondent highlighted, “When I go into the classroom, it is a different reality, there was no segment put in place to kind of transition you from what you are experiencing at The MICO to the culture shock that you go out there to face.” Another student noted, “some of us have a really hard day at the schools because of some of the things we see, we were not expecting them because of the way how we were taught at The MICO.” Students experience a drastic difference between the classroom and what they learnt. These results are comparable to Pulido-Criollo, et al., who emphasized that the stressors for nurses arise from a mismatch between academic preparation and practical training or from the settings created by universities and hospitals. In this regard, educational models must consider simulations of the real life that students would experience at work, as students feel unprepared.

Students experience culture shock when they come from the classroom to their teaching practicum and this impacts academic performance negatively as this uncertainty and feeling of being ‘unprepared’ may result in students not performing as well. These findings relate to Karaca, et al., and Vungkhanching, et al., who found that students who felt supported experienced fewer mental health issues. The better the mental health state, the better one will perform academically. This challenge no doubt takes a toll on their mental health, as they have not been equipped to deal with some of the challenges. This challenge further impacts students' mental health as the classroom is not what they expected; this creates a feeling of not being supported and prepared in the way necessary to deal with the challenges.

Another finding of this study is the impact that COVID-19 had on these batches of final-year students. These students would have experienced some form of online schooling due to COVID. Many were trained online but are now asked to teach students face-to-face. Students express that this poses a challenge for them mentally and academically. One student expressed, “for the first week of my teaching practice, I ended up in the hospital because of an anxiety attack because I am trained online. I’m used to Zoom, So I became comfortable using the internet for my lessons. So when I was thrown out there to do face-to-face TP, it took a toll on me, and I got an anxiety attack.” Another student noted, “We did our focus observation online and team teaching online. So we’re used to that modality. But being that we’re out here now, it is used to..., I get depressed, I don’t eat. My whole eating schedule changed. When I’m under pressure.” The findings suggest that the pandemic is still impacting students and their performance in the classroom.

A student of behaviour sciences shared their experience highlighting: “I have to be carrying out counselling sessions and in addition to that, I have courses within the institution at MICO that I have not completed. So, I have to be going to classes for those courses. So, sometimes, you find that by the time you leave the practicum setting and you reach home, you’re basically drained”. These factors notably have had an impact on student academics poorly. The students again felt ill-equipped to deal with the challenges they were being faced with. Elder's life course development theory spoke on how social change and life paths can impact behavioural continuity in understanding how an individual’s environment shapes their circumstances. It can be seen in this study that the life-changing pandemic (an external factor) impacted and shaped these students even though the conditions such as online schooling have passed. Furthermore, the students expressed feeling anxious and mentally drained, which is consistent with the findings of previous studies, as Gordon highlighted that depression and anxiety are the most common issues reported by UWI students. Lipson, et al., also highlight that students face depression, anxiety and suicidal ideation. One individual noted that “if they are disturbed mentally, then it means that they will not be able to focus on that which is of paramount importance”.

Transitioning from university life to adulthood is also a major determinant of mental health challenges, impacting students' performance. Concerns about careers, potential future employment and student debt were mentioned in past literature. The findings of this study, are also consistent with this as one respondent noted that, “when the stakes are high like you’re barely managing to follow your courses and it's the last year and your student’s loan is about to finish”. All these factors take a toll on the mental health of students and in turn impact their performance. The challenges faced impact the overall performance. How well the student teacher performs in the institution’s training impacts their performance to determine if they pass. One respondent noted, “I have resorted to a stage where most times I am in the class and I feel like a zombie. I am speaking, I am teaching and I do not know what is coming out of my mouth”. This is as a result of the struggles being faced that have not been addressed. This is consistent with previous findings of Zada which suggest that students' academic performance declines when there is an increase in mental health problems. In this case, students are faced with mental health challenges which are affecting them negatively. Furthermore, another respondent highlighted how mental health issues can affect the quality of lesson plans and by extension, one's academic performance. The respondent noted, “Whenever the assessor arrives at the school to mark you or grade you and she sees the lesson plan and it is not up to standard, why? Again, because of how you are affected mentally.”

It can be seen where mental health issues impact the academic performance of students. Students face numerous challenges, such as the complexities of the final year, transitioning into adulthood and the struggles with that, COVID 19. Due to these factors, students are zoning out during teaching practicum, not being motivated and writing poor lesson plans, impacting their overall academic performance during final year. The life course developmental theory emphasizes the importance of understanding individuals' experiences and trajectories across their lifespans, including the interactions between personal characteristics, social contexts and life events. The transitions as final-year students can be seen as an experience which can heighten stress levels and exacerbate mental health issues, impacting their ability to concentrate, study effectively and perform well academically.

College/university engagement of students who have mental health issues

Considering that mental health impacts students' academic performance, universities must develop strategies to combat its impact and ensure students are supported on this journey, especially during their final year. The respondents highlight four major strategies: Seminars, guidance counsellor support, guild advocacy and social gatherings.

Students perceive that the university doesn't care and many expressed their grievances, highlighting, “the university college itself does not do enough for its fourth-year undergraduate students when it comes to mental health.” One focus group respondent noted, “I think that when persons or students make mention of mental health, I think it is being downplayed”. There is the belief that the issue isn't being taken seriously by the school administration. This belief may have grounds as one administrator referring to the students highlighted, "I find them a little bit more anxious and they’re not very resilient in terms of pressing in or persevering. I don’t get that because it seems as if they are a little bit more quicker to just give up and say, “I can’t do it, it is just too much’, I don’t see many of our final year students being ready to take on challenges”. This highlights that in part, there is the perception that students should be ‘tough’ and that being more anxious is their fault, instead of the circumstances that they face.

Furthermore, there is a lack of awareness of strategies by students, “no, I’m not aware of any strategies”, “no I am not aware of any strategies put in place for fourth-year students.” One respondent further noted that “they give their issues to our guild and they will share the information to our practicum department and other departments and these are the same issues that lead us to having these mental health issues.” These findings agree with early studies suggesting that more needs to be done to make students aware of the services available and find innovative ways to reach students. This may not be a strategy directly related to mental health, but it provides an avenue for students to share their struggles and be advocated for. Other strategies mentioned were social events, the importance of this was acknowledged, as one person noted, “specially organized events where they can just let their hair down, whether it’s a party or a fete or a birthday party, whatever it is would be fun”. Additionally, peer counselling was suggested as a possible area of focus, which was also suggested by Brown.

Counselling services are offered to students, however, respondents highlighted that this and other strategies are not catered to the final year students specifically and their needs. Students were told that “they could speak with guidance counsellors at the school in regards to our experiences or struggles that we may have during our experience in TP. I know that they always send an email, from the guidance counsellors department, if I’m not mistaken those persons can come and speak with counsellors and there are also some events and workshops and stuff like that and persons can come and get advice and stuff." "Sometimes, the guidance counsellors might have what you call lunch hour chats." The use of this strategy is also found in previous literature as found that counselling sessions can be effective.

Seminars were also noted as ways in which the school assisted, however, students do not generally find it effective, “I think they had one seminar in which I don't think it was that effective in dealing with the whole mental health of undergrad". Students had mixed responses, for the behavioural science department, we will from time to time have persons have mental health seminars, the strategies learned and the methods and discussions that we have and the ways of coping, seeking support, talking about the issues. Another respondent also mentioned, “I’m a part of the behavioural sciences group and within my group, we have a mentor and that mentor, I think she is also/I would say she is a guidance counsellor." This student noted that the strategies were effective, as "for support, I would say that it has been very effective, sharing has really been helping-talking to my batch-mates has really been helping."

To release the stresses that they have, many students have taken their mental health in their own hands: One respondent noted, "I realize that I was having headaches, I felt stomach aches, I had sleepless nights and I then had to be speaking positive affirmations upon my life on a daily basis to say ‘hey, it is outside of my control, I have control over it’ and I would have made the necessary steps to speak with someone in relation to the issues" Another respondent highlighted, "I’m turning on my speaker and I listen to music until I fall asleep. I find that helps me to cope with the stress of the day."

Many people believe that the institution lacks the necessary programs and have suggested a number of improvements and strategies to implement. Literature has suggested the use of chatbots, tele-health and online life-crafting interventions respondents have suggested a stipend to alleviate the financial burdens of practicum, "Once you’re going on practicum, they will subsidize your spending. So, should they implement that, that can lessen the burden on most if not all fourth-year practicum students." There are also calls to limit the coursework over the last school year since people are faced with teaching practicals as well as research papers. Persons also called for improved mental health initiatives for students requesting, "the hosting of one to one session so if you’re struggling and that person could listen to you and talk to you and guide you through it, as well as one to one sessions or group sessions which is small groups ranging from about 6-10 persons.” An administration worker also suggested, “weekly counselling session for fourth-year students to try and encourage them.”

Administration's perception of the effectiveness of the current mental health intervention strategies

The findings of this study have suggested that there are mixed views with regard to administrators' perception of the effectiveness of mental health intervention strategies. Many schools are finding ways to incorporate a broader culture of wellness into their policies, systems and day-to-day campus life. It is important to acknowledge whether these strategies are indeed working and to note what can be improved to better aid students.

In referring to effective strategies the counselling centre was highlighted. One administrator expressed, “the effectiveness of these strategies is that the students actually, the material that is provided for them.” Another respondent highlighted, “I think it is, to some extent it works but as I said previously, probably there is a little more that could be done to address persons who are really struggling mentally to complete their studies and for final-year". The effectiveness perceived by administrators is similar to the finding of Gordon, it was also found that counselling can be very beneficial to students to improve their coping mechanisms. This is a similar finding, expressed by students, as they were unaware of any strategies catering to final-year students specifically. Final-year students are in a major transitioning period. They require support catered to them, that caters to their specific issues, namely those faced in the off-site teaching practice. This is why the university must find creative ways to reach students, as was highlighted by Brown the onus cannot fall solely on the counselling centre or the counsellors available. The university must engage in other meaningful ways to engage final-year students specifically. Telehealth, group therapy and peer-to-peer counselling has been found as viable options. Another effective strategy mentioned is a personal development course, this individual perceived it as effective highlighting, "I know personal development says a lot but they actually put a twist to it in terms of bringing on that good mental health practice to see the students growth and development”.

Other administrators however perceive that these strategies are not effective in terms of mental health. A general finding is that many of the initiatives highlighted are not specifically catered to mental health. One administrator notes that the seminars held "mostly tell you what to expect in the classroom and just give you a heads up". This may be beneficial knowledge, however, students require knowledge that will aid them in adapting to the challenges and taking care of their mental health in the process. Other administrators had also expressed that they perceive that the university isn't doing enough. Hosting a mental health week and having a discussion simply isn't enough for students and are perceived to be ineffective. The respondent referring to the hosting of seminars noted, "They’ll send them in an email but most people don’t really read those emails. They might come with persons who can discuss and talk." While some administrators perceive the counsellors as effective, others are of a different opinion, " I hear that they normally have one on one guidance sessions, I don’t think it’s effective enough for the final years because a lot of them as I see...when you talk to them, they’re stressed out, downtrodden, they’re discouraged and they have a lot of issues on their plate.”

Academic performance is widely recognized as a crucial aspect of a student's trajectory and overall success. However, it is important to acknowledge that this can be impacted by the state of the student’s mental health. This study has provided insights into how poor mental health has had a significant impact on final-year students' academic performance. The study found that the major struggles they face include stress, depression and anxiety. These factors were attributed to the demanding requirements of the final year, the culture shock of the classroom environment, challenges associated with the transition to online learning and the looming transitions after university.

Given the evident influence of mental health on students' academic performance, it is imperative for universities to develop effective strategies to address and mitigate these impacts, especially during the final year. The study participants highlighted four major strategies that have been employed: seminars, guidance counsellor support, advocacy from student leadership and social gatherings. However, the study also revealed mixed views regarding the perceived effectiveness of these mental health intervention strategies from the administration's perspective. This indicates the need for further evaluation and assessment to determine the actual impact of these strategies on students' well-being and academic performance.

In conclusion, the findings of this study emphasize the significant influence of mental health on final-year students’ academic performance. Universities must prioritize the development and implementation of strategies that effectively address mental health challenges and provide comprehensive support to students, particularly during the final year. By continuously assessing the impact of these strategies and incorporating student feedback, educational institutions can refine their approaches and better aid students on their academic journey. Ultimately, a comprehensive and supportive approach to mental health will not only improve academic outcomes but also contribute to the overall well-being and success of students.

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