Editor’s note: Field Finds is a regular feature of Field Educator. These concise literature reviews provide information and guidance to field educators and field instructors. Each review concludes with three discussion questions as inspiration for further thought on the subject matter.
Introduction
This edition of Field Finds explores the existing literature on student mental health challenges in social work and field education. The following themes are discussed: 1) the prevalence of social work students with mental health concerns; 2) social work students’ attitudes toward others with mental illness; 3) complex issues to consider, and 4) strategies for supporting students.
Prevalence of Social Work Students with Mental Health Challenges
Understanding mental health challenges across college and university campuses has developed into an important body of research knowledge. The Adverse Childhood Experiences (ACE) questionnaire assesses the presence of certain adverse experiences in childhood and relates these to health and social outcomes in adult life (Felitti et al., 1998; Thomas, 2016). The ACE questionnaire has been used on college campuses to better understand the prevalence of adverse childhood experiences among students (McGavock & Spratt, 2014). According to the Centers for Disease Control and Prevention (CDC), adverse childhood experiences are “potentially traumatic events that occur in childhood (0–17 yrs.), and can include experiencing violence, abuse, or neglect; witnessing violence in the home or community; having a family member attempt or die by suicide; substance misuse, mental health problems, instability due to parental separation or household members being in jail or prison” (CDC, 2022). The results of childhood stress may impact college students’ academic performance and college success. Students with a history of adverse childhood experiences are more vulnerable to anxiety and depression, and are more likely to drop out or take longer to complete college than the traditional four years.
Social work educators have observed an uptick in the number of students experiencing high levels of stress, burnout, and mental illness (Horton et al., 2009). Lee et al. (2021) linked adverse childhood experiences with higher levels of perceived stress among MSW students. Thomas (2016) used the ACE questionnaire to determine the prevalence of childhood adversity among MSW students at a U.S. university. A total of 86 students across four social work classes completed the questionnaire. Overall, 42% of participants had four or more ACEs, pointing to previous trauma within a substantial population of MSW students. According to the scale, such a score places an individual at greater risk of adverse health and social outcomes as they age. While an elevated ACE score does not necessarily mean a person will develop mental health challenges, Thomas cautioned that students with a history of trauma may be triggered by the social work course material and/or field placement experiences.
In a larger study, Gair and Baglow (2018) surveyed 2320 social work students from 28 Australian universities about the impact of financial stress on their daily lives. A subset of 829 individuals provided qualitative feedback in the online survey, and reported challenges juggling finances, field placement, and paid work. The researchers found that some social work students were juggling a “toxic brew” of financial challenges, paid work, and family obligations, and that this could lead to future mental health challenges. These findings indicate that social work and field educators need to pay focused attention to the impact of financial, family, and work stress on educational outcomes and performance in field education. Field education may become the “tipping point” for some students, and field directors should be aware of this concern.
Ting (2011) examined the rates of depression among 215 BSW students and the barriers to accessing mental health services. The study was conducted at a mid-Atlantic state university in the US. Approximately 50% of the participating students scored high on a depression scale, yet many reported they would not seek help for their mental health, based on a multitude of reasons. These included a lack of time; concerns around confidentiality, lack of resources to access services, distrust, and fear of the process of seeking help; a preference for seeking informal help (i.e., from family or friends) over help from a stranger (therapist); cultural competency (skills of communicating and interacting with people of other cultures from our own) (”Cultural Competence,” 2022); concerns about the quality of services provided by the helping professional; and a potential desire for perfection and control (that is, these students felt that to seek help was to admit weakness). This study helps us to understand the myriad reasons why our students do not seek help.
In an in-depth conceptual analysis, Baird (2016) addressed the prevalence of anxiety as a concept and barrier for social work students. The article paid focused attention to the field supervisory relationship and how this can potentially amplify student anxiety. Triggers may include a sense that the relationship is not safe and concerns about performance when being observed by the supervisor. It is suggested that field supervisors who normalize student anxiety in the context of field placement learning may help mitigate the student’s potential anguish. While anxiety can be a debilitating emotion, Baird highlights the powerful role that anxiety can play in motivating and promoting student learning and growth.
Ying (2011) examined whether social work students’ field placement experiences may exacerbate or create “disequilibrium” or mental health challenges. This mixed methods study showcased how students can feel a sense of inadequacy, which may result in low self-esteem and higher levels of depression, as demonstrated in this quote: “I feel very inadequate…. You want to have a sense of competence and feeling incompetent is very frustrating” (p. 287). This study revealed how students, who may feel competent in a traditional classroom, may struggle more with experiential learning in a field placement setting.
In somewhat dated literature, Collins (2006) and Regehr et al. (2001) suggested that it is often at the point of the field placement that students may face increased mental health challenges. Collins states social work students fear voicing their concerns because of fear of prejudice from others, i.e., faculty and field supervisors. Allen and Trawver (2012) reiterated that many social work students fear that sharing their internal struggles will result in their dismissal from their program and/or field placement.
Social Work Students’ Attitudes Towards Others With Mental Illness
A team of researchers at a U.S. public university heard social work students articulate stigmatizing beliefs about mental health in the classroom, and this created the impetus for a study on whether such internalized beliefs are common among social work students and, if so, how this might impact their work with clients with a mental health diagnosis. Zellmann et al. (2014) surveyed 198 BSW students on their attitudes and beliefs about service users with mental health concerns. Although the survey demonstrated that the majority of students did not hold stigmatizing beliefs, such beliefs were found in a subset of individuals. The authors challenged social work educators to explore ways in which future research and curriculum design can mitigate such attitudes before students begin interacting with service users. The specific impact of such negative attitudes in field placement settings was not examined in this study and is worthy of greater attention.
Covarrubias and Han (2011) explored the attitudes toward and beliefs held by 71 graduate social work students about serious mental illness (SMI). The authors used specific measures to identify mental health stigma, including the desire for social distance and restrictions on the SMI population. The study found that students who had friendships with people with SMI were more likely to report attitudes of acceptance and understanding. This study demonstrates the need to help students develop greater proximity to and relationships with people with SMI. The authors suggested a need for mental health placements so that students can begin to develop understanding and compassion for others. Curating field placements that can help social work students break down internal biases around mental illness can inform and infuse greater compassion for oneself and others.
Complex Issues to Consider
In another study, researchers in Israel explored the experiences of social work students who have psychiatric difficulties (Goldberg et al., 2015). Twelve participants were recruited to discuss their self-reported mental health challenges. Social work students with such lived experiences have the opportunity to embrace their unique “insider” status to empathize with others. A similar study emphasized the learning that social work students receive from working with service users with lived experiences of mental health challenges (Kraus & Moran, 2019). This research demonstrates how students can learn about themselves and others from the unique vantage point of the service user.
Watson et al. (2017) explored the attitudes and beliefs of social work faculty towards students with identified mental health issues. The study revealed that the majority of faculty upheld positive and encouraging beliefs about students with mental health concerns; however, there are times that faculty may advise such students to pursue a different career outside of social work. The authors suggest that is important to consider that students with lived experience may possess greater empathetic engagement towards others as a result of their journey.
Todd et al. (2019) published a detailed conceptual paper that suggested there are three key factors social work educators should consider when navigating social work student mental health issues: 1) concerns about legal liability if a student is removed from their course because of mental health concerns; 2) conflict between the role of gatekeeper and the profession’s commitment to social justice and strengths-based practice, and 3) a lack of tools to objectively measure student performance in field placements. The authors implore social work educators to see mental health issues in social work education from social justice and human rights perspectives. They compare and contrast how social work educators navigate these issues in four countries—the USA, Canada, the UK, and the Republic of Ireland—and conclude that North American social work education tends to use policies that are reactive and not nuanced to the complexity of managing individual student mental health issues. In the UK and Ireland, policies tend to focus on protecting the public over students’ rights when mental health issues surface or are self-reported (Todd et al., 2019).
Other authors have outlined the complexities of navigating these issues for social work faculty. Anand (2022) has written a reflective paper about navigating student mental health challenges in Delhi, India, in which they explored the complexity of managing boundaries with students through a series of carefully curated case studies emanating from their own personal and professional experiences. Anand highlights how hard it can be for field education faculty liaisons to support students’ mental health while also working to preserve the relationship with field supervisors and focusing attention on the needs of clients being served by the student at risk. Much of the literature describes the “tightrope” that social work faculty traverse when addressing these complex issues of student mental health (Kraus & Moran, 2019; Todd et al, 2019; Ying, 2011).
Strategies for Supporting Students
In a seminal article, Iacono (2017) showed how the concept of self-compassion has great potential in helping students navigate burnout and stress. In her extensive review, she examined literature that supports the notion that care and compassion for oneself can help promote overall well-being in the helping profession, namely social work practice (Iacono, 2017; Neff & Costigan, 2014). She provides an important blueprint for understanding and cultivating self-compassion in social work education, and by extension, field education.
Two U.K. researchers, Grant and Kinman (2012), examined how to create and build resilience in the social work profession. This unique study determined that emotional intelligence and associated competencies, such as reflective ability, aspects of empathy, and social confidence, were found to be key predictors of a resilient individual. In another U.K. study, researchers examined the role that positive psychology constructs—resilience, self-compassion, and intrinsic motivation—can play in helping social work students navigate their mental health challenges (Kotera et al., 2019). Building on Iacono’s (2017) review, Kotera et al. stated it is crucial to integrate the concept of self-compassion into the social work curriculum. The field seminar is a natural place to integrate and apply self-compassion.
In a study from Australia, researchers conducted qualitative interviews with 17 social work students, to support the students and possibly prevent the exacerbation of mental health challenges due to the stress of obtaining a social work degree (Agllias et al., 2016). The authors determined key themes that can better support social work student retention and may mitigate future mental health concerns. One important theme is cultivating a sense of belonging in the social work educational journey; students valued belonging to a learning community in which others had shared values. This sense of belonging can occur within a cohort learning environment, e.g., a BSW cohort.
A repeated theme in the literature is the infusion of mindfulness training into the social work curriculum. Iacono (2017), Grant and Kinman (2012), and Murphy (2022) all highlighted the importance of cultivating this skill. Focused attention on mindfulness training can be incorporated into the field seminar class and can be woven in as a regularly featured activity throughout the academic year.
Summary
Three themes have emerged: 1) social work students are at higher risk for having or developing mental health issues; 2) some social work students may have internalized stigma and beliefs about mental illness that may impact their readiness to practice; and 3) the complex issues that social work educators must address include gatekeeping concerns, setting appropriate boundaries with students who exhibit mental health challenges, and understanding disability rights and policies related to this subject. Anand (2022) has demonstrated the need for us, as social work educators, to be reflective of our journey working with students with mental health challenges; we should not work in isolation, but rather find colleagues with whom we can debrief. Underlying this complexity is the very real professional obligation to use our social work values as a moral compass for addressing the mental health challenges of social work students.
Discussion Questions
- What issues do you experience in supporting students with mental health challenges in field education?
- What strategies do you employ in your curriculum and in your field supervisor training to help navigate these issues with students?
- What one piece of advice would you give other field directors concerning managing student mental health challenges in field education?
References
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