37 University students’ access to mental health care: a qualitative study of the experiences of mental health services professionals through the lens of candidacy

Background The escalating prevalence of mental health issues among university students is alarming, particularly as many do not receive necessary mental health interventions. While existing qualitative research has shed light on the perceived barriers students face accessing mental health care, our study explored the experiences of healthcare professionals who interact with these students. Our aim is to enhance the understanding of students' accessibility to mental health care. Methods Between June 2022 and January 2023, we conducted semi-structured interviews with 23 professionals from university services, NHS general practice, crisis teams and psychological services in London. Data analysis was carried out concurrently with data collection, utilising reflexive thematic analysis and abductive analysis principles. The concept of 'candidacy' was instrumental in deciphering the ongoing phenomena observed in the data. Results Our findings indicate that students' access to appropriate mental health care is intricately linked to their evolving social context, the structure, and pressures of the local health system. Professionals highlighted variability in students' perceptions of what health issues warranted medical attention. The students who made it to a professional's service were often those with more resources and better relationships to leverage. Once in the system, the actions professionals took were heavily influenced by their specific roles and expertise, available resources, but also by their service's relationship with other organisations, and the types of support students deemed acceptable. Conclusions The concept of candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and the challenges of emerging adulthood. Our research suggests that mere policy shifts promoting increased use of mental health services may not yield better outcomes for students without holistic consideration of inter-service relationships and available resources.