Entering adulthood (age 17 to 25)

Young people aged 17 to 25 are entering adulthood. Mental health conditions that occur at this age can have long-term impacts on young adult’s lives, which can increase over time and impact future life chances, including increasing the likelihood of difficulties at education and unstable employment (Khan, 2016).
It has been estimated that around a quarter of disability (measured in disability-affected life years or DALYs) experienced by young people aged 15-19 in Cambridgeshire and Peterborough is due to mental health conditions (Institute for Health Metrics and Evaluation, 2022), making this a major proportion of the burden of disease.
Entering adulthood often comes with multiple transition points, such as leaving school, entering the workforce, and moving out of the family home. Young adults experiencing difficulties with finances, housing, education and employment are more likely to experience poor mental health.

Local strategies

Recent local strategies have highlighted the importance of working with young people, to support their transition to adulthood; and the need for help and treatment for young people who are not in employment, education or training (NEET).

Table 12: Summary of recent local strategies relating to the mental health of young adults

Demographics

In Cambridgeshire and Peterborough in 2021, there were 51,080 young people aged between 15 and 19 (5.7% of the total population) and 55,561 young adults aged between 20 and 24 (6.2% of the total population) (Office for National Statistics, 2022b).
Young adults (aged 20-24) make up 14.3% of the population of Cambridge City, in part due to the high number of university students of this area (Office for National Statistics, 2022b)

Mental health need

Based on the national NHS Mental Health of Children and Young People Surveys (NHS Digital, 2022), it is estimated that there are 5,273 children aged between 17 and 19 with a diagnosable mental health condition, autism or ADHD in Cambridgeshire and Peterborough (95% confidence interval: 4,567 – 6,064). Note that autism and ADHD are not mental health conditions, but are included here as young people seeking a diagnosis are child and adolescent mental health services (via YOUnited).

Table 7: Estimated prevalence of mental health conditions in children (aged 17 – 19) in Cambridgeshire and Peterborough. Data source: Children and Young People Mental Health Dashboard. Note: lower and upper estimates are generated from 95% confidence intervals

Table 12: Estimated prevalence of mental health conditions in young adults (aged 17 to 19) in Cambridgeshire and Peterborough, 2023. Data source: Children and Young People Mental Health Dashboard.

Self-harm

Self-harm is when somebody intentionally damages or injures their body and can be a way of expressing or coping with overwhelming emotional distress. Hospital admissions data provides one insight into self-harm, although as it does not capture the true prevalence within our local area. A detailed review of self-harm prevalence in children and young people in Cambridgeshire and Peterborough was carried out by Fullscope in 2022 (Fullscope, 2022). Self-harm will also be covered in chapter 8 of the mental health needs assessment.

There were over 700 hospital admissions due to self-harm amongst children and young people (aged 10 to 24) in Cambridgeshire and Peterborough 2020/21. The rate of hospital admissions was above the national average in both Cambridgeshire and Peterborough from women and girls, but similar to the national average in men and boys.

Figure 26: Hospital admissions due to self-harm in 10- to 24-year-olds per 100,000 of the population, 2008/9 – 2020/21. Data source: Fingertips

Protective and risk factors

Young adults experiencing difficulties with finances, housing, education and employment are more likely to experience poor mental health.

Homelessness: in 2021/22, there were 934 households in Cambridgeshire and Peterborough owed duty under the Homelessness Act where the main applicant was aged 16 to 24 (Office for Health Improvement and Disparities, 2022). The estimated prevalence of mental health conditions in young people experiencing homelessness ranges from 48 to 98% (Hodgson et al., 2013).
Substance use: there were 185 hospital admissions due to substance use in young people (aged 15 to 24) in 2018/19 to 20/21. Hospital admissions due to substance use are below the national average in both Cambridgeshire and Peterborough.
University students: In Cambridge, there are around 12,000 students at Anglia Ruskin University and 24,000 students at the University of Cambridge. The prevalence of mental health conditions seems to be similar in university student and non-student populations (Royal College of Psychiatrists, 2021a).
Young parents: in 2020/21, there were 45 new mothers under the age of 18 across Cambridgeshire and Peterborough (Office for Health Improvement and Disparities, 2022). Mothers under 20 have higher rates of poor mental health for up to 3 years after birth, and are 3 times more likely to experience postnatal depression, compared to older mothers (Public Health England, 2019a).
Young people not in employment, education or training (NEET): in 2021, 2.9% of 16- and 17-year-olds (381 young people) in Cambridgeshire were either NEET or their activity was unknown; compared to 5.0% of 16- and 17-year-olds in Peterborough (254 young people) (Department for Education, 2021). Amongst young people who are NEET, there is a high prevalence of mental health problems and substance abuse issues (Goldman-Mellor et al., 2016).

University students

The prevalence of mental health conditions seems to be similar in university student and non-student populations (Royal College of Psychiatrists, 2021a). However, some students can be at greater risk of experiencing mental health conditions due to a combination of academic, social and financial factors (Thorley, 2017). A review of risk and protective factors for students found that (Campbell et al., 2022):

LGBTQ+ students are at 1.5 to 4.5 times more likely to have mental health problems, including depression, anxiety, self-harm and suicidal behaviour.
Experiences of childhood trauma are significantly associated with poor mental health, although it is unclear if this poses additional stresses for students at university.
Autistic students are more likely to experience depression than their peers.
Students with a personal or family history of mental illness are more likely to experience mental health problems during university.
Protective factors include social support and psychological strengths (such as self-esteem and resilience).

Nationally, suicide rates amongst university students have increased since 2010. However the suicide rate is lower in students compared the same age group in the general population (Gunnell et al., 2020).

Barriers to accessing mental health support faced by university students

National research suggests that fewer than 1 in 5 university students meeting criteria for mental health conditions seek or receive any treatment (Duffy et al., 2019).
There has been an increase in demand for university mental health services over recent years, which may be due to increasing risk factors for poor mental health (such as financial pressures and social isolation) and decreased stigma around seeking support (Duffy et al., 2019).
Continuity of care can be difficult for students. There are ‘significant difficulties’ coordinating care between primary and specialist care, and support provided by universities (Universities UK, 2021):
- There is a lack of information sharing between higher education providers and NHS services, and students often need to report their stories multiple times when moving between university and GP services.
- Students who experience more complex mental health issues which require support from secondary mental health services, often find frequent transitions between NHS trusts difficult, due to discontinuity of care and differing thresholds between mental health services.
- Most of the student population is transient and moves between family homes and university several times per year. Students can often fall through gaps in care between home and university GPs, particularly if they move back home during periods of mental health crisis.
International students may face additional barriers to accessing mental health support, because of language and cultural differences, and a lack of understanding of the UK healthcare system (Universities UK, 2021). The University of Cambridge has a higher proportion of international students than the national average (HESA, 2023).

What is the local picture?

Half of all young adults enter higher education by the time they are 30 years old (Universities UK, 2021). In Cambridge, there are around 12,000 students at Anglia Ruskin University and 24,000 students at the University of Cambridge.

A 2018 survey of over 1700 students at Anglia Ruskin University found that (Belcher, 2018):
- 1 in 3 students reported having a mental health condition before coming to university.
- Most respondents experienced stress, anxiety and sleep problems whilst at university.
- Half of students were worried about their own mental health and/or the mental health of a friend.
- 2 in 3 students felt their studies had contributed to their mental health problems.
A 2018 survey at the University of Cambridge found that (Ropek-Hewson, 2019):
- 67% of postgraduate students reported having mental health problems (both diagnosed and undiagnosed). Women, LGBTQ+ students, and students in the humanities were more likely to report mental health problems.
- 61% of respondents felt that a ‘competitive and high pressured university environment’ had impacted their mental health; and 37% reported that financial problems had an impact.

In terms of accessing support:

A 2018 survey of over 1700 students at Anglia Ruskin University found that concerns about waiting times for the Counselling and Wellbeing Service, as well as the availability of counsellors, were common (Belcher, 2018).
There was a 28% increase in the number of people accessing support from the University of Cambridge’s central mental health services from 2017 to 2021 (Shepka & Mulroy, 2022). 3 times as many people sought out mental health support from college-based mental health services over this time period.

Figure 27: How many students accessed the following forms of mental health support at the University of Cambridge, in 2017 and 2021? Data source: (Shepka & Mulroy, 2022)

What works to promote good mental wellbeing?

There is a range of evidence around the promotion of good mental wellbeing in adults, which will be covered in chapter 5 of the needs assessment.

Additional resources

References

Full list of references is included at the end of this chapter.