This chapter follows on from the previous chapter, now focussing on challenges of transition to university for students already diagnosed with a mental illness. It examines the pros and cons of different options in this situation, highlighting the time involved in negotiating health service transfers. Financial and geographical organisation of health services result in dangerous gaps in treatment and support. Academic studies can be therapeutic and contribute to recovery and self-esteem but high levels of competitiveness threaten success and mental well-being. Wellbeing and pastoral support are important factors in choice of a university for people with pre-existing mental illness. Mental illness can delay the adolescent maturational process. Formal mentoring into and during university life can be particularly helpful for those vulnerable to mental illness. Transitions occurring further on in university life also require careful management. Staff and students with mental disorders who need periods of sick leave should be supported both to leave academia and to return later on. If a return is not possible, as well as at the end of a course or contract, there is a potentially high risk gap where university services are no longer accessible.

Universities should recognise neurodiversity as conferring risk for mental health conditions and suicide. Evidence-based support and monitoring can reduce the risk of these occurring and can also reduce dropout and improve academic and psychosocial outcomes for these students and staff members. Staff training in recognition and management of neurodiverse conditions should be delivered at levels appropriate to staff roles. Despite growing interest in both ASD and ADHD in adults, many people who could benefit from diagnosis have not received it. Professionals need to be aware of underdiagnosis of both ASD and ADHD in girls and probably in ethnic and other minority groups. Lack of recognition deprives these vulnerable people of the supports universities can offer to people with neurodiversity. Lay people who take on caring or ‘buddying’ roles for people with neurodiversity need to be well-supported within a helping community rather than expected to shoulder responsibility alone. Waiting lists at many NHS clinics are too long to provide timely assessment for students. University mental health staff may be able to create recognised training programmes and negotiate agreements about diagnosis and prescribing with local GPs.

UK university life lends itself to experimentation in sexual behaviour, orientation and gender identity. The experience of sexual liberation can affect trust and communication with students’ culture and family of origin. Casual sexual encounters (‘hooking up’) are common at first. Those who settle into more monogamous ‘dating’ enjoy better mental health. Mental illness is associated with less healthy sexual experiences. The sexual dimension of life is important to the student age group and should be considered in assessment and treatment. Despite the relatively tolerant environment, university LGBTQ+ communities are at higher risk of mental illness. Students with ASD may also need extra support to negotiate sexual development. Some students have previous sexual trauma, which may still be unaddressed. Some school sex education protects students from gender-based violence throughout university, but classes are often delivered without awareness of pupils’ ethical and relational concerns. Social media provides influential, but often misleading sex education. High reliance on online dating is associated with poorer levels of mental health. Excessive alcohol and drug consumption are strongly associated with both perpetrating gender-based violence and becoming a victim.