This introductory chapter sets out the need for a handbook of university mental health. It considers the health of staff alongside that of students, and that does not presume American systems of education and healthcare. Far more of the UK population expects to attend university, with a consequent expansion in the size and numbers of institutions. Financial constraints mean that universities can no longer run as elite communities of self-governing scholars, but are now governed according to business models, with implications for the wellbeing of all involved. In the context of population-wide increases in mental disorder and demand for treatment, more students than ever now disclose a psychiatric diagnosis. The recent COVID pandemic and lockdown disproportionately threatened the well-being of students and may have changed for good some of the ways in which education and healthcare are delivered. The author summarises her own personal and professional of UK university life and describes the motivation for embarking on the production of a single author handbook on this topic. A wide readership is welcomed to the book, which will provide a series of interlinked but standalone chapters to be consulted piecemeal as well as read as a whole.

Any discussion of the classification of psychiatric disorders should begin with the frank admission that any definitive classification of disease must be based on aetiology. Until we know the causes of the various mental illnesses, we must adopt a pragmatic approach to classification that will best enable us to care for our patients, to communicate with other health professionals and to carry out high-quality research.

In physical medicine, syndromes existed long before the aetiology of these illnesses were known. Some of these syndromes have subsequently been shown to be true disease entities because they have one essential cause. Thus, smallpox and measles were carefully described and differentiated by the Arabian physician Rhazes in the tenth century. With each new step in the progress of medicine, such as auscultation, microscopy, immunology, electrophysiology and so on, some syndromes have been found to be true disease entities, while others have been split into discrete entities, and others still jettisoned.

This book is about some of the psychosocial aspects of emergencies, incidents, disasters, and disease outbreaks.

My clinical and academic engagement with the mental health consequences of, and responding to emergencies and disasters began when the Herald of Free Enterprise capsized in Zeebrugge Harbour on 6 March 1987, causing the deaths of 193 passengers and crew. Many more people survived; some were injured, and the impacts on the mental health of the survivors became a major long-term issue. I learned a huge amount from patients who were referred to me. This incident occurred relatively soon after the American Psychiatric Association had first included post-traumatic stress disorder (PTSD) in its Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. There have been huge developments in science and practice relating to the mental health aspects of disasters in the 37 years that have elapsed since the Zeebrugge ferry tragedy.

It is well established that people suffering from a mental disorder have poorer physical health outcomes, including increased mortality, than those without such a disorder (1). In addition, people with severe mental illness are more likely to be admitted to non-psychiatric medical services, have longer admissions and present with more emergencies (2). The mental health consultation-liaison (CL) team is perfectly placed to ensure holistic assessment and integrated care of this population, with the opportunity to improve both physical and mental health outcomes.

Over the past 20 years, we have seen a dramatic shift in how we conduct our daily lives. With digital shopping, ordered items are delivered the same day and communicating is easy with distant family. The years 2020–22 and the global pandemic brought an escalated pace of change, including in healthcare with vaccine appointments booked online.2 However, the same cannot be said about mental health services where the experiences of both delivering and receiving help lags behind.

This issue was raised by Rebecca Cotton, Director of Policy at the Mental Health Network, in the publication quoted above. If you ask the question ‘How much has mental health changed in the last 20 years?’, we expect that, like her, your answer will be that it hasn’t changed much!

In the past 100 years, there has been a revolution in our understanding of the brain. So far, this has done little to disrupt mainstream psychiatric practice. That is set to change. New neuroscience-based treatments are emerging, while evidence from neuroscience and genetics are calling into question traditional diagnostic boundaries. Psychiatrists of the future will need to integrate their understanding of brain imaging, molecular diagnostics, psychological factors and social context to provide neuroscience-informed care plans.

People volunteer at different stages of their careers, from student days to post retirement. The reasons are varied, but common motivations include altruism and the desire to ‘give something back’. Many readers may wish to contribute to the welfare of people overseas with mental illness, alongside some who feel a deep desire to do what they can for those who have little access to mental health care. For people from a diaspora background, there may be a desire to help ‘back home’. For others, it is motivated by a need for refreshment and to gain new perspectives away from the usual daily professional ways of working. Some may feel the desire to contribute to colleagues’ development or make an impact on trainees and the next generation. Other volunteers may crave ethical travel, and some mention the increasing appeal of learning from colleagues in varied and low resource settings. Whatever the reason(s), careful reflection is indeed needed as outlined in Chapters 3 and 4 on ethical considerations.

There are many high-profile reports about the link between social media and mental health, and these sit within a broader social climate where people are asking pressing questions about the extent to which social media can ’affect’ or ’impact’ individuals. It is natural to fear new and fast-growing technologies, but regressing to the media ’effects’ models that have for so long been discredited may not be helpful, or indeed accurate. One of the aims of this chapter is therefore to argue that social media are not one thing and to instead introduce several aspects of the phenomenon to readers, briefly tracing standout phases in their evolution, the characteristics that differentiate them from older media technologies, their (increasingly controversial) business and governance models, and finally their use and non-use among particular social groups.