Understanding international student mental health

Andy Winter

Campus Life Director
University of Nottingham

For international students, transition to a UK university involves substantial adaptation. The culture shock of moving to the UK and finding themselves within a new environment can create psychological and physical disorientation. This may be heightened by challenges like the loss of social support, independent living, and difficulties with communication. 

Every student responds differently, but it's not unusual that they may suffer from low mood, anxious or fearful thoughts, tiredness, insomnia, loss of self-confidence, and loneliness. Many carry a weight of expectation from families with pressure to achieve. This is particularly true where families have made significant financial investment to support the student's studies. They may have additional difficulties where there is a crisis back home and where the distance and cost of travel mean that it is not easy to return.

When things get challenging, it's not always easy for them to access support. Mental health, support services, and therapies are viewed very differently in different cultures. In many countries there is still substantial stigma and shame attached to mental ill health. Just the practical understanding of how to access care in the NHS can be a barrier for students getting the care they need.

Work previously undertaken at the University of Nottingham into the experience of Chinese and Malaysian students indicates that there are a complex range of factors that can impact international students' health and wellbeing. Each year at Nottingham over 27% of our population are international students so it's crucial that we understand how to best support their needs. In addition, the number of international students presenting at our specialist services is increasing year on year. For example, in our Mental Health Advisory Service we have increased from 119 international students in 2015–16 to 185 in 2017–18. And this upward trend shows no sign of abating.

Universities are now prioritising mental health, adopting whole university approaches, based on Universities UK's Stepchange framework to improve outcomes. There is of course no 'one-size-fits-all' solution: different student populations and different types of institution require different interventions. The mental health needs of international students differ in significant ways from those of home students, and must be addressed differently by universities and healthcare providers. However, few currently provide targeted mental health support for these students. This is not to say that there aren't examples of good practice within the sector. Providing explanatory documentation about the NHS and how health services in the UK work is a positive health promotions intervention. Peer-led programmes like the Global Buddies scheme that University of Nottingham Students' Union runs deliver culturally appropriate and sensitive support. External providers offering bilingual services and technological delivery are providing new approaches to addressing issues.

But for all of the good work within the sector, there is no store of best practice or specific guidance for colleagues. That's why we have recently submitted a business case to the Office for Students' Achieving a step change in mental health outcomes competition call that is focused on creating a toolkit for the higher education sector as a whole. Working with colleagues from SOAS, University of Leeds, Student Minds, and CampusLife, our intention is to provide resources and examples of best practice that will allow institutions to co-create local responses to the needs of their international students. Through effective engagement and coproduction we believe that we can all establish more culturally competent services.

At a time when Brexit and the Augar review make for an uncertain future, one thing that we can be certain of is that so long as Universities look to recruit international students, there will be a need for services and initiatives that are tailored to meet their needs.

Andy will be speaking on supporting international students' mental health at Universities UK International's flagship annual conference – the International Higher Education Forum – on March 27th at Imperial College London. He will share the stage with Professor Kathryn Mitchell, Vice Chancellor, University of Derby; Yinbo Yu, International Students' Officer, NUS; and chair Debbie McVitty - Wonkhe's Editor.

Leave a Comment

jones3210 says:
28 March 2019 at 11:40

Hey, it's constructive for me.

I loved this blog.

thank you for the post.

fitnesshealthforever says:
23 April 2019 at 08:31


Hey, very nice site. I came across this on Google, and I am stoked that I did. I will definitely be coming back here more often. Wish I could add to the conversation and bring a bit more to the table, but am just taking in as much info as I can at the moment. Thanks for sharing.


GB Mag
GB Mag says:
16 May 2019 at 16:43

As the founder of GB Mag I have had the privilage of meeting thousands of international students and I regularly hear about the anxiety they go through both when they arrive and throughout their studies.  They need a different kind of support to home students becuase they are not only rising to the academic challenages of university but they are also experiencing extreme culture shock. 

These conbining factors cause a lot of stress which can quickly spiral if the student doesn't know where to go for help and ssupport.

WSNE Consulting
WSNE Consulting says:
7 October 2019 at 07:21

Thanks for writing for students. This is one of the best blog for me. I am completely agree with your thoughts. 

Ada says:
17 March 2020 at 13:29

As a current research student currently watching my health and mental wellbeing deteriorate due to my institution not being able to provide me with clarity on what support I could get and the implications for student's enrollment and immigration consequences. I am still trying to recover from the shock of an email I received regarding my health situation which basically implies that as an international student you are not allowed to be sick or you risk being chucked out of the UK. I pose a question to UK universities - What are the UK universities really doing to fight for the health and wellbeing of the students under this restrictive immigration style of policing or are we just one of those goods that universities access and then abandon? I am really disappointed in the system.

Joy Dimiri
Joy Dimiri says:
19 March 2021 at 11:47


Thank you for this page. I am relieved of finding it, as I can pour my emotions out as I write. I came to the UK, January 2015 to study MA Youth work, Health and Community Development Studies, however, I suffered a thalamic bleed that led to a stroke, same year. My studies were extended for 6 months and I completed with a Postgraduate diploma in June 2017.

In September 2018, I enrolled for MSc Social work, completed my studies in December 2020. I qualified with a Merit in Social worK and registered with Social Work England in February 2021. I have dreamed and hoped to work in the UK. I got a job as a Children/Family Social worker in a Council, but the Council can't sponsor me as an immigrant.

International students go through HELL to survive in the UK. My emotional health has been a complete wreck, as I labour daily to survive with 2 children. I  am highly skilled, qualified, have worked in Health and Social Care for about 5 years, yet the Immigration system can throw me away like dirty water, as my student visa will expire very soon.

What a system !!!, why should an International student have any hope in the United Kingdom, why the injustice? why must our spirit be broken into pieces, especially when we are committed to the growth of this country?

It is so unfair, and unjust. No human being deserves to be treated in such an undignified manner.

We Are Together logo on pink background

We are together: students supporting the national effort against Covid-19

12 March 2021
Over the past year, staff and students at UK universities have played a vital role in fighting Covid-19 through research and supporting their local communities. Here, three students from across the UK share their stories.

group of students sat outside in a cafe working

Supporting LGBT students studying overseas

10 March 2020
Stonewall's Emma Kosmin on steps universities can take to provide support for LGBT students studying overseas.