There are high levels of alcohol in the UK population, with a particularly damaging pattern of ‘binge drinking’. Extreme alcohol use remains embedded in university culture. Since COVID and lockdown, male students, postgraduates and academic staff are likely to have increased their alcohol consumption. Starting university marks a rise in alcohol intake, to reduce social anxiety and ‘belong’ to the prevailing culture. High risk sexual behaviours rise significantly when alcohol is taken. Death by suicide, and deliberate self-harming, are associated with alcohol use. This is an important modifiable risk factor in addressing sexual violence and suicide. Mental disorders are strongly associated in complex interactions with alcohol use. Heavy alcohol use may be associated with other substance misuse and addictive behaviours. Abstaining from alcohol may result in striking improvements in mental health and academic performance. The rights and wellbeing of non-drinkers need to be acknowledged too. Information campaigns and paying lip service to disapproval do not work. The student age group tends to be less risk-averse than older groups. It falls to university authorities in partnership with local communities to control high risk alcohol intake.

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.

This, the first of two chapters on the transition from school and home to university, addresses general principles of the nature of transitions. All significant transitions involve normal healthy grieving what is lost (‘homesickness’), alongside rebuilding helpful structures and finding new relationships. Concepts of ‘thresholders’ and ‘transition aged youth’ are discussed alongside growing evidence that dynamic changes in the adolescent brain and mind continue longer than previously thought. Other life transitions are considered from an interpersonal perspective, acknowledging that parents and other family members simultaneously experience disruptive role transitions when a student leaves the family. Individual differences and diverse backgrounds make it difficult to know how much adult capacity can be realistically expected of new students. A list of ‘readiness skills’ is provided for consideration, without the expectation that these will all be mastered before leaving home and school. The author suggests that university need not be the automatic immediate option for school leavers and discusses benefits of using wider criteria than the purely academic to choose a university. Finally induction courses, summer schools and other ways of preparing for university are discussed. These include the peer expectation of using alcohol to manage the inevitable social challenges.

Better nurturing of ethnic diversity can be associated with improved academic achievement as well as more ethical university communities. Despite ‘wake up calls’ such as the Black Lives Matter movement, there is no room for complacency. The UK does not have predominantly black universities, though student cultural societies allow a sense of belonging. Individuals from minority ethnic groups should not automatically have to take responsibility as BAME campaigners. White staff and students need to overcome defensiveness to prevent ‘white fragility’ from blocking progress. In choosing a university, families of all ethnicities can ask whether the institution is signed up to Advance HE’s race equality charter (REC). Staff should assertively support BAME staff appointments and grant applications, and ensure that racial awareness trainings are evidence based. University Disciplinary procedures need to offer greater openness to complaints of discrimination and harassment. In University counselling services appointing more BAME practitioners improves the ethnic diversity of the clinical group, whether or not clients opt to meet with a clinician of non-white ethnicity. BAME students need extra support to return to academia after a mental illness as they are at greater risk of ‘dropping out’.