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.