This wide ranging chapter examines the relationship of mental health with physical aspects of behaviour such as exercise, eating and sleeping and the consequences of dysregulation for both academic success and mental health. The loss of home and school structures at a time of continued physical and brain development puts the student age group at high risk of dysregulation-related disorders, including the so-called ‘eating disorders’. The author discusses benefits of restoring institutional structures such as canteens and adolescent-friendly timetabling. Physical activity, including outdoor activity is important for physical and mental health of all students and staff, and not just a competitive activity for the prestige of an institution. Universities will inevitably host many young people with eating disorders, given the demographic involved. The UK is underprovided with specialist eating disorders services, so that universities may need to develop expertise to support young adults in association with NHS clinics. However, eating disorders can affect people of any age or gender. Staff as well as students may experience these conditions and should be offered services where their privacy is protected.

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.

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.