Digital technology is ubiquitous in university life. It became indispensable during COVID as a means of delivering teaching and also therapy. University websites and intranets can be valuable repositories of respected health information, signposting and self-help resources, but these need to be kept up to date. There is still a generation gap in terms of being ‘media savvy’ and older people have different experiences online. Society is waking up to the relentless commercial interests driving our online interactions and the psychological conditioning involved. Society needs to protect young brains in particular from exploitation and harm. Long periods spent online mimic psychiatric disorders, by interfering with concentration, causing sleep deprivation, dysregulation, obsessional checking behaviours, body image dysphoria and abnormal interpersonal relations. Unmonitored content and algorithmic amplifications increase distress. Rising rates of deliberate self harm and suicide rates appear to be associated with online experience. Legal and institutional regulation is unlikely to occur without grass roots campaigning. Schools and families usually provides some protection and online safety education. This needs to be reinforced and revisited during the transition to university. Clinicians and others concerned about mental health or wellbeing should explicitly ask questions such as ‘what’s going on for you online?’

Substance misuse is already widespread in UK schools, The greater freedoms of university make undergraduates particularly vulnerable to starting or increasing. Legal and medical agencies focus more on forensic consequences of established addiction. University drug use is not only recreational but may be motivated by improved performance or appearance. It is not clear whether the UK actively pursues eradication of non-medicinal drugs or prefers arrangements for safer consumption. Most universities officially ban drug use, but some student unions are permitted to provide facilities to enhance safer consumption. Lessons can be learned from the benefits and challenges of the UK smoking ‘ban’ and the history of alcohol ‘prohibition’. Drug use prevention and management need more rigorous research to discover what works and what doesn’t. Universities are ideally placed to conduct this. Meanwhile regulations need regular review by students, staff and authorities in collaboration. There is paucity of NHS treatment options for substance misuse. Confidential group-based support such as that provided by 12-step groups may provide particular advantages for students living away from home. Students and staff with drug-related concerns can also access advice from University Counselling Services and University Mental Health Advisors.

Three groups of severe mental illness have disproportionately high rates of suicide – Schizophrenia, bipolar disorder, and anorexia nervosa – but effective treatment can save lives. Despite more positive conversations about mental health, we often avoid the very mention of schizophrenia and psychotic disorders. It is impossible and unsafe to support a seriously mentally ill person unaided. Clinicians and lay carers need to be part of a mutually supportive network. Integrating care involves a series of permissions - preferably arranged in advance – to communicate with confidentiality, privacy and dignity. Effective treatment of acute psychoses involves thoughtful prescribing and monitoring of medication. It is understandable to feel angry and sad about having an illness that interrupts life and education. There are effective treatments even for the most severe mental illnesses that affect young students. However, it takes far longer to see recovery than with most physical conditions. Policies on admissions, fitness to study and time taken out of studies need to take account of this. Students usually need care to be transferred to the location of the family home and later back again. NHS teams may be able to use telemedicine to communicate with a distant University.