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The intersection of immigration status and mental health creates a unique psychological burden that many mental health practitioners are not always equipped to address. As universities in the UK continue to welcome increasing numbers of international students, a critical gap has emerged in our understanding and treatment of visa-related anxiety, and its broader implications for student wellbeing.听

In addition to the usual pressures of adjusting to the university environment and academic assignments, there are a number of complex factors that impact this population. These include cultural isolation, identity challenges, financial pressure, and constant fear of administrative errors affecting immigration status. These concerns go unaddressed, as students either don鈥檛 know what resources are available, or universities don鈥檛 offer support specific to these concerns.听

International students face a multifaceted challenge that extends far beyond typical academic pressures. The constant uncertainty surrounding visa status creates a persistent background anxiety that colours every aspect of the educational experience. By recognising these anxieties as legitimate mental health concerns, and adapting therapeutic approaches accordingly, universities can better support their international student populations, and create truly inclusive educational environments.听

Social and financial barriers听

The fear of administrative errors affecting immigration status creates a unique form of hypervigilance. Students report constantly checking and re-checking documentation, experiencing sleep disruption before visa-related appointments, and facing difficulty concentrating on studies due to immigration concerns. This administrative burden leads to a number of mental health concerns, including persistent anxiety about staying within visa boundaries and constant pressure to demonstrate academic success.听

A recent study analysed data from students who participated in the BBC鈥檚 Loneliness Experiment in 2018, and identified key themes in the international student experience, including heightened awareness of being away from family, social confusion, and fear of being perceived as a burden.¹ The study, which assessed experiences of students across European universities, revealed that loneliness significantly influences students鈥� wellbeing, emotional health and social functioning, often stemming from cultural disconnection and language barriers.听

Although students from many different backgrounds report experiencing loneliness at university,² international students face a unique challenge. They are navigating the social landscape, while adjusting to an entirely new cultural context. This is not limited to language barriers and homesickness 鈥� there are more subtle, everyday issues that arise. For example, adopting an anglicised version of your name, or an entirely new 鈥楨nglish鈥� name. Some of these adjustments are a matter of convenience, but others come from feeling pressure to make others comfortable.听

Higher tuition fees, restricted work hours and exchange rate fluctuations create a constant source of stress. This financial pressure can manifest as guilt around family sacrifices made to fund their education. This leads to reluctance to spend on social activities, which in turn leads to further isolation.听

鈥業 arrived in the UK full of excitement for the year ahead, and with the resolve to do well in my studies because of how expensive this was. This anxiety about money kept growing as I kept up the currency conversions in my head, as well as the attached shame of being around others who didn鈥檛 seem as stressed about spending. Once, I dropped and lost one of my newly purchased earphones, which led to a breakdown unlike anything I had ever experienced before 鈥� or since,鈥� recounts Shriya Bajpai, a former international student in London.听

These financial barriers are tied to another, often overlooked, social barrier: passport privilege. It is not uncommon for students in Europe to go on trips to other countries, and this impacts social dynamics if a student has to plan months in advance (with the constant risk of their visa being rejected, even after paying significant fees to apply). This restricts professional opportunities as well, for students who would have liked to travel for conferences or academic events.³听

A well-meaning university counsellor may suggest taking a break, visiting home or seeking a change of scenery 鈥� not realising how logistically and financially impossible this may feel for an international student. It is crucial to understand the intersecting challenges, and offer resources that take these subtle barriers into account.听

Visa anxiety听

Similar to social and financial concerns, visa anxiety cannot be treated with the same interventions a therapist may use for other forms of anxiety. Visa听anxiety represents a unique form of stress that differs from general anxiety disorders in several key ways. Unlike common anxiety triggers, visa concerns involve concrete, bureaucratic deadlines and requirements that can directly influence a student鈥檚 entire life. For international students, this creates a distinctive psychological burden, where their academic future, professional opportunities, and even their ability to remain in their current home, depend on getting through the visa process.

In university contexts, this anxiety is particularly complex because it intersects with academic performance and social pressures. Students must maintain specific enrolment status and grade requirements to keep their visas valid, creating a feedback loop where academic stress heightens visa concerns and vice versa. This can manifest in behaviours like excessive class enrolment to ensure full-time status, or reluctance to seek mental health support for fear of any impact on visa status.听

Universities must recognise that standard anxiety management approaches cannot fully address this. Wellbeing advisors and counsellors are not always well versed in how visa requirements influence course selection and academic decisions. A leave of absence, for example, is not a viable suggestion for most international students, no matter how severe their mental health struggles may be.听

That being said, there are ways to address the anxiety without dismissing these legitimate concerns. Helping students document deadlines and requirements, and schedule meetings with the right people, can lighten the emotional burden. On a more daily basis, counsellors can also help students focus on tasks within their control, create concrete plans for 鈥榳hat if鈥� scenarios, and encourage them to find affordable ways to socialise and take care of themselves.听

Discrimination and internalised racism听

Beyond academic pressures and visa anxieties, international students in the UK contend with microaggressions and broader anti-immigrant sentiment.⁴ These experiences, whether subtle or overt, contribute to feelings of alienation and influence mental wellbeing.听

Microaggressions 鈥� offhand comments about accents, assumptions about intelligence based on nationality, or dismissive attitudes towards non-Western education systems 鈥� can erode students鈥� confidence and sense of belonging. Even well-intentioned remarks (鈥榶our English is so good!鈥�) can reinforce the idea that international students are perpetual outsiders.听

A rarely discussed form of discrimination is the alienation that comes from a student鈥檚 own community. For many international students, finding people from similar cultural backgrounds can be a source of comfort 鈥� until they realise that belonging isn鈥檛 always guaranteed. Discrimination doesn鈥檛 just come from the wider society; it can also come from those they expect to be allies. Terms like 鈥楩OB鈥� (Fresh Off the Boat) or 鈥榝reshie鈥� are often used by second-generation immigrants to distance themselves from newer arrivals, reinforcing a hierarchy of belonging that leaves international students feeling excluded. Many university wellbeing teams are well equipped to deal with external discrimination, but the internalised racism⁴ is an important nuance that often goes unaddressed.听

This unexpected exclusion adds another layer to adjustment struggles. Addressing this requires honest conversations within communities about internalised racism, and the ways in which migration shapes identity. Universities can play a role by fostering dialogue between international students and local diaspora communities 鈥� helping both groups recognise that belonging is not a limited resource.听

At a systemic level, anti-immigrant rhetoric in public discourse creates an environment where students may feel unwelcome or even unsafe. The uncertainty surrounding visa policies, combined with media narratives that frame immigrants as a burden, fosters a sense of precarity that extends beyond the classroom.听

The limitations of Western mental health paradigms听

Western mental health frameworks often fall short in addressing the complex psychological needs of international students.⁶ These paradigms typically emphasise individualism, direct communication, and a clear separation between mental and physical听health 鈥� concepts that may conflict with other cultural worldviews.

For instance, many Asian cultures understand psychological distress through somatic symptoms, and may resist the Western focus on verbal emotional expression. The emphasis on seeking professional help can also clash with cultural values that prioritise community support networks or view mental health challenges as shameful.听

鈥榃orking with international students, I鈥檝e seen how cultural norms shape their approach to mental health,鈥� says Sumukh Nijhawan, a psychotherapist on placement and a former international student in the UK. 鈥楳any come from environments where struggles were either minimised, met with silence, or expected to be handled privately. I remember one client who told me: 鈥淏ack home, we鈥檙e taught to push through, pray, or talk to family, but what do you do when none of those feel like an option?鈥� When they finally started therapy, they admitted: 鈥淚 wish I had done this sooner.鈥濃�櫶�

Cultural context听

Western diagnostic criteria may also misinterpret cultural expressions of distress as pathological, while missing culturally specific manifestations of psychological struggles. Although Western frameworks do allow faith to be incorporated into mental health practice, the spiritual elements are sometimes watered down and stripped of their cultural context.⁷ A common example of this is using mindfulness to boost productivity 鈥� this is a fundamental misunderstanding of the Buddhist practice, which emphasises mindfulness as a tool for releasing an attachment to achievement.⁸听

Many international students who have sought support from their universities found the counselling 鈥榦verly clinical鈥� and 鈥榠ndividual focused鈥�.⁹ The professional鈥檚 background had an impact on this as well. Although many counselling training programmes include a cultural competence module, there may still be an assumption that a shared cultural context exists between the clinician and client. International students, however, face unique stressors 鈥� acculturation stress, language barriers, microaggressions 鈥� that Western frameworks may not address.听

There is also little focus on the impact of separation from a cultural community, and the role of family and society in individual decision making. Many students come from cultures where major decisions are not made individually, but through family consultation or community consensus. Although this can contribute to anxiety at times, it can also keep a student tied to collective bonds and identity anchors.听

University counselling services, and Western culture in general, emphasise boundary setting in a way that can feel alien to many international students. The language around certain cultural responses may seem unnecessarily pathological 鈥� collectivist thinking can be seen as a lack of autonomy, multigenerational living as codependency, and indirect communication as passive aggression.听

Western psychological vocabulary can be limited, and some emotional concepts may have no Western equivalent. For example, maya in Hindu culture is literally translated to 鈥榠llusion鈥�, but it has a deeper meaning around our understanding of reality, or seeing things from only one, limited perspective.¹⁰ Disconnects like this can lead to counselling sessions being spent on explaining fundamental differences in mindset.听

Structural changes听

Many universities have implemented culturally听specific support groups, sometimes led by international students themselves. There is also an increased emphasis on destigmatising mental health support, and providing counselling in different languages. However, effective support for international students requires a fundamental shift in how mental health services are conceptualised and delivered. This involves systemic changes which include integration of cultural expertise, changes in service accessibility and clear resource navigation. Research also recommends that universities implement comprehensive support systems, including embedding social integration into teaching practices, providing cultural navigation support, and training staff in culturally appropriate approaches.¹听

Many wellbeing services are disjointed from university cultural organisations and immigration services, because there is an assumption that the services do not overlap. However, developing partnerships with these groups could provide an important perspective, and a more holistic approach to international student wellbeing.听

Collaboration with immigration advisors could help create an understanding of common issues that arise for these students, and with the development of group support spaces that incorporate their unique struggles. They can also provide updates on immigration听systems, which can be used to address the potential psychological impact on students who are on a visa.

These resources need to be readily available 鈥� clear pathways of support that don鈥檛 require navigating multiple steps or co-ordinating with several different people. Representatives from mental health services can make regular visits to student accommodations, or create flyers that can be seen from anywhere on campus. It is crucial to have regular, offline reminders that wellbeing services are available.听

Structural issues play a role in accessibility as well. There is a lack of recognition at the institutional level about the critical importance of mental health services to student success and retention.¹¹ While awareness is growing, mental health support is still not seen as core to the university鈥檚 educational mission in the same way as academic departments or research.听

University counsellors are often struggling to manage overflowing waiting lists, which leaves little room for cultural competency training that goes beyond surface level awareness. This means that support for counsellors is as important as support for students, and universities must regularly assess their support services through feedback collection from both students and counsellors.听

Future directions and recommendations听

International students navigate a complex web of challenges that extend far beyond academics. Their mental health is shaped by systemic barriers 鈥� passport privilege, inflexible Western frameworks of care, visa-related anxiety, and the broader institutional structures that often fail to recognise their unique needs. While many universities offer support, these services are often not designed with international students in mind, leaving gaps in accessibility, cultural competence and practical relevance.听

A truly effective approach to international student wellbeing requires a shift in perspective. Mental health services must move beyond one-size-fits-all models, and instead integrate culturally responsive care, and acknowledge the emotional toll of navigating systemic inequities. Institutions must also take responsibility for creating environments that foster inclusion, rather than placing the burden of adaptation solely on the students.听

Improving international student mental health is not just about better services, it鈥檚 about recognising their lived realities, and ensuring that support systems are built in collaboration with different teams and points of view. In order to truly support these students, wellbeing services must recognise these challenges not as individual struggles, but as systemic issues that require real change.听

University and College Counselling May 2025