Legal Education Digest
N Kelk, S Medlow and I Hickie
Sydney Law Review, Vol 32, No 1, 2010, pp 113-122
The Tristan Jepson Memorial Foundation was established in 2006 in memory of Tristan Jepson, a young lawyer who took his own life as a consequence of severe clinical depression. The foundation has now hosted four annual lectures which have been well attended by legal practitioners, academics, students and journalists. The first of these lectures was followed by a workshop in which the claim arose, that while North American research shows unusually elevated levels of depression and other mental illnesses in law students and practitioners, the Australian situation is quite different. At that time, no research had been conducted that could confirm or refute the suggestion that Australian law students and practitioners enjoy better mental health than their North American counterparts; and the Jepsons felt their concerns could not be taken seriously in the absence of such research. Accordingly, they instigated the present research in conjunction with the Brain & Mind Research Institute (BMRI) of the University of Sydney.
The impact of attending law school upon students’ mental health has been investigated both cross-sectionally and longitudinally in North America. The cross-sectional studies typically compare law students with medical students and what they reveal is that law students report higher perceived stress scores; greater depression and anger, and lower contentment and feelings of friendliness than do medical students (particularly with regard to academic, time, fear of failure, classroom and economic stress). Naturally, one question to arise from these results concerns whether students entering into law bring with them pre-existing personality characteristics and mental health problems from which their medical counterparts are freer.
Longitudinal studies of law students’ mental well-being have been designed for the dual purposes of discovering whether or not these students differ significantly from the general population and other undergraduate populations prior to entering law school, and whether or not their mental wellbeing really deteriorates during their candidature as reported anecdotically. One study found that prior to starting their law degree, new law students demonstrated higher positive affect, life satisfaction and subjective wellbeing than did other undergraduates (with no statistically significant differences found for negative affect). However, a rapid decline was seen across studies regarding students’ mental wellbeing with the onset of symptoms of obsessive-compulsiveness, interpersonal sensitivity, paranoid ideation, hostility, depression, anxiety and loss of subjective wellbeing within the first year of law school attendance. These symptoms worsened throughout the students’ candidatures and, according to at least one study, were still present two years after the students’ graduation.
The present research is part of a larger study that was designed to assess the mental health literacy, attitudes, personal experiences and behaviours of both law students and practising lawyers.
The participants were 741 (65.8 per cent female) final-year law students who were recruited from 13 Australian universities. Ages ranged from 19–53 years with an average age of 25 years.
All participants received a letter explaining the purpose of the study, a participant information sheet and the International Depression Literacy Survey (IDLS). The IDLS was devised by staff of the BMRI and has been used in several projects spanning many years. It is referred to as a questionnaire about ‘depression literacy’; that is, it assesses a participant’s understanding of the character of depression and how it affects individuals and the community. The questionnaire also assesses the participant’s self-awareness of depression and his or her risk of experiencing depression. Self-awareness and risks of experiencing depression were assessed with the use of the K10 (the Kessler Psychological Distress Scale) in which participants are asked how often in the last 30 days they have experienced certain psychological or behavioural events. The possible range of scores is 10–50 and individuals’ scores are classified as follows: 10–15 = no or low distress; 16–21 = moderate distress; 22–29 = high distress; 30–50 = very high distress.
The IDLS was administered at various times during the academic term and was available for completion on both a password-protected website and on paper. Several universities’ ethics committees decided that a classroom was an inappropriate setting for completing the survey and students of these universities had only the option of the web-based version. One university offered both the online and paper options to its students and three others used the paper version only. This resulted in 60.4 per cent of participants completing the survey online and 39.6 per cent completing it on paper.
Overall, the law student sample had a higher level of reported distress than did other Australian samples for which this measure is available. For example, in a large community sample of the general Australian population, approximately 13 per cent of people aged between 18 and 34 years reported having high or very high levels of distress whereas 35.4 per cent of law students reported high or very high levels of distress (χ2 (1) = 307.79, p<0.001). Somewhat smaller but similar differences existed between law students and final year medical students (χ2 (1) = 15.9, p<0.001). Odds ratios revealed that law students were 2.4 times as likely to fall into the ‘high or very high’ grouping than medical students and 3.5 times as likely to fall into the ‘high or very high’ grouping than members of the general population.
Approximately one third (35.1 per cent) of participants reported that they had experienced depression personally, and half (50.2 per cent) of the participants reported that someone very close to them had experienced depression – there was some overlap between these groups.
Attitudes towards seeking help were assessed through a series of questions for all participants about their likely behaviour should they become depressed. A second series of questions, directed only to those participants who reported themselves as having had depression, clarified which actual treatments (if any) they had received.
Nearly four in 10 (39.1 per cent) participants reported that they would not seek professional help if they were to experience depression. Among those who reported that they would seek help, the major professional groups from which they would seek help were: general practitioners (75.0 per cent), counsellors (71.1 per cent), psychologists (68.0 per cent) and psychiatrists (54.1 per cent) (n = 422; multiple answers permitted).
The major nonprofessional groups from which participants would seek help were: friends (75.8 per cent), family members (74.0 per cent), personal trainers (52.4 per cent), naturopaths or herbalists (20.7 per cent) and the clergy (19.9 per cent) (n = 734; multiple answers permitted).
One of the factors which might influence attitudes towards help-seeking is the participant’s belief about the effectiveness of different forms of intervention. Only 8.4 per cent of participants believed that professional help would lead to a complete recovery without relapse and a further 15.7 per cent believed that recovery would be followed by relapse. However, 70.9 per cent of participants believed that people who had no help for depression were likely not to improve or to get worse. So, not only did they see professional intervention as ineffective, they also saw the eventual untreated outcome as gloomy.
Of those participants who had had personal experiences of depression, 77.0 per cent had received treatment (largely from general practitioners, psychiatrists, psychologists and counsellors). This figure greatly exceeds the percentage of people who have reported receiving help in general community surveys. For example, in the recently released ‘National Survey of Mental Health and Well Being’, only 35 per cent of people who reported experiencing mental illness in the previous 12 months achieved access to treatment. This suggests, as might be expected with a group with such a high level of education, employment and income, that the population from which the law student sample is drawn is well connected with medical services and other sources of support.
Just under half (49.3 per cent) of the participants had sought information about depression. Participants who had experienced depression (or who had a close acquaintance who had experienced depression) looked for information much more frequently (58.0 per cent) than those who had not experienced depression (16.0 per cent). However, note that 42 per cent of those who had experienced depression never reported having sought information about it.
By far the most common source of information cited is the internet (83.7 per cent) followed by doctors (31.2 per cent), friends (25.7 per cent), family (20.4 per cent) and books or magazines (16.6 per cent). Just 7.5 per cent of participants who had sought information did so from a mental health organisation.
Just under half of the participants (49.6 per cent) correctly estimated the proportion (one in five) of Australians who might be expected to experience depression. Those participants who had had an experience of depression themselves or through a close acquaintance gave the correct response in 56.6 per cent of cases, whereas those who had no such experiences reported the correct response in only 28.7 per cent of cases. Participants also selected up to six illnesses or injuries from a pre-determined list which they believed to cause the most death or disability in Australia. Only 39.6 per cent of participants included depression as one of the top six maladies whereas 49.7 per cent included alcohol abuse (which does not appear in the factual list).
The survey asked participants to report on a number of possible sources of discrimination which might be experienced by depressed people. Almost a third (30.6 per cent) of participants thought that their friends might discriminate against them if they experienced depression and 20.4 per cent thought that their family might do so. Given that these two groups are likely to be important in assisting people to find treatment or to support them during periods of acute illness, it is of concern that such numbers of participants expected discrimination from this quarter. Two-thirds (66.9 per cent) of participants also thought that it was likely that their employers would be discriminatory and 83.6 per cent of participants expected discrimination from strangers.
Overall, most of the participants disagreed with the negative attitudes and agreed with the positive attitudes indicating that as a population, the participants generally report positive attitudes towards depressed people.
The present research was designed to provide a ‘snapshot’ (cross-sectional) view of Australian law students’ experiences and knowledge of, and attitudes towards depression and help-seeking. Like their North American counterparts, Australian law students have higher rates of psychological distress than those in the general population of a similar age, and approximately one-third of participants reported having experienced depression personally.
Given these findings, it is of interest that many of the participants said that they would not seek professional help for depression should they develop it, and held quite strong negative views about the effectiveness of mental health professionals in treating people with depression. On the more positive side, those who had actually experienced depression had received treatment in far greater numbers than would be expected based upon Australian community norms. This suggests that resistance to treatment is more attitudinal than behavioural.
If the experience of Australian law students is similar to that of their North American counterparts, one would expect that as new undergraduates entering into law schools, Australian students are not particularly distressed or depressed but that they quite quickly become so. Clearly, longitudinal data are needed not only to test this hypothesis, but also to uncover the precipitating factors, both personal and institutional, that account for the students’ decline should it be observed.
In a situation such as the present one, where the precise causes of depression among law students are unknown, it remains possible to formulate policies and procedures which will be effective in reducing the negative outcomes of mental illness. By focusing upon the known risk factors and establishing supportive environments with strong school, family and institutional connectedness, the onus of maintaining wellbeing and seeking treatment where necessary is removed from the individual and is more appropriately placed within broader, community contexts. Accordingly, within universities, law schools might consider establishing relationships with organisations which promote the mental health of students. These will include student health services, student counselling services, vocational counselling services and disability services. In addition, student organisations such as student guilds or unions may have policies and services relevant to this aspect of student support.
It has also been suggested that law education is more competitive than other forms of tertiary education. Clearly, such competition might work to reduce the level of support that sub-groups of students give each other. Accordingly, competitive elements of the educational setting need to be publicly acknowledged and support mechanisms made available to students. Furthermore, students must be taught that although their educational experiences may necessitate some level of competition, the competitive elements need not be taken into their personal lives. Like all professionally trained people, law students must develop differing skills that can be used in the professional and personal aspects of their lives.
It remains to be seen whether stress, in both the presence and absence of depression, is or is not a significant problem among this population. Law schools taking an interest in the levels of stress among their students would be advised to use an instrument such as the K10 to conduct regular, anonymous monitoring so that trends in levels of distress can be observed across all stages of the students’ candidature.
If law schools are to consider introducing curriculum changes with a view to improving students’ personal and coping skills, it must be emphasised that such changes will need to be broadly based and the messages within these programs consistently applied across all stages of the course if medium or long-term changes are to be observed.
The public activities of the Tristan Jepson Memorial Foundation have raised awareness within the Australian context of the problem of depression among law students and the potentially devastating consequences to students, their families and universities when this illness is not treated successfully. Following the most recent annual lecture and the publication of Courting the Blues: Attitudes Towards Depression in Australian Law Students and Legal Practitioners, interest in these issues has been heightened within a number of Australian law schools. It is hoped that the present research will further the Foundation’s goal of improving the quality of life of law students by stimulating longitudinal research and, where necessary, institutional change.