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Good Practice Briefing: Responding to the student mental health crisis

Universities are responding to a growing student mental health crisis highlighted in a number of recent reports. HEi-know examines the context and looks at some examples of good practice across the sector.

 

Student mental health has become one of the highest profile higher education issues in recent years.

Numerous surveys and studies suggest that rising proportions of students are struggling with depression, anxiety and stress, prompting claims of a mental health crisis on campus. Spates of student suicides at individual institutions, such as York and Bristol, have also come to national attention.

The last ten years have seen changes in students’ experience of higher education with the potential to adversely affect their mental health, according to experts.

Three factors in particular provide a context for the continuing rise in student mental ill-health - financial difficulties experienced by both home and international students; heightened anxiety for some about securing graduate-level employment; and the development of social media which can expose young people and students to pressures that previous generations did not experience to the same degree.

The Institute for Public Policy Research (IPPR) report Not by Degrees, published last month revealed a fivefold increase in the proportion of students who disclose a mental health condition to their university.

But the problem extends well beyond the 15,395 students, or 2 per cent of the total student population, who self-declare. According to a report on a 2015 NUS survey carried out for the All Party Parliamentary Group on Students, eight out of 10 students said they had experienced mental health issues in the previous 12 months, with a third reporting suicidal thoughts.

Universities have seen dramatic increases in the number of students seeking counselling support. Some 94 per cent have seen a rise in demand for counselling in the last five years, according to the IPPR report. At 61 per cent of institutions, demand has risen by at least a quarter. In some universities, up to 1 in 4 students are using, or waiting to use, counselling services.

According to a paper from the Higher Education Policy Institute (HEPI), some universities need to triple their funding on mental health services if they are to meet this growing demand, describing the scale of the problem among students as “bigger than ever before”.

A report by Unite Students, published this month, found that those with mental health issues struggled with many elements of university life, such as where they lived, how they socialised and what they needed to do to find a job. However, the report’s survey data suggests that a significant minority do not feel confident about accessing services that may help them.

In recognition of the growing problem students mental health now presents to institutions, Universities UK has drawn up a new framework to help them meet the challenge.

Published last month, it aims to give vice chancellors a blueprint to embed good mental health across all university activities and across the whole student population.

The framework recommends that mental health is made a strategic priority and that funding should be available for interventions which support prevention and early intervention. As well as identifying and focusing on at-risk groups, more general campaigns should be part of the mix, along with extensive staff and student training. Partnerships with NHS services are “essential” and working with charities and local communities is also advised.

Universities are responding to the challenge of safeguarding students’ mental health in a variety of ways. Many, including Bristol, York and King’s College London, are investing more funds in student wellbeing services, in the hope that reaching students early will avoid more acute problems in the future.

Academics with responsibility for pastoral care are being trained to spot the signs of a student who is failing to cope and sign post them to services. Teams of students are also being recruited and trained.

Money is also being spent on beefing up crisis responses, ensuring that mental health professionals are in place to provide acute interventions.

Universities are strengthening their ties to local NHS mental health services to try to avoid situations where students are ‘bounced back’ by GP practices or mental health support to university teams. Institutions are also working with other outside agencies, such as local authorities and charities, to buy-in services. National organisation Nightline now works with many universities in the UK to provide an out-of-hours listening service manned by student volunteers, for instance.

Innovative approaches at institutions include embedding wellbeing in the curriculum allowing a wider audience to understand the link between good mental health and good learning, using the student body to challenge stigma and champion mental health, homing in on specific problems, such as suicide risks or tricky transition periods and researching what interventions actually work. Many universities are also using digital technology to reach students and offer online alternatives to face-to-face services.

 

CASE STUDIES

 

University of Derby

 

At Derby, the Student Wellbeing Service is not only about providing bespoke, reactive services. Staff from the service are also working with academics to embed wellbeing into the curriculum.

“We are aiming not to just neutralise poor wellbeing but to encourage students to have good wellbeing and to learn well and to make the link between wellbeing and learning,” said Gareth Hughes, Psychotherapist and Research Lead for Student Wellbeing.

One example is the University’s business management programme. When the academic team were rebuilding their curriculum, Hughes worked with them to embed wellbeing and deliver specific sessions to their students.

“It’s not about “oh someone from wellbeing is coming in to talk about wellbeing today”,” he said. “It is part of the curriculum. I will be turning up to deliver a session which is related to what they are being taught on that module. For instance there is a personal development module and a human resources module.”

The approach means the service can reach more students in an academic context and aim to deliver to 100 per cent of undergraduate programmes.

Derby also has a programme to support students with specific needs, for instance students with dyslexia or autism, which includes a summer school. Get Ahead is a welcome event for any student who has a disability, long term health condition, Autism/Asperger Syndrome or a mental illness and involves a two day programme prior to the beginning of university, when undergraduates come in to be enrolled and receive information and support before the whole cohort arrives.

The psychological wellbeing team offers counselling, and specific interventions for problems such as exam anxiety, writers block, motivation and sleep issues. The service standard is to try and see students within two weeks.

Crucially, the mental health team is separate to the counselling team.

“That is really important because they do different things,” said Hughes. “The mental health team see students who have pre-declared, to help them to set up support and they also respond to mental health crisis and liaise with NHS services. They are all mental health professionals.”

 

Nottingham Trent University

Nottingham Trent University’s mental well-being provision was recognised as “outstanding” in the Times Higher Education Leadership and Management Awards this year. According to Professor Martin McGinnity, Pro Vice Chancellor for Student Affairs, close relationships with the NHS and other providers is part of the success story.

Student services has streamlined its online referral route for students so they can get a prompt response from well-being practitioners and quick access to online services that are provided by SilverCloud, the NHS’ online space providing personalised programmes to help people with a wide range of mental and behavioural problems.

A partnership with the NHS’s Nottingham Primary Health, Wellbeing and Recovery College, also means students can sign up to easily accessible courses on campus, helping them to deal with any mental and physical health changes they might experience during their time at the university.

Weekly sessions cover subjects like anxiety and depression but also more general issues that could affect most undergraduates at some point, such as motivation, stress, time management, tuning in and staying focused.

Recognising the particular risks associated with the exam season, the university devised the Stamp out Stress (SOS) campaign which provides well sign-posted support, from self-help information and podcasts to library familiarity sessions.

Students can book Mindfulness Walks on all three campuses, spending about an hour and 15 minutes in the open air, getting some fresh air, some physical exercise and giving them time to think and reflect

Free “Look After Your Mate” training, provided by the Student Minds national charity, has also been introduced. It gives students who may be concerned about a friend an introduction to mental health issues, including spotting the signs of when someone may be struggling, communication techniques, signposting, boundaries, self-care and looking after yourself whilst supporting a friend.

 

University of Worcester

Worcester’s ground-breaking “Suicide Safer” project was instigated by the Vice Chancellor Professor David Green in 2014 and the buy-in from senior leadership has been integral in its development. The project is drawing up a new model of suicide prevention, which can be spread across the sector, based on staff training, awareness-raising and the findings of a countrywide Suicide Audit Group, which looks at suicide data and identifies trends.

Led by Professor Jo Smith, the team aims to develop, evaluate and promote an intervention model and identify key components which contribute to the development of a suicide safe university. The team includes representatives from independent agencies and charities, local Government and the NHS. Two student researchers are being co-funded by the James Wentworth-Stanley Memorial Fund, set up following the death of James Wentworth-Stanley, who took his own life, aged 21, in 2006.

John Ryan, Pro-Vice Chancellor (students), said: “Suicide affects mostly young people between the ages of 14 and 35, of which most university students fall square into. It’s incredibly important to be raising this issue and to be talking about mental health more widely.”

Key principles behind its work include the creation of ‘compassionate communities’ where student support can be mobilised; prevention and early intervention to reduce the need for future more complex interventions; crisis services; education and mental health awareness and sensitivity including a workforce that can intervene early; partnerships and joined up services in response to crisis and sharing resources and expertise.

Targeting vulnerable groups is crucial, especially those with special needs, international students, young people from different cultural backgrounds and students with identified mental health difficulties.

Upping support at vulnerable times, such as the first few weeks of term, Christmas, Valentine’s Day and exam season, is also important. The university’s mental health counselling team runs the Listening Ear drop in counselling service for freshers and their parents, for instance.

 “The most important things is for people to talk and feel that their concerns are listened to,” said Professor Smith. “One of the keys to suicide prevention is maintaining wellbeing and early intervention to prevent the downward spiral that, in some cases, can lead to suicidal thoughts,”

As part of “Suicide Safer” academic staff at Worcester who work with undergraduates are receiving training on mental health issues. Half of the university’s six institutes also have a “mental health lead”, a member of academic staff responsible for training and helping colleagues to support student mental health and wellbeing.

As one of only a handful of university’s in the UK with an explicit suicide prevention strategy, Worcester’s senior leadership is sharing lessons from the project with the wider sector, delivering lectures and participating in policy roundtables.

 

University of Hull

 

Like universities across the sector, Hull has seen an increase in the uptake of mental health services.

“I think that is in part because of increased demand but also because we are all being more proactive in terms of access. It’s a bit like building an extra lane on the motorway, you increase traffic as a result,” said Martin Batstone, Hull's Head of Student Support.

The increase in demand stems from general emotional wellbeing concerns rather than complex mental illness cases and Hull has been able to meet that demand through its partnership with Let’s Talk, a free NHS-commissioned service that the university is able to offer on campus.

“Our very experienced team of mental health advisers will initially see students, who can just turn up on the day. That will typically be followed up by a 50 minute appointment,” said Batstone. “Then we can offer sessions with the Let’s Talk Depression & Anxiety service who come on to campus and offer a range of therapeutic support including Counselling and CBT.”

From a student’s point of view, it is a seamless service. It is also responsive to the level of demand, giving it an advantage over the traditional in-house counselling services where waiting lists can grow.

“We keep a spread sheet of the various issues that students come to us with and there are over 100 different categories,” said Batstone. “The range of support we can deliver on is much broader than we could have delivered under the old model. We’re really pleased with the way it has gone. It’s worked well for us and for the NHS.”

Another innovation is the development of Wellbeing Champions. Research suggests that a high percentage of students would prefer to talk to a friend or a fellow student about their problems before accessing formal support, so a team of student volunteers at Hull have been trained up to lend a “peer ear”.

Around 20 Wellbeing Champions are active on campus raising awareness, reducing stigma, offering support around campus and signposting their peers to the services that are available. They have a visible presence on campus at popular student ‘hotspots’ and at specific Wellbeing promotional events, particularly mental health awareness week.

“They help with awareness campaigns but they also just talk quite naturally with their peers about problems and concerns and what next steps to take,” said Batstone. “They are often students who have had experience of mental health issues themselves or within their family so already have some understanding of what it is like to manage. They are great ambassadors and the insights we have gained from these students have been very valuable to us.”

 

 

University of Sussex

Universities across the sector are using their research expertise to investigate what interventions actually work in the quest to keep students mentally healthy.

At Sussex University, 180 students are undertaking mindfulness training as part of a new research project looking at how effective it is in helping them cope during more stressful times of the academic year.

The Sussex Mindfulness Research Project is a collaboration between the School of Psychology at the University and the Sussex Mindfulness Centre, which is part of the local NHS trust.

The intervention project will examine the processes through which mindfulness has an impact on a person's general well-being and mental health, through offering mindfulness training to students in return for taking part in a multi-phase research project.

Dr Helga Dittmar, the lead investigator, said: “There is already a wealth of evidence to suggest that mindfulness training is beneficial for concentration, attention focus, and stress relief. As well as helping us with our research, participants will gain ideal skills for students to put to good use during study assessments.”

The research project is the first step in a longer-term research initiative which aims to promote positive mental health and well-being among students.

Its finding will allow the Sussex Mindfulness Centre to understand better how and when mindfulness training is most effective, improving its service to students.

The health and wellbeing pages on the University’s website have been carefully constructed with their audience in mind and provide a wealth of information to students.

Crucially, they include a section on “studying well”, making the explicit link between how a student might feel about their academic progress and their mental health. It provides information for students who need personal academic advice, as well as information on generic study skills and details of workshops on improving your study skills and dealing with procrastination.

 

University of Exeter

A recent review of mental health and wellbeing provision at the University of Exeter has led to a new focus on preventative initiatives in a bid to develop students’ psychological robustness.

A project worker has undertaken research, internationally and inside and outside the university context, around the definition of resilience, what it means to become more resilient and the skills and tools people need to develop their coping strategies, manage transition and bounce back when faced with adversity.

“We see this very much as an illness prevention, health promotion project, helping all students to flourish and to remain well through positive psychology” said Mark Sawyer, head of wellbeing services at Exeter.

The initiative will be delivered through the iExeter app, the university’s free app that provides all current, new and prospective students with personalised information and services and is the main mechanism for communication with the student body.

Pages are currently under construction for the app which will help develop resilience. Students will begin with a self-assessment, pinpointing their strengths and challenges, and get easy access to modules on specific topics, such as thinking strategies and other skill development. The app will be backed up by more information on the university website.

A series of focus groups are being held to garner students’ views on what the content should be and the best platform to deliver it to ensure it has currency with its intended audience.

Academics in the university’s Mood Disorder Centre, are particularly interested in the project and in time, will be enlisted to evaluate the app and trial specific interventions around resilience. These need not necessarily be face-to-face but could be electronic, online therapy.

Exeter is also strengthening its links to the NHS to improve the services it can provide to students.

“I think one of the things universities struggle with is how to link closely with NHS services,” said Sawyer. “With the increase in the number, severity and complexity of cases coming through, it has become even more important to start looking at the bridge between what we can provide as early intervention, first stage support and the more evidence-based specialist treatment.”

The university has started a conversation with senior operational managers in the Devon Partnership Trust, the local mental health trust, to look at the potential for commissioning a bespoke provision for the university.

“The student community makes up a fifth of the city’s population and is quite a unique group,” said Sawyer. “They are only here for certain six and a half months of the year and NHS waiting lists don’t always accommodate that and we need to look at different ways of providing services and crisis support. Given the amount of crisis we deal with, to be a part of the discussions about the Trust’s new plans for the delivery of services is very helpful. The idea is how do we get our students more focused support in the community they are a part of on campus?”

From this academic year, the NHS community mental health team, and staff from the university’s wellbeing team, will be holding monthly meeting to discuss cases that are of concern to the university and where extra support is needed from the specialist agencies. This new initiative will allow more coordinated support to be planned - a huge step forward in dealing with more acute cases.

“In the past, the scenario has been one where we ring them up in a crisis situation and say ‘are you going to see this student, they need to see someone now’ and the health professional would not know anything about the case in advance. It was a reactive response,” said Sawyer. “What these monthly meeting will foster is a proactive planned way of looking at how best to help students where we feel a joint-approach in necessary. We feel that is a really positive development.”

 

University of Cardiff

Cardiff University counselling and wellbeing has an extensive range of services for students experiencing personal, emotional or psychological difficulties – or for those who are just interested in living a more healthy lifestyle.

Appointments are offered in person, over the phone, or via webcam, instant messaging or email, while a daily walk-in service allows students to have a 15 minute chat with a member of staff who can advise them about next steps.

Last year, the service introduced “exercise referrals” for students who want to kick-start some form of physical activity to boost their health and wellbeing but are unsure of where to start.

The scheme, a collaboration between the University’s Student Support and Sport services, is fully funded and gives the students eight weeks of one-to-one support with a member of the Sport Team.

Current activity levels are assessed before a tailored programme of activities is devised aimed at boosting the student’s general fitness and mental wellbeing. Schedule weekly check-ins review progress and help with motivation. The programme is not necessarily gym based, if this is not something the student enjoys, but participants do have free access to the gym. It could involve taking part in the “Walk to Wellbeing” scheme, another initiative student services runs, or even a home exercise DVD.

Some 38 students have benefited from the scheme so far. One undergraduate who has just started the tailored workouts said: “I felt quite tired and low before the session, but it left me in a better place.”

Patt Wrangles, Head of Health and Wellbeing at Cardiff University, said: “This is a scheme we are very enthusiastic about. Where students have attended the assessment session and completed the scheme, the feedback is really good and we would like to broaden it further in the future.”

 

University of Bristol

 

Earlier this month, Professor Hugh Brady, the Vice-Chancellor and President of Bristol University, made a public commitment to addressing the stigma around mental health.

In an event organised by the university at the Wills Memorial Building, Professor Brady, staff and students signed the Time to Change pledge, a national campaign led by charities Mind and Rethink Mental Health.

It marked a step change in the university’s approach to student mental health and wellbeing and follows a difficult year in which five cases of suspected student suicides have left the institution reeling.

Backing the public commitment to change is £1 million of funding. The university is hiring a team of 28 full-time mental health advisers and managers who will be embedded in academic departments.

Their role will be to identify and assist students at an early stage who might be struggling so they can be offered support before any issues start to escalate. The teams are due to start working in schools from spring 2018.

According to Mark Ames, the university’s director of student services, one of the argument’s for employing dedicated staff is the amount of time academics are now having to spend trying to help students who are struggling with signs of anxiety or depression.

The new team will not only give students the support they need, it will free up lecturers time.

“Hopefully, students will also experience an enhanced level of academic support, as lecturers and personal tutors will have more time to focus on supporting student academic and personal development knowing that their emotional wellbeing is supported by the new service,” said Ames.

As well as student wellbeing advisers, a new Mental Health Advice Team will work with students managing severe and enduring mental health difficulties to ensure they get speedy access to healthcare and design a programme of study that is effective for them. University GPs will also have additional capacity to provide same-day extended mental health appointments to students. 

“More broadly, we are promoting a culture of openness and aim to change the way we think, talk and act about the wellbeing and mental health of those who study and work here,” said Ames. “We are encouraging students to share their experiences, highlighting ways they can manage their wellbeing and take part in activities outside their studies, as well as ensuring they know where and how to seek support when they need it.” 

 

University of Coventry

Coventry has harnessed technology to help support the growing numbers of students who are presenting with mental health issues.

In the past, the counselling service had struggled to cope with the volume and waiting list had developed at times so student could not be offered appointments. There was also little flexibility in the system.

“That’s really not good for students because they are unlikely to come back,” said Tracy Cullis, group director for student services. “So we decided to do something different.”

The university invested in new software which allowed students to book their own appointments online. The number of people failing to show up for appointments has reduced significantly from 17 per cent under the old system.

“What we are finding is that students might book an appointment at 3am or 6am,” said Cullis. “If they book an appointment and can’t make it they can cancel it and rebook it. It has meant that for the last few years we haven’t had a waiting list and the students are really happy with it because they are more in control.”

Another investment, The Big White Wall, a digital mental health and counselling system, is also paying off.

Initially purchased for students on placements or studying abroad so support could still be offered while they were off campus, it has proved so popular that it has been extended across the cohort.

It takes the form of a peer-to-peer support group. A student who might be feeling depressed can post on the site and other users respond and give advice. The posts are monitored 24/7 by clinical psychologists who look out for trigger words or more serious issues. If a student is talking about self-harming, for instance, they would intervene and offer help and support. The website also includes diagnostic tests and modules on how students can help themselves manage their own mental health issues.

“Our students really appreciate this service,” said Tracey, “particularly international students, who might be less comfortable speaking to someone face-to-face. In a recent review of our tutorial system, students said the Big White Wall had more impact on retention and learning outcomes than personal tutors.”

Students are signposted to the digital service at enrolment and at various times of the year, with publicity material produced by the company.

 

University of Glasgow

David Duncan, the Chief Operating Officer and University Secretary at Glasgow University, has been appointed as the University’s new Mental Health Champion and tasked with leading its approach to mental health.

The move reflects a growing concern about the number of students presenting with mental health issues of varying degrees of severity and an increase in the number of staff reporting mental health conditions or being absent from work due to mental ill health.

“While much is already being done to address these issues, we believe a more coherent approach is needed to promote mental health and wellbeing, provide advice to staff and students on mental health issues, and support those who need help,” he said.

Following a comprehensive external review of current provision, the university has drawn up an action plan, supported by the Student Representative Council (SRC) and the unions, which sets out the first step towards an integrated strategy.

Short term priorities in the whole-university approach to tackling mental health issues include strengthening counselling provision, Cognitive Behavioural Therapy (CBT), wellbeing assessments (aimed specifically at reducing the assessment waiting list) and mental health advice for students who have been diagnosed as having a mental health related disability or condition.

Peer support and suicide prevention training is part of the plan and a core number of staff across the University will receive Mental Health First Aid training.

In the medium term, student services will explore the value of software and new technologies as a means of providing advice and support and there will be an annual review of the resource that is allocated to address mental health issues, with adjustments made as necessary.

“A lot of the plan emphasises awareness raising and trying to normalise discussions around mental health issues to reduce stigma,” said Duncan. “Another strand is trying to promote positive mental health so that people don’t fall in to mental ill health. We are training up peer support people and introducing mental health first aid training in a reasonably big way so we develop a first responder network across the university.”

The potential wellbeing needs of specific groups are also being considered. For instance the university has a sizable proportion of students who live at home who can be faced with family issues that can compound work and study related issues.

 

This Good Practice Briefing was originally published by HEi-know in October 2017

 

 

 

 

 

 

 

 

 

 

 

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