'The way universities are run is making us ill': Inside the student mental health crisis.

Our response to Samira Shackle's article:

University Mental Health Adviser Network (UMHAN) members support students with a range of mental health difficulties. This might be by providing effective liaison between the student and external services, such as the NHS, or by ensuring that the person can access their teaching and learning in a way which is most accessible to them.

Mental Health Advisers co-ordinate support for students with mental health difficulties and act as a point of contact for the duration of their studies. They may offer email and telephone contact, as well as 1:1 appointments, and/or drop-ins. They may also facilitate peer support sessions, or access to other University support services, such as counselling or financial advice. They are employed by Universities, often with extensive mental health-specific backgrounds, which provide the clinical skills to be able to understand the impact institutional culture and tasks have on mental health. It also means they are able to assess risk – not just clinical mental health risk, but risk of an individual not achieving their academic potential, or even leaving University.

Specialist Mental Health Mentors are often able to offer more regular contact with a student, as they are generally funded through Disabled Students' Allowances, for work with a named student. They can discuss strategies to help improve general wellbeing, focussing on areas such as time management, self-help strategies to help with the impact of difficulties on studying, managing an identity as someone with a mental health difficulty, coming to terms with a diagnosis and supporting the student with the psychological impact of their mental health condition on their studies and life at university.

It is encouraging that the issue of mental health in Higher Education (HE) continues to be reported as an area of hidden need amongst our communities. The age range of many people going to study in HE coincides with the peak age of onset for a range mental health difficulties (RCPsych, 2011), with 75% of mental health difficulties developing by the mid-20s. Continuity of care, mentally-healthy learning environments and early intervention are all necessary steps to improve national mental health for these age ranges.

An increasing emphasis on wellbeing initiatives and whole-University approaches to student mental health is welcome. These approaches are congruent with investing in a resilient nation, with several research projects taking place on student mental health and the Office of Students funding for a range of innovative approaches. StudentMinds are developing a Student Mental Health Charter to recognise and reward good practice.

However, we need to recognise there will always be significant numbers of students with mental health difficulties at every University and, instead, structure HE (courses, accommodation, support and financial arrangements) around this reality. This requires inter-agency working applied across the sector.
 
As the article rightly points out, students with severe mental health difficulties are at "considerable risk” of academic failure and dropping out. UMHAN members often encounter ways in which HE is structured that are counter-productive to mental health and exclude people with academic ability and those enduring long-term difficulties that can and do develop their academic ability. The sector has a responsibility to actively consider the framework of HE and how this impacts on people’s mental health. Tackling mental health difficulties and inequalities that arise in education will improve educational attainment, retention, employment opportunities and physical health, increasing economic productivity, social functioning and quality of life. An example of a practical step for change is with regards the number, and continued use, of timed, unseen assessments (or exams), for which UMHAN developed a policy position.

 The article rightly draws attention to the distress experienced by people in HE for many reasons, and the tragic consequences of desperation. The loss of life, the impact on families and friends, colleagues, are continual, painful reminders of the suffering and endurance that people with mental health difficulties face, and from which we need to take actions. Through empowering the person, taking on the realities of their situation, having a compassionate education system, we may foster hope of a better or different future.

In this context, relying on disclosure, and potentially being assessed for being fit to study, disproportionately affects people with mental health difficulties, and other disabled people. This may inadvertently reduce someone seeking help to address the impact on their education and their access to appropriate services, for fear of losing their education at the point of being in distress.

UMHAN believes that the needs of people with mental health difficulties in HE should be seen with the same parity as someone with mental health difficulties entering, say, employment at this age range, with healthcare and education support services working together to help the person achieve their goal(s). There are particular opportunities and risks posed by the transition, the culture, and learning environment that need careful assessment, and UMHAN would like to see more liaison between CAMHS services and Adult services as well as with University specialists to ensure care as well as rights are enacted. Additionally, work needs to be done in schools and colleges, and via organisations such as UCAS, to prepare students for this transition, and to promote disclosure and services available, including Disabled Students’ Allowances.

The recent focus on student mental health, and particularly Universities’ responsibilities, has provoked rapid investment and review in some institutions. However, UMHAN is concerned that much of this work has been done without fully understanding the impact of the whole range of support and approaches currently being undertaken, or the value of clinical skills (including liaison with NHS services). This has led, in some cases, to reduced or underfunded University-based mental health support to face increasing demand, and the introduction of non-professional staff to work with people with considerable and sometimes acute mental health needs in the education context.

This issue has also been recently highlighted in a paper by members of the British Association for Counselling and Psychotherapy.

UMHAN has many members who feel uncomfortable with the fact that the many recent developments and reviews of services have been undertaken by staff without clinical or mental health experience. These have included outsourcing services, and splitting or removing support service teams. Given the high amount of risk that individual members of staff are often carrying, we would advocate the development of multi-disciplinary teams, with the recognition of the value of the different roles of staff working in student mental health; this approach would enable better communication, shared decision-making and risk-holding, and would therefore support both students and staff alike.

UMHAN would also like to see how the occupational risks associated with University life are assessed and addressed within healthcare services. For example, a student failing a course or suffering from presenteeism or perfectionism may become increasingly desperate around assessment periods, as the article suggests. The “threat” of losing an education (and future job prospects) with the costs incurred are arguably just as significant as losing a job, but this is unlikely to feature in occupation-specific assessment of risk.

UMHAN would like to hear more about the valid and valuable contributions that people with mental health difficulties make within their communities just because of who they are (or because of their experience). Many people with mental health difficulties go about their lives, and contribute to others’, without this being problematised because of well-intentioned institutional policy and process. Students, staff, family, practitioners, friends and anyone interested in the mental health of people living and working in Higher Education can join in University Mental Health Day to speak up, take action, and pledge to make HE mentally-healthy.

UMHAN welcomes the opportunity to work with all parties interested in student mental health. Email us: [email protected]