Introduction
This meeting of the All-Party Parliamentary University Group will explore issues around student mental health and wellbeing with contributions from speakers with a range of views and experiences.
With around half of all school leavers now going into higher education, university students are a significant proportion of the 18-25 year old population, but face unique challenges due to the particular situation that they find themselves in and the major transitions that they are making at this time in their lives. Mental health has become a more salient topic amongst the public, media and policy makers in recent years attracting a greater focus from various government departments. Due to such public and political attention, as well as series of tragic suicide cases at universities, higher education institutions are increasing prioritising the mental health of their student bodies and coming up with innovative solutions to provide more support services for their students and staff to improve their general wellbeing.
This guide will give further information about the different responses there have been to address the problems that have arisen with student mental health problems, as well as some of the difficulties that are still yet to be solved.
Students’ differing mental health needs
In the last ten years, the total number of students disclosing a mental health condition to their higher education institution has increased significantly: from 9,675 in 2007-08 to 57,305 in 2017-18. Research by the IPPR published in 2017, which was commissioned by Universities UK, found that 94% of universities have experienced a sharp increase in the number of people trying to access support services in the last five years.
Students may experience particular vulnerabilities in terms of their mental health, particularly during transitions to university. During this time, many students will be living away from home for the first time, having moved away from their established support networks and facing pressures in progressing to the more independent and often intense nature of degree-level study.
There is a much wider challenge around young adult mental health. 75% of mental illness starts by age 24. The prevalence of common mental disorders – anxiety/depression, eating disorders – is increasing, especially in young women. Young people appear to be experiencing mental distress and difficulty in greater
numbers than ever before and, in many cases, the provision and availability of support services has not kept up pace.
At the most severe end, poor mental health among students can result in self-harm or even students taking their own lives. Recent ONS data has revealed that the rate of suicides in the student population is increasing, though still significantly lower than in the wider population. In less severe cases, unaddressed mental health issues can also lead to higher drop-out rates amongst students and underperformance in their studies.
As with the wider population, any student can be affected by mental illness at any stage of their lives and therefore support must be easily accessible and able to adapt to different personal characteristics.
There are, however, certain groups of students that face unique challenges and therefore require support that takes into account their personal needs and circumstances. A selection of these groups are outlined below:
- International students may face additional barriers because of differences in culture and language, and a lack of information about how care services in the UK work.
- Students from disadvantaged families are more likely to have to take up paid work while studying due to financial pressures which has been identified as a risk factor for poor mental health among students.
- LGBTQ+ students have been found to be at higher risk of developing poor mental health, this is reflective of the wider population. This may be due to experiences of discrimination and a lack of understanding throughout at earlier stages of their lives.
- Distance learning students often have different characteristics and face different barriers to students that have moved away from home; many students that undertake part-time or distance learning do so due to an existing mental or physical health condition. Mental health is the largest category of disability amongst Open University students.
Unite Students’ ‘Everyone in’ report from 2017 found that students with a mental health condition are less happy and more likely to think about dropping out of university. While they are positive about the support offered by their university, only 48% declared that they had disclosed their condition to their university and many lack confidence to seek support when they need it.
Political context
The Conservative Party 2017 manifesto had a dedicated section on mental health. It argued that since 2010 Conservative, or Conservative-led, governments had increased funding for mental health services and committed to a new Mental Health Bill which aims to lead to ‘parity of esteem’ between physical and mental health treatment. The manifesto also recognised specific challenges around children and young people’s mental health and committed to better care access for these groups.
In December 2017, the Department for Health and Social Care (DHSC) and the Department for Education (DfE) published a joint green paper on ‘Transforming children and young people’s mental health provision’ which it then consulted on. This green paper committed to the establishment of “a new national strategic partnership with key stakeholders focused on improving the mental health of 16-25-year-olds by encouraging more coordinated action, experimentation and robust evaluation.” This would bring together schools, colleges and universities to make progress in relation to young people’s mental health. Although most of the recommendations focused on changes to mental health provisions in schools and colleges rather than universities there were three core proposals:
1. To incentivise and support all schools and colleges to identify and train a Designated Senior Lead for mental health. 2. To fund new Mental Health Support Teams, which will be supervised by NHS children and young people’s mental health staff. 3. To pilot a four-week waiting time for access to specialist NHS children and young people’s mental health services.
The former Universities Minister Sam Gyimah supported the University Mental Health Charter which is being developed by Student Minds in partnership with the UPP Foundation, the Office for Students (OfS), the NUS and Universities UK (UUK). The former minister showed a particular interest in ‘opt-in’ systems and stated that the Department for Education was looking to prioritise the wider issue of transitions to university.
The OfS has said that using their role as sector regulator to improve mental health and wellbeing among students is a priority. They claim to have an important role in identifying issues where there may be systemic gaps in support or advice for students, and aim to promote and incentivise change. In October 2018 they launched a £6 million Challenge Competition to help universities and colleges, working with students and student unions, and partners such as the NHS and charities, to drive a
step change in mental health support for students. The OfS are currently working with Research England to deliver 17 projects, worth a combined £1.5 million, to improve support for the mental health and wellbeing of postgraduate research students. They directly challenge providers to support students’ mental health and wellbeing, particularly those students from underrepresented groups, in the Access and Participation Plans that providers must have if they wish to register in certain categories.
There has been cross-party support for making mental health a priority and addressing the particular needs of students. In their 2017 manifesto Labour promised to ring-fence mental health budgets and invest in early intervention by increasing the proportion of mental health budgets spent on support for children and young people. Both Labour and the Liberal Democrats proclaimed a goal to give mental health the same priority as physical health. In their manifesto the Liberal Democrats made a commitment to reducing waiting times for mental health services so that people would not wait more than six weeks for therapy for depression or anxiety and no young person would wait more than two weeks for treatment when they experience a first episode of psychosis, as well as to examine the case for introducing a dedicated service for children and young people.
In the Budget 2018, the Chancellor committed to growing the share of the overall NHS budget going towards mental health services over the next five years, increasing funding for mental health by £2 billion per year by 2023-24.
Earlier this month the NHS released their 10-year plan which detailed arrangements to address mental health problems among young people. As part of this the NHS committed that funding for children and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending. The plan stated “NHS England is working closely with Universities UK via the Mental Health in Higher Education programme to build the capability and capacity of universities to improve student welfare services and improve access to mental health services for the student population, including focusing on suicide reduction, improving access to psychological therapies and groups of students with particular vulnerabilities.”
Sector response
In September 2017, UUK launched the Stepchange framework encouraging university leaders to adopt a strategic approach to the issue of student and staff mental health. Aligned with similar approaches developed for schools and colleges, the whole university approach looks to embed mental health across all university functions and aspects of student and staff experience. The Stepchange framework recognises the need to take a whole university approach to student and staff mental
health, recognising that all parts of a student’s experience have an impact on their mental health, e.g. accommodation, admissions, teaching, etc. In order to effectively support students, institutions need overarching strategies that cover all these aspects of university life, with a clear focus on prevention and early intervention.
The framework sets out eight domains and proposes a continuous improvement process driven by sustained leadership focus, engagement with students and staff and comprehensive audit. This strategy makes a number of recommendations for institutions, such as:
- Make mental health a strategic priority, galvanising support among staff and students to adopt a whole institution approach to mental health, with appropriate resource allocated - Effectively measure data on the issue, track progress and deploy evidence-based interventions - Provide staff training on health literacy and promotion, and ensure effective signposting of support - Focus on prevention, enhancing learning, social, physical and digital environments to promote student health, ensuring that academic policies (and adjustments) align with support - Organise campaigns against mental health stigma and encourage disclosure via champions and open discussion - Support transition through mental health discussions with parents, schools and colleges, and focus on vulnerable groups during transitions
Stepchange is being formally piloted at Cardiff University, the University of the West of England, Bristol (UWE), and the University of York with support from the Office for Students. The evaluations of these pilots will be published in March 2019.
Last year, Universities UK convened a Services Task Group, chaired by Paul Jenkins, Chief Executive of the Tavistock and Portman NHS Foundation Trust, to develop a framework for effective partnership between universities and the NHS and to improve how services are designed and delivered to students. This work was published in May 2018 as ‘Minding our future: starting a conversation about the support of student mental health’. It aims to improve the coordination of care between the NHS and universities, so that all students can access the care they need.
This guidance recognised significant difficulties in coordination of care between universities and NHS services, with particular challenges around sharing of patient data, lack of parental/carer support, mobility of student populations, specialist needs and funding anomalies. To address these issues, the document called for stronger
links with NHS services, a focus on prevention, and joint development of commissioning strategies.
At Universities UK’s annual conference at the start of September, UUK launched new guidance to prevent student suicides. This guidance was produced in collaboration with PAPYRUS, the UK’s national charity dedicated to the prevention of young suicide. This guidance covered a number of areas including: steps to prevent student suicide, intervening when students get into difficulties, best practice for responding to student suicides, case studies on approaches to suicide prevention through partnership working and a checklist highlighting steps university leaders can take to make their communities safer. A longer guide for university practitioners was published the following week and UUK has been continuously working with their members in the coming months to promote the adoption of this guidance.
Student Minds have announced plans to develop a Charter for student mental health, which will be created in partnership with a range of leading charities and Higher Education bodies including the Office for Students (OfS), National Union of Students (NUS) and Universities UK. The Charter will recognise and reward those institutions that demonstrate good practice, make student and staff mental health a university- wide priority and deliver improved student mental health and wellbeing outcomes.
The programme was announced with support from the previous Universities Minister, Sam Gyimah, at a round table event on student mental health in Bristol on 28th June 2018. The development phase is supported by a £100,000 grant to Student Minds from the UPP Foundation and will follow an iterative process, shaped by coproduction with students, staff and partner organisations. It’s anticipated that the charter will take an outcomes-focused, banded approach, setting out basic, advanced and aspirational goals. Training and expert support will also be provided to support the change and assessment process.
The University of Bristol has recently launched an ‘opt-in’ system, with early signs showing that 94% of all students (both new and returning) agree to be involved in the scheme. The system creates an opportunity for students to allow for a trusted source, such as a parent, guardian or close friend, to be told about a mental health crisis. The aim of the new scheme would hopefully mean fewer deaths, allowing university support services to work with loved ones to meet the students’ needs. There are concerns however that those students that have chosen not to opt-in to the scheme are those that are currently or most at risk of suffering from a mental health condition and so have decided against opting-in through fear of having this disclosed.
Disclosure, consent and legal issues
Given that students are over the age of 18 when they enter university there are complicated legal arrangements regarding duty of care and data protection which may differ to arrangements in a school or college setting. Universities have a duty of care to their students which may be enhanced in cases of students with a declared mental health condition. Staff in a variety of roles across an institution, not just those providing designated pastoral care should therefore receive specialist training.
The relationship between universities and their students is governed by a student contract which is subject to consumer law and therefore institutions are under a legal obligation to provide and deliver what students have “signed up for” both in terms of academic and pastoral services.
Universities are also subject to the Equality Act 2010 and therefore a balance must be struck between ensuring any disciplinary procedures are enforced, but that actions do not equate to discrimination or victimisation of students with a mental health condition. Under the Act universities must forward plan for the needs of mentally or mentally disabled students and make reasonable adjustments (not defined in law).
There has been ongoing debate about whether, in the light of a spate of recent student suicides, universities should be required to disclose detail of students’ mental health to parents or guardians or whether this would be a breach of data protection laws. This was discussed in detail at a recent Universities UK roundtable chaired by Professor Julia Buckingham, Vice-Chancellor of Brunel and one of today’s speakers. One of the options that has been discussed by the sector is for UCAS to introduce a section of the university application form in which students can opt in to have certain information about their wellbeing shared with their next of kin.
Next Steps
Universities UK is in the process of developing a mental health audit for universities to assess and benchmark progress. This is expected to be released this coming September, as well as a What Works good practice exchange platform for mental health in higher and further education.
The Student Minds Charter is also expected to be released in September. This will give a clearer indication of the work that specific institutions are doing to improve student wellbeing, to what extent they are making this policy area a priority, and how this can be measured in terms of outcomes on student mental health.