Breaking point: a call for action to support college counselling services in Scotland
University and College Counselling, September 2023

Scottish college students are facing an unprecedented mental health crisis. In December 2022, the Mental Health Foundation published, Thriving Learners College Research, a landmark report which showed that 54% of Scottish college students present with moderate to severe symptoms of depression. Furthermore, 4% of college students indicated that they had attempted suicide in the last six months.¹ Recent figures further show there have been at least 16 student suicides at Scotland’s colleges since 2016.²

Existing studies have demonstrated that embedded higher education counselling services are effective in improving mental health and academic outcomes of students. For instance, a study by Murray et al. on a large UK university counselling service indicated that 63% of students showed reliable improvement on clinical measures following counselling intervention.³ Similarly, another study which surveyed two UK university services, found that 83% of students felt that enrolling in counselling improved their academic outcomes.⁴ These findings demonstrate the crucial role college counselling services play in addressing the student mental health crisis.

Given the severity of the mental health crisis facing students, there is an urgent need to evaluate whether Scottish college counselling services are currently equipped to meet students’ needs. In 2020, a report by the National Union of Students showed that only one in five Scottish college students were aware of the mental health and wellbeing support available to them at their institution.⁵ Although colleges have been able to increase awareness for counselling services since then, one in three surveyed college students remain unaware of the wellbeing and counselling support available to them.¹ Further insights into the challenges facing Scottish college counselling services come from the Thriving Learners College report (2022), which included 18 qualitative interviews with college stakeholders in student mental health and wellbeing.¹ A shared sentiment among stakeholders was that there has been an increase in the severity and complexity of cases presenting to college counselling services since the COVID-19 pandemic. Furthermore, stakeholders criticised that a lack of onward referral pathways hindered adequate support provision for students with complex mental health needs. These findings demonstrate the importance of taking a closer look at the structure and functioning of college counselling services.

Therefore, in April 2023, our research group Phronesis Research published an independent report titled, College Counselling Services in Scotland: Insights and Perspectives Amidst the Student Mental Health Crisis, providing further insights into mental health provision across Scottish colleges, and their role in supporting student mental health. We filed Freedom of Information requests to the Scottish Government and all 27 Scottish colleges in February 2023. This report is based on data from 25 colleges, as two institutions did not get back to us within the required timescale. This article discusses key findings and recommendations from the report.

Rising student demand

Our report revealed a sharp increase in student demand for college counselling services over the past 10 years. There has been a 1,828% increase in the number of students requesting counselling services, from 186 students in the academic year 2012/13, to 3,586 students in 2021/22. These findings underline the expanding need for higher education mental health provision across Scotland. However, not all institutions face equivalent demand for counselling services. For example, at one college, more than one in five students requested counselling, while at another college, only one in 20 students requested counselling. There are several reasons why some colleges may face higher demand for counselling services – such as higher mental health difficulties within the student population, or more accessible and appealing counselling services.

Examining mental health disability disclosures across colleges can provide further insights into the predicted demand for student counselling services over the coming years. In 2021/22, a staggering 7% of the total college student body disclosed a mental health disability to their institution. In consideration of these findings, it is essential that college counselling services are adequately equipped to support rising student demand.

Waiting times for counselling services

Increased demand for counselling services has led to longer waiting times at some colleges. At four colleges, the average waiting time for counselling was more than 30 days. Further, a closer look at maximum waiting times revealed that students at some institutions waited longer than three months for a first counselling session. Prolonged waiting times for counselling services can have a detrimental impact on students’ mental health and academic performance, emphasising the urgent need for increased resources in addressing the mental health concerns of college students.⁶

Understanding the sociodemographic characteristics of counselling users

Understanding the sociodemographic characteristics of counselling users can help colleges to identify gaps in service provision. Our report showed that in the academic year 2021/22, 63% of students who received counselling at Scottish colleges were female. Contrastingly, only one in three students who received counselling were male. Although male students often report higher psychological wellbeing in national studies, they are more likely to die by suicide than female students.⁷ Therefore, colleges should consider the potential role of stigma in understanding the lower uptake of counselling services by male students.⁸ Further, colleges should implement targeted outreach efforts to promote the use of counselling services among this demographic.

Gender minority students are a small but notable group (3%) of counselling users. According to prior research from the Thriving Learners College report, gender minority students experience higher levels of depressive symptoms, self-harm and serious psychological issues compared to male and female students.¹ Therefore, it is crucial for colleges to provide counselling services that meet the unique needs of this population. This may involve ensuring that counsellors are trained in issues relating to gender identity and expression. By taking proactive steps to support the mental health and wellbeing of gender minority students, colleges can help ensure that all students have access to the care they need to thrive. As an example, one institution has already implemented a clinical group specifically designed to support LGBTQIA+ students.

Supporting students with complex mental health needs

Many of the students presenting at counselling services present with quite severe and complex mental health needs. In 2021/22, 5% of service users reported actively self-harming or experiencing suicidal ideation. Furthermore, anxiety (22%) and depression (15%), which often require sustained support, are the two most common presenting problems at Scottish college counselling services. Due to a focus on short-term counselling provision, sustained counselling support goes beyond what most college counselling services can provide. Although it is commendable that the majority of Scottish colleges (96%) extend their standard package of counselling support for at-risk students, many students with complex mental health needs may not be able to receive the support they require.

It is essential that colleges establish external referral pathways into community mental health teams to refer students who require further support. However, only 11 colleges are currently able to make direct referrals, indicating that a considerable number of at-risk students may not be receiving the necessary support. Colleges looking to establish pathways may wish to collaborate with local NHS branches, CAMHS services or mental health charities.

Colleges must make counselling services accessible to all students

Ensuring that college counselling services are accessible and inclusive to all students, including those with disabilities, is a core responsibility for Scottish institutions. Our report showed that most colleges are unable to offer adequate counselling support to deaf or hard of hearing students. While some colleges are able to offer counselling in British Sign Language, alternative provision solutions were often limited to email or text counselling or instant messages. Furthermore, two colleges reported not being able to offer any counselling provision for deaf or hard of hearing students, highlighting a lack of accessible mental health provision.

Colleges are in need of more counsellors

One integral challenge facing Scotland’s colleges is that students have less access to counsellors than their university peers. While the average counsellor-to-student ratio across Scotland’s universities is one counsellor to 2,087 students, the ratio is more than twice as high at Scotland’s colleges (1:5,629). Although these figures are concerning, it is important to note that some colleges offer both internal and external counselling streams, which means it is not always possible to evaluate the true availability of counsellors.

The availability of counsellors varies significantly across Scotland’s colleges. While one institution has a ratio as low as one counsellor to 1,273 students, the highest ratio stands at one counsellor to 14,169 students. Several colleges rely on external services to provide counselling support to students. Overall, to meet the growing demand for counselling services, there is an urgent need to employ more counsellors across Scotland’s colleges.

An uncertain funding future

The Scottish Government plays a pivotal role in supporting Scotland’s college counselling services. Since 2019, at least 41 FTE mental health counsellors have been appointed by colleges using government funding. Remarkably, government funding was used to introduce counselling services at several colleges in Scotland that previously did not provide any form of internal counselling provision to students.

In March 2023, 21 college principals wrote to the Scottish Government requesting that sustained investments be made to support the future of counselling services.⁹ Several colleges stated that they will not be able to continue to employ their counsellors without government funding. In July 2023, the Scottish Government confirmed an additional £3.21 million to extend student mental health funding at colleges and universities for the next academic year. However, the purpose of this funding is to offer a one-time provision to assist colleges and universities in transitioning to a more comprehensive framework for addressing students’ mental health needs.¹⁰ Considering rising mental health disability disclosures and increasing student demand for counselling services, the withdrawal of long-term funding will considerably undermine colleges’ capacity to support student mental health.

Recommendations

The Scottish Government must commit to sustained long-term investments in college counselling services. This commitment is crucial for ensuring that colleges are able to provide effective mental health support to students. With the rising demand for counselling services, it is imperative that the Government recognises the importance of college counselling services and provides the necessary funding to sustain them.

College counselling services should set clear targets in waiting times and evaluate them on an annual basis to ensure student needs are consistently being met. Annual evaluation of average and maximum waiting times should inform service design and development.

College counselling services should improve the quality standards of routinely collected data to better understand demographic differences in service utilisation and student demand to ensure equitable access to mental health support. Routinely collecting and analysing data on the sociodemographic characteristics of counselling users (e.g., gender, ethnicity, year of study) can help colleges to identify gaps in service provision, and address potential barriers to accessing counselling services.

College counselling services must ensure that their services are accessible and inclusive to all students, including those with a disability. Nearly one in five Scottish college students disclose a disability to their institution. The example of deaf and hard of hearing students showed that not all colleges are currently able to accommodate the needs of disabled students. Colleges must take proactive steps in understanding the disability characteristics of their total student body, and prepare to accommodate diverse accessibility needs.

External referral pathways to community mental health services must be established at all college counselling services to support students with complex mental health needs to acquire sustained care. While it is encouraging that some colleges already collaborate with local NHS branches and charities to establish direct referral pathways, it is critical that these pathways are established across all Scottish colleges.