Up and down the country I see great work being done to support students by welfare departments in universities, and I have been impressed by the sheer number of initiatives to address a growing issue.
Last year I called for UK universities to adopt the whole-university approach of the UUK Stepchange Framework to ensure we have the right support, systems, training and partnerships in place for optimum mental health and wellbeing.1 Wellbeing is the key addition here, as we want to create a healthy, productive environment where everyone has what they need to thrive and grow.
I want to start by exploring why UUK and universities across the sector are taking a significant interest in this area and how the Stepchange Framework developed.
It started as a social movement within the university system, when some vice-chancellors started to mutter in the corner (which is often what happens when you put vice-chancellors together in a room), talking about the pressures they were seeing in their institutions. In particular, pressures within the parts of our universities offering support and services to students and, in certain cases, staff; and putting that alongside feedback we were getting from staff, our trade unions and student surveys in terms of how people were feeling generally within the environments where they were studying, working and living.
These conversations and surveys have led to some big questions and conversations within university circles. Within our institutions we have a group of individuals, predominantly 18 to 24 year olds, who are going through massive transitions: transitions in terms of leaving home for the first time, or leaving their home country to come and study in a very different environment; transitions as they progress and move through university from one year to the next, and then of course a transition into employment or further study.
The 18 to 24 age group is particularly vulnerable to the onset of mental health problems. We can also see in our data for the sector that there has been a significant rise in numbers of students disclosing and declaring that they have mental health issues. In 2015/16 across England this had risen to 15,395 students and of course those are just the ones who are declaring. That’s the tip of the iceberg, and it’s five times more than we were seeing in 2006/7. We also know that one in four adults will experience mental ill health at some point during their life.2 We are all on a continuum of mental health – sometimes we feel better than at other times, and acknowledging this presents some serious questions about its significance for our staff and students.
Last year we also saw the Government’s Green Paper: ‘Transforming children and young people’s mental health’,3 which highlighted that probably one in 10 young people have some form of diagnosable mental health condition, and the significant challenge of transitions during young people’s time at school and beyond. Not surprisingly, such issues accompany many of those individuals into universities and the workplace.
We are also seeing increased demands within the NHS, as well as in the health and social care systems. We are all very familiar with the headlines that signal that mental health services are under significant stress. We are not coping well in trying to keep pace with the demands that are coming to our services, and this is true within the university sector, within the school sector and within the general community sectors.
So we have to start to think differently about what we can do in universities, to rethink the model of support. Through Stepchange, we have begun to ask the questions and start to work out what our baseline for providing support across our institutions is, and whether we are in a position where we can learn from and with each other.
At the University of the West of England (UWE Bristol), we have been engaging in the Stepchange project with two other universities, York and Cardiff, and we are all piloting the UUK Stepchange Framework. However, across all universities, the approach is about working in partnership, working with students, sharing, and being very open and honest in terms of what we are seeing across our universities. Importantly, we are working with other organisations, the Higher Education Funding Council, Student Minds UK, and, within our own institutions, the students’ union, and others.
We know already that, of course, mental health does not exist in isolation. Hence, we have to start thinking about the needs of the whole person. We need to look at how the university structure and curriculum are helping or hindering. We have to start thinking about general health – about exercise, where people are living, how they are living, how they are socialising, nutrition, sleeping; all of those things. And in particular, for our students, we have to consider relationships and how they are developing good relationships. We are also interested in how they are engaging in risk behaviours, since we have a group of individuals, predominantly aged 18 to 24, who may, with peers, be encouraged to engage in things that they wouldn’t have done under a parental eye. So we’ve also had to face up to looking at things like drugs, alcohol and starting to look at the influence of that on violence – including sexual violence – on our campuses, as well as considering the mental health implications of such behaviours.
So our approach is quite broad – it has to be – and we are beginning to call it, in our university, mental wealth. This is in recognition of the fact that it’s the mental health and wellbeing of individuals that we need to be considering. Why is that important? Well, as universities we want to ensure that our staff and students thrive and flourish and we want to get the best from them.
The other important thing, of course, is that on occasions in our universities we do see, unfortunately, some students taking their own lives, and that is a very tragic event. It happens in our institutions and the hardest thing for a vice-chancellor to do is to sit in front of friends, family, partners, and be asked: ‘How did this happen?’, ‘Why did this happen?’. And to have to say that you don’t know. According to universities’ data, some 40 per cent of those who take their own lives are not known to campus support services.4
We need to understand what we could do that might ensure we are better able to spot people who are vulnerable.
We want to try and get to a position where we improve mental health and wellbeing across our campuses, because that’s the right thing to do. The mental wealth that we are talking about is concerned with developing a positive wellbeing in individuals and communities, and raising awareness of mental health issues as well as providing timely access to support when there is a need.
Of course, universities are already doing a huge amount of work and we should be incredibly proud of that work. At UWE Bristol, this includes interventions which recognise the transitions students go through, such as having a managed university welcome, to help students make friends at the anxious time of starting at university. And ‘Feelgood February’, to help with the period after Christmas when, among other things, the reality of exams has set in.
We also work very closely with our students as part of a network to train them to engage with their peers. We have workshops to empower students and improve their resilience, self-belief, self-esteem and confidence, and this is particularly important to some students who wouldn’t necessarily go to counselling services, those who feel that maybe through their own beliefs, or through their own experiences, that’s not something they can do. They may, however,
talk quite happily to peers who have been in similar situations. This is something we see quite frequently in our international students.
We also have interventions that offer online support. Many of our students don’t want to engage face to face to begin with. Instead, they prefer to be anonymous. Developing a wellbeing service that is able to not only deliver face-to-face interventions, but also to create opportunities for students to take that first step of asking for support and help, which could be online, is a priority.
In terms of our counselling services themselves, we’ve seen high levels of student satisfaction with some of the plethora of services offered. We’ve been doing some work at the university around therapeutic interventions and we’ve developed a solution-focused approach and a 90-minute initial therapeutic consultation that works with the students. It’s proved incredibly effective for supporting those students who are in early mental ill health and distress. It helps them to engage with the counsellors, it gets them to begin to build their own toolsets, their understanding of how to manage their own mental wellbeing. Some will go on to further sessions, but many don’t. That initial 90 minutes is enough to get them into a place where they can manage their own mental health and wellbeing. We also offer drop-in sessions every week, in the afternoon, with no appointments necessary. For many, making that appointment is a barrier, and so we remove some of that hurdle by having appointment-free drop-in sessions. In September 2017 we also started a pilot with Kooth Student,5 an online platform where students can access counsellors out-of-hours, including at weekends and in the evenings. These are professional online counsellors, who engage with the students; there’s also a moderated forum with self-help materials. Early indications are that students are engaging with that very positively. Of course, this is something we will evaluate as it rolls forward.
And then we have a lot of online self-help that students can access. This includes five-minute animations developed by the university around stress and anxiety, and what it’s like to go through an examination period, highlighting what normal emotions might be and getting students to see that it is normal to feel anxious on occasions.6
We have also developed an app, called SAM, which has had over a million downloads worldwide.7 It’s free, it’s all about enabling students to understand their own mental health, wellbeing and anxiety, and it enables them to track how they are feeling. We are also working with our students’ union to ask what we can do together. Our strategy is being co-developed with students. The students’ union runs Nightline, another approach to supporting students, and peer-to-peer support schemes. The students’ union message is very simple, and is focused on making sure that students know that they are not alone: ‘It’s OK not to feel OK. There are other people like you: you’re not different’. I’ve found that to be a really important campaign.
The starting point of course is that the conversations have to be open, in an environment that gives permission for people to talk about mental ill health. We are talking about mental health in an open way, challenging each other, of course, but also recognising what we are currently doing – trying to normalise these conversations, reducing stigma and recognising that we all have mental health, and that at various points in our lives our mental health on that continuum moves towards ill health. Getting people to understand their own mental health is an important part of this. The students’ union engages with students at a completely different level from our senior management and central services, and sometimes it will come up with things that we haven’t thought of.
We are now building on this platform to develop and drive forward our Mental Wealth Strategy, which draws on the UUK Stepchange Framework. What we have been trying to do is first of all understand the university’s current situation. We have now completed an audit across the institution to get a full picture of all the services and things we are doing around mental health and wellbeing. We have come up with a list of some 200 activities that are badged as supporting mental health, which clearly feels like a lot, and some activities will overlap. So we are trying to understand what is duplicated and what is evidenced as being most effective.
For UWE Bristol, our Mental Wealth initiative is a strategic priority, and it’s a whole-university initiative, involving staff and students. What we want to be able to do is to offer the best environments for our staff and students in terms of support for mental wealth. To do that, we need to be honest about what’s working and what’s not. What we can’t do, as universities, is just throw more and more resource and money at this, without understanding the impact of what we are doing and whether or not it is making a difference.
At UWE Bristol, we are looking to ensure mental wealth is embedded throughout everything we do – at every level. This includes how we manage transitions to and through university, and how we design and manage our curriculum. Some of our early priorities are staff training to ensure staff are able to support students, and curriculum design to ensure that assessments don’t all come together and that students aren’t under pressure to make presentations to their new colleagues in their first week at university.
Understanding where our students are coming from, and the relationships that we have with schools, and understanding how we can engage with the networks that we have in the locality, with the NHS and others, is an important part of the Stepchange Framework and what we are driving forward at UWE Bristol.
We need to work with the entire community on all of this – schools and parents as well as students. We are having conversations with the NHS, local councils, other universities, schools and colleges and accommodation providers, to take a whole-city approach to the problem. We are exploring how we can better link up our systems, especially with regards to information and data sharing.
Drug use is a good example. We know teenage years and university can be a time for experimenting, and we know, because of the internet, that students have much easier access to drugs than they ever had before. Tackling drug use requires a joined-up approach across agencies and across the sector. In Bristol, we are looking to see how we can take a citywide approach to it. And if we can’t prevent young people from experimenting, we at least need to make sure they have the full facts so that they understand the risks and are as safe as they can be.
For me, working with schools prior to students joining us is also key to both managing expectations, providing advice and building resilience.
We know we need to do more to engage with parents and families to ensure that they feel they can tell us if they are concerned about their child. That might be in the form of upfront printed or online information prior to students starting university, or easily accessible helplines. Essentially, it is about encouraging them to look out for each other.
We want to make sure that through our strategy we are creating the best possible environment and systems for students to flourish and thrive in. This encompasses looking at the types and frequency of academic contact time and a well-paced curriculum, finding ways of reducing isolation in the first year, emotional resilience training, and providing a wide range of activities to engage students from the start of their university journey that doesn’t involve alcohol, but helps them make friends. It’s about creating an environment where students can recognise stress and feel empowered to either seek help for themselves or others and call on support services. It is about the entire community working together – our staff and students working together. This is by far the most important thing for us to do, because it reaches the greatest numbers of students and staff. We can only do it in partnership; we can only do it if we work together. That is the overwhelming conclusion: together. Joining things up, we stand a chance; if we can’t do that, we are in real trouble.
Professor Steve West is Vice-Chancellor and President of the University of the West of England Bristol. He holds advisory appointments in higher education and in his discipline, healthcare policy and practice. He is Non-Executive Director for the Office for Students, and Chair of the UUK Mental Health in Higher Education Working Group.
References
1. http://www.universitiesuk.ac.uk/stepchange (accessed 30 March 2018).
2. https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/#. Wr3j5tMbO8o (accessed 30 March 2018).
3. https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 30 March 2018).
4. https://www.ippr.org/files/2017-09/not-by-degrees-170901.pdf (accessed 30 March 2018).
5. https://student.kooth.com/ (accessed 30 March 2018).
6. http://www1.uwe.ac.uk/students/healthandwellbeing/wellbeingservice/self-help-resources.aspx (accessed 30 March 2018).
7. http://sam-app.org.uk/ (accessed 30 March 2018).
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