A holistic approach to student mental health and wellbeing – five key areas higher education institutions should consider

The Office for Students (OFS) estimates that student mental ill-health has increased by over 500% since 20101 in UK universities. Research has found that 22% of students have been diagnosed with a mental ailment and that 34% have struggled with a psychological issue which they felt they needed professional help. In addition, 45% use drink or drugs to help them cope with problems, 43% worry often or all the time, and 9% think about self-harming often or all the time2. The explanation for this increase can be divided into three groups:

• Societal factors: there has been a significant increase in the demand for mental health services in society. This increase in demand has coincided with a reduction in the availability of mental health services through the NHS. The majority of students in UK universities are between the age of 18-25, which is the most vulnerable age for people to suffer mental health issues. The combination of these factors has contributed towards an increase in students with mental health issues and, as such, an increase in demand for support services.
• University student characteristics: students often couple self-identity with academic excellence. Many students have put their hopes and dreams into coming to university and excelling academically and/or through the wide array of extra-curricular opportunities available. This creates pressure for students when they arrive and compete against equally successful and excellent students. In this eventuality, it is easy to see how students can start to question themselves and their abilities. This self-doubt can be a factor in the development of anxiety, depression and other mental illnesses. This is particularly pertinent within the most competitive universities.
• The University environment: environment(s) within a university can either create new mental health issues for students or exacerbate existing issues. Universities should focus on resolving these issues.

Data from the OFS has demonstrated that students experiencing mental illness are more likely to withdraw from university, to underperform academically, and are less likely to secure higher level employment or go on to post–graduate study. When aggregated to an institutional level, these metrics are used for university rankings and ultimately to help potential new students select their preferred university. Improving student mental health and wellbeing is not only a moral obligation for universities, it is a necessity for institutional academic, financial and league table performance.

Universities have responded to this increase in demand in different ways, with varying levels of success. A common response has been to increase the supply of services such as counselling, disability support and proactive courses and awareness campaigns. Research by the HuffPost revealed budgets for mental health services rose by an average of 71% across the sector between 2012-18. At least seven institutions spent more than £1 million on mental health support in 2019, compared to just one in 2012. Vast differences in budgets for campus mental health services exist, with comparable figures showing a £1.4m difference between the lowest-spending institution and the highest-spending university in 20183.

Whilst the universities continue to spend more and more on these services as they grow organically to respond to demand, there is little evidence to suggest the current provision will get ahead of demand and start to reduce the demand for services in the future. It is unsustainable for the current trends in spending to continue indefinitely.

The Covid-19 pandemic has presented opportunities as well as threats to student mental health and wellbeing. The necessity for remote working can increase student isolation, removing multiple touchpoints between a student and the university. This can inhibit the university’s ability to identify potential issues early and direct at-risk students to the support they need. However, the pandemic has forced universities to fully embrace digital delivery methods. This has significantly increased the accessibility of programme content. Whilst many institutions have been doing this for years, others resisted implementing simple steps such as lecture recordings and digital content. Students now have far more control over how and when they receive content and learn. The level of change brought about by the pandemic provides a rare opportunity to take a holistic view of student mental health and wellbeing across an entire institution and identify improvements that will really make a difference to the institution and its students.

The key question is how do universities improve the student experience whilst reducing the demand for front line mental health services, such as counselling and improve the effectiveness of these services when they are required?

When looking to find the answer to this question, it is important to state that there is no magic solution. With ~165 universities in the UK, what may work for one institution may not work for another. When comparing the effectiveness of different university services, it is important to look externally for principles of models that could work, with the inherent understanding that a “lift and shift’ approach is neither appropriate nor likely to be successful. Instead we must look for elements of models that each institution could learn from, acknowledging the differences and similarities where they exist. I have identified five key areas through supporting multiple universities redesign how they approach student mental health and wellbeing.

1. Strategy: be clear on the role of the university in supporting its students’ mental health and wellbeing

Whilst student counselling services started to be introduced in the UK in the 1950s, the responsibility and duty of care of these services often remains ill-defined and unclear. The University Mental Health Charter comments ‘until recently, there has been limited guidance on how universities should support the mental health and wellbeing of the members of their community’. There are also sizeable gaps in the evidence base outlining what interventions or responses may be most effective and in which contexts they do and do not work. SMaRteN, the student mental health research network, has been established to begin to address the gaps in evidence. Alongside this, the What Works Centre for Wellbeing, has begun to collect examples of good, evaluated practice to share with the higher education sector.

Universities need an institutional strategy for student mental health and wellbeing that cuts across and unites all aspects of the university, both professional and academic. This should clearly outline what the university is responsible for and what it is not responsible for. It can be helpful to strip this back to its most basic, a university is responsible for providing the support students need to deliver on the institutional mission regarding teaching, learning and research.

2. Coordination: introduce a one University approach

In 2017, Universities UK launched the Step Change framework, calling for universities to take a ‘whole university approach’ to university mental health. This aims to shift the conversation away from simply focusing on the provision of reactive services, such as counselling, and towards considering the impact of the university environment in its totality on wellbeing and the need for universities to be proactive in supporting students and staff. To successfully reverse the trend of increasing demand for front line mental health services universities must rebalance resources and activities towards preventative services, such as specialist mentoring. Student wellbeing must be placed at the heart of curriculum and assessment design. Where reactive services are required, efforts should be made to improve the coordination and collaboration between these services to increase their effectiveness and efficiency.

3. Prioritise: focus on resolving the trigger issues that often create or exacerbate mental health issues for students

Spikes in demand for support services are often linked to transition points and/or particularly stressful periods for students. These include: enrolment, year abroad, fieldwork, graduation and employment, extenuating circumstances and examinations. Several universities are looking to redesign the curricula to be more developmental, with a better balance of formative and summative assessment. Assessments should be spread out and timetabled around student needs and pedagogical and andragogical best practice as opposed historic ways of working.

Support services should proactively identify preventative measures that could be introduced to support students during these periods, meanwhile reducing the demand for mental health services. This should include identifying and resolving pain points in students interacting with university services and processes as well as proactive support, such as nutritional advice.

4. Student centred: increase the flexibility of services

Universities should proactively create an environment whereby students are able to raise mental health issues early and receive the support they need quickly. This is often better for the student and more cost effective in the long run from the University’s perspective. Mental health issues that are not dealt with are more likely to get worse over time and require more support and resources to resolve. Covid-19 has required universities to adopt a more multi-channelled approach to teaching, learning and services, including student support. When done well, this can make services more flexible and accessible for students. Examples of this include 15-30 minute online counselling sessions. Digital platform such as the Big White Wall offer innovative alternatives to support student wellbeing. Universities should avoid returning back to the way things where when on campus teaching restarts.

5. Training: train staff in how to recognise and respond to students with mental health issues

When considering the effectiveness of mental health services, it is important to acknowledge the formal and informal services and actors who contribute. Student mental health and wellbeing is complex and heavily influenced by a range of factors, only some of which are within the control of the University. There is often a complex web of services and actors who students contact regarding mental health issues. When the official support services are stretched and waiting times are long, students resort to contacting other members of staff regarding their mental health issues. This can place unfair stress on staff members, such as tutors and porters, by putting them in situations for which they are untrained and unqualified. For example, porters are often relied upon in crisis situations regarding student mental health. Universities should look to train staff and triage students to areas of support to ensure staff aren’t exposed to situations for which they are ill-prepared and unqualified.

Universities cannot and should not try to resolve the mental health issues of all students, but they should look to avoid creating new ones or exacerbating existing issues. This requires a truly coordinated approach from across all aspects of a university. Student wellbeing should be placed at the centre of a university’s mission, rather than being seen as the responsibility of a single support service.