Universities must prioritise support for student mental health

We are at the start of a new academic year. Over 400,000 new students will be experiencing the excitement and challenge of starting their higher education journey for the first time. For most students this will be an extremely positive experience, but for others there may be anxiety as they adapt to the pressures of university life.    

The need for universities to be more effective at identifying and supporting students who may have psychological and emotional needs was brought into sharp focus last year. A number of tragic cases of student suicides at Bristol University highlighted the strain being placed on university counselling services due to the significant increase in students reportedly seeking support for mental health issues, and the devastating consequences where a university has been unable to identify that a student is potentially at risk.  

Although most of the media coverage has centred on the experience of students at Bristol, the risk of students suffering from mental health concerns has significantly increased across all universities across the UK. There is now pressure on the sector from both the government and regulators and charities to address the need for more effective mental health support on campus as a priority.

On 16 September, Sam Gyimah, the universities minister, wrote an open letter to all UK university vice chancellors which states that prioritising student mental health is "non-negotiable" and that it is "essential" that "leadership" on this critical issue comes from the "top" of all higher education institutions.

According to research previously carried out in the UK, approximately one in every four adults suffer from mental health issues. As a demographic young adults of student age are regarded as at a particular risk given the pressures of relationships, managing money, and the constant intrusion of social media.  

At university these pressures are amplified. Many students are taking their first steps toward adult independence including securing accommodation, dealing with financial commitments, registering with doctors for the first time and dealing with both the pressures of studying for a degree and the social pressures of mixing in a diverse modern university community.

There is little or no transitional support provided between school and university. Many students are also at an age where they are going through huge personal and psychological changes.  The range of issues facing a student when they start university can jointly or individually create anxieties and in turn impact on a student's mental wellbeing. These factors include financial worries, loneliness, social media and peer pressure. The stigma associated with having mental health problems can cause students to be reticent in coming forward for help.

While the issues that some students can experience have been widely recognised for some time, it is clear from recent figures that student mental health problems are growing and that it is now a key issue for the sector to address.

Analysis by the Institute of Public Policy Research, reported last year, found more than 15,000 students disclosed a mental health issue to their university in 2015/16, compared to approximately 3,000 in 2006.

Evidence of the rise was supported by data disclosed by UK universities in response to a freedom of information request submitted by the Union of University of East Anglia Students which found that 94% of UK universities had reported an increase in students demanding counselling services, as reported by the National Union of Students (NUS) in January this year.

Data published last year by the Higher Education Statistics Agency also revealed a sharp rise in university drop out rates from students who had known mental health issues.

In June, the Office for National Statistics (ONS) reported that there had been 95 suicides among higher education students in England and Wales in the year ending July 2017, up from 77 in 2006/07. This report coincided with the spate of unexplained student deaths or suicides at Bristol University – 10 inside 18 months. However, it should be noted that the same statistics show that the percentage risk of suicides amongst university students (4.7%) are still significantly lower than the percentage risk of suicides amongst all 21-24 year olds nationally (8.7%) .  

Pressure increasing on institutions

In light of the statistics, the level of support that universities have in place to support students with mental health issues has come in for scrutiny from a wide variety of stakeholders in the sector.

In June, the universities minister in England, Sam Gyimah, said that universities "risk failing an entire generation of students" unless they improve their mental health services for students. In a statement that gained widespread media coverage, Gyimah said it is incumbent on universities to "see themselves as ‘in loco parentis’" to ensure support is available to students when they need it.

At the time, the minister said: "It is not good enough to suggest that university is about the training of the mind and nothing else, as it is too easy for students to fall between the cracks and to feel overwhelmed and unknown in their new surroundings."

Following this statement, the minister also announced plans for a charter which would detail the basis criteria that all UK universities would be expected to meet in order to demonstrate that they met the required standard for student mental health protection. The work on drafting a charter will be led by the charity, Student Minds, and include input from the Office for Students (OfS), the National Union of Students (NUS) and Universities UK (UUK). However, it is unlikely that a charter will be in place until 2019.  

In the meantime, there is now a significant call for bodies within the sector to act swiftly to address potential failings. Clare Marchant, chief executive of the Universities and Colleges Admissions Service (UCAS) in the UK, acknowledged in a recent press interview that there is more that universities and UCAS itself can do to support the transition between secondary and higher education for school-leavers and combat potential mental health issues that could arise in that period of their lives.

Universities have also been told by the newly established independent regulator of higher education in England, the OfS, that the growing mental health crisis among students must be tackled as a "top priority". This message was echoed in a further communication from Gyimah to vice chancellors on 16 September. He expects university leaders to "act now" in setting high standards in pastoral care and ensuring that support for student mental health is embedded in the culture and structure of an institution including all policies, procedures and guidance.   

Student bodies themselves are also placing pressure on their institutions. Hundreds of students at Bristol University organised a march in May demanding the institution improve its mental health services.

The challenges universities are facing

However, despite the impression given by the media, there is widespread recognition across universities in the UK of their obligations to address student mental health issues, both from a moral and legal standpoint.

In fact the sector has already made a number of attempts to develop robust policies and procedures for supporting vulnerable. Guidelines on student mental health policies and procedures for higher education were first issued in 2000 by the Committee of Vice-Chancellors and Principals (CVCP), now Universities UK (UUK), and the Standing Conference of Principals (SCOP), now GuildHE. That guidance was updated in 2015.

However, as the statistics show, the environment in which universities are operating is constantly changing, posing new challenges to the way in which they address this complex topic.

Institutions have an increasingly diverse and international student population with different needs, including in respect of mental health care. According to a 2013 report by the Equality Challenge Unit, the number of disabled students at university who have declared a mental health condition increased from 5.9% to 9.6% between 2007 and 2012.

Students today also arguably have a broader range of concerns than they once did, requiring institutions to be alert to a wider range of potential issues so as to provide adequate support. Concerns can range from how to fund university tuition fees and succeed in exams and in a competitive job market, to how they adapt to unfamiliar environments and a loss of support networks, and respond to peer pressure, including around drug and alcohol use as well as social media influences.

For universities there is challenge to ensure students are able to receive timely access to mental health support services they offer. Delivering that level of care, particularly when universities are seeking to expand and more and more students move into off-site and private accommodation, requires significant resources, including investment in counselling services. The level of support on offer at universities differs from institution to institution, however.

Universities must be alert to the potential for individual cases to fall through any gaps in their internal support networks, and ensure that their own services are joined up with those provided externally, such as through local authorities and the NHS.

The universities minister's call for universities to act 'in loco parentis' is well intentioned, but it raises further questions for institutions over how to do this without infringing in the freedoms of students, and whether it is even practical for them to assume this role given the increase in student numbers.

Universities would be well advised to closely monitor how the minister's plans to make it easier for universities to share personal data on students' mental health with parents or trusted persons develop. Sam Gyimah said he would explore a new mechanism where students could opt in to permit data concerning their mental health to be shared with those individuals, thereby providing universities with a way to navigate concerns that sharing information might breach data protection law.

Changes universities can make

As we have already noted above, one of the concerns raised by the minister is that all too often operational issues are dealt with below senior management team level. Senior managers at universities are now under pressure to do more to embed their mental health and wellbeing strategy into the culture of their organisation. Gyimah has stated that such a step is "non-negotiable". This was one of the central messages contained in UUK's #stepchange campaign, launched in September 2017, where "a whole university approach" to addressing student mental health issues was advocated.

While, there will clearly be pressure on universities to invest more in their support and counselling networks, this will not be sufficient on its own. There also needs to be a more joined up approach to the issue of student mental health which is reflected within the character of a university itself. Supporting student mental health must become a strategic aim of an institution and be reflected in the design of policies, procedures and training as well as the integration of consistent good practice across the institution.

Part of that work will involve universities working with the government and schools to look at how all parties can play a greater role in helping students in the difficult transition from school to university and becoming independent learners. This will be supported by recent guidance for students produced by Student Minds which helps students navigate the new challenges they face.

Universities should also positively engage with potential students who flag mental health issues at the pre-admission and admission stages to better plan support for needs.

Universities should be open to collaboration with student groups, mental health bodies, the NHS, and local authorities, among others, to inform the design of their mental health procedures and support plans. More engagement with collaborative partners, placement providers and external accommodation owners is also important to ensure better support is available to students.

There is evidence that training staff in how to respond when they suspect students are struggling with mental health issues can make a real difference. The Times reported in July that approximately 80 residential support staff at Leicester University had received such training and that one of those trained, a porter at the university, had helped to save the life of a student after finding a suicide note in a halls of residence.