Mental health in teaching and learning

Is it possible to embed mental health into the curriculum?

There’s a tendency to think of student mental health – and repeated findings about it in surveys and studies – as something that is about what happens outside of the classroom, to be addressed by student services.

But it’s also arguably a teaching and learning issue. As we argued here, mental health issues look to be collective, influenced by academic practice (both positively and negatively) and everyone’s problem.

So if Education Officers and Welfare Officers need to collaborate, and course reps need to intervene to get these issues on the agenda, where do we even start?

Developed as a partnership between the University of Derby, King’s College London, Aston University, Student Minds and Advance HE, and funded by the Office for Students via a Challenge Competition, a new toolkit has been created to provide guidance on the ways in which curriculum can support both wellbeing and learning.

It’s not especially accessible for the layperson, and so here we’ve done some summarising and highlight fishing to provide some ways in to what ought to be a resource that guides curriculum review in universities.

Underpinning arguments and theory

The argument goes like this. Wellbeing is related to our surroundings, our activity and behaviour, the quality and quantity of our social connections and our understanding of ourselves and our relationship to the world.

As a consequence, every aspect of university life will have a potential impact on the wellbeing of students – whether considered and planned for or not.

As such, the curriculum is important to mental health and wellbeing because it is one of the few guaranteed points of contact between students and the university. It is also central to the student experience as it provides focus, structure, engagement, connection and purpose.

That’s why the intro to the toolkit says that if universities are to take mental health and wellbeing seriously, the role of the curriculum must be core to their response.

In addition:

• Some have raised concerns that a focus on mental health would distort the purpose of the curriculum, but evidence demonstrates a link between student mental health and wellbeing and student learning, persistence, creativity, problem solving, satisfaction and achievement.
• Students who experience poor mental health are more likely to withdraw, underperform and be dissatisfied with their learning and experience.
• Positive wellbeing has been associated with better and deeper learning, higher levels of creativity and problem solving, higher achievement and better levels of student satisfaction.
• How students are taught and assessed, and how they engage with learning, can have an impact on their wellbeing.
• There are then practical, financial and moral reasons to ensure that the curriculum is supporting good wellbeing and learning.

Helpful definitions

Good mental health means more than the absence of illness. It refers to a dynamic state of internal equilibrium in which an individual experiences regular enduring positive feelings, thoughts and behaviours, can respond appropriately to normal negative emotions and situations and is able to make a positive contribution to their community.

Mental illness means a condition and experience involving thoughts, feelings, symptoms and\or behaviours, that causes distress and reduces functioning, impacting negatively on an individual’s day to day experience and which may receive, or be eligible to receive, a clinical diagnosis.

Mental health problems or poor mental health refers to a broader range of individuals experiencing levels of emotional and\or psychological distress beyond normal experience and beyond their current ability to effectively manage. It includes those who are experiencing mental illness and those whose experiences fall below this threshold, but whose mental health is not good.

Wellbeing encompasses a wider framework of which mental health is an integral part, but which also includes physical and social wellbeing. Optimum wellbeing is defined by the ability of an individual to fully exercise their cognitive, emotional, physical and social powers, leading to flourishing.

Anxiety and Learning

There’s a major debate about anxiety and learning. What should students be able to “push through”, and what should be treated with concern? How should we respond to increased levels of anxiety? And when it comes to stress and anxiety, what are the dividing lines between helpful, tolerable, intolerable and harmful?

Anxiety is a fear response to a perceived threat. Students become anxious about education when they view it or the environment as a threat to them.

• That may be stimulated by social and cultural experiences, which, for instance, leave students feeling marginalised, ostracised or humiliated.
• Alternatively, it may arise from a fear of failure or the perceived consequences of failure.

The consequences can be emotional and practical. Students can be scared of the emotional pain they will feel if they fail. They can also fear the practical outcomes of failure, which may not be realistic e.g., they may fear that failing an assignment might lead to them having to drop out of university.

The contours of the debate go something like this:

• Stretch is being challenged in ways that can be positive for learning, wellbeing and achievement. It has been shown to be helpful in motivating someone to engage in helpful behaviours (such as studying and academic performance). Being challenged pushes us to grow and develop. Meeting and overcoming challenges by mastering new skills and knowledge has powerful, positive payoffs for wellbeing.
• Boredom can have a negative effect on wellbeing. A lack of challenge in our lives can lead to low motivation and a lack of meaning and purpose. Students in a co-creation group that worked on the toolkit reported that when they found modules boring, they became disengaged, lost motivation and began to doubt their future, which in turn reduced their mood.
• High levels of stress and anxiety can reduce cognitive functioning at a neurological level. This reduces students’ ability to engage in complex thinking, to access old memories or make new, complex memories, to problem solve and to maintain concentration. In other words, anxiety reduces the capacity for learning and academic performance at a biological level.

When asking students or their reps to reflect on teaching, learning and assessment tasks, they should reflect on:

• Was I appropriately prepared and did I understand what I had to do and how to do it?
• Did I recognise my own skills and resources?
• Did I have the necessary skills to undertake the task or was I able to develop them as a result of completing the task?
• Did I have the necessary and appropriate support from staff?
• Did I have the necessary and appropriate support from other students?
• Did I have the resources I needed – including time?
• Did I feel intrinsically motivated and focussed on the aspects of the task that were meaningful to me?
• Was I in an environment that felt psychologically safe?

And do students and their reps feel that these standards were met?

• If students need to know, understand or be able to do something, it must be taught to them first.
• If students have previous experience of a task and know how to tackle it, they will be less anxious.
• Normalising mistakes in the classroom (online or face to face) can create a learning environment that lowers anxiety and increases learning.
• Classroom activities that identify students’ current level of knowledge and understanding mean that teaching and learning activities can be calibrated to the group.

Wellbeing and the Curriculum

Students may not join societies, live in halls of residence or access student services but they must interact with their curriculum if they are to progress and remain a student.

Recent shows that the design and delivery of curriculum can have both positive and negative impacts on student wellbeing and on student learning. Changes to the structure of the curriculum, to curriculum content, to modes and methods of assessment, to grading and to the social environment within the classroom (online and in person) and in group learning activities, have the potential to improve both student wellbeing and learning.

So when asking students and their reps to reflect on the curriculum on their programme, they might look at the following for things that can harm wellbeing:

• curricula can undermine students’ sense of autonomy if it is overly prescriptive or if students do not have clarity on why they are being asked to engage in particular learning and assessment tasks.
• curricula can undermine students’ sense of competence and achievement if it is not appropriately stretching, if feedback is overly critical or absent, if students are not supported to develop their ability to self-reflect on their own growth.
• curricula can undermine autonomous motivation if learning is confused, improperly sequenced, lacks personal meaning and assumes the existence of pre-knowledge which students do not have.
• deadline bunching results in students having to complete significant amounts of work at the same time, potentially competing with other responsibilities leading to exhaustion and the adoption of surface leaning strategies.
• the learning environment feels hostile or potentially threatening – e.g., if it lacks psychological safety or peers are characterised as the competition rather than collaborative learners.
• the learning environment encourages students to adopt unhealthy study behaviours – going without sleep, working long hours without breaks, etc.

So students could, for example, be asked to give scores and reasons against these kinds of standards and concepts:

1. Learning provides meaning, purpose and a sense of fulfilment
2. The learning environment is inclusive, supportive, health promoting and psychologically safe
3. The curriculum supports sustainable personal growth in knowledge, understanding, skills and confidence
4. The curriculum engages student voice and teaching, learning and assessment are modified in response to student learning, experience and insight

Assessment and wellbeing

Assessment is regarded as a potential risk point which can create unhelpful stress, anxiety, self-doubt and fatigue. This is particularly the case when students and assessment design have a performance focus – when reaching a specific set of predetermined standards is the reason assessment exists and is the centre of student focus. This is what is meant by “high stakes” assessment – there is a significant price to pay for failure – and students will be focussed mainly or solely on what they need to do to succeed.

That also means that little attention will be paid to the opportunity to learn through the assessment!

So ideally:

• While assessment is often associated with risks to wellbeing, if well designed it can support learning and wellbeing.
• Assessment for learning places a priority on promoting student learning, rather than on measuring ability to meet predetermined criteria.
• Assessment for learning is seen as a component part of teaching and learning. Learning can be supported through the design of the task, through feedback and through accompanying exercises.
• An assessment for learning strategy can support a performance focussed culture that is beneficial for learning and wellbeing.

So reps and students might be invited to reflect on:

• Was it clear what knowledge, understanding and skills I was developing when assessment was set?
• Were assessment briefs used to highlight the learning and development students expected by completing the task?
• Were there accompanying meta-cognitive tasks, like requiring students to reflect on their own work or provide responses to feedback detailing how they will apply it in future learning?
• Was feedback used to highlight the learning and development students gained from completing the task?

As well as the aspects we’ve pulled out here, there’s plenty more in the toolkit that’s worth taking a look at.

Read more

Advance HE: Education for mental health toolkit