Higher risks and longer delays: Student mental health advisors on the front line

Every year student mental health advisers feed back on their their caseloads and conditions. Rachel Spacey and Sam Gamblin find that this year's results make for worrying reading

Rachel Spacey is Policy and Engagement Officer at the University Mental Health Advisers Network

Sam Gamblin is Charity Manager at the University Mental Health Advisers Network

Every year at the University Mental Health Advisers Network (UMHAN), we survey our 600+ members to find out more about their caseloads and working conditions.

This also helps us gauge the current state of student mental health support from staff who work on the front line supporting students with mental health conditions on a daily basis.

Our latest member survey report was published recently and, in parts, makes for worrying reading.

Our core membership is made up of professionals working either in a Mental Health Adviser (MHA) role (or similar) or in Specialist Mental Health Mentoring (SMHM). Advisers and Mentors normally have a postgraduate or professional qualification in mental health and significant experience.

UMHAN members including advisers, mentors, managers and associates, help students navigate the complexities of student life and life outside of higher education, including the academic processes which often negatively affect mental health and wellbeing.

Our members were asked to consider their responses to the online survey in relation to the previous academic year (2022-23) and 104 completed it – approximately 17 percent of our members and consistent with previous member survey response rates.

High numbers of students with complex needs

Most mentors worked with somewhere between 11 and up to 30 students. Their caseload had stayed about the same in the last 12 months but for most, over half their caseload was made up of “high risk” students.

We define “high risk” in terms of deteriorating mental health, severity of mental health condition, suicide, serious harm to self or others, neglect, abuse, becoming socially isolated, at risk of radicalisation or experiencing significant disruption to their education.

They highlighted the increased numbers of students who are neurodivergent (primarily Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Condition (ASC)) presenting with mental health conditions or awaiting formal diagnoses.

Similarly, advisers, many of whom worked with up to 25 students and some between 26-50 students, observed their caseload had either stayed the same or increased over the last year.

For most advisers, almost half their caseload was made up of “high risk” students. Advisers reported dealing with more students who presented with complex or higher needs than in the past and a caseload complicated by the reality that it was harder to refer them to NHS services.

While caseloads do vary amongst members and some members work part time, for example, what the survey data did highlight was that staff’s working days are often back to back with appointments and those cases are complex and require a lot of emotional input from staff.

Since our last Member Survey report in 2022 which first revealed an increase in members’ workloads and the proportion of caseloads in the “high risk” category, student mental health has remained firmly under the full glare of the spotlight of the media, government and the HE sector.

Supporting students with their mental ill health and/or mental health conditions to transition into, stay and succeed in education has never been so strategically and operationally important and yet the role of our members and other support services staff in retention is rarely mentioned.

Worryingly, we see again that the majority of members are struggling to fit CPD into their schedules. All Accredited Practitioner members (Advisers and Mentors) are subject to UMHAN’s supervision and CPD requirements and yet the key reasons members can’t attend our online meetings is because they are unable to block out the time in their schedule to attend and/or because they do not have time for CPD.

Struggling to fit in training and CPD

Well-resourced support service teams and staff would not only have the opportunity and time to undertake relevant CPD but would feel supported to do so by managers and senior leaders and yet approximately a third of respondents were concerned that they did not spend enough time reflecting on their practice and a minority actually felt that they were not supported to undertake CPD by their employer.

Practitioners need to ensure their skills and knowledge remain up to date, and that they have time for reflective practice – this is not a “nice to have” but is vital in ensuring safe practice.

This lack of support for professional development and career progression was one of the reasons cited by UMHAN members who are considering leaving their roles in the next five years, along with low pay, workload, work-related stress and the responsibilities of the role and reiterates the findings of Hannah Borkin’s study of disability support staff in HE as reported in Wonkhe last year.

However, whilst low pay coupled with increasing caseloads and responsibilities means some members are considering leaving their current role in the near future, a more flexible working environment, post-pandemic, was the norm for most respondents and was generally viewed positively.

As part of a university-wide commitment to supporting student mental health, it is imperative that advisers and mentors are encouraged and supported by their managers and senior leadership to undertake relevant CPD. Moreover, ensure they have protected time for CPD activity during the working week.

As members note the increasing complexity of need they are presented with, it is important that they are able to access the most up-to-date knowledge and information from their communities of peers and experts.

Waiting times… unacceptable and getting longer

This is the first year we have explicitly asked members about referrals to NHS services and average waiting times. As our members frequently convey to us the amount of risk they hold whilst students wait for referrals to other services, we felt it was crucial that we explored this in some detail.

Historically, we have found that member caseload is affected by local NHS capacity. Whilst, importantly, the quickest waiting times were referrals to crisis/acute mental health services, with the majority of respondents citing between 24 hours and one week, for the remainder, more worryingly, they cited anywhere from 1-6 weeks to 2 years or more.

The longest waiting times were for diagnostic assessments for ADHD and ASC with most members selecting 2 years plus for both. Mentors, in particular, highlighted the escalating numbers of students who are neurodivergent presenting with mental health conditions or awaiting formal diagnoses.

This is especially alarming when research from Unite Students found that in a survey of approximately 2000 university applicants, over half of neurodivergent students had experienced depression and almost two thirds had experienced anxiety in the last two years – percentages which were well above the average for all applicants.

Noting that with increased waiting times, some students are not formally diagnosed until after they complete their studies and in spite of the Right to Choose (the NHS Constitution gives people living in England the right to choose where to have treatment) some private assessment centres are not currently accepting individuals for their waiting list.

Referrals by UMHAN members to NHS and statutory services is an ongoing source of concern. Some were unable to refer directly to NHS services whilst others described how their referrals were ignored, not accepted or that the referral criteria seemed to have become more stringent.

What is the impact of this? University services and UMHAN members are having to manage and hold risk, gap filling for NHS services. It is clear that NHS waiting times and thresholds are having a huge impact on students and mental health teams working in HE.

While we applaud efforts to create better partnerships with NHS services locally, feedback from our members shows that statutory services are struggling to respond to students at all levels of need. Senior leaders in our sector need to put pressure on the government to ensure NHS funding remains at the forefront of conversations around student mental health.

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