It is not sustainable to expect universities to offer specialist mental health support

The mental health challenge is real - but universities are at risk of being pushed to deliver mental health support beyond their educative mission, argues Debbie McVitty

Debbie is Editor of Wonkhe

Back in the early noughteens when the £9,000 undergraduate fee was looming in England, the debate about risks around rising student expectation focused on an imagined version of a luxury student experience.

This essay by academic Howard Hotson in the London Review of Books in 2011 was a bit of a reference point in that era:

To judge from the American experience, comfortable accommodation, a rich programme of social events and state of the art athletic facilities are what most 18-year-olds want when they choose their ‘student experience’; and when student choice becomes the engine for driving up standards, these are the standards that are going to be driven up.

Hotson’s argument was that for their substantial investment students would expect sumptuous campus facilities, cutting edge digital learning environments, four-poster beds and the like. This was a direct critique of the market model which was justified in government by the notion that student choice would drive learning and teaching quality – the riposte was that it would drive a facilities and student lifestyle arms race as universities competed over the glossiness of the shop window rather than the quality of the product.

Thinking back while I’m sure there was a discourse around student mental health and the need for improved support services, I’m fairly confident that nobody anticipated that the student expectation “problem” would end up being about access to student support services against a backdrop of a substantial increase both in reported mental health conditions and experiences of mental ill health in the young population. About as far from the luxury argument as you can get.

The mental health phenomenon is real. At our recent Secret Life of Students event we rehearsed all the evidence linking poor mental health to student belonging and sense of community, confidence to speak freely, and poverty and students’ struggle to make ends meet. Most especially, we drew the link between mental health and physical health – including sleeping, eating, and exercise. Former GP and student mental health expert Dominique Thompson memorably pointed out in one of the panels that lack of access to dental care among students can also be implicated in mental ill health: “Dental health is mental health!”

The broader point is that the higher education sector, and its partners, and government, probably need a more robust agenda for student health in all its forms – one that acknowledges that mental ill health can be a symptom of and catalyst for other related issues, rather than (or as well as) a phenomenon that occurs spontaneously.

But given the mental health “turn” in HE policymaking it’s not surprising that there are numerous calls for universities to further enhance mental health support. I’d not be remotely surprised if pushing forward a student mental health agenda formed a plank of the Labour offer to students at the General Election – especially if the party continues with its commitment to stick to the current government’s spending plans which would limit wiggle room to anything more substantive on student finance.

Pushed in the wrong direction

Given all the good work that’s going on in this space it feels churlish and possibly counter-productive to sound a note of caution. But I am worried about where this mental health turn takes us. It’s widely understood in student support circles that the worry about a possible student death by suicide or students otherwise coming to harm “on their watch” keeps some university staff awake at night. Privately some senior leaders, while acknowledging the reality of students’ struggles, also worry about a drift towards a culture of hand-holding, or excessive expectations of support that may not be all that helpful in preparing students to thrive on departure from the university. And more publicly, universities are increasingly frank about the financial pressures they are facing and the implications for the scale and diversity of services that can be provided.

It is legitimate, I think, to worry about the extent to which the contemporary stories and narratives that circulate about mental health can tend towards catastrophising relatively normal and periodic feelings of anxiety, low mood, and low confidence. Learning that these feelings are part of life, and crucially, that we can develop the tools to avoid them overwhelming us, is part of developing emotional maturity (admittedly, for many of us that’s a journey that we’re all plugging away on whatever age we are).

Expressing the problem as being about mental ill health embeds the presumption of the best solution – more support for mental good health. But even the briefest of glances at the excellent TASO mental health toolkit suggests that the jury is out on the efficacy of a lot of the available interventions, and that careful design and resourcing is required to get the most impact from any programme of support.

I also think that it remains true that a lot of money is spent on wellbeing “window dressing” around things like self-care awareness weeks, or yoga classes, or puppy petting, or what have you, that contribute to a discourse about mental ill health and raise the pressure on students and staff to be healthy, without actually giving them the means. The NSS mental health question which asks students to make judgements about how well the support on offer has been communicated rather than the quality of the support itself may actually encourage this kind of visible busywork-type activity further.

I am all for therapy and psychological intervention and have benefited from counselling support in the past – in the best of all possible worlds we would all have access to a friendly therapist simply to help us process the ups and downs of our lives. In an only moderately just world, those who need therapeutic support at key moments in their lives would be able to access it freely and easily via the National Health Service. But I’m not convinced that the corollary of that universal provision being unavailable is that universities should feel obligated to step in.

When the number of students needing a helping hand was relatively small, it’s much less of an issue to invest that resource – if the money is there, and the students appreciate it, and the NHS isn’t doing what it’s supposed to, then why wouldn’t you? And I know it sounds wildly counter-intuitive to suggest withdrawing support when the need is increased, but where I think we risk ending up is actually somewhere akin to the worst of all possible worlds where universities are held responsible in the public consciousness for students’ mental health, but are functionally unable to meet the expectation. If that is the case in some or a growing number of institutions, it would be better to be honest about it rather than pulling resources out of the core educational mission to service specialised support provision – or generic promotional activity – that may only fuel the need rather than reduce it.

Prevention rather than cure

One of the insights that falls out of the Secret Life data on the links between mental health and, well, everything else, is that there is plenty that can be done to respond to the social phenomenon of rising mental ill health within the framework of universities’ education mission. A lot of that is about really effective transition support that recognises that students may need help with “adulting” – cooking, shopping, sleep hygiene, making friends – as well as preparation for academic study. It’s about inclusive pedagogy, curriculum, and academic support that engages students’ interests, and is flexible and empathetic in response to students’ challenges. It’s about human centred service design and compassionate communication. It’s about a jobs strategy that looks for opportunities for students to undertake meaningful, reasonably paid work. It’s about co-creation and students feeling like they matter to their institution and that they can make a contribution to their community. It’s about staff workload and the recognition that achieving that three point bump in the league tables is rarely worth the cost in morale.

All of this kind of thing is picked up in impressive detail in the University Mental Health Charter – which only observes that where support services exist, they should be effective and accessible, and does not specify what kind of services should exist. Likewise, in the categories of risk and information sharing, the onus is on providers to have a plan in place to assess risk, share information with trusted contacts, and a dialogue with NHS and statutory services, not to provide the support directly. It needs to be possible, in other words, for an institution to commit to the principle of supporting good mental health in the way the UMHC prescribes, while not being obliged to spread the available resource thinly to maintain a veneer of direct mental health support.

What I also think is missing from the discourse around mental health on campus is an activist agenda on the part of universities and SUs around student and young people’s health and wellbeing. In fact, some of the debates about universities’ responsibilities can actively neutralise the possibility of generating political energy around the broader reality of broken public services, climate emergency, economic malaise and regional inequality, and the spiralling cost of housing. While mental ill health can manifest in anyone, and there need not be a socio-economic trigger, it doesn’t seem like that much of a coincidence that we’re seeing this spike in mental ill health against the current economic backdrop. To some extent treating mental ill health only manages the symptoms, it doesn’t tackle the larger issues.

In the months and years ahead universities will continue to have to make some very tough decisions about where to direct their available resources – and be courageously explicit about how they navigate the balance between investing in healthy learning and working environments, managing the risks that come with students who have diagnosed or emerging mental health challenges, and providing direct support to distressed students. I’d suggest that in some cases, accepting that some forms of direct support are simply no longer sustainable may be the tricky reality that universities will have to confront.

5 responses to “It is not sustainable to expect universities to offer specialist mental health support

  1. The boundaries between NHS and university services have become extremely blurred; expectations are high from students, staff, parents and the public around services providing tailored, specialist and 1:1 support. The reality is many universities are now offering better and quicker support than is provided by local statutory services, and yet the discourse is still that HEPs should do more.

    As you say, there are many and complex social determinants which effect mental health, of both staff and students, many of which are out of the remit of HEPs.

    At UMHAN we’d suggest that universities should be directing their energies tothe areas they do have control over – a good start would be ensuring that legislative duties under the Equality Act 2010 are met, as demonstrated in the Abrahart case. This means ensuring polices and processes, including assessment methods, are inclusive and flexible.

    A focus on staff wellbeing, as mentioned in Kate Lister’s blog post, would also have direct benefits for student mental health.

  2. “the riposte was that it would drive a facilities and student lifestyle arms race as universities competed over the glossiness of the shop window rather than the quality of the product” an almost perfect description of where UK Universities now are, replete with all the Destroying Educational Institutions one intersection at a time word salad whilst striving for Equity while ignoring Equality of Opportunity. The damage that does to both staff and students mental well being is irrelevant to the vociferous minority driving those agendas and name calling others, and for staff it’s a huge worry as one word out of place or context may cause a pile-on and demands for dismissal, no matter how ‘woke’ and ‘with the agenda’ they’ve been.

    1. Once Academic’s , and even more ‘other staff’ without the protection of tenure and ‘Academic Freedom’ (something Academic’s are losing fast in many Universities) are so threatened students soon find themselves under pressure to conform to the ‘new normal’, with ‘new speak, and ‘double think’ creating even more mental health pressures.

  3. I started to work in Higher Education around 25 years ago at Nottingham Trent University,and was employed as a Mental Health Development Officer, considering the needs of students who had mental health difficulties. When I took up that post the question I was most frequently asked was whether there were any students who had mental health conditions. As a result of the discussions we had with students and staff, and the wave of students who presented to me with complex needs, it rapidly became apparent that what was needed was specialist support.

    The team that developed out of that need was one of the first specialist mental health support services in a UK university. It was set up to support students in undertaking their education, and as such was very much focused on the core educational mission of a higher education provider.

    I don’t doubt the need for students to have access to therapeutic support. Still, my work was never primarily about ‘therapy’ but was about the practical challenges of studying, whilst experiencing a mental health difficulty. It had as much in common with support provided to Dyslexic students as it did to ‘Counselling’, which was already well embedded in most universities.

    Working with like-minded colleagues we set up UMHAN (The University Mental Health Advisors Network), around 20 years ago. There were six of us at the time, now UMHAN has hundreds of members, and contrary to popular understanding there are more mental health professionals working in Higher Education today with this sort of role, than there are counsellors. Generally, our members are extremely busy, and the biggest complaint they face from students and academics is that they are not always able to see students quickly. There was an argument around 20 years ago about whether universities should provide this type of specialist support, but contrary to some narratives, this now forms an extensive part of what universities have been offering for many years, it is not in any sense new.

    The article conflates the provision of specialist support with filling gaps in NHS provision, which I think are two different issues. One of the things which I think is core to the professional understanding of UMHAN members is the need to support and encourage the need for people to be exposed to some level of risk – it is the exposure to risk which allows people to grow the capability to cope with the challenges of the adult world. To describe mental health support as being about ‘hand holding’ is therefore to fundamentally misunderstand the purpose of such support.

    Such misunderstandings are common, and UMHAN members often share their concerns about the drift of the university sector into areas, which as the article suggests are not sustainable. Rather than the primary concern being about resources, it should I think be about the fact that there is a danger that approaches which are adopted could be counterproductive. Unhappiness, anxiety, elation, joy are all human emotions which are extremely common, robust mental health is as much about having the skills to bounce back from setbacks, drawing on, but not depending on, resources which may be at your disposal. Of course mental health professionals working in Higher Education know all this, and as such are able to support countless students in developing independent coping strategies, which allow them to continue their education, and prepare them for life beyond university.

  4. Hello I have been a counsellor in the UK working in Higher Education since 2012. I wonder how much the reader of this article will appreciate the complexity of the work that students bring to counselling, as well as the benefits this provides to the individual and institutions. My recommendation to universities would be to embrace the fundamental demographic and social changes that are taking place and their impact on the mental health of students, and to embrace the opportunity afforded to them, in the current socio-economic climate, to empower the journey of individuals. I encourage the reader of this article to think of a mental health crisis – not as a sign that there is something broken – but as a sign that there is something in a stage of transformation taking place within the person. This, I feel, is in keeping with the ethos of what a university in the 21st century is trying to provide. I predict that sooner or later attitudes will shift, and therapy centres will become more central to how we transform lives and help people achieve.

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