Mental health advisors are the jam in the sandwich

Sam Gamblin and Rachel Spacey discuss the role of, and pressures on, mental health advisers and mentors inside universities

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

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

As students start the new academic year – undergraduates and postgraduates, new and returning – their friends and families may be worrying about how they will settle into university life.

They may well have concerns about how student life may impact their mental health.

There has never been as much emphasis on student mental health as there is at present – following the parliamentary debate in June about whether there should be a statutory legal duty of care for students, triggered by the online petition from #ForThe100 – a movement launched in support of families of students who died by suicide at university.

Universities minister Robert Halfon rejected the call – but did announce the subsequent creation of the HE Mental Health Implementation Taskforce (HEMHIT). The taskforce must produce a plan for improvement in mental health support by December 2023 – and by May 2024, show what has been achieved, what work still needs to be done and areas requiring additional intervention.

It will address four specific areas set out by the minister – including the adoption of good practice and the University Mental Health Charter, a review of student suicides, the creation of a university student commitment (compassionate communications) and student data analytics.

“Please can the first person to read this reply to me”

Meanwhile here at UMHAN – the University Mental Health Advisers Network – we are celebrating our 20th year as a membership charity.

We were set up as a small networking organisation for Mental Health Advisers (MHAs) in 2003 with our own Jiscmail list (the subheading above was our first message from Phil Scarffe) – but the need for specialist staff to manage more complex student mental health issues was identified in the 1990s. Indeed, student mental health became a concern for universities after WW2 as historian Sarah Crook has highlighted.

When we talk about student mental health, we use the terms “mental ill health” as a broad term describing mental distress – whilst “mental health conditions” are those which are clinically diagnosable.

We pay tribute to our approximately 600 members in many different roles across HE and Further Education supporting students with their mental ill health and mental health conditions working in, or alongside, mental health and wellbeing services.

Our members have a rich and wide range of professional backgrounds and experience such as social work, nursing, occupational therapy, psychology and psychotherapy. The majority of UMHAN members are either Mental Health Advisers (MHAs) or Specialist Mental Health Mentors (SMHMs – a role funded largely through Disabled Students’ Allowances (DSAs)).

MHAs typically co-ordinate support for students experiencing distress or difficulties due to a Mental Health Condition, removing barriers to successful study whilst Specialist Mental Health Mentors (SMHMs) who started joining UMHAN in 2016, help students improve their self-management competencies, as well as being alert to ongoing risk factors.

They come from over 150 different organisations, including both the largest and smallest specialist providers. A large number have crisis response, safeguarding and risk/safety planning in their job descriptions and are recruited because of their specialist training and experience in this area.

But we know that disability and mental health teams within institutions are not necessarily joined up or using the same systems. For example, a student who discloses their mental health condition on their UCAS form will often be seen or contacted first by someone from a disability team – and there may be a completely different registration or triaging process for mental health support from specialist teams.

For students this can mean sharing the same information repeatedly, and receiving a fragmented package of support. As SMHM support is normally overseen by a Disability team, there is also potential that MHAs miss out on the insight and opportunities that could be provided by working together.

The jam in the sandwich

UMHAN recognises all the amazing work which is being done by staff in universities, under a climate of austerity and when public services are underfunded and under-resourced.

We know that our members, and wider student services teams, are delivering a range of remarkable and impactful services and support, which save lives every day, help students achieve their own personal goals and improve student outcomes and achievements.

As member Peter Glenn wrote in 2003:

…MHAs are… the jam in the sandwich between psychiatrist and student, or medical evidence and student or academic and student or university and student.

Our members work with around 250,000 students with mental health conditions (interestingly Higher Education Statistics Agency (HESA) data for 2021/22 indicates that just under 120,000 UK domiciled students declared a mental health condition).

However, we acknowledge that much of this work remains unseen and is therefore unvalued by universities. A recent report commissioned by the Department for Education (DfE) to map higher education policies and practices to support student mental health was based primarily on a survey completed by senior leaders at universities. Neither MHAs or SMHMs are mentioned within that report.

Indeed, the report gives the impression that higher education providers either rely on self-help materials or therapy – when in fact they deliver so much more. It’s no surprise then that many UMHAN members feel undervalued, with a high number planning to leave their roles within the next five years according to our most recent member survey.

Recruitment is already a problem in these specialist roles, as it is across the entire mental health workforce.

More honest conversations

So, after 20 years, we welcome the subject of student mental health being given much more focus and priority in higher education. As UMHAN member Jo Culpin noted in 2021, we need to have more honest conversations about student mental health because there is still stigma attached to mental health.

There have been numerous research projects, funding rounds, reports and guidance produced by individuals and organisations many of which reiterate the same themes that we have been highlighting for the past two decades. We believe that this is more than enough time to act on some of those key issues:

  • A focus on the transitions in and out of university for statutory services, making it easier for students to transfer their care between locations and child/adult services and access appointments and medication
  • Developing a more compassionate and trauma-informed culture on campuses, which extends to staff as well as students
  • Increased funding to ensure that systems and data are fit for purpose and can deliver real insights into the issues that affect student mental health as well as demonstrating its extent and complexity.

However, no action from universities can plug the gaps left by insufficient resourcing of the NHS – record numbers of students are reaching out for our support, many of whom have not met thresholds for support from Child and Adolescent Mental Health Services (CAMHS) or have been waiting for years for ADHD/Autism assessments until they have reached a crisis whilst at university.

Students with emotionally unstable personality disorder (EUPD) are on waiting lists for years rather than months or even weeks for dialectical behaviour therapy (DBT), a type of cognitive behavioural therapy (CBT) especially adapted for people who feel emotions very intensely.

Universities are struggling to get psychotic students on campus assessed. Our members have told us that it can be extremely difficult to communicate this risk to the NHS. Community teams are simply not responding, even if a student is psychotic or recently discharged from hospital. The list goes on.

It is within this climate that services and individual members must hold and contain this risk – sometimes to ensure a student can continue studying, and other times to ensure that a student stays alive.

That’s why we are so passionate about reducing the stigma surrounding mental health conditions and improving inclusivity in higher education, removing the barriers to the full participation of students with mental health conditions because mental health is something that everyone in universities needs to be thinking about.

Leave a Reply