What works in tackling mental health inequalities?

TASO's Sarah Chappell highlights a new report that challenges providers to tackle inequalities in mental health

Sarah Chappell is Senior Research Officer at the Centre for Transforming Access and Student Outcomes (TASO)

It’s fair to say that mental health isn’t an under researched area.

We know what mental health interventions are available within higher education providers, and the services that students can be referred to, and on the whole have an understanding of what interventions work best to support mental health concerns.

However, there’s still a huge amount that we don’t know about supporting student mental health. In particular, we have not yet solved how to tackle inequalities with regard to student mental health, nor established the long-term impact of mental health support on higher education related outcomes, including retention and attainment.

Where is mental health inequality?

The Centre for Transforming Access and Student Outcomes (TASO) was set up to close equality gaps. Published this week to coincide with Mental Health Awareness Week, our new report on mental health inequalities therefore places a huge focus on better understanding how mental health issues are maintaining or exacerbating equality gaps in  outcomes, and the efficacy of interventions to address these.

Certain groups of students have a higher prevalence of mental health issues than others and are consequently at greater risk of experiencing mental health challenges whilst in HE. These include students who identify as LGBTQ+, students from Black, Asian and minority ethnic backgrounds, mature students, and students who have been in care. These at-risk groups are already underrepresented and disadvantaged in HE, having poorer outcomes in terms of entry rates, likelihood of dropout, attainment, and progression to employment or postgraduate study. Thus it appears that poor mental health likely exacerbates existing inequalities.

What can we do?

Our review of the evidence on student mental health interventions revealed that support appears to be focused on student mental health and well-being in general and there is a paucity of evidence regarding interventions targeted at at-risk groups. Nonetheless, some studies show that existing mental health interventions, including cognitive behavioural therapy and mindfulness, can be tailored to address specific mental health concerns, including those related to race, gender and sexuality. Technology-based interventions, particularly in response to the covid-19 pandemic, have a growing evidence base and may more effectively reach marginalised groups.

It is worth noting, however, that what was revealed in the evidence review doesn’t necessarily represent what is actually happening within providers. As part of the report, we held roundtable discussions with a wide range of sector stakeholders who told us about the support they are offering and the associated challenges. Psychological interventions and mindfulness programmes are easier to evaluate on a larger scale, providing an explanation as to why the evidence base here is stronger than for a lot of other mental health interventions. These initiatives are more difficult to implement within providers, however, particularly in small and specialist institutions and FE colleges. Roundtable participants also highlighted a range of targeted support they are delivering which was not picked up in the literature.

An area that did marry-up well in terms of the evidence and the sector consultation was the emergence of peer mentoring and support as an effective initiative. Peer support groups and networks, emulating group therapy processes, can effectively support the mental health of students and lend themselves to supporting specific sub-groups. For instance, there is evidence to suggest that these initiatives can successfully support those experiencing race related concerns in particular. HEPs also report implementing peer support initiatives for students who identify as LGBTQ+, young carers, care-experienced students and students from Black, Asian and minority ethnic backgrounds.

How students seek help

Our report also highlighted an issue around disclosure and help-seeking behaviour. Many students, and in particular those from already disadvantaged and underrepresented backgrounds, are unlikely to disclose their mental health issues to their institution. UCAS data shows that around 50 per cent of students with a mental health condition are choosing not to disclose in their application to HE. The most cited reason is fear that it will affect the outcome of their application.

Findings from the sector consultation suggest that stigma, cultural barriers, fear of losing opportunities and wanting a fresh start are key reasons why students do not disclose any mental health issues or seek support while studying. This emphasises the need for more research on the impact of framing of mental health support at universities and colleges so that students feel more confident disclosing any issues related to mental health and well-being and subsequently seeking support.

Peer-led interventions could be a key solution here with these initiatives likely effective due to students being more comfortable to talk about concerns with their peers. This was corroborated during our consultation with stakeholders, including during interviews with students who had experience of mental health issues while in higher education.

Beyond “inclusive by design”

While many, including myself, advocate an “inclusive by design” approach to mental health support, existing inequalities demonstrate that more needs to be done to support those at greater risk of experiencing poor mental health while studying. It is clear that providers are providing a substantial amount of targeted support for specific student groups, however, a lack of resources and, in some cases, knowledge around evaluation means we are yet to understand the impact of these interventions, particularly on longer term outcomes.

As part of its research theme on mental health, TASO will be conducting further research into student mental health inequalities, with a view to helping to inform policy and practice with a solid evidence base. It’s essential that we grow our understanding of these issues and what works to address them, or risk further marginalising students who already face so many inequalities within higher education.

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