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Where is the line between tailoring and universality in mental health support?

Ahead of a parliamentary debate on student mental health and disability, Jim Dickinson reviews the results of a Petitions Committee survey of students and parents
This article is more than 1 year old

Jim is an Associate Editor at Wonkhe

The Commons Petitions Committee has published the results of a survey on experiences of mental health support at university.

(TW: Suicide, depression, mental health)

86 per cent of current students said they had suffered with poor mental health at university. Just 1 per cent said their university was “very supportive” of their mental health, 40 per cent said that their university was “unsupportive” or “very unsupportive”, and 67 per cent said they would feel “uncomfortable” or “very uncomfortable” discussing their mental health with their academic supervisor or tutor.

63 per cent of current and 85 per cent of former students said their university did not offer – or they weren’t sure if it offered – a mentoring scheme. 38 per cent of current and 87 per cent of former students said their university did not offer – or they weren’t sure if it offered – study skills training.

35 per cent of current and 80 per cent of former students said their university did not offer – or they weren’t sure if it offered – arrangements to accommodate the needs of students with poor mental health (e.g. deadline extensions). And 20 per cent of current and 64 per cent of former students said their university did not offer – or they weren’t sure if it offered – a disability support service.

Self-selecting samples

The survey was distributed to the 130k signatories of the petition calling for a statutory legal duty of care that will be debated in Parliament on June 5th – and so some will argue that the circa 1500 current and previous students and parents completing it were bound to be negative.

Given that DfE research on the issue surveyed providers, we could just as easily argue that they were bound to be positive about what was on offer – and even that revealed significant variability in what is on offer.

Our work on belonging last year found that belonging, inclusion and mental health are all connected – and our own polling in January and February (around 90 higher education providers, sample around 1600 weighted for gender and age) had 66 per cent agreeing that support services were appropriate and sufficient to students’ needs.

So caveats about overall representativeness aside, the qualitative comments are interesting insofar as they drive home the point about variability:

Parent: “I have 3 children either at, or just finished at university. The variance in overall care between those that see students as important and those that do not care is significant.”

And the variability isn’t just between institutions:

In my experience, no pastoral support was given as academic tutors were very variable in their willingness/ability to coach effectively or offer pastoral support. Every student needs access to regular support to help maintain positive mental health and a net of support (which is adequate and not oversubscribed) to help effectively with any issues in mental health.”

On counselling, some were worried about capacity:

The counselling service at my university only allows students to access 6 sessions during their whole time at the university. Given that students are typically at university for 3+ years I feel that students should be able to access it more than once.”

The self-rationing we often see in the NHS is evident too:

A lot of students feel discouraged to opt into the current university services because the waiting lists are so long and most universities only provide a maximum of 5 counselling sessions a year. This simply isn’t enough and many of the staff who work in the student support departments also believe that this should change […] I still am on a 6+ month waiting list for the 5 counselling sessions my university offers.

And the pass-the-parcel between unqualified academics and stretched central services continues:

Students can wait a whole academic year to be seen and supported and the burden of care is often left with personal tutors in the department.

Aspirations and minimums

Comments on support for disabled students and students with special educational needs are even more worrying, both because this is an area where there are supposed to be hard legal minimums, and because we have no way as a sector of determining whether these minimums are being met:

My son is autistic and this was on his UCAS application and details were provided to his University. But no support was put in place. Instead, he was expected to fill in more forms and register with the disability service – things that he was not capable of doing because of his autism. His mental health deteriorated to the point that he stopped going to lectures and tutorials. We did not know this. No-one from the University checked up on him. He had no appointments with a personal tutor. We did not know anything was a problem until he sent us a message indicating that he did not want to live.

The relationship between parents, students and their provider feels unsettled too – even when the policies are clear:

With the ‘trusted contact’, I have had the opportunity to put someone down which I did when I started at university. However, when I experienced a mental health crisis and told the student wellbeing team I was suicidal, they did not contact my ‘trusted contact’ or ask if they could. They also did not offer me any support other than telling me to go to A&E if I hurt myself. So while it’s good for a university to have the ‘trusted contact’ option it’s also important that they use it.

There’s also a mismatch when it comes to noticing – if a student is missing, or struggling:

My son did not attend lectures for a whole term due to mental health issues and no one noticed or cared. It was a fellow student who encouraged him to tell us what was going on and to contact student welfare.

Luck of the draw

In our belong polling, we looked at the qualitative responses on support at university of students who self-declared high levels of anxiety and low levels of happiness – and again, consistency was an issue:

Availability and accessibility of services

The university only offers 4 sessions of counselling, which do not really give you any time to develop a bond with the counsellor.

One would always need to wait for over 1 month to access mental health support provided by university.

Long wait for emails and appointments

Quality of services

They have objected my extension requests, against DSN policy.

Support services are adequate here.

they are terrible. huge wait lists and the support is weak.

Awareness and information about services

Don’t know enough about them

I’m not aware of the services

The support services should be better advertised

Specific characteristics support

It’s hard for me to connect with mental health support services, because of cultural differences

not enough provision for students with complex/multiple disabilities

There is hell don’t get me wrong, but there is still a lot of progress that needs to be made like increasing awareness of learning difficulties such as ADHD

Available to all?

At the heart of all of these findings, and the case being made by the #ForThe100 campaign, is the question of what should be offered universally to students in HE – with associated monitoring of awareness and effectiveness.

In the qualitative findings in the DfE research, providers often argued that provision should be tailored to the particular needs of the student body at that provider. There is of course a subtle difference between tailoring of that sort and what many argue ought to be minimums available regardless of the provider type.

As such the list in the report of suggestions to improve support at universities is interesting – because it begs the question: which of these shouldn’t be available to all students in HE?

  • Counselling.
  • A welfare officer / student advice service.
  • A disability support service.
  • Study skills training (such as courses on coping with stress or planning work).
  • Arrangements to accommodate the needs of students with poor mental health (e.g. extensions to assessment deadlines).
  • Mental health training for all student-facing staff, including training on neurodivergent students.
  • Offering students the option to give details of a “trusted contact” during their university induction.
  • Regular pastoral meetings with each student to check on their wellbeing and mental health.
  • Safe spaces on campus that are open 24 hours a day.
  • Accessible 24-hour mental health helplines for students.
  • A 24-48 hour grace period for assessment deadlines.
  • A student mentor in each hall of residence.
  • An opt-in welfare check service for students with poor mental health.
  • Exit interviews if students leave university.
  • Drug and alcohol awareness programmes.

It may be that the current funding arrangements in higher education prevent that kind of universality – but if that’s the case, Parliamentarians and the public need to understand that in more detail. It feels like the sector is nervous about saying so out loud – but a message that is, in effect, tantamount to “we’re doing our best but can’t hit a universal standard” is too confusing, and lets the bargain basement-eers off the hook.

It may also be that some think providers should be free to offer less than all that if students want to choose a provider that charges a lower amount in tuition fees – but if that’s the case, we need to put applicants (and their parents) in a position where they have sufficient information to make that choice – and disabuse them of the idea that all students are somehow protected.

We need, in other words, to establish not just the unit of resource flowing from the tuition fee, but to determine what it must cover as well as what it could. If we’re able to do that over free speech, teaching quality, careers support and grade inflation, why on earth can’t OfS’ B Conditions or the UK Quality Code cover this?

And more specifically – if OfS can require providers to “have the capacity and resources necessary to facilitate compliance with its proposed condition of registration over the prevention and handling of harassment and sexual misconduct”, why can’t it do the same over mental health and disability? If your answer is “well the money isn’t there”, that would at least provide clarity over what needs to happen next.

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