Why might a student avoid a university’s mental health emergency contact protocol?

Myles-Jay Linton reports the findings of research exploring students giving permission - or not - for their families to be contacted in the case of a mental health emergency

Myles-Jay Linton is Vice Chancellor's Fellow at the Elizabeth Blackwell Institute for Health Research at the University of Bristol

Ensuring that students are encouraged to develop independently, while also making sure that the best support is available to them in the most serious of circumstances remains a challenge for universities.

I’ve been teaching in universities since 2015. In that time, I’ve seen first hand that for students university can be a time for tremendous growth but also personal difficulty.

Navigating the transitions into, through and out of university involves ongoing social, academic and psychological hurdles. Nationally available data indicates rising levels of mental health difficulties among young people and rising requests for mental health support among university students.

Implementing emergency contacts

The University of Bristol launched a new student mental health strategy in 2018. The strategy included a policy where students are given the opportunity at registration to declare whether the university may contact their emergency contact if there are serious concerns about their mental health and welfare. Emergency contacts are often parents, but they could also be partners, siblings or another part of a student’s social network.

Having a policy like this in place enables staff supporting students to make an informed decision about widening the circle of support available to a student if the university identifies that they are experiencing serious challenges to their welfare. These are important decisions, and they have legal, ethical and practical implications. Understandably, the advantages and disadvantages a policy like this presents have prompted ongoing debate across the sector.

Readers familiar with the University Mental Health Charter introduced in 2019 will know that one of the key sections of the “Support” domain is guidance on information sharing. The Information Commissioner’s Office has also provided practical tips. Both overlap in their recognition of circumstances where it is in the best interests of a student to share information with relevant emergency contacts.

At the University of Bristol the overwhelming majority (93 per cent in 2018) of students do opt in. National data from the 2020 HEPI/Advance HE student academic experience survey of more than 10,000 full-time undergraduate students also indicated that only 16 per cent of students would not want their parents contacted if there were any/extreme concerns about their mental health. Nonetheless, because so few universities are known to invite students to opt in there is very little evidence outlining how students subject to this policy actually perceive it.

A deeper look

I initiated a research project on the topic of opting into the emergency contact protocol with three questions in mind:

  1. Did students remember how they had opted at the beginning of the academic year?
  2. What were the similarities and differences between students who did and did not opt in?
  3. If students chose not to opt in, what factors motivated that decision?

My research used data collected through the annual University of Bristol Student Wellbeing Survey. The survey has been running since 2018 and was developed with collaborative input from academics, students, sabbatical offers, and student services staff, embodying a whole university approach. All registered students are invited to participate in the online anonymous survey each year.

Along with demographic questions and measures of mental health, in 2019 students were invited to anonymously report whether they had opted in at registration, and if not, why. The reasons students provided were analysed qualitatively to better understand the underlying motivations driving how students opted.

The majority of students surveyed could not remember whether they had opted in or not at registration (54 per cent). Most of the students who did remember their decision opted in (25 per cent) and the smallest proportion of students did not opt in (18 per cent).

Mature students, students from a black, Asian or minority ethnic background and international students were significantly less likely to opt in. Students who reported higher levels of anxiety and depression symptoms were also less likely to opt in.

The four main reasons students did not opt in were:

  • Unhelpful anticipated outcomes: Fears about the emotional impact on emergency contacts, such as panic and stress. Further, students were worried emergency contacts would quiz them on their feelings or pull them from their studies.
  • Seriousness of student difficulties experienced: Students described their current mental health difficulties as not being serious enough for the policy to be helpful, but indicated they understood its value if they were a risk to themselves or others.
  • Quality of relationship with their emergency contacts: Students indicated that they didn’t have an adequate emergency contact because they were care leavers, bereaved, had a poor relationship with family members, or indicated that their emergency contact was one of the causes of their difficulties.
  • Situational appropriateness: Students discussed wanting to be treated as independent adults, or explained how their emergency contact lived far away in another country, or claimed that it was not any university’s place to directly contact a student’s family.

Applying the findings to policy

Reviewing all of this data there are three clear policy recommendations:

  1. Clarity: universities need to be clear with students so they know what they are opting into and why
  2. Discussion: Where students do come into contact with student support, staff should discuss how a student has opted and any motivations for not opting in (especially if serious risks to their welfare arose in the future)
  3. Vital interests: Alongside opt in policies, universities still need good procedures in place to assess what is in the vital interests of students – particularly given that students experiencing the highest levels of mental health difficulty may be the least likely to opt in

An important limitation of the research is that the survey respondents represented only ten per cent of students within the University of Bristol. Nonetheless, the most valuable part of the research so far has been sharing the findings with staff and students across the university.

The results have prompted conversations with staff about how to discuss the policy with students encountering difficulties resistant to family involvement. Simultaneously, insights from staff members supporting students on a daily basis have informed future research plans.

View and download the full published research findings here.

3 responses to “Why might a student avoid a university’s mental health emergency contact protocol?

  1. As people at the sharp end know – Very very difficult with some groups to work out if it is a real opt-in or a ‘required’ opt-in from family members – like how some students have parents that veto internships or where they live or who they mix with.

    Having said that – an important piece of work read the paper over lunch and would recommend others do the same.

    1. Hi Alan, I’m pleased you found the article a valuable read. I also think you make a really good point about ‘who’ is opting-in when the policy decision can be so heavily influenced by the emergency contact. I really hope the forthcoming research helps to unpack the (many) reasons lots of students do opt-in.

  2. Thanks for this Myles-Jay. We are encouraging our daughter’s University (another Russell Group Uni) to consider “opt-in” so your paper is a useful tool in that conversation.

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