The Oxford Student Mental Health Network says:
Findings from a research study into the needs of staff at the University of Hull revealed that:
- Over one third of the academic staff respondents from the University have had experience of supervising students with a mental health problem in the previous 5 years.
- Of these mental health problems, 60% were classified as minor and 28% as 'severe' or 'life threatening'.
- The biggest difficulty, faced by 27% of tutors, was getting students to acknowledge their mental health problem and accept help.
- 26% of tutors felt they lacked the knowledge, skills and experience needed to deal with students with mental health problems.
- 11% of tutors felt they lacked support in their roles from colleagues and other staff members.
- 10% of tutors felt they did not have sufficient time to respond to students with mental health needs.
- 10% of tutors felt confusion over their role.
HEFCE Project: Responding Effectively to Students' Mental Health Needs 1996 - 1999.
Who is involved?
A variety of people internal and external to the educational institutions have a role to play in supporting students with mental health problems. These include:
- The student himself/herself.
- The student's family.
- Other students within the institution.
- Staff members within the institution.
- The educational institution as a whole.
- Health Services, Social Services and voluntary sector agencies.
Research shows that when contemplating approaching someone in a position of authority, students are much more likely to approach their tutor about emotional or life problems than they are a counsellor or GP. Additionally, it is not just tutors who provide support, students who experience emotional or mental health problems may approach a range of staff who work in educational institutions. OSMHN's own research has found that lecturers, administrative, residential and domestic staff may all have a concern about the mental health of students.
I am finding that I am not only responsible for the day to day running of the halls but also act as a counsellor and a mediator for the students.
Staff often have two main concerns:
- How can you tell if the student has a mental health problem?
- What should you do about it?
How can you tell if the student has a mental health problem?
Students may come to university or college with an existing mental health problem which they may or may not have revealed to anyone.
The university are often finding that on entrance students do not mention their mental health problem. The students have a fear that if others find out that they are in treatment that it will be revealed more widely.
This is quite understandable. Many people are reluctant to mention their mental health problems on an application form, and few students make any such declaration. Staff may encounter any of the following situations:
- Some students will be up-front about their mental health situation and make staff aware of their needs from the outset, for example by contacting a Disability Adviser.
- Some students may have their problems well under control and feel that there is no need to mention them unless they are likely to have an impact on their academic performance.
- A significant number of students will encounter their first mental health problem during their studies.
- Other students will have a mental health problem which is impacting negatively on their studies or other aspects of their life but do not declare it or access support.
This latter group cause staff in educational institutions much concern. In an Oxford College, Sell and Robson (1998) found that 63% of students felt there was a stigma attached to seeking help from a professional.
People are unwilling to seek professional counselling because they fear that that they will get a label attached to them.
As a result, staff and the institution as a whole have a role to play in identifying students in difficulty and ensuring their needs are met.
What is a mental health problem?
Distinguishing between minor setbacks and more serious problems is not always easy for staff to do. OSMHN's own research has highlighted that staff sometimes have difficulty determining when a student's mental health problem is serious enough to require medical intervention. At the other extreme staff are worried that students are sometimes using a minor mental health problem as an excuse to obtain allowances on their academic work.
I find it hard to recognise when a student is in need of support or using mental health as an excuse.
There was a case of a college not picking up on someone's deterioration. He gradually deteriorated over 5 to 8 weeks and was left to his own devices and nobody guided him to the GP or College Doctor. He had been in his room for a week and was really unwell.
Secondary healthcare staff member
A member of staff's ability to appraise the situation may depend on a number of factors such as:
- the nature of their contact with the student.
- how well they know the student.
- how much knowledge and experience they have of welfare and health issues.
What to look for?
In many cases a distressed student may approach you directly, either to discuss their problems, or because they are concerned about their ability to work. In some cases the student won't have raised any issues with you but perhaps you, other students or staff are concerned. You may notice some of the following indicators that all is not well:
- changes in the way that the person looks or behaves.
- continuing difficulties with academic work.
- withdrawal from activities.
- mood changes.
- weight loss.
- bizarre or challenging patterns of behaviour.
- reliance on alcohol or illicit drugs.
What should you do about it?
Feedback from OSMHN's research and staff workshops have indicated that many staff members are unsure about how to respond to students with mental health difficulties.
When approached by a student with mental health needs, the major concern is "am I doing this effectively". It is hard not to get overwhelmed.
If you are aware, or suspect, that a student is having problems with their mental health, there are a number of things that you can do. In becoming involved, it is important that you respect the student's need for confidentiality and that you know the appropriate limits to your involvement.
If your role involves contact with the student you may be able to raise your concerns with them while they are on their own. Whilst you must respect the student's need for confidentiality, there will be some situations in which you cannot keep things to yourself.
My fear is that a student will confide in me and ask me not to tell anyone and then something awful happens.
If there is a possibility that the student is likely to cause harm to themselves or others then you have a responsibility to pass that information on to someone else such as your manager, a General Practitioner or other responsible party. Your institution should have policies and guidelines which will help clarify the situation for you.
Other practitioners will have their own confidentiality codes, especially Health Service staff, counsellors and advice workers. Unless the student consents to the sharing of information, they won't be able to pass personal information back to you, but they may be able to give general advice on the situation and what you can do.
If you feel there is any threat to your safety you should not try to raise your concerns with a student in an isolated location.
It is an emotive field and at times staff get hooked in because they care. But because they see the job on a caring level rather than as providing a service they can get blinded to everything else.
You need to consider what is reasonable for you to offer to the student in terms of:
Your job role
Take into account your responsibilities within your job role and consider your workload. Some staff can find themselves becoming inappropriately over-involved with the needs of individual students.
You can get sucked in by the student and it is important to be able to refer on before boundaries are crossed.
Your knowledge and skills
Stick to what you do well and don't try to be an amateur psychotherapist.
You sometimes find tutors or others who are inappropriately trying to do too much, perhaps using limited counselling skills. Without awareness, staff can develop false dependency relationships with students, or in good faith set up relationships with student whose needs they can never fulfil. This situation can be serious when they get out of their depth and there is a crisis.
If you feel that your skills and knowledge are limited you could consider attending a training course. See the section on staff mental health resources for more information.
Your personal limits
Before questioning a student, consider how well you are able deal with other people's distress, do not upset the student if you cannot deal with the consequences.
It is very easy to open up someone's feelings, but much more difficult to work with them.
I would want to warn residential staff and others to look out for the conversations with the student that go along the lines of "I don't want you to tell anyone else this but ...". It could happen to a hall warden. We get it and we say that we must share information in our team. It is about colluding with them and not doing that, and recognising that it could be time for treatment to be required.
Secondary health care staff member
The best help you can offer is to:
Be clear about what you can and cannot offer
It is not your responsibility to 'fix' a student's mental health problem and you should not be afraid to communicate your limitations to the student both in terms of the level of support you can provide and the amount of time you have available.
What can seem like minimal support to a staff member may be very beneficial to an individual student.
Staff are often fearful of not being able to help the student. However, sometimes all the student wants is a listener. Staff needn't have all the answers but sometimes the best support is to just sit down and offer the student time.
Take action to reduce the student's stress
Consider what allowances you can make for students with mental health difficulties within your role. For example, as a lecturer is it possible to negotiate study times, extend deadlines, change assessment arrangements and teaching styles? Much can be learnt from good practice techniques within other institutions.
The fact that everything is assessed through the finals puts massive stress on people. The academic subject itself is not the challenge, it is the time management and being able to cope that is the challenge.
There is possibly a lack of realisation by tutors that they need to help some students keep things in perspective by saying "you look tired, you mustn't go overboard". People's moods can change a lot, e.g. students can feel great when they are complimented by a tutor but criticism has the opposite effect on their moods.
Help the student find other sources of support
Raise your own awareness of support services within your institution and locally and be prepared to refer students to health or counselling services for help with their emotional or mental health problems. Remember that sources of support can include self-help materials and web sites as well as specific individuals and services.
Look after yourself
From a staff perspective (and I have experienced quite a few students with mental health problems), it can be stressful. Very often you don't feel you get the support you need. You are having to deal with the individual, the situation, your feelings towards it and other students and their feelings towards it. In the case of other students who are around at the time of the crisis, you need to protect them from seeing it for both parties' sake. You also have to inform and deal with other staff members in other departments of the university. There needs to be some aftercare for staff. It is not proactive, you have to seek it out.
Staff needs are often neglected. You can reduce your own stress by recognising and identifying your boundaries and limitations and also seeking support and advice from colleagues. Your institution has a duty to ensure that the needs of its staff are being met.
If you are still unsure about what to do, you can also seek advice from your institution's counselling service or disability advisers.
Your responsibilities will depend on your position and your organisation and you should make sure that these are clear.
In terms of the standard of care owed to students, the general principle is that the institution has a duty to take 'reasonable care'. In relation to those in any profession or job, the standard expected is said to be the standard of an "ordinary man exercising and professing to have the special skill in question." It is therefore important that institutions ensure that those members of staff such as tutors, hall managers, wardens, student support personnel, whose work involves pastoral contact with students receive appropriate training to carry out their duties with reasonable care. It is necessary, too, to ensure that all categories of staff are clear as to when and how matters should be referred on to specialist services or agencies, whether or not these are within or outside the institution.
Ideally, this awareness of referral practice should be underpinned by the implementation of clear procedures which assign specific responsibilities for ensuring that students are appropriately supported and referred. These procedures should indicate clearly the limitations of institutional support and highlight where it may be necessary to seek support or intervention from outside agencies and bodies, and the action to be taken.
AMOSSHE 2001 Responding to Student Mental Health Issues
The UK journal 'Student BMJ' published this in 2003:
More students seek help for mental health problems
By Andrew Iles London
The number of UK students seeking help for mental health problems is increasing, says a new report by the council of the Royal College of Psychiatrists. The report also shows that mental health problems are becoming more severe in the United Kingdom's student population.
Although more students in higher education than young people not in higher education report mental illness, the incidence of severe mental illness is highest in the non-student population, says the report. Higher education is associated with increased stress from the emotional demands of the change from home and school to the less structured world of college, independent study, examinations, and money worries.
Despite the wide spread provision of university counselling and pastoral services, access to specialist NHS student mental health care services is variable. The report recommends the formation of a dedicated student mental health service by NHS trusts and the promotion of mental health by higher education institutions.
Dr Mike Hobbs, chairman of the working group that prepared the report, said, "We hope to bring the findings of our report to the widest possible audience so that effective and coordinated action can be taken. It is vital that we develop high quality mental health services for all students who need them and that these services are adequately resourced."
National Union of Students executive member, Helen Symons, added, "We are working to remove the stigma and misunderstanding around the issue of mental health and we cannot afford to lose talented students because they have not been able to access the help they need."
The UK government plans to have 50% of young people in higher education by 2010, a number which would overwhelm current mental health resources.
Source: studentBMJ 2003;11:393-436 November ISSN 0966-6494
The Royal College of Psychiatrists report included the following recommendations:
- mental health promotion should be addressed actively in each higher education institution.
- higher education institutions should have formal mental health policies which set out clear frameworks for supporting students with mental health problems.
- local health services should develop student mental health strategies in consultation with university health and counselling services.
- if the size and needs of the student population warrant it, consideration should be given to the formation of a dedicated student mental health service in collaboration with local public health services.
- special attention should be given to the accommodation needs of students with severe mental illnesses.
The British National Union of Students states:
Colleges report an increase in the number of students seeking some form of counselling.
Although rates of suicide for those at college is lower than the UK average for the 15-25 age group, the rate of student suicides between 1983/84 and 1993/94 rose fourfold. Of these, male students were three times more likely to take their own life; the most vulnerable were mature students, with nearly half of the suicides aged 25 or over.
Not surprisingly, the main cause of stress amongst students is financial worries, although academic concerns and worries about the availability of future employment are also a factor.
New students can also suffer bouts of depression. One study has suggested that 61 per cent of freshers feel depressed at some time or other. 12 per cent were estimated as feeling suicidal at some time, whilst 1 per cent actually attempted it. It has also been suggested that between 10 and 20 per cent of students will need psychiatric treatment before they graduate. Another critical time for depression can be when first years return to college following the first Christmas vacation. This is known as the 'January phenomenon', and is often caused by the fact that the student has just discovered that her/his parents are breaking up - studies suggest that parents often wait until children have left to go to college before ending their relationship and, contrary to their expectations, this can be painful for the student.
There is evidence to indicate that students are often reluctant to approach institutional counselling and other help agencies with any mental health problems because of a fear that this might have an adverse effect on their future studies. At some colleges there have been reports of the counsellors being told to inform teaching staff if a student approaches the service more than once with a mental health problem.
The most common form of severe mental illness is schizophrenia. For the population as a whole it is estimated that one in a hundred people will develop this illness, and it usually strikes those aged between 18 and 25. It is therefore not surprising that there will be some students who do have a severe mental illness.
Ideas for Action
Look at ways of providing outlets for students, especially when it comes to stress. Many unions have organised workshops around the time of exams to look at ways of relieving tension which have proved helpful. Inviting local health agencies who can run these is a good idea, or your college counselling service - as at Cambridge - may also be able to do this. Aromatherapy and acupuncture can be very popular; even getting somebody to give tips on basic relaxation techniques can be helpful. For example, Aberystwyth produced some beer mats which had some ideas for ways of reducing stress which included silly things to do to take your mind off exams, whilst Lancaster distributed free stress balls.
Consider ways to help students to feel more comfortable, especially when they first arrive at college. This can involve getting second and third years to be a link person for new students. Their role is to spend the first few weeks talking to them, letting them know what is happening and trying to make them feel part of the place. This should not be too intrusive, and should take account of different cultural factors, especially around alcohol, thus it is vital that training is provided. Such support may be required for more than just a few weeks, with the other key time being once the second term/semester has begun.
Some unions have developed a student advocacy service. This involves agencies from in and outside the college collaborating to provide a service to give students some choice about the agencies they might want to approach, without being judgmental. NUS works with Rethink to raise awareness of mental health and illness. You can find a wealth of information at the Rethink website.
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