The students reaching breaking point

As mental health problems continue to spiral, how can each and every Vice-Chancellor implement a holistic approach to student wellbeing?

Being at university is known to be an exciting and rewarding time – a chance to learn new skills, challenge yourself academically and make friends for life. But for many of the UK’s students, this simply isn’t the case. In recent years, we’ve seen a sharp decline in the mental health of our students. Let’s just recap the figures. Almost five times as many students as 10 years ago have disclosed a mental health condition to their university. In 2015–16, more than 15,000 UK-based first-year students disclosed mental health issues. The 2006 figure was about 3,000 and the rise risks overwhelming university services. Student suicides rose sharply between 2007 and 2015 – from 75 to 134, and a record 1,180 students with mental health problems dropped out of university in 2015, a rise of 210% on five years earlier.

Sobering statistics indeed. So, as universities evolve into profitable businesses, students become customers, and the focus has seemingly been to create the very best student experience, where have we gone wrong? And more importantly, what can we do to make it right?

Lead by example 

Towards the end of last year, Universities UK published the step change framework to help improve the mental health and wellbeing of university students. The framework is aimed at supporting university leaders to help embed good mental health across all university activities.

“The UUK piece was designed to try to encourage universities to look holistically at their approach, from a staff and student perspective, from how estates are designed and used, to how curriculums are built,” said UWE Bristol V-C Professor Steve West.

The framework aims to challenge universities to understand what they are currently doing to support students and staff with mental health problems and to consider all aspects of university life against set criteria. It’s a pilot scheme that’s been triggered across three universities – York, Cardiff and UWE.

UWE Bristol also recently launched Mental Wealth First – its strategy to prioritise the mental health of its staff and students at all times. Prof West continued: “By the age of 14, 50% of mental ill health is identified and diagnosed. And now 50% of 18–24-year-olds go to university – a hugely diverse group. When you join all those facts up, and when you read the feedback from national staff and student surveys, you start to understand that this is an issue that needs to be examined systematically and holistically in our institutions.”

Prof West stressed that in order for these holistic approaches to be implemented, they must be led from the top down. “The step change in student mental health begins with higher education leaders adopting mental health as a strategic imperative. In my view, the only people able to do this kind of joined-up thinking are the V-C and the senior executive.”

West also explained that every university has to do this for themselves, but with support and with the ability to draw on evidence and best practice. “It’s about understanding what type of university you are, what type of students you have; you can’t have a one-size-fits-all solution.”

With over 130 universities and 500+ HE institutions across the country, there’s huge variability in how people are engaging with this agenda. “The big trick is to get this at board and V-C level to be taken seriously. Rather than it only being understood at a student/counsellor/welfare services level. It needs to be done at top level to drive strategic thinking,” reiterated West.

To raise it to that level, Universities UK is engaging with the NHS, Public Health England representatives and leading charities to begin to, in West’s words, “expose the fact that we don’t have joined-up services, and that actually, we’re failing students.”

Strategic change

The UUK initiative is very different to any previously trialled in that it asks universities to consider the issue strategically from a whole system approach. “Strategic change is one thing; actually getting it implemented is another thing,” said Hamish Elvidge, Founder of the Matthew Elvidge Trust.

“We’re at an early stage of a potentially significant change in the sector. The vision is that every university and every HE college considers the wellbeing of every student and staff a priority. But this is not going to be solved in the next 6–12 months. That would be unrealistic. To achieve the kind of cultural understanding required, it’s likely to take between 3–5 years to be fully effective and embedded. Individual V-Cs and senior leaders need to go on their own journeys of understanding.”

The Matthew Elvidge Trust was formed shortly after Matthew took his own life, aged just 23, after a very short period of anxiety and depression. The main objective of the Trust is to increase awareness and understanding of the importance of wellbeing and good mental health. The Trust also advised the UUK framework.

“Good mental health needs to be part of the language of education because it permeates every aspect of the student experience. It’s the foundation of the learning that allows you to cope with life’s ups and downs,” continued Hamish.

Hamish, like UWE’s Steve West believes that the focus needs to be on joining up services, and focusing on mental health and wellbeing, long before students get to undergraduate age. “There’s very little been done around a whole school approach, which illustrates to me the challenge that universities have – if young people, up to the age of 18, aren’t being educated in the importance of good mental health then they’re still not going to be ready for university,” explained Hamish.

“We need a long-term strategy for zero to 25-year-olds, a comprehensive approach to young people’s mental health and wellbeing. The Government are trying to provide more support to people who have a problem; I’d rather they invested more in preventing these problems in the first place.”

This is a concern shared by the University of Bristol’s V-C Professor Hugh Brady: “I think it’s fair to say it is the public health issue of our time,” he said.

“What really strikes us is all those students who report mental health issues when they come to our University, the number of them whose problems began in secondary school and, perhaps even more disturbingly, in some cases in primary school.”

The University of Bristol hit the headlines in recent months for its rising number of student suicides. Seven students have taken their lives in an 18-month span while studying at the Russell Group university. Around 500 people took part in a march in the city last month to demand changes to Bristol’s mental health services.

The institution has since activated a multi-tiered strategy to improve its student services and has said that “Collectively, this approach represents one of the highest levels of investment in pastoral care in the UK higher education sector.”

Prof Brady explained: “We undertook an institution-wide conversation on the future direction of the University about two-and-a-half years ago. And very quickly support for mental health emerged. It was clear that the student body saw this as a priority and it was something they urged us to invest more in. So, there has been a gradual ramping up in our investment in that area since then.”

An additional £1m annually will go towards a new Student Wellbeing Service. It has also been investing in more support for students living in University residences – The 24/7 support team will work with the new Student Wellbeing Service to support students through a combination of full-time trained staff and live-in peer mentor support.

“The scale of the problem is challenging us to look at the life cycle of the student through our institution,” Brady added.

“With a combination of curricular initiatives and pastoral care initiatives, we can best support our students and help them build resilience, so they can deal with the ups and downs of life before they get to crisis point. Equally, the way we work with other institutions in our cities, and the NHS particularly in our cities, has got to change. It’s got to be a more streamlined, with tighter and deeper relationship than maybe previously,” the V-C stressed.

“Almost five times as many students as 10 years ago have disclosed a mental health condition to their university.”                    

Collaboration is key 

Like UWE Bristol V-Cs, Prof Brady agrees that the very top-level decision-makers must be involved if we are to see improvements across the sector: “Change needs to come from the top, because of the scale of the challenge, and also because it really touches almost every aspect of university life.”

The University of Bristol and UWE have now agreed to work in partnership on this issue to try to ensure services and approaches are as aligned as possible and in many cases collaborative in terms of delivery.

Future-thinking solutions 

Since the launch of UUK’s step change initiative last year, momentum and interest has been gaining traction across the sector, and UWE’s Steve West believes that significant progress will be made over the coming months. “Here’s a prediction: my ambition is to get us there in six months. But to do it in a collaborative way, and not a finger-wagging way. It’s about being clear in policy and encouragement; it’s about government working with other partners to create a holistic solution. What it isn’t about is driving one solution forward. Because that won’t work. It’s about being smarter than that – using KPIs in a sophisticated way because what we’re seeing [the mental health crisis] has, I think, been aggravated by governments in the past, especially their policies towards schools.”

If there is one thing that West stresses it is that top-level engagement is crucial for these developments to take place. “The V-C and the senior executive; they have the levers to pull together support services. It’s really important that we get this right; we’re gathering some momentum and pace – it’s important to keep the channels open.

The underlying causes of the rise in student mental health problems continue to be a matter of debate. The burden of increased debt; an uncertain jobs market; and the well-documented pitfalls of social media platforms, all play their part. But regardless of the cause, it is a problem that is very visible at most institutions, but nonetheless something that still seems to bypass most senior decision-makers. Senior leadership must now come on board to drive some strategic thinking. Change must come from the top, down.

 

“University students often lead very demanding and stressful lifestyles, whether it’s attending classes, working to meet coursework deadlines or attending late-night parties, which often leaves minimal time for rest. Sleep deprivation can impact important aspects of the mind and body, such as mood, energy, the ability to learn, memory and efficiency.
“Memory and learning are consolidated during sleep and this mostly happens during REM sleep – a phase in the sleep cycle that occurs after deep sleep. Cramming for exams are extremely common amongst students, and due to the pressure of wanting to do well, they can be tempted to pull all-nighters. However, this is counter-productive, as with fewer hours to reach the REM phase, the brain doesn’t get enough time to absorb what they’ve studied the night before.
“Ideally students should have at least 7.5 hours of sleep per night in order to perform and flourish, both physically and mentally. Not only does a good night’s sleep improve cognitive functioning, it restores energy, increases focus and attention span. It also balances metabolism, helps fight off common infections and improves mood significantly.”
Natalie Pennicotte-Collier is a sleep and performance wellbeing expert at Hypnos Contract Beds.
For more information on Hypnos, please visit www.hypnoscontractbeds.com.  

 

I certainly worry about the sheer volume of sensory input from mobile phones, whether that’s visual alerts or vibratory alerts or students actively on social media for very long periods of the day.
This pattern has been seen not just in the UK but equally in China and the US, so very, very different countries with very different higher education systems and very different funding models, and that has led a lot of us to at least speculate that social media, while having a lot of benefits for students and society, maybe is contributing in some way to this surge in mental health issues students are presenting with.
Professor Hugh Brady, Vice-Chancellor, University of Bristol.