Mental health: States of mind

The challenges this September and beyond for protecting students’ and staff’s mental health will undoubtedly be beyond anything we have experienced before in higher education. Cathy Parnham looks at some of the key concerns

During lockdown earlier this year, we learnt that two of the top concerns for students at that time were health and social distancing and the loneliness due to isolation*.

In fact, Fresh Student Living identified that 82% of students felt lonely before the pandemic. Finances were also a major concern – as was future employment post-pandemic, with seven in 10 18–24-year-olds expressing concerns.

These concerns remain and are evidenced in research carried out by Student Hut between 22 and 26 July 2020**:
57% of students say that not being able to see friends and family is impacting their mental health
Over 50% of students said that career prospects/security, and the financial impact of Covid-19, are affecting their mental health
And 47% feel that their university could support their mental health by providing more information about how Covid-19 will be affecting the university.

Transitioning to university life can be daunting at the best of times: from worries over making new friends to managing finances, many students suffer anxiety while at university. Now add in Covid-19, and there are even greater concerns this year for new – and existing – students.

Katie Laverty, director of student services, Keele University, comments: “Students may have financial concerns relating to the impact on work due to Covid-19, or they could have other worries, such as the health of loved ones and themselves, or they may have experienced a bereavement.

It’s important that we do what we can as an institution to support all our students within the first few weeks of term and beyond.”

Support & monitor

There has never been so challenging a time for a student to embark on university life, so getting the right mental health support in place is vital – and must include remote access to services.

At Keele, Laverty tells us, “All the usual support services team including counselling and mental health, chaplaincy, disability, money and welfare and international help are still available – they are just being accessed slightly differently, such as via live virtual chat, phone or email.

“Our Start to Success project team has also developed several resources to support students through the pandemic and we’ve undertaken some specific work to support our nursing students who went on placement during the pandemic.”

Laverty also points to external support that is widely available including Big White Wall, Student Minds and Higher Horizons.

In fact, Student Space – a new initiative funded by the OfS and led by Student Minds has just been launched, specifically to help “to close those gaps in student support services which have become apparent during the pandemic”, says universities minister, Michelle Donelan. Student Space aims to tackle stresses that Covid-19 has brought and to sit along existing services that universities, the NHS and other providers offer, with provision for immediate support such as via text or phone, or CBT.

Even with robust support systems in place, it is essential to monitor students to identify those who are struggling. This may be particularly important during the first term when online learning currently seems likely.

Like many universities, Keele will be looking to a hybrid delivery model of learning that will offer “seminars, laboratory practicals (including field-based activity) and placement activities, complemented by online delivery, to replace large group teaching like lectures which cannot be accommodated at present due to social distancing”, Laverty tells us.

“This,” Laverty explains, “means there will still be plenty of contact with staff and other students across the university. We also have a range of peer support programmes to allow peer-to-peer support, allowing us to talk to other students about any concerns they have.”

Maintaining motivation

Remote working has its challenges – while for some students, they may focus better and feel less stressed around exam times; for others, the discipline of self-motivation may be difficult. Keeping students motivated and on track – particularly freshers – could be extremely challenging.

Dr Raphael Hallett, director of Keele Institute for Innovation and Teaching Excellence (KIITE), shares some of Keele’s plans to tackle this: “Our programmes will be operating a flexible, digital approach. For each module, there will be a weekly menu of online activities offering digital modes of engagement, such as recorded lectures to watch and comment on, directed readings to annotate, and structured tasks and group analysis that help students get to grips with concepts. Live online presentations, collaborative work and discussions will add to the mix.”

Six in 10 students have told us that they are concerned about their mental health – Kas Nicholls, Student Hut

Hallett adds: “Allowing our students to engage with digital content at their pace, there are more opportunities to check in with other students and tutors to build up a strong sense of belonging and community. Students can go back over material they may not understand and discuss it online with fellow students and tutors.

“These online activities will be supplemented with small group sessions on campus such as practical classes, laboratory classes, workshops and tutorials. These will be designed to enable social distancing but will give our students another crucial layer of social and intellectual contact.

“Most importantly, this approach is flexible. Students will still be able to study effectively if further restrictions are placed on campus activity – our students are part of the Keele community wherever they are.”

A word from the NUS

Sara Khan, vice president (Liberation), NUS, speaks out on the impact of Covid-19

The material pressures on students’ lives have long been a core driver of the mental health crisis and many have worsened due to the pandemic, such as difficulties with housing and financial hardship. With government support, such as the furlough scheme and eviction ban coming to an end – and the economy continuing to worsen – many students will continue to be impacted by these pressures.

To support student mental health, universities must prioritise the removal of these material pressures, both in the university itself and in the local community, through promoting access to professional support services, financial aid and reviewing their own provision.

The experience of the most marginalised students must be at the core of decision-making when adapting to university life. For example, disproportionate numbers of black and brown students will have lost loved ones to the virus, had to take on caring responsibilities and are more likely to have been living in the more insecure and poorer-quality private rented sector throughout the pandemic.

Finally, it is essential that services and resources designed to support students are not only ringfenced, but boosted and tailored to the new issues students will be facing and adapted appropriately for the context of social distancing. Loneliness will be more acute due to social distancing and the likely need for long periods of self-isolation among students – either due to immigration requirements, developing Covid-19 symptoms or further lockdowns.

Universities need to plan for the context of possible scenarios such as a second wave of the virus or local/national lockdowns. If universities are not working in partnership with their students’ union every step of the way when planning to reopen, they’re failing to safeguard student mental health.

Stressed out staff

And it’s not just students who are suffering from mental health issues – the number of cases of staff seeking help had been rising prior to Covid-19, with excessive workloads being one of the biggest causes.

A report by Liz Morrish published in 2019*** cites that “over two-thirds of staff, from whatever discipline, academic or professional services, currently struggle for half of their time to complete their workload and nearly one-third struggle all the time”.

Allowing our students to engage with digital content at their pace, there are more opportunities to check in with other students and tutors to build up a strong sense of belonging and community – Dr Raphael Hallett, Keele University

The original report also highlighted a 70% increase in referrals to counselling and a 60% increase in referrals to occupational health for female staff. In an update to the report this year, “at all 17 universities surveyed, there has been a rise in staff access to counselling of 155% in recent years”.
Now factor-in having to adopt to new working practices, aid students who might be struggling, deal with their own health concerns and, potentially, juggle childcare and older relatives, and the levels of stress could be severely exacerbated.

Nick Bennett, co-CEO and co-founder of Fika, calls for “scalable solutions” to support staff as the need to “prevent mental health decline in higher education has never been higher. Hundreds, if not thousands, of higher education workers have been furloughed or faced redundancy, and countless others are picking up additional workloads and facing extreme economic and cultural challenges.”

Bennett believes a mixed approach of support is needed and not just individual one-to-one or face-to-face: “Just as with student wellbeing, the solution has to be scalable, collective and focused on preventative as well as reactive care.”

Warwick University, one of the universities cited in Liz Morrish’s report, offers a range of support, from confidential one-to-one personal tutor slots to group talk sessions, and mindful movement and relaxation sessions.

Its wellbeing strategy for staff and students alike focuses on ‘Work, Live, Learn and Support’ and endorses a community approach “to share responsibility for mental health, identifying difficulties early, to accelerate targeted, effective and timely interventions”.

Another solution that over 40 universities have adopted for both staff and student wellbeing is Fika’s commercially available four-week Bounce Back course, to help staff “bounce back from the challenges presented by the pandemic”. This features a mental fitness personal trainer ‘‘to help staff recuperate, build their mental fitness and prepare psychologically for the year ahead”.

Community is key

There is no one-size-fits all approach for supporting mental health and it is clear that a diverse range of support is needed for staff and students alike.

One clear need, though, seems to be for community. The lack of contact with family and friends has been one of the biggest challenges students have faced during Covid-19.

Kas Nicholls, director of research at Student Hut, says: “Six in 10 students have told us that they are concerned about their mental health at the moment, with the majority citing lack of contact with friends and family, impact on future career prospects and financial issues as the main driver for their mental health issues.”

There has been a rise in staff access to counselling of 155% – Liz Morrish, Pressure Vessels report

This is echoed by Laverty who identifies community as being one of the three key areas to ensuring a smooth transition to university life – the others being “the student experience and support”.

The sense of community – whether physical or digital – is vital in supporting students – and staff – through the challenges Covid-19 brings. The ability to share and discuss experiences and concerns, work together cohesively, and have that sense of belonging cannot be underestimated.

* Fresh Student Living –
** Student Hut (provided by Net Natives)
*** Pressure Vessels: The epidemic of poor mental health among higher education staff –

Student mental health and the law

Tragically, Bristol University student Natasha Abrahart, who suffered from severe social anxiety, took her own life while studying there. Her parents believe the university should have done more to support Natasha, knowing that she suffered from panic attacks. They are now suing the university for disability discrimination under the Equality Act 2010 and negligence, stating the university had a responsibility “to take reasonable care” of their daughter’s “wellbeing, health and safety”.

In light of the above case, we asked lawyer Geraldine Swanton to explain ‘reasonable care’ and whether universities should be worried about being sued.

Q. What is ‘reasonable care’?

In the context of negligence, universities must take reasonable care not to cause reasonably foreseeable harm by their careless acts and omissions. In cases of mental ill health, which is likely to be considered a disability, there is also a duty to make reasonable adjustments to prevent students from suffering substantial disadvantage when compared with students who are not disabled. Depending on the particular manifestation of mental ill health, that could require universities to provide alternative modes of assessment or to alter the learning environment for the individual disabled student.

Q. Should providers be worried about students, parents or staff suing?

Yes. Students have become much more willing to enforce their rights, particularly as consumers and, if disabled, under the Equality Act. In addition, parents of disabled students often have to advocate for their children’s needs from a very early age and frequently feel compelled to continue to do so when their children attend university, though they have no direct legal relationship with the university.

It is important, therefore, that all staff understand their duty to make reasonable adjustments for disabled students, including academic staff at the coal face.

Staff, particularly personal tutors, sometimes feel that they are being asked to provide support for students with mental ill health that transcends their expertise as educators. It is important to recognise that there is a risk that, if staff assume responsibility for providing specific healthcare advice, the university becomes vulnerable to liability if that advice is not provided to specialist healthcare standards.

It is important, therefore, that professional boundaries are maintained and that any concerns regarding a student’s mental ill health are dealt with by encouraging students to seek professional help or by making a referral to the appropriate internal support service.

Having clear policies and providing relevant training help to provide effective support for students while maintaining those important boundaries.

Q. What else can universities do?

Universities have legal duties to take reasonable care not to cause harm (negligence); to conduct their undertaking in such a way to ensure, so far as reasonably practicable, that students are not exposed to risks to their health and safety; and to make reasonable adjustments to prevent disabled students suffering substantial disadvantage when compared with students who do not have a disability.

In addition, to ensure positive outcomes for students, a focus for the HE regulator (the Office for Students), universities should take into account the characteristics of their student body. If mental ill health is an increasingly common concern, then universities should consider providing a variety of support services to enable students to engage effectively in their programmes of study and in the university community.

Those services range from wellbeing workshops and counselling sessions to social clubs and exercise programmes, and are ways that universities can help students to navigate the challenges that university and young adulthood can pose, while maintaining proper professional boundaries.

Geraldine Swanton is legal director and education sector specialist at law firm Shakespeare Martineau

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