Protecting students’ mental health

Over a decade after I started university, I’ve been reflecting on the life-changing Churchill Fellowship trip that I made in the summer of 2017 to Canada and Australia to explore preventative mental health interventions for students. In the photo you can see me (front row, second from left) visiting the Australian youth mental health charity Batyr. Two years on, this seems like a fitting moment to consider some of the changes that Student Minds, the charity where I’m proud to serve as CEO, has started to bring about since I stepped off the plane.

Before I get into possible solutions, why does student mental health even matter? The first thing to acknowledge here is the scale of the problem. Today, almost 50% of young people who grow up in England will attend a higher education institution. Factoring in international students too, there are 2.3 million students studying at UK universities. Of these, between a third and a quarter will experience mental illness during their studies. Data collected by universities and NHS services also suggests that demand for mental health services is rising.

It’s well known that mental health difficulties can have a significant impact on people’s educational, economic and social outcomes. My Fellowship was based on the principle that it doesn’t have to be like this. Our students are the community members, leaders, teachers, and doctors of the future, and if we create healthy communities for our students, there can be a multitude of positive impacts for wider society.

Over the last 18 months, it's been quite a whirlwind for everyone involved with Student Minds, the UK’s student mental health charity. The period of my travel fellowship coincided with a huge shift in attention on the cause we’ve been working on: from government, the university and health sectors, and students themselves. This has widened the scope and potential impact of my findings, and meant we needed to be agile, to prioritise seizing the moment. I'm immensely grateful to all of our staff, volunteers and partners for embracing this. Student Minds now develops innovative approaches to support healthy university communities, collaborates on research, and empowers students, university professionals and connected communities to create change.

So what did I learn on my travels? Here are four key insights gained during the experience.

Research well to innovate

Before I went away, I understood that the evidence base in this area is sketchy. Our Chair was already exploring the idea of establishing a research network, and I found that I gained renewed enthusiasm for research, ignited by many academics I met. With the number of students who feel they are experiencing mental distress rising, we need to better understand why this is.

Academics have pointed to a range of potential causes for increasing distress, and some of these have more evidence than others: student lifestyle and changes in sleep, debt, bullying (online or otherwise), sexual violence, loneliness, demographic changes, increased academic pressure and focus on high grades. But it’s not just about finding out the ‘why’, we also need to close research and practice gaps. On my Fellowship, I would often meet disconnected individuals from the same university, who were not making the most of one another's strengths.

I also saw lots of great examples of collaboration. For instance, the fascinating research around the concept of wellbeing literacy, and development of a measurement tool called a Wellbeing Profiler, by the team at the Centre for Positive Psychology at the University of Melbourne, which pushes thinking beyond prevention to create thriving communities; and the unique work at the Black Dog Institute, evaluating a range of new digital interventions and even influencing policy-makers through non-typical means such as art and theatre performance.

Through meeting so many academics, I gained a healthy scepticism for schemes making claims to cure the ‘crisis’, but maintained an optimistic desire to identify better digital approaches. Lots of people want to do good and innovate in this area, but there can be mixed intentions and limited evaluations. This is why recent initiatives, like SMaRTeN and the What Works Centre HE platform, are so important in providing clear evidence and knowledge translation for our wider sector.

Enable choice and empowerment

Over my seven weeks abroad, I met with a range of individuals supporting preventative approaches to student mental health: student influencers, academics, psychiatrists, mental health nurses, charity CEO’s and policy-makers. The biggest message I took from them was one of empowered decision-making.

Student Minds has enabled hundreds of students to facilitate projects, so we’ve always considered student empowerment important, but what I didn't fully appreciate before my trip was the complicated history in mental health treatment and advocacy, and what real empowerment in healthcare could and should look like. It was inspiring to hear about co-production practice at organisations like Orygen, and to learn more about how to make decisions informed by both student and professionals voices with data.

Orygen is known for its clinical excellence, and should be recognised also for its strong youth participation processes involving youth councils, online training opportunities and youth participation in all of its research. At times in this space, there are inter-generational differences and misunderstandings at play, but clearly the only way we'll design effective approaches for this community is if they are co-designed ‘with’ and not done ‘to’ people.

One of the first things my Fellowship inspired me to do was to recruit a staff member to breath energy into our student-led influencing. Seeing examples, such as the Canadian organisation Jack.org, successfully empower students with the tools to campaign on the issues that they care about on their campuses, has supported the development of d our thinking around how we can build a stronger movement and organise around the issues that matter to students.

I'm excited that we've since been developing our organising model. We have explored social movement and campaigns theory, and adopted a new model that is based around LEAD - our campaigning principles of Listen, Empower, Action, Debrief. This means that our campaign groups are increasingly making a concerted effort to identify and understand the challenges that students face on their campuses, and then taking action to get these voices heard and create change. We’ve also empowered students to influence and share their voice with university ministers, and published a toolkit on co-production in university communities to share the learning more widely.

Collaborate, but have creative conflict

Before I left for Canada, many of the organisations that needed to collaborate to create change were thankfully already pulled round a table by Universities UK (UUK), for the development of the strategic framework ‘Step Change’, which has engaged university boardrooms with mental health. In September 2017, UUK launched Step Change, developed with the input of a range of professionals and seeking to set out for university leaders the case for and core dimensions of a university-wide approach to mental health and wellbeing.

Student Minds have been exploring student engagement within such an approach and have been working with the University of York, Cardiff University, the University of the West of England and UUK to pilot the implementation of a ‘Whole University Approach’ to student mental health at these three universities. This kind of collaboration across regions and organisations is clearly important.

What my Fellowship brought home to me, in addition, is the need to create space for the uncomfortable part of collaboration, the part where you get people in a room and see different things and everyone is challenged. I felt this in week one of my Fellowship, in a training room with acclaimed psychiatrist Professor Stan Kutcher, who established TeenMentalHealth.org. I initially felt challenged by Stan’s hypothesis that well-meaning awareness-raising about mental health may be contributing to confusion over language and the ‘over-pathologising’ of normal ranges of emotions. But sitting with that discomfort and seeking to understand more has not only enriched my understanding of the different ways mental health can be conceptualised and why, but has also led to a fantastic collaboration to bring a suite of mental health literacy resources (including Know Before You Go and Transitions) to the UK. These resources (which explore the differences between the normal ups and downs of life and when something might benefit from professional or other support) have received backing from the Department for Education and UCAS, reaching thousands of students to support the transition from school and college to university.

Be courageous

During my Fellowship, I witnessed a lot of courage from students and professionals. Be it the courage of the student who was leading a conference committee alongside their degree; or the courageous vision of a range of professionals leading city-wide or country-wide change programmes in spite of complex funding systems; the teams at CAMH, universities in Toronto, and Halifax’s Stay Connected team; and at a national level the teams behind the development and evaluation of Headspace and Access Open Minds to transform health care for 16-25 year olds; and of course the courage of digital self-help innovators like the Reach Out team.

I took a leadership lesson from the people I met. I recognised that I needed to be more courageous on my return to the UK, in order to enable transformation. Some of this was internally focussed, such as the courage to relocate the charity from Oxford to Leeds so we have the infrastructure to grow. The most obvious and substantial act was turning the idea of the University Mental Health Charter, which some of our wider team had been mulling on for some time, into something tangible. The Charter involves a process of bringing the whole community together, setting out to co-produce a shared vision for excellence and reward institutions that achieve it.

Of course, some of the courage we’ll need is still in the making. We're going to have to be brave and not sit on the fence with some issues - such as what we think appropriate NHS and student services provision for students should look like, and spending more time tackling the risk factors and causes of mental illness in our society. Understanding the challenges, experiences and barriers of different demographics across the student population is essential to our efforts in addressing these inequalities, including communities like LGBTQ+ students, black and minority ethnic students and international students. There also appears to be huge potential for working collaboratively with academics and students in the design of our curriculum in the first place.

What's exciting, though, is that thanks to my Fellowship and the opportunities it's given us, I'm absolutely confident that together we can truly achieve healthy university communities where everyone can thrive.

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