Mental health and wellbeing work is highly inconsistent

The allegation of those campaigning for a statutory duty of care for students in higher education is that while there are examples of good practice across the sector, the standard (and sometimes existence) of support is not consistent.

At the Petitions Committee session on the issue on May 16, Mark Shanahan (whose son Rory died by suicide at Sheffield University back in 2018) argued that students do not enjoy a “parity of approach”:

…we need the law to get universities to act consistently and find their different ways to get to that duty of care. What we want are competent communities that care about their students. It is far too patchy. UUK has said that already.

Mental health campaigner Ben West raised the difference between best practice and minimum practice:

Why on earth are we calling it best practice and not basic practice? We have lifesaving policies that we say are best practice. “Here they are, adopt them if you want.” Why on earth are they best practice? Health and safety laws are laws and statutory, not voluntary for a reason, because they point at an employer or they point to the construction company and say, “You have to wear hard hats. If you don’t wear hard hats, you’re breaking the law”. If it was voluntary they would not do it.

Universities UK President Steve West reassured the committee by discussing a snap poll that had been carried out in England:

On suicide-safer Universities, which is a UUK framework, we have just done a snap poll in terms of the guidance. We asked how many universities have adopted it. We had a response rate of 83 universities out of 115. The poll was open for four days—this is England only—and 99% have adopted suicide-safer universities; 89 per cent have adopted or are adopting the placement guidance, so there was a whole raft of additional areas; 93 per cent have adopted or are adopting the trusted contact guidance; and 100 per cent have adopted or are adopting postvention guidance.

It’s worth remembering, of course, that “universities in England” is not the same as “the higher education sector” – and even if we set aside the devolution issues, we still have the long tail of FE and alternative providers on the OfS register to think about.

To what extent is the sector as a whole engaging with the voluntary policies that some argue mean we should back off from formal regulation?

Policies and practice

To help answer that question, the Department for Education (DfE) has published the results of a survey and qualitative follow-up of providers to understand the range of policies and practices being used to support student mental health and wellbeing.

We’re talking here about the extent to which providers have adopted mental health and wellbeing at a strategic level, and practices adopted by providers in supporting students’ mental health and wellbeing and suicide prevention, as well as how these are designed and evaluated.

It would almost certainly be fair to assume that providers that responded to the researchers’ emails and phonecalls (May to September 2022) are much more likely to have good things to say – but even if we take the findings at face value, the results are pretty shocking.

To distinguish between higher education provider type to allow for comparisons, IFF Research divides the OfS register into private providers (PPs), Further Education colleges with HE provision (FECs) and universities/HE institutions (HEIs) – the latter of which are most likely to be members of Universities UK.

The headline finding here is that the proportion of higher education institutions with a mental health and/or wellbeing strategy increased from 52 per cent in 2019 to 66 per cent in 2022 – and among FE colleges and private providers, 64 per cent and 49 per cent respectively had a strategy in place.

Only 70 per cent of HEIs said they were offering joined-up care pathways between themselves and local NHS services – falling to 63 per cent for FEIs and just 16 per cent for private providers.

And on suicide prevention policies, 66 per cent of higher education institutions had one, alongside 54 per cent of FE colleges and just 42 per cent of of private providers.

No need here

In the qualitative findings, two themes emerged for why private providers were saying they didn’t need a policy:

• The perception among these providers was that their students were generally older, living with their families, and often in the town or city in which they were assumed to have existing support networks. As a result, these providers regarded their students as being less at risk of suicide, compared to younger students living away from home for the first time.
• There was also the perception that their students spent less time on the provider’s site, compared to a student living on campus. As a result, these providers assumed it was less likely that the student would experience a mental health crisis on site. They believed that signs of distress would be recognised earlier by the students’ friends, family or possibly work colleagues and that the first sign that the provider would notice is non-attendance.

Both of those reasons sound faulty – and both sound more like excuses than reasonable strategic justifications.

One respondent from an HEI was upset that Student Minds might need to cover its costs:

I was all up for it, thought it was great for benchmarking, but you had to pay, and our budget is too tight. The rich universities can pay for it and wear it as a badge of honour but if I had that budget, I would spend it on student services. Should this really be a money-making scheme?

Another who critiqued the UUK and Papyrus Suicide-Safer Universities framework doesn’t sound like they’ve actually read said framework:

There is an assumption that parental involvement in these situations is always helpful but that isn’t the case. There is also the question of informed consent in this. Our students are adults, not children.

The results get more surreal the further you get into the report. Among HEIs with a suicide prevention strategy, 50 per cent said that it was “published” – so for the other half, presumably secret copies are sent to those referenced in the document.

Just 64 per cent of providers had consulted with students when developing their mental health and wellbeing policies, and only 15 per cent had consulted with them over suicide policies.

And the question of consistency was a key finding when discussing staff training – providers spoke of situations where a member of staff, typically academic staff, had attempted to help a student themselves, either practically or emotionally which had resulted in difficult, inappropriate, or unhelpful situations for both the student and staff member:

Often, it’s because they they’re trying to be really kind and supportive and they end up getting in a pickle because they’ve … not referred early enough to our team.”

And while training was often offered, take up was noted as an issue for HEIs that said that even if they were able to offer training to all members of staff, they would struggle to get everyone to attend:

This was seen as an attitudinal issue, often on the part of academic staff who may not see student mental health and wellbeing as part of their role, or who may take an interest in the issue, but believe that they do not need training to know how to handle such situations.

Take up is low because they are not mandatory. Academics are having conversations that they are not equipped to deal with.”

You would want proactive policies to make a difference before a crisis – but on monitoring, just 38 per cent of HEIs and 30 per cent of private providers said they collected data to monitor student mental health among all students, with some saying that they did not ask students about their mental health or wellbeing in these surveys as they did not think this information would be useful in supporting students:

We ask questions about service awareness, service use and satisfaction but we don’t ask “how are you feeling?” and I don’t think that we should. What do you do with that data?

Oh, I don’t know, establish whether your policies were making a difference?

Freedom to (not) deliver

There is, in any diverse sector of providers of something, an important set of arguments about one size not fitting all, and needing to respond to the needs of the actual students (and staff) that you have.

There’s also a set of important arguments about risk-based in regulation and designing interventions that motivate action rather than cause resistance.

But there’s no getting away from it. This research paints a chaotic and highly uneven picture of provision – where students are not able to access consistent support either within or across the sector, can’t rely on a minimum standard of strategy or consultation, and in most cases can’t even be sure that their provider knows whether their policies are having any impact.

Compare this evidence base to that on offer for the Higher Education (Freedom of Speech) Bill, and then remind yourself that we will soon have a Director for Freedom of Speech and Academic Freedom, and no regulation whatsoever around mental health and wellbeing in higher education.

Wales will soon have the right approach here. Everywhere else should follow suit.