The discussion of the role of universities in supporting student mental health has been rumbling for years, and of late has crystallised around the emotional issue of student deaths by suicide.
Following the discussion on duty of care at the Parliamentary Petitions Committee this week, Jim Dickinson asked the provocative question of whether it’s time for a support excellence framework. Working on the frontline of this issue, I felt duty bound to offer my own personal reflections on how we might bridge the gap between what is being asked for, and what might be both useful and deliverable.
Perhaps controversially for someone in my position, I do think there’s a role for higher education regulators to play in this, and it would be ideal if (for once) this could be done on a UK-wide basis so that prospective students, parents and other interested stakeholders could see exactly where the whole sector stands.
Working in Wales for the last eight years, I’ve seen the massive benefits of collaboration between HEIs and the regulator to design interventions which work, like our South East Wales Mental Health University Liaison Service (MHULS), or the myf.cymru resource bank developed by colleagues in North Wales. A bit more of this on this issue, and we might find our way to something which works for everyone.
Regulated process
One of the most challenging elements of the current discussion for me is that the petitioners seem to want universities to be regulated on the outcome of our actions – to be able to demonstrate that we have prevented harm.
But as any sports coach or management consultant will tell you, if you focus exclusively on the outcome and ignore the process, you’re attacking the problem from the wrong end. I think we should work with our regulators to better define the processes we should be using, making them more transparent, more consistent and (hopefully) providing reassurance to people with legitimate concerns as a result of their lived experience.
There’ll be as many views as there are directors of student services as to those processes, but here’s my version:
Agreed caseloads for university mental health staff. This is normal in the NHS, social care and other regulated sectors. Why not ours? Why not set out national standards that ensure that staff aren’t carrying excessive caseloads, which would help reduce the risk of something being missed and ensure that universities are responding to the needs of their particular student population?
Standardised risk management processes. We’ve achieved this with MHULS, where all HEIs and the NHS are using the same language, risk scoring and response frameworks. It makes communication and managing expectation much easier when everyone working with students knows what constitutes a serious risk factor, and what to do when it’s disclosed.
Published information-sharing and referral policies. When a student discloses an issue, how is this referred on internally for specialist support? And then when and how will a student be referred on to external specialist providers in the NHS or third sector? This will differ from university to university, but there’s no reason we shouldn’t be transparent about it.
Published evidence of how student mental health is considered in all university decisions. We need to show that we are actively designing out risk factors by how we think about curriculum and assessment, residential and learning spaces, and everything else that’s the day-to-day work of institutions. If we continue to focus solely on the response, then we aren’t addressing some of the issues at source.
Best practice, but with teeth
Many colleagues will say that all this is contained within guidance already available to the sector. But in a resource-constrained environment, “optional” guidance will never have the teeth of regulated activity, where actions are published and outputs monitored. Just look at the investment that’s pouring into employability in England now that there are potentially serious consequences for not taking action on graduate outcomes.
Every time we refer to the available guidance and the best practice already happening, we sound defensive and unwilling to engage with the issue. I understand the defensiveness – it can feel like hard-working, over-stretched professionals who really are trying their absolute best, are under constant attack. But it’s not going to get us to a solution. We need to propose sensible, workable, impactful approaches that we can co-produce.
It’s been rightly noted that there are also external factors at play. Higher education institutions are not islands. Sunday Blake commented on The Wonkhe Show that universities shouldn’t be treating students with complex issues and suicidality.
I agree. But when pathways into the NHS are unclear, services over-stretched and support rationed, university professionals find themselves holding and managing these risks for far too long. The UK’s national governments must intervene and ensure that students are able to get the help they need when they need it. The MHULS model is a good one, but it was created from goodwill and individual commitment, not from national policy.
Action needed
One way or another, we need to find our way to a consensus on what we do about this.
At the moment, our responses risk us appearing to be on the wrong side of an argument with bereaved parents. I don’t think we are. I believe we all want students to be safe, happy, and successful. Many of us will have seen the devastation among colleagues when something does go wrong.
It’s time we channel those experiences into positive, sector-wide action for everyone’s benefit.
Legal protections for Universities will be required so they can share concerns and information, without the students express permission, with students families will be key, not just the regularised provision of support alone. Especially as it’s the families that are driving the codification of supposedly independent young adults as ‘children’ needing SENCO support, at what age will they be considered ‘adults’?
I’m driving this as a former Head of Department at an English University, also a former Director of Teaching and Learning and a current Senior Tutor John. I’m sure you’re considered an ‘adult’, but have no qualms about your employer having a statutory duty of care for you. This is not about impinging on anyone’s independence – it’s not in loco parentis or a means for unis to intrude on student privacy. But it is about driving a culture change through law so that all HE providers deliver ‘reasonable care’ for students. That it has taken a group of people who have been bereaved by suicide to push for change says more about the glacially-slow pace of change in a sector that has exploded in terms of student numbers, but simply doesn’t have the processes in place to truly support the students’ journey from Welcome Week to Graduation.
Kirsty, we are not looking to regulate outcomes, but the maintenance of the whole student journey, ensuring effective processes are implemented across the whole sector, underpinned by a framework with clear roles and responsibilities for all staff. A statutory duty of care covers more than mental health, and if HE institutions are not held accountable for getting this right, they remain very likely to get too much wrong too often. This is not retributive. It’s about underpinning a learning environment for institutions so that far fewer things go wrong – and if they do, there is an imperative on us to learn.