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Up and down the country I see great workÌýbeing done to support students by welfareÌýdepartments in universities, and I haveÌýbeen impressed by the sheer number of initiativesÌýto address a growing issue.

Last year I called for UK universities to adopt theÌýwhole-university approach of the UUK StepchangeÌýFramework to ensure we have the right support,Ìýsystems, training and partnerships in place forÌýoptimum mental health and wellbeing.¹Ìý Wellbeing isÌýthe key addition here, as we want to create a healthy,Ìýproductive environment where everyone has whatÌýthey need to thrive and grow.

I want to start by exploring why UUKÌýand universities across the sector are taking aÌýsignificant interest in this area and how theÌýStepchange Framework developed.

It started as a social movement within theÌýuniversity system, when some vice-chancellorsÌýstarted to mutter in the corner (which is often whatÌýhappens when you put vice-chancellors together in aÌýroom), talking about the pressures they were seeingÌýin their institutions. In particular, pressures withinÌýthe parts of our universities offering support andÌýservices to students and, in certain cases, staff; andÌýputting that alongside feedback we were getting fromÌýstaff, our trade unions and student surveys in termsÌýof how people were feeling generally within theÌýenvironments where they were studying, workingÌýand living.

These conversations and surveys have led to someÌýbig questions and conversations within universityÌýcircles. Within our institutions we have a group ofÌýindividuals, predominantly 18 to 24 year olds, whoÌýare going through massiveÌý transitions: transitionsÌýin terms of leavingÌýhome for the first time,Ìýor leaving their homeÌýcountry to comeÌýand study in a veryÌýdifferent environment;Ìýtransitions as theyÌýprogress and moveÌýthrough universityÌýfrom one year to the next, and then of course aÌýtransition into employment or further study.

The 18 to 24 age group is particularly vulnerableÌýto the onset of mental health problems. We can alsoÌýsee in our data for the sector that there has been aÌýsignificant rise in numbers of students disclosingÌýand declaring that they have mental health issues.ÌýIn 2015/16 across England this had risen to 15,395Ìýstudents and of course those are just the ones whoÌýare declaring. That’s the tip of the iceberg, and it’sÌýfive times more than we were seeing in 2006/7. WeÌýalso know that one in four adults will experienceÌýmental ill health at some point during their life.^2ÌýWe are all on a continuum of mental health –Ìýsometimes we feel better than at other times, andÌýacknowledging this presents some serious questionsÌýabout its significance for our staff and students.

Last year we also saw the Government’s GreenÌýPaper: ‘Transforming children and young people’sÌýmental health’,³ which highlighted that probably oneÌýin 10 young people have some form of diagnosableÌýmental health condition, and the significant challengeÌýof transitions during young people’s time at schoolÌýand beyond. Not surprisingly, such issues accompanyÌýmany of those individuals into universities andÌýthe workplace.

We are also seeing increased demands withinÌýthe NHS, as well as in the health and social careÌýsystems. We are all very familiar with the headlinesÌýthat signal that mental health services are underÌýsignificant stress. We are not coping well in tryingÌýto keep pace with the demands that are coming toÌýour services, and this is true within the universityÌýsector, within the school sector and within theÌýgeneral community sectors.

So we have to start to think differently aboutÌýwhat we can do in universities, to rethink theÌýmodel of support. Through Stepchange, we haveÌýbegun to ask the questions and start to work outÌýwhat our baseline for providing support acrossÌýour institutions is, and whether we are in a positionÌýwhere we can learn from and with each other.

At the University of the West of England (UWEÌýBristol), we have been engaging in the StepchangeÌýproject with two other universities, York andÌýCardiff, and we are all piloting the UUK StepchangeÌýFramework. However, across allÌý universities, theÌýapproach is about working in partnership, workingÌýwith students, sharing, and being very open andÌýhonest in terms of what we are seeing across ourÌýuniversities. Importantly, we are working withÌýother organisations, the Higher Education FundingÌýCouncil, Student Minds UK, and, within our ownÌýinstitutions, the students’ union, and others.

We know already that, of course, mental healthÌýdoes not exist in isolation. Hence, we have to startÌýthinking about the needs of the whole person. WeÌýneed to look at how the university structure andÌýcurriculum are helping or hindering. We have toÌýstart thinking about general health – about exercise,Ìýwhere people are living, how they are living, howÌýthey are socialising, nutrition, sleeping; all of thoseÌýthings. And in particular, for our students, we haveÌýto consider relationships and how they are developingÌýgood relationships. We are also interested in howÌýthey are engaging in risk behaviours, since we haveÌýa group of individuals, predominantly aged 18 to 24,Ìýwho may, with peers, be encouraged to engage inÌýthings that they wouldn’t have done under a parentalÌýeye. So we’ve also had to face up to looking at thingsÌýlike drugs, alcohol and starting to look at theÌýinfluence of that on violence – including sexualÌýviolence – on our campuses, as well as consideringÌýthe mental health implications of such behaviours.

So our approach is quite broad – it has to be – andÌýwe are beginning to call it, in our university, mentalÌýwealth. This is in recognition of the fact that it’s theÌýmental health and wellbeing of individuals that weÌýneed to be considering. Why is that important? Well,Ìýas universities we want to ensure that our staff andÌýstudents thrive and flourish and we want to get theÌýbest from them.

The other important thing, of course, is that onÌýoccasions in our universities we do see, unfortunately,Ìýsome students taking their own lives, and that is aÌývery tragic event. It happens in our institutions andÌýthe hardest thing for a vice-chancellor to do is to sit inÌýfront of friends, family, partners, and be asked: ‘HowÌýdid this happen?’, ‘Why did this happen?’. And to haveÌýto say that you don’t know. According to universities’Ìýdata, some 40 per cent of those who take their ownÌýlives are not known to campus support services.⁴Ìý

We need to understand what we could do thatÌýmight ensure we are better able to spot peopleÌýwho are vulnerable.

We want to try and get to a position where weÌýimprove mental health and wellbeing across ourÌýcampuses, because that’s the right thing to do. TheÌýmental wealth that we are talking about is concernedÌýwith developing a positive wellbeing in individualsÌýand communities, and raising awareness of mentalÌýhealth issues as well as providing timely access toÌýsupport when there is a need.

Of course, universities are already doing aÌýhuge amount of work and we should be incrediblyÌýproud of that work. At UWE Bristol, this includesÌýinterventions which recognise the transitionsÌýstudents go through, such as having a managedÌýuniversity welcome, to help students make friendsÌýat the anxious time of starting at university. AndÌý‘Feelgood February’, to help with the period afterÌýChristmas when, among other things, the realityÌýof exams has set in.

We also work very closely with our students asÌýpart of a network to train them to engage with theirÌýpeers. We have workshops to empower students andÌýimprove their resilience, self-belief, self-esteem andÌýconfidence, and this is particularly important to someÌýstudents who wouldn’t necessarily go to counsellingÌýservices, those who feel that maybe through theirÌýown beliefs, or through their own experiences, that’sÌýnot something they canÌýdo. They may, however,
talk quite happily toÌýpeers who have beenÌýin similar situations.ÌýThis is something we seeÌýquite frequently in ourÌýinternational students.

We also haveÌýinterventions thatÌýoffer online support.ÌýMany of our studentsÌýdon’t want to engageÌýface to face to beginÌýwith. Instead, theyÌýprefer to be anonymous. Developing a wellbeingÌýservice that is able to not only deliver face-to-faceÌýinterventions, but also to create opportunities forÌýstudents to take that first step of asking for supportÌýand help, which could be online, is a priority.Ìý

In terms of our counselling services themselves,Ìýwe’ve seen high levels of student satisfaction withÌýsome of the plethora of services offered. We’ve beenÌýdoing some work at the university aroundÌýtherapeutic interventions and we’ve developedÌýa solution-focused approach and a 90-minuteÌýinitial therapeutic consultation that works withÌýthe students. It’s proved incredibly effective forÌýsupporting those students who are in early mentalÌýill health and distress. It helps them to engage withÌýthe counsellors, it gets them to begin to build theirÌýown toolsets, their understanding of how to manageÌýtheir own mental wellbeing. Some will go on toÌýfurther sessions, but many don’t. That initial 90Ìýminutes is enough to get them into a place whereÌýthey can manage their own mental health andÌýwellbeing. We also offer drop-in sessions everyÌýweek, in the afternoon, with no appointmentsÌýnecessary. For many, making that appointmentÌýis a barrier, and so we remove some of that hurdleÌýby having appointment-free drop-in sessions.ÌýIn September 2017 we also started a pilot withÌýKooth Student,⁵ an online platform where studentsÌýcan access counsellors out-of-hours, includingÌýat weekends and in the evenings. These areÌýprofessional online counsellors, who engageÌýwith the students; there’s also a moderatedÌýforum with self-help materials. Early indicationsÌýare that students are engaging with that veryÌýpositively. Of course, this is something we willÌýevaluate as it rolls forward.

And then we have a lot of online self-help thatÌýstudents can access. This includes five-minuteÌýanimations developed by the university aroundÌýstress and anxiety, and what it’s like to go throughÌýan examination period, highlighting what normalÌýemotions might be and getting students to seeÌýthat it is normal to feel anxious on occasions.⁶

We have also developed an app, called SAM,Ìýwhich has had over a million downloads worldwide.^7ÌýIt’s free, it’s all about enabling students to understandÌýtheir own mental health, wellbeing and anxiety,Ìýand it enables them to track how they are feeling.ÌýWe are also working with our students’ unionÌýto ask what we can do together. Our strategy isÌýbeing co-developed with students. The students’Ìýunion runs Nightline, another approach toÌýsupporting students, and peer-to-peer supportÌýschemes. The students’ union message is veryÌýsimple, and is focused on making sure thatÌýstudents know that they are not alone: ‘It’s OKÌýnot to feel OK. There are other people like you:Ìýyou’re not different’. I’ve found that to be a reallyÌýimportant campaign.

The starting point of course is that the conversationsÌýhave to be open, in an environment that givesÌýpermission for people to talk about mental ill health.ÌýWe are talking about mental health in an openÌýway, challenging each other, of course, but alsoÌýrecognising what we are currently doing – trying toÌýnormalise these conversations, reducing stigma andÌýrecognising that we all have mental health, and thatÌýat various points in ourÌýlives our mental healthÌýon that continuumÌýmoves towards illÌýhealth. Getting peopleÌýto understand theirÌýown mental health is anÌýimportant part of this.ÌýThe students’ unionÌýengages with students atÌýa completely differentÌýlevel from our seniorÌýmanagement and central services, and sometimes itÌýwill come up with things that we haven’t thought of.

We are now building on this platform to developÌýand drive forward our Mental Wealth Strategy,Ìýwhich draws on the UUK Stepchange Framework.ÌýWhat we have been trying to do is first of allÌýunderstand the university’s current situation. WeÌýhave now completed an audit across the institutionÌýto get a full picture of all the services and things weÌýare doing around mental health and wellbeing. WeÌýhave come up with a list of some 200 activities that areÌýbadged as supporting mental health, which clearlyÌýfeels like a lot, and some activities will overlap.ÌýSo we are trying to understand what is duplicatedÌýand what is evidenced as being most effective.

For UWE Bristol, our Mental Wealth initiative is aÌýstrategic priority, and it’s a whole-university initiative,Ìýinvolving staff and students. What we want to be ableÌýto do is to offer the best environments for our staffÌýand students in terms of support for mental wealth.ÌýTo do that, we need to be honest about what’s workingÌýand what’s not. What we can’t do, as universities, isÌýjust throw more and more resource and money at this,Ìýwithout understanding the impact of what we areÌýdoing and whether or not it is making a difference.

At UWE Bristol, we are looking to ensure mentalÌýwealth is embedded throughout everything we do –Ìýat every level. This includes how we manageÌýtransitions to and through university, and how weÌýdesign and manage our curriculum. Some of ourÌýearly priorities are staff training to ensure staff areÌýable to support students, and curriculum design toÌýensure that assessments don’t all come togetherÌýand that students aren’t under pressure to makeÌýpresentations to their new colleagues in theirÌýfirst week at university.

Understanding where our students are coming from,Ìýand the relationships that we have with schools, andÌýunderstanding how we can engage with the networksÌýthat we have in the locality, with the NHS and others,Ìýis an important part of the Stepchange FrameworkÌýand what we are driving forward at UWE Bristol.

We need to work with the entire community onÌýall of this – schools and parents as well as students.ÌýWe are having conversations with the NHS, localÌýcouncils, other universities, schools and collegesÌýand accommodation providers, to take a whole-cityÌýapproach to the problem. We are exploring howÌýwe can better link up our systems, especiallyÌýwith regards to information and data sharing.

Drug use is a good example. We know teenageÌýyears and university can be a time for experimenting,Ìýand we know, because of the internet, that studentsÌýhave much easier access to drugs than they everÌýhad before. Tackling drug use requires a joined-upÌýapproach across agencies and across the sector.ÌýIn Bristol, we are looking to see how we can takeÌýa citywide approach to it. And if we can’t preventÌýyoung people from experimenting, we at least needÌýto make sure they have the full facts so that theyÌýunderstand the risks and are as safe as they can be.

For me, working with schools prior to studentsÌýjoining us is also key to both managing expectations,Ìýproviding advice and building resilience.

We know we need to do more to engage withÌýparents and families to ensure that they feel theyÌýcan tell us if they are concerned about their child.ÌýThat might be in the form of upfront printed or onlineÌýinformation prior to students starting university,Ìýor easily accessible helplines. Essentially, it is aboutÌýencouraging them to look out for each other.

We want to make sure that through ourÌýstrategy we are creating the best possibleÌýenvironment and systems for students toÌýflourish and thrive in. This encompasses lookingÌýat the types and frequency of academic contactÌýtime and a well-paced curriculum, finding waysÌýof reducing isolation in the first year, emotionalÌýresilience training, and providing a wide range ofÌýactivities to engage students from the start of theirÌýuniversity journey that doesn’t involve alcohol,Ìýbut helps them make friends. It’s about creatingÌýan environment where students can recogniseÌýstress and feel empowered to either seek help forÌýthemselves or others and call on support services.ÌýIt is about the entire community working togetherÌý– our staff and students working together.ÌýThis is by far the most important thing for usÌýto do, because it reaches the greatest numbers ofÌýstudents and staff. We can only do it in partnership;Ìýwe can only do it if we work together. That is theÌýoverwhelming conclusion: together. Joining thingsÌýup, we stand a chance; if we can’t do that, we areÌýin real trouble.

Professor Steve West is Vice-ChancellorÌýand President of the University of the West ofÌýEngland Bristol. He holds advisory appointmentsÌýin higher education and in his discipline, healthcareÌýpolicy and practice. He is Non-Executive DirectorÌýfor the Office for Students, and Chair of the UUKÌýMental Health in Higher Education Working Group.

References

1. http://www.universitiesuk.ac.uk/stepchangeÌý(accessed 30 March 2018).
2. https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/#. Wr3j5tMbO8o (accessed 30 March 2018).
3. https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 30 March 2018).
4. https://www.ippr.org/files/2017-09/not-by-degrees-170901.pdf (accessed 30 March 2018).
5. https://student.kooth.com/ (accessed 30 March 2018).
6. http://www1.uwe.ac.uk/students/healthandwellbeing/wellbeingservice/self-help-resources.aspxÌý(accessed 30 March 2018).
7. http://sam-app.org.uk/ (accessed 30 March 2018).

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